A thyroid cancer specific monoclonal antibody which recognizes cryptic epitope(s) of human thyroglobulin

A monoclonal antibody (TCM-9) specific for human thyroid cancer but not for Graves' disease, adenoma or normal thyroid tissue was shown to recognize a 300 K protein but not to bind to native or mature human thyroglobulin (Tg). In this study, we investigated further the antigen recognized by TCM-9. When purified Tg was treated with periodate, dithiothreitol (DTT) and sodium dodecyl sulfate (SDS), immunoblotting of treated Tg with TCM-9 revealed an apparent enhancement of the staining only with DTT-treated Tg. Furthermore, the DTT-treated Tg was shown to bind dose-dependently to plates coated with TCM-9. We performed SDS-PAGE and immunoblot analyses on the immune complex obtained from a homogenate of thyroid cancer tissue which was preincubated with an excess of anti-Tg monoclonal antibody. When the protein was autoradiographed with [125I]TCM-9, a definite band was observed. The results indicate that TCM-9 is likely to be directed against a masked epitope of thyroglobulin which can be exposed after treatment with a reducing agent.

Endocrine pathophysiology of luteal phase deficiency as assessed by GnRH/TRH stimulation tests performed in the early follicular and midluteal phases of the menstrual cycle

To investigate endocrine pathophysiology of luteal phase deficiency (LPD), GnRH/TRH stimulation tests were performed in the early follicular (EFP) and midluteal phases (MLP) of the menstrual cycle in 52 infertile women with a history of short luteal phase, in whom pituitary responsiveness to GnRH/TRH and steroidogenic competency of the corpus luteum were analyzed. Twelve women with either elevated basal-LH or exaggerated PRL response to GnRH/TRH in EFP were eliminated, and the remaining 40 women were studied. Basal-FSH in EFP inversely correlated with steroidogenic parameters in MLP, indicating that compromised folliculogenesis causes LPD. In a fraction of LPD women, decreased basal-LH in MLP was associated with decreased basal-progesterone (p), in spite of normal steroidogenic potential of the corpus luteum, suggesting that aberrant LH secretion is another progenitor of LPD. The other group of LPD women showed shortening of high phase period and/or extravagant discrepancy in endometrial dating without apparent abnormal endocrine parameters, suggesting that unknown factors are involved in establishment of LPD. From the diagnostic point of view, they were discriminated into three groups, normal, incomplete LPD and complete LPD groups, with a modified classification of LPD; 1) shortening of high phase period < 11 days, 2) delay in histological to chronological dating of the endometrium > 2 days, and 3) decreased max-P in MLP < 10 ng/ml. Normal (n = 14) and complete LPD (n = 7) groups consisted of women having all the criteria of classification within and out of the cut-off values, respectively. The remainders were enrolled into incomplete LPD group (n = 19). Complete LPD group mainly consisted of women having compromised folliculogenesis as a cause of LPD. In contrast, incomplete LPD group appeared a mixture of heterogeneous populations as to the genesis of LPD. GnRH/TSH stimulation test, especially when performed in MLP, would unveil endocrine pathophysiology of LPD and provide an accurate standard for diagnosis of LPD.

Sustained uterine contractions: a cause of hypointense myometrial bulging

Fifteen pregnant women were studied with magnetic resonance (MR) imaging. In 14 women, the myometrium exhibited distinct hypointense bulging on T2-weighted images that distorted the gestational sac and decidua but not the outer uterine coutour. In 12 women, an obvious discrepancy was observed between the inner myometrial configuration on T1-weighted images and that on intermediate and T2-weighted images. In three women who underwent serial T2-weighted studies separated by about 30 minutes during one MR examination, hypointense myometrial bulging was observed at a different site on each study. In two women who underwent follow-up MR study within a week after dilation and curettage, the previously distinct hypointense bulging completely disappeared. These findings confirm the transient and mobile nature of this myometrial bulging. This phenomenon can be attributed to sustained uterine contractions, which partially force the blood out of the uterus. The decrease in blood volume results in a decrease in water content, which accounts for the decrease in myometrial signal intensity on T2-weighted images.

[E-cadherin expression and cancer invasion and metastasis]

E-cadherin (ECD) is a transmembrane glycoprotein that mediates the calcium dependent adhesion of cells and plays a major role in cell-cell adhesion of normal epithelium. In present study, we have established the positive ECD expressed clone (ECD(+)) and the negative ECD expressed clone (ECD(-)). Anti human ECD monoclonal antibody (HECD-1) disturbed the mutual adhesion of ECD(+) effectively but didn't disturb that of ECD(-). ECD(+) did not invade the collagen/fibroblast gel, but ECD(-) did. Furthermore, ECD(+) acquired invasiveness in the collagen gel when HECD-1 was used. Clinicopathologically, we have investigated the correlation between expression of ECD and metastasis in human esophageal and gastric cancers by immunohistochemical staining using HECD-1. ECD expression of these lymph node metastatic tumor in the primary sites was more reduced than that of non metastatic tumor significantly. These results indicated that reduction or dysfunction of ECD diminishes intercellular adhesion and acquires invasive and metastatic capacity in human cancer cells.

Chimeric studies of the extracellular domain of the rat thyrotropin (TSH) receptor: amino acids (268-304) in the TSH receptor are involved in ligand high affinity binding, but not in TSH receptor-specific signal transduction

A series of chimeric TSH-LH/CG receptors were constructed by substituting homologous segments of the extracellular domain of the rat TSH receptor with corresponding segments of rat LH/CG receptor: C1 (amino acids 37-123 substituted), C2 (91-112), C3 (173-234), C4 (233-266), C5 (268-304), C6 (112-305) and C7 (36-404). After transfection in Cos-7 cell, TSH- and LH/CG-receptor activities of these chimeras were evaluated and compared with those of deletion mutants involving the same residues [Kosugi et al. Thyroid 1:321 (1991)]. Western blot analyses revealed that most of the chimeric receptor proteins were normally synthesized and integrated in the membrane of transfected Cos-7 cells: an antibody to a TSH receptor specific synthetic peptide (residues 352-366) identified 170-190kDa and 90-100kDa TSH receptor structures in the plasma membrane fractions of Cos-7 cells transfected with wild-type TSH receptor cDNA and the C1 to C6 chimeras, but not C7 or wild LH/CG receptor cDNA. Despite this, no receptor except C5 exhibited any significant TSH receptor activities either in [12I]TSH binding or in cAMP responses to TSH and thyroid-stimulating antibodies (TSAbs) from Graves' patients. The chimeric receptor C5 exhibited only low affinity TSH binding (Kd = 3.5 x 10(-8) M), as did its counterpart the M2C mutant with residues 268-304 deleted. However, unlike M2C, C5 demonstrated a significant cAMP response to TSH as well as to TSAbs. The cAMP increase in response to TSH in the wild type receptor was observed at 10(-11) M TSH. In C5 the response was first evident at 10(-10) M TSH, but the maximum cAMP stimulation by TSH and TSAbs in C5 (EC50 = 6.7 x 10(-10) M) was approximately the same as the wild type receptor (EC50 = 1.5 x 10(-10) M). Inhibition of either TSH- or TSAb- stimulated cAMP increase by thyroid-stimulating blocking antibodies (TSBAbs) was also preserved in C5. These results suggest that amino acids 268-304 do not include an important determinant required for signal transduction, since a significant cAMP response to TSH and TSAbs was observed in the C5 receptor with these residues substituted. Additionally, these residues appear to be involved in ligand high affinity binding because high affinity TSH binding was lost in the chimeric receptor C5.

Stimulation of human platelet Ca(2+)-ATPase and Ca2+ restoration by calpain

To clarify the possible role of calpain (calcium activated neutral protease; EC 3.4.22.17) in Ca2+ homeostasis of human platelets, we investigated the effects of cell permeable calpain inhibitors, calpeptin and E-64d (EST), on the restoration of cytoplasmic Ca2+ ([Ca2+]i) in both Fura-2 and aspirin (ASA) loaded platelets. Although neither calpeptin (30 microM) nor EST (250 microM) altered the increase of [Ca2+]i in thrombin (1 U/ml) stimulated platelets, both calpain inhibitors delayed the decrease of [Ca2+]i back towards the basal level. These observations suggested that calpain might be involved in Ca2+ restoration. Then, the activity of Ca(2+)-ATPase was examined in thrombin (2 U/ml) stimulated platelets. Thrombin produced a rapid rise in Ca(2+)-ATPase activity by 2-fold at 8 s of incubation, which then returned to below the basal activity within 2 min. Calpeptin inhibited transient Ca(2+)-ATPase activation induced by thrombin in a dose related manner. Ca(2+)-ATPase of isolated platelet membranes was digested by purified human platelet calpain-I and Ca(2+)-ATPase activity was investigated. With a short incubation (8-15 s), Ca(2+)-ATPase activity was increased about 2-fold and then it decreased below the basal level at longer incubations or at a higher calpain/membrane ratio. The initial rate of Ca2+ uptake was also increased by about 2-fold with a short incubation (8-15 s). For molecular characterization of the Ca(2+)-ATPase, the formation of the enzyme-phosphate complex (EP) was investigated. The membrane bound intact 105 kD Ca(2+)-ATPase was converted by calpain to a fragment of approximately 50 kD.(ABSTRACT TRUNCATED AT 250 WORDS)

[Interferon therapy after ablation of Kent bundle for a patient with chronic hepatitis type B complicated with WPW syndrome]

Cardiotoxicity of interferon-alpha or gamma, such as fatal arrhythmia and myocardial infarction, has been reported. Therefore cardiotoxicity of interferon should be seriously considered before administration for patients with a pre-existing heart disease. We treated a patient with chronic active hepatitis type B, coexisted with Wolff-Parkinson-White syndrome, who has had frequent attacks of paroxysmal atrial fibrillation. To prevent the occurrence of fatal arrhythmia with an interferon therapy in this patient, we performed radiofrequency catheter ablation of the Kent bundle. After the successful ablation, we could safely administered recombinant interferon alpha-2b for chronic hepatitis type B.

Augmentation of antitumor immunity in regional lymph nodes by local immunotherapy

We have previously reported that the antitumor effect of OK-432, a streptococcal preparation, is markedly augmented when injected intratumorally together with fibrinogen (OK-432/fbg) [1]. In order to elucidate the effects of this immunotherapy on regional lymph nodes (RLN), we carried out both morphological and functional analyses of the RLN from colonic cancer patients treated with OK-432/fbg. Computer-aided morphometry revealed that the maximal cross-sectional areas and the broadest diameters of the RLN were significantly greater (p < 0.01) in patients who had undergone local immunotherapy than in patients who had not. The component structures of RLN, such as sinus, follicle and paracortex, were all enlarged in the OK-432/fbg-treated patients, and necrosis of metastatic tumors was observed. RLN lymphocytes recovered from OK-432/fbg treated patients showed elevated reactivity to phytohemagglutinin (PHA) and the stimulation index was clearly higher than that of control patients. Flow cytometric analysis revealed a predominance of T-cells, especially CD4 subsets, and higher positivity for both CD25 and HLA-DR. Furthermore, RLN lymphocytes killed more effectively K562 and Daudi cells in the patients who had had immunotherapy. These results suggest that the effect of local immunotherapy with OK-432/fbg is not restricted to the site of injection but extends to the lymph nodes, and contributes to tumor regression through the augmentation of cellular immunity.

Percutaneous transluminal angioplasty of supra-aortic arterial stenoses in patients with concomitant cerebrovascular and coronary artery diseases--report of two cases

Percutaneous transluminal angioplasty (PTA) was performed on supra-aortic arterial stenoses in two patients with concomitant cerebrovascular disease (CVD) and coronary artery disease (CAD). One patient had suffered small cerebral infarctions in the left frontal and temporo-occipital regions, and the other a lacunar stroke in the left pontine region. The former had stenosis of the left internal carotid artery as well as severe triple-vessel CAD. The latter had stenosis of the left subclavian artery as well as severe single-vessel CAD of the left circumflex artery. The PTA procedure successfully dilated the cervical arterial stenosis in both patients, while no cardiac complications occurred. In patients with concomitant CAD and CVD, PTA may be safer than endarterectomy or bypass grafts for supraaortic arterial stenoses.

Establishment and characterization of a monoclonal antibody recognizing the Dewar isomers of (6-4)photoproducts

We established a monoclonal antibody (DEM-1) that recognizes UV-induced DNA damage other than cyclobutane pyrimidine dimers or (6-4)photoproducts. The binding of DEM-1 antibody to 254 nm UV-irradiated DNA increased with subsequent exposure to UV wavelengths longer than 310 nm, whereas that of the 64M-2 antibody specific for the (6-4)photoproduct decreased with this treatment. Furthermore, the increase in DEM-1 binding was inhibited by the presence of the 64M-2 antibody during the exposure. We concluded that the DEM-1 antibody specifically recognized the Dewar photoproduct, which is the isomeric form of the (6-4)photoproduct. The DEM-1 antibody, however, also bound to DNA irradiated with high fluences of 254 nm UV, suggesting that 254 nm UV could induce Dewar photoproducts without subsequent exposure to longer wavelengths of UV. Furthermore, an action spectral study demonstrated that 254 nm was the most efficient wavelength for Dewar photoproduct induction in the region from 254 to 365 nm, as well as cyclobutane dimers and (6-4)photoproducts, although the action spectrum values in the UV-B region were significantly higher compared with those for cyclobutane dimer and (6-4)photoproduct induction.

[A case of surgical treatment of patent ductus arteriosus using left heart bypass in an adult]

This paper describes a new operative method for patent ductus arteriosus using left heart bypass. A 57-year-old woman with patent ductus arteriosus associated with severe pulmonary hypertension was successfully operated upon. Because of aneurysmal dilatation and calcification of the aortic side of the ductus, PDA was divided under left heart bypass with centrifugal pump. Postoperative course was uneventful, and is now well.

Lung cancer incidence rate for male ex-smokers according to age at cessation of smoking

Lung cancer incidence rate after the cessation of smoking was assessed for male ex-smokers according to the age at cessation, using the results from a case-control study for ex-smoker versus continuing smoker, and the lung cancer incidence rate function for continuing smoker estimated from Japan Vital Statistics and the "Six-prefectural Cohort Study" in Japan. This hospital-based case-control study consisted of 776 lung cancer cases (553 current smokers and 223 ex-smokers) and 772 controls (490 current smokers and 282 ex-smokers) who started smoking at ages 18-22. The odds ratio of developing lung cancer for ex-smokers compared to continuing smokers according to years since the cessation of smoking was estimated for four age groups (55-64, 60-69, 65-74 and 70-79). Given that the number of years since cessation of smoking is the same, reduction of the odds ratio appeared to be greater for the younger age group than for the older age group, reflecting the shorter period of exposure for the younger age group. Lung cancer incidence rate (per 100,000) was assumed to be expressed by the following function; 1.7 x 10(-5) x (age -24.3) for continuing smokers and 0.15 x 10(-5) x (age) for nonsmokers. Lung cancer incidence rate among ex-smokers according to years since cessation was then estimated to be the above function multiplied by the odds ratio from the case-control study for each age group. In contrast to the greater reduction of the odds ratio among younger ex-smokers, reduction of the incidence rate, in terms of rate difference, was considerably greater for older ex-smokers due to a high incidence rate of lung cancer for older continuing smokers. This indicates that the absolute magnitude of reduction of the lung cancer incidence rate after cessation of smoking is greater for older ex-smokers, although the relative magnitude of reduction is greater for younger ex-smokers.

Characterization of epidermal growth factor receptor in a rat thyroid cell line, FRTL-5

A rat thyroid cell line FRTL-5 showed no significant binding of epidermal growth factor(EGF) either in the presence or absence of thyrotropin(TSH). Conditioned medium from FRTL-5 did not inhibit the specific binding of [125I]EGF to HeLa cell which has EGF receptors (EGF-R). Two bands of 170KD and 80KD obtained by immunoprecipitation with solubilized FRTL-5 and anti-EGF-R monoclonal antibody indicated autophosphorylation activity. The activity was enhanced by several thyroid cell growth factors including TSH. dibutyryl-cAMP(db-cAMP), insulin like growth factor I(IGF-I). Interleukin 1 beta (IL-1 beta) and phorbol ester. EGF alone enhanced the autophosphorylation activity. These data indicate that FRTL-5 possesses unique EGF-R with low affinity to EGF and that the tyrosine kinase of the receptor is activated during cell proliferation.

Prognostic significance of transforming growth factor-alpha in human esophageal carcinoma. Implication for the autocrine proliferation

BACKGROUND

The authors recently used immunostaining to demonstrate that patients with epidermal growth factor receptor (EGFR) overexpression have poor survival after surgery. However, the clinical significance of transforming growth factor (TGF)-alpha, one of the ligands of EGFR, has not been demonstrated in esophageal carcinoma.

METHODS

Immunohistochemical study for TGF-alpha and EGFR was performed on 57 esophageal squamous cell carcinomas using monoclonal antibodies.

RESULTS

TGF-alpha expression was positive in 35% of the tumors, and EGFR overexpression, defined as stronger staining in cancer cells than in normal epithelium, was positive in 43% of the tumors, according to the authors' arbitrary criteria. The incidence of TGF-alpha positivity was relatively higher in patients with the EGFR overexpression (EGFR+) than in the patients with non-overexpression (EGFR-). The survival rate was significantly lower in patients with TGF-alpha(+) than in those with TGF-alpha(-) (P < 0.01) and in patients with EGFR(+) than in patients with EGFR(-) (P < 0.01), respectively. Considering TGF-alpha and EGFR expression simultaneously, the survival rate of the patients with TGF-alpha(+)/EGFR(+) tumors was the lowest of the four subgroups, with statistically significant differences noted. These relationships between the immunoreactivities and survival curves were observed in the analysis within patients with node-positive disease. In addition, a multivariate statistical analysis demonstrated that TGF-alpha was the only significant variable, whereas EGFR and nodal status provided no additional information regarding postoperative survival.

CONCLUSION

The results presented suggest that TGF-alpha may act as an autocrine growth factor through hyperproducing EGFR and that its expression and EGFR overexpression may prove useful as a valuable prognostic indicator for patients with esophageal carcinoma.

[Predictive factors for in-hospital mortality and delayed mortality following aneurysmal subarachnoid hemorrhage]

It is important to detect predictive factors for in-hospital and delayed mortality of patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm. Forty-eight patients with initial bleeding of aneurysmal SAH were referred to our hospital from January 1982 to December 1985. In-hospital mortality was 16.7% (8 to 48), and 15% (6) of forty patients died later during the follow-up period. Using the Kaplan-Meier method we were able to conclude that, cumulatively, there was 70.8% probability that much patients would survive for 10 years. We analysed predictive factors of in-hospital and delayed mortality retrospectively. The most significant predictive factor for in-hospital mortality was SAH grading on admission, and for delayed mortality (29.2%) age on admission was the best predictive factor. In fact, two patients died with cardiac event during the follow-up period. This result suggests that, although the SAH grading on admission was the second most significant factor for delayed mortality, patients who survived in the acute phase had a survival probability similar to those in a normal control group.

Translocation of human platelet calpain-I

Intracellular localization of calpain (calcium dependent cysteine proteinase) was studied in resting or activated human platelets. When stimulated with 2 U/ml thrombin, approximately 40% of total cellular calpain activity and 25% of antigen translocated mainly to the intracellular membrane fractions with autolytic activation. Translocation of calpain was completely abolished by the addition of EDTA to the sonication medium. However an endogenous calpain inhibitor (calpastatin) activity was not detected in the membrane fractions both in resting and in thrombin stimulated platelets. Translocation of calpain was also observed in the platelets stimulated with ionomycin, collagen or phorbor myristate acetate (PMA). These data suggest that cytosolic calpain reversibly translocates to the intracellular membranes during platelet activation without an interference by calpastatin.

The effect of fructose on fructose 2,6-bisphosphate level and fructose 6-phosphate, 2-kinase activity in the perfused rat liver

In order to investigate the effect of fructose on the metabolic rates of liver glycolysis, changes in fructose 2,6-bisphosphate content and fructose 6-phosphate, 2-kinase (F6P2kinase) activity were examined using perfused rat liver. When the starved liver was perfused with 0.5 mM fructose, the fructose 2,6-bisphosphate level was 6.66 nmol/g liver, or the maximum. However, with further increases in the fructose concentration, increments in the fructose 2,6-bisphosphate level gradually decreased. F6P2kinase was inactive in the starved rat liver. By perfusion with the medium containing fructose or even without fructose, however, the enzyme was activated. The suppression of the increase in the fructose 2,6-bisphosphate level by perfusion at higher fructose concentrations was at least partly due to the inhibition of F6P2kinase by F1P.

Response of sympathetic nervous system activity to dynamic exercise in patients with chronic mitral regurgitation and after valve replacement

To evaluate sympathetic activity during dynamic exercise, 8 patients with mitral regurgitation (MR), 17 patients after mitral valve replacement (MVR) and 5 control subjects were studied by echocardiography, right heart catheterization and by estimation of plasma catecholamines from the right atrium during supine bicycle exercise. No differences in left ventricular (LV) systolic function were noted at rest and during exercise between the patients with MR and control subjects, but it was significantly lower in patients with MVR (p < 0.05) than in control subjects. Plasma norepinephrine (NE) levels during exercise were significantly higher in patients with MR and MVR than in control subjects (p < 0.01 and p < 0.05, respectively). Significant rise in plasma epinephrine levels were noted only in patients with MVR (p < 0.05) during exercise. The relationship of systolic blood pressure/end-systolic dimension and plasma NE levels during exercise, showed lower LV inotropic reserve in patients than in control subjects. Cardiac index (CI) and plasma NE relationship further showed that rise in CI at peak exercise was achieved in patients by a compensatory greater increase in plasma NE. Thus in MR, myocardial dysfunction may be manifested during exercise by a compensatory sympathetic activation and that it continues after MVR.

The efficacy of extracorporeal shock wave lithotripsy on single dense calcified gallstones according to computed tomography

The efficacy and complications of extracorporeal shock wave lithotripsy (ESWL) for single gallstones were compared between 15 patients with a CT-lucent stone and 18 patients with a dense calcified stone. In all of five patients with a stone smaller than 10 mm in diameter, complete or sufficient clearance was observed, regardless of calcification. However, in 28 patients with a stone larger than 11 mm in diameter, the rates of complete or sufficient clearance were lower in those with a dense calcified stone (64%) than in those with a computed tomography (CT) lucent stone (93%). There was no difference in the rate of complications between patients with a CT-lucent stone and those with a dense calcified stone. These results thus suggest that extracorporeal shock wave lithotripsy may be safely employed for patients with a single calcified gallstone.

Therapeutic efficacy of granulocyte colony stimulating factor against rat cecal ligation and puncture model

To identify the therapeutic efficacy of granulocyte colony stimulating factor (G-CSF) in severe sepsis, we examined its effect on the mortality and pathological changes in vital organs using the rat lethal sepsis model. Rats were given 15 micrograms of recombinant human (rh)G-CSF after the onset of peritonitis brought about by cecal ligation and puncture. The mortality rate after 72 h was significantly decreased by administration of 15 micrograms of rhG-CSF (p < 0.001). In addition, the administration of rhG-CSF induced an improvement in liver and renal functions. It also produced marked pathological improvement in the lungs. These results strongly indicated that administration of rhG-CSF, even after the onset of sepsis, was effective in decreasing the mortality from peritonitis-induced multiple organ failure, and this finding was clearly useful in the clinical treatment of such sepsis-induced critical illness.

Hypercalcemia associated with all-trans-retinoic acid in the treatment of acute promyelocytic leukemia

Recent reports have described clinical benefits of all-trans-retinoic acid (ATRA) therapy for acute promyelocytic leukemia (APL). This paper describes severe hypercalcemia (serum calcium: 18.7 mg/dl) in association with ATRA treatment in a 14 year old girl with APL. Serum parathyroid hormone (PTH) concentrations were normal (0.21 ng/ml), which precludes the possibility of primary hyperparathyroidism or ectopic PTH secretion as a cause of the hypercalcemia. As for the factors which can accelerate mineral resorption, there were no apparent increases in the levels of PTH-related protein (PTH-rP), prostaglandins and vitamin D metabolites. In our in vitro experiment, ATRA did not stimulate the leukemic cells to produce PTH-rP. We speculate that ATRA, like PTH, may increase osteoclastic activity and induce hypercalcemia.