Mitochondrial glutathione redox and energy producing function during liver ischemia and reperfusion

The glutathione in mitochondria is thought to play a crucial role in protecting mitochondria against ischemia-reperfusion-induced injury. However, little is known about the mitochondrial redox system. This study was conducted to clarify changes of mitochondrial glutathione redox during liver ischemia and reperfusion and its role on energy producing function. Rats were divided into three groups each of which were treated respectively with saline (Control), buthionine sulfoximine (BSO), which induces a rapid decrease in tissue glutathione concentrations, and gamma-glutamylcysteine ethyl ester (GCE), which conversely induces a rapid increase in tissue glutathione concentrations before induction of ischemia. Liver ischemia was induced for 120 min, and blood reflow was subsequently restored for 60 min. Total and mitochondrial glutathione concentrations, mitochondrial respiratory function, and tissue adenine nucleotide were determined after both the ischemic and the reperfusion periods. In all groups, concentrations of the reduced form of glutathione (GSH) gradually decreased during ischemia and reperfusion. On the other hand, significant increases in mitochondrial GSH were apparent after reperfusion despite significant decreases during ischemia in the control and GCE groups. Total and mitochondrial GSH in the BSO and GCE groups were significantly lower and higher, respectively, compared with the control throughout the experiment. Recovery of the mitochondrial energy producing function and cellular adenine nucleotide after reperfusion were dependent on GSH concentrations. We conclude that mitochondrial GSH concentrations dramatically change in a different manner from cytosolic concentrations after reperfusion, and that recovery of the mitochondrial energy-producing function might be closely associated with mitochondrial GSH concentrations.

Interleukin 8 as a novel target for intervention therapy in acute inflammatory diseases

Aberrant production of interleukin 8 (IL-8) has been shown in various human inflammatory diseases. Recent investigations in animal models using either blocking antibodies against IL-8 or disruption of the gene encoding the IL-8 receptor have revealed the involvement of IL-8 in the recruitment of neutrophils and in neutrophil-associated tissue injury in acute inflammation. These studies suggest that IL-8 is a novel target to alleviate acute inflammation. This review describes the properties of IL-8 and discusses different therapeutic approaches to target IL-8, particularly the use of humanized monoclonal antibodies against IL-8 and inhibition of IL-8 gene transcription.

Detection of mouse IL-8 receptor homologue expression on peripheral blood leukocytes and mature myeloid lineage cells in bone marrow

Interleukin-8 (IL-8) exhibits activities on bone marrow progenitor cells such as regulation of their growth and their mobilization into peripheral blood. In order to clarify the molecular mechanism of the effects of IL-8 on mouse bone marrow cells, we examined the cellular distribution of mouse IL-8 receptor homologue by an immunofluorescence analysis. Peripheral blood Gr-1+ mature granulocytes, and a substantial portion of NK1.1+ natural killer cells in peripheral blood and spleen were stained positively with anti-mouse IL-8 receptor homologue antibody, whereas CD4+, CD8+, or B220+ lymphocytes in peripheral blood and spleen, and thymocytes were not. Moreover, a small portion of ER-MP20+ monocytes in peripheral blood but neither peritoneal resident nor bone marrow macrophages were stained with anti-IL-8 receptor homologue antibody. In bone marrow, mature granulocytes and to a lesser degree, metamyelocytes and myelocytes expressed IL-8 receptor homologue. Moreover, lineage marker (Lin)-c-kit+ bone marrow progenitor cells started to express IL-8 receptor homologue only 5 days after in vitro culture with IL-3 and stem cell factor when metamyelocytes and myelocytes appeared. These results indicated that myeloid lineage cells express a substantial number of IL-8 receptor homologues only at the stage of myelocytes.

Transient hepatofugal portal blood flow after hepatectomy in a patient with cirrhosis: report of a case

We report herein the case of a 60-year-old man who developed hepatic failure with simultaneous transient hepatofugal portal blood flow after undergoing hepatectomy for hepatocellular carcinoma accompanied by cirrhosis with a splenorenal shunt. The transient hepatofugal portal blood flow was detected by color Doppler ultrasonography. Following this case report, the possibility of a relationship between hepatofugal portal blood flow, portal-systemic shunts, and postoperative hepatic failure is discussed.

Use of Blocking Antibodies as Probes for in Vivo Functions of Chemokines

Leukocyte infiltration into an inflammatory site is one of the pathological hallmarks of inflammatory reaction. Locally produced chemotactic factors are presumed to mediate the sequence of events leading to tissue injury associated with the infiltration of leukocytes. Chemotactic cytokines (chemokines) have been identified as being produced by various types of cells upon stimulation with inflammatory stimuli and exhibit a variety of effects on leukocytes in vitro and in vivo. Administration of highly specific neutralizing antibodies against these chemokines in several types of animal inflammation models clearly suggests important roles of these chemokines in recruiting and activating specific types of leukocytes at the inflammatory sites. Anti-IL-8 Ab treatment prevented neutrophil-dependent tissue damage as well as neutrophil infiltration in lipopolysaccharide (LPS)-induced dermatitis, LPS/IL-1-induced arthritis, lung reperfusion injury, and acute immune complex type glomerulonephritis in rabbits. Moreover, anti-MCP-1 Ab and anti-RANTES Ab inhibited macrophage infiltration in IgA immune complex alveolitis in rats and influx of lung macrophages in a murine model of endotoxemia, respectively. The use of anti-MIP-1alpha Ab also revealed that MIP-1alpha mediates eosinophil infiltration in allergic, granulomatous reactions in vivo.

Detection of ras gene mutations in perioperative peripheral blood with pancreatic adenocarcinoma

Surgeons wish to know of any correlation between an operation and the incidence of metastasis. In perioperative periods, pancreatic cancer cells were identified by detecting mutant K-ras gene by two-step PCR and RFLP analysis in blood samples taken from peripheral blood. In no case was K-ras point mutation detected in blood before operation, although the mutant hand was observed in all cases at the time the lesion was resected. Surprisingly, in five of ten cases, positive bands were identified just after laparotomy, before we had reached the primary lesion. In almost all cases, mutant K-ras was detected until the fourteenth postoperative day. These findings suggest that cancer cells exist in the circulation, and have a potential for hematogenous metastasis during the perioperative period. In conclusion, surgical stress causes hematogenous dissemination of pancreatic cancer cells, and surgeons should employ the appropriate anti-metastasis therapy in the perioperative period.

Effect of temperature on morphology of electrochemically-deposited calcium phosphates

Calcium phosphates were electrochemically deposited on titanium plates at temperatures from 4 degrees C to 92 degrees C in a solution of NaCl, K2HPO4 and CaCl2 x 2H20. Scanning electron microscopic studies showed that granular deposits formed on the electrode at electrolyte temperatures of 4 degrees C, 22 degrees C, and 37 degrees C; needle-like deposits formed at 52 degrees C-92 degrees C. The width and length of the needles increased with the temperature of the electrolyte. Based on the results of characterization by electron diffractometry. Fourier transform infrared spectroscopy and X-ray diffractometry, the granular deposits were identified as carbonate-containing calcium phosphate with low crystallinity, and the needle-like deposits as carbonate-containing apatite crystals elongated along the c-axis. Crystallinity of the deposits increased with the temperature of the electrolyte, whereas the orientation indices of the apatite increased with temperature up to 82 degrees C and slightly decreased at 92 degrees C.

Usefulness of simultaneous determination of alpha-fetoprotein and des-gamma-carboxy prothrombin in hepatocellular carcinoma

Serum gamma-fetoprotein (AFP) and plasma des-gamma-carboxy prothrombin (DCP), a protein induced by vitamin K absence or antagonist II (PIVKA-II) levels, were measured in 197 patients with primary hepatocellular carcinoma (HCC). DCP levels were determined by conventional enzyme immunoassay kit (E-1023) and a newly developed high-sensitivity kit using the avidin-biotin complex method. Cut-off levels of AFP and DCP by the E-1023 kit and of DCP by the high-sensitivity kit were put at 100 ng/ml, 0.1 arbitrary unit (AU)/ml, and 0.004 AU/ml, respectively. Positive rate of AFP and DCP by the E-1023 kit and the high-sensitivity kit for HCC was 48%, 44%, and 57%, respectively. The positive rate by combination assay with AFP and DCP by the high-sensitivity kit increased up to 73%. There was no correlation between serum levels of AFP and those of plasma DCP. A significant correlation between tumor size and DCP levels was observed, but not with AFP. The postoperative disease-free survival rates of patients in the group with elevated levels of AFP and DCP were lower than those with normal levels of AFP and DCP. There were various patterns of change in the AFP and DCP levels at the time of recurrence compared with preoperative patterns. The combination assay of AFP and DCP levels is useful for the diagnosis, prognosis, and postoperative monitoring for recurrence of HCC.

Advances in hepatic resection and results for hepatocellular carcinoma

The mortality and morbidity of hepatic resection for hepatocellular carcinoma (HCC) have decreased in recent years because of the various advances in hepatic resection. Various improvements are evident in dissecting apparatus, liver hepatic inflow clamp, cold hepatic perfusion technique, intraoperative ultrasonography, accurate assessment of hepatic function, autologous blood transfusion, and so on. Five-year survival after hepatic resection for HCC was reported at 26-59% in Eastern as well as Western series. The prognostic factors were portal invasion, multiplicity, serum alpha-fetoprotein level, tumor size, associated cirrhosis, age, alcohol abuse, histologic classification, DNA ploidy, and surgical margin. Segmental or lobar hepatic resection brought about better survival, especially in stage I and II patients. Effective adjuvant therapy should improve the diagnosis.

Intracaval endovascular ultrasonography for malignant hepatic tumor: new diagnostic technique for vascular invasion

Successful operation for hepatic tumor extending to the inferior vena cava (IVC) depends heavily on accurate preoperative imaging. We investigate the diagnostic value of intracaval endovascular ultrasonography (US) in the diagnosis of invasion to the IVC. A retrospective study of 26 consecutive patients of hepatic tumor with possible invasion of the IVC was performed using conventional imaging techniques from the right femoral vein with an 8-French, 20-MHz intravascular US. Nineteen of 26 cases were operated on and 15 cases were resected, including three cases of combined resection of the IVC. The sonographic criterion for IVC invasion was obliteration of a single echogenic layer of the IVC wall or intracaval tumor mass. The results of intracaval endovascular US were compared with those of CT and cavography. Vascular invasion was obtained in seven of 26 cases. Vascular invasion was confirmed by pathologic examination of five resected specimens, including two autopsy and two operative findings. The sensitivity, specificity, and overall accuracy of intracaval endovascular US for the diagnosis of the IVC invasion were 100%, 94.7%, and 96.1%, respectively. The values were 85.7%, 63.2%, and 69.2% for CT and 71.4%, 68.4%, and 69.2% for cavography, respectively. The intracaval endovascular US clearly visualized the IVC and established the presence and extent of tumor invasion. Intracaval endovascular US is a useful technique that can precisely evaluate the IVC for possible hepatic tumor invasion, especially when presence or extent of vascular invasion is not definitely established by conventional imaging techniques.

Surgical treatment for hepatocellular carcinoma and concomitant esophagogastric varices

Preventing a rupture of esophagogastric varices (EGV) is very important in aggressively treating hepatocellular carcinoma (HCC) in cirrhotic patients. We therefore performed simultaneous partial hepatic resection and direct interruption procedure on nine patients with HCC and concomitant EGV. Patients were selected on the basis of their stages of HCC and hepatic functional reserve. Postoperative hospital courses of all patients were uneventful. Six patients had recurrence of HCC and received non-surgical anti-tumor treatments. Only one patient had upper gastrointestinal bleeding at 18 months after operation, and the other eight patients have had no episodes of upper gastrointestinal bleeding during the follow-up period. The 5-year survival rate of these patients was 48%. This operative procedure is quite effective and is one of the treatments of choice for patients with less advanced HCC and concomitant risk of EGV.

Mechanism and prevention of ischemia-reperfusion injury of the liver

Interruption of liver blood flow is often necessary as an operative technique in liver surgery. However, this procedure causes liver damage and can be a factor in postoperative liver failure. Interruption of oxygen and substrate supply and accumulation of metabolites contribute to a great variety of cellular and subcellular dysfunctions. Impairment of liver microcirculation occurs after reperfusion. It has been presumed that there is an imbalance between the activities of vasoconstrictors and vasodilators which would determine the vascular condition during ischemia and reperfusion phases. Some mediators are known to act as cytotoxic factors, especially after reperfusion following ischemia. The phenomenon in which organ damage becomes worse, even after reperfusion, is called reperfusion injury. Mediators released from accumulated polymorphonuclear neutrophils and activated Kupffer cells such as oxygen radicals and inflammatory cytokines are associated with ischemia-reperfusion injury of the liver. Regulation of these mediators will be a therapeutic necessity for this kind of liver injury in the future.

Clinical significance of carcinoma invasion of the extrapancreatic nerve plexus in pancreatic cancer

To elucidate the clinical significance of neural invasion in pancreatic carcinoma, a clinicopathological study was performed. Neural invasion is a common feature of pancreatic carcinoma whose clinical significance has not yet been determined. Over a period of > 10 years, 129 of 204 (63%) patients with pancreatic carcinoma underwent resection by extensive radical surgery. A clinicopathological study of those specimens of pancreatic carcinoma was performed, with particular reference to neural invasion. Intrapancreatic neural invasion was observed in 116 of 129 (90%), of which 80 (69%) showed extrapancreatic nerve plexus involvement. A statistically significant (p < 0.001) correlation between the grade of intrapancreatic neural invasion and extrapancreatic nerve plexus invasion was observed. The postoperative survival rate for patients with extrapancreatic nerve plexus involvement was significantly (p < 0.001) lower than that for patients without extrapancreatic nerve plexus involvement. Patients who survived for > 3 years after operation had no extrapancreatic nerve plexus invasion even when portal vein wall invasion was observed.

Doxorubicin-induced disturbance of the energy metabolism after hepatectomy

This study was designed to clarify effects of gamma-glutamylcysteine ethyl ester, a prodrug of glutathione, on doxorubicin-induced changes in liver energy metabolism after hepatectomy. Rats were divided into two major groups dependent on whether hepatectomy had been performed. Rats undergoing hepatectomy were subdivided into three groups: the control group, 70% of the liver was resected; the doxorubicin group, after hepatectomy 2 mg/kg body weight doxorubicin was administered intraperitoneally; and the doxorubicin + gamma-glutamylcysteine group, 30 min before hepatectomy 50 mg/kg body weight of gamma-glutamylcysteine ethyl ester was injected intravenously and other procedures were performed as in the doxorubicin group. In the group not undergoing hepatectomy, 2 mg/kg body weight doxorubicin was administered intraperitoneally after a sham operation. Rats in each group were sacrificed 24, 72, and 120 hr after hepatectomy or sham operation, and the remnant liver was isolated. Liver mitochondrial function, adenine nucleotide concentrations, and glutathione and glutathione peroxidase activities were determined. Doxorubicin did not show any significant effects on parameters measured in rats not undergoing hepatectomy. Liver mitochondrial function was increased significantly 24 hr after hepatectomy, and significant decreases in adenine nucleotide concentrations were observed 24 and 72 hr after hepatectomy. Doxorubicin inhibited the increase in mitochondrial function associated with hepatectomy and delayed recovery of liver adenine nucleotide concentrations. Significant increases in tissue glutathione concentrations were observed 24 and 72 hr after hepatectomy. These significant increases in glutathione concentrations were not observed in rats treated with doxorubicin 72 hr after hepatectomy. Furthermore, doxorubicin decreased glutathione peroxidase activity after hepatectomy. Administration of gamma-glutamylcysteine ethyl ester lessened these doxorubicin-induced changes. These results indicate that changes in the glutathione redox system might be involved in the doxorubicin-induced deterioration of the remnant liver energy metabolism. Clinical application of gamma-glutamylcysteine ethyl ester might be expected.

LFA-1 (CD11a/CD18) and ICAM-1 (CD54) antibodies attenuate superoxide anion release from polymorphonuclear leukocytes in rats with experimental acute pancreatitis

The inhibitive effects of anti-CD11a/CD18 (LFA-1) and anti-CD54 (ICAM-1) antibodies on the generation of superoxide anion (O2-) by polymorphonuclear leukocytes (PMNs) was elucidated in rats induced with experimental acute pancreatitis. We investigated the generation of O2- by PMNs in two protocols: in the first, we measured the active oxygen-producing ability of PMNs isolated from blood in normal rats; in the second, we measured it from blood, peritoneal cavity, and bronchial alveolar lavage fluid in rats 3 h after the induction of pancreatitis. In normal rats, although LFA-1 antibody attenuated the generation of O2-, ICAM-1 antibody did not. However, in pancreatitis rats, both LFA-1 and ICAM-1 antibodies reduced the generation of O2- by PMNs isolated from blood and the peritoneal cavity. These results showed not only that both LFA-1 and ICAM-1 antibodies have a protective effect on the generation of O2-, but also that LFA-1 has a direct inhibitive effect on the generation of O2- by PMNs in this model. Furthermore, histological studies showed there to be less neutrophil accumulation in the lungs of LFA-1- and ICAM-1-treated animals compared to control animals.

Histopathology of the liver in non-cirrhotic portal hypertension of unknown aetiology

Non-cirrhotic, long-standing portal hypertension of unknown aetiology is being re-evaluated histopathologically and clinically. In this study, we examined 107 livers with this condition (92 wedge biopsy and 15 autopsy specimens) from five institutions in Japan. These cases were histologically categorized into four groups: idiopathic portal hypertension (66 cases), nodular regenerative hyperplasia (14 cases), partial nodular transformation (two cases), and incomplete septal cirrhosis (25 cases). These four groups shared several histological features: dense portal fibrosis with portal venous obliteration and intralobular slender fibrosis. In addition, the histopathological features characteristic of one group were also found to a mild degree in other groups. The histopathological lesions preceding portal venous obliteration remain speculative. However, the portal venous obliteration may be responsible for the occurrence of sustained portal hypertension and several of the pathological changes in these livers. It seems likely that idiopathic portal hypertension, nodular regenerative hyperplasia, partial nodular transformation and incomplete septal cirrhosis comprise a family of non-cirrhotic, long-standing portal hypertension in Japan, and the histological differences between them may reflect chronological progression of a single disease.

A case report of simultaneous surgery for Wolff-Parkinson-White syndrome combined with hemolytic anemia and mitral stenosis

A 46-year-old woman with mitral stenosis, WPW syndrome, hemolytic anemia due to spherocytosis, and hypothyroidism with Hashimoto's thyroiditis, was admitted with palpitations and dyspnea due to paroxysmal atrial fibrillation with a rapid ventricular response, and was treated by electrical cardioversion. We selected surgical intervention to treat the mitral stenosis and WPW syndrome, as some tachycardia episodes due to atrial fibrillation have resulted in repeated congestive heart failure. In 1983 we simultaneously performed a division of the posteroseptal accessory pathway and a mitral valve replacement with a bioprosthetic valve under cardiopulmonary bypass, using a membrane oxygenator after splenectomy to compensate for the hemolytic anemia due to spherocytosis. Her postoperative course was favorable and she is now in good health with no episodes of tachycardia, congestive heart failure nor anemia occurring during the 10 years that have followed the operation. Simultaneous surgery for WPW syndrome combined with other cardiac abnormalities and hematologic disorders achieved acceptable results in this case.

Extrapancreatic nerve plexus invasion by carcinoma of the head of the pancreas. Diagnosis with intraportal endovascular ultrasonography

CONCLUSION

The intraportal endovascular ultrasonography (IPEUS) could diagnose the second portion of the extrapancreatic nerve plexus invasion and provide precise information in operative strategy. But, the first portion was not visualized clearly owing to poor tissue penetration of the ultrasound beam, which may have reduced diagnostic accuracy. Improvement of the scanning area is expected to make intraportal endovascular US even more useful.

BACKGROUND

Pancreatic cancer easily invades the retroperitoneal tissue, especially the extrapancreatic nerve plexus. We evaluated the extrapancreatic nerve plexus invasion of the pancreatic cancer with IPEUS. IPEUS was performed intraoperatively in 20 consecutive resected cases with carcinoma of the head of the pancreas.

METHODS

IPEUS was performed with an 8-French, 20 MHz intravascular ultrasound catheter. IPEUS visualized the inferior pancreaticoduodenal artery (IPDA) in the extrapancreatic nerve plexus. The high-echoic area around the IPDA corresponds to the second portion of the extrapancreatic nerve plexus. The sonographic criterion for detection of the extrapancreatic nerve plexus invasion is low-echoic infiltration around the IPDA.

RESULTS

Extrapancreatic nerve plexus invasion was confirmed with resected specimens in 10 patients. The IPDA could not be visualized in two patients. In 18 patients, the diagnostic accuracy of invasion was evaluated. For diagnosis of extrapancreatic nerve plexus invasion with intraportal endovascular US, the sensitivity, specificity, and overall accuracy were 87.5, 90, and 88.7%, respectively.

Atrial activation during chronic atrial fibrillation in patients with isolated mitral valve disease

BACKGROUND

A computerized 32-channel mapping system has been developed to investigate the characteristics of the atrial activation sequence. The system is capable of displaying sequential atrial maps and provides a rapid and dynamic means of verifying the activation sequence of atrial fibrillation.

METHODS

Using this system, we performed intraoperative atrial activation mapping in 10 patients with chronic atrial fibrillation who were undergoing isolated mitral valve operations.

RESULTS

Regular and repetitive activation (cycle length ranged from 131 to 228 milliseconds) originated in the left atrium in all 10 patients. Two patterns of repetitive activation in 2 patients and three patterns in 1 patient appeared alternately during the observation period in the left atrium. In contrast to the repetitive activation in the left atrium, the activation sequence of the right atrium was extremely complex and chaotic. In 7 of the 10 patients, the same pattern of right atrial activation was never repeated during the observation period. In 2 patients, revolution of repetitive activation in the right atrium sporadically appeared, but the pattern of activation immediately deteriorated to a complex and chaotic pattern. In 1 patient, repetitive activation emerged from the low lateral portion of the right atrium. Because our mapping technique was limited by the number of available atrial electrodes, discrete reentrant circuits or ectopic foci could not be demonstrated in the present study. However, the activation sequences during chronic atrial fibrillation suggested that (1) the left atrium would act as an electrical driving chamber for atrial fibrillation in the majority of the patients and (2) atrial activation patterns are different in each case.

CONCLUSIONS

Computerized intraoperative mapping should guide surgeons in determining the appropriate surgical procedure and facilitate operation for chronic atrial fibrillation associated with mitral valve disease.

[Identical twin sisters with IgA nephropathy]

This report described 45-year-old identical twin sisters with IgA nephropathy. Case 1 presented with microscopic hematuria and proteinuria at the age of 39. Case 2 was found proteinuria at the age of 32. Both the physical examination and laboratory data of these cases were normal. Serum level of IgA was not elevated. The renal biopsy specimen of two cases showed slight mesangial proliferation by light microscopy and mesangial IgA deposition by immunofluorescence microscopy. Their serotype for HLA was found to be HLA-A2, A24, Bw35, Cw1, Cw3, DRw8, DRw12. Several reports indicated the familial occurrence of patients with IgA nephropathy and a strong association with HLA-Bw35 in those patients. The present cases also suggested that an abnormal immune response-linked HLA system may be involved in the development of IgA nephropathy.