Clinical trials of GH treatment in patients with Turner's syndrome in Japan--a consideration of final height. The Committee for the Treatment of Turner's Syndrome

Clinical trials of human GH (hGH) therapy in Turner's syndrome were started in 1986. Between 1986 and 1990. 362 patients were enrolled; 115 were treated for more than 6 years. The age at the start of treatment ranged from 5 to 18 years (mean 10 years). Fifty-one patients received hGH at a weekly dosage of 0.5 IU/kg and 64 received 1.0 IU/kg by daily s.c. injection. Both treatment groups showed a statistically significant growth increase during the initial 4 years of treatment. The rate of increase in height was significantly greater for the initial 2 years with the high dose than with the low dose. The increases in height over 6 years of treatment (expressed by S.D. score for chronological age) were 1.48 +/- 0.8 with 0.5 IU/kg per week and 1.80 +/- 1.0 with 1.0 IU/kg per week. To date, 260 patients have stopped GH therapy. In 32% of them, the height attained was above the -2 S.D. value for normal girls. In 27%, the growth rate was not sufficient when they stopped treatment. The mean final height (growth rate < or = 1.0 cm/year) of patients treated for more than 6 years was 142.2 +/- 6.5 cm (n = 15) with 0.5 IU/kg per week, and 144.3 +/- 3.9 cm (n = 15) with 1.0 IU/kg per week. The adult height was improved by GH treatment, although final height did not differ statistically between the two dose regimens. No remarkable adverse events occurred during the treatment. These results indicate that hGH treatment improves the final height in patients with Turner's syndrome.

Osteopathia striata, short stature, and characteristic facies: a previously unknown skeletal dysplasia

We report two sporadic cases of a hitherto undescribed skeletal dysplasia with short stature and characteristic facies. The present patients, a 6-year-old girl and a 15-year-old boy, were almost equally affected. Craniofacial anomalies included a sloping forehead, bitemporal bulging, sparse medial eyebrows, a prominent nasal bridge, hypertelorism, proptosis, a beaked nose, hypoplastic alae nasi and a pointed chin. Shallow orbits, short anterior cranial fossae and bitemporal bossing found on skull radiograph corresponded with the facial dysmorphism. Thickening of the dorsum sellae was another hallmark in the skull. Skeletal survey revealed mild osteopenia, interpediculate narrowing of the lumbar spine with short neural arches and, most important, osteopathia striata of the long tubular bones. There was no sclerosis of the craniofacial bones. The clinical and radiological findings in the present patients were overall inconsistent with those of previously known skeletal dysplasias and congenital malformation syndromes, which possess osteopathia striata as a cardinal feature.

CONCLUSION

The unique clinical and radiological constellation of our patients constitutes a hitherto unknown bone dysplasia.

T-stem cell leukemia/lymphoma with both myeloid lineage conversion and T-specific delta recombination

We evaluated retrospectively the clinical and biological characteristics of six patients with CD7+ early T-acute lymphoblastic leukemia and lymphoma (T-ALL/LBL) originating from prothymocyte stage I (pro-T I) or II cells. Patients exhibited mediastinal mass (five of six) and lymphoadenopathy (five of six) but without leukocytosis and circulating blast cells (six of six). All patients achieved a complete remission. All but one had a relapse with a transformation to the mixed type (triphenotype--three cases, biphenotype-two cases) including myeloid features in three patients. The altered phenotypes were myeloperoxidase (MPO)+ (three of five), CD13+ (four of five), CD33+ (three of five) and CD19+ (three of five). The difference for MPO-positivity were observed between the bone marrow (BM)- and lymph node (LN)-blast cells (three of three). On cytogenetic analysis, there is no common abnormality in these patients. Immunomolecular analysis revealed T-cell lineage specific delta gene rearrangements [D delta 2-J delta 1 (five of six) and V delta 1-J delta 1 (one of six)] in all cases. Furthermore, D delta 2-J delta 1 occurred even in the cases with the pro-T I phenotype. Rearrangements of TCR beta, gamma or immunoglobulin heavy chain genes occurred in three patients. The same rearranged band(s) appeared at both diagnosis and relapse, indicating the same originality of the pro-T leukemic cell clone (three of three). We suggest that this type of CD7+ early T-ALL/LBL was transformed from a pro-T I or II cell, such as T-stem cell leukemia/lymphoma, which is a subtype of CD7+ stem cell leukemia as defined by Kurtzberg et al. This study reveals that pro-T I and II cells might be capable of myeloid, T- and B-lymphoid differentiation, and T-cell lineage specific TCR delta recombination occurs.

MAP kinase links the fertilization signal transduction pathway to the G1/S-phase transition in starfish eggs

The mechanism by which fertilization initiates S-phase in the zygote is examined by manipulating the activity of MAP kinase in mature starfish eggs. These unfertilized eggs, which are arrested at G1-phase after the completion of meiosis, have high MAP kinase activity but undetectable cdc2 kinase activity. Either fertilization or inhibition of protein synthesis causes a decrease in MAP kinase activity, which is followed by DNA synthesis. Inactivation of MAP kinase with its specific phosphatase, CL100, initiates DNA synthesis in the absence of fertilization, while constitutive activation of MAP kinase with MEK represses the initiation of DNA synthesis following fertilization. Thus, in unfertilized mature starfish eggs, a capacity for DNA replication is already acquired, but entry into S-phase is negatively regulated by MAP kinase activity that is supported by a continuously synthesized protein(s) but not by cdc2 kinase. Upon fertilization, downregulation of MAP kinase activity is necessary and sufficient for triggering the G1/S-phase transition.

CXCR4/fusin is not a species-specific barrier in murine cells for HIV-1 entry

Since some murine cells expressing human CD4 fail to internalize HIV-1, another block was thought to be located at the level of viral entry in addition to CD4. Recently, CXCR4 was shown to function as a coreceptor for T cell line-tropic HIV-1 entry. Here we demonstrated that cells expressing murine CXCR4 and human CD4 fused with cells expressing the env proteins derived from T cell line-tropic HIV-1 and were infected with T cell line-tropic HIV-1 strains. In contrast, the same cells were not infected with chimeric clones constructed by substitution of monocyte- or macrophage-tropic strain-derived env region or V3 region into T cell line-tropic HIV-1, indicating V3 loop of envelope protein is required for murine CXCR4mediated HIV-1 entry. We conclude that murine CXCR4 is not a species specific barrier to the entry of T cell line-tropic HIV-1.

Scanning electron microscopic evaluation of the skin surface after ultrasound exposure

BACKGROUND

Transdermal drug-delivery systems have become widely accepted clinically for the administration of several systemic drugs. Recently, research on ultrasound irradiation to facilitate the penetration of drugs through the skin have been reported. The present study investigated the morphological changes induced in skin after ultrasound irradiation to hairless mouse skin and human skin.

METHODS

Hairless mice and human skin were immersed in an ultrasound irradiation water tank. Ultrasound was delivered for a duration of 5 min. Ultrasound frequency of 48 kHz was generated at an intensity of 0.5 W/cm2. The surface of the skin was observed with scanning electron microscopy for comparison with skin samples unexposed to ultrasound energy.

RESULTS

For hairless mouse exposed to ultrasound, the cells of the stratum corneum of the skin surface were almost completely removed. The polygonal cells of the stratum spinosum and basal cells were exposed. In addition, large craterlike pores with a diameter of 100 microns were formed sporadically in some of the skin samples. In contrast, the surface of human skin exposed to ultrasound showed only slight removal of keratinocytes around the hair follicles.

CONCLUSION

The removal of the stratum corneum and other alterations in hairless mouse and human skin by ultrasound may explain the enhancement of transdermal drug penetration. The effect on human skin was relatively minor compared with that on hairless mouse skin.

Elimination of adult T cell leukemia cells by ultrasound in the presence of porfimer sodium

Sonodynamic effects using porfimer sodium (Photofrin; Pf) on leukemic and normal cells were evaluated. The purpose of this experiment was to compare cell survival among MT-2 cells, normal peripheral mononuclear cells (PMNCs) and adult T cell leukemia (ATL) patients' PMNCs after sonodynamic treatment. Cells were exposed to 450 kHz ultrasound at an intensity of 500 mW/cm2. The survival rate of MT-2 cells exposed to ultrasound alone for 80 s was 20.1 +/- 4.8%, whereas survival rates exposed to ultrasound in combination with 25, 50 and 100 microg/ml of Pf resulted in 11.5 +/- 2.9, 3.2 +/- 1.6 and 1.6 +/- 1.4%, respectively. There was a significant difference of cell survival between the group exposed to ultrasound alone and the Pf-combined groups (n = 6, p < 0.05). On the other hand, in the normal human PMNCs, no significant differences of cell survival rates were found between ultrasound-treated groups with and without Pf. We similarly examined the survival rate of PMNCs in the peripheral blood of five acute-type ATL patients (n = 5) after ultrasound (60 s, 300 mW/cm2) exposure with or without 100 microg/ml of Pf. Comparison of cell survival rate between ultrasound alone and ultrasound plus Pf showed significant differences (69.4 +/- 22.5 and 30.0 +/- 23.0%, respectively). There were no significant cytotoxicities in all Pf alone treated groups of the MT-2 cells, the normal PMNCs and the ATL patients' PMNCs (p < 0.05). It was suggested from this study that there was a specific selectivity of sonodynamic effects to MT-2 cell lines and ATL patients' PMNCs. It is anticipated that this new method of treatment, i.e. sonodynamic therapy, could be used for extracorporeal blood treatment of acute-type ATL patients.

Short-term breast-feeding may reduce the risk of vertical transmission of HTLV-I. The Tsushima ATL Study Group

To establish a desirable preventive measure against mother-to-child transmission of HTLV-I through breast milk, we conducted a prospective study to investigate the seroconversion rate among children born to HTLV-I carrier mothers on two highly HTLV-I-endemic islands where 8% of pregnant women carry HTLV-I. Between 1985 to 1991, 428 pregnant women were found to be positive against anti-HTLV-I antibody and were advised not to breast-feed their newborn babies. Among them, 212 women (50%) accepted this advice and the other mothers proceeded to breast-feed. Results were obtained from 277 children born to HTLV-I carrier mothers and were followed up until more than 30 months of age. When the seroconversion rate was analyzed by feeding manner, short-term breast-feeders (< or = 6 months) showed a statistically significant lower seroconversion rate than long-term breast-feeders (2/51; 3.9% vs. 13/64; 20.3%, p < 0.05). On the other hand, four out of 162 bottle-fed children (2.5%) became positive. It is hypothesized that maternal HTLV-I antibody may protect babies from HTLV-I infection through breast milk during the first 6 months.

Analysis of the steroidogenic acute regulatory protein (StAR) gene in Japanese patients with congenital lipoid adrenal hyperplasia

Genomic DNA from 19 Japanese patients with congenital lipoid adrenal hyperplasia (lipoid CAH) representing 16 different families was examined to identify the genetic alterations of steroidogenic acute regulatory protein (StAR). Ten of 19 patients had a 46,XX karyotype and nine had a 46,XY karyotype. Six of the 46,XX patients have experienced spontaneous pubertal changes including breast development and irregular menstruation whereas none of the 46,XY subjects displayed pubertal changes. Eight different mutations were identified. Sixteen patients were either homozygotes or compound heterozygotes for the Q258X mutation. The seven other mutations identified were 189delG, 246insG, 564del13bp, 838delA, Q212X, A218V and M225T. The 189delG, 246insG, 546del13bp and Q212X mutants encode truncated proteins. COS-1 cells transfected with expression vectors encoding cDNAs for the mutant StAR proteins which affect the C-terminus, 838delA, A218V and Q258X, exhibited no steroidogenesis enhancing activity. However, the M225T mutant retained some steroidogenic activity. The patient with the M225T mutation had late onset of this disorder and some capacity to secrete testosterone in response to hCG. These findings suggest: (i) that the Q258X mutation can be used as a genetic marker for the screening of Japanese for lipoid CAH, (ii) that the C-terminus of StAR plays an important role in the protein's activity and (iii) that there are differences in the extent of functional impairment of the testis and ovaries in lipoid CAH.

Spontaneous puberty in 46,XX subjects with congenital lipoid adrenal hyperplasia. Ovarian steroidogenesis is spared to some extent despite inactivating mutations in the steroidogenic acute regulatory protein (StAR) gene

Congenital lipoid adrenal hyperplasia (lipoid CAH) is the most severe form of CAH in which the synthesis of all gonadal and adrenal cortical steroids is markedly impaired. We report here the clinical, endocrinological, and molecular analyses of two unrelated Japanese kindreds of 46,XX subjects affected with lipoid CAH who manifested spontaneous puberty. Phenotypic female infants with 46,XX karyotypes were diagnosed with lipoid CAH as newborns based on a clinical history of failure to thrive, hyperpigmentation, hyponatremia, hyperkalemia, and low basal values of serum cortisol and urinary 17-hydroxycorticosteroid and 17-ketosteroid. These patients responded to treatment with glucocorticoid and 9alpha-fludrocortisone. Spontaneous thelarche occurred in association with increased serum estradiol levels at the age of 10 and 11 yr, respectively. Pubic hair developed at the age of 12 yr 11 mo in one subject and menarche was at the age of 12 yr in both cases. Both subjects reported periodic menstrual bleeding and subsequently developed polycystic ovaries. To investigate the molecular basis of the steroidogenic lesion in these patients, the StAR gene was characterized by PCR and direct DNA sequence analyses. DNA sequence analysis revealed that one patient is homozygous for the Gln 258 Stop mutation in exon 7 and that the other patient is a compound heterozygote with the Gln 258 Stop mutation and a single A deletion at codon 238 in the other allele causing a frame-shift, which renders the StAR protein nonfunctional. These findings demonstrate that ovarian steroidogenesis can be spared to some extent through puberty when the StAR gene product is inactive. This is in marked contrast to the early onset of severe defects in testicular and adrenocortical steroidogenesis which are characteristics of this disease.

SPONASTRIME dysplasia: report on a female patient with severe skeletal changes

We report on a 6-year-old girl with SPONASTRIME dysplasia, characterized by short-limbed dwarfism, a relatively large head, midfacial hypoplasia, a saddle nose, moderate deformities of the vertebral bodies, striated metaphyses, and normal intelligence. She showed severe skeletal changes including marked delay of epiphyseal ossification, evident metaphyseal dysplasia, and osteopathia striata more pronounced than in most of the previously reported patients with this disorder. The patient we describe and a male patient reported by Camera et al. [1994: Pediatr Radiol 24:322-324] are likely to represent the severely-affected end of the clinical spectrum of the disorder. These finding thus rule out the X-linked mode of inheritance of the disorder proposed by Camera et al. [1994: Pediatr Radiol 24: 322-324]. Alternatively, the two severely-affected patients may represent a variant form of the disorder. There is evidence that SPONASTRIME dysplasia is a genetically heterogeneous disorder.

Molecular cloning and characterization of a murine pre-B-cell growth-stimulating factor/stromal cell-derived factor 1 receptor, a murine homolog of the human immunodeficiency virus 1 entry coreceptor fusin

Pre-B-cell growth-stimulating factor/ stromal cell-derived factor 1 (PBSF/SDF-1) is a member of the CXC group of chemokines that is initially identified as a bone marrow stromal cell-derived factor and as a pre-B-cell stimulatory factor. Although most chemokines are thought to be inducible inflammatory mediators, PBSF/SDF-1 is essential for perinatal viability,. B lymphopoiesis, bone marrow myelopoiesis, and cardiac ventricular septal formation, and it has chemotactic activities on resting lymphocytes and monocytes. In this paper, we have isolated a cDNA that encodes a seven transmembrane-spanning-domain receptor, designated pre-B-cell-derived chemokine receptor (PB-CKR) from a murine pre-B-cell clone, DW34. The deduced amino acid sequence has 90% identity with that of a HUMSTSR/fusin, a human immunodeficiency virus 1 (HIV-1) entry coreceptor. However, the second extracellular region has lower identity (67%) compared with HUMSTSR/fusin. PB-CKR is expressed during embryo genesis and in many organs and T cells of adult mice. Murine PBSF/SDF-1 induced an increase in intracellular free Ca2+ in DW34 cells and PB-CKR-transfected Chinese hamster ovary (CHO) cells, suggesting that PB-CKR is a functional receptor for murine PBSF/SDF-1. Murine PBSF/ SDF-1 also induced Ca2+ influx in fusin-transfected CHO cells. On the other hand, considering previous results that HIV-1 does not enter murine T cells that expressed human CD4, PB-CKR may not support HIV-1 infection. Thus, PB-CKR will be an important tool for functional mapping of HIV-1 entry coreceptor fusin and for understanding the function of PBSF/SDF-1 further.

Monthly urinary gonadotropin and ovarian hormone excretory patterns in normal girls and female patients with idiopathic precocious puberty

To identify the developmental changes in monthly urinary gonadotropin and ovarian hormone excretion, consecutive 30-d first morning void urinary specimens were collected from 36 normal girls, one normal woman, and 15 female patients with idiopathic precocious puberty. Of these children, three normal girls and three patients with precocious puberty volunteered to collect these specimens on 2-3 occasions over a time interval of 0.5-3.2 y. When sampled, six were early prepubertal, nine late prepubertal, eight early pubertal, eight mid-pubertal, and eight late pubertal normal girls, and six were early pubertal and 14 mid-pubertal patients with precocious puberty. The mean level of monthly urinary LH, FSH, and total estrogen excretions increased with pubertal maturation. In prepuberty, the mean LH level was lower than the mean FSH level, and neither showed significant episodic fluctuations. In early puberty, mean FSH levels increased with remarkable fluctuations, and mean LH levels were low with few variations in the course of a month. At the onset of puberty, gonadotropin excretory patterns underwent specific changes, showing at the same time periodically and every other day fluctuating patterns. Urinary total estrogen and pregnanediol excretion fluctuated independently from these periodic variations in urinary gonadotropins. These patterns were observed in six out of 16 patterns in normal pubertal girls and 10 out of 20 patterns in precocious puberty. Once the urine LH level exceeded the urine FSH level, however, these periodic variations disappeared. The cycle of a normal postmenarcheal girl aged 14 y showed a pattern similar to that of a normal adult. In patients with precocious puberty, the hormonal patterns were similar to those of sexual stage-matched normal girls.

Structure and function of Cas-L, a 105-kD Crk-associated substrate-related protein that is involved in beta 1 integrin-mediated signaling in lymphocytes

Integrin/ligand binding evokes tyrosine phosphorylation of various proteins. We reported previously that a 105 kD protein (pp105) was tyrosine phosphorylated by the engagement of beta 1 integrins in T lymphocytes. We show here that pp105 is a novel p130Cas (Crk-associated substrate)-related protein. Deduced amino acid sequence revealed that pp105 contains conserved motifs with p130Cas, and both pp105 and p130Cas bind to focal adhesion kinase (pp125FAK) and Crk. However, pp105 has a clearly distinct structure from p130Cas, and pp105 is preferentially expressed in lymphocytes, whereas p130Cas is expressed in adherent cells. With these findings, we designate pp105 as Cas-L, lymphocyte-type Cas. Furthermore, we demonstrate that integrin/ligand binding results in the recruitment of Crk, Nck, and SHPTP2 to pp105. These findings further define the roles of pp105/Cas-L and pp125FAK in the integrin-mediated signaling pathways.

Growth response to growth hormone therapy in patients with different degrees of growth hormone deficiency

Growth response to GH therapy in prepubertal patients with idiopathic GH deficiency (GHD) was analyzed in terms of the chronological age at the start of GH treatment and the GH secretory capacity, by using the large database provided by the International Cooperative Growth Study (ICGS) Japan. 1192 patients, aged from 3 to 10 years were divided into three groups with the following maximum GH values in GH stimulation tests: Group A: both < or = 5 ng/ml, group B: both 5-10 ng/ml, group C: one > 10 ng/ml. Analysis of age-related growth response using with delta height SDS (delta height SDS) as a response variable revealed that the group A patients responded better to GH, while there was no differences between the other groups. Simple and multiple regression analysis showed that IGF-I and chronological age (CA) negatively correlated with growth response, and target height SDS-height SDS positively correlated. These three most important predictors accounted for 49% of the variation in the growth response in group A, whereas six variables such as CA, frequency of GH injection, % overweight, GH dose, target height-height SDS, and pretreatment height velocity SDS accounted for only 28% of those in groups of B and C. These results lead us to conclude that growth response to GH is related to the degree of GH impairment with its cut-off level of 5 ng/ml. From these findings it might be suggested that treatment regimen should be tailored to individual requirements according to the degree of GHD.

Beta 1 integrin-mediated signaling in human T cells

Beta 1 integrin/ligand binding evokes tyrosine phosphorylation of various proteins. In our previous studies, we have shown that the engagement of beta integrin molecules induced tyrosine phosphorylation of 140, 120, 110-105, 80-70, 60-55 and 45 KD proteins in peripheral T lymphocytes. Several tyrosine-phosphorylated proteins have been identified such as PLC gamma (pp140), pp125FAK(pp120), Paxillin(pp70), p59fyn/p56lck(pp60-55) and MAPkinase (pp45). However, a 105 KD tyrosine-phosphorylated protein(pp105) has not been identified. Recently, we demonstrated that pp105 is identified as a novel p130Cas related protein. pp105 is preferentially expressed in lymphoid cells, while p130Cas is expressed in adherent cells. With these findings, we designated pp105 as Cas-L, "lymphocyte type Cas." Cas-L is directly associated with FAk-C-terminal region in an integrin stimulation-dependent manner, and tyrosine phosphorylated Cas-L binds to the SH2 domains of Crk, Nck and SHPTP2. These findings reveal a novel architecture of beta 1 integrin-mediated protein tyrosine phosphorylation and further suggest the involvement of Crk, Nck and SHPTP2 in the downstream of beta 1 integrin-mediated signaling pathway.

[A case of aphallia]

We report a case of aphallia in a male neonate. The phallus was completely absent. The urethral meatus was located between the well developed bifid scrotum containing normal testes. Voiding cystourethrography revealed grade II VUR on the right side. The karyotype was 46XY. Other urogenital anomalies were not detected. Bilateral orchiectomy was performed at 2 months of age. The sex assignment and management of aphallia were discussed.

Isolation and characterization of the cDNA for an A-like cyclin in Adiantum capillus-veneris L

We have isolated and characterized the cDNA for a homolog of a cyclin from the fern Adiantum capillus-veneris L. Three fragments of cDNAs for cyclin homologs were amplified by the PCR from the cDNA of germinating spores with degenerate primers that encoded the highly conserved region in the so-called cyclin box. We isolated a full-length cDNA for cyclin from a lambda ZAPII-cDNA library that has been derived from spores using an amplified fragment as a probe. The cDNA insert (Cyc-Ac1) in one positive clone was 2.0 kb in length, having an open reading frame of 1,599 bp that encoded 532 amino acids. The putative CycAc1 protein had a cyclin box and a destruction motif, and it was homologous to A-type cyclins. Northern blot analysis was performed to study the expression of CycAc1 during the first cell cycle in the haploid generation of the fern. CycAc1 mRNA was not detectable in dormant spores, during the first G1 phase, and at the onset of the S phase in imbibed spores after breaking of dormancy. This mRNA became detectable after the termination of the S phase, and it accumulated during the second G1 phase. Although CycAc1 was classified as an A-like cyclin, the failure to detect CycAc1 mRNA at the onset of the S phase suggests that CycAc1 might not play a role in the replication of DNA during the S phase.

Defects of B-cell lymphopoiesis and bone-marrow myelopoiesis in mice lacking the CXC chemokine PBSF/SDF-1

The chemokines are a large family of small, structurally related cytokines. The physiological importance of most members of this family has yet to be elucidated, although some are inducible inflammatory mediators that determine leukocyte chemotaxis. Pre-B-cell growth-stimulating factor/stromal cell-derived factor-1 (PBSF/SDF-1) is a member of the CXC group of chemokines PBSF/SDF-1 stimulates proliferation of B-cell progenitors in vitro and is constitutively expressed in bone-marrow-derived stromal cells. Here we investigate the physiological roles of PBSF/SDF-1 by generating mutant mice with a targeted disruption of the gene encoding PBSF/SDF-1. We found that mice lacking PBSF/SDF-1 died perinatally and that although the numbers of B-cell progenitors in mutant embryos were severely reduced in fetal liver and bone marrow, myeloid progenitors were reduced only in the bone marrow but not in the fetal liver, indicating that PBSF/SDF-1 is responsible for B-cell lymphopoiesis and bone-marrow myelopoiesis. In addition, the mutants had a cardiac ventricular septal defect. Hence, we have shown that the chemokine PBSF/SDF-1 has several essential functions in development.

Selective immunomodulation: utilization of CD29/VLA molecules

Accumulating evidence suggests that the VLA/CD29 molecule plays an important role in T-cell costimulation, and CD4+CD29/VLA+ memory T cells play a key role in induction of CD8 killer effector T cells which are considered to be a major population involved in graft rejection. To target limited elements of the T-lymphocyte population, we have described the preparation of a bispecific antibody-toxin conjugate designed to target CD4+CD29+ memory T cells. We also showed that the solid-phase crosslinking of VLA-4 by the antibody against this molecule or by its ligand, the CS-1 region of fibronectin, stimulates tyrosine phosphorylation of 140, 120-105, 80-70, 60-55, 50 and 45 kilodalton proteins. In addition, we identified the pp140 protein as PLC gamma, pp120 protein as pp125FAK, pp70 and pp50 proteins as paxillin, and pp60-55 proteins as pp59fyn and pp56lck, and pp45 as MAP kinase, respectively. Moreover, we demonstrated that pp125FAK is directly associated with paxillin. The paxillin binding domain of pp125FAK is homologous to the paxillin binding domain of vinculin. Mutations in the conserved amino acid residues between pp125FAK and vinculin result in the loss of paxillin-binding activity. Because VLA/CD29 is preferentially expressed on CD4 memory T cells, the above described system will be used to develop a novel drug design for providing selective immunosuppression useful for organ transplantation.

[Two cases of von Recklinghausen's disease with diffuse pulmonary changes]

Two patients with von Recklinghausen's disease had diffuse pulmonary diseases. The pulmonary diseases were interstitial fibrosis and emphysematous bullae. In case 2, examination of a specimen obtained by transbronchial lung biopsy revealed fibrotic interstitial thickening and adenomatous hyperplasia. Diffuse pulmonary abnormalities in von Recklinghausen's disease have been said to be fibrotic changes and emphysematous changes, as shown in roentgenograms in these two cases. The biopsy specimen obtained in case 2, however, revealed fibrotic changes only, which could not be distinguished from findings in cases of idiopathic interstitial pneumonia. In case 2, bronchoalveolar lavage fluid was also examined but it did not reveal any unique features of von Recklinghausen's disease. Since 1978, von Recklinghausen's disease has been diagnosed 10 times in our hospital, but diffuse pulmonary diseases was seen in only two of those 10 cases.

Cholesterol-independent membrane disruption caused by triterpenoid saponins

The membrane-disrupting activity of 15 triterpenoid saponins, obtained from Chinese plants of the genus Aralia, was investigated using phosphatidylcholine liposomes with and without cholesterol. The permeability of the membrane was examined by monitoring the induced fluorescent dye release from the liposome. On the basis of the obtained results, the structure-activity relationship among glucuronides of oleanolic acid was discussed. This takes into account particularly the variation in the carboxyl function. Namely, the saponins could induce a permeability change on liposomal membrane without cholesterol when they are glycosylated at both C-3 and C-28 of the oleanolic acid. There also exists a great similarity in the time-course curves for dye-release within such saponins, reflecting their similar action with the lipid bilayer membrane. The saponins glycosylated only at C-3 could also exhibit the same activity with somewhat different action profiles when the glucuronic acid is esterified, while those with the free glucuronic acid required cholesterol in the liposomes to induce permeability change thereof.