Development and validation of a questionnaire measuring quality of life in primary caregivers of children with atopic dermatitis (QPCAD)

BACKGROUND

Disease-specific health-related quality of life (HRQoL) instruments for primary caregivers of children with atopic dermatitis are useful in evaluating the efficacy of treatment in clinical practice and study. However, no such scale has been available in Japan.

OBJECTIVES

To develop and validate a self-administered instrument specifically designed to measure quality of life in primary caregivers of children with atopic dermatitis (QPCAD).

METHODS

This study consisted of three successive phases: the item generation phase, pilot test phase and validation phase. In the item generation phase, questionnaire items were derived from 33 qualitative interviews with primary caregivers. In the pilot test phase, the face and content validity of the preliminary scale were assessed (n = 33). In the validation phase, the questionnaire was finalized and assessed in terms of statistical performance (n = 416).

RESULTS

The QPCAD included 19 items in the following categories: 'exhaustion', 'worry about atopic dermatitis', 'family cooperation' and 'achievement'. The reliability of internal consistency was fair (Cronbach's alpha coefficients 0.66-0.87). The QPCAD subscales and total score were significantly correlated with psychological health, physical health, anxiety, depression and severity score, with mild to moderate correlation coefficients. Test-retest reliability and responsiveness to change in severity were also satisfactory.

CONCLUSIONS

The QPCAD is an appropriate tool for assessing HRQoL of primary caregivers of children with atopic dermatitis in clinical practice and clinical trials.

Analysis of gene expression in peripheral blood eosinophils from patients with atopic dermatitis and in vitro cytokine-stimulated blood eosinophils

Investigation of differentially expressed genes in eosinophils of patients with allergic diseases such as atopic dermatitis (AD) will provide important information for elucidating possible mechanisms of pathology. To identify novel genes that are expressed in AD, we compared gene expression in samples of peripheral blood eosinophils from AD patients and healthy volunteers. RNA was extracted from peripheral blood eosinophils. The expression of various genes, such as those for cytokine receptors, eosinophil activation marker, platelet activating factor (PAF) receptor, eosinophil-specific granular proteins and apoptosis-related genes, was confirmed using real-time reverse transcription-polymerase chain reaction (RT-PCR). Peripheral blood eosinophils of healthy volunteers were also isolated and stimulated for introduction of various cytokines. RNA was extracted and gene expression was monitored. Several genes, such as those for cytokine receptors (granulocyte-macrophage colony-stimulating factor (GM-CSF) receptor alpha and beta chain and interleukin (IL)-3 receptor alpha chain), CD44 and PAF receptor were expressed at significantly higher levels in AD patients than in healthy volunteers. In addition, the anti-apoptotic genes, bcl-2 and bcl-xL, were expressed at increased levels in AD patients. No single gene expression correlated with clinical markers, such as eosinophil count or IgE levels. Expression of GM-CSF receptor beta chain and IL-3 receptor alpha chain in isolated blood eosinophils of healthy volunteers was stimulated by IL-5, IL-4, interferon (IFN)-gamma and GM-CSF. Expression of bcl-2 and bcl-xL was also increased after stimulation with IL-5, IL-4 or IFN-gamma. The in vitro enhancement of cytokine-stimulated gene expression correlated well with the enhancement observed in clinical samples of eosinophils, suggesting that cytokines may affect gene expression in vivo in eosinophils of patients with AD.

Human mast cell progenitors in peripheral blood from atopic subjects with high IgE levels

BACKGROUND

It remains unclear whether the number of circulating mast cell progenitors is increased in patients with atopic diseases. Distinct genotypes are reported to affect mast cell/basophil activation.

OBJECTIVE

We compared the number and function of mast cell progenitors present in the peripheral blood from donors with normal IgE (IgE < 400 U/mL) and those with atopic dermatitis accompanied by high serum IgE (IgE > 5000 U/mL).

METHODS

Purified peripheral blood cells were cultured in serum-free methylcellulose containing stem cell factor (SCF), IL-6 plus IL-3. Fresh methylcellulose containing the cytokines was layered over every 2 weeks. The cultured mast cells were retrieved from the methylcellulose and were functionally analysed.

RESULTS

Mast cell colonies were distinguished at 6 weeks of culture as other colony types had been degenerated. The number of mast cell colony-forming cells varied depending on donors and was not significantly increased in peripheral blood from the hyper-IgE atopic patients. A significant inversed correlation was found between the number of mast cells per one colony and the ages of donors. The cultured mast cells derived from atopic patients and those from normal IgE donors equally expressed Fc epsilon RI and released histamine through Fc epsilon RI, although IL-4 priming in vitro markedly enhanced the function of mast cells regardless of donors.

CONCLUSIONS

These results indicate that the number of circulating mast cell progenitors may be regulated by unknown individual factors unrelated to IgE levels. Mast cell function may be regulated largely by environmental factors, such as IL-4, but not determined by their progenitors' genotypes.

Gene expression screening of human mast cells and eosinophils using high-density oligonucleotide probe arrays: abundant expression of major basic protein in mast cells

Mast cells (MCs) and eosinophils are thought to play important roles in evoking allergic inflammation. Cell-type--specific gene expression was screened among 12,000 genes in human MCs and eosinophils with the use of high-density oligonucleotide probe arrays. In comparison with other leukocytes, MCs expressed 140 cell-type--specific transcripts, whereas eosinophils expressed only 34. Among the transcripts for expected MC-specific proteins such as tryptase, major basic protein (MBP), which had been thought to be eosinophil specific, was ranked fourth in terms of amounts of increased MC-specific messenger RNA. Mature eosinophils were almost lacking this transcript. MCs obtained from 4 different sources (ie, lung, skin, adult peripheral blood progenitor--derived and cord blood progenitor--derived MCs, and eosinophils) were found to have high protein levels of MBP in their granules with the use of flow cytometric and confocal laser scanning microscopic analyses. The present finding that MCs can produce abundant MBP is crucial because many reports regarding allergic pathogenesis have been based on earlier findings that MBP was almost unique to eosinophils and not produced by MCs. (Blood. 2001;98:1127-1134)

Adrenocortical function in patients with severe atopic dermatitis

BACKGROUND

Adrenocortical suppression is a potential complication of the use of topical corticosteroids in patients with atopic dermatitis (AD).

OBJECTIVES

To determine whether or not the adrenocortical suppression observed in patients with severe AD is a sole result of the application of topical steroids.

METHODS

A total of 45 patients with severe AD that required hospitalization for treatment were enrolled. These patients were divided into two groups according to the treatment received before hospitalization: group 1 had not used topical corticosteroids for at least three months (n = 17), while group 2 had used topical corticosteroids daily (n = 28). Otherwise, these two groups were matched to clinical characteristics. A rapid ACTH test was performed upon hospital admission. Topical corticosteroids were then applied to both groups. The second ACTH test was performed just before discharge, an average of 23 days after the first test.

RESULTS

The basal serum cortisol levels as well as the response to ACTH stimulation in the first examination were significantly lower in the AD patients than in the controls (P < .001), although there were no significant differences in the results between groups 1 and 2. The followup study of adrenocortical function at hospital discharge showed that morning basal serum cortisol levels were significantly increased in group 1 (P < .01), despite their topical corticosteroid treatment, while no significant increase or decrease was seen in group 2.

CONCLUSION

Our findings suggest that the adrenocortical suppression seen in patients with AD may be caused by the percutaneous absorption of topical corticosteroids as well as by other factors related to the disease.

Beta-adrenergic agonists and bronchial hyperreactivity: role of beta2-adrenergic and tachykinin neurokinin-2 receptors

BACKGROUND

beta(2)-Adrenergic agonists are the most widely used bronchodilators for the treatment of asthma. On the other hand, there is concern that excessive use of beta(2)-agonists may contribute to the exacerbation of asthma. However, the mechanism of such adverse effects of beta(2)-agonists is not completely clear.

OBJECTIVE

The aim of this study was to assess the direct influence of beta(2)-agonists on airways by analyzing the effect of a beta(2)-agonist, fenoterol, on airway sensitivity in an animal model and on tachykinin neurokinin-2 receptor expression in bovine tracheal smooth muscle.

METHODS

We performed an acetylcholine challenge test on ovalbumin sensitized guinea pigs that were exposed to daily inhalation of ovalbumin and fenoterol. We also investigated the effects of fenoterol on neurokinin-2 receptor messenger RNA and density with Northern blot analysis and receptor binding assay.

RESULT

The increase of airway responsiveness and the decrease of beta(2)-adrenergic receptors were found in guinea pigs that were treated with fenoterol. There were time- and dose-dependent increases of neurokinin-2 receptor mRNA and of density in tracheal smooth muscle that was treated with fenoterol.

CONCLUSION

This increased airway responsiveness, increased neurokinin-2 receptor expression, and decreased beta(2)-adrenergic receptor density may be relevant to asthma exacerbation.

Up-regulation of airway smooth muscle histamine H(1) receptor mRNA, protein, and function by beta(2)-adrenoceptor activation

Histamine, released from activated mast cells, causes bronchoconstriction mediated by H(1) receptors, whereas beta(2)-agonists are widely used for the relief of bronchoconstriction. In this study, we examined the effects of the beta(2)-adrenoceptor agonist, fenoterol, on the expression of H(1) receptors at the mRNA and protein levels, and functional responses. Incubation of bovine tracheal smooth muscle with fenoterol (10(-7) M) for 2 h increased H(1) receptor mRNA (maximum approximately 190%). The number of H(1) receptors was increased after 12 and 18 h without any change in binding affinity. In the contraction experiments, the concentration-response curves for histamine-induced contraction were shifted significantly to the left after 18-h exposure to fenoterol, consistent with the increase in receptor number. The fenoterol-induced increase in H(1) receptor mRNA was concentration-dependent and was abolished by propranolol and ICI 118551, but not by CGP 20712A, indicating that fenoterol acts via beta(2)-adrenoceptors. These effects were mimicked by other cAMP-elevating agents forskolin and prostaglandin E(2), and by the stable cAMP analog 8-bromo-cAMP. Cycloheximide alone produced superinduction of H(1) receptor mRNA and augmented the fenoterol-induced increase in H(1) receptor mRNA. Fenoterol increased both the stability and the transcription rate of H(1) receptor mRNA. Pretreatment with dexamethasone did not prevent fenoterol-induced up-regulation of H(1) receptor mRNA. Thus, fenoterol increases the expression of airway smooth muscle H(1) receptors via activation of the cAMP system through increased gene transcription and mRNA stability. This mechanism may be involved in the adverse responses encountered with the clinical use of short-acting beta(2)-agonists.

beta(2)-adrenoceptor agonist-induced upregulation of tachykinin NK(2) receptor expression and function in airway smooth muscle

Neurokinin A (NKA) induces bronchoconstriction mediated by tachykinin NK(2) receptors in animals and humans, and may be increased in asthma. Because beta(2)-adrenoceptor agonists are the most widely used bronchodilators in asthma, we investigated the effects of the beta(2)-adrenoceptor agonist fenoterol on NK(2) receptor messenger RNA (mRNA) and receptor density as well as the functional responses of bovine tracheal smooth muscle to the NK(2) receptor agonist [beta-Ala(8)]-NKA(4-10) in vitro, using Northern blot analysis, receptor binding, and organ bath studies. Incubation with fenoterol induced a time- and concentration-dependent upregulation of NK(2) receptor mRNA (71% increase after 12 h at 10(-7) M fenoterol), which was abolished by propranolol (a nonselective beta-adrenoceptor agonist) and ICI118551 (a selective beta(2)-adrenoceptor antagonist), but not by CGP20712A (a selective beta(1)-adrenoceptor antagonist), indicating that fenoterol acts via beta(2)-adrenoceptors. These effects were mimicked by forskolin and prostaglandin E(2) (PGE(2)), both agents that increase cyclic adenosine monophosphate (cAMP), and by the cAMP analogue 8-bromo-cAMP. The upregulation was blocked by cycloheximide, indicating that it requires new protein synthesis, and was accompanied by an increase in both the stability of NK(2) receptor mRNA and the rate of NK(2) receptor gene transcription. Radioligand binding assay using the selective NK(2) receptor antagonist [(3)H]SR48968 showed a significant increase in the number of receptor binding sites after 12 h and 18 h, which was accompanied by an increased contractile responsiveness to the NK(2) receptor agonist [beta-Ala(8)]-NKA(4-10). Dexamethasone completely prevented the fenoterol-induced increase in NK(2) receptor mRNA and in the contractile response. We conclude that beta(2)-adrenoceptor agonists induce upregulation of functional NK(2) receptors in airway smooth muscle by increasing cAMP, and that this can be prevented by a corticosteroid. The increased responsiveness could be relevant to asthma control and mortality.

Evaluation of the staphylococcal exotoxins and their specific IgE in childhood atopic dermatitis

BACKGROUND

Superantigenic exotoxins produced by Staphylococcus aureus and their specific IgE antibodies are thought to be important precipitating factors of atopic dermatitis (AD), but there are few reports evaluating these 2 factors at the same time.

OBJECTIVE

We examined whether the presence of the exotoxins sampled from the skin of patients with AD and the levels of anti-exotoxin IgE antibodies in their sera correlated with their severity of AD.

METHODS

Patients with mild-to-severe AD, 1 to 22 years of age, were evaluated by using Leicester's scoring system. Specific IgE antibodies against these exotoxins were determined by using ELISA. S aureus was isolated from 3 different areas of the skin. We examined whether the exotoxin (staphylococcal enterotoxin [SE]A, SEB, SEC, SED, and toxic shock syndrome toxin-1) could be detected.

RESULTS

The levels of SEB-specific IgE were correlated with the severity of AD. Five of 6 patients having very high SEB-specific IgE antibody titers were under 6 years of age, and SEB was most frequently isolated (41%). There was no difference in severity between patients with or without exotoxin-producing S aureus. The severity of 9 patients who had both exotoxin-producing S aureus on the skin and specific IgE antibody against the same exotoxin in sera was significantly higher than that of the other patients.

CONCLUSIONS

Anti-SEB IgE titers correlate well with the severity of AD. The presence of exotoxin-producing S aureus may precipitate AD through its specific IgE antibody.

Glucocorticoids reduce tachykinin NK2 receptor expression in bovine tracheal smooth muscle

Neurokinin A is not only a potent bronchoconstrictor, but also has immuno-modulatory effects in animals and man, mediated via tachykinin NK2 receptors. We have examined the effect of the glucocorticoid, dexamethasone, on tachykinin NK2 receptor mRNA and the number of tachykinin NK2 receptors in bovine tracheal smooth muscle in vitro by Northern blot analysis using a human tachykinin NK2 receptor cDNA probe and receptor binding assay using [3H]SR48968 [(S)-N-methyl-N[4-acetylamino-4-phenylpiperidino-2(3,4-dichlorophenyl) butyl]benzamide]. Tachykinin NK2 receptor mRNA showed a time-dependent suppression (62% reduction after 6 h at 10(-7) M of dexamethasone), as well as a concentration-dependent suppression after the incubation with dexamethasone (IC50 = 1.3 x 10(-8) M). This suppression was abolished by the glucocorticoid receptor antagonist, mifepristone (RU38486), indicating that dexamethasone acts via the glucocorticoid receptor. It was also abolished by the protein synthesis inhibitor, cycloheximide (10 microg/ml), indicating that new protein synthesis is required on this suppression. Using the RNA polymerase inhibitor actinomycin D (5 microg/ml), we showed that the stability of tachykinin NK2 receptor mRNA was not affected by dexamethasone (t1/2 = 5 h). Nuclear run-on assays revealed a 51% reduction in the rate of tachykinin NK2 receptor gene transcription after treatment with dexamethasone for 6 h. Radioligand binding assay using an selective tachykinin NK2 receptor antagonist, [3H]SR48968 showed a significant decrease in the number of receptor binding sites after 16 h (Bmax = 262 +/- 23 versus 213 +/- 13 fmol/mg protein for vehicle and dexamethasone treatment respectively, P < 0.05), with no significant change at the earlier time points. These results suggest that glucocorticoids act on glucocorticoid receptors to decrease tachykinin NK2 receptor expression by decreasing the rate of tachykinin NK2 receptor gene transcription.

Study of liver function in infants with atopic dermatitis using the 13C-methacetin breath test

Serum glutamic-oxaloacetic transaminase (GOT) levels were determined in 214 infants (133 males and 81 females) with atopic dermatitis during their first visit to the Department of Allergy, National Children's Hospital, Tokyo, Japan. Compared with the normal hospital range, their levels were found to be significantly higher, a tendency which was more conspicuous in lower age groups. We carried out a 13C-methacetin breath test (MBT), administering the stable-isotope-labeled compound to 11 children with higher serum GOT values and 5 within the normal range to investigate hepatic metabolism of methacetin in infants with atopic dermatitis. 13C-methacetin was given orally, and the 13CO2 level in the breath was determined immediately before and after administration, by mass spectrometry. Compared to the normal controls, the atopic infants demonstrated significantly lower 13CO2 peak excretion and delayed peak time. The clearance rate of 13CO2 was also decreased. These results suggest some relationship between atopic dermatitis and liver function in infants.

[Adrenocortical function in children with near fatal asthma]

The adrenal function of children with near fatal asthma was evaluated by a modified rapid ACTH test. The rapid ACTH tests, which were performed within six months of each life-threatening asthmatic episode, showed extremely low responsiveness. The response in the subjects was significantly lower than that of patients who had received high dose of corticosteroid therapy. It was suggested that the adrenocortical function of children with near fatal asthma had been already suppressed and that adrenal suppression could easily occur in such patients. We advocate the following measures: (1) environmental control, education of patients and their families, physical training accurate medication should be supplied to reduce the use of corticosteroids, (2) sufficient doses of corticosteroids should, however be given to patients with acute exacerbation, (3) not only lung function tests or allergic examinations, but also adrenocortical function tests should be performed on severe asthmatic patients.

[Diagnosis of sinusitis in children with allergic diseases--comparison of waters projection radiographs and CT scans]

Sinusitis is common in children with allergic diseases, and the relationship between sinusitis and reactive airway diseases involving asthma has been reported. Most pediatricians and physicians base their diagnosis of sinusitis on findings from plain radiographs of the sinuses, especially Waters projection radiographs. We compared the diagnoses made by 11 pediatric allergists using 56 Waters projection radiographs with transverse CT findings. The ratio for the two diagnosis being consistent (normal plain radiographic findings and normal CT findings, or abnormal plain radiographic findings and abnormal CT findings) was approximately 60%. Sinusitis in children is often misdiagnosed on the basis of findings from Waters projection radiographs alone. Therefore, the use of CT findings for the diagnosis of sinusitis together with Waters projection radiographs is recommended.

Effect of inhaled beclomethasone dipropionate on bronchial responsiveness in patients with asthma

We investigated the effect of 300 micrograms of inhaled beclomethasone dipropionate (BDP) daily on bronchial responsiveness to methacholine and pulmonary function of 22 subjects with asthma in a single-blind, crossover study. The severity of bronchial hyperresponsiveness lessened significantly during treatment with BDP (P < .01). No significant changes occurred in FEV1 or in the control value of airway conductance. We conclude that a 300-micrograms total daily dose of BDP is an efficacious treatment for patients with asthma. Because suppression of adrenal function and systemic adverse effects can occur in asthmatic patients treated with inhaled corticosteroids, especially children, long-term treatment with inhaled steroids should employ minimal daily doses necessary.

Adrenal function of children with bronchial asthma treated with beclomethasone dipropionate

The function of the hypothalamic-pituitary-adrenal (HPA) axis was investigated in nine asthmatic children treated by inhalation of beclomethasone dipropionate (300 micrograms/day) for 12 weeks. The trial was designed as a prospective study. The 24-hour urinary free cortisol, serum cortisol, response to ACTH, and nocturnal serum cortisol followed by 20-minute sampling were measured before and after the study period. No significant changes were found, suggesting that inhaled beclomethasone, in a daily dose of 300 micrograms, does not cause suppression of the HPA axis.

Wheat-dependent exercise-induced anaphylaxis: inhibition by sodium bicarbonate

We present a case of wheat-dependent exercise-induced anaphylaxis, in which pretreatment with sodium bicarbonate inhibited reappearance of anaphylactic symptoms following wheat and exercise provocation. Decrease in blood pH relative to elevation in plasma histamine levels was also inhibited. These results suggest possible efficacy of pretreatment with sodium bicarbonate as a preventive measure in patients with exercise-induced anaphylaxis.

[The effect of sustained-release theophylline granules in the inhibition of exercise-induced asthma]

We studied the protective effect of sustained-release theophylline granules on early or late response in exercise-induced asthma (EIA) in 16 patients ranging in age from 7 to 18 years. A standardized exercise test was examined 2 hours after administration of theophylline granules on one day and after no medication on another day. On both days, the lung functions and the serum theophylline and cortisol concentrations of the patients were examined before exercise and over a period of 8 hours after exercise. On days without medication, early response was seen in 16 patients and late response in 6. On days with medication, the theophylline granules inhibited early response in 13 of the 16 patients and late response in 5 of the 6 patients. This suggests that theophylline preparation is a useful drug for inhibiting the dual responses of EIA.

Changes in filament actin accompanying IgE-dependent and -independent histamine release from IL-3-dependent cultured human basophils

When cord blood mononuclear cells were cultured in the presence of rhIL-3 for 5 weeks or more, 40-90% of cultured cells became morphologically mature basophils. We analyzed the kinetics of histamine release, changes in filament actin (F-actin), and movement of intracellular Ca2+ ([Ca2+]i) induced by IgE-dependent (anti-IgE) and -independent (fMLP) stimuli in these cultured basophils. Anti-IgE and fMLP released 24.5 +/- 5.4% and 14.5 +/- 4.5% histamine from the cells, respectively. Anti-IgE caused actin polymerization with a peak response at 15 min, which began much later than the elevation of [Ca2+]i. In contrast to anti-IgE stimulation, fMLP induced rapid actin polymerization with a peak response at 30 s in correlation with kinetics of histamine release. Our results indicate that cord blood-derived cultured basophils show similar cell functions to mature basophils, and are useful models with which to investigate the mechanisms of degranulation, specifically when a large amount of highly purified cells are required.

[A case of massive hemoptysis occurring after lung injury due to a torn segment of pleural calcification]

A 64-year-old man was referred to our hospital because of little improvement of hemoptysis lasting three days after drug therapy. A chest roentgenogram and fiberoptic bronchoscopic examination performed on the second hospital day when the patient experienced a massive hemoptysis of about 2,000 ml revealed arterial bleeding from the left upper lobe. Even after extensive embolizations of the left upper bronchial, the first, second, third and 4th intercostal arteries, the patient's hemoptysis did not improve. On the 73rd hospital day the patient underwent left upper lobectomy. Macroscopic and microscopic examinations in the resected specimen revealed lung injury due to a torn segment of pleural calcification after tuberculous pleuritis, resulting in the massive hemoptysis. Although physicians encounter many patients complaining of hemoptysis and/or hemosputum, this case is considered to be very rare.

Exercise-induced anaphylaxis: improvement after removal of amalgam in dental caries

We present a case of exercise-induced anaphylaxis with improvement following the removal of dental amalgam. Although her symptoms were unresponsive to various kinds of therapy until removal of the amalgam, her symptoms related to exercise improved remarkably after the removal. The increase in plasma histamine levels for exercise provocation test also improved. This suggests that sensitivity to metals might cause exercise-induced asthma in some patients.

Influence of fecal anorexigenic substance (FS-T) on plasma amino acids in Wistar and Zucker obese (fa/fa) rats

An anorexigenic substance (FS-T), found in feces, isolated and injected intraperitoneally, induced significant feeding suppression in Wistar rats and in genetically obese Zucker rats (fa/fa) and their lean littermates. The concentration of total plasma amino acids 2 h after FS-T injection (the time of maximum feeding suppression) was 71.0, 68.6 and 60.2% of that of controls for Wistar and Zucker obese and lean rats, respectively. By 48 h after injection of FS-T, food intake and the concentration of total plasma amino acids had returned to normal. Plasma tryptophan levels and the ratio of tryptophan to neutral amino acids were also monitored to elucidate the relation between FS-T and appetite. Two h after injection of FS-T, the ratio of tryptophan to neutral amino acids had increased in Wistar rats, while no change was detected in either obese or lean Zucker rats. However, no change was observed in plasma glucagon levels in Wistar rats, but a significant increase was found in both obese and lean Zucker rats at 2 h after FS-T injection.

Dual inhibitory effect of bredinin

Bredinin inhibition of cell growth was investigated in the mouse lymphoma cell line L5178Y. Bredinin caused the accumulation of IMP and the reduction of XMP. It was converted to the 5'-phosphate within the cells. Bredinin 5'-phosphate but not bredinin competitively inhibited both IMP dehydrogenase and GMP synthetase. Thus the inhibition of cell growth is probably due to bredinin 5'-phosphate, which inhibits the consecutive enzyme reactions IMP dehydrogenase and GMP synthetase. These inhibitions result in the accumulation of IMP and the reduction of XMP.

Incorporation of alpha-1-antichymotrypsin into human stomach adenocarcinoma cell nuclei and inhibition of DNA primase activity

Incorporation of alpha-1-antichymotrypsin (ACT) into human stomach adenocarcinoma cell nuclei and the effect of ACT on DNA primase from the same carcinoma cells were studied. ACT or [125I]-ACT were observed in carcinoma cell nuclei and high specific radioactivity was detected in washed nuclear fraction when 0.4 mg of ACT or [125I] ACT (8 x 10(7) cpm) was intravenously injected into carcinoma bearing nude mice 2 h before killing. The molecular weight of radioactivity presented in cell nuclei was same as the intact ACT on SDS-polyacrylamide gel electrophoresis. ACT inhibited DNA primase activity and this inhibiting activity was stable than its chymotrypsin inhibiting activity. The results presented here show ACT is incorporated into carcinoma cell nuclei without modification of its molecular weight and may inhibit DNA primase activity.

Alpha-1-antichymotrypsin (ACT) as an immune regulatory agent

This study was carried out to elucidate the interaction of alpha-1-antichymotrypsin (ACT) with the immune reaction induced by interleukin-2 (IL-2). ACT, isolated from human sera and determined to be a single glycoprotein, was added to human peripheral T-cell cultured with IL-2. It was found that ACT effectively suppressed T-cell activation induced by IL-2, but the suppressive effect of ACT was inversely proportional to the concentration of IL-2. A similar effect was found when T-cells were stimulated with PHA. ACT had a suppressive effect when suboptimal concentrations of PHA were used, however this suppressive effect could not be found at the optimal PHA concentration. These findings suggest that ACT may be a regulatory agent in immune reactivity where low concentrations of IL-2 are present. Even under normal conditions, an individual is surrounded and invaded by numerous foreign elements and it may be that small amounts of IL-2 are constantly produced, which would indefinitely trigger chained immune reactions if there were no regulatory agent like ACT.

Binding of modified alpha-1-antichymotrypsin to mitogen-stimulated human lymphocyte membrane: a model for immune suppression

Alpha-1-antichymotrypsin (ACT), an acute phase reactant protein elevated during acute inflammation, and its derivatives (asialo ACT and acid-exposed asialo ACT) were investigated their effect on lymphocyte proliferative responses, and evidence for binding to lymphocyte membranes as well as the characteristics of this binding were investigated. Acid-exposed asialo ACT significantly reduced 3H-thymidine incorporation into human peripheral lymphocytes stimulated by phytohemagglutinin (PHA) though native ACT could not inhibit the mitogen-induced lymphoproliferation and asialo ACT moderately inhibited it. In order to determine the interaction of ACT and its derivatives to lymphocyte membranes, the binding of 125I-labelled ACT and its derivatives to membranes of intact lymphocyte and extracted lymphocyte membranes was examined. The binding of 125I-labelled native ACT and asialo ACT to resting and PHA-stimulated lymphocyte membrane was low. And the binding of 125I-labelled acid-exposed asialo ACT to resting lymphocyte membrane was also low. However, when lymphocytes were stimulated by mitogens the binding of 125I-labelled acid-exposed asialo ACT increased significantly. The binding of 125I-labelled acid-exposed asialo ACT to the membrane extracted from PHA-stimulated lymphocytes was time-dependent and saturation was reached at 120 min at 37 degrees C. One mg of membrane could bind a maximum of approximately 83 pmol of acid-exposed asialo ACT with dissociation constant of 0.73 microM. Other unlabelled serum glycoproteins such alpha-1-antitrypsin, alpha-1-acid glycoprotein, transferrin, and proteinase inhibitors including chymostatin, leupeptin and soy bean trypsin inhibitor did not compete with 125I-labelled acid-exposed asialo ACT for binding sites in simultaneous competition assays.

Inhibition of DNA synthesis by alpha-1-antichymotrypsin

The effect of alpha-1-antichymotrypsin (ACT), which is known as an efficient serum protease inhibitor and is detected in tumor cell nuclei, on DNA synthesis was studied. ACT inhibited the activity of DNA polymerase alpha purified from human stomach adenocarcinoma. Other human serum proteins including serum albumin, alpha-1-acidglycoprotein, alpha-1-antitrypsin, and immunoglobulin G, as well as other protease inhibitors, such as leupeptin, pepstatin, PMSF and chymostatin, did not affect the activity of DNA polymerase alpha. It was therefore concluded that the inhibitory action of ACT on DNA polymerase alpha was direct phenomenon unrelated to its protease inhibitory activity. Furthermore, the effect of ACT on DNA synthesis was also studied using lysolecithin-permeabilized cultured human stomach carcinoma cells. ACT added in the medium inhibited DNA synthesis and the degree of inhibition depended on incubation time. It was proportional to ACT concentration and the concentration of ACT required for 50% inhibition was 0.8 mg/ml.

The production of anorexigenic substances by intestinal flora

The role of intestinal flora in the production of anorexigenic substance was investigated. Proteus mirabilis (P. mirabilis) and Escherichia coli (E. coli) were found to produce an anorexigenic substance, while Enterococcus faecalis (E. faecalis, type 1 and 2) and Staphylococcus intermedius (S. intermedius) did not. The anorexigenic substance was purified and was detected as, a single though broad band by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The specific activity of the final form of the purified substance was 120 units/mg carbohydrate. The substance contained no protein residue and appeared to be a lipopolysaccharide. The evidence that intestinal flora produces an anorexigenic substance leads to an interesting assumption that the intestinal flora may be responsible for regulating food intake.

High molecular mass type i.v. collagen-specific metalloprotease from human carcinoma tissue

A protease degrading type IV collagen was purified more than 8000-fold from human stomach carcinoma tissue. This protease degraded type IV collagen, while type I, II, III and V collagen, laminin, fibronectin, casein, albumin and hemoglobin were not affected. This enzyme had a pH optimum of pH 7.0-8.0 and was inhibited completely by EDTA and o-phenanthroline, but not by seryl, thiol and carboxyl protease inhibitors. Furthermore, the molecular mass of this enzyme was estimated to be 1 MDa by Sepharose 6B column and HPLC-gel filtration. The molecular mass and substrate specificity of this metalloprotease from human carcinoma tissue indicate it to be a new protease.

Effect of alpha-1-antichymotrypsin on DNA synthesis in permeabilized human cells

The effect of Alpha-1-antichymotrypsin(ACT) on DNA synthesis was studied using lysolecithin-permeabilized cultured human stomach carcinoma cells. ACT added in medium inhibited DNA synthesis and the degree of inhibition is incubation time dependent. It is proportional to ACT concentration and the concentration of ACT required for 50% inhibition was 0.8 mg/ml.

Inhibition of human DNA polymerase alpha by alpha 1-antichymotrypsin

alpha 1-Antichymotrypsin (ACT), which is known as an efficient serum protease inhibitor and is detected in tumor cell nuclei, was found to inhibit the activity of DNA polymerase alpha purified from human stomach adenocarcinoma. The concentration of ACT required for 50% inhibition was 1.0 mg/ml and the manner of its inhibition showed the partially competitive relationship between ACT and DNA in the assay system. Furthermore the removal of ACT by anti-ACT antibody lost its antichymotryptic and anti-DNA polymerase activities in parallel. On the other hand, it did not inhibit the activity of human DNA polymerase beta. Other human serum proteins including serum albumin, alpha 1-acid glycoprotein, alpha 1-antitrypsin, and immunoglobulin G as well as other protease inhibitors such as leupeptin, pepstatin, phenylmethylsulfonyl fluoride, and chymostatin did not affect the activity of DNA polymerase alpha. Furthermore ACT heated at 60 degrees C did not inhibit DNA polymerase alpha, although it could still bind to DNA as well as native ACT. It was therefore concluded that the inhibitory action of ACT on DNA polymerase alpha was a direct phenomenon unrelated to its protease inhibitory or DNA binding activities.

Incorporation of alpha-1-antichymotrypsin into carcinoma cell nuclei of human stomach adenocarcinoma transplanted into nude mice

Human stomach adenocarcinomas containing alpha-1-antichymotrypsin (ACT) in their cell nuclei were transplanted into nude mice. The presence of ACT was monitored using an immunohistochemical technique with horseradish peroxidase-labeled rabbit anti-ACT Fab' as well as single radial immunodiffusion. Two weeks after transplantation, ACT could be found neither in transplanted carcinoma cells nor in the sera of carcinoma-bearing nude mice. However, if human ACT was injected i.v., it could be detected in the transplanted carcinoma cell nuclei 2 h after injection. The ACT was detected immunohistochemically and was confirmed by biochemical fractionation using 125I-labeled ACT. On the other hand, the amount of ACT production was not sufficient to indicate biosynthesis. These results demonstrated that ACT detected in stomach carcinoma cell nuclei was not synthesized in carcinoma cells but was incorporated from the blood circulation.

Objective monitoring of graft-versus-host disease: alpha 1-antichymotrypsin concentration changes after bone marrow transplantation in patients developing graft-versus-host reactions

The levels of alpha 1-antichymotrypsin (ACT) was monitored in patients who underwent bone marrow transplantation. Seven received HLA-identical sibling bone marrow grafts, two received transplants from twins and one was given HLA-nonidentical marrow from his father. A dramatic increase of ACT was observed in all patients who developed graft-versus-host disease (GvHD). ACT did not rise at all in the case of patients who received marrow from twins, even in a patient who was given three transplants from the same donor. The patient transplanted from his father died from GvHD and the increase of ACT was the greatest fluctuation measured.

Feeding suppression induced by a fecal anorexigenic substance (FS-T)

Intraperitoneal (IP) injection of a fecal anorexigenic substance (FS-T) induced significant suppression of feeding and this suppression recovered on the second day. At 2 hr after IP injection, at the time of maximum feeding suppression, plasma glucose, insulin and free fatty acid (FFA) levels did not change but amino acid level decreased. Intra-third cerebral ventricle (ICV) infusion of FS-T induced parallel but more potent feeding suppression. Analysis of meal patterns demonstrated that suppression of feeding after ICV treatment continued into the second day. FS-T was applied electrophoretically to glucose-sensitive and non glucose-sensitive neurons in the lateral hypothalamic area (LHA) and to glucoreceptor and non glucoreceptor neurons in the ventromedial hypothalamic nucleus (VMH). It significantly inhibited glucose-sensitive neurons but not non glucose-sensitive neurons, and excited both neuron types in the VMH. FS-T might thus work directly through the hypothalamic feeding control centers to suppress feeding. Even after pronase treatment of FS-T, a non-dialysable fraction of large molecular weight, consisting of protein and carbohydrate, maintained the original anorexigenic activity.

Neuraminidase activity in human peripheral lymphocytes: its increase in chronic active liver disease

The activity of neuraminidase (sialidase) in peripheral white blood cells was measured by a fluorometric method using 4-MU NANA as a substrate. The activity in mononuclear cells, which was predominantly lymphocytes, was 2.5 times higher than that in polymorphonuclear cells (neutrophils). The former's activity was directly proportional to the number of the cells, but that of the latter was found to be suppressed by an increasing number of cells. Thus, the increased number of PMN contaminated in MNC fraction somewhat obscured neuraminidase activity affecting suppressively . The enzyme activity in MNC of 25 control subjects (15 males and 10 females) was 254 +/- 73 pmoles per hour per 10(6) cells and there was no difference between the values in males and females (233 +/- 59 vs. 284 +/- 81). The activity in 20 patients with chronic active liver disease was significantly higher than that in controls (551 +/- 135, p less than 0.01). The amount of sialic acid in MNC, which was 1.4 times more than that in PMN, revealed a tendency for a positive correlation between neuraminidase activity. A new finding of the increase of lymphocyte neuraminidase activity was introduced and its pathological significance particularly in liver disease was discussed.

The biological activity of alpha-1-antichymotrypsin: the change of chymotrypsin-inhibitory and immunoenhancing activities by heat treatment

The relationship between chymotrypsin-inhibitory and immunoenhancing activity of alpha-1-antichymotrypsin was studied. alpha-1-Antichymotrypsin was treated at 50 degrees C, 55 degrees C or 60 degrees C for 15 min. It was found that antichymotryptic activity was reduced by half when alpha-1-antichymotrypsin was heated at 55 degrees C and was not detected at all when heating was carried out at 60 degrees C. alpha-1-Antichymotrypsin which was heated at 60 degrees C did not form a complex with chymotrypsin, but became a substrate for chymotrypsin. The effect of native and heated alpha-1-antichymotrypsin on antibody response was studied in mice. alpha-1-Antichymotrypsin increased the number of anti-sheep erythrocytes antibody producing cells even when it was heated at 60 degrees C. Circular dichroism and single radial immunodiffusion were used to detect conformational changes. Circular dichroism in the region of side chain absorption showed that the intensities of the spectra at 296, 284, and 265 nm decreased with a rise in temperature from 50 to 60 degrees C. In single radial immunodiffusion analysis, alpha-1-antichymotrypsin did not form a halo after being heated at 60 degrees C. In conclusion, when alpha-1-antichymotrypsin was heated at 60 degrees C, the immunoenhancing activity remained intact while the antichymotryptic activity was lost with the conformational change.

Human alpha-1-antichymotrypsin enhances primary antibody response in the mouse

The effect of human alpha-1-antichymotrypsin (alpha-1-Achy) on antibody response was studied in mice. alpha-1-Achy increased the number of antisheep erythrocyte antibody-producing cells. The increase was dependent on the dose of alpha-1-Achy injected (from 0.25 to 1 mg par mouse). alpha-1-Achy was effective if injected 2 days before or simultaneously with sheep erythrocytes. Asialylated alpha-1-Achy also enhanced the antibody response in the same way as native alpha-1-Achy. When alpha-1-Achy was heated at 60 degrees C for 15 min, it appeared to maintain immunoenhancing activity. However, when treated at 70 degrees C for 15 min, an intermediate immunoenhancing activity was observed, and heating at 100 degrees C for 15 min resulted in loss of activity.

Analysis of the tissue and cellular localization of alpha-1-antichymotrypsin by an immunohistochemical technique

The cellular localization of alpha-1-antichymotrypsin (alpha 1-ACT) was studied immunohistochemically using rabbit HRP-labeled Fab' against human alpha 1-ACT. alpha 1-ACT was found in cell nuclei of carcinomas of the stomach, liver, breast, pancreas and leiomyosarcoma and in cell nuclei of lymphoid cells infiltrated into the stomach carcinoma mass. alpha 1-ACT was not found in carcinoma cells of the colon, uterus, rectum or esophagus, or in lymphoid cells infiltrated into the rectal carcinoma mass or into inflammatory regions such as gastric ulcers or appendicitis. Further, alpha 1-ACT was not found in normal cells around the carcinoma mass or in normal tissues.

Anorexigenic substance isolated from feces of rat and mouse

A substance was isolated from the feces of conventional rats and mice which were fed laboratory diets. Marked reduction in food intake occurred for a few hours after intraperitoneal administration of this substance, while water intake also decreased. Two hr after the injection, when the anorectic effect appeared to be the strongest, no change was found in body temperature or blood glucose, but free amino acids in plasma were decreased. A comparative study using germfree and conventional mice indicated that the anorexigenic substance was produced by gastrointestinal microflora, since the yields of the anorexigenic substance from germfree mice was less than one tenth of that from conventional mice. A partially purified form of the substance, with large molecular weight, was isolated by Sephadex G-150 fractionation. It contained protein but the anorexigenic activity was not diminished by protein digestion.