Effect of Aspirin on Cancer Chemoprevention in Japanese Patients With Type 2 Diabetes: 10-Year Observational Follow-up of a Randomized Controlled Trial

OBJECTIVE

This study analyzed the efficacy of low-dose aspirin in cancer chemoprevention in patients with diabetes.

RESEARCH DESIGN AND METHODS

This study was a posttrial follow-up of the Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD) trial. Participants in the JPAD trial (2,536 Japanese patients with type 2 diabetes and without preexisting cardiovascular disease) were randomly allocated to receive aspirin (81 or 100 mg daily) or no aspirin. After that trial ended in 2008, we followed up with the participants until 2015, with no attempt to change the previously assigned therapy. The primary end point was total cancer incidence. We investigated the effect of low-dose aspirin on cancer incidence.

RESULTS

During the median follow-up period of 10.7 years, a total of 318 cancers occurred. The cancer incidence was not significantly different between the aspirin and no-aspirin groups (log-rank, P = 0.4; hazard ratio [HR], 0.92; 95% CI, 0.73-1.14; P = 0.4). In subgroup analyses, aspirin did not affect cancer incidence in men, women, or participants aged ≥65 years. However, it decreased cancer incidence in participants aged <65 years (log-rank, P = 0.05; HR, 0.67; 95% CI, 0.44-0.99; P = 0.048). After adjusting for sex, hemoglobin A_1c, smoking status, and administration of metformin and statins, aspirin significantly reduced cancer incidence in participants aged <65 years (adjusted HR, 0.66; 95% CI, 0.43-0.99; P = 0.04).

CONCLUSIONS

Low-dose aspirin did not reduce cancer incidence in Japanese patients with type 2 diabetes.

Acute coronary syndrome due to coronary artery compression by a metastatic cardiac tumor

A 60-year-old female without coronary risk factors was admitted to the hospital with ST-elevation acute coronary syndrome (ACS). She had previously suffered breast cancer and received radical mastectomy followed by chemotherapy and radiation. Emergent coronary angiography showed an occlusion of the proximal left anterior descending coronary artery (LAD) and coronary angioplasty was performed. Coronary computed tomography (CT) angiography (CTA) disclosed a tumor invading the left ventricular anterior wall and surrounding the coronary artery. Myocardial single-photon-emission CT (SPECT) using 123I-BMIPP showed a defect in the same portion. A fusion image of the CTA and the SPECT delineated a tumor surrounding the coronary artery. She finally died two months later from a terminal condition. Autopsy demonstrated a tumor involving the left ventricular anterior wall and surrounding the LAD. Pathology of the affected LAD showed only fibrous plaque without vulnerable plaque, thrombus, or tumor invasion to the coronary wall. Thus, compression of the coronary artery by the metastatic tumor was the most likely mechanism of ACS.

Acetylcholine- and ergonovine-induced coronary microvascular spasm reflected by increased coronary vascular resistance and myocardial lactate production

Diagnosis of coronary microvascular spasm remains largely speculative because it has been mostly based on chest pain and electrocardiographic ST-segment shift with slow filling of contrast medium into the coronary artery. A patient with resting chest pain and normal coronary angiograms underwent provocative tests with intracoronary acetylcholine (ACh) and ergonovine. During the tests, coronary diameter and flow velocity in the left anterior descending (LAD) coronary artery were measured with quantitative coronary angiography and intracoronary Doppler guide wire, respectively. Vascular resistance of the LAD and lactate production were determined separately. With injections of 100 microg of ACh and 20 microg of ergonovine, chest pain occurred with ST-segment elevation in the precordial leads in the absence of epicardial coronary spasm. Coronary vascular resistance increased by 2.2- and 1.6-fold of the baseline value with ACh and ergonovine, respectively. Myocardial lactate production was noted during the ST-segment elevation. Coronary microvascular spasm was verified by the increment in coronary vascular resistance and myocardial lactate production with concomitant ST-segment elevation in the presence of normal coronary angiograms.

Independent predictors of the severity of angiographic coronary atherosclerosis: the lack of association between impaired glucose tolerance and stenosis severity

Independent predictors of the severity of coronary atherosclerosis are ill defined. We sought to determine the predictors and examine the association of impaired glucose tolerance with stenosis severity. Four hundred thirty-seven patients were studied who underwent coronary angiography for suspected coronary artery disease. Serum concentrations of total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDLc), lipoprotein(a) [Lp(a)] and apolipoproteins (Apo A-I and Apo B) were measured and low-density lipoprotein cholesterol (LDLc) concentration was calculated. Except the patients treated for diabetes mellitus (DM), patients were classified into three groups such as normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and DM by glucose tolerance test. Coronary atherosclerosis index (CAI) representing the severity of coronary atherosclerosis was determined by summation of the stenosis score of all lesions on coronary angiograms. Results indicated that age, total amount of cigarettes smoked, Apo B/Apo A-I, and LDLc/HDLc correlated with CAI, whereas HDLc and Apo A-I concentrations inversely correlated with CAI. TC, TG, Lp(a), LDLc, Apo B concentrations and body mass index did not correlate with CAI. One- and two-hour plasma glucose concentrations and the area of plasma glucose concentration under the curve at the glucose tolerance test did not correlate with CAI, revealing that post-challenge glycemia is not associated with stenosis severity. CAI in IGT patients was significantly lower than that in DM patients but did not differ from that in NGT patients, indicating that IGT does not affect the stenosis severity. Multivariate analysis showed that age, male gender, Apo B/Apo A-I, DM, systemic hypertension, and total amount of cigarettes smoked were independent predictors of CAI.

Improvement of endothelium-dependent coronary vasodilation after a single LDL apheresis in patients with hypercholesterolemia

The purpose of this study was to determine whether a single LDL apheresis would improve impaired endothelium-dependent dilation of the coronary artery in patients with hypercholesterolemia. Hypercholesterolemia is associated with impaired endothelial function, and human studies using cholesterol-lowering drugs indicate that endothelial function in the coronary arteries improves with reduction of serum LDL cholesterol over 6 to 12 months. The internal diameter of the left coronary artery and the coronary blood flow were measured by intracoronary Doppler-wire measurement and quantitative angiography before and immediately after a single LDL apheresis in a population of 15 patients with familial hypercholesterolemia. Endothelium-dependent vasodilation was assessed by intracoronary infusion of acetylcholine (1, 10, and 50 microg/min), and endothelium-independent vasodilation was assessed by intracoronary bolus infusion of isosorbide dinitrate (2.5 mg) or papaverine (10 mg). A single 3-hour LDL apheresis reduced serum LDL cholesterol by an average of 86.6 +/- 1.7%. After the LDL apheresis, the changes in the coronary artery diameter and coronary blood flow in response to an infusion of 50 microg/min of acetylcholine increased significantly compared to the pre-apheresis values (from -19.7 +/- 4.8 to -2.9 +/- 3.0% [P < 0.01] and from 80.7 +/- 27.6 to 155.3 +/- 23.5% [P < 0.01], respectively). The LDL apheresis did not significantly change the response of either parameter to infusion with isosorbide dinitrate or papaverine. The endothelial function of the epicardial coronary artery and the coronary microvasculature improved in hypercholesterolemic patients after only a single LDL apheresis, a procedure that markedly reduces the serum level of LDL cholesterol.

Long-term administration of pravastatin reduces serum lipoprotein(a) levels

BACKGROUND

The long-term effect of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors on serum lipoprotein(a) (Lp(a)) levels has been poorly investigated.

OBJECTIVE

This study sought to examine the effect of 24 months' administration of pravastatin on serum Lp(a) levels.

SUBJECTS

23 patients with coronary artery disease and serum low-density lipoprotein (LDL) cholesterol levels of 120 mg/dl or above were included.

METHOD

Serum levels of lipids and Lp(a) were serially determined after the administration of pravastatin for 24 months.

RESULTS

Serum LDL-cholesterol (LDL-C) levels significantly decreased from 1 month after the drug administration and the reduction persisted for 24 months, whereas Lp(a) levels did not decrease at 3 months after the administration but significantly decreased at 12 months or more. The reduction in the Lp(a) levels was not related to the dose of pravastatin.

CONCLUSIONS

The results indicated that long-term administration of pravastatin for 12 months or more significantly reduced serum Lp(a) levels and the reduction of Lp(a) levels occurred much later than that of LDL-C levels. The delayed reduction in serum Lp(a) levels after the administration of pravastatin may be associated with a retarded inhibition of Lp(a) synthesis by the drug.

A single nucleotide polymorphism of the low molecular mass polypeptide 7 gene influences the interferon response in patients with chronic hepatitis C

Transporter associated with antigen processing (TAP) and low molecular mass polypeptides (LMP) play crucial roles in the human leukocyte antigen (HLA) class I-restricted antigen presenting systems. This study was performed to elucidate whether these antigen-presenting gene polymorphisms could influence the response to interferon (IFN) treatment in patients with chronic hepatitis C. Polymorphisms of TAP and LMP genes in 175 hepatitis C virus (HCV) patients were determined by polymerase chain reaction-restriction fragment length polymorphism. The frequencies of these genes were compared between sustained-responders (n=49) and nonresponders (n=126), classified by biochemical and virological responses to IFN. The distributions of TAP1*, TAP2*, and LMP2 genes between sustained-responders and nonresponders did not differ. However, LMP7-K gene frequency in sustained-responders was higher than that in nonresponders [odds ratio 2.3 (95% confidence interval 1.1-4.6); 16%vs 7.9%]. Multivariate analysis revealed that LMP7-K and HCV-RNA quantity were independent factors influencing the outcome of IFN therapy [4.5 (1.4-14); P=0.011, 0.40 (0.24-0.65); P=0.0003, respectively]. Furthermore, among patients with a low viral load (< or = 2.0 Meq/mL), the LMP7-K positive patients had an even higher ratio of sustained response compared to those without LMP7-K [5.9 (1.6-22); 82%vs 44%; P=0.0062]. These findings suggest that a single nucleotide polymorphism of LMP7 gene is one of the important host factors which independently influence the response to IFN in patients with chronic hepatitis C.

Microvascular angina accompanied by epicardial coronary artery spasm

A case of microvascular angina accompanied by coronary artery spasm is described. A 54-year-old woman had anginal pain at rest and during exercise. Both exercise testing and rapid atrial pacing caused significant ST depression in the inferior and all precordial leads. Exercise thallium myocardial scintigraphy was negative despite similar ST depressions. Coronary angiography revealed insignificant stenoses of the left anterior descending coronary artery after the injection of nitrate. Intracoronary acetylcholine provoked diffuse spasm of the artery with concurrent myocardial lactate production. Coronary flow reserve assessed with papaverine was 2.75. The combined use of amlodipine and high-dose nicorandil was effective for the treatment of angina.

Overview of studies on rat sperm motion analysis using a Hamilton-Thorne Sperm Analyzer--collaborative working study

This collaborative study was conducted to determine the utility and sensitivity of nine sperm motion parameters generated by a Hamilton-Thorne Sperm Analyzer (HTM-IVOS) for detecting adverse effects of chemicals on sperm motion in rats. The efficacy of sperm motion parameters was investigated using nine reproductive toxicants: adriamycin, alpha-chlorohydrin (3 different studies were carried out), dinoseb, ethylene glycol monoethyl ether, 2,5-hexanedione, sulfasalazine, trimethyl phosphate, and ornidazole. The percentage of motile sperm (% motile sperm), the only parameter expressing the status of semen containing non-motile sperm, detected adverse effects on sperm motion in 9 out of 10 studies. However, weak effects on sperm motion were not detected by this parameter in 4 out of 7 studies in which sperm motion disorders were noted at medium or low dosages. The percentage of progressively motile sperm (% progressive sperm) and the sperm velocity parameters (average path velocity, straight line velocity, and curvilinear velocity) detected adverse effects on sperm motion in all studies. In 7 studies which noted sperm motion disorders at medium or low dosages, weak effects on sperm motion were detected by the % progressive sperm in 5 studies and by the sperm velocity parameters in 6 studies. In 10 studies, amplitude of lateral head displacement (ALH) did not detect adverse effects on sperm motion in 4 studies, and beat cross frequency (BCF) failed to detect adverse effects on sperm motion in 3 studies. Because ALH and BCF show the swimming pattern of spermatozoa as head movement, the characteristics of these parameters are different from the % progressive sperm and the sperm velocity parameters. Straightness (STR) and linearity (LIN), which are secondary parameters calculated from sperm velocity parameters, could not detect adverse effects on sperm motion when the sperm velocity parameters did not detect adverse effects. On the basis of these results, we concluded that the % progressive sperm and sperm velocity parameters are useful and sensitive indicators for detecting adverse effects on sperm motion. However, in the % progressive sperm, setting up a suitable threshold of VAP and/or STR is important to gain further sensitivity for detecting adverse effects on sperm motion. The % motile sperm is useful for assessment of sperm motion disorder, and ALH and BCF are useful for evaluating the swimming pattern of sperm. STR and LIN are not very useful for detecting adverse effects on sperm motion.

A single amino acid substitution in MDEG2 specifically alters desensitization of the proton-activated cation current

To clarify functional roles of MDEG2 (mammalian degenerin-2), a modulatory subunit of proton-activated cation channels, in MDEG1/MDEG2 heteromer, we replaced the Gly481 residue in MDEG2 with cysteine or phenylalanine and characterized them electrophysiologically. Expression of MDEG1 in Xenopus oocytes elicited proton-activated cation currents that were rapidly desensitized. Co-expression of MDEG1 and MDEG2 (or MDEG2-G481C) displayed similar current traces as MDEG1 alone. In contrast, co-expression of MDEG1 and MDEG2-G481F dramatically attenuated desensitization of the proton-activated currents. Interestingly, the G481F mutation in MDEG2 did not alter other channel properties including maximal whole-cell currents, ionic selectivity, pH-sensitivity and affinity for amiloride. Thus, Gly481 in MDEG2 specifically controls inactivation process of the MDEG1/MDEG2 channel.

A novel strategy for cancer therapy by mutated mammalian degenerin gene transfer

Mammalian degenerin (MDEG) is a member of the amiloride-sensitive sodium ion channel family, and its site-directed active mutant (MDEG-G430F) induces massive Na+ influx into cells, leading to cell ballooning and cell bursting. We attempted a novel therapeutic approach for gastric cancers by transferring MDEG-G430F into cancer cells using tumor-specific promoters. In carcinoembryonic antigen (CEA)-producing gastric cancer cells, the level of cell death observed when MDEG-G430F was used with a CEA promoter was similar to that observed when using a potent nonspecific promoter such as the cytomegalovirus promoter. In an in vivo study, fusogenic liposome complexes containing MDEG-G430F driven by the CEA promoter were injected intraperitoneally into CEA-producing gastric cancer cells in a mouse peritoneal dissemination model. Although all 15 of the control mice were dead by 50 days postinoculation, 13 of the 15 mice treated with MDEG-G430F survived. These results indicate that transferring MDEG-G430F into cancer tissues using tumor-specific promoters can achieve striking and selective cancer cell death irrespective of the transcriptional efficiency of the promoters used in vivo, and suggest that this approach is a promising new strategy for cancer gene therapy.

Coronary artery-left ventricle fistula complicating balloon angioplasty--a case report

The authors describe a coronary artery fistula complicated balloon angioplasty. The proximal left anterior descending coronary artery was dilated, but a septal branch was occluded by thrombus. Angioplasty was used on the septal branch, but a pseudoaneurysm communicating with the left ventricle occurred. Follow-up angiography revealed spontaneous closure of the fistula.

Evolution of left ventricular involvement in arrhythmogenic right ventricular cardiomyopathy

Left ventricular (LV) involvement in arrhythmogenic right ventricular cardiomyopathy (ARVC) is fairly well known, but the evolution of LV involvement during long-term follow-up has not been well documented. We describe such evolution in a patient followed for 9 years. Evolution was confirmed by a progressive perfusion defect of the LV wall in myocardial scintigrams and by the development of LV asynergy with ventricular aneurysm formation in left ventriculograms. As the right ventricle progressively enlarged, we concluded that ARVC is a diffuse and progressive myocardial disease that affects both ventricles.

[Efficacy of cibenzoline for chest oppression and ventricular arrhythmia during effort and alcohol consumption in a patient with hypertrophic obstructive cardiomyopathy: a case report]

A 67-year-old man presented with chest oppression and palpitation during effort and alcohol consumption. Echocardiography demonstrated asymmetric septal hypertrophy and systolic anterior motion of the anterior mitral leaflet with a pressure gradient of 80 mmHg across the left ventricular outflow tract (LVOT), leading to the diagnosis of hypertrophic obstructive cardiomyopathy. During the treadmill exercise test, blood pressure decreased with electrocardiographic ST-segment depression and subsequent frequent premature ventricular contractions. Holter-electrocardiographic monitoring also showed ST-segment depression with premature ventricular contractions during effort and alcohol consumption. Coronary angiography showed no abnormalities and cardiac catheterization at baseline showed a systolic pressure gradient of only 2 mmHg across the LVOT. However, the gradient increased to 33 mmHg after premature ventricular contraction, 27 mmHg at Valsalva maneuver and 75 mmHg with dobutamine infusion (5 micrograms/kg/min) and disappeared with 70 mg of intravenous cibenzoline. Medication with cibenzoline (300 mg/day) for one month reduced the LVOT gradient at rest to 53 mmHg and strikingly improved symptoms and exercise tolerance and also suppressed premature ventricular contractions during exercise and alcohol consumption. We conclude that cibenzoline was effective for reduction of LVOT gradient both at rest and during exercise and alcohol consumption.

P-ANCA-positive Wegener's granulomatosis presenting with hypertrophic pachymeningitis and multiple cranial neuropathies: case report and review of literature

An autopsy case of hypertrophic pachymeningitis and multiple cranial neuropathies is reported. A 53-year-old woman with paraplegia and various neurological signs which developed over a 2 year period was diagnosed as having an epidural mass with thickened dura mater extending from the lower cervical to the thoracic spinal cord. In addition, bilateral episcleritis, blephaloptosis, and blindness of the right eye with various cranial nerve deficits were found to be caused by the mass lesions involving the paranasal sinuses, orbit, and the cavernous sinus. Perinuclear antineutrophil cytoplasmic antibody (p-ANCA) was positive, but cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) was negative by enzyme-linked immunosorbent assay. The partially removed epidural mass with hypertrophied dura mater and biopsy of the paranasal lesions showed chronic granulomatous inflammation with vasculitis. The remaining lesions resolved with steroid therapy with remarkable neurological improvement. The positive p-ANCA test, paranasal involvement, the report of a similar histopathological case and a review of the literature on granulomatous pachymeningitis suggest the presence of p-ANCA-positive Wegener's granulomatosis with central nervous system involvement characterized by hypertrophic pachymeningitis and/or multiple cranial neuropathies.

[Invasive examination of cardiovascular disease]

Invasive cardiovascular examination by coronary angioscopy and by using a Doppler guide wire, a pressure guide wire and intravascular ultrasound has extensively developed. A Doppler guide wire is used for measurement of flow velocity and evaluation of coronary blood flow. Previous studies demonstrated by assessing maximum coronary vasodilatory capacity that endothelium-dependent or independent vasodilation was impaired in hypertension and hypercholesterolemia or in syndrome X. Elevation of coronary vascular resistance during coronary microvascular spasm has been verified by using a Doppler wire. A pressure guide wire provides coronary transstenotic pressure and is available in calculating myocardial fractional flow reserve(FFRmyo). FFRmyo is an important parameter to assess the coronary functional stenosis that is culprit for myocardial ischemia. It is calculated from the ratio of the mean transstenotic pressure to the mean pressure proximal to the stenosis during maximum coronary hyperemia. The value of FFRmyo considered as necessary for coronary intervention is below 0.75. Intravascular ultrasound(IVUS) is applied as both a diagnostic tool and for intervention purpose. It enabled tissue characterization of the vascular wall as well as measurements of vascular diameter, vascular lumen area and plaque area. It also aided in optimal devise selection, decision of interventional endpoint and assessment of restenosis. IVUS promoted deployment of high-pressure stents to obtain a large post-procedural lumen area as well as abolition of anticoagulation in case of optimal stent deployment. Coronary angioscopy has been developed to investigate the pathogenesis of acute coronary syndrome, where disrupted yellow plaque and overlying thrombus play important roles. Angioscopy has also evidenced regression of intimal hyperplasia after coronary stenting.

Rat epididymal sperm motion changes induced by ethylene glycol monoethyl ether, sulfasalazine, and 2,5-hexandione

Epididymal sperm was examined using the Hamilton-Thorne Sperm analyzer (HTM-IVOS, version 10.6) in male rats treated with known male reproductive toxicants that act by different mechanisms to detect effects on sperm motion. Three agents known to produce changes in sperm motion at high exposure levels were administered at lower levels. Ethylene glycol monoethyl ether (EGEE), sulfasalazine (SASP), and 2,5-hexandione (2,5-HD) were administered by oral gavage to adult male Sprague-Dawley rats at 250 or 500 mg/kg/day, at 300 or 600 mg/kg/day, or at 100 or 250 mg/kg/day, respectively. The males were treated with EGEE, SASP, and 2,5-HD for 35, 28, and 28 days, respectively. The males treated with EGEE and SASP were mated with untreated females to assess male fertility. All males were examined for body weight, testicular and epididymal weight, epididymal sperm count, and sperm motion. The sperm motion parameters included percentage of motile sperm, percentage of progressively motile sperm (progressive motility), curvilinear velocity (VCL), average path velocity (VAP), straight line velocity (VSL), amplitude of lateral head displacement (ALH), beat cross frequency (BCF), linearity (LIN), and straightness (STR). For the male rats treated with SASP, no treatment-related effects on percentages of motile sperm or sperm count were observed despite impaired male fertility. However, abnormal motion of epididymal sperm from the SASP treated males was detected by a significant reduction in mean progressive motility, VAP, and ALH, and an increase in BCF and STR. For the males treated with 2,5-HD for 4 weeks, most parameters generated by the HTM-IVOS indicated decreased sperm motion despite no remarkable changes in testicular weight, epididymal weight, or sperm count. In the EGEE-treated males at 250 mg/kg/day for 5 weeks, abnormal motion of epididymal sperm was detected by decreased progressive motility and increased BCF, although there were no treatment-related effects on testicular weight or male fertility. Progressive motility was decreased in all treated groups and the difference from the control value was of the greatest magnitude among the sperm motion parameters generated by the HTM-IVOS. Velocity parameters (VAP, VSL, VCL) responded sensitively to abnormal sperm motion in the SASP and 2,5-HD studies. In spite of decreased sperm motion, BCF values were significantly increased in all treated groups except the 7-week EGEE high-dose group, where there were no motile sperm to evaluate. ALH was significantly decreased in the treated groups in which remarkable effects on sperm motion were noted. There were no significant changes in ALH at the low-dose of EGEE at which only mild effects on sperm motion were observed. STR was increased for epididymal sperm from the males treated with SASP when compared with the controls. For the males treated with EGEE and 2,5-HD, however, STR was decreased when compared with the controls. There were no significant differences in LIN in any of the groups treated with SASP, in which remarkably reduced sperm motion was detected by the other parameters. In conclusion, among the parameters generated by the HTM-IVOS, progressive motility was significantly decreased in all treated groups and the most valuable for detecting slight changes in sperm motion induced by these three different target toxicants. Further investigation with a larger set of compounds is needed to evaluate which IVOS parameters are the most sensitive in detecting motion changes.

Transient severe mitral regurgitation complicating myocardial stunning due to coronary vasospasm

As in papillary muscle dysfunction complicating mitral prolapse, dyskinesis of the left ventricular wall underlying the papillary muscles has been shown to cause mitral regurgitation following myocardial infarction. Myocardial stunning has been experimentally evidenced to cause mitral regurgitation due to a wall motion abnormality, but it has not yet been clinically defined. We report a clinical case of transient severe mitral regurgitation complicating myocardial stunning caused by coronary vasospasm. Transient wall motion abnormality beneath the anterolateral papillary muscle was considered to be responsible for the mitral regurgitation.

Primary pericardial synovial sarcoma with detection of the chimeric transcript SYT-SSX

We report a case of a 19-year-old woman with a primary pericardial synovial sarcoma that extended from the right ventricular free wall to the posterior aspect of the left anterior thoracic wall. Synovial sarcoma was diagnosed by the detection of the chimeric transcript SYT-SSX using reverse transcriptase-polymerase chain reaction (RT-PCR). This transcript is generated by reciprocal translocation between chromosomes X and 18, and is specific to synovial sarcoma that usually occurs in the extremities of young adults. When pathological and immunohistochemical diagnosis of synovial sarcoma is difficult, the molecular biological technique using RT-PCR becomes a powerful method of confirmation of this neoplasm.

Reproductive study. II: Prenatal and postnatal development study with candoxatril in Sprague-Dawley rats

Candoxatril, a prodrug for candoxatrilat, a selective inhibitor of neutral endopeptidase, was administered orally to groups of 24 female rats at doses of 0, 120, 400 or 1200 mg/kg/day from gestation day 6 to lactation day 21 to assess effects on pre- and postnatal development of F1 offspring. All dams were allowed to litter and to raise their F1 offspring until lactation day 21. The F1 offspring were examined for postnatal developmental indices, reflex behaviors and memory. A functional observational battery (FOB) was also conducted. A marked increase in spontaneous activity of the dams was observed in all candoxatril-treated groups. Maternal body weight gain was decreased in the 400 and 1200 mg/kg/day groups during the treatment periods. No significant differences were found for reproductive parameters. The male and female pups in the 1200 mg/kg/day group had significantly lower body weights beginning on postnatal days 21 and 14, respectively, through to the end of the study. There were no drug-related effects on pre- and postnatal developmental indices, FOB, sensory function tests or memory test. The no observed adverse effect levels were 120 and 400 mg/kg/day for the F0 dams and F1 offspring, respectively.

Rearrangement of the ventricular capillary network in stroke-prone spontaneously hypertensive rats (SHRSP) following a late start of treatment with the angiotensin converting enzyme blocker temocapril

The effects of the angiotensin converting enzyme (ACE) blocker temocapril on the capillary network of the left ventricle were studied in stroke-prone spontaneously hypertensive rats (SHRSP). The ACE blocker was dissolved in the drinking water and supplied to 24 and 32 week old SHRSP ad libitum for 5 weeks. The capillaries of the wall of the left ventricle were studied using a double staining method to differentiate the arteriolar, intermediate and venular capillary portions. Capillary density increased and capillary domain areas decreased in all capillary portions compared with untreated control SHRSP in both age groups. The proportion of venular capillary portions was increased by temocapril treatment. The results indicate that the late start of ACE blockade caused the regression of the hypertrophied cardiomyocytes, which is characteristic of SHRSP, and the rearrangement of capillary portions. The plasma concentration of angiotensin II was significantly lower in temocapril-treated SHRSP compared to the control group. The implication is that intrinsic angiotensin II exerts an appreciable effect on the function, structure and capillary network in the left ventricular wall in SHRSP.

Head-up tilt test combined with isoproterenol infusion provokes coronary vasospastic angina

The association of the autonomic nervous system with coronary vasospasm has been controversial. The aim of the present study was to examine the involvement of the autonomic nervous system in coronary vasospasm by applying the head-up tilt (HUT) test to patients with coronary vasospastic angina. Fifteen consecutive patients with coronary vasospastic angina and without significant organic coronary stenoses underwent the HUT test. Prior to the test, coronary spasm was documented angiographically by using an intracoronary injection of acetylcholine or ergonovine. The HUT test was performed in the early morning and repeated in the afternoon if the test was positive in provoking angina pectoris and syncope or presyncope. If the test was negative, it was repeated under intravenous infusion of isoproterenol at a rate of 1-2 microg/min. The HUT test under isoproterenol infusion in the morning provoked vasospastic angina with syncope or presyncope in 9 of the 15 patients. In the test-positive group, heart rate was significantly reduced (104+/-17 beats/min to 84+/-25 beats/min, p<0.05), which preceded a reduction in systolic blood pressure (158+/-25 mmHg to 125+/-17 mmHg, p<0.001), angina attack and syncope. The HUT test without isoproterenol infusion in the morning and the HUT test in the afternoon with or without isoproterenol infusion failed to provoke angina. The heart rate reduction preceding reduced systemic blood pressure and anginal attack suggested that parasympathetic nerve excitation plays an important role in coronary vasospasm. The results also implied that the HUT test combined with isoproterenol infusion is useful for the provocation of coronary spasm.

Development of obstructive hypertrophic cardiomyopathy from nonobstructive hypertrophic cardiomyopathy

A rare case of obstructive hypertrophic cardiomyopathy (HC) with mitral regurgitation (MR) is reported, which developed over 7 years from nonobstructive HC in an elderly woman. Systolic anterior motion of the anterior mitral leaflet was the most likely cause of the outflow obstruction and mitral valve replacement combined with septal myectomy resulted in complete abolition of the outflow tract gradient and MR.

Involvement of growth factor receptor-bound protein-2 in rat hepatocyte growth

Growth factor receptor-bound protein-2 (GRB-2) is a protein linking receptor tyrosine kinase and Sos (Son of Sevenless gene; Ras GDP/GTP exchange protein), leading to activation of the Ras-mitogen-activated protein kinase (MAPK) cascade. So far, it remains unclear how GRB-2 plays a role in signal transduction pathways evoked by hepatotrophic factors. This study was attempted to evaluate the involvement of GRB-2 in signalling in rat hepatocyte growth. Using rat cultured hepatocytes stimulated by hepatotrophic factors and regenerating livers after partial hepatectomy (PH) we examined GRB-2-mediated linkage of hepatotrophic factor receptors to signal transducing molecules such as Sos or dynamin-II by immunoprecipitation and western blot analysis. In primary cultured hepatocytes stimulated with hepatocyte growth factor (HGF) or epidermal growth factor (EGF), GRB-2 linked HGF receptor or EGF receptor, respectively, to Sos which activated the mitogen-activated protein kinase (MAPK) cascade. In contrast, in primary cultured hepatocytes stimulated with insulin, GRB-2 linked insulin receptor substrate-1 (IRS-1) to dynamin-II as well as Sos. In the early phase after PH, GRB-2 activated the Ras-MAPK cascade by linking HGF receptor, IRS-1, or EGF receptor to Sos. In the late phase after PH, a complex of IRS-1-GRB-2 associated with dynamin-II, indicating that GRB-2 may transduce signals from IRS-1 to dynamin-II. We conclude that GRB-2 may play a role in transmitting signals from hepatotrophic factors to not only MAPK but also to other signalling pathways in hepatocyte growth.

Activation of mitogen-activated protein kinases/extracellular signal-regulated kinases in human hepatocellular carcinoma

Mitogen-activated protein kinase/extracellular signal-regulated protein kinase (MAPK/ERK) is a key molecule in intracellular signal transducing pathways that transport extracellular stimuli from cell surface to nuclei. MAPK/ERK has been revealed to be involved in the physiological proliferation of mammalian cells and also to potentiate them to transform. However, its role in the outgrowth of human hepatocellular carcinoma (HCC) has yet to be clarified. Therefore, in this study, we investigated the activation of MAPK/ERK and its associated gene expression in HCC. MAPK/ERK was activated in 15 of 26 cases of HCC we examined (58%), and its activity level was significantly higher in HCC than in the adjacent non-cancerous lesions. Besides, MAPK/ERK activation in HCC was positively correlated with protein expression of transcription factor c-Fos. Furthermore, in 25 of 26 cases of HCC which genomic DNA was available, 22 cases without genomic DNA amplification exhibited positive correlation, not only between protein expression of c-Fos and cyclin D1, but also between MAPK/ERK activation and cyclin D1 expression. Concerning the relationship between MAPK/ERK activation and the clinicohistopathological features of HCC, the tumor (HCC) versus non-tumor (non-cancerous counterpart) ratio (T/N) of MAPK/ERK activity was positively correlated with tumor size, but neither with the stage of HCC nor the degree of differentiation of HCC. In conclusion, these findings suggest that MAPK/ERK activation in human HCC may play an important role in multistep hepatocarcinogenesis, especially in the progression of HCC; at least in part, through cyclin D1 up-regulation primarily induced by MAPK/ERK via c-Fos.

Familial evidence of vasospastic angina and possible involvement of HLA-DR2 in susceptibility to coronary spasm

An association between genetic factors and susceptibility to coronary spasm has not been proven. Because we encountered 7 patients with familial occurrence of vasospastic angina (VSA) in 3 families, the association of a genetic factor with coronary spasm was assumed. HLA typing as one of the genetic markers was performed in the 3 families, and the affected members in each family were found to share a HLA haplotype, carrying both HLA-DR52 and DQ6. This raised the possibility that one of the susceptibility genes for coronary spasm is located in the HLA region. To assess this possibility, HLA typing was performed and compared in 110 patients with VSA but without a family history of VSA (VSA group) and 55 patients with chest pain syndrome (CPS group) as control subjects. All patients underwent a provocation test for coronary spasm, and spasm was angiographically documented in the VSA group but not in the CPS group. Of all HLA antigens, the frequency of only HLA-DR2 was significantly higher in the VSA group than in the CPS group (39.1% vs 18.2%, p<0.01). The result implied that HLA-DR2 is in linkage disequilibrium with a susceptibility gene of VSA and thus is possibly involved in susceptibility to coronary spasm in some patients with VSA.

Galactosyl transfer onto p-nitrophenyl beta-D-glucoside using beta-D-galactosidase from Bacillus circulans

beta-D-Gal-(1-->4)-beta-D-Glc-OC6H4NO2-p and its isomers (beta-D-Gal-(1-->3)-beta-D-Glc-OC6H4NO2-p and beta-D-Gal-(1-->6)-beta-D-Glc-OC6H4NO2-p) were synthesized from lactose and beta-D-Glc-OC6H4NO2-p, using transglycosylation by the beta-D-galactosidase from Bacillus circulans. This reaction was efficient enough for us to do a one-pot preparation of galactosyl-glucoside from lactose. The order of the production of the transfer products was (1-->4) > > (1-->3) > (1-->6) in the initial stage of the reaction, and the same relationship was observed for the hydrolytic rate toward the three galactosyl-glucosides. The production of (1-->4)- and (1-->3)-linkages greatly decreased during the subsequent reaction and much more of the (1-->6)- than of the (1-->4)- and (1-->3)-transfer products was found in the later stage of the reaction.

Epiretinal membrane formation in Terson syndrome

Clinical features of epiretinal membranes were examined in 22 eyes of 13 patients with Terson syndrome who were treated with pars plana vitrectomy. The shape and localization of the epiretinal membranes were intraoperatively evaluated and correlated with the presence or absence of posterior vitreous detachment (PVD). Patients with complete PVD, but with no membrane found during surgery, were followed postoperatively. Membrane formation ultimately developed in 13 of the 22 eyes. In eight eyes, PVD was incomplete and the epiretinal membrane was found at the optic disc or along the temporal vascular arcades, displaying retinal folds and vascular tortuosity. Three eyes had massive tractional retinal detachment; five of those with complete PVD developed a thin epiretinal membrane around the posterior pole that became more apparent during long-term follow-up. From these observations, we can classify epiretinal membrane formation in Terson syndrome into two groups: with complete, or with incomplete, PVD. It also appears that multiple pathological processes involving the vitreoretinal interface were responsible for the formation of epiretinal membranes.

Binding cells of 125I-iodoamphetamine in rat liver

We recently reported that transrectal or intestinal portal scintigraphy with 123I-iodoamphetamine (IMP) could be a useful method for the non-invasive and quantitative evaluation of the portosystemic shunt in portal hypertension, but what cells in the liver trap IMP has not been clarified. This study was aimed at elucidating whether IMP was extracted by parenchymal cells, sinusoidal endothelial cells, Kupffer cells or fat storing cells. Each type of liver cell was isolated from rats and cultured. The cells were incubated with 125I-IMP and the radioactivity of the lysate was determined. Nonspecific binding was assessed in the presence of an excess of unlabeled IMP, and specific binding was determined by subtracting the nonspecific from total binding. Specific binding observed in parenchymal cells, endothelial cells and Kupffer cells was 70.2 +/- 0.4, 4.2 +/- 1.4 and 2.3 +/- 0.8 pmol/well, respectively, but no specific binding was observed in fat storing cells. The binding in parenchymal cells was much higher than that in endothelial cells or Kupffer cells (p < 0.005). In addition, the binding to parenchymal cells reached equilibrium within 20 min and was not saturable over the concentration range tested (0.5-10 microM). These findings indicate that IMP is mostly extracted by parenchymal cells in the liver.

High expression of heparin-binding EGF-like growth factor in rat hepatocarcinogenesis

Heparin-binding epidermal growth factor (EGF)-like growth factor (HB-EGF) is a member of the EGF family and is highly expressed in hepatoma tissues but not in normal liver. However, it is unknown when HB-EGF is induced during hepatocarcinogenesis and what are the mechanisms underlying its high expression in hepatoma. To address this issue, the expression of HB-EGF was investigated during hepatocarcinogenesis in LEC (Long-Evans with a cinnamon-like coat color) rats, which spontaneously develop hepatitis and hepatoma. LEA (Long-Evans with an agouti coat color) rats were used as controls. Furthermore, the induction of HB-EGF mRNA by various agents was investigated in a rat hepatoma cell line and hepatocytes in primary culture. Expression of HB-EGF mRNA in the liver was very low at the stage of acute and chronic hepatitis and markedly increased at the stage of hepatoma in LEC rats. Non-involved tissues adjacent to hepatoma showed low expression of HB-EGF mRNA. Immunochemical studies revealed positive staining in hepatoma tissues. Induction of HB-EGF mRNA by several growth factors was observed in a hepatoma cell line but not in normal hepatocytes. Our results suggest that HB-EGF is associated with the early progression steps of hepatoma.

Bilateral internal carotid artery disease secondary to cervical radiation. A case report

A patient with radiation-induced bilateral carotid artery disease is presented. A fifty-six-year-old man was admitted to hospital for evaluation of recurrent transient ischemic attacks. He had received cervical radiation for pharyngeal squamous cell carcinoma five years earlier. The radiation was directed at the cervical fields bilaterally and the anterior cervical field using x-rays for a total of 120 Gy. Computed tomography of the brain obtained at admission revealed a low-density area in the right parietal lobe. Carotid arteriograms revealed a completely occluded right internal carotid artery and a severely narrowed left internal carotid artery. There was good collateral supply from the posterior communicating arteries to the internal carotid arteries, bilaterally. The patient was medically treated with anticoagulant and antiplatelet therapy and has been free of subsequent cerebral ischemic attacks.

T-cell mediated polyclonal B-cell activation in a case of B-cell lymphoma associated with polyclonal hypergammaglobulinemia

The mechanism of abnormal immunoglobulin production in non-Hodgkin's lymphoma is still poorly understood. We report a case of B-cell type non-Hodgkin's lymphoma associated with marked elevated polyclonal hyper-gammaglobulinemia (serum IgG was 7598 mg/dl; IgM, 455 mg/dl). We conducted a mixed lymphocyte culture test using peripheral lymphocytes obtained from the patient and a healthy volunteer. After co-culture with the patient's CD3+ cells, not only the patient's CD3- cells but also control CD3- cells produced greater amounts of IgG and IgM. Elevated IL-6 was also detected from the patient's CD3+ cells. This strongly suggests that B-lymphoma cells stimulate CD3+ cells to produce IL-6 and hence activate normal CD3- cells.

Identification of a transforming growth factor beta-1 activator derived from a human gastric cancer cell line

It has been shown that some types of tumour cells produce activated transforming growth factor beta-1 (TGF-beta 1). However, the mechanism for the activation of TGF-beta 1 derived from tumour cells has not been fully elucidated. The present study was undertaken to characterise an activator of latent TGF-beta 1 secreted from a human gastric cancer cell line, KATO-III. Western blot analyses using antibodies for TGF-beta 1, latency associated peptide (LAP) and latent TGF-beta 1-binding protein (LTBP) revealed that, in the cell lysate of KATO-III, TGF-beta 1 protein was expressed as a small latent complex of TGF-beta 1 and LAP. This was also confirmed by a gel chromatographic analysis of the cell lysate obtained from KATO-III. A 2.5 kb transcript of TGF-beta 1 mRNA was detected in KATO-III cells by Northern blot analysis. A gel chromatographic analysis of the conditioned medium from KATO-III cells revealed, in addition to the active form of TGF-beta 1, a factor which activated latent TGF-beta 1 from NRK-49F cells at fractions near a molecular size of 65,000. This factor was inactivated by heat (100 degrees C), acidification, trypsin and serine protease inhibitors. TGF-beta 1 activity in KATO-III cell lysate was not detected in the untreated state, but potent TGF-beta 1 activity was detected after acid treatment. These results suggest that KATO-III releases not only a latent TGF-beta 1 complex but also a type of serine protease, different from plasmin, plasminogen activator, cathepsin D, endoglycosidase F or sialidase, which activates the latent TGF-beta 1 complex as effectively as acid treatment.

Activation of Na+/H+ exchanger by hepatocyte growth factor in hepatocytes

The effect of the hepatocyte growth factor (HGF) on the Na+/H+ exchanger was studied using primary cultured hepatocytes. HGF induced intracellular pH (pHi) elevation of 0.10 pH units in hepatocytes cultured for 4 to 7 hours; the response was lower after other culture periods. Even with the same culture period, intercellular heterogeneity was found in the responsiveness to HGF. This heterogeneity may be partially accounted for by the weak but significant correlation observed between the basal pHi level and the degree of pHi elevation caused by HGF in hepatocytes. The pHi elevation caused by HGF was blocked on pretreatment of the hepatocytes with amiloride, suggesting that HGF activates the Na+/H+ exchanger. This hypothesis was confirmed by the fact that HGF increased the initial rapid rate of cell alkalization of acid-loaded hepatocytes. The tyrosine kinase inhibitor, genistein, also blocked the elevation, consistent with the fact that HGF receptor/c-met has a tyrosine kinase domain. To clarify the signal transduction pathway from tyrosine kinase to the Na+/H+ exchanger, we examined the effects of inhibitors of other kinases (H-7, H-8, and W-7) on the HGF-induced pHi elevation and found that only W-7 blocked it. This pHi elevation was also prevented on preincubation of the hepatocytes with thapsigargin, which blocks the calcium response caused by HGF. These results suggest that HGF activates the Na+/H+ exchanger in hepatocytes through a tyrosine kinase-calcium/calmodulin-dependent pathway.

Expression and phosphorylation of rat c-met/hepatocyte growth factor receptor during rat liver regeneration

Hepatocyte growth factor receptor is identified as a heterodimeric tyrosine kinase encoded by the c-met gene. This study was designed to determine how the c-met/hepatocyte growth factor receptor participates in the intracellular events involved in rat liver regeneration induced by administration of carbon tetrachloride. Expression of the rat c-met mRNA increased, peaking 24 h after carbon tetrachloride administration almost in parallel with MET protein expression. Histochemical studies demonstrated that expression of the rat c-met was enhanced in cells surrounding the damaged areas, and also that the distribution of cells expressing MET was almost in accordance with that of cells expressing proliferating cells nuclear antigen. The MET protein underwent intense tyrosine phosphorylation peaking at 12 h after carbon tetrachloride administration, and prior to DNA synthesis. Phospholipase C gamma and phosphatidylinositol 3-kinase, intracellular signal transducing molecules containing Src homology 2 domain, were associated with the MET protein following tyrosine phosphorylation in vivo. These observations suggest that expression and tyrosine phosphorylation of MET protein associated with signal transducing molecules may provide a mechanism whereby hepatocyte growth factor exerts its action on hepatocyte growth during rat liver regeneration induced by carbon tetrachloride administration.

Thyroid stimulating antibody in sera of Graves' ophthalmopathy patients as a possible marker for predicting the efficacy of methylprednisolone pulse therapy

Nine patients with Graves' ophthalmopathy (GO) were treated with intravenous methylprednisolone pulse therapy and followed up by ophthalmological assessment, magnetic resonance imaging, and thyroid-associated autoantibody (thyroid stimulating antibody (TSAb), TSH binding inhibitor immunoglobulins (TBII), and anti-eye muscle antibody (EMAb)). Ophthalmological assessment was performed by the ophthalmopathy index (OI) which was made on the basis of the system recommended by the American Thyroid Association Committee. EMAb was expressed as the ratio of density of the 64 kDa band of eye muscle membrane to that of 92 kDa non-specific band found with all normal sera when assessed by western blotting. Five patients with mild ophthalmopathy (OI < 4) did not show progressive improvement in OI. Three of 4 patients with severe eye disease (OI > 4) showed a progressive and distinct improvement in OI. These 3 patients had high TSAb levels before methylprednisolone pulse therapy. One patient with severe ophthalmopathy did not respond to this pulse therapy; this patient's TSAb was negative. A significant positive correlation was observed between the activity of TSAb before treatment and the improvement in OI (delta OI) (r = 0.86, P < 0.01, n = 9). The relationship between delta OI and EMAb did not reach significance. These results suggest that TSAb in sera of GO patients can be a useful marker for predicting the efficacy of methylprednisolone pulse therapy.