IL-12 regulates T helper type 1 cytokine responses in human infectious disease

We investigated the role of IL-12 in regulating T cell and cytokine responses in human infectious disease by using the spectrum of leprosy as a model. Tuberculoid patients mount strong T cell responses to Mycobacterium leprae, with production of the type 1 cytokines IL-2 and IFN-gamma in lesions; whereas lepromatous patients manifest weak T cell responses to M. leprae, with production of the type 2 cytokines IL-4 and IL-10 in lesions. We found expression of IL-12 p40 mRNA, as measured by PCR amplification, and IL-12 p70, as measured by immunohistochemistry, to be 10-fold greater in tuberculoid lesions than in lepromatous lesions. The ability of M. leprae to stimulate release of IL-12 from monocytes was inhibited by rIL-4 and rIL-10. M. leprae-induced T cell proliferation in tuberculoid patients was blocked by the addition of neutralizing Abs to IL-12. Furthermore, rIL-12 stimulated proliferation of CD4+ type 1 T cell clones from tuberculoid lesions, but not CD8+ type 2 T cell clones from lepromatous lesions; however, both responded to rIL-2, rIL-12 augmented M. leprae-specific T cell proliferation in lepromatous patients, thereby causing the selective expansion of CD4+ T cells and increasing T cell IFN-gamma production. These data indicate that IL-12 is an important mediator in the generation of the type 1 cytokine response in human infectious disease.

IL-12 regulates T helper type 1 cytokine responses in human infectious disease

We investigated the role of IL-12 in regulating T cell and cytokine responses in human infectious disease by using the spectrum of leprosy as a model. Tuberculoid patients mount strong T cell responses to Mycobacterium leprae, with production of the type 1 cytokines IL-2 and IFN-gamma in lesions; whereas lepromatous patients manifest weak T cell responses to M. leprae, with production of the type 2 cytokines IL-4 and IL-10 in lesions. We found expression of IL-12 p40 mRNA, as measured by PCR amplification, and IL-12 p70, as measured by immunohistochemistry, to be 10-fold greater in tuberculoid lesions than in lepromatous lesions. The ability of M. leprae to stimulate release of IL-12 from monocytes was inhibited by rIL-4 and rIL-10. M. leprae-induced T cell proliferation in tuberculoid patients was blocked by the addition of neutralizing Abs to IL-12. Furthermore, rIL-12 stimulated proliferation of CD4+ type 1 T cell clones from tuberculoid lesions, but not CD8+ type 2 T cell clones from lepromatous lesions; however, both responded to rIL-2, rIL-12 augmented M. leprae-specific T cell proliferation in lepromatous patients, thereby causing the selective expansion of CD4+ T cells and increasing T cell IFN-gamma production. These data indicate that IL-12 is an important mediator in the generation of the type 1 cytokine response in human infectious disease.

Impaired interleukin-8-dependent chemotaxis by synovial fluid polymorphonuclear leukocytes in rheumatoid arthritis

The accumulation of polymorphonuclear leukocytes (PMN) in synovial fluid is a common feature of rheumatoid arthritis (RA). We studied the chemotactic response of PMN obtained from the synovial fluid and from the peripheral blood of patients with RA using a modified Boyden's method, in which interleukin-8 (IL-8) or N-formyl-methionyl-leucyl-phenylalanine (FMLP) was used as a chemotactic agent. The IL-8-induced response of peripheral blood PMN from 15 patients with RA did not differ from that of 15 healthy controls. A decreased chemotactic response to IL-8 was, however, observed in PMN from the synovial fluid of 12 patients with RA compared with peripheral blood cells of the same individual. This defective chemotactic ability of PMN was inversely correlated with the number of infiltrating cells in the synovial fluid. We also obtained similar results with FMLP. These results indicate that the chemotactic ability of PMN may be reduced after migrating to the synovial fluid.

[Studies on angiotensin I converting enzyme (ACE): inhibitory effect of imidapril, a novel ACE inhibitor (II). Inhibition of various tissue ACEs ex vivo]

The antihypertensive mechanism of imidapril was investigated in relation to its inhibition of ACE activities in the serum, thoracic-abdominal aorta, lung, kidney, heart and brain from adult spontaneously hypertensive rats (SHRs). In comparison with normotensive rats (NTRs), the ACE activities in the aorta, heart, brain and lung were higher, while those in the serum and kidney were considerably lower. Imidapril (2 mg/kg) showed remarkable inhibitions within 6 hr in all tissues, except for the brain, after a single oral administration. Consecutive administration of imidapril (2 mg/kg/day) for 30 days produced inhibitions in all tissues. The inhibitions in the serum, aorta and lung were greater, and the duration of inhibition in the aorta, brain and lung were longer. Blood pressure declined gradually until 6 hr, and the reductions were significant at 24 hr after the single and chronic administrations. Imidapril (0.5 mg/kg, ineffective on normal blood pressure) inhibited ACE activities in NTRs similarly. Enalapril at the same dose exhibited less ACE inhibition and antihypertension. These results suggest that the ACE inhibition in the serum, lung and aorta by imidapril correlate with the antihypertension in SHRs; especially, the lung and vascular ACE inhibitions play an important role in the duration of antihypertension in SHRs.

[Structural changes in jaw bone marrow after hemorrhagic infiltration]

Normal saline solution flushing of the inner mandible was done on twelve dogs, to confirm the effect of hemorrhagic infiltration that occurs in the fatty marrow. Histological examinations were performed at 1 hour, 5 days, 10 days, 2 weeks, 1 month and 3 months.

RESULTS

1. Marrow extrusion occurred at approximately 1 atm (injection pressure). 2. At 1 hour, marrow cavities located between the 2 injection holes with the exception of the extraction sites were filled with infiltrated blood cells. Fatty marrow was moderately replaced by the infiltrated blood cells in the extraction cavities and outer distal areas of the injection holes. 3. A sequence of histogenetic events occurred. The area of bone formation gradually expanded in the fibrous tissue area. 4. Expansion of the bone formation area was almost completed at 2 weeks. Most of the original marrow was transformed into thin trabeculae-forming areas, and hematopoiesis and sinusoidal capillaries formed in the new marrow. These conditions at 2 weeks were similarly maintained at 1 month. 5. At 3 months, the number of trabeculae, sinusoidal capillaries and hematopoietic area decreased, with the increase of adipose cells. 6. These results indicate that the area of fatty marrow where the hemorrhagic infiltration occurred was transformed into the bone formation area, and the marrow activates particularly high between the period of 2 weeks and 1 month.

[A case of coronary artery bypass grafting without cardiopulmonary bypass in a patient of both coronary ostial stenosis due to Takayasu's arteritis]

A 61-year-old female admitted with the diagnosis of both coronary ostial stenosis & the severe calcified aorta due to Takayasu's arteritis. She underwent coronary artery bypass grafting successfully, using the right internal thoracic artery to RCA & the left internal thoracic artery to LAD, without cardiopulmonary bypass. Coronary artery bypass grafting without cardiopulmonary bypass is one of the useful surgical technique for the patient with the severe calcified aorta due to Takayasu's arteritis.

[Clinical experiences of granulocyte colony stimulating factor for granulocytopenia after AC bypass]

We have successfully treated 3 cases of granulocytopenia, using Granulocyte Colony Stimulating Factor (G-CSF) after AC bypass surgery. All cases were male, aged 68, 75 & 54 years old, and underwent AC bypass surgery without transfusion except in case 1. Granulocyte cell counts decreased to 135/mm3 on 39th post-operative days (POD) in case 1, 624/mm3 on 13 rd POD in case 2, and 514/mm3 on 20th POD in case 3. In case 1, 300 micrograms of G-CSF was given intravenously for 3 days. In case 2, 100 micrograms of G-CSF for 1 day and 50 micrograms for 3 days was given subcutaneously, and in case 3, 100 micrograms of G-CSF was also given subcutaneously for 2 days. And their granulocyte cell counts all increased within few days. G-CSF is effective for patients with granulocytopenia after AC bypass surgery, but we need more experiences to know the best way of administration.

[A case of Bacillus cereus prosthetic valve endocarditis]

A rare case of prosthetic valve endocarditis by Bacillus cereus was reported. The patient was 43-year-old Japanese man, who had mitral valve replacement 5 months prior to this admission. Remitral valve replacement was immediately done successfully. His postoperative course was uneventful for 8 months.

[A case report of thymolipoma with high titer of serum anti-acetylcholine receptor antibodies--thymolipoma, a review of 49 reports in Japan]

A 22-year-old man was diagnosed as thymolipoma by chest CT scan & MRI. In spite of high titer of serum anti-acetylcholine receptor antibodies, he showed no symptom of myasthenia gravis. An extended thymectomy was done successfully. Tumor was 21 x 15 cm in size and 620 g in weight. Histopathologically the tumor was diagnosed as thymolipoma. The titer of serum anti-acetylcholine receptor antibodies was decreased within normal limit and postoperative course was uneventful. To our knowledge, the 49 case reports in Japan were reviewed.

Congenitally abnormal plasminogen in juvenile ischemic cerebrovascular disease

BACKGROUND AND PURPOSE

Congenitally abnormal plasminogen is characterized by markedly decreased fibrinolytic activity and has been reported mainly in association with venous occlusive disease.

CASE DESCRIPTION

We found three young adult patients (34, 45, and 27 years old at onset) with ischemic cerebrovascular disease, all of whom had congenital plasminogen abnormalities but no other known risk factors. Hemostatic tests of all three patients revealed plasma plasminogen activities at almost one half of the normal level despite normal plasma plasminogen antigen levels. They were found to be heterozygotes with abnormal plasminogen (normal Ala-601[GCT] to abnormal Thr-601[ACT]) by DNA sequence analysis after polymerase chain reaction.

CONCLUSIONS

Congenital plasminogen abnormalities could be one of the risk factors of juvenile ischemic cerebrovascular disease of the arterial as well as venous type.

The cytokine network in lesional and lesion-free psoriatic skin is characterized by a T-helper type 1 cell-mediated response

As a psoriatic lesion develops at sites of previously uninvolved skin, cytokines and their subsequent induction of various adhesion molecules may play important pathophysiologic roles. To further define the cytokine network in psoriasis, biopsies were obtained from both lesional skin and lesion-free skin of individuals with psoriasis and compared to normal skin biopsies from control subjects. Each biopsy was analyzed using polymerase chain reaction for expression of cytokines and immunostaining to detect adhesion molecules. The results indicate that psoriatic lesions have a type 1 cytokine profile (i.e., interleukin[IL]-2, interferon[IFN]-gamma, and tumor necrosis factor[TNF]-alpha), without a significant component of type 2 cytokines (i.e., IL-4, IL-5, and IL-10) accompanied by aberrant expression of endothelial cell leukocyte adhesion molecule (ELAM)-1 and vascular cell adhesion molecule (VCAM)-1 on dermal endothelial cells, and ICAM-1 on epidermal keratinocytes. Four of five lesion-free biopsies from psoriatic patients had prominent cytokine mRNA expression compared with skin from normal donors (particularly TNF-alpha, IL-1 alpha, IL-1 beta, with lesser increases in IFN-gamma and granulocyte/macrophage colony-stimulating factor [GM-CSF]), which was accompanied by aberrant adhesion molecule expression in the same four samples. We conclude that a particular T-cell population producing type 1 cytokines accumulates in psoriatic lesions. In addition, clinically lesion-free skin is characterized by increased levels of various cytokine mRNAs, and aberrant adhesion molecule expression in both dermal and epidermal compartments.

Comparative study of the cellular fatty acids of methicillin-resistant and -susceptible Staphylococcus aureus

The cellular fatty acid compositions of 26 strains of methicillin-resistant Staphylococcus aureus (MRSA) and 17 strains of methicillin-susceptible S. aureus (MSSA) were analyzed by gas-liquid chromatography. The fatty acid compositions of the two groups were very similar with 16 identified components. The major fatty acids were Ci14 = 0, Ci15 = 0, C18 = 0 and C20 = 0. Among these fatty acids, the percentage of the Ci15 = 0 fatty acid component of MRSA strains (11.4 +/- 3.9%) was statistically higher than that of MSSA strains (6.2 +/- 2.4%) (p < 0.001). On the other hand, the percentage of the C20 = 0 fatty acid components of MRSA strains (20.2 +/- 8.8%) was statistically lower than that of MSSA strains (30.7 +/- 10.4%) (p < 0.001). The production of beta-lactamase and beta-hemolysin in both groups' strain was also unrelated to the relative amounts of the fatty acid components. These results indicated a statistical tendency for the percentage fatty acid compositions of the MRSA strains to be quantitatively different from those of the MSSA for both the Ci15 = 0 and C20 = 0 fatty acid components. Analysis of the fatty acid compositions may have an application in the differentiation of MRSA and MSSA strains.

Continuous column culture system for adherent cells

A new continuous column culture system for adherent cells was developed using beads. The beads were packed in a column and an appropriate medium was continuously passed through. The whole system was kept under closed conditions. L cells and C6 cells were cultured by this new system. The number of cells increased linearly up to 16 days and reached a maximum at around 18 days. As the heat production remained constant for 16 days, it can be concluded that cells grown in this system had identical characteristics. The final concentration of cells reached was 1.0 x 10(8) ml-1. The cells could grow both in the upward and the downward direction. Advantages of this system are: (1) Cells can be recovered in their adherent form on the beads; (2) cells can easily be collected from the column by trypsinization, and (3) cells remaining in the column after trypsinization can grow again.

Cytokine production at the site of disease in human tuberculosis

Clinical and immunologic evidence suggests that tuberculous pleuritis provides a model to understand protective immune mechanisms against Mycobacterium tuberculosis. We therefore evaluated the pattern of cytokine mRNA expression and cytokine production in pleural fluid and blood of patients with tuberculous pleuritis. RNA was extracted from mononuclear cells, reverse transcribed to cDNA, and amplified by polymerase chain reaction (PCR). After normalization for T-cell cDNA, cDNA from pleural fluid cells and peripheral blood mononuclear cells (PBMC) was amplified with cytokine-specific primers. PCR product was quantified by Southern blot. For the Th1 cytokines gamma interferon (IFN-gamma) and interleukin-2 (IL-2), PCR product was greater in pleural fluid than in blood, whereas PCR product for the Th2 cytokine IL-4 was decreased in pleural fluid compared with blood. Concentrations of IFN-gamma were elevated in pleural fluid compared with serum, but IL-2, IL-4, and IL-5 were not detectable. Mean concentrations of IFN-gamma and IL-2 in supernatants of M. tuberculosis-stimulated pleural fluid cells were significantly greater than corresponding concentrations in supernatants of stimulated PBMC. In situ hybridization showed that increased IFN-gamma production by pleural fluid cells was associated with a 20- to 60-fold increase in the frequency of antigen-reactive IFN-gamma-mRNA-expressing cells. Because IL-10 can be produced by T cells and macrophages, pleural fluid cells and PBMC were normalized for beta-actin cDNA content and then amplified by PCR with IL-10-specific primers. IL-10 mRNA was greater in pleural fluid cells than in PBMC and was expressed predominantly by macrophages. IL-10 concentrations were elevated in pleural fluid versus serum. These data provide strong evidence for compartmentalization of Th1 cytokines and IL-10 at the site of disease in humans with a resistant immune response to mycobacterial infection.

Immunosuppressive roles for IL-10 and IL-4 in human infection. In vitro modulation of T cell responses in leprosy

IL-10 and IL-4 have been shown to exert an inhibitory effect on cell-mediated immune responses. Our previous studies of leprosy demonstrated that IL-10 and IL-4 mRNA were preferentially expressed in lesions from lepromatous patients, those immunologically unresponsive individuals that manifest widespread infection. To define more precisely the regulatory roles of these two cytokines in the immune response to infection, we studied in vitro responses to Mycobacterium leprae. M. leprae triggered IL-10 release from PBMC of patients and healthy donors; the predominant source of the IL-10 was found to be monocytes/macrophages. Stimulation of PBMC in the presence of neutralizing anti-IL-10 mAb indicated that endogenous IL-10 production inhibits PBMC proliferation and release of TNF-alpha, GM-CSF, and IFN-gamma. Paradoxically, studies using neutralizing anti-IL-4 mAb indicated that endogenous IL-4 production enhances PBMC proliferative responses most strikingly in lepromatous patients. We found that rIL-4 expanded CD8+ T cells from lepromatous patients in vitro. CD8+ T cells from lepromatous patients have been shown to suppress CD4+ T cell responses, in part by the release of IL-4. Our study indicated that endogenous IL-4 production inhibited IL-10 secretion and, concomitantly, increased TNF-alpha and GM-CSF release. The present data suggest that, on balance, IL-4 and IL-10 contribute to immunosuppression in human infectious disease.

Immunosuppressive roles for IL-10 and IL-4 in human infection. In vitro modulation of T cell responses in leprosy

IL-10 and IL-4 have been shown to exert an inhibitory effect on cell-mediated immune responses. Our previous studies of leprosy demonstrated that IL-10 and IL-4 mRNA were preferentially expressed in lesions from lepromatous patients, those immunologically unresponsive individuals that manifest widespread infection. To define more precisely the regulatory roles of these two cytokines in the immune response to infection, we studied in vitro responses to Mycobacterium leprae. M. leprae triggered IL-10 release from PBMC of patients and healthy donors; the predominant source of the IL-10 was found to be monocytes/macrophages. Stimulation of PBMC in the presence of neutralizing anti-IL-10 mAb indicated that endogenous IL-10 production inhibits PBMC proliferation and release of TNF-alpha, GM-CSF, and IFN-gamma. Paradoxically, studies using neutralizing anti-IL-4 mAb indicated that endogenous IL-4 production enhances PBMC proliferative responses most strikingly in lepromatous patients. We found that rIL-4 expanded CD8+ T cells from lepromatous patients in vitro. CD8+ T cells from lepromatous patients have been shown to suppress CD4+ T cell responses, in part by the release of IL-4. Our study indicated that endogenous IL-4 production inhibited IL-10 secretion and, concomitantly, increased TNF-alpha and GM-CSF release. The present data suggest that, on balance, IL-4 and IL-10 contribute to immunosuppression in human infectious disease.

Clinical significance of serum soluble HLA class I antigens in systemic lupus erythematosus

Serum soluble HLA (SHLA) class I antigens in patients with systemic lupus erythematosus (SLE) were examined by enzyme-linked immunosorbent assay. The primary antibody used was W6/32, anti-HLA class I mouse monoclonal antibody, and the secondary antibody was peroxidase-conjugated anti-mouse IgG antibody. The reactivity of SHLA class I antigens, the number of peripheral lymphocytes, and the clinical state of SLE were compared. The results were as follows; 1) Sixteen of 55 samples from SLE patients were SHLA class I antigen-positive (29%). 2) The reactivity of SHLA class I antigens was closely related to disease activity. 3) The number of lymphocytes and the reactivity of SHLA class I antigens were negatively correlated. 4) Nine of 23 samples from the active SLE patients were SHLA class I antigen-negative. Of these, 7 were from patients with a nephrotic syndrome due to lupus nephritis. It is concluded that SHLA class I antigens can be an useful marker for monitoring the clinical state of SLE.

Analysis of intestinal flora of a patient with congenital absence of the portal vein

A 14-year-old female patient, admitted for a closer examination of liver tumour (hepatocellular adenoma), was diagnosed as having a congenital absence of the portal vein. The blood ammonia level (approximately 120 micrograms dl-1) in the superior mesenteric vein was markedly low compared to the normal value of 300-350 micrograms dl-1 in the portal vein. The decreased ammonia concentration and urease activity of the patient's faeces were demonstrated. The dominant intestinal flora in the faeces of the patient, before operation, was Bifidobacterium sp., Bifidobacterium breve, Bifidobacterium lonqum, Lactobacillus plantarum, and after the operation Bacteroides vulgatus, Veillonella parvula, Peptococcus magnus Bifidobacterium longum. In contrast, Bifidobacterium bifidum, Bacteroides ureolyticus, Bacteroides ovatus and Bacteroides distasonis, B. ovatus, Bifidobacterium adolescentis were dominant flora in the faeces of two healthy volunteers, respectively. Among microorganisms isolated from the patient, Morganella morganii, Candida sp., Eubacterium aerofacience and Eubacterium rectale were strongly positive in urease activity in vitro; Streptococcus mitior, Staphylococcus intermedius, Micrococcus kristinae, Selenomonas ruminantum, Bacteroides ureolyticus and Lactobacillus casei ss. pseudoplantarum from the healthy volunteers. These results imply the homeostatic regulation system of faecal ammonia concentration by urease-producing microorganisms in the patient.

Cytokine patterns in the pathogenesis of human leishmaniasis

The host response to infection appears to be regulated by specific patterns of local cytokine production. In the mouse, resistance to many pathogens including Leishmania is associated with a TH1 cytokine profile, IL-2 and IFN-gamma; whereas susceptibility to infection is associated with production of TH2 cytokines, IL-4, IL-5, and IL-10. To determine the cytokine patterns of the local immune response to Leishmania infection in humans, we used the polymerase chain reaction to compare cytokine mRNAs in biopsy specimens of American cutaneous leishmaniasis. In localized cutaneous leishmaniasis and the Montenegro delayed-type hypersensitivity reaction, type 1 cytokine mRNAs such as IL-2, IFN-gamma, and lymphotoxin were relatively predominant. In the chronic and destructive mucocutaneous form of leishmaniasis, there was a mixture of type 1 and type 2 cytokines, with a striking abundance of IL-4 mRNA in lesions. These results suggest that clinical course of infection with Leishmania braziliensis in man is associated with specific local patterns of cytokine production.

[Surgical treatment of membranous ventricular septal aneurysm with posterior ventricular septal defect--a case report]

A 45-year-old woman was hospitalized for examination of a cardiac murmur. She had undergone surgery for a membranous ventricular septal defect at the age of 22. Cardiac catheterization showed a membranous ventricular septal aneurysm and a residual shunt. At reoperation, we found the membranous septal aneurysm to be accompanied with a posterior ventricular septal defect. The septal defect was closed with a Dacron patch, and the septal aneurysm was excised, with direct closure. Membranous ventricular septal aneurysm is generally associated with membranous ventricular septal defect. Cases of membranous ventricular septal aneurysm with posterior ventricular septal defect are rare.

Isolation and characterization of a high molecular weight type IV collagenase isolated from human carcinoma tissue

A proform of high molecular weight type IV collagenase was isolated and purified 1230-fold from human metastatic carcinoma tissue. Like matrix metalloproteinases (MMPs), the enzyme was activated by trypsin and degraded type IV collagen and gelatin at a neutral pH, the activity was inhibited by EDTA and o-phenanthroline. However, the molecular weight was much higher than MMPs which degraded type IV collagen, gelatinase A (MMP-2; 72 kDa gelatinase/type IV collagenase) (EC 3.4.24.24), gelatinase B (MMP-9; 92 kDa gelatinase/type IV collagenase) (EC 3.4.24.35), stromelysin-1 (MMP-3; 57 kDa) (EC 3.4.24.17) and stromelysin-2 (MMP-10; 57 kDa) (EC 3.4.24.22). The other significant difference from MMPs was that the enzyme was not activated by 4-aminophenylmercuric acetate nor inhibited by TIMP. Taking together these results, this high molecular weight type IV collagenase might be a newly found enzyme different from MMPs or might have the same configuration as MMPs already reported.

[A case of thymic cyst & thymolipoma with ocular myasthenia gravis]

A 65-year-old woman with ocular myasthenia gravis (MG) and thymic tumor underwent expanded thymectomy. Histologically the tumor was thymic cyst and thymolipoma. To our knowledge, there has been no case reported in medical literatures, which is thymic cyst & thymolipoma with ocular MG. This case suggests some effect of steroid therapy.

[A case of myocardial revascularization in a patient after renal transplantation]

A 46-year-old woman after renal transplantation 10 years ago underwent CABG using the right internal thoracic artery to LAD, the left internal thoracic artery to Circumflex and the right gastroepiploic artery to RCA, with the diagnosis of unstable angina (triple vessels disease) after failed PTCA. The postoperative course has been uneventful. To our knowledge, this is the first case who underwent GABG after renal transplantation in Japan.