Total synthesis and chemical biology of the sarcodictyins

The sarcodictyins A-F and eleutherobin comprise a family of marine-derived diterpenoids with potent cytotoxicities against various tumor cell lines. Investigations have revealed that several of these compounds exert their cytotoxic effects through tubulin binding in a mechanism analogous to that of the clinical anticancer drug Taxol. The biological importance, challenging molecular architecture, and relative scarcity of these natural products have prompted several groups to undertake their total chemical synthesis. In this review, we summarize the current synthetic efforts and examine the preliminary structure-activity relationships which have emerged from early combinatorial libraries.

[Percutaneous transluminal coronary angioplasty for restenosis following Palmaz-Schatz stenting: larger size balloons are more effective?]

Intracoronary stenting reduces the restenosis rate after percutaneous transluminal coronary angioplasty (PTCA). However, restenosis still occurs in 20% to 30% of patients after stenting. Management of in-stent restenosis has become a significant challenge in interventional cardiology. The efficacy of re-PTCA with a larger balloon was investigated for restenosis following Palmaz-Schatz stenting. Clinical and angiographic results were compared in 46 consecutive patients with in-stent restenosis after one Palmaz-Schatz stenting. Twenty patients underwent redilation with a slightly larger balloon than used at the stenting (Large group) and 26 underwent redilation with the same size balloon as at the stenting (Control group). The clinical factors, lesion characteristics, lesion length, reference diameter and minimal luminal diameter at re-PTCA for the in-stent restenosis did not differ significantly between the 2 groups. Minimal luminal diameter of the Large group after re-PTCA was significantly larger than that of the Control group (3.1 +/- 0.2 vs 2.9 +/- 1.2 mm, p < 0.05). Follow-up angiography showed that the minimal luminal diameter of the Large group was significantly larger (2.1 +/- 0.6 vs 1.7 +/- 0.6 mm, p < 0.05) and the re-restenosis rate of Large group tended to be lower than that of the Control group (15% vs 38%, p = 0.07). Re-PTCA for in-stent restenosis with a slightly larger balloon than used at the stenting reduces the re-restenosis rate.

Toxicological response of rats to a novel monoamine oxidase type-A inhibitor, (5R)-3-[2-((1S)-3-cyano-1-hydroxypropyl)benzothiazol-6-yl]-5- methoxymethyl-2-oxazolidinone (E2011), orally administered for 13 weeks

(5R)-3-[2-((1S)-3-cyano-1-hydroxypropyl)benzothiazol-6-yl]-5- methoxymethyl-2-oxazolidinone (E2011) is a novel monoamine oxidase type-A (MAO-A) inhibitor. In order to assess toxicological profiles of E2011, doses of 0 (as controls), 30, 100 mg/kg of E2011 were administered to male and female Sprague-Dawley rats once a day for 13 weeks orally by gavage. No mortality or any toxic signs except salivation occurred due to E2011 treatment. Decreased body weight gain and food consumption, increases of alkaline phosphatase and increases of liver weight were the major treatment-related findings observed predominantly in the 100 mg/kg group. Histological examination revealed nuclear enlargement of hepatocytes with appearance of altered cell foci in some cases, and acinar atrophy in Harderian glands in the 100 mg/kg group. Since the histopathological findings in the liver were indicative of an ongoing carcinogenic process, glutathione S-transferase placental form (GST-P) positive hepatic foci were identified immunohistochemically and examined morphometrically. Although GST-P positive hepatic foci were detected in all groups including controls, the number and area of GST-P positive hepatic foci were significantly higher in female rats treated with 100 mg/kg than those in controls. In this paper, possible mechanisms of specific lesions in the liver and Harderian glands will be discussed.

Ectopic vas deferens opening into the ureter

PURPOSE

A pediatric case of ectopic vas deferens opening into the ipsilateral ureter is reported.

METHODS/RESULTS

Ectopic opening of the vas deferens was detected incidentally at ureterocystotneostomy being performed for vesicoureteral reflux to the solitary kidney of a 7-month-old boy with anorectal anomaly.

CONCLUSIONS

The preservation of the patency of the seminal tract is recommended.

Paracortical hyperplasia of superficial lymph nodes in a new mutant strain of hairless rats (ISh): a lesion similar to human dermatopathic lymphadenopathy

The dermal histology and the regional draining superficial lymph node of a new mutant strain of hairless rats (ISh) were investigated. The homozygote ISh rat was characterized as having naked and wrinkled skin. The comedo-like cysts in the skin resembled human acne and vulgaris. Histopathologically, many Langerhans' cells positive for anti-protein kinase C type II antibody (PKC-II) were recognized in the epidermis. The superficial lymph nodes were significantly larger than those of the heterozygote. The paracortex of these lymph nodes was expanded and the number of Langerhans' cells mainly increased in these areas. These lymph node lesions were similar to those of human dermatopathic lymphadenopathy. The ISh rats should be a very useful animal model for studying dermatopathic lymphadenopathy in humans. Furthermore, they may be a valuable animal model for investigating the mechanisms of not only maturation, movement and migration of Langerhans' cells, but also of their function for antigen presentation.

[Urodynamic studies on the untethering of spinal lipoma in the children]

We performed conus untethering on 44 children with spinal lipoma. In this retrospective study, we studied urological examinations obtained in 36 consecutive patients. Urological examinations were ultrasonography of bladder and kidney, voiding cystourethrography (VCG), and urodynamic cystometry. In those of them, 6 patients had already had urinary dysfunction at preoperative stage, but 4 patients' spinal lipoma was one complication of cloaca exstrophy and 2 patients' spinal lipoma after repairment of their myelomeningocele. In the remaining 30 cases, 18 patients (60.0%) as the group 1 did not have urinary dysfunction and abnormality in any urological examinations. Another 7 patients (23.3%) as group 2 also did not have urinary dysfunction, but abnormal vesicoureteral reflux (VUR) was found out in their VCG examination. At postoperative stage, abnormal VUR resolved or improved in all these 7 cases, but one of them showed transient urinary retention. Two patients of 18 in the group 1 had to require clean intermittent self-catheterization at postoperative stage. These observations confirmed that children with spinal lipoma were more likely to present with urological findings, and so it was imperative that a diagnosis be made and treatment be instituted as early as possible.

Chronic effects of a novel synthetic anthracycline derivative (SM-5887) on normal heart and doxorubicin-induced cardiomyopathy in beagle dogs

This study was designed to investigate the chronic cardiotoxic potential of SM-5887 and a possible deteriorating effect of SM-5887 on low-grade cardiotoxicity pre-induced by doxorubicin in beagle dogs. In the chronic treatment, beagle dogs of each sex were given intravenously once every 3 weeks, either a sublethal dose of doxorubicin (1.5 mg/kg) or SM-5887 (2.5 mg/kg). The experiment was terminated 3 weeks after the ninth dosing. Animals which received over six courses of doxorubicin demonstrated the electrocardiogram (ECG) changes, decrease of blood pressure and high-grade histopathological cardiomyopathy, while animals which were terminally sacrificed after the SM-5887 administration did not show any changes in ECG, blood pressure and histopathological examinations. To examine a possibly deteriorating cardiotoxic effect of SM-5887, low-grade cardiomyopathy was induced in dogs by four courses of doxorubicin (1.5 mg/kg). Nine weeks after pre-treatment, dogs were given four courses of either doxorubicin (1.5 mg/kg) or SM-5887 (2.5 mg/kg) once every 3 weeks. The low-grade cardiotoxic changes were enhanced by the additional doxorubicin treatment. On the contrary, the SM-5887 treatment did not progress the grade of cardiomyopathy. In conclusion, SM-5887 does not have any potential of chronic cardiotoxicity and deteriorating effect on doxorubicin-induced cardiotoxicity in dogs.

Giant cell tumor of bone in an aged Fischer 344 rat

A giant cell tumor (GCT) was detected on the distal end of the femur in a 98-wk-old male Fischer 344 rat. The yellowish white mass had expanded, compressing adjacent muscle tissues. The tumor had an osteolytic and relatively homogeneous appearance and was composed of multinuclear giant cells scattered in a mass of mononuclear stromal cells. No osteoid tissue formation was observed. The tumor cells were strongly immunoreactive for ED-1 and some were also positive for alpha-smooth muscle actin, suggesting that the tumor originated from the monocyte/macrophage lineage showing myofibroblastic differentiation. This is the first report concerning spontaneous GCT of bone in a rat.

[A case report of glomerulocystic kidney disease with hypothyroidism in a new born infant]

We report a rare case of glomerulocystic kidney disease (GCKD) with congenital hypothyroidism. A gigantic abdominal mass was noted at birth. There was no family history of renal cystic disease. Ultrasonography revealed diffuse granular cysts in the markedly enlarged kidneys. Blood examination showed moderate renal failure and hypothyroidism. Bilateral nephrectomy was conducted at 47 days of age to relieve respiratory failure and severe abdominal distention caused by the growing cystic kidneys. Histological findings of the kidney showed numerous glomerular cysts without renal dysplasia. There were no other malformations. These findings were compatible with GCKD.

[Assessment of enlarged left atrium with 99mTc-tetrofosmin SPECT and echocardiography]

This study was performed to clarify the possibility of visualization and quantification with 99mTc-tetrofosmin (Tf) myocardial scintigraphy in cases with a large atrium demonstrated by trans-thoracic echocardiography (TTE). Myocardial SPECT was evaluated in 4 patients with mitral stenosis and 15 patients with mitral regurgitation. Left atrium was identified in 12 out of 19 cases from an antero-posterior projection. The Tf uptake ratio of the left atrium, which was defined as the ratio of ROI count of the left atrium divided by the ROI count of the left ventricle, showed a good correlation with the left atrial area obtained by both trans-thoracic and trans-esophageal echocardiography (r = 0.88 and 0.91, respectively), These data suggest that Tf myocardial SPECT is a useful method of evaluating left atrial enlargement.

Follow-up of children after fetal treatment for obstructive uropathy

BACKGROUND

Improvement in the ability to evaluate fetuses with obstructive uropathy, combined with technologic advances, has allowed successful fetal treatment of these conditions in Japan. We analyzed the prenatal and postnatal clinical courses of patients who underwent shunt placement in utero.

METHODS

We treated 6 patients who underwent fetal intervention and were transferred to us for urologic management. Gestational age at detection of abnormalities ranged from 11 weeks to 31 weeks, and fetal intervention was done between 16 weeks and 32 weeks. Excluding 1 infant who was delivered 6 days after the intervention, the mean period between shunt placement and delivery was 17 weeks.

RESULTS

Urologic pathology included prune belly syndrome with urethral hypoplasia in 3 patients, cloacal anomaly in 1, posterior urethral valves in 1, and pelviureteric junction stenosis of a solitary kidney in 1. Four patients required ventilation support in the neonatal period, and 2 of them suffered frequent infections during follow-up. Five patients who underwent vesico-amniotic shunt placement continue to require clean intermittent catheterizations via vesicostomy because of hypoactive detrusors and hypoplastic urethras. After urologic treatment, serum creatinine in 5 patients reached a minimum of less than 0.4 mg/dL at some time during the first year of life. Another patient with a minimum creatinine level of 1.0 mg/dL has moderate renal insufficiency.

CONCLUSION

From our series, it appears that early (before 20 weeks of gestation) shunt placement in severe lower urinary tract obstruction may benefit renal and pulmonary function. However, its efficacy in regard to bladder function remains questionable: shunt placement does not permit regular storage and evacuation, which may be essential for functional bladder development.

[Perinatal management of posterior urethral valves detected by prenatal ultrasonography]

PURPOSES

Posterior urethral valves (PUV) are the most common cause of mechanical infravesical obstruction in children. It is emphasized that this disorder has broad spectrum of severity, and patients presenting signs and symptoms in neonates or early infancy are at high risks for renal failure. The clinical pictures changed dramatically with the introduction of prenatal diagnosis by ultrasonography (USG). We report on perinatal management of PUV detected by prenatal USG, especially stressing on the significance of early delivery in risky fetuses.

PATIENTS AND METHOD

From 1987 to 1996, we treated 6 patients with PUVs who had been detected by prenatal USG. Fetal hydronephrosis was noticed between 26 to 29 weeks of gestation. Oligohydramnios was apparent at the same weeks of the detection or 2 to 7 weeks later. Fetal conference including obstetrician, neonatologist, anesthesist and urologist was taken place to discuss the date and mode of delivery. Among the patients, 5 were induced early delivery around 30 weeks of gestation. After birth, serum Cr was monitored, and small feeding tube was placed in the urethra. Primary valve ablation was indicated in 4 patients whose Cr returned to near normal after the urethral drainage. One required upper tract diversion because of the continuous elevation of Cr levels.

RESULTS

Of the patients, one died of respiratory failure from lung hypoplasia. Ventilation support was needed in 3 patients. The patient who required upper tract division went into ESRF when he was 6 months old. Except for this patient, renal function improved in 4 patients with nadir Cr levels between 0.4 mg/dl to 0.6 mg/dl. Transurethral valve ablation was done on 5 patient between 16th to 40th days after birth with the lowest body weight at operation of 1450 g. Cystometric studies in neonatal periods showed small capacity, and hypertonic bladder in all patients. Valve ablation and administration of anticholinergics improved bladder function.

CONCLUSION

Prenatal ultrasonography clearly demonstrate the pathological features of the fetus with PUVs. Because oligohydramnios started in the early 3rd trimester indicates acute renal failure of the fetus, early delivery followed by emergency treatment may salvage the most severe type of this entity.

[Bladder hemangioma in a child: a case report]

We report a case of bladder hemangioma in a child. An 8-year-old girl was referred to our hospital for the evaluation of painless hematuria. Neither pyuria nor bacteriuria was detected. She had no dysuria. Intravenous pyelography showed deformity of the bladder without dilation of the upper urinary tract. Voiding cystourethrography revealed a filling defect of the bladder. Reddish blue masses were seen cystoscopically at the right wall and the dome of the bladder. Partial cystectomy was performed. From the histological findings, the diagnosis was cavernous hemangioma of the urinary bladder. Her postoperative course was uneventful and no recurrence was seen at the cystoscopical examination 3 months postoperatively. This is the 15th case of bladder hemangioma in children reported in Japan.

[A clinical study of intermittent hydronephrosis]

A clinical study was conducted on the intermittent hydronephrosis in children. Of 78 children with hydronephrosis due to ureteropelvic junction obstruction operated between 1991 and 1995, 5 had intermittent hydronephrosis. All 5 patients were boys between 6 months and 6 years of age. Presenting symptoms were intermittent flank pain and vomiting. Ultrasonography performed during pain attack demonstrated dilation of the renal pelvis in all patients. Diuretic renography demonstrated obstruction in 4 of the 5 children and deterioration of renal function on the affected side in 2. The cause of ureteropelvic junction obstruction was aberrant vessels in 2 cases, fibrous band in 1, ureteral kinking within adventitia in 1 and a ureteral polyp in 1. Postoperatively, all patients have been relieved from the pain. In summary, ultrasonography at the time of symptom attack as well as diuretic renography are useful for the diagnosis and observation of intermittent hydronephrosis.

Selective deficiency of debrisoquine 4-hydroxylase activity in mouse liver microsomes

Cytochrome P450 enzymes belonging to the CYP2D subfamily have been shown to be one of determinants of the polymorphic drug oxidations in the human and the rat. Debrisoquine 4-hydroxylation is a typical reaction catalyzed by these enzymes. However, various strains of mice were observed to have much lower debrisoquine 4-hydroxylase activity than Wistar rats, whereas other monooxygenase activities in mice toward bunitrolol, propranolol, imipramine and amitriptyline, which are mediated by the CYP2D enzymes in the rat, were comparable to those of the rats. Immunoblot analysis of mouse liver microsomes with an antibody raised against a rat CYP2D enzyme indicated that the mouse liver contained a P450 enzyme(s) immunochemically related to the rat CYP2D enzyme. The antibody inhibited propranolol ring-hydroxylase and imipramine 2-hydroxylase activities, as well as testosterone 16alpha-hydroxylase activity, a typical reaction of mouse CYP2D9, but not debrisoquine 4-hydroxylase activity in mouse liver microsomes. We partially purified a P450 enzyme (designated P450 ML2d) from livers of male ddY mice by monitoring the cross-reactivity with the antibody. The partially purified enzyme was indicated to belong to the CYP2D subfamily from its N-terminal amino acid sequence, but the homology of the sequence to other CYP2D enzymes of the mouse (CYP2D9-11) was 62%, suggesting that P450 ML2d is a novel P450 enzyme. P450 ML2d had the oxidation activities for the rat CYP2D-substrates, such as propranolol 4-hydroxylation and imipramine 2-hydroxylation, in higher rates than those of the microsomes, but did not exhibit debrisoquine 4-hydroxylase activity. Our result is the first finding that a mouse CYP2D enzyme also metabolizes substrates for the rat CYP2D enzyme, in addition to steroids, but the enzyme had a limited specificity for the substrates of the CYP2D enzymes of the rat and the human.

["Ghost Hanako's syndrome": report of 2 cases--initial stage of nonneurogenic neurogenic bladder (Hinman syndrome)?]

Two girls aged 6 and 7 years old with established urination habit complained of daytime incontinence and deterioration of nocturia after they started school life. They were quite afraid of the lavatory and sometimes skipped urination during school time completely. Voiding cystography revealed bladder trabeculation and vesicoureteral reflux. On cystometry, bladder compliance was preserved with no uninhibited contraction. Ghost tales about labatories, such as "the tale of Ghost Hanako," prevail in almost every elementary school in Japan. In some children, especially schoolgirls, lavatory phobia results in dysfunctional voiding. Such "Ghost Hanako's syndrome" may be an early phase of non-neurogenic neurogenic bladder (the Hinman syndrome). Detailed information regarding school life and urination habit is important for the treatment of this entity.

[Influence of low high-density lipoprotein cholesterolemia induced by probucol on the progression of coronary atherosclerosis]

The influence of probucol-induced low high-density lipoprotein (HDL) cholesterolemia on the progression of coronary atherosclerosis was studied in 320 patients with angina pectoris or myocardial infarction, 32 patients with probucol 500 mg/day, 288 patients without probucol, who underwent follow-up angiography at intervals of at least 2 years. The 288 patients were divided into two groups depending on the serum HDL-cholesterol (HDL-C) level at the follow-up angiography: the low HDL-C group had a serum HDL-C level below 40 mg/dl (152 patients) and the control group had 40 mg/dl or above (136 patients). Coronary sclerosis index was defined as the total products of coronary scores (0-6) by segments according to the American Heart Association reporting system in the branches without angioplasty and was compared between the three groups. In the probucol group, serum HDL-C level was significantly reduced from 43.9 +/- 10.6 (at baseline) to 31.1 +/- 7.6 mg/dl (at follow-up, p < 0.01) and was lower than that in the other two groups (low HDL-C group 33.1 +/- 5.0 mg/dl, p < 0.07; control group 52.6 +/- 9.8 mg/dl, p < 0.01). Coronary sclerosis index was most increased in the low HDL-C group (8.3 +/- 5.4-->11.9 +/- 6.1, p < 0.01), whereas there was no significant change in the probucol group (7.2 +/- 5.9-->9.1 +/- 6.8, p = 0.24). Our results showed that treatment with probucol inhibits the progression of coronary atherosclerosis despite the decrease in HDL-C level. One possible reason may be remarkable improvement in the other lipid factors, especially the low-density lipoprotein cholesterol level (165.7 +/- 33.9-->123.7 +/- 29.0 mg/dl, p < 0.01).

Differentiating between multiple system atrophy and Parkinson's disease by positron emission tomography with 18F-dopa and 18F-FDG

Both the striatal 18F-dopa uptake and brain glucose metabolism were studied by PET with 6-L-[18F]fluorodopa (FD) and [18F]fluorodeoxyglucose (FDG) in 9 patients with multiple system atrophy (MSA) and 15 patients with idiopathic Parkinson's disease (PD). Five of the 9 MSA patients were diagnosed as having olivopontocerebellar atrophy, whereas 2 had striatonigral degeneration and 2 demonstrated Shy-Drager syndrome. The FD uptake ratios to the occipital cortex in the MSA patients at 120 min after the administration of FD were 2.07 +/- 0.31 (mean +/- SD) and 1.96 +/- 0.29 in the caudate and the putamen, respectively, and decreased compared to those in the controls (2.72 +/- 0.11, 2.71 +/- 0.10). The same ratios in the PD patients were 2.07 +/- 0.36 and 1.74 +/- 0.24, respectively, which also decreased, but the decreased uptake in the putamen was more prominent. The caudate-putamen index (CPI)(%), which was calculated by a formula based on the difference in the uptakes in the caudate and putamen divided by the caudate uptake, indicated 5.6 +/- 4.6 in the MSA patients and 14.8 +/- 5.4 in the PD patients. The CPI for all PD patients was more than 7.0, which was the mean + 2SD for the controls, but the CPI for 3 MSA patients was more than 7.0 (accuracy: 88%). The glucose metabolic rates for each region in the PD patients showed no difference from the normal controls. The frontal and the temporal cortical glucose metabolism and the caudate, the putaminal, the cerebellar and the brainstem glucose metabolism in the MSA patients decreased significantly in comparison to those in the controls. But, as the glucose metabolic rates in such regions of each patient overlapped in the two groups, the accuracy of the FDG study for differentiation was lower than that of the FD study. The putaminal glucose metabolic rates, for example, in 3 PD patients were less than 6.8 (mg/min/100 ml), which was the mean-2SD for the controls, while those in 3 MSA patients were more than 6.8 (accuracy: 75%). In addition, the combination of these two methods slightly improved the accuracy. The glucose metabolism is useful for evaluating the regional metabolic activity of the brain, and the FD study, which is specific to the dopamine system, seems to be more useful for differentiating between MSA and PD.

[Pathological study of the kidney and the lung in patients with Potter sequence]

PURPOSES

The condition in infants showing the characteristic facial abnormalities, limb deformities, and pulmonary hypoplasia induced by oligohydramnios is termed Potter sequence (PS). In addition to bilateral renal agenesis, Potter sequence could be caused by other urological abnormalities such as cystic dysplasia and obstructive uropathy. Although lethal in most of the patients with PS, some exceptional infants were reported to survive in spite of the antenatal demonstration of oligohydramnios from renal abnormalities. These surviving patients put new questions to us regarding the management of both respiratory and renal failure starting from the newborn periods. The diversity of clinical courses in patients with antenatally detected PS may imply that this entity has a spectrum of severity. Our study of infants autopsied on the diagnosis of PS was undertaken to determine various histological grade of the kidneys and the lungs.

MATERIALS AND METHODS

Thirty-two autopsy cases of PS (19 males and 13 females) diagnosed by the presence of the characteristic stigmata, oligohydramnios, and renal or urological abnormalities were studied retrospectively. Patients were divided according to the urological abnormalities into 3 groups; renal hypodysplasia, urinary obstruction, and polycystic kidney disease (PCKD). Renal histology was evaluated by two parameters; renal glomerular count (RGC), and dysplastic grade. Developmental aspects of the lung were judged by lung/body-weight ratio (L/ B ratio) and radial alveolar count (RAC) proposed by Emery.

RESULTS

The underlying urological disorders included renal hypodysplasia in 22 patients, obstruction in 7, and polycystic kidney disease in 3. Dysplastic grade of 29 patients with hypodysplasia and obstruction consisted of grade 4 in 12 patient, grade 3 in 9, and grade 2 in 8. In 10 kidneys from 8 patients with grade 2-dysplasia, RGC was significantly fewer than that of normal fetuses for the gestational age. The term patient with PS showed the glomerular count equivalent to normal fetus of around 25 weeks of gestation. L/B ratio indicated definite pulmonary hypoplasia in 25 of 29 patients. The ratio was much smaller than normal in another 4 patients. RAC was calculated in 24 patients; of these only 2 had normal count for gestational age. In another 22, the number of air space stopped to increase at about 20 to 25 weeks of gestation. There was a tendency for L/B ratio to decrease according to dysplastic grade (1.3% for grade 2 vs. 0.9% for grade 3 and 4).

CONCLUSION

The primary urological abnormalities leading to PS included bilateral renal hypodysplasia, obstructive uropathy, and PCKD. Histological study of the kidneys indicates that PS is the spectrum disease with various degree of nephron formation. The development of the lung depends, in part, on the grade of renal dysplasia.