Eculizumab treatment in paediatric patients diagnosed with aHUS after haematopoietic stem cell transplantation: a HSCT-TMA case series from Japanese aHUS post-marketing surveillance

Haematopoietic stem-cell transplantation (HSCT)-associated thrombotic microangiopathy (HSCT-TMA) is a serious complication with high mortality. Accumulating evidence suggests that complement dysregulation is potentially involved in the development of HSCT-TMA. We retrospectively analysed the clinical characteristics and outcomes of thirteen paediatric patients who were diagnosed with atypical haemolytic uremic syndrome and treated with eculizumab to manage HSCT-TMA during post-marketing surveillance in Japan. The median time from HSCT to TMA was 31 days (Interquartile range, IQR;21-58) and the median doses of eculizumab was three (IQR;2-5). Seven patients (54%) were alive at the last follow-up while six died due to complications related to HSCT. Six of seven survivors initiated eculizumab after insufficient response to plasma therapy. Following eculizumab treatment, median platelet counts and LDH levels in all survivors significantly improved and renal function improved in 4/7 patients. All survivors possessed potential risk factors of complement overactivation. During the follow-up period after eculizumab discontinuation (median;111.5 days, IQR;95-555), no TMA recurrence was observed. In this analysis, eculizumab showed benefit in over half of this paediatric patient population. Ongoing clinical studies are expected to optimize the treatment regimen of terminal complement pathway inhibitor, and it may become a therapeutic option for paediatric HSCT-TMA in the future.

Application of a scoring system in Japanese patients diagnosed with atypical hemolytic uremic syndrome to assess the relationship between the score and clinical responses to eculizumab

BACKGROUND

Atypical hemolytic uremic syndrome (aHUS) is caused by complement dysregulation and is generally diagnosed by exclusion from other disorders of thrombotic microangiopathy (TMA). Eculizumab, a terminal complement inhibitor, has been approved for aHUS treatment since 2013 in Japan. Recently, a scoring system was published to support diagnosis of aHUS. Herein we modified this scoring system to apply it to patients diagnosed with aHUS and treated with eculizumab, and assessed the association between the score and clinical responses to eculizumab.

METHODS

One hundred eighty-eight Japanese patients who were clinically diagnosed with aHUS, treated with eculizumab, and enrolled in post-marketing surveillance (PMS) were included in this analysis. Some of parameters in the original scoring system were replaced with clinically similar parameters collected in the PMS to modify the system, hereafter referred to as the TMA/aHUS score, which ranges from -15 to 20 points. Treatment responses within 90 days after eculizumab initiation were also assessed, and the relationship between treatment response and TMA/aHUS scores calculated at TMA onset was explored.

RESULTS

The median (range) TMA/aHUS score was 10 (3-16). Receiver operating characteristic curve analysis showed that the cutoff value of TMA/aHUS score to predict treatment response to eculizumab was estimated as 10, and negative predictive value indicated that ≥ 5 points was appropriate to consider assessing the treatment response to eculizumab; 185 (98%) patients had ≥ 5 points and 3 (2%) had < 5 points. Among the patients with ≥ 5 points, 96.1% showed partial response and 31.1% showed complete response. One of the three patients with < 5 points met partial response criteria. No significant difference in the TMA/aHUS scores was observed between survivors and non-survivors, suggesting that the score was not appropriate to predict the outcome (i.e., survival/death) in patients treated with eculizumab.

CONCLUSION

Almost all patients clinically diagnosed with aHUS scored ≥ 5 points and responded to eculizumab. The TMA/aHUS score system could become a supporting tool for the clinical diagnosis of aHUS and probability of response to treatment with a C5 inhibitor.

TRIAL REGISTRATION

This study was conducted as per good PMS practice guidelines for drugs (MHLW Ministerial Ordinance No. 171 of 2004).

Loss of RUBCN/rubicon in adipocytes mediates the upregulation of autophagy to promote the fasting response

Upon fasting, adipocytes release their lipids that accumulate in the liver, thus promoting hepatic steatosis and ketone body production. However, the mechanisms underlying this process are not fully understood. In this study, we found that fasting caused a substantial decrease in the adipose levels of RUBCN/rubicon, a negative regulator of macroautophagy/autophagy, along with an increase in autophagy. Adipose-specific rubcn-knockout mice exhibited systemic fat loss that was not accelerated by fasting. Genetic inhibition of autophagy in adipocytes in fasted mice led to a reduction in fat loss, hepatic steatosis, and ketonemia. In terms of mechanism, autophagy decreased the levels of its substrates NCOA1/SRC-1 and NCOA2/TIF2, which are also coactivators of PPARG/PPARγ, leading to a fasting-induced reduction in the mRNA levels of adipogenic genes in adipocytes. Furthermore, RUBCN in adipocytes was degraded through the autophagy pathway, suggesting that autophagic degradation of RUBCN serves as a feedforward system for autophagy induction during fasting. Collectively, we propose that loss of adipose RUBCN promotes a metabolic response to fasting via increasing autophagic activity.

Identification of CUL4A-DDB1-WDFY1 as an E3 ubiquitin ligase complex involved in initiation of lysophagy

Macroautophagy is a bulk degradation system in which double membrane-bound structures called autophagosomes to deliver cytosolic materials to lysosomes. Autophagy promotes cellular homeostasis by selectively recognizing and sequestering specific targets, such as damaged organelles, protein aggregates, and invading bacteria, termed selective autophagy. We previously reported a type of selective autophagy, lysophagy, which helps clear damaged lysosomes. Damaged lysosomes become ubiquitinated and recruit autophagic machinery. Proteomic studies using transfection reagent-coated beads and further evaluations reveal that a CUL4A-DDB1-WDFY1 E3 ubiquitin ligase complex is essential to initiate lysophagy and clear damaged lysosomes. Moreover, we show that LAMP2 is ubiquitinated by the CUL4A E3 ligase complex as a substrate on damaged lysosomes. These results reveal how cells selectively tag damaged lysosomes to initiate autophagy for the clearance of lysosomes.

High Prevalence of Pollinosis Symptoms among the Farmers Cultivating Japanese Pears

In a district of Japanese pear cultivators, a questionnaire survey and an IgE antibody survey were conducted on the pollinosis. A high prevalence of 36.3 % of the farmers complained of pollinosis symptoms. By the IgE antibody survey, the symptoms were found to be related to the airborne pollens in the orchard.

Allergenic pollens and spores in the working environment of Japanese pear farmers

Occupational allergies such as pollinosis are reported in several agricultural works in Japan. Many pollens and spores were observed in Japanese pear orchard during the artificial pollination season. By the study on daily symptoms in an allergic farmer, we confirmed that the pollinosis symptoms were most common and most severe during the artificial pollination. These results suggest that the exposure to allergenic pollens and spores induces allergic symptoms. Thus, caution should be paid for the avoidance of the exposure to these allergenic pollens and spores to prevent the allergy.

Staphylococcal scalded skin syndrome. II. Serum level of anti exfoliatin and anti alpha-toxin in patients with staphylococcal scalded skin syndrome or bullous impetigo

In order to study the differences between staphylococcal scalded skin syndrome (SSSS) and bullous impetigo, the anti exfoliatin level was assessed in the sera from both groups of patients, and no significant difference in the level was found. However a significant difference was noted in the anti alpha-toxin levels in sera from both group of patients; that of SSSS patients was much lower than that of impetigo patients and of children in a control group. Five out of 6 patients with SSSS showed an unchaged level of anti alpha-toxin at the second examination, while an increased anti exfoliatin level was noted in 4 out of 6 SSSS patients.

Effects of maternal exposure to cadmium on pregnancy outcome and breast milk

OBJECTIVE

The effects of cadmium (Cd) on birth weight have been discussed in the scientific literature. However, investigations on the effects of maternal body burden of Cd on the next generation during pregnancy and lactation have been limited. The relation between maternal exposure to Cd and pregnancy outcome or Cd in breast milk in Japanese mothers was investigated.

METHODS

Cd concentrations in urine and colostrum milk samples of 57 mothers were measured by atomic absorption spectrophotometery. The relations between maternal urinary Cd and infant growth, gestational age at birth, and Cd in breast milk were investigated.

RESULTS

The rate of perterm deliveries of mothers with higher urinary Cd (> or =2 nmol/mmol creatinine (Cr)) was higher than that of mothers with lower urinary Cd (<2 nmol/mmol Cr). The gestational age was significantly correlated with urinary Cd even after adjustment for maternal age. The height and weight of newborn infants of mothers with higher urinary Cd were significantly lower than those of the newborn infants of mothers with lower urinary Cd, but these decreases were ascribed to early delivery induced by Cd. The Cd in breast milk of mothers with higher urinary Cd was significantly higher than that of mothers with lower urinary Cd. A significant positive correlation was found between maternal urinary Cd and Cd in breast milk.

CONCLUSION

Maternal exposure to Cd seems to increase early delivery, which leads to a lower birth weight. Also, the Cd is transferred in part to the next generation through breast milk after birth.

Development of the fluorometric ELISA method for determination of alpha1-microglobulinuria in a cadmium-polluted area in Japan

OBJECTIVES

To evaluate the usefulness of a newly developed fluorometric enzyme-linked immunosorbent assay (fluorometric ELISA) method for quantification of alpha1 -microglobulin (alpha1-m, protein HC) in an epidemiological study.

METHODS

Urinary alpha1-m in 37 female inhabitants in a cadmium-polluted area, including seven cases with Itai-itai disease, and ten inhabitants in a non-polluted area in Japan were examined. The alpha1-m was measured by both the fluorometric ELISA and a commercially available enzyme immunoassay (EIA) method to evaluate correlation of the two measurements. Concentration of beta2-microglobulin (beta2-m) was also determined in the same samples.

RESULTS

The detection limit of this method was 3 ng/ml or less of alpha1-m. A significant, high positive correlation was obtained between the alpha1-m concentrations measured with the fluorometric ELISA and that of EIA (r = 0.95, P < 0.0001). A significant association was also shown between the alpha1-m and beta2-m concentrations in the urine samples. The concentrations of urinary alphal-m of the inhabitants in the cadmium-polluted area (mean: 6.21 mg/l, 95% confidence interval (95% CI): 4.06-9.50 mg/l) were significantly higher than those of the reference area (mean: 2.19 mg/l, 95% CI: 1.90-2.67 mg/l). The urinary alpha1-m level of the Itai-itai patients was shown to be highest at 39.63 mg/l (95% CI: 28.27 55.55 mg/l). When the cut-off value of 10 mg/l was employed, alpha1-m had a sensitivity of 100% and specificity of 100% for Itai-itai disease.

CONCLUSION

These results suggest that this fluorometric ELISA is a useful tool to determine urinary alpha1-m in the epidemiological survey of renal tubular dysfunction, especially in the cadmium-polluted area of Japan.

Renal tubular dysfunction in male inhabitants of a cadmium-polluted area in Toyama, Japan--an eleven-year follow-up study

An eleven-year follow-up study was carried out to elucidate the changes in the level of environmental exposure to cadmium (Cd) from rice after soil replacement of polluted paddy fields and these effects on urinary excretion of Cd in male inhabitants of a Cd-polluted area in Toyama, Japan. In addition, the prevalence of renal tubular dysfunction (RTD) was examined to clarify the progress of Cd-induced RTD. One hundred and twenty-seven male inhabitants born between 1914 and 1929 in 11 districts of the Cd-polluted Jinzu River basin and 31 reference subjects in 2 adjacent districts were examined twice in 1985-86 and 1996-97. The geometric means of Cd concentrations in polished rice (Cd-R) in the Cd-polluted areas were 0.18 ppm in 1985 and 0.21 ppm in 1986; these values were significantly higher than those of the reference areas (0.13 ppm in 1985 and 0.12 ppm in 1986). After 11 years, the Cd-R levels were significantly decreased to approximately half (0.08 ppm in 1996, 0.12 ppm in 1997) due to soil replacement of polluted paddy fields, which has been carried out since 1980. The mean Cd levels in urine (Cd-U) were significantly reduced from 7.9 and 9.5 microg/g creatinine in the initial study to 6.9 and 6.8 microg/g creatinine in the follow-up study. However, the prevalence of RTD, which was determined by urinary beta2-microglobulin exceeding 1 mg/g creatinine and urinary glucose exceeding 150 mg/g creatinine, increased from 18 and 23% in the 1985-86 study to 25 and 32% in the 1996-97 study, and a total of 12 new cases (12%) of RTD were found. Whereas, only one subject (4%) in the reference control areas was identified as RTD. Cd-induced RTD was prevalent, progressive and irreversible for male inhabitants of the Cd-polluted Jinzu River basin, although the environmental exposure to Cd through rice was significantly reduced by soil replacement of polluted paddy fields.

Social class difference in catch up growth in a national British cohort

AIM

To examine the influence of socioeconomic status on growth pattern in height from age 7 to 23 years.

METHODS

Prospective cohort study. A total of 10 200 white singleton born children from the 1958 British birth cohort (National Child Development Study) were analysed.

RESULTS

Differences in height by birth weight persisted throughout the follow up period. However, the mean differences in height between low birth weight infants (<2500 g) and adequate birth weight infants (>/=2500 g) were less notable in social classes I and II than in the lower social classes. The catching up of growth in height of low birth weight infants was also more pronounced in social classes I and II than in other social classes. That is, the mean height deficits of low birth weight infants were decreased from 2.9 cm at age 7, to 1.6 cm at age 16, and 2.5 cm at age 23; the significant difference disappeared after age 16 in social classes I and II. Although such improving tendency was more pronounced among the preterm born infants, a similar growth pattern was observed among the term infants. Such improvement was not observed in the other social classes.

CONCLUSION

The growth retardation in height by birth weight can be overcome by improved social conditions and proper health care from childhood to adulthood.

A novel avian hypothalamic peptide inhibiting gonadotropin release

The neuropeptide control of gonadotropin secretion at the level of the anterior pituitary gland is primarily through the stimulatory action of the hypothalamic decapeptide, gonadotropin-releasing hormone (GnRH), which was originally isolated from mammals and subsequently from non-mammals. To date, however, an inhibitory peptide of gonadotropin release is unknown in vertebrates. Here we show, in a bird, that the hypothalamus also contains a novel peptide which inhibits gonadotropin release. Acetic acid extracts of quail brains were passed through C-18 reversed-phase cartridges, and then the retained material was subjected to the reversed-phase and cation-exchange high-performance liquid chromatography (HPLC). The peptide was isolated from avian brain and shown to have the sequence Ser-Ile-Lys-Pro-Ser-Ala-Tyr-Leu-Pro-Leu-Arg-Phe-NH(2). Cell bodies and terminals containing this peptide were localized immunohistochemically in the paraventricular nucleus and median eminence, respectively. This peptide inhibited, in a dose-related way, gonadotropin release from cultured quail anterior pituitaries. This is the first hypothalamic peptide inhibiting gonadotropin release reported in a vertebrate. We therefore term it gonadotropin-inhibitory hormone (GnIH).

Seasonal allergic conjunctivitis induced by Japanese pear pollen

PURPOSE

To evaluate the ocular findings in patients with Japanese pear (Pyrus pyrifolia Nakai) pollinosis.

METHODS

Twenty-two farmers working on artificial pollination in Japanese pear orchards were examined for ocular itching, conjunctival conditions, presence of eosinophils in the conjunctival specimen, and nasal symptoms. Serum IgE antibody to Japanese pear pollen was determined in 16 farmers.

RESULTS

Of the 22 subjects, 3 (Nos. 3, 4, and 13) exhibited ocular itching, conjunctival hyperemia, eosinophils in the conjunctival specimen, and positive serum IgE antibodies to Japanese pear pollen. In these patients, the conjunctivitis disappeared after treatment with topical cromoglycate.

CONCLUSION

The present study demonstrated that seasonal allergic conjunctivitis may be induced by Japanese pear pollen (entomophilous flower pollen).

[A follow-up study on renal tubular dysfunction in women living in the cadmium-polluted Jinzu River basin in Toyama, Japan. Part 1. Changes in the level of exposure to cadmium after soil replacement of polluted paddy fields and the related effects on the prognosis of renal tubular dysfunction]

A follow-up study on renal tubular dysfunction was carried out on 193 female inhabitants of the cadmium (Cd)-polluted Jinzu River basin and 40 reference subjects living in an adjacent area in 1994-95. They were 54 to 70 years old when the initial examination was conducted in 1983-84. In the Cd-polluted Jinzu River basin, extensive reclamation of polluted rice fields has been conducted since 1979; as a result, the average Cd concentrations in polished rice consumed by the subjects in the 1994-95 study (0.12 ppm in 1994, 0.14 ppm in 1995) were significantly lower than those in the 1983-84 study (0.26 ppm in 1983, 0.29 ppm in 1984). The average Cd levels in urine in the follow-up study (7.5 micrograms/g Cr. in 1994, 7.7 micrograms/g Cr. in 1995) were also significantly lower than those in the initial study (13.5 micrograms/g Cr. in 1983, 13.3 micrograms/g Cr. in 1984). However, the mean values for urinary excretion of beta 2-microglobulin (beta 2-m) (3.9 mg/g Cr. in 1994, 3.7 mg/g Cr. in 1995) and glucose (203 mg/g Cr. in 1994, 251 mg/g Cr. in 1995) in the follow-up study were significantly higher than those obtained at the initial examination (2.0 mg/g Cr. and 125 mg/g Cr. in 1983 and 1.1 mg/g Cr. and 78 mg/g Cr. in 1984 for beta 2-m and glucose excretion, respectively). The magnitude of increase in urinary excretion of beta 2-m and glucose in inhabitants of the Cd-polluted area was significantly higher than that of the inhabitants of the reference area. Moreover, an increase was observed in the prevalence of renal tubular dysfunction determined by urinary beta 2-m exceeding 10 mg/g creatinine and urinary glucose exceeding 150 mg/g creatinine only among inhabitants of the Cd-polluted area; it is noteworthy that 31 new cases of renal tubular dysfunction were observed in the follow-up study. These results indicate that renal tubular dysfunction among inhabitants of the Cd-polluted Jinzu River basin is irreversible and progressive, and many new cases of renal tubular dysfunction were also noted over a period of 11 years, despite the fact that Cd exposure had decreased over the past 11 years.

Isolation and characterization of a novel bioactive peptide, Carassius RFamide (C-RFa), from the brain of the Japanese crucian carp

A novel bioactive peptide with the C-terminal RFamide was isolated from the brain of the Japanese crucian carp, Carassius auratus langsdorfii, by using the intestine of the fish as the bioassay system. The primary structure of the peptide was determined to be SPEIDPFWYVGRGVRPIGRFamide and it was designated Carassius RFamide (C-RFa). The sequence of C-RFa was found to be significantly homologous to the molluscan neuropeptide termed Achatina cardioexcitatory peptide 1 (ACEP-1). Both peptides have RPXGRFamide structure in their C-terminal moieties. C-RFa was found to have an excitatory effect on visceral muscle tissues of fish, newt, quail, and rat. In the stomach of the fish, Zacco temminckii, IGRFamide (C-RFa 17-20) was shown to be the minimal structure required for the excitatory effect and PIGRFamide (C-RFa 16-20) to be almost equipotent with the parent peptide C-RFa.

[Comparison of predictive methods of Sugi (Cryptomeria) atmospheric pollen counts using mean temperature, solar radiation and male flowering index--an example of Toyama Prefecture]

The previous years mean temperature of July, total solar radiation of July and August and the male flowering index were used to predict atmospheric pollen counts. We examined the adaptability of these predictions and we get following results: 1. Following good harvest years of male flower, atmospheric pollen counts predicted by previous year's mean temperature of July and the total solar radiation of July and August are higher than the actual atmospheric pollen count. 2. Prediction of atmospheric pollen counts by factors within the previous five years are more exact because matured Cryptomeria forests are increasing yearly. 3. There are few errors in prediction by the flowering index because the flower index reflects the actual harvest of male flower.

Clinical manifestations of Japanese cedar pollinosis: an epidemiological study

In an investigation of the clinical features of Japanese cedar pollinosis in Toyama Prefecture, Central Japan, an epidemiological study was carried out in 1991 by means of questionnaires. There were 1,720 female and 1,163 male patients, a total of 2,883 patients. In both female and male patients, the highest incidence was found in those in their thirties. The most frequent onset was 19th March 1991, when the maximum number of air-borne pollen was detected and also the highest temperature in March was recorded. The 236 patients in the children's group ranged in age from 5 to 15 years, and the number of male children was greater than that of female. The number of patients tended to increase only gradually up to the age of 11 years, and then rapidly from 12 to 15 years of age. The greatest number of patients developed symptoms at the age of 10 years. HD-RAST positivity was definitely higher in the children group than in the adult group. No significant association was found between the age of development of symptoms and HD-RAST positivity.

Cross-sectional assessment of renal function in the inhabitants of a cadmium-polluted area

To understand the development of cadmium (Cd)-induced renal tubular dysfunction, cross-sectional assessment of renal function in the inhabitants of the Cd-polluted Jinzu River basin in Toyama, Japan, was carried out. Sixty-seven men and 78 women, aged 56 to 71 years whose urinary beta 2-microglobulin (beta 2-m) exceeded 1,000 micrograms/g creatinine, were examined and divided into five groups according to their values of fractional excretion of beta 2-m (FE beta 2-m). Comparisons were made between six groups including the inhabitants of a non-polluted area as a reference group. Significantly increased values of fractional excretion of urate (FEUA), calcium (FECa), sodium (FENa), and chloride (FECl), serum creatinine and beta 2-m, and urinary protein were detected even in the subjects with FE beta 2-m level below 1 percent compared with the reference group. Fractional phosphate reabsorption (percent TRP) was significantly decreased in the subjects with FE beta 2-m level above 10 percent. Creatinine clearance (CCr) decreased with increase in FE beta 2-m, and the subjects with FE beta 2-m above 30 percent showed significantly decreased CCr values compared to those with FE beta 2-m below 30 percent. In summary, FEUA, FECa, FENa, and FECl, as well as low-molecular-weight proteins such as beta 2-m, are increased in the early stage of Cd-induced renal tubular dysfunction. Although percent TRP was maintained by the decreased CCr, there was a marked decrease in percent TRP in subjects with progressive stage showing FE beta 2-m level above 10 percent. No sex difference in renal tubular dysfunction was found in this cross-sectional study.

[Relationships between atmospheric Sugi (Japanese cedar)-pollen counts and indices of climatic conditions]

Atmospheric pollen surveys have been conducted using Durham's standard sampler for 12 years in Toyama Prefecture. The relationships between Sugi (Japanese cedar, Cryptomeria japonica D. Don) pollen and some indices of climatic conditions were analyzed. The results were as follows: 1. Total pollen counts showed a tendency to increase for 12 years, although the variation of the count was relatively large. 2. Significant correlations were found between pollen counts and some indices of the climatic conditions in July of the previous year, such as duration of sunshine, mean daily temperature and daily maximum, as well as minimum temperature. 3. Significant correlation was found between pollen count and duration of sunshine in January and March, and the amount of snowfall in March of the observed year using multiple regression analysis. Pollen counts were shown to be relatively high in years with short sunshine in January and long sunshine and heavy snow in March.

[Characteristics of pollen scattering from male sugi flowers in relation to occurring of symptoms in Japanese cedar pollenosis patients]

Generally, airborne scattering of sugi (Cryptomeria japonica D. Don) pollen begins to be observed coincidentally with the flowering of the male sugi flowers between February and April. However the male sugi flowers disperse a certain amount of pollen in early January, only small levels of which can be detected with a Durham's sampler. In some Japanese cedar pollinosis patients, allergic symptoms have been reported to occur in early January. Among 1,366 Japanese cedar pollinosis patients studied, 265 have experienced allergic symptoms before the first day of pollen scattering as determined with a Durham's sampler. Accordingly, it is suggested that substantial amounts of sugi pollen are scattered from early January, and that clinical symptoms can be induced in highly sensitive Japanese cedar pollinosis patients from early January, even before the flowering of sugi.

Occupational allergy to adult chironomid midges among environmental researchers

A case of occupational allergy to chironomid midges in research work is described. A researcher was exposed to adult chironomid midges during his research and developed allergic rhinitis after 10 years of such exposure. Using the midge extract of adult Chironomus plumosus (CP) (Linnaeus, 1758), both immediate skin test and the ophthalmic challenge test gave positive results. IgE antibody against adult CP was also demonstrated by the radioallergosorbent test. Four of the five serum samples of the environmental researcher examined showed a positive radioallergosorbent test to at least one of the adult midges breeding around eutrophic Japanese lakes. Enzyme-linked immunosorbent assay inhibition test and immunoblot experiments indicated that the remaining hemoglobin is one of the major allergens of adult CP. These results demonstrate that the exposure to adult chironomid midges is an important occupational hazard among environmental researchers.

Hypoproduction of erythropoietin contributes to anemia in chronic cadmium intoxication: clinical study on Itai-itai disease in Japan

Itai-itai disease is a condition caused by long-term exposure of the inhabitants of Toyama prefecture, Japan, to cadmium intoxication. The characteristic clinical features of this disease include renal tubular dysfunction, osteomalacia, and anemia. In order to clarify the pathogenesis of the anemia, the red blood cell count, hemoglobin concentration, hematocrit, serum iron level, total iron-binding capacity, serum ferritin level, serum erythropoietin level, creatinine clearance, fractional excretion of beta 2-microglobulin, and bone marrow morphology were determined in ten patients with Itai-itai disease. Low serum iron or ferritin levels were not observed, and bone marrow aspiration did not reveal any specific hematological disorders. A close relationship was observed between the decrease in the hemoglobin level and the progression of renal dysfunction. Low serum erythropoietin levels were detected despite the presence of severe anemia. These results suggest an important role of renal damage in the anemia which develops in Itai-itai disease.

Single-mode 1.34-microm Nd:YVO(4) microchip laser with cw Ti:sapphire and diode-laser pumping

We report cw single-mode output at 1.34 microm in a Nd:YVO(4) microchip laser pumped separately with a Ti:sapphire laser and a diode laser in the region of 809 nm. The 0.5 mm x 1.0 mm x 1.0 mm Nd(3+)-doped YVO(4) crystal produced output powers as high as 60 mW with slope efficiencies as high as 40% and laser thresholds between 155 and 275 mW by use of a pumped volume of approximately 150-microm diameter and 0.5-mm length. Data are also presented for the laser's performance as a function of pump wavelength and for the spectral variation of the output with crystal temperature.

[A study of thyroid hormone levels of inhabitants of the cadmium-polluted Kakehashi River basin]

We compared thyroid hormone levels of inhabitants (19 men and 16 women) of the cadmium (Cd)-polluted Kakehashi River basin in Ishikawa Prefecture, with those of subjects (23 men and 47 women) living in a non-polluted area. In addition, we investigated the relationships between the thyroid hormone levels and indices of renal dysfunction induced by Cd exposure. The following results were obtained: 1) The free T4 level of females was significantly lower than that of controls. 2) The T3 level of inhabitants of both sexes was significantly higher than that of controls. 3) The level of free T4 among females became lower with the increases of urinary beta 2-microglobulin (beta 2-MG), urinary protein, urinary sugar, urinary amino acids and serum creatinine (Cr) levels, and with decreases of creatinine-clearance (CCr) and %TRP. 4) We could not find any relationship between the increase of T3 and the indices of renal dysfunction induced by Cd exposure in either sex.

Cadmium induces interleukin-8 production in human peripheral blood mononuclear cells with the concomitant generation of superoxide radicals

Acute or chronic exposure to cadmium (Cd) causes severe organ damages with the infiltration of leukocytes, neutrophils in particular occurring in the acute phase. Interleukin-8 (IL-8), a novel neutrophil chemotactic and activating cytokine, is produced by various types of cells in response to a wide variety of inflammatory stimuli. The administration of an antibody against IL-8 has been shown to inhibit neutrophil infiltration in several animal models, indicating a causal relationship between IL-8 and neutrophil infiltration. Hence, in this study we investigated whether Cd induced IL-8 production in human peripheral blood mononuclear cells (PBMC). Cd, over a wide range of concentrations, did induce human PBMC to produce large amounts of bioactive IL-8, the maximal induction being observed at 10(-4) M. The production was inhibited specifically by a metal chelating agent, ethylenediaminetetraacetic acid (EDTA). Steady level of IL-8 mRNA increased within 30 min after the addition of Cd and reached a maximal level at 2 h, decreasing thereafter. A protein synthesis inhibitor, cycloheximide, failed to inhibit IL-8 mRNA accumulation, indicating that new protein synthesis was not required for IL-8 mRNA induction. Concomitantly with the induction of IL-8, within 10 min Cd generated reactive oxygen intermediates (ROI) in human PBMC. A radical scavenger, N-acetyl-L-cysteine (NAC), inhibited both IL-8 production and the generation of ROI, implying the possible involvement of ROI in IL-8 production. This notion was also supported by our findings that a superoxide generating agent, paraquat, induced IL-8 production in human PBMC and that NAC blocked this paraquat-induced IL-8 production.

[Abnormalities of calcium, phosphorous and vitamin D metabolism with proximal renal tubular dysfunction in subjects environmentally exposed to cadmium]

Calcium, phosphorus and vitamin D metabolism were examined in 21 male and 13 female subjects with renal tubular dysfunction in the cadmium-polluted Jinzu River basin in Toyama prefecture, Japan. Multiple proximal renal tubular dysfunction was detected in all subjects showing increased FE beta 2-m and FFua, generalized aminoaciduria and renal glucosuria. Reduced ability of tubular reabsorption of phosphate resulted in hypophosphatemia in 31% of the women. Despite decreased tubular reabsorption of calcium, the level of serum calcium remained normal in all subjects. Serum 1,25-dihydroxyvitamin-D [1,25(OH)2D], which is produced in the proximal tubules through 1 alpha-hydroxylation from 25-hydroxyvitamin-D [25OHD], was normal or increased to more than 60pg/ml. The serum level of 1,25(OH)2D was inversely related to creatinine clearance in both the men (p < 0.05) and women (p < 0.01). Serum iPTH was slightly increased to more than 0.9 mg/ml, whereas the levels of other hormones, including 25OHD, calcitonin, thyroxine (T4) and triiodothyronine (T3) were normal. The serum alkaline phosphatase activity and serum osteocalcin concentration were significantly increased compared to those of controls in both sexes. Bone loss detected by the measurement of bone density was prominent in female subjects. These results support the hypothesis that the serum phosphate concentration is more important than the serum concentration of 1,25(OH)2D for abnormalities of bone metabolism in cadmium-induced renal tubular dysfunction.

[Sugi (Cryptomeria japonica D. Don) pollen scattering out of season]

We investigated the preseasonal blooming conditions of the male flowers of Sugi (Cryptomeria japonica D. Don) which flowers commonly in spring. We also investigated atmospheric Sugi pollen during all seasons for three years from 1988 through 1991 to determine pollen scattering in autumn. Our results showed that a discernible amount of pollen is scattered from the middle of October into December; this scattering would be expected in the following spring. Almost none of the buds of the flowers collected in October and in November bloomed when incubated at temperatures ranging from 6 degrees C to 20 degrees C after low-temperature treatment to arise the blooms from dormancy. However, small numbers of the male flowers from various Sugi trees bloomed and scattered pollen under these conditions. We found that the ratio of the blooming male flowers was one-third or less per blossom. The ratio changed depending on the growth stage and incubation conditions. In conclusion, the density of airborne Sugi pollen scattering is not high in autumn in general. However, the density would be expected to be high enough to induce allergic reactions and clinical symptoms in some areas of Sugi growth, especially in a good harvest year.

[Prediction of the day on which sugi (Cryptomeria japonica D. Don) pollen scattering will begin--from view point of plant physiology]

We investigated the cumulative thermal constant and threshold temperature for the development of sugi (Cryptomeria japonica D. Don) male flowers to predict the day on which pollen scattering would begin. The threshold temperature for the development of sugi male flowers was 0.17 degrees C and the cumulative thermal constant was 184 degrees C/day. Using these results, we determined how long it would take for sugi to be awaken from dormancy and we investigated the meteorological date. Reactivation from dormancy requires 3 days, where the minimum temperature is less than 3 degrees C with a mean temperature of less than 6 degrees C; the following day must have a maximum temperature of more than 10 degrees C, and these conditions must be maintained for at least 2 days. From these results, it is not difficult to predict the day on which sugi pollen scattering will begin.

[Study of an outbreak of itai-itai disease]

We studied an outbreak of itai-itai disease in the Jinzu River basin, in Toyama, Japan. One hundred and fifty females recognized as itai-itai disease patients till by 1990 were studied for the ages and years of onset and residence in the cadmium-polluted area. 1. Cases were recognized from as early as 1929, increased gradually to the peak of 1955-1959 and rapidly decreased up to the 1970s. 2. It was found that the later the patients was born, the younger the age of onset, though there was no difference of ages of onset between the cases born in the 1910s and the cases born from 1920. 3. The onset of itai-itai disease was most frequently seen at 50-59 years of residence in the cadmium-polluted area. It was found that the later a person started to inhabit the cadmium-polluted area, the shorter the period of residence in the cadmium-polluted area up to onset of itai-itai disease. 4. Comparing the patients who inhabited the cadmium-polluted area from birth and those who had moved there from non-polluted areas, the age of onset was higher in the latter, but there were no significant differences in the period of residence up to onset. From these findings, it appeared that itai-itai disease was not caused by aging, but by cadmium exposure starting from the 1910s.

[Relationships between the pollen productions in sugi (Cryptomeria japonica D. Don) forests and the patterns of atmospheric scattering pollens in Toyama Prefecture--the example of Toyama Prefecture in 1990]

We investigated the geographical distribution of sugi (Cryptomeria Japonica D. Don) forests and the male flower-setting conditions of them in Toyama prefecture. The relationships between our findings and the atmospheric pollen scattering patterns were also studied. The results were as follows. 1. Atmospheric pollen counts and their scattering patterns were fairly easily explained by the geographical distribution of 30-year old sugi forests, the male flower-setting conditions and the first day pollen was scattered in those forests. 2. Total atmospheric counts and maximum sugi pollen peaks were significantly affected by the proximity of sugi forests at altitudes of less than 200 meter. 3. In the atmospheric pollen survey, the detected pollen counts decreased according to the distance between the observation sites and the sugi forests. And few pollen grains were observed from natural sugi forests growing at distances of 20 km to 30 km from the observation sites.

[Evaluation of qualitative and quantitative tests for proteinuria and glucosuria as screening tests for cadmium-induced renal tubular dysfunction]

To evaluate the screening tests for cadmium-induced renal tubular dysfunction, qualitative and quantitative tests for urinary protein and glucose have been done in 146 urine samples obtained from subjects who had lived in the cadmium-polluted Jinzu River basin in Toyama Prefecture, Japan. The subjects consisted of 66 men and 80 women aged 55 to 71 years with beta 2-microglobulinuria exceeding 1,000 micrograms/g creatinine. The results obtained from this study were as follows; 1) The positive reaction (above 1+) for protein by the dipstick method was seen in 19.7% of men and 20.0% of women, and for glucose using Tes-tape in 48.5% of men and 33.8% of women. 2) The geometric means of protein and glucose concentrations in urine were 16.4 mg/dl and 12.7 mg/dl in men, and 14.2 mg/dl and 6.8 mg/dl in women, respectively. 3) The criteria of the primary screening in the health survey system for the residents in cadmium-contaminated areas conducted by the Japan Environment Agency were a proteinuria level exceeding 10 mg/dl and a glucosuria above (+/-) with Tes-tape. Nearly all subjects with urinary beta 2-microglobulin exceeding 30 mg/g creatinine were screened by these criteria in both sexes, whereas only 52.9% of men and 30.0% of women who had urinary beta 2-microglobulin between 10 to 30 mg/g creatinine could be screened in this manner. These results indicate that semiquantitative tests are insufficient as initial tests for screening cadmium-induced renal tubular dysfunction.

Impaired urine concentrating ability in Itai-itai (ouch-ouch) disease

A case of Itai-itai (ouch-ouch) disease with reduced urinary kallikrein excretion and slightly enhanced renin-angiotensin-aldosterone system is described. Although it is well known that cadmium toxicity frequently affects the renal tubular lesions, this report is the first to demonstrate the impaired urine concentrating ability in this disease.

Determination of human aspartate aminotransferase isoenzymes by their differential sensitivity to proteases

The effect of various proteases (trypsin, chymotrypsin, subtilisin, protease 401, and thermolysin) on the mitochondrial isoenzyme (m-AST) and cytoplasmic isoenzyme (c-AST) of human and swine aspartate aminotransferase (AST;EC 2.6.1.1) was evaluated. All procedures including the reaction with proteases and the subsequent determination of the AST activity were carried out in an automatic analyzer. The mammalian c-AST was efficiently inactivated by chymotrypsin, subtilisin and protease 401 while m-AST activity decreased very slowly with these proteases. Thermolysin and trypsin showed much less effect on c-AST activity. Especially, chymotrypsin at concentrations of 0.5-1.0 g/L inactivated human c-AST almost completely but showed no detectable inactivating effect on m-AST. Thus chymotrypsin appears to be the most suitable protease for the differential determination of AST isoenzymes in human serum. Further studies on the effects of proteases with AST from other species showed that Escherichia coli AST resembled mammalian m-AST while Pseudomonas AST resembled c-AST.

Urinary trehalase activity as an indicator of kidney injury due to environmental cadmium exposure

One hundred and seventy-eight subjects, patients with Itai-itai disease and their family members, aged 12-87 years living in a cadmium (Cd)-polluted area in the Jinzu River basin (Cd-exposed group) and 176 controls (control group) were examined. In the Cd-exposed group urinary trehalase increased with increasing age, urinary beta 2-microglobulin (beta 2-m) and retinol-binding protein. Although urinary cadmium was higher in the Cd-exposed group, no particular correlation was found between urinary trehalase and urinary cadmium. Seventeen men and 11 women showed raised urinary trehalase activities despite normal values of urinary beta 2-m (less than 300 micrograms/g.creatinine), suggesting that urinary trehalase increases earlier than urinary beta 2-m. In 19 patients with Itai-itai disease included in the Cd-exposed group, urinary trehalase decreased with decreasing reciprocal of serum creatinine, suggesting that urinary trehalase decreases in the most advanced cases of chronic cadmium nephropathy due to reduced tubular cell mass.

Diffuse midperipheral acute retinal pigment epitheliopathy

We examined a 16-year-old boy with a remarkable decrease in vision OS. Typical lesions of acute retinal pigment epitheliitis (Krill's disease) were not present in the macula but were diffuse in the midperiphery. Angiographic findings were similar to those in Krill's disease. The left fundus returned to normal two weeks later, but ten months passed before electro-oculography, light sensitivity, and dark adaptation were normal. Thus, there may be two types of acute retinal pigment epitheliitis: one is Krill's disease, and the other is a vast disturbance in the retinal pigment epithelium.

Elevation of urinary trehalase activity in patients of itai-itai disease

The elevation of urinary trehalase activity in patients of itai-itai disease was examined. Urinary trehalase was correlated with tubular reabsorption of phosphorus (%TRP): the lower the trehalase activity, the worse was %TRP. Furthermore, this activity was inversely correlated with urinary glucose and urinary total protein. In itai-itai disease, the excretion of beta 2-microglobulin seems to be maximal, and urinary trehalase activity was low in the latter stages of the disease. It is inferred that itai-itai disease produces extremely severe tubular damage as well as glomerular dysfunction.

Phage patterns of Staphylococcus hyicus subsp. hyicus isolated from chickens, cattle and pigs

Bacteriophage typing was performed on 285 strains of Staphylococcus hyicus subsp. hyicus isolated from pigs, chickens, and cattle, using the 5 S. hyicus subsp. hyicus phages, S9, S13, S39, S188 and CH11. One hundred and twenty-eight (64.3%) of the 199 swine strains, 62 (100%) of the 62 chicken strains, and 24 (100%) of the 24 cattle strains were typable at either routine test dilution (RTD) or 100 X RTD. Most (124/128) of the typable swine strains showed phage patterns consisting of lytic reactions with one or more of the phages S9, S13, S39 and S188. Phage patterns including phage CH11 were detected in only 4 swine strains. All of the typable chicken strains showed phage patterns consisting of lytic reactions with phage CH11. Cattle strains had the phage patterns that were found most frequently in swine and chicken strains. This study suggested that phage typing might be a useful marker for distinguishing ecovars within S. hyicus subsp. hyicus.

Muscle tone and drug sensitivity of isolated bovine iris sphincter are enhanced at low temperatures

The effects of temperature on nerve-mediated or carbachol-induced contractions of isolated bovine iris-sphincter muscles were studied. A decrease in temperature (to below 36 degrees C) led to contraction of the iris sphincter. The contractile responses induced by intramural cholinergic nerve stimulation were augmented by moderate cooling (29 degrees-31 degrees C), but were markedly inhibited by severe cooling (less than 22 degrees C). On the other hand, after cooling the contractile amplitude induced by carbachol (3 X 10(-7) M) was enhanced to 258% +/- 16% (29 degrees-31 degrees C), and 185% +/- 12% (20 degrees-21 degrees C) of control levels. Whereas the cooling-induced development of muscle tone was inhibited by the presence of indomethacin and FPL-55712, the application of prostaglandins (10(-9) to 3 X 10(-8) M) led to restoration of the sensitivity of the muscle observed at low temperatures. As low temperatures increase the response of bovine iris-sphincter muscle, temperature might affect the state of the iris during intraocular clinical surgery and in cases of intraocular inflammation.

Urinary trehalase activity and renal brush-border damage in inhabitants of a cadmium-polluted area (Jinzu River basin)

Elevated urinary trehalase activity was observed in the inhabitants of the Jinzu River basin. Urinary trehalase activity was correlated with other urinalysis components, such as beta 2-microglobulin, glucose, amino nitrogen, and cadmium, of which a high level was observed in cadmium-polluted areas as compared with the reference area. Renal trehalase is specifically localized in tubular brush borders [M. Nakano, J. Histochem. Cytochem., 30 (1982) 1243-1248]. From these results it is inferred that tubular brush-border damage occurs in inhabitants of the Jinzu River basin.