LYMPHATIC SYSTEM MALFORMATIONS IN NOONAN SYNDROME: TWO CASE REPORTS AND IMAGING ANALYSIS

Lymphedema is a well-known complication of Noonan syndrome (NS) but the lymphatic malformations in NS are poorly understood. We report clinical, genetic, and imaging information about a boy and girl with NS and late-onset lower extremity lymphedema. A de novo mission mutation of RIT1 (NM_006912.5) c.246T>A, p.Phe82Leu was identified in the girl, who also showed systemic lymphatic hyperplasia and dysfunction. Magnetic resonance lymphangio-graphy (MRL) of the boy clearly demonstrated segmental dilated and hyperplastic lymphatics with impaired transport function in an affected limb and pelvic region. Indocyanine green lymphography (ICGL) showed delayed and partial enhancement of the lymph vessels in the affected limb but no lymph reflux was detected. No causative mutation was identified in the second case. Lymphoscintigraphy (LSG) failed to show lymph vessels in either of the children. Our study showed that MRL is a reliable and accurate test that can be used to demonstrate morpho-logical and functional defects of the lymphatic system. Moreover, ICGL is sufficiently sensitive to determine the functional condition of peripheral lymph vessels. The combined use of imaging modalities can give an accurate diagnosis of complex lymphatic system anomalies in NS and other syndromic diseases.

A LYVE-1/CRSBP-1 Mutation in Inherited Primary Lymphedema

Primary lymphedema is clinically and genetically heterogeneous with germline mutations identified in approximately 20 primary lymphedema genes. The lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1) gene, also known as cell-surface retention sequence binding protein-1 (CRSBP-1), encodes the major hyaluronan receptor in lymphatic endothelia and is one of the most specific lymphatic vessel markers. However, the role of this lymphatic endothelial specific protein in the development of the lymphatic system and lymphatic diseases remains unclear. Here, we report a missense mutation c.18C>G (p.S6R) in exon 1 within the N-terminal extension domain (outside the hyaluronan binding region) of LYVE-1 in three generations of an inherited lymphedema family with or without clinical symptoms. Lymphatic imaging revealed a partial, weak and delayed enhancement of tortuous lymph collectors in the distal part of the lymphedematous lower limb. Our findings revealed that LYVE-1/CRSBP-1 mutation in primary lymphedema cases is connected with both structural and functional lymphatic defects.

Role and timing of second-line therapies for patients with recurrent platinum-resistant ovarian epithelial cancer

OBJECTIVE

To explore the regimens and prognoses of second-line therapies for recurrent platinum-resistant ovarian epithelial cancer (OEC).

MATERIALS AND METHODS

The clinical profiles and second-line regimens were retrospectively analyzed for 65 recurrent platinum-resistant OEC patients treated at Zhejiang Provincial Tumor Hospital during January 2003 to January 2013. In conjunction with literature reviews, the second-line therapies for platinum-resistant recurrent OEC were discussed.

RESULTS

Their average age was 55.2 years. The stages were I (n=4), II (n=3), III (n=45), and IV (n=13). The predominant type was serous adenocarcinoma (n=47, 72.3%). Chemotherapy was refused (n=14) and resistant (n=5 1). One case was lost to follow-up and another three withdrew early. An average of four chemotherapeutic courses were offered in 61 cases. Among them, five cases selected chemotherapy after a second operation. The average therapy-free interval (TFI) was 3.5 months. The efficacies were evaluated for 61 cases. CR (n=5) and partial remission (PR, n=22). The overall survival (OS) rate was 43.6% and average progression-free survival (PFS) was 15.44 months.

CONCLUSION

The efficacy of second-line therapy for recurrent platinum-resistant OEC is rather poor and the feasibility and efficacy of second operation are to be further explored.

Rare Variants in LAMA5 Gene associated with FLT4 and FOXC2 Mutations in Primary Lymphedema May Contribute to Severity

Mutations in the Fms-related tyrosine kinase 4 (FLT4) and forkhead box protein C2 (FOXC2) genes cause Milroy disease (MD) and lymphedema-distichiasis syndrome (LDS), respectively, but the mechanism underlying disease pathology remains unclear. Applying whole-exome sequencing to two families with MD, one LDS family, and one sporadic LDS case, we identified four rare variants in the laminin subunit alpha-5 gene (LAMA5) in subjects carrying novel and known missense FLT4 mutations and a 7-bp duplication and 1-bp insertion in FOXC2. Phenotyping was expanded in some individuals using magnetic resonance lymphangiography, indiocyanine green fluorescence lymphography, and immunofluorescent lymphatic staining of skin tissue. Skin lymphatic staining showed the existence of dermal lymphatic vasculature in the MD case. Significant lymphatic dysfunction was observed in both MD and LDS patients. In the MD patient, tortuous lymphatics in the dorsum of the foot were slowly enhanced on indocyanine green fluorescent lymphography (ICG) imaging. Dilated lymph collectors with disruption and lymph leakage were observed in the familial LDS case on magnetic resonance lymphangiography (MRL). Numerous tortuous lymph collectors were visualized along the entire length of affected lower limbs on MRL imaging, and retrograde lymph flow was observed in the lymph collectors during ICG lymphography in the isolated LDS case. The finding of rare LAMA5 variants together with FLT4 and FOXC2 mutations suggests that these mutations may be co-responsible for these disorders and most likely interfere with the function of lymphatics. Further, larger studies are needed to confirm these results.

A NOVEL FLT4 GENE MUTATION AND MR LYMPHANGIOGRAPHY IN A CHINESE FAMILY WITH MILROY DISEASE

Milroy disease is a congenital onset lymphedema linked to FLT4 gene mutations in the tyrosine kinase domain. So far, a total of 59 different FLT4 variants have been identified. Here, we report a novel FLT4 gene mutation in a Chinese family with Milroy disease and present their clinical symptoms and MR lymphangiographic findings.

Which is the appropriate surgical procedure for Stage I endometrial carcinoma?

OBJECTIVE

To study the appropriate surgical procedure for Stage I endometrial carcinoma (EC), the clinical and pathological features and prognosis factors, as well as types were analyzed retrospectively.

MATERIALS AND METHODS

This is a retrospective study of 277 patients with early-stage EC in clinical Stages I that received surgery between January 2000 and March 2008. The appropriate surgical procedures were divided into three types (procedure I-III: hysterectomy with or without ovary preservation, subradical hysterectomy plus pelvic lymph node biopsy, and radical hysterectomy pelvic plus lymphadenectomy) according to the clinical stage.

RESULTS

Tumor invasion of the cervix and deep muscularis as well as the parametrium, EC Stage Ib, grade 3 and ascites had carcinoma cells, were high-risk factors of EC metastasis to the retroperitoneum (p < 0.05). The ovarian preservation of EC Stage Ia had no effect on overall survival. The three types of procedure for the EC Stage Ia were not correlated significantly to the three-year and five-year survival rates. The three-year and five-year survival rates of three surgical procedures for the EC Stage Ib were significantly correlated. The survival rates of surgical procedures II and III were significantly higher than that of procedure I (P < 0.05).

CONCLUSION

Subradical hysterectomy plus pelvic lymph node biopsy was recommended for EC Stage 1b with high-risk factors. There was no evidence of benefit in terms of overall or recurrence-free survival for radical hysterectomy plus pelvic lymphadenectomy in women with Stage I EC.

Magnetic resonance lymphography (MRL): point and counter-point

Two preeminent lymphologists debate the findings, implications, interpretations, and value of magnetic resonance lymphography (MRL) in the evaluation of peripheral lymphedema. Their contrasting views are discussed in the context of different lymphatic imaging modalities including MRL, lymphoscintigraphy, and microscopic anatomy.

Magnetic resonance lymphography at 3T: a promising noninvasive approach to characterise inguinal lymphatic vessel leakage

PURPOSE

To explore the feasibility of using 3T high-resolution MR lymphangiography to characterize inguinal lymphatic vessel leakage (LVL).

MATERIALS AND METHODS

Sixteen patients with known inguinal LVL underwent 3T MR lymphangiography and T(2)-weighted imaging. The presence or absence of inguinal LVL and the responsible lymphatic vessels were determined using the above imaging modalities and confirmed by surgical procedure. Afterwards, fifteen patients with recurring LVL following conservative treatment were referred to surgical intervention.

RESULTS

Specific inguinal LVL enhancement patterns and leaking lymphatic vessels were detected in 15 of 16 patients. Compared to the SNR of enhanced lymph nodes, that of the enhanced LVL was significantly greater (t = 7.149, p < 0.01), thereby making it possible to differentiate between LVL sites and enhancing inguinal lymph nodes. Furthermore, the steepest contrast enhancement curve slope of enhanced LVL was lower than that of enhanced lymph nodes (t = -2.860, p = 0.02). After MR diagnosis, 15 patients successfully underwent open exploration and ligation of the leaking lymphatic vessel. Clinical follow-up did not demonstrate recurrence of lymphatic fluid in the groin.

CONCLUSIONS

High-resolution MR lymphangiography combined with T(2)-weighted imaging is a promising approach to identifying specific features of lymphatic vessel leakage in the groin.

Influence of CYP2C9 and CYP2C19 genetic polymorphisms on pharmacokinetics and pharmacodynamics of gliclazide in healthy Chinese Han volunteers

BACKGROUND AND OBJECTIVE

CYP2C9 is the major contributor to gliclazide metabolic clearance in vitro, while the pharmacokinetics of gliclazide modified release are affected mainly by CYP2C19 genetic polymorphisms in vivo. This study aims to investigate the influence of CYP2C9 and CYP2C19 genetic polymorphisms on the pharmacokinetics and pharmacodynamics of gliclazide in healthy Chinese Han volunteers.

METHODS

Eighteen healthy Han subjects with various combinations of CYP2C9 and CYP2C19 genotypes received 80 mg gliclazide. Plasma gliclazide concentrations were measured by a liquid chromatography-tandem mass spectrometry method for 84 h and plasma glucose and insulin levels were measured up to 15 h post-dose.

RESULTS AND DISCUSSION

There was no difference in either pharmacokinetic and or pharmacodynamic parameters of gliclazide when group A (CYP2C9*1/*1, CYP2C19 extensive metabolizers) was compared with group B (CYP2C9*1/*3, CYP2C19 *1/*1). When group C (CYP2C9*1/*1 and CYP2C19 poor metabolizers) was compared with group A, the AUC(0-∞) and C(max) in group C were significantly higher [83.94 ± 40.41 vs. 16.39 ± 5.10 μg·h/mL (P = 0.000) and 1.50 ± 0.85 vs. 0.45 ± 0.18 μg/mL (P = 0.000)], and the oral clearance was significantly lower [1.17 ± 0.63 vs. 5.38 ± 1.86 L/h (P = 0.000)]. The half-life of gliclazide was also significantly prolonged in group C subjects when compared with that of group A (33.47 ± 12.39 vs. 19.34 ± 10.45 h), but the difference was not significant (P = 0.052). The increase in serum glucose level at 11 h after dosing (ΔC(glu11)) in group C was significantly higher than that of group A (-1.08 ± 0.42 vs. 0.22 ± 1.01 mmol/L, P = 0.022). The corresponding insulin levels showed no difference between the two groups.

CONCLUSION

CYP2C9*3 was not associated with any change in the disposition of gliclazide. CYP2C19 polymorphisms appear to exert the dominant influence on the pharmacokinetics of gliclazide in healthy Chinese Han subjects, and may also affect the observed pharmacodynamics of the drug as a result.

Effect of Rosiglitazone on Cardiac Fibroblast Proliferation, Nitric Oxide Production and Connective Tissue Growth Factor Expression Induced by Advanced Glycation End-products

This study investigated the effects of the peroxisome proliferator-activated receptor-γ agonist rosiglitazone (RGZ) on cardiac fibroblast proliferation, nitric oxide content and connective tissue growth factor (CTGF) expression following incubation with advanced glycation end-products (AGEs). Cultured neonatal rat cardiac fibroblasts were incubated with various concentrations of AGEs for 48 h. Cells were also incubated with 200 mg/l AGEs plus various concentrations of RGZ. Cardiac fibroblast proliferation and cell cycle status were detected using a 3-(4, 5dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay and flow cytometry. Western blotting was used to measure the expression of CTGF and nitric oxide content was evaluated using a nitrate reductase assay. AGEs significantly accelerated proliferation, increased CTGF expression and decreased nitric oxide production in cardiac fibroblasts. These effects of AGEs were inhibited by RGZ in a dose-dependent manner. Treatment with RGZ could be a valuable therapeutic approach in diabetic patients with myocardial fibrosis.

Lymphedema in China--experiences and prospects

The history of prevention and treatment of lymphedema in China is long. Filarial lymphedema was the most common type of the disease in the past with 5 million patients countrywide in the 1950's. Great efforts have gone into controlling filariasis during the past 50 years, and China now has essentially eliminated filariasis. In contrast to the reduction in filarial lymphedema, there has been a trend of increase in secondary lymphedema cases after malignant tumor surgery. Although there are no precise figures on the incidence of lymphedema nationwide, physicians and therapists are in great clinical demand. Traditional Chinese medicine has shown effectiveness for prevention and treatment of inflammation and alleviating swelling. The combination with Western medicine may offer improved methods for lymphedema treatment.

Trafficking of hyaluronan in the interstitium and its possible implications

The mechanisms underlying the pathological changes in lymphedematous tissue are far from clear, and it is becoming apparent that plasma proteins may not be the only key factors responsible for holding water in the interstitium. This review focuses on an "old" macromolecule--hyaluronan (HA) which is one of the major components of the interstitium and has a close relationship with the lymphatic system. Growing recognition of the multiple functions of this macromolecule for important physiological and pathological events may be helpful in identifying the crucial changes in tissues subjected to lymphatic circulation insufficiency and ultimately in the search for rational therapeutic approaches to prevent or reverse these tissues changes.

Effects of L-arginine on the proliferation of human renal mesangial cells and production of extracellular matrix

AIM

To investigate the effect of L-arginine (L-arg) on the proliferation of human mesangial cells and production of collagen.

METHODS

The influence of L-arg on the cell proliferation was determined by MTT assay, immunocytochemical detection of expression of proliferative cell nuclear antigen (PCNA), and flow cytometrical analysis of cell cycle. Procollagen III and total collagen level in the supernatant and expression of collagen IV mRNA in human mesangial cells were determined by radioimmunoassay, hydroxyproline colorimetric assay, and reverse transcription polymerase chain reaction (RT-PCR).

RESULTS

L-Arg induced inhibition of human mesangial cell lines (HMCL) in a concentration- and time-dependent manner. Immunocytochemical study for PCNA showed the number of cells was decreased, though the percentage of PCNA positive cells was increased in L-arg-treated group. Flow cytometrical analysis showed that cells in S and G2/-M phases were markedly increased in L-arg-treated group compared with those in control group. Furthermore, L-arg significantly inhibited the production of procollagen III and total collagen in the supernatants determined by radioimmunoassay and hydroxyproline colorimetric assay (P < 0.05 and 0.01, respectively) and inhibited the expression of collagen IV mRNA determined by RT-PCR (P < 0.01).

CONCLUSION

L-arg could exert an inhibitory effect on the proliferation of human mesangial cells and production of extracellular components, which strongly suggested its potential therapeutic role in the chronic renal scarring.

Gene expression of monocyte chemoattractant protein-1 in human monocytes by exposure to advanced glycosylation end products

AIM

To explore the effects of advanced glycosylation end products (AGEP) on monocyte chemoattractant protein-1 (MCP-1) gene expression in human peripheral blood monocytes/macrophages (PBMC).

METHODS

Expression of MCP-1 mRNA in PBMC incubated with AGEP-bovine serum albumin (AGEP-BSA) was examined by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) with beta-actin as an internal standard. Sequencing of RT-PCR products was performed to confirm the specificity of amplification for MCP-1 gene.

RESULTS

AGEP-BSA stimulated monocytes to express MCP-1 mRNA in a glucose-concentration-related fashion. The levels of MCP-1 mRNA were increased slightly when monocytes were exposed to AGEP-BSA 200 mg/L (glycosylated with glucose 20 mmol/L), and increased markedly when exposed to AGEP-BSA 200 mg/L (glycosylated with glucose 50 mmol/L), but decreased slightly when exposed to AGEP-BSA 200 mg/L (glycosylated with glucose 80 mmol/L). Expression of MCP-1 mRNA was undetectable in freshly isolated monocytes, but was induced at 12 h and reached a maximal level at 24 h and was almost undetectable at 36 h after the monocytes were incubated with AGEP-BSA 200 mg/L (P < 0.01).

CONCLUSION

AGEP enhanced MCP-1 mRNA expression in human PBMC.

Antagonistic effect of 3,6-dimethamidodibenzopyriodonium gluconate on lipid peroxidation in cerebral cortical neuronal cultures and rat brains during focal cerebral ischemia reperfusion

AIM

To study 3,6-dimethamidodibenzopyriodonium gluconate (I-93) antagonistic effects on lipid peroxidation in cerebral cortical neuronal cultures and rat brains during focal cerebral ischemia-reperfusion.

METHODS

Cerebral cortical neurons were cultured and rat focal cerebral ischemia-reperfusion model was established by reversible middle cerebral artery occlusion (MCAO) without craniectomy. The efflux of lactate dehydrogenase (LDH) from neurons, content of malondialdehyde (MDA) in neurons and brain homogenate, activity of superoxide dismutase (SOD) in brain homogenate, and index of cerebral edema as well as brain morphology were investigated.

RESULTS

I-93 10-40 mumol.L-1 concentration-dependently inhibited efflux of LDH and elevated levels of MDA induced by addition of H2O2(10 mumol.L-1) in vitro. I-93 0.5 mg.kg-1 improved the cerebral morphology, reduced brain edema, decreased MDA content, and enhanced SOD activity in brain homogenate.

CONCLUSION

I-93 protects neurons from H2O2-induced neurotoxicity and ischemia-reperfusion mediated damage by increasing the activity of antioxidant enzymes and suppressing the generation of lipid peroxides.

Clearance of increased serum advanced glycosylation end products in patients with end stage renal disease by hemodialysis

AIM

To study the effect of removal of hemodialysis using acetate membrane on serum advanced glycosylation end products (AGEP) in 36 patients (59.1 +/- 1.6) with end stage renal disease (ESRD).

METHODS

Serum AGEP levels were determined with quantitative fluorescence spectrometry, flow injection analysis (FIA), and competitive enzyme-linked immunosorbent assay (ELISA) using a polyclonal antibody directed against AGEP.

RESULTS

The serum AGEP levels in patients with ESRD quantified by fluorescence spectrometry, FIA, and ELISA were higher than those in controls [(25 +/- 5) vs (7.5 +/- 1.5), (6.1 +/- 1.8) vs (1.4 +/- 0.5), and (37 +/- 20) vs (9 +/- 10) kU/L, respectively] and markedly reduced to [(22 +/- 6), (4.2 +/- 1.4), and (19 +/- 14) kU/L, respectively] after hemodialysis.

CONCLUSION

Increased serum AGEP levels in the circulation of patients with ESRD were reduced effectively by hemodialysis.

[The pathogenic mechanism and prevention and treatment of muscle contracture after replantation of severed palm or wrist]

OBJECTIVE

To explore the pathogenic mechanism of intrinsic muscle contracture after replantation of severed palm or wrist, and put forward the prevention and treatment methods.

METHODS

From 1985 to 1997, 48 cases were received replantation of severed palm or wrist, among them, 9 cases with thumb adductor contracture and 6 cases with intrinsic muscle contracture were occurred in different degree. Two cases with mild thumb adductor contracture were received conservative treatment, and 7 cases with moderate thumb adductor contracture and 6 cases with intrinsic muscle contracture were received operative treatment. The pathogenic mechanism, clinical results, and prevention methods were studied in those 15 cases.

RESULTS

The postoperative function recovery was better in 4 cases, moderate in 5 cases with thumb adductor contracture, and better in 3 cases, moderate in 1 case with intrinsic muscle contracture, and moderate in 1 case, poor in 1 case with intrinsic muscle contracture of cord-like induration. Followed up 1 to 10 years, no recurrence was observed in all of 15 cases. The incidence and degree of thumb adductor contracture and intrinsic muscle contracture were closely related to the ischemia time of replanting graft.

CONCLUSION

Prevention of thumb adductor contracture and intrinsic muscle contracture is most important in severed palm or wrist replantation. When the ischemia time of replanting graft is longer than 12 hours, the effective decompression in myofascial compartment is performed in time to reach satisfactory result.

Effect of advanced glycosylation end products on diacylglycerol signaling pathway in cultured rat aortic smooth muscle cells

AIM

To investigate whether diacylglycerol (Dia) signaling pathway is stimulated by advanced glycosylation end products (AGEP) and to determine effect of vitamin E and aminoguanidine on Dia level induced by AGEP in cultured rat aortic vascular smooth muscle cells (VSMC).

METHODS

The effect of AGEP on Dia level in cultured VSMC was measured by radio-enzymatic assay. Quantitative measurements of [32P]phosphatidic acid were performed by thin-layer chromatography and autoradiography.

RESULTS

The Dia level in VSMC incubated with AGEP-BSA was markedly increased in a concentration-dependent, biphasic manner. The early phase was rapid and transient, peaking at 15 s. The late phase reached the maximal level at 10 min and decayed slowly. The Dia levels in VSMC exposed to different concentrations of AGEP-BSA and AGEP-BSA glycosylated for various periods were greatly increased compared with control group. Vitamin E 50, 100 nmol.L-1 prevented the AGEP-BSA-stimulated elevation of Dia level in VSMC, from (940 +/- 43) pmol.L-1 to (599 +/- 38), (290 +/- 21) pmol.L-1, respectively. In aminoguanidine-treated AGEP-BSA groups, Dia level in the cells incubated with the same concentration of AGEP-BSA (100, 200 mg.L-1) were decreased to (260 +/- 8) and (289 +/- 10) pmol.L-1, respectively. Early glycosylated low-density lipoproteins (LDL) did not affect Dia level.

CONCLUSION

AGEP causes a robust stimulation of Dia signaling pathway in VSMC. Vitamin E and aminoguanidine attenuate the production of Dia.

Changes of tissue fluid hyaluronan (hyaluronic acid) in peripheral lymphedema

Hyaluronan (hyaluronic acid or HA) is an important component of the extracellular matrix which is synthesized in the tissue, transported in lymph and catabolized mainly in lymph nodes and the liver. In 39 patients with chronic peripheral lymphedema, the HA content in lymphedematous interstitial fluid was measured using radioimmunoassay. For comparison, the concentration of HA in serum and normal tissue fluid were also determined. These samples were also tested for protein concentration. The results showed that the HA concentration in interstitial fluid of a lymphedema limb was 22 x 10(3) +/- 10(3) (aspiration) and 30 x 10(3) +/- 4 x 10(3) (wick) ng/ml which were significantly higher than that in interstitial fluid, serum and lymph of normal limbs (control) and interstitial fluid of limbs with venous edema (p < 0.001). The protein concentration in these fluids did not show significant differences between lymphedema and those with normal limbs. The findings suggest that HA stagnates in the limb with impaired lymph drainage which may exert a deleterious effect on the interstitium.

The role of magnetic resonance imaging in diagnosis of peripheral lymphatic disorders

Magnetic resonance imaging (MRI) was used in 13 patients with peripheral lymphedema and 2 patients with extensive cavernous lymphangioma of the limb for the purpose of evaluating its role in diagnosis of lymphatic disorders. In chronic lymphedema, MRI showed deformity of lymphatics at different tissue levels. In the subcutis, MRI characteristically displayed diffuse edema or a honeycombed pattern consistent with reticular lymphangiectasis and "lakes" with a marked increase in signal intensity with T2-weighted imaging. In lymphedema hyperplasia and chylous reflux, MRI depicted dilated retroperitoneal lymphatic collectors and lumbar trunks. In cavernous lymphangiomatosis, MRI demonstrated a prominent lattice-like pattern which had lower signal intensity on T1-weighted imaging and higher intensity on T2-weighted imaging. The findings of MRI are valuable not only for accurate assessment of lymphatic dysplasia syndromes but also provide a blueprint for treatment options.

Expression of receptor for advanced glycosylation end products (AGEP) and inhibition of AGEP-induced cytosolic calcium elevation by diltiazem in cultured rat aortic smooth muscle cells

AIM

To study whether there is a high affinity receptor for advanced glycosylation end product (AGEP) on thoracic aorta smooth muscle cells (ASMC) and to test effect of diltiazem on elevation of cytosolic free calcium induced by AGEP.

METHODS

Interactions of AGEP-bovine serum albumin (BSA) with ASMC were studied with radioligand binding assay and cytosolic free calcium ([Ca2+]i) was examined in cultured ASMC with Fura 2-AM.

RESULTS

AGEP-BSA was specifically bound to cells at 4 degrees C and was taken up and degraded at 37 degrees C. These processes were concentration-dependent and saturable. Scatchard analysis indicated that the receptor was with dissociation constant of 65.3 +/- 1.5 nmol.L-1 and its maximal binding capacity of 1.57 +/- 0.04 nmol/g cell protein. Early glycated low density lipoprotein (LDL) was not recognized by this receptor. AGEP-BSA elevated cytosolic free calcium in a concentration-dependent manner. Pretreatment with diltiazem inhibited AGEP-BSA-induced elevation in concentration- and time-dependent manners.

CONCLUSION

There was a high affinity receptor for AGEP on ASMC, which mediated internalization and degradation of AGEP. Pretreatment with diltiazem inhibited the AGEP-induced elevation of cytosolic free calcium.

Effects of advanced glycosylation end products on proliferation and cytosolic free calcium in cultured rat aortic smooth muscle cells

AIM

To study the effects of advanced glycosylation end products (AGEP) on aortic smooth muscle cell (ASMC) proliferation and its relationship with cytosolic free calcium ([Ca2+]i).

METHODS

The effects of AGEP modified bovine serum albumin (AGEP-BSA) on the incorporation of [3H]TdR and [3H]Leu into cultured ASMC were observed. The [Ca2+]i of cultured ASMC was determined with Fura 2-AM.

RESULTS

AGEP-BSA stimulated the incorporation of [3H]TdR and [3H]Leu into ASMC in concentration and time-dependent manners (P < 0.01), especially [3H]TdR. In AGEP 200 mg.L-1 group, after 12-h exposure, the incorporation of [3H]TdR obviously increased, but DNA synthesis was concentration-dependently decreased in AGEP 300-400 mg.L-1 groups. The peak incorporation of [3H]TdR was 10 times vs control (P < 0.01). The [Ca2+]i of ASMC incubated with AGEP-BSA for 40 min was increased from control groups 121 +/- 4 to 492 +/- 20 nmol.L-1 (P < 0.01). [Ca2+]i induced by AGEP was elevated with the concentration and incubating time of glucose with BSA. [Ca2+]i in BSA incubated with glucose 80 mmol.L-1 for 12 wk was 580 +/- 37 nmol.L-1 (P < 0.01).

CONCLUSION

AGEP stimulated proliferation of ASMC associated with the elevation of [Ca2+]i.

The regulatory effects of cytokines on lymphatic angiogenesis

The effects of fibroblast growth factor basic (bFGF), transforming growth factor alpha (TGF alpha), recombinant human epidermal growth factor (EGF), recombinant human tumor necrosis factor alpha (TNF alpha), and recombinant interleukin 1 alpha (IL-1 alpha) on lymphatic angiogenesis were assessed in cultured newborn bovine lymphatic endothelial cells (NBLEC). bFGF, TGF alpha, and EGF stimulated the proliferation of NBLEC in a dose-dependent manner, but the combination of either two growth factors did not show synergistic effects on NBLEC DNA synthesis. TNF alpha and IL-1 alpha suppressed the multiplication of NBLEC. Treatment with bFGF markedly increased the migration of NBLEC. The tissue plasminogen activator (t-PA) activity was enhanced by bFGF. TNF alpha also promoted NBLEC t-PA activity. These results suggest that bFGF is a major multifunctional lymphatic endothelial cell targeted cytokine, and both growth and pro-inflammatory cytokines exert differential regulatory effects on lymphatic endothelial cell proliferation, migration and t-PA activity.

[Enhancement on expression of LDL receptors in cultured rhesus renal epithelial cells by verapamil]

In order to investigate the anti-atherogenic properties of calcium antagonists, human serum low density lipoproteins (LDL) were isolated by density gradient ultracentrifugation and iodinated with 125I by iodine monochloride method. Effects of verapamil on activity of LDL receptors in cultured rhesus renal epithelial cells were examined by radioligand analysis. The receptor-mediated binding, internalization, and degradation of cultured cells pretreated with verapamil 44 mmol.L-1 for 24 h and cells pretreated for 24 h and incubated for 10 h with verapamil were increased compared with control group (61 +/- 11, 52 +/- 8 vs 20 +/- 3.5, 1006 +/- 106, 579 +/- 124 vs 253 +/- 78, 630 +/- 43, 541 +/- 46 vs 374 +/- 53 125I-LDL/micrograms.g-1 cell protein). In verapamil-treated cells without verapamil pretreatment, increased internalization and degradation were not significant, and binding was not increased. When the cells were pretreated with verapamil 22 mmol.L-1 for 24 h and then incubated with 5, 20, 50 125I-LDL/mg.L-1, binding and internalization were increased, increased degradation was seen only with 50 125I-LDL/mg.L-1. The results indicated that the verapamil enhances expression of LDL receptor in cultured rhesus renal epithelial cells, which might contribute to the protective effects of calcium antagonists in experimental and human atherosclerosis.

The influence of local hyperthermia on lymphedema and lymphedematous skin of the human leg

The influence of microwave and hot water immersion hyperthermia on lymphedema and lymphedematous skin of the leg in 12 patients was studied using circumference and volumetric measurements, immunohistochemistry and "quantitative" lymphoscintigraphy. Whereas heating was associated with a reduction in the girth and volume of the leg, lymph flow as assessed by lymphoscintigraphy was unchanged. Neither absorption of the radiolabeled nanocolloid from the injection site nor the rate of tracer accumulation in the inguinal lymph nodes was significantly altered by heat therapy. Histologically, the lymphedematous skin after heat treatment showed near resolution of perivascular cellular infiltration, disappearance of "lymph lakes" and dilatation of blood capillaries. Labeling of skin migrating immune cells with monoclonal antibodies confirmed subsidence of dermal cellular infiltration; nonetheless, there was nonspecific stimulation of resident epidermal immune cells, endothelial cells, macrophages, lymphocytes and keratinocytes by intense expression of class II and other antigens. There seemed to be a direct relationship between the subsidence of dermal inflammation and a decrease in leg edema. We suspect that subsidence of local inflammation in the lymphedematous limb with alteration in the extracellular protein matrix after regional heating accounts for the reduction in peripheral edema.

Use of tonometry to assess lower extremity lymphedema

Tissue tonometry was used to assess the outcome of microwave hyperthermia in treatment of 9 patients with lower extremity lymphedema. After microwave treatment, tissue tonicity of the lymphedematous leg returned toward normal. This improvement correlated with a reduction of leg volume and circumference, decrease in "inflammation" in the edematous subcutaneous tissue and clinical episodes of cellulitis. Possible factors involved in this shift in tissue tonicity toward normal include mobilization of excess fluid and plasma proteins from the interstitium, reduction in microvascular cellular infiltrate and changes in the elastic and viscoelastic properties of matrix collagen, elastin and ground substance following hyperthermia.

Mesenteric lymph node transplantation in syngeneic rats: changes in cellularity and architecture

The cellular architectural and functional changes of transplanted mesenteric lymph nodes in rats were studied. After lymph nodes were transplanted with interruption of both the afferent and efferent lymphatics, the nodal cellular content gradually became depleted. One month after operation, the recirculating lymphocyte count in the transplanted node was only 3.5% of that in control nodes, whereas the number of mononuclear cells per mg tissue of transplanted node was only 28% of normal. In the transplanted nodal paracortex, the cells of high endothelial venules (HEV) became less prominent and gradually flattened altogether. In the transplanted nodal cortex, germinal centers and follicles also sharply decreased and later disappeared. Three months after transplantation, the normal compartmentalization of the transplanted nodes were no longer distinguishable. Regeneration of afferent lymphatics was not detected in transplanted nodes and the lack of circulating antigen and stimulated lymphocytes was probably responsible for the histological and functional involution of grafted mesenteric lymph nodes.