[A case of Sjögren's syndrome with a high titer of anticardiolipin antibody that developed as parkinsonism]

A 50-year-old-male consulted us, complaining of gait disturbance. He was diagnosed as having Parkinson syndrome, but had no benefit of drugs for Parkinson disease. On admission he showed symptoms of parkinsonism such as parkinsonian gait, bradykinesia and muscle rigidity, and recurrent aseptic meningitis. Additionally, his condition was complicated by Sjögren's syndrome, based on the preliminary criteria of Sjögren's syndrome established by the European Community. Because his parkinsonism and meningitis were considered to be caused by Sjögren's syndrome, he was administered corticosteroids, which improved his parkinsonism and aseptic meningitis. The brain MR images in our case did not match those typically reported in cases of central nervous system Sjögren's syndrome (CNS-SS). Although the most common abnormalities are small distinct areas of increased signal intensity on T2-weighted images, the MR images in our case revealed periventricular diffuse areas of increased signal intensity on T2-weighted images. Although his parkinsonism and aseptic meningitis are believed to the effects of vasculitis caused by Sjögren's syndrome, it is also possible that his parkinsonism is related to Binswanger's disease resulting from a high titer of anticardiolipin antibody. Our report proposes a possible relationship between anticardiolipin antibody and CNS-SS when MR images reveal diffuse high intensity areas on T2-weighted images.

Epstein-Barr virus-associated hemophagocytic syndrome and fatal infectious mononucleosis

Virus-associated hemophagocytic syndrome (VAHS) has been thought to be a distinct clinical entity, characterized by intermittent fever, enlarged liver and spleen, and the appearance of hemophagocytosis. Hemopoietic cells are actively ingested by monocytes/macrophages in various organs, including lymph nodes, bone marrow, liver, and spleen. Epstein-Barr virus (EBV) is now thought to be one of the major causes for the development of this unique syndrome. Additionally, VAHS is often associated with fatal infectious mononucleosis (IM). The relationship between EBV-associated VAHS and fatal IM is discussed in this concise review.

Erythropoietin in mouse avascular yolk sacs is increased by retinoic acid

Erythropoiesis begins first in the visceral yolk sac (VYS) of the embryo; however, the involvement of erythropoietin (EPO) in yolk-sac erythropoiesis has not been studied adequately. This study reports the expression of EPO in normal and hypoxic VYSs and alterations in yolk sac components induced by retinoic acid (RA) in mice. Gravid mice (plug day = day 0 of gestation) were given one oral dose of 60 mg/kg of RA in olive oil on days 6, 6.5, 7, 7.5, or 8 of gestation and were sacrificed 2.5, 3, or 3.5 days later. Control mice received olive oil without RA. None of the dams developed anemia, but more than 80% of the embryos of the dams that received RA on day 6, 6.5, or 7 of gestation had avascular yolk sacs (AVYs) and anemia. In these AVYs, the adenosine triphosphate (ATP) level was as low as 18-59% of that in the control VYSs. Reverse transcription-polymerase chain reaction and Southern analysis of products demonstrated that mRNA for EPO receptor (EPR) was expressed in both VYSs and AVYs on days 9-11 of gestation, and EPO mRNA was present in VYSs and AVYs on days 9 and 10 of gestation and in vehicle-exposed VYSs on day 11 of gestation. Furthermore, enzyme immunoassay of EPO indicated that AVYs contained more EPO protein than control VYSs. Light microscopy revealed that, in AVYs, in addition to the defective hemopoietic cells, the endodermal layer was exclusively altered: The presence of focal proliferated regions and the separation from the mesenchyme led to a single layer from which some immature cells seemed to be migrating. Immunolocalization of EPO showed its presence in all components of VYSs with a characteristic distribution pattern: In the endodermal layer, cells with positive EPO staining decreased as gestation advanced, and erythroid precursor cells showed positive staining. In AVYs, the proliferated endodermal cells had EPO in abundance; in the separated regions, the distinction between positive and negative EPO staining became clearer than that in the control VYSs, and the immature cells in the lumens also had EPO. EPR was seen on the cell surface of the corresponding cells that reacted to EPO. These findings suggest that VYSs not only produce EPO temporarily but also respond to the oxygen content in situ. EPO and EPR appear to be synthesized in the endodermal cells of the VYSs that are likely to respond to the circumstances induced by RA.

De novo DNA cytosine methyltransferase activities in mouse embryonic stem cells

It has been a controversial issue as to how many DNA cytosine methyltransferase mammalian cells have and whether de novo methylation and maintenance methylation activities are encoded by a single gene or two different genes. To address these questions, we have generated a null mutation of the only known mammalian DNA methyltransferase gene through homologous recombination in mouse embryonic stem cells and found that the development of the homozygous embryos is arrested prior to the 8-somite stage. Surprisingly, the null mutant embryonic stem cells are viable and contain low but stable levels of methyl cytosine and methyltransferase activity, suggesting the existence of a second DNA methyltransferase in mammalian cells. Further studies indicate that de novo methylation activity is not impaired by the mutation as integrated provirus DNA in MoMuLV-infected homozygous embryonic stem cells become methylated at a similar rate as in wild-type cells. Differentiation of mutant cells results in further reduction of methyl cytosine levels, consistent with the de novo methylation activity being down regulated in differentiated cells. These results provide the first evidence that an independently encoded DNA methyltransferase is present in mammalian cells which is capable of de novo methylating cellular and viral DNA in vivo.

Complications of childhood Sjögren syndrome

Sjögren syndrome (SS) is a common disorder in adults and involves both glandular and extraglandular systems. We report here four cases of childhood SS complicated by chronic thyroiditis, interstitial nephritis or sweat gland inflammation. Additionally, in one of these cases, the central nervous system was involved. All of these complications are common in adult cases.

CONCLUSION

Childhood SS is a systemic "ductilitis" or "exocrinopathy" with complications which are commonly observed in adult cases.

137Cs concentration in soil samples from an early survey of Hiroshima atomic bomb and cumulative dose estimation from the fallout

Low background gamma-ray measurement has been performed to determine the 137Cs content in soil samples collected in a very early survey of the Hiroshima atomic bomb. These soil samples were collected just 3 d after the explosion within 5 km from the hypocenter and were not exposed to the global fallout from nuclear weapon tests. Out of 22 samples, 137Cs was detected for 11 samples, and their radioactivities ranged from 0.16-10.6 mBq g-1 at the time of the measurement. A comparison of the 137Cs deposition with the rainfall area within Hiroshima city indicates that the rainfall area was wider than the previously proposed one. Cumulative exposure by the fallout has been estimated to be 0.31 mC kg-1 (0.12 R) in Hiroshima city except for the heavy fallout area and at most 1.0 mC kg-1 (4 R) in the heavy fallout area.

[Enhancement of cytotoxic effect of anticancer agents of renal cell carcinoma]

BACKGROUND

Human renal adenocarcinomas do not adequately respond to cancer chemotherapy. Their multidrug resistance is mainly conferred by the P-glycoprotein (P-gp). In this study, we analyzed effects of P-gp modulators on enhancement of anticancer activities against human renal cell carcinomas.

METHODS

ACHN/ADM human renal adenocarcinoma cells with a high level expression of P-gp and 28 surgical specimens of renal cell adenocarcinomas were recruited. Adriamycin (ADM) and vinblastin (VLB) were used as anticancer drugs, and verapamil (Ver) and cyclosporin A (CsA) were as P-gp modulators. The chemosensitivity was determined by the ATP-assay.

RESULTS

Ver and CsA exhibited 1.5-fold and 6-fold increase, respectively, in the anticancer activities of ADM against ACHN/ADM cells. The anticancer activities of VLB were also enhanced by the modulators; 7-fold for Ver and 11-fold for CsA. In the chemosensitivity test of clinical specimens, the cancer for which the viability of the cells assessed by the ATP-assay was 50% or less than 50% after exposure to the anticancer drug with or without a P-gp modulator was defined as sensitive to the drug. Of the 14 clinical specimens exposed to anticancer drugs without Ver, only 3 tumors and 1 tumor were sensitive to ADM and VLB, respectively, whereas with Ver, 6 tumors and 4 tumors were sensitive to ADM and VLB, respectively. Of the other 14 clinical specimens exposed to anticancer drugs without CsA, only 3 tumors and no tumor were sensitive to ADM and VLB, respectively, whereas, with CsA, 9 tumors and 6 tumors were sensitive to ADM and VLB, respectively.

CONCLUSION

This study indicate that Ver and CsA have effects on enhancement of the anticancer activities of ADM and VLB against human renal adenocarcinomas. The addition of Ver or CsA to chemotherapy will be a potential circumvention of P-gp-mediated multidrug resistance of renal cell adenocarcinomas.

Detection of low-level expression of P-glycoprotein in ACHN renal adenocarcinoma cells

A highly sensitive reverse transcriptase-polymerase chain reaction (RT-PCR) assay and a flow cytometric assay were used to examine ACHN cells for the expression of P-glycoprotein. The expression of P-glycoprotein was detected at the RNA and protein levels in ACHN cells by RT-PCR and flow cytometry, respectively. However, it was below the limit of detection by immunoblotting. The intracellular accumulation of adriamycin in ACHN cells was enhanced by verapamil, cyclosporin A and medroxyprogesterone acetate. Therefore, this study has demonstrated that low-level expression of P-glycoprotein detectable only by RT-PCR and flow cytometry plays a significant role in reducing the intracellular concentration of antitumor agents and thus contributes to the multidrug-resistant phenotype of ACHN cells.

Strabismus surgery in ocular myasthenia gravis

We evaluated the efficacy of eye muscle surgery in 4 patients with ocular myasthenia gravis with troublesome diplopia. All patients were in remission and had shown a consistently stable angle of deviation for at least 6 months preoperatively. The extent of eye muscle surgery was based on the degree of deviation in the primary position, and conventional recession and resection procedures were performed in 3 patients and hang-loose recession with an adjustable recession in 1. Single binocular vision was obtained in 3 patients in the primary position without prism correction or compensatory head posture. Electron-microscopic studies on the eye muscle specimens obtained at strabismus surgery revealed non-specific degenerative findings for the muscle fibers and sarcomeric disorganization compared to that in a control extraocular muscle.

Epitope analysis of HLA-DR-restricted helper T-cell responses to Der p II, a major allergen molecule of Dermatophagoides pteronyssinus

T-cell epitopes of Der p II, a major allergen of Dermatophagoides pteronyssinus, were analyzed by using human T-cell clones. We tested 38 cloned T cells from two Japanese patients with allergic rhinitis, and identified at least two peptides (K33-T47 and I58-C73) as helper T-cell epitopes. The former epitope was shown to be restricted by HLA-DRB1*1502, and the latter by HLA-DRB1*0405, both of which are typical Japanese HLA-DR alleles, suggesting that those T-cell epitopes might be important for the onset of house-dust mite allergy in the Japanese population. We prepared 15 analog peptides of the HLA- DRB1*1502-restricted 15-mer peptide. Of those 15 residues, five (F35, L37, A39, F41, and E42) were critical for the epitope activity, and three residues (F35, A39, and E42) seemed to be included in anchor motifs for HLA-DRB1*1502. The epitope peptide was also recognized by HLA-DRB1*1502-positive healthy donors; however, only allergic T cells showed Th2 functions. Antigen-presenting cells of nonallergic donors were able to activate allergic T cells to express Th2 function. This seemed to suggest that antigen recognition of T cells, as well as additional unknown factors which promote Th2, rather than Th1, responses, might be important for the onset of house-dust mite allergy.

Bruceanols G and H cytotoxic quassinoids from Brucea antidysenterica

Two new quassinoids, bruceanols G [1] and H [4], were isolated from Brucea antidysenterica, and their structures were elucidated by spectral evidence and chemical transformation. Bruceanol G exhibited significant cytotoxicity against the COLO-205 and KB neoplastic cell lines with ED50 values of 0.44 and 0.55 microM, respectively.

The reliability of a video-enhanced Hirschberg test under clinical conditions

PURPOSE

To examine the reliability and usefulness of a video-based Hirschberg test under clinical conditions.

METHODS

The authors estimated ocular deviation in 87 patients with strabismus through automated analysis of corneal reflex displacement using a video refractor. The reproducibility of measurement, the comparison with the prism and alternate cover test (PACT), and the distribution of the Hirschberg ratio were investigated.

RESULTS

The 95% limits of agreement of the video-based Hirschberg test evaluated by repeated measurements were +/- 0.18 mm (equivalent to +/- 2.2 degrees or +/- 3.8 prism diopters [PD] of calculated strabismic deviation) for the horizontal deviation and +/- 0.28 mm (equivalent to +/- 3.4 degrees or +/- 5.9 PD) for the vertical deviation. The 95% limits of agreement between the Hirschberg measures and the PACT were within +/- 7.8 degrees or +/- 13.7 PD. The average (+/- SD) Hirschberg ratio was 12.3 +/- 1.2 degrees/mm or 21.8 +/- 2.1 PD/mm.

CONCLUSIONS

The video-enhanced Hirschberg measurement shows good reproducibility and ease of application, even in the testing of infants. In quantitative analysis, however, systematic measurement error resulting from intersubject variance of the Hirschberg ratio should be taken into consideration.

Germinoma arising in the basal ganglia in early stage: CT and MR findings

We report a patient with a germinoma originating in the left basal ganglia. Unenhanced computed tomography (CT) revealed a relatively well-defined high-density lesion, which was slightly enhanced with contrast medium. No tumor stain was noted on angiography. The mass showed hypointensity on T1-weighted magnetic resonance imaging (MRI), and heterogeneous hyperintensity on T2-weighted imaging. The lesion was homogeneously enhanced after the administration of Gd-DTPA. To our knowledge, the MR findings of basal ganglia germinoma have been retrospectively reviewed in just four reported cases, only two of which were examined with Gd-DTPA enhancement. The two cases revealed relatively large masses with cysts and peritumoral edema, and were slightly enhanced after the intravenous injection of Gd-DTPA. Our case was thought to be in the early stage, and its CT and MR findings were slightly different from those of previously reported cases.

X-linked lymphoproliferative disease: twenty-five years after the discovery

The X-linked lymphoproliferative disease (XLP), one of six described X-linked immunodeficiencies, stems from a mutation at Xq25 which renders males impotent to mount an effective immune response to the ubiquitous EBV. Purtilo, who first observed this disease in 1969, established a Registry in 1980 to serve as a worldwide resource for the diagnosis, treatment, and research of this condition. Since Purtilo's death in late 1992, the Registry and research unit have not only continued to function as a worldwide consultative service, but have contributed the following. First, the number of affected boys has continued to grow; some 272 among 80 kindreds have been identified. Second, some boys (10%) who inherit the mutated XLP gene are immunologically abnormal even before evidence of EBV exposure. Third, the search for the XLP gene has been narrowed to a small region on Xq25. Its identification is near at hand; once cloned, this gene may well illustrate how the body orchestrates the complex immune response to EBV. Therein lies the justification for the quest for this gene, not only for the benefit of the few surviving boys and those to be born to female carriers, but also for defining its role in defending the body against a ubiquitous DNA virus.

[Multiple eccrine spiradenoma. Histological association with dermal cylindroma]

A case of multiple eccrine spiradenomata is reported. One of the tumours was histopathologically associated with dermal cylindroma, and immunohistochemical studies showed that the cylindroma cells differentiate towards the secreting portion of the eccrine sweat gland. The relationship among multiple eccrine spiradenomata, dermal cylindroma and multiple trichoepitheliomata is discussed.

Simple assay for evaluation of Epstein-Barr virus specific cytotoxic T lymphocytes

Epstein-Barr virus (EBV)-specific cytotoxic T lymphocytes (CTL) are considered to be one of major defenses against the activation of EBV infection. We have developed a simple assay for evaluation of EBV-CTL by means of culturing peripheral blood mononuclear cells at the concentration of 2 x 10(6) cells/ml infected by B95-8 EBV, in the presence or absence of cyclosporin A (CSA). No lymphoblastoid cell line was established from ten EBV-seropositive healthy individuals in the absence of CSA. In contrast, cell lines were established from ten EBV-seronegative healthy individuals in the absence of CSA, indicating lack of EBV-CTL in these individuals. Methods described herein are simple and correlate well with EBV-CTL activity when compared to conventional methods, such as outgrowth regression or chromium-51 release assays.

Inhibitory effects of quassinoids on Epstein-Barr virus activation

Short-term in vitro assays for tumor promoters and anti-tumor promoters (Epstein-Barr virus activation test) were carried out for 45 quassinoids. As a result, some quassinoids showed potent activity, more than 50% inhibition at a molar ratio of 1:1 (TPA/quassinoids). These results led to the following structure-activity relationships: (1) a methyleneoxy bridge and side chain enhance the activity and (2) a sugar moiety reduces the activity.

Epstein-Barr virus (EBV) hypersensitivity of peripheral B lymphocytes in patients with EBV genome-positive Burkitt's lymphoma

Peripheral blood mononuclear cells (PBMC) from four Japanese patients with Epstein-Barr virus (EBV) genome-positive Burkitt's lymphoma (BL) during remission were exposed to the B95-8 strain of EBV. Maximum concentrations of the EBV-determined nuclear antigen (EBNA) before cellular DNA synthesis were similar to those of healthy counterparts. Subsequently, EBV-immortalised cell lines were established. These immortalised lymphoblastoid cells were treated with 12-O-tetradecanoylphorbol-13-acetate (TPA) and superinfected with the P3HR-1 strain of EBV. EBV early antigens (EA) and viral capsid antigen (VCA) were expressed in approximately 3-10 fold higher concentrations by these lymphoblastoid cells than by those from patients with other types of malignant neoplasia including EBV genome-negative BL and from healthy counterparts. Moderate to extremely high IgG antibody titres to EBV VCA as well as IgG antibodies to EA were demonstrated in these patients during the study. These results suggest that defective underlying cellular mechanisms for regulating the replication of EBV may be present in patients with EBV genome-positive BL.

Bruceosides D, E, and F, three new cytotoxic quassinoid glucosides from Brucea javanica

Three new quassinoid glucosides, bruceosides D [1], E [2], and F [3], were isolated from Brucea javanica, and their structures were elucidated by spectral evidence and chemical transformation to known compounds. Compounds 1-3 show selective cytotoxicity in the leukemia and non-small cell lung, colon, CNS, melanoma, and ovarian cancer cell lines with log GI50 values in the range of -4.14 to -5.72.