Proteolysis of classic anti-neutrophil cytoplasmic autoantibodies (C-ANCA) by neutrophil proteinase 3

C-ANCA, which are directed against neutrophil proteinase 3 (PR3), are specific markers for the diagnosis of active Wegener's granulomatosis (WG). The correlation between C-ANCA titre and WG disease activity suggests that these autoantibodies are involved in the development of WG. We have previously observed that C-ANCA interfere with PR3 proteolytic activity and with complexation of PR3 with its major physiologic inhibitor alpha 1-antitrypsin (alpha 1-AT). The possible pathogenic importance of C-ANCA may be related to the stability of C-ANCA IgG-PR3 complexes. In the present study we tested proteolysis by PR3 of human IgG and proteolysis of C-ANCA IgG complexed to the enzyme. All human IgG subclass proteins were cleaved by PR3. Digestion products were compared with those obtained by human neutrophil elastase (HNE)-mediated proteolysis of human IgG subclass proteins. Although cleavage products of similar size could be identified, the proteolytic activity of both enzymes towards human IgG differed. Furthermore, inhibiting C-ANCA IgG were cleaved into small peptides when complexed to PR3. The possible pathogenic consequences of these findings will be discussed.

Pancreatitis is a risk factor for pancreatic cancer

BACKGROUND & AIMS

The Department of Veterans Affairs (VA) maintains a computerized file of all hospital discharges since 1970. In taking advantage of this large database, the present study aimed to determine whether pancreatitis is a risk factor for pancreatic cancer.

METHODS

A case control study compared the occurrence of pancreatitis in 2639 patients with pancreatic cancer and a matched control group of 7774 subjects using multivariate conditional logistic regression.

RESULTS

The odds ratio associated with pancreatitis increased from 2.04 (95% confidence interval [CI], 1.53-2.72) 7 or more years before the first diagnosis of cancer to 2.14 (CI, 1.68-2.72) 3 or more years before cancer diagnosis and to 2.31 (CI, 1.87-2.86) 1 or more years before cancer diagnosis. In a multivariate analysis, all types of pancreatitis or chronic pancreatitis alone were associated with a significant risk, their odds ratios being 3.42 (CI, 1.98-5.91) and 2.23 (CI, 1.43-3.49), respectively. No influence was exerted by other variables, such as history of gallstone disease or alcoholism, frequency of hospital discharges with pancreatitis, and length of coverage in the VA system.

CONCLUSIONS

A history of pancreatitis constitutes a significant risk for subsequent development of pancreatic cancer. The increase of the risk with decreasing time before the diagnosis of cancer may indicate that a fraction of pancreatic cancers are initially misdiagnosed as pancreatitis.

Evaluation of dyspepsia and functional gastrointestinal disorders: a cost-benefit analysis of different approaches

OBJECTIVE

To establish a decision rule for diagnostic testing in patients with dyspepsia.

DESIGN

Medical decision analysis using a decision-tree model.

METHODS

Costs and benefits associated with two alternative strategies are compared. In the first strategy, empirical therapy alone is provided. The second strategy also includes tests to diagnose the cause of dyspepsia.

RESULTS

It is more beneficial to test than to employ empirical treatment alone if the a-priori probability P of an organic disease is larger than the ratio of the costs T of testing to the costs C of a missed diagnosis: P > T/C. In most clinical situations, the costs of a missed diagnosis outweigh the costs of testing by a factor of 5-10, for which the cost ratio is 10-20%.

CONCLUSION

Diagnostic tests should be performed in patients with dyspepsia, whenever the probability of finding organic disease exceeds the ratio of the cost of testing to the cost of missing this diagnosis.

Mouse egg integrin alpha 6 beta 1 functions as a sperm receptor

Binding between sperm and egg plasma membranes is an essential step in fertilization. Whereas fertilin, a mammalian sperm surface protein, is involved in this crucial interaction, sperm receptors on the egg plasma membrane have not been identified. Because fertilin contains a predicted integrin ligand domain, we investigated the expression and function of integrin subunits in unfertilized mouse eggs. Polymerase chain reactions detected mRNAs for alpha 5, alpha 6, alpha v, beta 1, beta 3, and beta 5. Immunofluorescence revealed alpha 6 beta 1 and alpha v beta 3 on the plasma membrane. GoH3, a function-blocking anti-alpha 6 monoclonal antibody, abolished sperm binding, but a nonfunction-blocking anti-alpha 6 monoclonal antibody, a function-blocking anti-alpha v beta 3 polyclonal antibody, and an RGD peptide had no effect. Somatic cells bound sperm avidly, but only if they expressed alpha 6 beta 1. A peptide analog of the fertilin integrin ligand domain inhibited sperm binding to eggs and alpha 6 beta 1+ cells and diminished GoH3 staining of eggs. Our results indicate a novel role for the integrin alpha 6 beta 1 as a cell-cell adhesion receptor that mediates sperm-egg binding.

Autoantibodies to the laminin P1 fragment in HgCl2-induced membranous glomerulopathy

Exposure to mercuric chloride induces the development of a membranous glomerulopathy with high proteinuria in DZB rats, in which immunoglobulin (Ig)G1 and IgG2a bound in the glomeruli were previously found to react with laminin of the EHS tumor and several unidentified glomerular basement membrane components. Monoclonal antibodies were prepared by fusing cervical and mandibular lymph node cells from a HgCl2-treated DZB rat with a nonsecreting mouse myeloma. Monoclonal antibodies were screened for reactivity with collagenase-digested glomerular basement membrane and kidney sections; upon subcloning, eight stable hybridomas were obtained, named MEC1 to MEC8. MEC2 (IgG1, kappa), MEC3 (IgM, kappa), and MEC5 (IgG1, kappa), as well as the polyclonal glomerular eluate, reacted preferentially with the P1 fragment of the laminin-1 (alpha 1 beta 1 gamma 1) isoform. MEC8 (IgM, kappa) reacted with the P1 and the E4 fragment of laminin. Both MEC6 (IgM, kappa) and MEC8 bound to actin and to various other, unidentified cellular antigens, indicating that MEC6 and MEC8 are polyreactive antibodies. MEC7 (IgM, kappa) bound to a cytoskeleton-linked cell membrane antigen, present on various epithelial cells and between heart muscle fibers and associated with small peripheral, intramuscular nerves. Several of the MEC monoclonal antibodies bound in vivo along the glomerular capillary wall. Although discrete electron-dense subepithelial immune aggregates were not detected and proteinuria was not induced, MEC3 localization changed from a continuous pattern into a fine granular pattern along the glomerular basement membrane, and focally along the TBM, upon passive transfer into naive DZB rats. These findings suggest a pathogenetic role for the P1 fragment of laminin either in the induction phase of HgCl2-induced membranous glomerulopathy as an immunogen or in the effector phase as a target antigen.

Costs of duodenal ulcer therapy with antibiotics

BACKGROUND

Intermittent or maintenance therapy with histamine2 antagonists, highly selective vagotomy, or antibiotic therapy to eradicate Helicobacter pylori all represent distinct, viable options to manage duodenal ulcer disease. Comparing the costs associated with these four approaches could help in deciding among them.

METHODS

The decision model of a Markov chain was used to compare the costs of the four approaches and their influence on the natural course of duodenal ulcers. Direct costs were calculated from the average wholesale prices of drugs and from charges for medical services submitted to and allowed by the Health Care Financing Administration. Average annual income was used to estimate indirect costs.

RESULTS

The model predicted that after antibiotic therapy, 99.7% of patient time is spent free of duodenal ulcer. The corresponding percentages were 96.6% for maintenance therapy, 94.4% for vagotomy, 89.4% for intermittent therapy, and 82.8% without therapy. For an individual patient after 15 years, the expected total costs of a treatment approach involving antibiotics are $995, compared with $10,350 for intermittent therapy with histamine2 antagonists, $11,186 for maintenance therapy with histamine2 antagonists, and $17,661 after vagotomy. Incorporating upper gastrointestinal tract endoscopy to verify eradication of H pylori raises the costs of the antibiotic therapy option to $2426. Increasing the annual infection rate of H pylori from baseline 1% to 10% raises the expected costs after 15 years to $3431. Decreasing the H pylori eradication rate from baseline 80% to 50% raises the costs to $2679.

CONCLUSIONS

Compared with other options, antibiotics to eradicate H pylori are the cheapest therapy for duodenal ulcer and provide the least time spent with an active ulcer. From an economic perspective, antibiotics represent the treatment of choice.

An alternatively spliced exon in the extracellular domain of the human alpha 6 integrin subunit--functional analysis of the alpha 6 integrin variants

Variants in the extracellular domain of the integrin alpha 7 subunit which arise as a consequence of alternative splicing of mRNA have recently been reported. Two alternative exons, X1 and X2, have been identified in the alpha 7 gene, and homologous exons were found for alpha 6 (Ziober et al., 1993). In this study, we have isolated the region of the alpha 6 gene containing exons X1 and X2 that are, like those of alpha 7, located between stretches of DNA that encode the homologous repeat domains III and IV, proximal to the three divalent cation binding sites of the alpha 6 subunit. We demonstrated by reverse transcriptase polymerase chain reactions and confirmed by sequencing that alpha 6X1 and alpha 6X1X2 mRNAs are generated by alternative splicing of exon X2. The alpha 6X1X2 mRNA is expressed in a limited number of tissues and cell lines and it is always co-expressed with the ubiquitous alpha 6X1 mRNA. Stable transfection of K562 cells with full length cDNAs for the alpha 6AX1X2 and beta 4 subunits resulted in cell populations that expressed the alpha 6AX1X2 variant, in association with either beta 1 or beta 4, on their surface. In addition, a population of cells was isolated that expressed the alpha 6AX1X2 variant at low levels and almost exclusively in association with beta 1. Comparison of the alpha 6AX1X2 integrins with alpha 6AX1 using similarly transfected cells showed no obvious differences between the alternative extracellular alpha 6A isoforms with respect to ligand specificity and activation-dependency of ligand binding. After treatment with the anti-beta 1 stimulatory antibody TS2/16, both the alpha 6AX1 beta 1 and alpha 6AX1X2 beta 1 integrin variants mediated cell adhesion to EHS tumor laminin (laminin-1), kalinin (laminin-5), human placental (laminin-2 and -4) and bovine kidney laminins. In contrast, the alpha 6AX1 beta 4 and alpha 6AX1X2 beta 4 integrins also mediated cell adhesion to laminin and kalinin without stimulation. Furthermore, the different transfectants did not differ in their ability to spread on kalinin. The presented data indicate that the X2 region in alpha 6 is not involved in defining ligand specificity or affinity.

Episialin (MUC1) overexpression inhibits integrin-mediated cell adhesion to extracellular matrix components

Episialin (MUC1) is a transmembrane molecule with a large mucin-like extracellular domain protruding high above the cell surface. The molecule is located at the apical side of most glandular epithelial cells, whereas in carcinoma cells it is often present at the entire surface and it is frequently expressed in abnormally large quantities. We have previously shown that overexpression of episialin reduces cell-cell interactions. Here we show that the integrin-mediated adhesion to extracellular matrix of transfectants of a melanoma cell line (A375), a transformed epithelial cell line (MDCK-ras-e) and a human breast epithelial cell line (HBL-100) is reduced by high levels of episialin. This reduction can be reversed by inducing high avidity of the beta 1 integrins by mAb TS2/16 (at least for beta 1-mediated adhesion). The adhesion can also be restored by redistribution of episialin on the cell surface by monoclonal antibodies into patches or caps. Similarly, capping of episialin on ZR-75-1 breast carcinoma cells, growing in suspension, caused adherence and spreading of these cells. We propose that there is a delicate balance between adhesion and anti-adhesion forces in episialin expressing cells, which can be shifted towards adhesion by strengthening the integrin-mediated adhesion, or towards anti-adhesion by increasing the level of expression of episialin.

180-kD bullous pemphigoid antigen (BP180) is deficient in generalized atrophic benign epidermolysis bullosa

Generalized atrophic benign epidermolysis bullosa (GABEB) is a form of nonlethal junctional epidermolysis bullosa characterized by universal alopecia and atrophy of the skin. We report a deficiency of the 180-kD bullous pemphigoid antigen in three patients with GABEB from unrelated families. We screened specimens of clinically normal skin from nine junctional epidermolysis bullosa patients (3 GABEB, 4 lethal, 1 cicatricial, 1 pretibial) by immunofluorescence using monoclonal antibodies to the 180-kD and 230-kD bullous pemphigoid antigens (BP180 and BP230). In the skin of the three GABEB patients there was no reactivity with antibodies to BP180, whereas staining for BP230 was normal. In the skin of the other six, non-GABEB patients, included in this study the expression of BP180 and BP230 was normal. Immunoblot analysis of cultured keratinocytes from one of the GABEB patients also failed to detect BP180 antigen, whereas BP230 was present in normal amounts. The deficient expression of BP180 is reflected in the RNA message, as in Northern blot analysis a reduced amount of BP180 transcripts, although of normal length, were detected. Interestingly, in another GABEB patient there were not-involved areas of skin, in which blistering could not be induced by rubbing. Biopsy material from these areas showed interrupted staining for BP180. There was no staining for BP180 in areas of clinically normal but involved skin of this patient. In conclusion, this study reveals that the BP180 antigen is deficient and the BP180 mRNA is reduced in generalized atrophic benign epidermolysis bullosa.

The cytoplasmic domain of alpha 6A integrin subunit is an in vitro substrate for protein kinase C

We have investigated whether the cytoplasmic domain of alpha 6A integrin subunit can be phosphorylated by Ser/Thr kinases using synthetic peptides as in vitro substrates. This domain was phosphorylated by protein kinase C (PKC) and cyclic AMP-dependent kinase (protein kinase A, PKA) but not by mitogen-activated protein kinase. While Ser1041 has been shown to be phosphorylated in PMA-stimulated cells in vitro, Ser1048 was phosphorylated by PKA. Furthermore pharmacological agents which induce a rise in cyclic AMP concentration failed to stimulate the phosphorylation of the alpha 6A cytoplasmic domain in intact cells. These results suggest that PKC, but not PKA, is involved in the physiological phosphorylation of the alpha 6A integrin subunit.

The mucin epiglycanin on TA3/Ha carcinoma cells prevents alpha 6 beta 4-mediated adhesion to laminin and kalinin and E-cadherin-mediated cell-cell interaction

TA3/Ha murine mammary carcinoma cells grow in suspension, do not adhere to extracellular matrix molecules, but do adhere to hepatocytes and form liver metastases upon intraportal injection. Recently we showed that the integrin alpha 6 beta 4 on the TA3/Ha cells is involved in adhesion to hepatocytes. However, despite high cell surface levels of alpha 6 beta 4, TA3/Ha cells do not adhere to the alpha 6 beta 4 ligands laminin and kalinin. Here we show that this is due to the mucin epiglycanin that is highly expressed on TA3/Ha cells. Some monoclonal antibodies generated against epiglycanin induced capping of most of the epiglycanin molecules. TA3/Ha cells treated with these mAb did adhere to laminin and kalinin, and an epithelial monolayer was formed on kalinin, with alpha 6 beta 4 localized in HD1-containing hemidesmosome-like structures and E-cadherin at the cell-cell contact sites. Similar results were obtained after treatment of TA3/Ha cells with O-sialoglycoprotein endopeptidase which removes all epiglycanin. In addition, the enzyme induced E-cadherin-mediated cell-cell aggregation. Both treatments also enhanced the adhesion to hepatocytes, but given the potent antiadhesive effect of epiglycanin it is remarkable that nontreated TA3/Ha cells adhere to hepatocytes at all. We found that during this interaction, epiglycanin was redistributed. We conclude that epiglycanin can completely prevent both intercellular and matrix adhesion, but that this effect can be overcome in certain intercellular interactions because of the induced redistribution of the mucin.

[Cost comparison of laparoscopic cholecystectomy and extracorporeal shockwave lithotripsy in the treatment of gallstones]

To aid in the choice between laparoscopic cholecystectomy and extracorporeal shock wave lithotripsy for the treatment of gallstones the costs of the two methods were investigated. A decision tree was constructed so as to set out the initial procedure costs of both techniques and possible subsequent costs due to treatment failure or complications. The computations were based on figures from the University Clinic, Erlangen, in 1993. The direct (medical) costs of laparoscopic cholecystectomy amounted to DM 3556, to which must be added further indirect costs of DM 3152 arising from loss of working capacity and premature death. The direct expenses for lithotripsy including outpatient aftercare were DM 6708 and the indirect expenses DM 1858. The overall costs per patient for lithotripsy are hence DM 1858 higher than those of laparoscopic cholecystectomy. This cost difference remained substantially unaltered even when the success rates of the two techniques were varied over a wide range. When lithotripsy is performed entirely as an outpatient procedure and inpatient costs hence disappear, the expected overall cost drops from DM 8567 to DM 6381. Omission of the lump sum charge for lithotripsy effects a similar drop in overall costs to DM 6379. Laparoscopic cholecystectomy is hence cheaper than lithotripsy. Only if lithotripsy can be performed at very low cost can it compete with laparoscopic cholecystectomy.

Constipation is not a risk factor for hemorrhoids: a case-control study of potential etiological agents

OBJECTIVES

Constipation is widely believed to cause hemorrhoids. However, recent evidence questions the importance of constipation in the development of this common disorder. In the present study, the association of hemorrhoids with constipation and other potential risk factors was examined.

METHODS

The analysis consisted of 325 consecutive patients who underwent proctoscopy at the Milwaukee VA Medical Center during 1989. Each participant was questioned regarding hemorrhoid symptoms, bowel habits, and associated medical conditions. At the time of proctoscopy, the presence or absence of hemorrhoids was recorded.

RESULTS

Hemorrhoids were identified in 168 subjects; the remaining 157 served as controls. No significant association was observed between constipation and hemorrhoids. Increasing age, cirrhosis, and varicose veins likewise were not associated with hemorrhoids. In contrast, the subjective complaint of diarrhea [odds ratio 2.1; 95% confidence limits (CL) 1.2-3.7] and obesity (odds ratio 1.7; 95% CL 1.1-2.7) were significantly associated with the presence of hemorrhoids.

CONCLUSION

The results of this analysis suggest that diarrhea but not constipation may represent a risk factor for the development of hemorrhoids.

Diseases preceding colon cancer. A case-control study among veterans

Patients with regular use of nonsteroidal antiinflammatory drugs (NSAIDs) appear to have a reduced mortality from colon cancer. As NSAID use is associated with gastrointestinal bleeding, endoscopic exploration of patients on NSAID may lead to more efficient screening and frequent detection of colon cancer. A case-control study was conducted among 12,304 veterans with a colon cancer diagnosed between 1988 and 1992. Four controls were matched by age, sex, and race to each case. The frequency distributions of previous discharge diagnoses in cases and controls were compared. Arterial embolism and thrombosis, spondylosis, peripheral vascular disease, angina, osteoarthrosis, and ischemic heart disease protected against future development of colon cancer. On the other hand, atrial fibrillation and flutter, as well as phlebitis and thrombophlebitis, were associated an increased occurrence of colon cancer after 5-10 years. The study contrasts diseases that are treated with aspirin with those that are treated with other anticoagulants. Both cause bleeding, but the reduced risk of colon cancer was seen only in conditions treated with aspirin. The difference between the two disease groups from the same VA patient population suggests that chronic use of NSAID truly protects against future development of colon cancer.

Periodicity of hospital admissions for inflammatory bowel disease

OBJECTIVES

It has been speculated that exacerbations of inflammatory bowel disease are influenced by seasonal variations.

METHODS

This hypothesis was tested in a large data base of the Health Care Financing Administration (HCFA), consisting of all hospitalized US Medicare beneficiaries from four consecutive years.

RESULTS

The total of hospital admissions (for all diagnoses) was characterized by a marked seasonal variation occurring similarly in each consecutive year. It was high during winter and low during summer. Peak and trough of admission rate varied by 10%. In striking contrast to this general pattern, both Crohn's disease and ulcerative colitis showed an annual pattern of variability without any clear-cut seasonality. However, the time trends of both diseases showed a striking parallelism concerning their short-term changes (affecting 1-3 consecutive months) and long-term changes (affecting 4-8 consecutive months). The parallelism of the temporal changes affected different age and sex groups alike.

CONCLUSIONS

The parallel monthly variations suggest that exacerbations in the activity of inflammatory bowel disease may be modulated by exogenous factors, and that Crohn's disease and ulcerative colitis may be influenced by identical modulators of disease activity.

Tyrosine phosphorylation of P-selectin in intact platelets and in a disulphide-linked complex with immunoprecipitated pp60c-src

P-selectin is a 140 kDa membrane glycoprotein found in secretory granules of platelets and endothelial cells where it is rapidly translocated to the plasma membrane upon cell activation. It then functions as a receptor for various types of leucocytes. Metabolic labelling of resting platelets with 32Pi showed that P-selectin is primarily phosphorylated on serine residues, although some tyrosine phosphorylation was observed as well. However, tyrosine phosphorylation of P-selectin was greatly stimulated by treatment with the permeating phosphatase inhibitor, pervanadate. When P-selectin immunoprecipitates were incubated with [gamma-32P]ATP (in vitro kinase assay), a fraction of P-selectin was phosphorylated on its tyrosine residues by a co-precipitated kinase. P-selectin phosphorylated in vitro co-migrated with 140 kDa surface-labelled 125I-P-selectin during SDS/PAGE under reducing conditions. Under non-reducing conditions, however, phosphorylated P-selectin was disulphide-linked to unknown protein(s) in a 205 kDa complex. In vitro kinase assays of the most abundant platelet tyrosine kinase, pp60c-src, demonstrated the presence of similar 140 and 205 kDa phosphorylated proteins in SDS/PAGE under reducing and non-reducing conditions respectively. Extraction and reprecipitation studies with proteins phosphorylated in vitro indicated that P-selectin and pp60c-src form a 205 kDa 1:1 disulphide-linked complex. In the complex, pp60c-src autophosphorylation is inhibited and P-selectin is phosphorylated on tyrosine residues. As protein disulphides in the cytoplasm of intact cells are extremely rare, our results suggest that P-selectin and pp60c-src, which co-localize in platelet dense granules, may be non-covalently associated and spontaneously form disulphide bridges during lysis. In addition, the observed tyrosine phosphorylation of P-selectin in intact platelets suggests that its function might be regulated by phosphorylation by pp60c-src.

The alpha 6 beta 4 integrin is a receptor for both laminin and kalinin

Previously, we have establish K562 transfectants that express either alpha 6A beta 1 or alpha 6B beta 1 (K alpha 6A or K alpha 6B) on their surface. Both cell lines bind to laminin and kalinin after treatment with the beta 1-stimulatory antibody TS2/16. Here we introduce the full-length beta 4 cDNA into the alpha 6A- and alpha 6B-expressing K562 cells and selected stably transfected cells. The beta 4 subunit was expressed on the surface of both transfectants and it formed dimers with the alpha 6A or alpha 6B subunits. Immunoprecipitation and preclearing analyses revealed that both transfectants expressed alpha 6 beta 1, in addition to alpha 6 beta 4. While K alpha 6A and K alpha 6B cells required TS2/16 stimulation for binding to laminin or kalinin, adhesion of the unstimulated beta 4-transfected K alpha 6A and K alpha 6B cells to these matrix components was already substantial. This adhesion was mediated by both alpha 6 beta 1 and alpha 6 beta 4 since it was completely blocked by an alpha 6-specific antibody or by a combination of anti-beta 1 and anti-beta 4 antibodies, but only partially by either of these latter two antibodies alone. Adhesion to laminin was completely blocked by an antiserum to laminin fragment E8 as was the adhesion to kalinin by an antibody to kalinin, demonstrating the specificity of adhesion. Both transfectants always adhered more strongly to kalinin than to laminin. Furthermore, binding to kalinin was less well blocked by antibodies to beta 4 than binding to laminin, indicating that the affinity of alpha 6 beta 4 for kalinin is higher than that for laminin. The fact that alpha 6 beta 1 mediated adhesion without TS2/16 stimulation on the beta 4-transfected K alpha 6A and K alpha 6B cells suggests that some activation of alpha 6 beta 1 had occurred in these cells, even though binding was increased when they were actively stimulated by the antibody TS2/16. Finally, we show that Mn2+ induced binding of solubilized alpha 6 beta 4 to matrix containing kalinin, deposited by the murine cell line RAC-11P/SD. This binding was inhibited by the anti-alpha 6 mAb GoH3. Together, these results indicate that both alpha 6 beta 1 and alpha 6 beta 4 are receptors for laminin and kalinin and that there are no differences in ligand specificity between the A and B variants of the alpha 6 subunit when associated with either beta 1 or beta 4.

Demonstration of type II hemidesmosomes in a mammary gland epithelial cell line, BMGE-H

Hemidesmosomes (HDs) are specialized cell-substrate junctions with distinct cytoplasmic plaques where intermediate filaments (IFs) are anchored. In our previous work, we described two types of HDs in terms of their molecular constituents, i.e. type I HD and type II HD [Hieda, Y., Nishizawa, Y., Uematsu, J., & Owaribe, K. (1992) J. Cell Biol. 116, 1497-1506]. In the present study we further characterized type II HDs in cultured cells, comparing their composition and function with those of conventional type I HDs. Although the two bovine mammary gland epithelial cell lines, BMGE+H and BMGE-H, were derived from the same tissue, their cell-substrate adhesion properties are markedly different. Immunological examination showed that BMGE-H cells express HD1 and the integrin alpha 6 beta 4 complex but not bullous pemphigoid antigens, while BMGE+H cells express all these components, i.e. the former have type II HDs and the latter have type I HDs. GoH3, a monoclonal antibody to the integrin alpha 6 subunit, inhibited BMGE-H cell adhesion to laminin as a substrate, as also observed for BMGE+H cells. These and electron microscopic results indicate that BMGE-H cells form type II HD-like structures containing HD1 and alpha 6 beta 4 which are associated with IFs. This structure mediates adhesion of the cell to laminin. This is the first demonstration of an adhesion function for type II HDs in cultured cells.

Distinct and overlapping ligand specificities of the alpha 3A beta 1 and alpha 6A beta 1 integrins: recognition of laminin isoforms

The ligand specificity of the alpha 3A beta 1 integrin was analyzed using K562 cells transfected with full-length alpha 3A cDNA and was compared with that of alpha 6A beta 1 in similarly transfected K562 cells. Clones were obtained that showed comparable surface expression of either alpha 3A beta 1 or alpha 6A beta 1 integrins. Those expressing alpha 3A beta 1 attached to and spread on immunopurified human kalinin and cellular matrices containing human kalinin, which is a particular isoform of laminin. In addition, alpha 3A transfectants adhered to bovine kidney laminins possessing a novel A chain variant. Binding to kalinin was blocked by a monoclonal antibody against the A chain constituent of kalinin and adhesion to both kalinin and kidney laminins by anti-alpha 3 and beta 1 monoclonal antibodies. The alpha 3A transfected cells bound more strongly to kalinin and bovine kidney laminins after treatment with the beta 1 stimulatory antibody TS2/16. A distinctly weaker and activation-dependent adhesion of alpha 3A transfectants was observed on human placental laminins possessing the Am chain variant (merosin), and no adhesion occurred on bovine heart laminins and murine EHS tumor laminin. Further inactive substrates were fibronectin, nidogen, and collagen types IV and VI, indicating that the alpha 3A beta 1 integrin is a much less promiscuous receptor than thought before. By contrast, alpha 6A transfected cells adhered to all laminin isoforms when stimulated with TS2/16. Adhesion also occurred only on bovine kidney laminins in the absence of TS2/16. These results demonstrate that both alpha 3A beta 1 and alpha 6A beta 1 integrins are typical laminin receptors but that their affinity and activation dependence for binding to various laminin isoforms differ considerably.

Cell phenotypes and differentiative transitions in mouse submandibular salivary gland defined with monoclonal antibodies to mammary epithelial cells

Recognition of distinct cell phenotypes within a given organ is important in defining cell relationships during development and in analyzing the role of cell-cell and cell-matrix interactions in growth and differentiation. Phenotypic definition of dissociated heterogeneous cell populations is also essential for studies on mechanisms regulating expression of cell lineage-specific gene products. Mouse submandibular salivary gland (SSG) cell phenotypes in the course of differentiative transitions in vivo and after enzymatic dissociation in primary culture were defined with monoclonal antibodies (MAb) to mammary epithelial cells and polyclonal antibodies to functional cell products. Proacinar cells and differentiating and mature acinar cells were uniquely recognized by an MAb designated 50B8. Ductal cell components were uniquely recognized by an MAb designated JSE3. JSE3 immunoreactivity was particularly useful for detecting the emergence of two SSG duct cell phenotypes, striated ducts and the hormone-responsive granular convoluted tubules (GCTs). JSE3-positive striated duct-like cells were visualized as early as Day 2 after birth and emergence of GCT-like structures from striated ducts was apparent between Days 10 and 11. Differential reactivity of acinar and ductal cells in the developing SSG with either MAb 50B8 or JSE3 suggests the existence of intermediate progenitor cells restricted in their differentiation potential. An interesting pattern of immunoreactivity was observed with an MAb designated 33A10. During the first 2 weeks of SSG postnatal development, shared 33A10 immunoreactivity was observed among proacinar and differentiating acinar cells and all differentiating ductal segments. Coincident with a decrease in proliferative activity at about Day 18, 33A10 immunoreactivity became restricted to the GCT cell lineage before the appearance of GCT functional products, epidermal and nerve growth factors. Although the SSG antigen recognized by MAb 33A10 is presently undefined, its expression pattern suggest a molecule with a dual role in development and growth events and in hormone-dependent secretory function. Advantage was taken of the observed differential immunoreactivities to define the phenotypic identity of dissociated, mature SSG cells before and after culture. Dissociated SSG fractions enriched for either JSE3- or 50B8-positive cells could be maintained in short-term cultures without loss of expression of duct- or acinar cell-specific immunoreactivity. In addition to providing markers for defining dissociated SSG cells before and after culture, the described immunoreactivities may permit separation or enrichment of an early duct cell population before its commitment to a specific cell lineage. This approach may also provide the means to define regulatory signals involved in the differentiation of intermediate progenitor cells.

Expression of the integrin alpha 6 beta 4 in peripheral nerves: localization in Schwann and perineural cells and different variants of the beta 4 subunit

Integrin alpha 6 beta 4 is expressed in human peripheral nerves, but not in the central nervous system. This integrin heterodimer has previously been found in perineural fibroblast-like cells and in Schwann cells (SCs), which both assemble a basement membrane but do not form hemidesmosomes. We show here that in SCs, which had formed a myelin sheath, alpha 6 beta 4 was enriched in the proximity of the nucleus, at Ranvier paranodal areas and at Schmitt-Lanterman clefts; alpha 6 beta 4 was also found at the grooved interface between small axons and non-myelinating SCs. Immunoprecipitation of human peripheral nerves, in combination with Western blotting showed that beta 4 is associated with the alpha 6A subunit. Northern blot analysis of human peripheral nerves showed a single beta 4 transcript of 6 kb. Using the reverse transcriptase polymerase chain reaction, we detected two mRNA species, one for the most common (−70, -53) form of beta 4 and the other encoding the (+53) variant of beta 4. Cultured SCs were devoid of alpha 6 beta 4 but expressed alpha 6 beta 1, indicating that SCs lose beta 4 expression when contact with neurons is lost. Thus, resting SCs in contact with axons express alpha 6A in combination with beta 4, irrespective of myelin formation. We suggest that alpha 6 beta 4 expressed in SCs plays a role in peripheral neurogenesis.

Hospital discharges resulting from esophagitis among Medicare beneficiaries

Despite the frequent occurrence of gastroesophageal reflux disease, until now only very few studies have dealt with the epidemiology of this common disorder. The Health Care Financing Administration complies annually 10 million records of all hospital discharges among Medicare beneficiaries distributed throughout the United States. The purpose of the present study was to take advantage of this large data set and analyze the demographic characteristics of patients discharged with esophagitis, esophageal ulcer, or esophageal stricture. The hospital discharge rates of all three diagnoses showed an age-related rise, the rise being most pronounced for esophageal stricture and, less significant, esophageal ulcer. The marked age dependency of esophageal stricture and ulcer may reflect the time necessary for complications to develop. While simple esophagitis affected women more frequently than men, significantly more men contracted its severe forms involving ulcers and strictures. All forms were more common in whites than blacks, and living in the southern parts of the United States was associated with an increased risk for esophagitis and strictures. The data suggest that besides varying exposure to environmental risk factors, differences in the pathophysiology among demographically stratified groups contribute to the occurrence of esophagitis.

Lymphocyte proliferation response to baker's yeast in Crohn's disease

The etiology of Crohn's disease is still unknown. The present study served to test the hypothesis that baker's yeast (Saccharomyces cerevisiae) plays a role in Crohn's disease. Blood samples were obtained from 12 patients and 15 healthy controls. Peripheral blood leukocytes were isolated and incubated alone or with different concentrations of baker's yeast. After 3 days, the cultures were pulsed with tritiated thymidine. None of the lymphocyte cultures from healthy controls, including 3 bakers, proliferated in response to yeast. In striking contrast, all 9 patients with Crohn's disease in remission, on no medication, showed a threefold increase in their lymphocyte proliferation rate. Lymphocytes from 3 patients on 1.5 g of olsalazine maintenance therapy failed to respond. These results are consistent with previous findings that showed increased titers of IgG and IgA antibodies to baker's yeast in patients with Crohn's disease as compared to healthy controls. They confirm the suspicion that baker's yeast itself or a related antigen play a role in Crohn's disease and suggest that anti-inflammatory agents may act, in part, by inhibiting lymphocyte proliferation.