The management of hyperthyroidism due to Graves' disease in Japan in 1988. The Japan Thyroid Association

The management of hyperthyroidism due to Graves' disease in Japan was the subject of a survey of the members of the Japan Thyroid Association (JTA), and the results were compared to those of the European Thyroid Association (ETA). In the questionnaire, in vivo and in vitro diagnostic procedures, the choice of treatment and the details of the treatment for a patient with typical, moderate and uncomplicated hyperthyroidism due to Graves' disease was at first asked, and eight variations with a single alternative were proposed to evaluate how each alternative would affect the choice of treatment. For the diagnostic procedures, thyroid uptake/scintigraphy was carried out by approximately 60% of the respondents and the isotope mainly used was 123I. The number of in vitro tests used for diagnosis averaged 8.1 +/- 1.8 tests. Measurements of basal TSH and free T4 were the most frequent tests performed to confirm the diagnosis of hyperthyroidism (94 and 80%, respectively). Determinations of microsomal, thyroglobulin and TSH-receptor autoantibodies were also employed by many respondents (96, 96 and 77%, respectively). On the other hand, the free T4 index and TRH test were less frequently employed. In the treatment of these patients, antithyroid drug treatment was the first choice, and surgery was not, in general, regarded as a primary therapy except in a patient with a large goiter. The frequency of the respondents who advocated radioiodine therapy was considerably higher for patients with recurrences and old age. No respondents proposed radioiodine therapy for young patients. Specialists tended to favor their own specialist treatment regimens. The initial dose of antithyroid drugs was reduced according to thyroid function, and withdrawal of antithyroid drug treatment was determined by some specific criteria (basal TSH in supersensitive assays, TSH-receptor autoantibodies, T3 suppression test, etc.). The aim of radioiodine therapy and surgery was to restore euthyroidism. The significant differences between the results from the JTA and those from the ETA were as follows; radionuclide used for thyroid uptake/scintigraphy was mainly 123I in Japan, but 131I in Europe, the number of diagnostic studies in Japan was more than that in Europe, and the dosage of antithyroid drugs was reduced according to thyroid function and discontinued based on certain specific criteria in Japan, but after fixed periods in Europe. These results may represent actual trends in how hyperthyroidism due to Graves' disease is managed in specialist clinics in Japan today and the differences between the JTA and the ETA.

Adsorption of vitronectin in human serum onto plastics is augmented by sodium dodecyl sulfate

We have investigated the adsorption of cell-spreading activity in human serum onto polystyrene plates after treatment of the serum with sodium dodecyl sulfate (SDS). Vitronectin in human serum was remarkably adsorbed onto the plate after boiling the serum with 0.1% SDS for 5 min. SDS was effective over the concentration range from 0.05 to 0.25%. Increase of the vitronectin adsorption was accompanied by an increase of cell spreading on the plates. The cell-spreading activity in SDS-treated serum was impeded by anti-vitronectin antibody but not by anti-fibronectin antibody. After treatment with SDS, fibronectin-depleted serum could induce cell spreading but vitronectin-depleted serum could not. These results indicate that vitronectin alone was the cell-spreading factor in SDS-treated human serum. However, SDS-treated pure vitronectin itself did not retain the cell-spreading activity. The activity was recovered when bovine serum albumin was added to pure vitronectin before or after boiling with 0.1% SDS. Therefore, vitronectin adsorbed from SDS-treated serum might retain the cell-spreading activity with the aid of serum protein. Treatment of serum with SDS provides an easy, specific, and efficient method of coating polystyrene plates with vitronectin.

Vitronectin exists in two structurally and functionally distinct forms in human plasma

Vitronectin (serum spreading factor, S-protein or epibolin) is a plasma glycoprotein implicated in cell adhesion, as well as in the regulation of complement-mediated cytolysis and antithrombin III function. Vitronectin was found to exist in fresh human plasma as a heterogeneous mixture consisting of 2% heparin-binding form and the remainder as a non-binding species. Heparin-binding vitronectin consisted of 6.5 S aggregates with a Stokes radius of 5.6 nm, which was enriched in the 65 kDa polypeptide, with a high content of molecules and a putative unfolded conformation. In contrast, non-heparin-binding vitronectin was a 4.2 S monomer with a Stokes radius of 3.9 nm, which appeared to be in a folded conformation with an immunologically cryptic site. Both vitronectins displayed similar activities in mediating the spreading of BHK fibroblastic cells on substrates. During blood coagulation, 5% more of the non-heparin-binding vitronectin was converted into the heparin-binding form, producing a greater than 3.5-fold increase in this species. Our results indicate that vitronectin normally exists in circulating blood in at least two structurally and functionally distinct forms which may serve different functions.

[A case of duodenal carcinoid associated with early gastric carcinoma]

This case involves a 51-year-old female. In 1983, a gastroscopic examination disclosed a submucosal tumor in the duodenum. In 1986, during follow-up observation, on her visit to hospital an early gastric carcinoma at the antrum was found. Thus, a distal gastrectomy, which entailed the complete removal of the Group 2 lymph nodes and the hepatoduodenal, intra-mesenteric lymph nodes, and Billroth I reconstructive surgery were both performed. A histopathological examination revealed that the antral lesion was a carcinoma, sig. m. ly0. v0. n(-), and that a lesion at the duodenal bulb was carcinoid, with cell that were positive to Grimelius staining and to somatostatin serotonin by an immunological staining. A metastases to the lymph nodes but only along the upper trunk of the common hepatic artery, also was found.

Phenotypic analyses and concanavalin-A-induced suppressor cell dysfunction of intrathyroidal lymphocytes from patients with Graves' disease

The expression of phenotypic markers and Concanavalin-A-induced suppressor activity was compared among mononuclear cells isolated from thyroid glands and peripheral blood of thionamide-treated patients with hyperthyroid Graves' disease and peripheral blood from normal subjects. Intrathyroidal lymphocytes were obtained by two different methods (TG-1 and TG-2 cells), gradient centrifugation of supernatants of minced thyroid tissue and overnight culture of thyroid debris after mechanical disaggregation and enzymatic digestion, respectively. The percentages of CD3+ cells (all mature T cells) among peripheral blood and TG-1 and TG-2 cells from Graves' patients were similar, but the percentages of B1+ cells (pan B cells) among the TG-1 and TG-2 cells were markedly increased compared to that in peripheral blood. The percentages of CD4+ cells among the TG-1 and TG-2 cells were significantly less than that in peripheral blood. The percentages of CD4+2H4+ cells among CD4+ cells in TG-1 and TG-2 cells also were significantly less than that in peripheral blood. The percentage of CD4+4B4+ cells among CD4+ cells in thyroid glands was markedly higher than that in peripheral blood. The percentages of CD8+ cells and CD8+CD11b- cells (cytotoxic T cells) in thyroid glands were significantly higher than those in peripheral blood from Graves' patients and peripheral blood from normal subjects. The CD8+CD11b+ cells were subdivided into two subpopulations on the basis of CD8 antigen density. The percentage of dull CD8+CD11b+ cells (natural killer cells) among TG-2 cells was lower than that in peripheral blood, but there was no significant difference in bright CD8+CD11b+ cells (suppressor-effector T cells) between thyroid glands and peripheral blood. The percent suppression induced by Concanavalin-A in both TG-1 and TG-2 cells was significantly decreased compared with that in peripheral blood. These results suggest that impairment of suppressor cell activity and an increased number of B cells exist in thyroid glands of patients with Graves' disease compared to those in peripheral blood. It, thus, appears likely that both B cell hyperactivity and suppressor T cell dysfunction may induce excess production of autoantibodies in the thyroid glands of such patients.

Glucose stimulation of protooncogene expression and deoxyribonucleic acid synthesis in rat islet cell line

The rat islet cell line, RIN, established from a transplantable, radiation-induced islet cell tumor represents a unique model to study mechanisms in the control of insulin secretion and biosynthesis. In this study, we have examined the effects of glucose on the protooncogene expressioN and cell growth using a clonal strain of RIN cell, RINr, under serum-free and glucose-free conditions. After 24 h pretreatment, cells were treated with different concentrations of glucose for up to 24 h and then subjected to RNA analysis. Agarose gel electrophoresis of total RNA extracts of RINr cells, followed by hybridization with v-myc DNA yielded a 2.4 kilobase c-myc messenger RNA (mRNA) transcripts. After 24 h pretreatment with serum-free and glucose-free medium, RINr cells expressed a low level of c-myc mRNA transcripts. An increase in c-myc transcripts was detectable within 30 min of D-glucose (200 mg/dl) addition, reaching a maximum of 10-fold within 2 h. Glucose stimulated the steady state of c-myc mRNA transcripts in a dose-responsive manner without any change of gamma-actin mRNA levels after 2 h of treatment. The level of c-myc transcripts then declined as the cells proceeded through G1 to the cycle. [3H]Thymidine uptake into DNA was dramatically increased after 24 h of glucose addition, suggesting that glucose itself stimulates DNA synthesis in RINr cells. These results indicate that glucose-induced proliferation of RINr cells is associated with the stimulation of c-myc gene expression.

Novel purification of vitronectin from human plasma by heparin affinity chromatography

The glycoprotein vitronectin (also called S-protein, serum spreading factor, or epibolin) promotes spreading of a variety of cultured cells, inhibits the cytotoxicity of membrane attack complex C5b-9, and modulates thrombin-antithrombin III activity. We developed a strikingly simple method to purify vitronectin from human plasma by heparin affinity chromatography. Serum was obtained from plasma by adding calcium and then centrifuging. The heparin-binding activity of vitronectin in human serum was activated with 8 M urea. The activated vitronectin specifically bound to heparin-Sepharose in 8 M urea and was eluted with 0.5 M NaCl containing 8 M urea. This procedure resulted in an approximately 250-fold purification of vitronectin with a 15-30% recovery; 3-6 mg of pure vitronectin were obtained from 100 ml human plasma within 2 days. The purified vitronectin preparations promoted spreading of BHK fibroblastic cells on substrates with a half-maximal activity at only 0.1 microgram/ml. This new method is very simple, rapid, inexpensive, and flexible. It could probably be readily scaled up for commercial applications.

Expression and regulation of c-erb-A mRNA from lymphocytes in patients with thyroid dysfunction

To investigate the expression and the regulation of nuclear triiodothyronine (T3) receptor at the gene level, cellular(c)-erb-A mRNA isolated from lymphocytes in patients with thyroid dysfunction was examined by Northern gel analysis and dot blot hybridization using viral (v)-erb-A cDNA probe. Human lymphocytes contained c-erb-A mRNA (approximately 2.0 kilobase (kb) in length), and c-erb-A mRNA, which was determined by dot blot hybridization, was observed to be increased in hypothyroid patients but unaltered in hyperthyroid patients. The high level of c-erb-A mRNA may contribute in part to the increase in nuclear T3 receptor and these results suggest the presence of up-regulation of nuclear T3 receptor at the gene level in the lymphocytes of hypothyroid patients.

Identification of the collagen-binding domain of vitronectin using monoclonal antibodies

Vitronectin is a 75 kilodalton (kDa) cell-adhesive glycoprotein found in animal blood and connective tissue, also termed serum spreading factor, S-protein, and epibolin. It promotes attachment and spreading of animal cells on tissue culture dishes, and it also binds to collagen. We established four mouse hybridoma lines producing monoclonal antibodies (M1, M2, M4 and M5) to human vitronectin. By immunoblotting, both epitopes recognized by M4 and M5 were suggested to exist in the amino terminal 5 kDa portion of vitronectin, and both M1 and M2 bound to the adjacent 35 kDa portion. Cell spreading on vitronectin-coated dishes was inhibited by M4 = M5 greater than M1, but not by M2. Collagen binding to vitronectin was inhibited by M2 greater than M4 = M5, but not by M1. These results indicate that the collagen-binding site is located near the cell-binding site in the amino terminal half of vitronectin. Independent inhibition of vitronectin binding to the cell and to collagen by these monoclonal antibodies will provide a potential tool to dissect the structure and function of vitronectin.

Islet cell surface antibodies in Graves' disease; as organ non-specific antibodies

To define ICA positiveness and its clinical correlation in AITD, ICSA were checked in Graves’ patients by indirect IF test using rat insulinoma (RINr) cells. Also Ig adherence to rat thyroid (FRTL5) and EB virus cloned human B lymphocytes that do not produce immunoglobulins were measured as the same method of ICSA with determination of organ specific antibodies in the sera.

The incidence of ICSA in Graves’ disease was 23.1 % (9/39) and the degree of the positiveness measured as % binding was roughly correlated to those of Ig adherence to FRTL5 and B cells. This ability to bind multiple organs of different species was not found to have any correlation with the titers of organ specific antibodies, but the incidence of organ specific antibody positiveness was much higher in the ICSA positive sera. Also there was a significant difference on the absorption pattern to FRTL5 and RINr cells between the sera of ICSA positive IDDM and Graves’ patients, where absorption and % binding to FRTL5, cell in ICSA positive diabetic sera were significantly lower than those to RINr cells in ICSA positive Graves’.

Treatment of Graves' ophthalmopathy with high-dose intravenous methylprednisolone pulse therapy

This preliminary study was undertaken to investigate the efficacy of high-dose iv methylprednisolone pulse therapy in 5 patients with Graves' ophthalmopathy. One gram of methylprednisolone sodium succinate was given iv daily for 3 successive days. The 3-day infusion was repeated 3 to 7 times at intervals of 1 week; total duration of pulse therapy was 3 to 7 weeks. The clinical improvement of eye involvements by pulse therapy was assessed immediately after the last pulse therapy. The clinical assessment of the effect of pulse therapy for Graves' ophthalmopathy showed a good response in 3 patients, a fair response in one, and no response in one. However, in one patient, who was judged to show no response, complete improvement of the enlarged extraocular muscle was observed on orbital computed tomography. Moreover, two patients, who have been followed without any other therapies, showed no relapse of eye involvements for 32 and 10 months, respectively. Although it is impossible to determine whether pulse therapy is more effective than other immunosuppressive therapies, the results of this preliminary study suggest that pulse therapy may be a good immunosuppressive therapy for Graves' ophthalmopathy too. Controlled studies are desired.

Serum TSH, thyroglobulin, and thyroidal disorders in atomic bomb survivors exposed in youth: 30-year follow-up study

Follow-up examinations to determine the frequency of thyroidal disorders were conducted by the Radiation Effects Research Foundation (RERF) on individuals in Hiroshima and Nagasaki who were less than 20 yr of age at the time of exposure to the atomic bomb. Concentrations of serum thyroid stimulating hormone (TSH), thyroglobulin (TG), and anti-TG antibody 30 yr after exposure were also determined. Nontoxic uninodular goiter was found in 13 cases of the 100 + rad exposed group (n = 477) and in three cases of the nonexposed group (n = 501). The prevalence in the 100+ rad exposed group was significantly higher (chi-squared = 6.584, p less than 0.01). Thyroid cancer was found in eight exposed cases, all of whom were in the 100+ rad group, and the prevalence was significantly greater (chi-squared = 7.919, p less than 0.01). Regardless of the presence or absence of thyroid disorders, serum TSH and TG levels were not statistically different between the 100 rad + exposed and nonexposed groups. Although hypothyroidism was found in 23 of the total cases, there was no correlation between its development and exposure to ionizing irradiation.

Reduction in the suppressor-inducer T cell subset and increase in the helper T cell subset in thyroid tissue from patients with Graves' disease

The expression of surface markers associated with activation and characterization was compared among T cells in thyroid glands and peripheral blood of 10 patients with Graves' hyperthyroidism receiving chronic antithyroid drug therapy, in peripheral blood of 15 patients with untreated hyperthyroid Graves' disease, and in peripheral blood of 21 normal subjects using two-color flow cytometry. In the chronically treated Graves' disease patients, the percentage of activated T cells (HLA-DR+ T cells) among total T cells was significantly higher in thyroid tissue than in peripheral blood, and the increase in percent activated T cells was also significant among both helper/inducer T cell (CD4+ cell) and suppressor/cytotoxic T cell (CD8+ cell) subsets. The percentage of activated T cells in peripheral blood was not significantly different between chronically treated hyperthyroid Graves' patients and normal subjects, whereas the percentage of activated T cells in the peripheral blood from untreated hyperthyroid Graves' disease patients was significantly higher than that in normal subjects or chronically treated hyperthyroid Graves' patients. The percentages of CD4+ cells and CD8+ cells among total T cells were not different between thyroid tissues and peripheral blood in patients with chronically treated hyperthyroid Graves' disease. When CD4+ were further divided into helper T cells (CD4+2H4- cells) and suppressor-inducer T cells (CD4+2H4+ cells) using two-color flow cytometry, the percentage of helper T cells among CD4+ cells was significantly higher in thyroid tissue than in peripheral blood, resulting in an increased ratio of CD4+2H4- cells to CD4+2H4+ cells. The percentage of CD4+2H4+ cells in peripheral blood, however, was not significantly different among untreated and chronically treated Graves' disease patients and normal subjects. From the findings of abnormalities in intrathyroidal T cell subsets, we suggest that the decrease in the function of suppressor T cells within the thyroids of Graves' disease patients may be due to a decrease in CD4+2H4+ cells within thyroid tissue.

Inhibitory effect of interferon-gamma on the response of human thyrocytes to thyrotropin (TSH) stimulation: relationship between the response to TSH and the expression of DR antigen

Thyroid epithelial cells (thyrocytes) in autoimmune thyroid disease have been found to express DR antigens on their surfaces, and interferon-gamma (IFN gamma) induces DR antigen expression. This study was undertaken to determine the effect of IFN gamma on the response of human thyrocytes to TSH stimulation and the relationship between the response to TSH and the expression of DR antigen induced by IFN gamma, using monolayer cultures of Graves' thyrocytes. When confluent thyrocyte monolayers were incubated with TSH or Bu2cAMP (DBcAMP) for 7-9 days, T3 and thyroglobulin concentrations in the culture medium increased gradually in a dose-dependent manner. However, when TSH or DBcAMP was added after the cells had been cultured for 4 days with IFN gamma, T3 and thyroglobulin secretion in response to both 10 mU/mL TSH and 1 mM DBcAMP was significantly inhibited. The inhibition by IFN gamma was dose dependent and correlated with the number of DR antigen-positive thyrocytes present on the last day of culture. IFN alpha and -beta did not affect the response of thyrocytes to TSH or DBcAMP stimulation. These results suggest that DR antigen-positive thyrocytes fail to respond to TSH stimulation at a site located distal to cAMP formation.

Heterogeneity of Graves' immunoglobulin G: comparison of thyrotropin receptor antibodies in serum and in culture supernatants of lymphocytes transformed by Epstein-Barr virus infection

It is well known that in patients with Graves' disease there is dissociation among values for TSH receptor antibodies such as TSH binding-inhibiting antibody (TBIAb) and thyroid-stimulating antibody (TSAb). This study was designed to compare TSH receptor antibodies in serum and in culture supernatants of lymphocytes transformed by Epstein-Barr virus (EBV) infection. TBIAb was assayed using solubilized porcine thyroid membranes and TSAb using cultured porcine thyroid cells. Transformation of peripheral lymphocytes by EBV was performed in eight untreated hyperthyroid patients with Graves' disease who had a clear dissociation between values for TBIAb and TSAb, even after multiple dilutions of serum. EBV-infected lymphocytes from a patient were distributed into the wells of 4 24-well culture plates. After the first 4-week culture, the cells in each well positive for TBIAb and/or TSAb were further distributed to 12 wells and cultured for 2 weeks. In the supernatants of 372 wells of the second culture in the 8 patients, 31 were positive for TBIAb, and 41 were positive for TSAb. Among the 76 wells positive for TSH receptor antibodies, 72 wells (94.7%) were positive in only 1 assay. These results suggest that there are two types of TSH receptor antibodies, one having a single function (TBIAb or TSAb) and the other multifunctional (both), in Graves' patients. The incidence of the single functional type is much greater than that of the multifunctional type. We conclude, therefore, that the heterogeneity of Graves' immunoglobulin G is due mainly to multiple antibodies with a single function.

Stimulation of thyroid adenylate cyclase activity by sera from patients with non-thyroidal illness

We have previously shown that sera from many hypothyroid patients stimulated adenylate cyclase activity as measured by serum bioactive TSH concentrations produced by FRTL-5 cell line. This TSH-stimulating activity did not correlate with serum immunoreactive TSH. IgG fractions of these sera did not stimulate FRTL-5 cells. The present study was, therefore, undertaken to investigate the thyroid stimulating activity of sera from patients with non-thyroidal illness. Studies were performed in 36 patients with various non-thyroidal illness. In these patients, serum concentrations of T4, free thyroxine, T3, and TSH were determined. In addition, sera were incubated with FRTL-5 cells or porcine thyroid cells in primary culture in the presence of 0.4 mM MIBX, and medium cAMP concentrations were determined by radioimmunoassay. Sera obtained from some patients with various non-thyroidal illness increased cAMP concentrations in culture media of FRTL-5 cells as well as that of porcine thyroid cells. The thyroid stimulating effects of sera were not disease specific and significantly correlated inversely with serum T3 and T4 concentrations. Serum TSH concentrations in these patients were within the normal range even by the newly developed ultrasensitive assay. Although the nature of substance(s) present in sera of patients with low T3 syndrome which stimulates thyroid adenylate cyclase is not entirely known, it is conceivable that there exist mechanisms independent of TSH to compensate the decreased serum T3 levels in low T3 syndrome.

Determination of the volume of the thyroid gland by a high resolutional ultrasonic scanner

We developed a new ultrasonic scanner for the thyroid and, in this study, the estimated volumes of the thyroids by this scanner were compared with the weights of those obtained at operation. In this ultrasonic scanner, an annular array transducer was employed instead of the conventional single element concave transducer. The distance of the focused area by this transducer was as long as 5 cm compared to 1 cm by the conventional transducer; therefore, the image obtained by the new scanner was so clear that it was not difficult to draw accurately the outlines of the thyroids. The volumes of the thyroids were calculated by a computerized digitizer. The estimated volumes of the thyroids by the ultrasonic scanner were closely correlated with their weights calculated by adding the actual weights of the thyroids removed to the estimates of the thyroids left at operation. Their correlation coefficients were as high as 0.99. This suggests that this new ultrasonic scanner is very useful in the determination of the volumes of the thyroids, since the measurement is very accurate, simple, and reproducible.

Interactions between TSH binding inhibiting--and adenylate cyclase stimulating--antibodies in Graves' disease

It is well known that there exists a dissociation between TSH binding inhibiting antibody (TBIAb) and thyroid stimulating antibody (TSAb) in some patients with Graves' disease. The present studies were undertaken to investigate the interaction between TBIAb and TSAb quantitatively using porcine thyroid cells in order to determine whether the binding sites of TBIAb and TSAb are identical or independent from each other. TBIAb was determined using solubilized porcine thyroid membrane and TSAb using cultured porcine thyroid cells, and both were expressed as equivalent amounts of bovine TSH. In order to avoid interassay variations, all determinations were performed with a single batch of porcine thyroids. Serum samples were obtained from ten untreated patients with Graves' disease; two were negative for TBIAb and TSAb, two were TBIAb negative and TSAb positive, two were weak positive for both, two were strong positive for both, and two were TBIAb strong and TSAb weak positive. IgG from each patient were mixed with equal amounts of IgG of the other nine patients. In order to observe interactions, measured values for TBIAb and TSAb of mixed samples were compared to estimated values (addition of values of original samples). The correlation coefficient between measured values and estimated values for TBIAb was +0.964, and that for TSAb was +0.989. These results that TBIAb does not interfere with the activity of TSAb and vice versa suggest that at least in some patients with Graves' disease, TBIAb and TSAb are different antibodies which have different binding sites.

[Free testosterone index: comparison with plasma free testosterone]

Blood-free testosterone indices were measured among 28 normal men (age; 24-48 yrs.), 20 normal women (20-36 yrs.), 18 pregnant women (22-31 yrs.), 17 males with hypogonadism (23-56 yrs.), 17 males with chronic hepatitis (20-42 yrs.), 24 males with liver cirrhosis (29-68 yrs.), 34 males with hyperthyroidism (20-42 yrs.) and 7 hirsute women (18-31 yrs.), and these were compared with the plasma concentrations of free testosterone. The testosterone index was obtained by multiplying the plasma concentration of testosterone by the percent of sex hormone-binding globulin (SHBG), non-bound testosterone precipitated by dextran-coated charcoal. A significant increase of plasma testosterone was observed in patients with chronic hepatitis (p less than 0.001) and hyperthyroidism (p less than 0.001) as compared with normal men and was also observed in pregnant (p less than 0.01) and hirsute women (p less than 0.01) as compared with normal women. The close negative correlation between plasma levels of testosterone and the percent of SHBG non-bound testosterone (r = -0.87, n = 79, p less than 0.001) was observed among normal men, male patients with chronic hepatitis and hyperthyroidism. The sex hormone binding capacity was increased from two to three fold in patients with chronic hepatitis and hyperthyroidism. The patients with compensated liver cirrhosis had increased plasma testosterone and a decreased percent of SHBG non-bound testosterone, and those with decompensated liver cirrhosis had decreased plasma testosterone and a normal percent of SHBG non-bound testosterone. The plasma concentration of free testosterone was normal in patients with chronic hepatitis and hyperthyroidism. It decreased in pregnancy (p less than 0.01) and increased in hirsute women (p less than 0.01). The blood free testosterone index was slightly high in one third of the patients with chronic hepatitis and hyperthyroidism as compared with that in normal men. However, a close correlation of the percent of SHBG non-bound testosterone and fractional free testosterone (%) measured by equilibrium dialysis (gamma = 0.82, p less than 0.001) was obtained in all subjects (n = 170). These data suggest that the blood free testosterone index parallels the plasma concentration of free testosterone and is useful to evaluate the status of androgenicity.

Specific stimulatory effects of Graves' IgG on the release of triiodothyronine from the patients' own thyroids

The present study was undertaken to investigate the release of thyroid hormones from cultured thyroid slices of untreated patients with Graves' disease in response to autologous IgG and IgG from other untreated patients with Graves' disease. Thyroid tissue (8-10 mg) was obtained by needle biopsy from 11 untreated patients with Graves' disease, and each biopsy was divided into 5 slices. Slices were then cultured in Ham's F-12 synthetic media for 7 days with IgG (1.3 mg/ml) obtained from the same patients, IgG obtained from other untreated patients, normal IgG, or bovine TSH (1.3 mIU/ml). Media were changed every day, and the concentrations of triiodothyronine (T3) in the media were measured by radioimmunoassay (RIA), and the concentrations of thyroidal cAMP were measured by radioimmunoassay on the last day of culture after incubation with 10 mM theophylline at 37 degrees C for 30 min. When thyroid slices were incubated with autologous IgG, the release of T3 increased from the 3rd day, and the increase was 3- to 10-fold above controls on the 5th day, and the production of thyroidal cAMP significantly increased 2- to 3-fold. However, when slices were incubated with IgG obtained from other untreated patients, the concentration of T3 in media and the production of thyroidal cAMP did not differ from that in controls. TSH increased the release of T3 from thyroid slices 2.5- to 10-fold above controls on the 5th day and the production of cAMP 4- to 5-fold. These results strongly suggest that thyroid hormone releasing IgG in patients with Graves' disease are highly specific for autologous thyroids.(ABSTRACT TRUNCATED AT 250 WORDS)

Release of thyroid hormone from circulating thyroglobulin in the rat

Under normal conditions, a small amount of thyroglobulin (Tg) exists in peripheral blood. However, the fate of circulating Tg is unclear. In the present study, in vivo labelled rat Tg was injected iv into rats whose thyroids had been blocked with KI to determine whether circulating Tg released thyroid hormone by hydrolysis in extrathyroidal tissues. Radiolabelled Tg was obtained from thyroid of rats injected with 125I 24h before sacrifice, and subsequently purified by ammonium sulphate precipitation. The plasma samples were obtained from tail veins or by cardiac punctures at various times following injection of [125I]rat Tg. The radioactive samples were separated into iodoprotein, iodoaminoacid and iodide fractions using columns of anion and cation exchange resins. The per cent radioactivity of the iodoprotein, iodoaminoacid an iodide fractions, respectively, was 91.2, 3.8 and 5.2 at 15 min and 66.9, 17.4 and 15.4 at 20 h after injection. In the iodoaminoacid fractions, the presence of T4, T3, MIT and DIT was defined by further fractionation using a Sephadex G-25 column. At 20 h after injection, more than 75% of the radioactivity of the iodoaminoacid fraction was found to be incorporated in T4 and T3. It is concluded that circulating Tg is hydrolyzed in extrathyroidal tissues and that thyroid hormone is released into the circulation, but the amounts of T4 and T3 released are not physiologically significant.

Kinetic study of immunoreactive human thyroglobulin

Thyroglobulin (Tg) can be detected in the circulation of normal subjects. Serum Tg is increased in patients with various thyroidal disorders including Graves' disease; however, little is known about Tg metabolism. Therefore, a kinetic study of human Tg was carried out in 13 normal men, 19-28 yr old, and 6 untreated hyperthyroid patients with Graves' disease, 3 men (22 to 25 yr old), and 3 women (21 to 63 yr old). Ten milligrams of Tg were injected as a bolus dose. Blood samples were collected before and 10 min, and 2, 4, 6, 8, 12 h and every 12 h up to 72 h after injection. Concentrations of serum Tg were measured by an RIA method developed in our laboratory. Anti-Tg antibody was not detected in any subject. Various indices of this kinetic study were calculated using single compartmental analysis. In 13 normal subjects, the mean serum concentrations of Tg were 17 +/- 12.6 (SD) ng/ml; mean half-life was 29.6 +/- 2.8 h; distribution volume was 11,210 +/- 3,076 ml/60 kg body weight; fractional decay was 2.40 +/- 0.22%/h; MCR was 268.9 +/- 87.8 ml/h X 60 kg; and release rate was 100.3 +/- 50.2 micrograms/day X 60 kg. Serum concentrations of Tg were increased in four of the six untreated hyperthyroid patients with Graves' disease. Their Tg half-lives and MCR were within the normal range. In the two patients who had normal serum concentrations of Tg, the Tg half-lives were shorter and MCR were greater than in normal subjects. The release rates of Tg were increased in all six of these patients. In summary, in hyperthyroid patients, Tg release is significantly greater than normal, whereas Tg metabolism is similar to that in normal subjects.

Degradation of circulating thyroglobulin

Reported half lives of rat Tg were different according to various investigators. In order to elucidate whether the derivatives of rat Tg in the peripheral circulation affect the results of kinetic studies of Tg, the present study was performed to investigate kinetics of rat Tg after separation of 19S Tg from its derivatives using gel-filtration. Radiolabeled Tg was obtained from thyroids of rats injected with 125I 24 hours before death, and subsequently purified by ammonium sulfate precipitation. The plasma samples obtained at varying time intervals after intravenous injection of 125I-rat Tg were fractionated on a Sephacryl S-300 column. As determined by sucrose density gradient, 99% of in vivo radiolabeled Tg was 19S. On gel-filtration, the injected labeled Tg and plasma samples obtained within two hours after injection showed a single peak in an identical area. A second peak in an area corresponding to a molecular weight of 60,000 to 70,000 appeared within six hours, and became as high as the first within 24 hours. In the second peak, 22.8 +/- 3.8% (mean +/- SE) of radioactivity was precipitated by anti-rat Tg antibody, and 14.4 +/- 1.7% (mean +/- SE) of radioactivity of its TCA precipitate was not extracted by n-butanol. Thus, the second peak could affect the results of Tg kinetic studies which utilize TCA precipitation, n-butanol extraction or RIA procedures. The half life of rat Tg in the present study was calculated from the disappearance curves of radioactivity of 19S Tg separated from other radioactive substances.(ABSTRACT TRUNCATED AT 250 WORDS)

Isolation, characterization and clinical evaluation of the gamma-glutamyltransferase associated with hepatocellular carcinoma

Sera from 24 patients with hepatocellular carcinoma (HCC), 30 patients with hepatobiliary diseases other than HCC and 5 normal subjects were analyzed for gamma-glutamyltransferase (GGT) isozymes. In ultracentrifugation, GGT I' was recovered in the non-lipoprotein fraction (the residue), together with GGTs I'', II', I and X. GGTs III to IX were recovered in lipoprotein fractions. GGTs in the lipoprotein fractions were removed beforehand by Affi-Gel Blue chromatography, leaving GGTs I', I'', II', I and X in the non-bound fraction, which was subjected to Con A-Sepharose chromatography. From the double affinity chromatography (DAC), GGTs I' and II' were recovered in the unbound fraction, and GGTs I, I'', II' and X in the bound fraction. GGT activities in the unbound fractions of sera from HCC patients were generally higher than those from patients with other benign hepatobiliary diseases. When the GGT activity of the unbound fractions in DAC was expressed as a percent of the sum of the unbound and bound activities (U/(U + B)) and 22% was set as the lower limit of positive values, 54% of the HCC cases had positive values, while none of the patients with hepatobiliary diseases other than HCC had positive values. The U/(U + B) ratio of GGT in DAC appears to be a clinically useful test for screening HCC.

Association of gamma-glutamyltransferase with plasma lipoprotein and lipid-protein complex in cholestasis

Distribution of plasma gamma-glutamyltransferase (GGT) activity among lipoproteins was studied by ultracentrifugation and polyacrylamide gradient gel electrophoresis of plasma from 2 normal controls, 7 patients with intrahepatic cholestasis, and 5 patients with biliary obstruction. Half the total plasma activity was associated with lipoproteins, and more than 90 per cent of the residue activity with macromolecular lipid-protein complex. Healthy subjects had the highest GGT activity in HDL, intermediate activity in LDL, and the lowest in VLDL. In cholestasis, GGT activity increased mainly by the following two mechanisms: 1) the appearance of cholestatic lipoproteins carrying GGT, such as lipoprotein X or Slow-Migrating HDL, or increase in concentration of lipid-protein complex with GGT activity and 2) increase in GGT activity per unit weight of HDL.

Monoclonal antihuman thyroglobulin antibodies

Six murine hybridomas secreting monoclonal antihuman thyroglobulin (Tg) antibodies (TAK 1-6) were established by cell fusion techniques. Solid phase RIA was employed to detect the anti-Tg antibody in culture supernatants of hybridomas. The characteristics of these monoclonal antibodies were analyzed by radioimmune blocking assay using rat Tg, human glycoproteins, thyroid hormones, and various preparations of Tg obtained from patients with thyroid disease as inhibitors. In the same system, competitive inhibition studies between 125I-labeled and unlabeled monoclonal antibodies were carried out to determine whether these antibodies recognized the same antigenic determinant. TAK 2 and 3 reacted with human Tg specifically and had equal binding activity using various preparations of human Tg. The other four monoclonal antibodies (TAK 1, 4, 5, and 6) cross-reacted with xenogeneic Tg (rat Tg) and their affinity for human Tg increased as the iodine content of Tg increased. Tg binding to TAK 1 and 4 was inhibited by T4, whereas Tg binding to TAK 5 and 6 was not inhibited by any thyroid hormone or their precursors. In conclusion, we prepared six monoclonal antihuman Tg antibodies. One group is specific for human Tg and recognizes the framework structure unmodified by iodination; the second group reacts with iodination-related epitopes other than iodoamino acids, and the third group recognizes determinants consisting of T4. These monoclonal antibodies provide important probes to detect the polymorphism of human Tg.

[The measurement of dializable free testosterone]

Non-protein bound testosterone is considered to represent an active androgen in blood, and it reflects in androgenicity. We measured the dializable free testosterone (AFT) in various disorders. The values of plasma testosterone (T), fractional free testosterone (%FT) and AFT were 560 +/- 151 (mean +/- SD) ng/dl 1.9 +/- 0.4% and 10.7 +/- 3.3 ng/dl in normal males (n = 43, aged 25-58), 51 +/- 12 ng/dl, 1.2 +/- 0.3% and 0.6 +/- 0.2 ng/dl in normal females (n = 30, aged 21-41), and 63 +/- 26 ng/dl, 0.6 +/- 0.3% and 0.4 +/- 0.2 ng/dl in pregnancy (n = 20, second and third trimester), respectively. Those values in normal females and pregnancy were significantly lower than those in normal males (p less than 0.001). In male, the concentrations of T and AFT in patients with primary (n = 43, aged 18-50) and secondary hypogonadism (n = 16, aged 22-66) were significantly decreased (p less than 0.001 vs normal males), respectively. The plasma concentration of total testosterone (T) was increased 1032 +/- 269 ng/dl in chronic hepatitis (p less than 0.001) (n = 21, aged 28-52) and 1455 +/- 366 ng/dl in hyperthyroidism (p less than 0.001) (n = 44, aged, 18-52). However, %FT in those disorders was significantly decreased 1.2 +/- 0.3% in chronic hepatitis (p less than 0.001) and 0.8 +/- 0.3% in hyperthyroidism (p less than 0.001), and plasma levels of AFT in both disorders were not different as compared with that in normal males.(ABSTRACT TRUNCATED AT 250 WORDS)

Distinct molecular species of human alpha-fetoprotein due to differential affinities to lectins

Resolution of human alpha-fetoprotein (AFP) into four distinct molecular species was demonstrated by a combination of two affinity chromatographies with crossed-immuno-affino-electrophoresis (CIAE) using concanavalin A (Con A) and Lens culinaris hemagglutinin (LcH)-A and LcH-B as affinity media. Of the four AFPs, AFP1 had no affinity for Con A, LcH-A, or LcH-B; AFP2 showed a high affinity for Con A, a low affinity for LcH-A, and an intermediate affinity for LcH-B (or a low affinity, depending on the lot of LcH-B preparations used); AFP3 revealed strong affinities for all of the three lectins; and AFP4, a trace component of hepatoma AFP in the present study, showed no interaction with Con A, but a definite interaction with LcH-A or LcH-B. These results were based on the determination of dissociation constants (Kd) of AFP-lectin complex by CIAE on isolated preparations of the three major hepatoma AFPs. These AFPs had identical electrophoretic mobilities of 0.86-0.87 (relative to human albumin) in the absence of lectins. The calculated mobilities of AFP2 and AFP3 were both reduced to 0.50-0.58 by saturation with lectins, but these two AFPs were clearly separated by 1 mg/ml LcH-A or LcH-B because of their large differences in Kd.

[Clinical observation on the transport of cefotiam into the bile and gall bladder tissue]

A clinical study was performed on concentration of cefotiam (CTM) in the gallbladder bile and the gallbladder tissue in benign diseases of the biliary tract. By an hour intravenous infusion the CTM concentration obtained 2 hours after the start of the infusion revealed that the level of the CTM in A bile was atmost same as that in B bile (3.1--46.0 micrograms/ml). The concentration in gallbladder tissue was 5.7--116 micrograms/ml. In addition, the CTM level was higher enough than the MIC of CTM covering more than 80% of the strains of E. coli and Klebsiella obtained from the focus. From these results, it is concluded that CTM is clinically effective and useful in the case of biliary disease.

An autopsy case of 17 alpha-hydroxylase deficiency with malignant hypertension

This is the first autopsy case of male 17 alpha-hydroxylase deficiency with malignant hypertension. The subject had hypertension, hypokalemic alkalosis, and pseudohermaphroditism. At age 21, 17 alpha-hydroxylase deficiency was diagnosed by low urinary excretion of 17-hydroxysteroids, low secretion rate of cortisol, and low plasma testosterone level in association with high urinary excretion of pregnanediol and high plasma progesterone and corticosterone. Urinary excretion of aldosterone and PRA were suppressed, and plasma ACTH was elevated. Hypertension and hypokalemic alkalosis were normalized with dexamethasone therapy. After missing 5 yr of follow-up, malignant hypertension developed, and PRA and aldosterone were elevated. Histological examination revealed some characteristic arteriolar lesions as in malignant nephrosclerosis. Juxtaglomerular hyperplasia and an increase of renin granules were observed, which reflected high PRA. Abnormal histological findings of endocrine organs were observed in the breast, the pituitary gland, the adrenal glands, and the testis.

Separation and quantitation of hepatoma-associated gamma-glutamyltransferase by affinity chromatography with Affi-Gel blue and Con A-Sepharose

Isozymes of serum gamma-glutamyltransferase (GGT) in patients with hepatocellular carcinoma (HCC) and other liver diseases were separated into two groups by double-affinity column chromatography with Affi-Gel blue and Con A-Sepharose, one recovered in the unbound fraction and the other in the bound fraction. Upon electrophoresis with polyacrylamide gradient gel slabs, the unbound fraction gave a GGTI1 band and a faint II1 band and the bound fraction gave a GGT I band and faint bands of GGT I", II' and X, when the original serum contained hepatoma-associated GGT (I1, I" and II') and high-molecular-weight lipid-protein complex, GGT(X). GGT I was present in all cases as a common isozyme. Other lipoprotein-associated GGT isozymes, III-IX, were removed by passing through Affi-Gel blue. GGT activities of unbound fraction in patients with HCC were generally higher than those in patients with non-HCC liver diseases, although the difference was not significant. When the percent of GGT activity of unbound (unbound + bound) was taken, 54% of patients with HCC had a ratio greater than 22%, whereas none of the healthy subjects or patients with other liver diseases gave values greater than this. The present technique may prove to be a useful clinical test for the diagnosis of HCC.

Partial purification and characterization of glycylprolyl dipeptidyl aminopeptidase in porcine pancreas

This study reports the presence of glycylprolyl dipeptidyl aminopeptidase in porcine pancreas, and its partial purification and some properties. Crude enzyme preparation was obtained by extraction from acetone-dried powder of the pancreas at pH 7.6. For solubilization of enzyme, freezing and thawing were carried out. Crude enzyme extract was fractionated with ammonium sulfate precipitation, gel filtration on Sephadex G-200 column and ion-exchange chromatography on DEAE-cellulose. Partially purified enzyme showed 2897-folds purification. The enzyme activity on polyacrylamide gel electrophoresis showed good agreement with a main protein band stained with Coomassie brilliant blue. Molecular weight of this enzyme from the pancreas was estimated to be 300000 by gel filtration on Sephacryl S-300 column. Optimum pH was between 8.5 and 9.0, and Km value for glycylproline-p-nitroanilide tosilate was 0.33 mM. This enzyme from the pancreas was a serine enzyme and was relatively stable to heat at 60 degrees C for 10 min.

Relationship between colloid droplets of thyroid follicular cells and serum thyroglobulin concentration in neonatal rats after thyrotropin releasing hormone (TRH) injection

Thyrotropin Releasing Hormone (TRH) shows the obvious and long-durated stimulation to the neonatal thyroid tissue through the pituitary. The sequential changes of serum thyroglobulin (Tg) levels and light and ultrastructural change in the cells of the thyroid gland were studied after TRH injection into neonatal rats. TRH injection induced a rapid increase of the colloid droplets in the thyroid follicular cells followed by a slow increase in serum Tg levels. Ultrastructurally, although marked surface activities consisting of formation of pseudopods and colloid droplets were observed after TRH injection, luminal colloid did not appear to go across the intercellular space between the thyroid follicular cells.