Effects of a novel elastase inhibitor, ONO-5046, on nephrotoxic serum nephritis in rats

ONO-5046 is a potent, specific and intravenously active inhibitor of neutrophil elastase. To examine the role of elastase in glomerulonephritis, we tested the effects of ONO-5046 on nephrotoxic serum (NTS) nephritis in a rat model of the disease in humans. Rats were administered ONO-5046 or phosphate-buffered saline (PBS) intraperitoneally 24 hours prior to injection of NTS, and they were then given equal doses of ONO-5046 or PBS three hours and 1, 2, 3, 4, 5 and 6 days later. Compared with the control groups, ONO-5046 significantly reduced proteinuria and hematuria, and suppressed the formation of crescentic glomeruli in a dose-dependent manner. Our results suggest that neutrophil elastase participates in NTS nephritis by degrading glomerular basement membrane proteins, and that the elastase inhibitor, ONO-5046, suppresses crescentic formation and glomerular injury caused by elastase.

Magnetic resonance imaging with gadolinium-diethylenetriamine pentaacetic acid is useful in assessment of tubal patency in a patient with iodine-induced hypothyroidism

A 32-year-old woman presented for evaluation of primary infertility. Because she had a history of iodine-induced hypothyroidism, conventional hysterosalpingography was contraindicated. Tubal patency was assessed by magnetic resonance imaging (MRI) after infusion of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). Visualization of the contrast medium in the peritoneal cavity revealed tubal patency. Our case indicates that MRI with gadolinium-diethylenetriamine pentaacetic acid is a safe, simple, and easy way to confirm that at least one tube is patent when a patient is at risk for hysterosalpingography. To our knowledge, this is the first report that tubal patency was diagnosed on MRI.

Resonance imaging of the eustachian tube cartilage in microtia

OBJECTIVE

The purpose of this study was to determine whether external and internal defects in microtia are related.

METHOD

Magnetic resonance images of the eustachian tube cartilage were evaluated for 20 patients who had unilateral microtia. Nineteen patients were classified as Grade 2, and one was classified as Grade 3. The Grade 3 patient also had unilateral facial palsy.

RESULTS

On T1-, T2-, and proton-density-weighted images, the eustachian tube cartilage was clearly identified as a pair of straight lines with low signal intensity. There was no evidence of hypoplasia of the eustachian tube cartilage on the microtic side in any Grade 2 patient, but hypoplasia was evident on the microtic side of the patient classified as Grade 3.

CONCLUSION

These findings are consistent with the view that impairment of embryonic development before 6 weeks results in injury to the immature primordium and malformation of both the external and middle ear. In contrast, injuries that occur at a later fetal age (i.e., after 3 months) do not appear to cause middle ear malformations.

Establishment and characterization of a new erythropoietin-dependent acute myeloid leukemia cell line, AS-E2

We have established an erythropoietin-dependent human leukemia cell line, AS-E2, from a patient with acute myeloid leukemia. These cells have many characteristics of late erythroid progenitor cells, they are positive for CD36, Glycophorin A, and CD71 but negative for CD41, and positive for benzidine and PAS staining. These cells express GATA-1 and have low affinity erythropoietin (EPO) receptor on their surface. Interestingly, AS-E2 cells are strictly dependent on EPO for their growth and survival; other cytokines including GM-CSF, stem cell factor, or IL-3 cannot support the growth of this cell line. These features are similar to late erythroid lineage cells, like normal BFU-E or CFU-E, and we have demonstrated that EPO stimulation induces the tyrosine phosphorylation of several proteins in AS-E2 cells including the EPO receptor and JAK2 kinase. This new cell line is a useful reagent to study biological and molecular events during the late stages of erythropoiesis, and to understand transforming events in human erythroid cells.

Characterization of the binding of nuclear envelope precursor vesicles and chromatin, and purification of the vesicles

The binding of nuclear envelope precursor vesicles and chromatin was characterized by using an in vitro system constituted from a Xenopus egg extract and demembranated Xenopus sperm chromatin. The results of binding studies in the presence of salts, urea, and a chelator showed that the binding involves an ionic interaction. Chemical modification studies suggested that a protein(s) in the vesicles, which is responsible for the binding with chromatin, has essential lysine, histidine, and methionine residues. The vesicle protein could not be extracted from vesicles with 1 M KCl, 2 M urea, or 0.1 M Na2CO3, suggesting that it is an intrinsic membrane protein. The protein was denatured with 8 M urea and 0.1 M Na2CO3, and could be renatured by incubation at 23 degrees C, suggesting that the native conformation of the protein is important for the binding. Affinity purification of nuclear envelope precursor vesicles was achieved by binding to chromatin and dissociation with 0.24 M NaCl. The vesicle fraction thus obtained exhibited the ability to form nuclear envelope on incubation with chromatin in Xenopus egg cytosol without any other membrane fraction. These results suggested that there is a nuclear envelope precursor vesicle population containing both a chromatin targeting protein and vesicle fusion machinery.

Cord blood IgE against milk and egg antigens

The aim of the present study was to reevaluate the prenatal production of specific IgE for eggs and milk and, in those cases, to determine whether there is a relation to the amount of maternal egg and milk intake. Total and specific IgEs from 160 cord blood-samples were determined by immunoassays using a paramagnetic particle solid phase and an enzyme-mediated chemiluminescent reaction for signal detection. The levels of cord blood IgE for total, egg, and milk were 0.63 +/- (SD) 1.10 IU/ml, 0.020 +/- 0.055, and 0.036 +/- 0.053 IU/ml, respectively. IgE levels specific to egg and milk over 0.03 IU/ml were observed in 33 and 70 out of 160 cases, respectively. To address whether the maternal intake of eggs and milk affects the level of cord blood IgEs, all mothers except 9 were interviewed, and the amount of eggs and milk taken during pregnancy was recorded. No correlation was seen between egg and milk intakes and cord blood IgE levels. Our data demonstrate a high incidence of the prenatal production of specific IgE for eggs and milk which is independent of maternal egg and milk intakes.

[Protective effect of nitric oxide on ischemic retina]

Nitric oxide (NO) is a free radical and was regarded as noxious to life. But recent studies show that NO is an important substance for transcellular signal transduction. It also seems to act as a neurotransmitter in the nervous system. In ischemic nerve tissue a release of glutamate is one of the critical factors that increase neuronal death, and some experiments suggest that NO may be involved in this process. Here we provide evidence that NO provides neuroprotection in ischemic retinas in vivo. Albino rabbits' eyes were subjected to 60 minutes of ischemia by raising intraocular pressure. Before ischemia the eyes were treated intravitreously with the NO-precursor L-arginine, the NO synthase-inhibitor nitro-L-arginine methyl ester hydrochloride (L-NAME), the NO-donor sodium nitroprusside (SNP), or solvent only. The amplitude of the b-wave was measured and the recovery ratio of the b-wave was analyzed hourly after reperfusion. The recovery ratio of b-wave in the eyes with L-arginine and with SNP increased more rapidly than in the controls, while the recovery ratio in the eyes with L-NAME increased in a way similar to that of the controls. These results suggest that NO plays a neuroprotective role in ischemic retina. It may be involved with S-nitrosylation of some proteins, including one of the glutamate receptors, the N-methyl-D-aspertate (NMDA) receptor.

Cystic teratoma of the greater omentum: a case report and review of the literature

Cystic teratoma in the greater omentum remains one of gynecology's rarest entities. A 28-year-old woman presented with a goose-egg-sized mass in the right lower quadrant. At laparotomy, the mass proved to be a cystic teratoma of the greater omentum. To our knowledge, this report documents the first case where an omental pedicle was torsioned.

[A case of Guillain-Barré syndrome treated with plasma exchange and intravenous high-dose immune globulin]

We describe a 69-year-old female with Guillain-Barré syndrome (GBS) whose paresthesia and weakness improved after plasma exchange (PE) and intravenous high-dose immune globulin (i.v.I.G.). She felt a paresthesia in her right arm, and 7 days later she noticed right arm weakness followed by gait disturbance within 2 days. She received a series of 6 PEs, but paresthesia and weakness did not improve. Following the last PE trial of this series, she was treated by i.v.I.G. (0.4 g/kg) for 5 days. After i.v.I.G., paresthesia and weakness improved in a few days. After 2nd series of 6 PEs, she was able to walk. In this clinical course, the treatment of i.v.I.G. after PE seemed to be effective. This case raises the possibility that i.v.I.G. might be the treatment in GBS patients with insufficient effect of PE.

In vivo effect of recombinant human leukemia inhibitory factor in primates

Leukemia inhibitory factor (LIF) is known to be a causative factor for cachexia and thrombocytosis in nude mice bearing human cancer cells. In the present study, we investigated whether recombinant human (rh) LIF can induce these biological activities in a primate model. rhLIF was synthesized by the expression of LIF protein in Escherichia coli. rhLIF (5, 20, or 80 micrograms/kg) was administered subcutaneously twice daily to cynomolgus monkeys for 14 consecutive days. A remarkable decrease of body weight (10%) was observed in the 80 micrograms/kg/day group. Approximately two-fold increases in platelet counts were observed at doses higher than 5 micrograms/kg/day when compared with control counts. These biological effects disappeared soon after the cessation of rhLIF treatment. Macroscopically, a remarkable reduction in subcutaneous fatty tissues and severe splenomegaly were observed. The results of this study demonstrate that rhLIF induces weight loss and thrombocytosis in a primate model.

Missense mutations of the glycoprotein (GP) Ib beta gene impairing the GPIb alpha/beta disulfide linkage in a family with giant platelet disorder

We describe here the molecular basis of an isolated hereditary giant platelet disorder (GPD) which is not accompanied with thrombocytopenia or leukocyte inclusion. Platelet aggregation with ristocetin and botrocetin was almost normal in this patient. Flow cytometric analysis showed that the glycoprotein (GP) Ib/IX complex was expressed on the platelet membranes at decreased levels. The amount of platelet GPIb alpha and the plasma glycocalicin concentration, the water-soluble extracellular portion of GPIb alpha, were also decreased. The anti-GPIb alpha antibody coprecipitated GPIb beta and GPIX, although the ratios of these polypeptides to GPIb alpha was greatly decreased compared with the ratio in normal platelets. Immunoblot analysis under nonreduced conditions showed that most of the GPIb alpha in the patient's platelets was not disulfide linked with GPIb beta. DNA sequencing analysis showed compound heterozygosity for two independent single nucleotide substitutions: from Tyr (TAC) to Cys (TGC) at residue 88, and from Ala (GCC) to Pro (CCC) at residue 108 in her GPIb beta gene. These substitutions were not found in genomic DNA samples from 108 normal individuals. These mutations might result in decreased expression of the GPIb/IX complex and may influence the association of the complex with the membrane skeleton, consequently impairing normal platelet morphology. Furthermore, the phenotype caused by mutations in the subunits of the GPIb/IX complex could span the spectrum from a normal phenotype, to isolated GPD, to a full-blown bleeding disorder, such as Bernard-Soulier syndrome.

Chronic opiate-receptor inhibition in experimental congestive heart failure in dogs

Acute administration of opiate-receptor antagonists has previously been shown to improve cardiac output aortic blood pressure, systolic ventricular performance, and the baroreflex function in conscious dogs with right-sided congestive heart failure (RHF). However, whether similar changes occur after chronic opiate-receptor inhibition in congestive heart failure is not known. To determine the chronic effects of opiate-receptor antagonism on RHF, we administered naltrexone (200 mg/day), a long-acting, orally active opiate-receptor blocking agent, to RHF and sham-operated animals for 6 wk. Naltrexone had no effects on resting heart rate, right atrial pressure, aortic pressure, or cardiac output in RHF dogs but increased the first derivative of right and left ventricular pressure with respect to time (dP/dt) at rest and improved the dP/dt response to isoproterenol. The inotropic responses to isoproterenol and forskolin in isolated right ventricular trabeculate muscle also were improved by chronic naltrexone in RHF. Myocardial beta-receptor density was reduced in the failing right ventricle compared with the control (58 +/- 3 vs. 108 +/- 6 fmol/mg protein, P < 0.01) but was unaffected by addition of naltrexone. Finally, naltrexone prevented the decline in baroreflex sensitivity that occurred in RHF (-0.2 +/- 0.5 vs. -6.0 +/- 0.5 ms/mmHg, P < 0.01). These effects of naltrexone did not occur in the shamoperated animals. Chronic opiate-receptor blockade with naltrexone attenuates the development of reduced adrenergic inotropic responsiveness and baroreflex subsensitivity that occur in RHF. Because there was a similar improvement in the forskolin response in the absence of significant alterations in myocardial beta-adrenoceptor density after naltrexone treatment, the improvement in adrenergically mediated inotropic effects probably is mediated via a postreceptor mechanism.

Histological localization of advanced glycosylation end products in the progression of diabetic nephropathy

We studied the immunohistochemical localization of advanced glycosylation end products (AGEs) in the progression of diabetic nephropathy. Fourteen NIDDM patients with diabetic nephropathy were evaluated: 2 patients with normoalbuminuria, 4 with microalbuminuria (MA) and 8 with overt proteinuria (OP). Three patients with minor glomerular abnormalities were used as nondiabetic controls. Immunoreactivity to a monoclonal anti-AGE antibody (6D12) was recognized on the internal elastic membranes of arterial walls in every diabetic group. Hyaline lesions of arterioles of the MA and OP groups demonstrated strong reactions with 6D12. A portion of the nodular and exudative lesions in glomeruli of OP group patients also revealed immunoreactivity to 6D12. No immunoreactivity to 6D12 was observed in nondiabetic control specimens. We confirm that the accumulation of AGEs began in arterial walls of the early stage and presented in glomerular lesions of the late stage of the progression of diabetic nephropathy.

Early increase of chondroitin sulfate glycosaminoglycan in the glomerular basement membrane of rats with diabetic glomerulopathy

A decrease in anionic change and the loss of heparan sulfate proteoglycan have previously been observed in the glomerular basement membrane (GBM) during diabetic glomerulosclerosis. We studied the chronological changes in the anionic character and the glycosaminoglycan content in the GBM of WBN/ Kob rats with spontaneous diabetes. Two types of cationic probes were used: polyethyleneimine (PEI) and cationic colloidal gold (CCG). Immunogold labeling was performed with anti-monoclonal-heparan-sulfate-glycosaminoglycan (HS-GAG) and anti-chondroitin-sulfate-glycosaminoglycan (CS-GAG) antibodies. The GBM width, the anionic sites and the GAG sites were investigated in diabetic WBN/Kob rats at 2, 10 and 19 months, compared with control rats. Diabetes was confirmed in WBN/Kob rats after 8 months in this study. The GBM width gradually thickened with age. The PEI anionic sites significantly decreased in the lamina rara externa (LRE) at 19 months (vs. 2 and 10 months). The HS-GAG sites also significantly decreased in the LRE at 10 and 19 months (vs. 2 months). However, the CCG anionic sites and the CS-GAG sites significantly increased in the LRE and the lamina densa at 10 months (vs. 2 months) and, after 19 months, returned to the level seen at 2 months. Results indicate that there is an early transient increase in CS-GAG in the GBM while HS-GAG decreases. We noticed a transient increase in the CCG anionic sites at this early stage of diabetic glomerulosclerosis as well. The increase in CS-GAG may provide a marker for early diabetic changes in the GBM.

[Report on the accuracy and the reliability of dip sticks]

Urinary examination with dip sticks is essential for clinical screening test and primary health care. Recently Japanese Society of Clinical Pathology has stressed the clinical use of dip sticks. Many dip sticks are available in Japan. However, few attempts have been done for external quality control of dip sticks. It is well known that there are considerable differences in the accuracy, sensitivity and stability of dip sticks. Makers are at variance in indicating concentration levels in accordance with the given color charts. Some urine chemistry analyzers for dip sticks have been developed. There was a few cases of simultaneous study on dip sticks from various makers. We, four technologists have attempted external quality control of eleven dip sticks for protein, glucose and occult blood with the same lot number (one was only for glucose) using the four different pooled urine samples and two artificial urine samples. Based on the results of this study, the following proposal to improve the accuracy and reliability of dip sticks was derived. 1) Users should have a plenty of knowledge on the difference of the quality of dip sticks of each makers. 2) Makers of dip sticks should clarify to users the method of examination, standard materials and errors. 3) Users should perform internal quality control using different pooled urine samples or different artificial urine samples on a daily basis before going with the routine work.

[Experience with and prospects for emergency Ippan kensa (urinalysis, fecal tests and body fluid tests]

Ippan Kensa (defined as urinalysis, fecal tests, and tests of cerebrospinal fluid, pleural fluid, ascites, and other body fluids) are done of fresh samples, as a rule, and such samples should be tested as soon as possible. Even for tests not ordered in an emergency, rapid results are desirable. In these two senses, all tests are somewhat urgent. Along with the rest of the hospital, our section moved into a new hospital complex in 1993, and that time, an order-entry and reporting system was implemented. Urinalysis was totally systematized from the start with two automated analyzers connected to an automated transportation system, and other tests were gradually automated and computerized. Time and labor were saved without decreased quality. Most routine tests are now done within 2.5 hours of sampling. Emergency tests are not handled by a special, formally established procedure in our laboratory, but at the request of a physician, any test can be done rapidly when necessary, because the system allows interruption at any time for testing of samples out of order. Our experience with this system suggests that automation and computerization are essential if emergency and urgent tests are to be done rapidly by a small staff. Further improvements in the high-quality automated analyzers already available, speeding results but allowing fewer false-positives and false-negatives can be expected.

Simplification of the Elmslie-Trillat procedure for patellofemoral malalignment. Is medial capsulorraphy necessary?

We describe a modification of the Elmslie-Trillat operation which includes a lateral retinacular release and medial realignment of the tibial tuberosity, but omits medial capsulorraphy. Seventy-five patients were reviewed with a follow up longer than 2 years and the results compared with the conventional Elmslie-Trillat procedure, which consists of lateral release, medial realignment of the tuberosity and medial capsulorraphy. The simpler operation can work as well and the period of rehabilitation is shorter. The incidence of injury to the saphenous nerve is reduced and the cosmetic appearance is more satisfactory. We conclude that medial capsulorraphy is usually unnecessary in this type of procedure.

Second transplantation with CD34+ bone marrow cells selected from a two-loci HLA-mismatched sibling for a patient with chronic myeloid leukaemia

A 43-year-old man with chronic myeloid leukaemia underwent a second transplant with CD34+ bone marrow cells selected from his two-loci HLA-mismatched sibling after rejection of the first graft from an HLA-matched unrelated donor. By immunomagnetic positive selection, CD34+ marrow cells at 0.95 x 10(6)/kg with 97% purity and CD3+ T lymphocytes at 1.3 x 10(4)/kg were collected and transplanted. Engraftment was confirmed to be of CD34+ cell-donor origin. The patient developed only grade I acute graft-versus-host disease (GVHD) and no chronic GVHD to date. These observations suggest that allogeneic CD34+ bone marrow cells are capable of reconstituting haemopoiesis and that CD34+ selection could be applicable to T-cell depletion.