New 5-HT3 (serotonin-3) receptor antagonists. III. An efficient synthesis of carbon 14-labeled (+)-8,9-dihydro-10-methyl-7-[(5-methyl-1H-imidazol-4- yl)methyl]pyrido[1,2-a]indol-6(7H)-one hydrochloride (FK 1052)

(+)-8,9-Dihydro-10-methyl-7-[(5-methyl-1H-imidazol-4- yl)methyl]pyrido[1,2-a]indol-6(7H)-one hydrochloride (FK 1052, 1) is a highly potent 5-HT3 (serotonin-3) receptor antagonist. For the study of the metabolism and disposition of FK 1052 (1), we synthesized carbon 14-labeled FK 1052 in three steps from 10-demethyl FK 1052 (8). The Mannich reaction and subsequent hydrogenolysis of the dimethylaminomethyl group enabled the efficient introduction of one carbon atom at the 10-position of the pyrido[1,2-a]indol-6,(7H)-one ring. The Mannich reaction of (+)-8,9-dihydro-7-[(5-methyl-1H-imidazol-4-yl)methyl]pyrido[1,2- ]indol-6(7H)-one (8) with [14C]paraformaldehyde and dimethylamine hydrochloride gave the [14C]-10-dimethylaminomethyl compound (20). Subsequent hydrogenolysis of 20 with palladium on carbon and ammonium formate, followed by recrystallization of the salt with (+)-di-p-toluoyl-D-tartaric acid, gave [14C]FK 1052 with a radiochemical purity of 99.4% and an enantiomeric excess of more than 97%.

New 5-HT3 (serotonin-3) receptor antagonists. V. Synthesis and structure-activity relationships of pyrrolo[2,1-c][1,4]benzoxazine-6-carboxamides

This paper describes the discovery of structurally novel heterocyclic carboxamides which are highly potent 5-HT3 (serotonin-3) receptor antagonists. Pyrrolo[2,1-c][1,4]benzoxazine-6-carboxamides (12 and 20) were found to possess potent 5-HT3 receptor antagonist activity on the von Bezold-Jarisch reflex in anesthetized rats. Structure-activity studies showed that compounds with small and lipophilic substituents such as chloro and methyl at the 8-position of the aromatic ring portion retained high potency, whereas those with bulky substituents showed essentially no activity. A dimethyl group at the 4-position slightly decreased the potency. 1-Azabicyclo[2.2.2]octan-3-amine as the amine part afforded the most potent activity. From this series, 20a was found to be the most potent 5-HT3 receptor antagonist, being 40-fold more potent than ondansetron (1).

Prognostic value of epidermal growth factor receptor expression in endometrioid endometrial carcinoma

We report here a retrospective study of epidermal growth factor receptor (EGFR) expression in 140 patients with human endometrioid endometrial carcinoma (median period of follow-up, 43.8 months; ranging from 1 to 155 months). Tumor specimens were immunohistochemically examined for the overexpression of EGFR, and the correlation among EGFR status, various clinicopathologic parameters, and prognosis was statistically evaluated. Monoclonal antibody (clone 31 G 7), which recognizes the extracellular domain of the EGFR molecule, was used for immunostaining. Ninety-four of 140 cases were immunohistochemically positive for EGFR (67.1%). The presence or absence of EGFR did not correlate with surgical stage, depth of myometrial invasion (DI), or lymph node involvement, but did correlate with histological grade and patient's age. Furthermore, patients with EGFR-positive endometrial carcinoma had a statistically significant shorter length of survival than those with EGFR-negative tumors (P = .018). This trend is more apparent among the patients more than 50 years old (P = .003). When adjusted for surgical stage, DI, and patient age, EGFR status retained prognostic value by multivariate analysis. However, when adjusted for surgical stage, histological grade, DI, and patient age, EGFR status failed to retain prognostic value by multivariate analysis. The results of this study suggest that EGFR expression is correlated with histological grade and greater invasiveness of human endometrioid endometrial carcinoma.

[Two operated cases of craniopharyngioma in patients over 70 years old]

This paper reports two cases of craniopharyngioma in the elderly (over 70 years old). The first case is a 74-year-old woman who was referred to us due to gait and visual disturbance. She was first treated conservatively because she showed signs of dementia, but her tumor grew remarkably and rapidly after placement of a ventriculoperitoneal shunt and then was partially resected. After two shunt revisions, the patient developed postoperative pneumonia, which became the main cause of her death. The second case was a 79-year-old female who was referred to us due to progressive visual disturbance. She was operated on and her tumor was totally resected. A bilateral subduroperitoneal shunt was placed to alleviate postoperative subdural effusion. Postoperatively, her visual field improved remarkably. When treating craniopharyngioma in the elderly, it is advisable to choose a conservative approach if applicable. When a more radical therapeutic approach is taken, it should be borne in mind that preexisting dementia and postoperative subdural effusion due to brain atrophy often preclude the patient's early recovery.

Nephrotic syndrome in a bone marrow transplant recipient with chronic graft-versus-host disease

A 21-year-old male developed massive proteinuria and microscopic hematuria, 1 year after allogeneic BMT for acute lymphoblastic leukemia. These symptoms occurred during an exacerbation of chronic cutaneous graft-versus-host disease (GVHD). Renal biopsy revealed granular deposits of IgG and IgM along the glomerular basement membrane, and subepithelial electron dense deposits. A diagnosis of membranous nephropathy was made. With prednisolone therapy proteinuria decreased gradually, and amelioration of cutaneous lesions was also noted. It was speculated that the disordered immune regulation of chronic GVHD resulted in the development of immune complex nephritis.

Macrophages in childhood IgA nephropathy

The role of glomerular macrophages in IgA nephropathy in children was investigated using a new monoclonal antibody (KP1) as a probe. The average number of glomerular macrophages per patient (ANM/P) was closely correlated with the degree of hematuria (P < 0.01) as well as with the degree of leukocyturia (P < 0.01) in the absence of any correlation with proteinuria, serum IgA levels or the interval between the detection of urine abnormalities and renal biopsy. ANM/P was significantly higher in patients diagnosed pathologically as having focal and diffuse proliferative glomerulonephritis than in patients with minor glomerular abnormalities or advanced sclerosis (P < 0.05). Among various types of glomerular morphology in individual patients, macrophages predominantly infiltrated glomeruli with cell-proliferative lesions despite an absence of any increase in glomeruli with minor abnormalities or with sclerosis. Macrophages were mainly localized within the capillary lumen in association with endocapillary proliferative lesions (tuft necrosis), they accumulated in areas of mesangial proliferation, and they were attached to Bowman's capsule in segmental lesions. Macrophages were less evident in sclerosis. Furthermore, ultrastructural analysis revealed macrophages in the paramesangial areas in close proximity to lytic changes in the glomerular basement membrane and effacement of epithelial foot processes. In addition, some cases in repeat biopsy shows prolonged or increased values of ANM/P after several years of interval in association with progression of proliferative lesions. These results suggest that macrophages infiltrate glomeruli during acute glomerular inflammation, and that they are involved in mesangial proliferation or the development of extracapillary lesions in the absence of apparent clinical symptoms. Furthermore, recurrence or prolonged infiltration may promote progression of IgA nephropathy.

ABO incompatible kidney transplantation in children

We have performed 7 pediatric kidney transplantations from living related donors of ABO incompatibility. All patients preoperatively underwent plasmapheresis with or without immunoadsorption to reduce anti-A and/or anti-B antibodies. Immunosuppression initially consisted of methylprednisolone, cyclosporine, azathioprine, antilymphocyte globulin and deoxyspergualin. At transplantation splenectomy was simultaneously performed in all patients. Median followup is 44 months (range 31 to 58). Patient and graft survival rates are 100% to date. There were no uncontrollable vascular rejection episodes, and post-transplant anti-A and/or anti-B antibody titers were always less than 1:32. Transplantation across the ABO blood barrier remains challenging today. However, our small series clearly shows that the preoperative reduction of ABO antibody, simultaneous splenectomy and strict immunosuppressive therapy cause successful long-term results in children.

New 5-HT3 (serotonin-3) receptor antagonists. IV. Synthesis and structure-activity relationships of azabicycloalkaneacetamide derivatives

The synthesis and structure-activity relationships of a series of new azabicycloalkanes as 5-HT3 (serotonin-3) receptor antagonists are described. Our study on the azabicycloalkaneacetamide derivatives showed that 2,3-dihydroindole as the aromatic ring moiety afforded potent 5-HT3 receptor antagonist activity, as judged by blockade of bradycardia induced by i.v. injection of 2-methylserotonin in anesthetized rats. 7-Azaindole as the aromatic moiety afforded weak 5-HT3 receptor antagonists activity. The best 5-HT3 antagonists in this study were endo-3,3-diethyl- (9k) and 3,3-dimethyl-2,3-dihydro-1-[(8-methyl-8-azabicyclo[3.2.1]oct-3-yl) acetyl-1H-indole (9d), being approximately 10-fold more potent than ondansetron (1). This study shows that the azabicycloalkaneacetyl group is a new pharmacophoric element as a basic nitrogen and a linking carbonyl moiety.

[Experimental study on early detection of alloxan-induced pulmonary injury by magnetic resonance imaging]

We studied the early detection of alloxan-induced pulmonary injury by magnetic resonance imaging in vivo. Permeability edema was induced in ten rats by intravenous injection of alloxan at 100 mg/kg. T1-and T2-weighted images were acquired in five rats every 30 min for 120 min after alloxan injection. Five rats served as controls. The rats were sacrificed immediately after imaging and examined microscopically. CT images were also acquired in five rats every 30 min for 120 min after alloxan injection. Five rats served as controls. The rats were sacrificed immediately after imaging, and the wet-to-dry ratio of the lung was measured. In T1-weighted images, relative signal intensity from the lung with permeability edema rose from 30 min to 120 min, and was greater than that from normal lung every time. In T2-weighted images, there was no statistically significant difference in relative signal intensity of the lung between permeability edema and the control during 120 min. In CT images, there was also no statistically significant difference in lung density between permeability edema and the control during 120 min. There was no statistically significant difference in the wet-to-dry lung ratio between edematous lung and normal lung. In histological study, mild congestion and interstitial edema were observed in edematous lung. These results suggest the potential capability of MR imaging in detecting the early phase of permeability pulmonary edema.

DsbA-DsbB interaction through their active site cysteines. Evidence from an odd cysteine mutant of DsbA

Formation of disulfide bonds in Escherichia coli envelope proteins is facilitated by the Dsb system, which is thought to consist of at least two components, a periplasmic soluble enzyme (DsbA) and a membrane-bound factor (DsbB). Although it is believed that DsbA directly oxidizes substrate cysteines and DsbB reoxidizes DsbA to allow multiple rounds of reactions, direct evidence for the DsbA-DsbB interaction has been lacking. We examined intracellular activities of mutant forms of DsbA, DsbA30S and DsbA33S, in which one of its active site cysteines (Cys30 or Cys33, respectively) has been replaced by serine. The DsbA33S protein was found to dominantly interfere with the disulfide bonds formation and to form intermolecular disulfide bonds with numerous other proteins when cells were grown in media containing low molecular weight disulfides such as GSSG. In the absence of added GSSG, DsbA33S protein remained specifically disulfide-bonded with DsbB. These in vivo results not only confirm the previous findings that Cys30 of DsbA is hyper-reactive in vitro but provide evidence that DsbA indeed interacts selectively with DsbB. We propose that the Cys30-mediated DsbA-DsbB complex represents an intermediate state of DsbA-DsbB recycling reaction that has been fixed because of the absence of Cys33 on DsbA.

Dynamic MRI with slow injection of contrast material for the diagnosis of pituitary adenoma

Magnetic resonance (MR) imaging of pituitary adenoma is usually carried out in dynamic studies with bolus contrast material injections, with the result that few strong images are obtained. Dynamic studies using a slowly injected contrast material were carried out in 14 cases of pituitary adenomas. The examinations were performed with a 1.5 Tesla superconducting MR imaging system using the spin-echo technique. Gd-DTPA (0.1 mmol/kg) was slowly injected (within 90 sec) by hand, providing seven to nine dynamic images during 350 sec from the start of injection. The average time to reach the maximum signal intensity was 170.6 sec in adenoma and 156.2 sec in normal gland tissue. The maximum contrast signal intensity ratio of adenoma to normal gland was 0.527 in the fifth image. The contrast of adenoma to normal gland tissue was calculated by the following formula: ASII (adenoma signal intensity index) = (adenoma signal intensity-tissue signal intensity)/tissue signal intensity. The most remarkable contrast between adenoma and normal tissue was obtained from the fourth to eighth images. In other words, we could obtain the strongest contrast at 144.8 sec to 299.6 sec from the start of contrast injection. Our results with slow injection suggest that stronger images can be obtained a longer period after contrast injection.

Differential expression of Fas antigen and Bcl-2 protein on CD4+ T cells, CD8+ T cells, and monocytes

Fas antigen and Bcl-2 protein are considered to be involved in cellular homeostasis. We precisely analyzed the expression of human Fas antigen and Bcl-2 protein on CD4+ T cells, CD8+ T cells, and monocytes. The positivities of Fas antigen on CD4+ and CD8+ T cells increased with aging. In CD4+ T cells, the Fas-/CD45RO+ subpopulation was dominant compared with the Fas+/CD45RO- subpopulation. Conversely, in CD8+ T cells, the Fas+/CD45RO- subpopulation was dominant compared with the Fas-/CD45RO+ subpopulation. Monocytes exhibited high positivity of Fas antigen and low fluorescence intensity of Bcl-2 protein compared with T cells. These results suggest that Fas antigen acts in different processes of cellular homeostasis between CD4+ and CD8+ T cells and that expression of Fas antigen and Bcl-2 protein is involved in homeostasis of monocytes as well as lymphocytes.

A transcription terminator signal necessary for plasmid ColIb-P9 replication

Replication of the IncI alpha plasmid ColIb-P9 requires the repZ gene, which encodes an essential, unstable initiator protein termed RepZ. Although many functional features of the ColIb-P9 replicon resemble those of structurally unrelated IncFII plasmids R1 and NR1, the role of transcription of repZ towards the replication origin is poorly understood. Using a series of deletion and substitution mutants of the ColIb-P9 replicon, we found that RepZ prefers to act in cis and that a spacer sequence between repZ and the origin is required for replication. This spacer element, referred to as CIS, retained strong transcription terminator activity. Efficient transcription terminators, whether Rho-dependent or -independent, were capable of replacing CIS function for in vivo replication; ColIb-P9 replicated better as transcription terminated more efficiently within CIS. When the CIS element was substituted for by a strong Rho-dependent terminator, such as lambda tR1 or E. coli trp t', in vivo replication of these recombinant replicons became dependent on the Rho factor, in contrast to the authentic ColIb-P9 replicon.

Early recurrence of hyperthyroidism in patients with Graves' disease treated by subtotal thyroidectomy

Prerequisites for surgical treatment of Graves' disease are that it can be done safely and that it is associated with a low incidence of recurrent hyperthyroidism. Early recurrence is especially undesirable. We studied 728 patients with Graves' disease treated by subtotal thyroidectomy using multivariate analysis in order to determine the factors related to early recurrence. The following factors were analyzed: age, sex, duration of medical treatment, weight of resected thyroid tissue, thyroid remnant size, preoperative level of thyroid-stimulating hormone (TSH) binding inhibitory immunoglobulin (TBII), and antimicrosomal hemagglutination antibody (MCHA). "Early recurrence" was defined as TSH suppression observed within the first year after surgery and continuing for at least 6 months. A total of 106 patients (14.6%) had early recurrence. Statistical analyses were performed by the chi-square test for univariate analysis and a logistic model for multivariate analysis. Significant factors were thyroid remnant size, MCHA, and TBII. These results indicated that TBII and MCHA are related to early recurrence of hyperthyroidism, and smaller remnant size is recommended for patients with a high MCHA titer or a high TBII level (or both) in order to avoid early recurrence.

A scintigraphical qualitative analysis of peripheral vascular sympathetic function with meta-[123I]iodobenzylguanidine in neurological patients with autonomic failure

In order to assess qualitatively the sympathetic functions of the peripheral vessels, we performed a scintigraphical study of the entire body with meta-[123I]iodobenzylguanidine (MIBG) in 13 patients with autonomic failure and 11 healthy subjects as control. The patients comprised seven with multiple system atrophy (MSA), two with pure autonomic failure (PAF), three with Parkinson's disease with autonomic failure (PD with AF) and one with familial amyloid polyneuropathy (FAP). No clinical evidence of vascular disease was noted in any of the patients and the control subjects. We investigated their autonomic functions using the head up tilt test as well as norepinephrine and isoproterenol infusion tests. We found that: (i) All of the control subjects showed satisfactory MIBG uptake; (ii) all of the patients with PAF and FAP, most of whom had postganglionic sympathetic lesions, showed supersensitivity and low MIBG uptake; (iii) almost all the patients with MSA, who were considered to have mainly preganglionic sympathetic lesions, showed supersensitivity and diminished MIBG uptake, although the patients with olivopontocerebellar atrophy showed supersensitivity but not diminished MIBG uptake. In conclusion, these results suggest that peripheral vascular scintigraphy using MIBG is useful in detecting peripheral adrenergic dysfunction.

Cloning, sequencing, and expression of the dipeptidyl peptidase IV gene from Flavobacterium meningosepticum in Escherichia coli

The dipeptidyl peptidase IV (DP IV, EC 3.4.14.5) gene from Flavobacterium meningosepticum was cloned by Southern and colony hybridizations using probes amplified by PCR, and expressed in Escherichia coli DH1. E. coli DH1 harboring pFDP-H1, which was a subclone derived from the positive clone pFDP-1, showed 3.5-fold higher activity than F. meningosepticum. Nucleotide sequencing analysis revealed an open reading frame of 2133 bp, coding for a protein of 711 amino acids with a predicted molecular weight of 80,626. The expressed enzyme in E. coli DH1/pFDP-H1 was purified about 345-fold with an activity recovery of 12.3%. The molecular weight of the purified enzyme was estimated to be 75,000 by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and 160,000 by gel filtration, respectively, suggesting a dimeric form of the native enzyme. The deduced amino acid sequence of DP IV was homologous to those of the serine proteases of the "prolyl endopeptidase family." A sequence near the C-terminal region and the putative catalytic triad residues were well conserved among these enzymes.

Modulation by bovine angiogenin of tubular morphogenesis and expression of plasminogen activator in bovine endothelial cells

Angiogenin is a potent angiogenic molecule in the chick chorioallantoic membrane assay and rabbit corneal assay. However, no angiogenic activity has been reported in in vitro system. In this study, we isolated and purified angiogenin from bovine milk, and the biological effect of the bovine angiogenin on bovine endothelial cells was examined in in vitro angiogenesis models. Bovine angiogenin significantly stimulated both cell migration and formation of tube-like structures in the collagen gel by bovine aortic endothelial cells. Angiogenin at 10-100 ng/ml stimulated about 2-fold higher the tube formation when basic fibroblast growth factor (bFGF) at 10 ng/ml stimulated about 3-fold over the control. Tubular morphogenesis stimulated by bFGF or angiogenin was almost completely blocked in the presence of aprotinin, an inhibitor of serine proteases. Angiogenin up-regulated both mRNA level and activity of urokinase type plasminogen activator, a key mediator of angiogenesis. Moreover, both bFGF and bovine angiogenin induced a marked increase of c-fos mRNA level at 30 min after stimulation. These novel effects of bovine angiogenin are to be discussed in relation to its structure specificity.

Regulation of lrp gene expression by H-NS and Lrp proteins in Escherichia coli: dominant negative mutations in lrp

Lrp (leucine-responsive regulatory protein) is a global transcription factor of Escherichia coli and regulates, negatively or positively, many genes including lysU, which encodes lysyl-tRNA synthetase. Dominant negative mutations that derepress lysU expression were isolated in this study. These mutations affected a predicted DNA-binding domain of Lrp and mutants were defective DNA-binding domain of Lrp and mutants were defective both in activation of ilvIH expression and in repression of lysU expression. Consistent with the previous notion that lrp is autoregulated, lrp expression was derepressed by these mutations and repressed by multi-copy plasmids carrying lrp+. Moreover, we found by gene fusion and Northern blot hybridization that the "histone-like" protein, H-NS, bound specifically to a promoter segment of lrp in vitro, and the level of lrp expression increased in the hns null mutant. These results indicated that the lrp gene is not only feedback regulated by Lrp but is also controlled by H-NS protein.

Management of recurrent hyperthyroidism in patients with Graves' disease treated by subtotal thyroidectomy

If the aim of surgical treatment for Graves' disease is not permanent hypothyroidism, it is difficult to avoid recurrent hyperthyroidism completely. The management of recurrent hyperthyroidism, however, is neither easy nor obvious. Improvement in the sensitivity of TSH assay has allowed the diagnosis of latent hyperthyroidism. Little is known about the clinical course of latent hyperthyroidism. We studied the management and outcome of recurrent hyperthyroidism in patients with Graves' disease treated by subtotal thyroidectomy. Between January 1988 and August 1991, 1115 patients with Graves' disease were treated by surgery. Postoperative thyroid function was evaluated by free T3, free T4 and TSH measurements. One hundred seventy-five patients with suppressed TSH secretion for at least 6 months were categorized as having recurrent hyperthyroidism. Eighty patients (45.1%) also had elevated thyroid hormone levels, (group 1). The remaining 95 patients (54.9%) had normal thyroid hormone levels with suppressed TSH values (group 2). In group 1, 58 patients were treated with antithyroid drug (ATD), 12 with iodine and 10 with radioiodine (RI). Remission of Graves' disease was obtained in 22 patients (11 by ATD, 1 by iodine and 10 by Ri). On the other hand, patients in group 2 were followed up without medication, and spontaneous remission was observed in 21 of theln (22.1%). It was difficult to induce remission of overt recurrent Graves' disease by ATD or iodine. In contrast spontaneous remission could be obtained in some patients with postoperative latent hyperthyroidism.

Different Ca2+ channels in soma and dendrites of hippocampal pyramidal neurons mediate spike-induced Ca2+ influx

1. Intracellular recordings, in conjunction with fura-2 fluorescence imaging, were used to evaluate the contribution of the different Ca2+ channel subtypes to the Ca2+ influx induced by back-propagating trains of action potentials. High-threshold channels contributed mainly to Ca2+ influx in pyramidal cell somata and proximal dendrites, whereas low-threshold and other Ni(2+)-sensitive channels played a greater role in more distal dendritic signaling. These data suggest that the different Ca2+ channel types participate in distinct physiological functions; low-threshold channels likely play a greater role in dendritic integration, whereas high-threshold channels are more important for somatic Ca(2+)-dependent processes.

Establishment and characterization of human gastric and colonic xenograft lines resistant to CPT-11 (a new derivative of camptothecin)

CPT-11-resistant human gastric and colonic xenograft lines were established by direct intratumoral injection of CPT-11 into subcutaneous SC-1-NU and CC-2-NU tumors in nude mice once a week for 10 months. The resistance of these xenograft lines to CPT-11 was confirmed by growth inhibition rate, to be 36.3% and 45.4%, respectively, compared to each parent cell line. DNA topoisomerase I activity of the nuclear extracts of SC-1-NU/CPT-11 and CC-2-NU/CPT-11, as assayed by relaxation of supercoiled DNA Col-E1, was significantly less than those of the parent lines. The cellular levels of topoisomerase I in those resistant lines measured by Western blot analysis were 0.57- and 0.79-fold lower than those of the parental lines, respectively. However, the activity of DNA topoisomerase II of those resistant cell lines assayed by decatenation of kinetoplast DNA was higher than that of the parental lines and the cellular levels of topoisomerase II in the resistant lines measured by Western blot analysis were 10.8- and 8.1-fold higher than those of the parent lines. Intracellular accumulation of CPT-11 in CPT-11-resistant tumors was not changed as compared to that of the parental lines, but hydrolysis of CPT-11 to more active SN-38 was reduced in the resistant tumors.