The polymorphism of transforming growth factor-beta1 gene in Japanese patients with systemic sclerosis

BACKGROUND

Transforming growth factor (TGF)-beta has been shown to be a potent stimulator of collagen production by fibroblasts, and could play a role in the pathogenesis of systemic sclerosis (SSc).

OBJECTIVE

To study the possible involvement of TGF-beta1 gene polymorphism in Japanese patients with SSc.

METHODS

Fifty-nine patients with SSc and 110 normal subjects were studied. Genomic DNA was extracted from skin tissues, and was amplified in a thermal cycler, generating a TGF-beta1 gene fragment with a size of 294 bp. The T to C transition at T869C (Leu10Pro) and the G to C transition at G915C (Arg25Pro) were identified by digestion with MspA1I and BglI, respectively.

RESULTS

At T869C (Leu10Pro), the frequency of the C allele in SSc (65.3%) was significantly higher than in normal controls (50.5%) (P < 0.01). SSc showed C/C allele 42.4%, C/T 45.8% and T/T 11.2%. Normal controls showed C/C allele 26.4%, C/T 48.2% and T/T 25.5%. The frequency of the C/C allele in SSc was significantly higher than in normal controls, in comparison with the T/T allele (P < 0.02), but no significant difference was found between the frequency of the C/C allele vs. the C/T allele. The frequency of the C/C allele showed no significant difference between diffuse and limited SSc. At G915C (Arg25Pro), all the normal controls and SSc patients showed only the G/G allele. These results are different from a previous study in which the frequency of the T/T allele was high in SSc at T869C (Leu10Pro).

CONCLUSIONS

This discrepancy may indicate that Japanese patients with SSc show a different genetic predisposition to TGF-beta1.

The polymorphism of telomerase RNA component gene in patients with systemic sclerosis

BACKGROUND

The molecular basis of senescence and immortalization is not still understood, but one hypothesis for which there has recently been much evidence involves the shortening of telomeres. It can be hypothesized that abnormalities of telomerase contribute to the emergence of abnormal fibroblast clones in systemic sclerosis (SSc).

OBJECTIVES

To study possible telomere abnormalities with respect to polymorphism of the telomerase RNA component gene.

METHODS

Fifty-three patients with SSc and 98 normal controls were studied. Polymerase chain reaction was used to amplify 598 bp of the telomerase RNA component gene. Amplified fragments were digested with restriction enzyme BsrDI.

RESULTS

The frequency of the A allele in SSc (41.5%) showed no significant difference from that in the normal controls (32.1%). The frequency of the A/A alleles in SSc (18.9%) was significantly higher than in normal controls (5.1%), compared with G/G (35.8% and 40.8%, respectively; P < 0.02), G/A (45.3% and 54.1%, respectively; P < 0.01) and G/G plus G/A (81.1% and 94.9%, respectively; P < 0.01).

CONCLUSIONS

These results showed the possible involvement of a telomerase abnormality in the emergence of abnormal fibroblast clones in SSc skin-derived fibroblasts.

Sarcoidosis with giant parotomegaly

We report the case of a 63-year-old man with bilateral parotid gland sarcoidosis. Giant, elastic, hard, subcutaneous tumors had been present on the right parotic and submaxillary regions for 11 years and on the left for 1 year. The patient had had diabetes mellitus for 8 years. Noncaseating epithelioid cell granulomata were revealed histopathologically in the periductal area of the parotid gland. Bilateral hilar lymphadenopathy was noted on chest x-ray studies. Serum levels of lysozyme were increased. Levels of serum angiotensin-converting enzyme were within normal limits. Tuberculin skin reaction was positive. The tumors gradually improved after treatment with oral minocycline. Giant parotomegaly, as it occurred in this case, is very rare.

Quantitative analysis of microchimerism in systemic sclerosis skin tissue

It has been reported that more male DNA of presumed fetal origin is present in the blood and skin of women with systemic sclerosis (SSc) as compared with healthy controls after delivery, but these findings are controversial. We sought to determine whether male cell DNA is present in SSc using a quantitative polymerase chain reaction for Y chromosome DNA. The study groups comprised 57 healthy women, 49 patients with SSc and 30 patients with connective tissue diseases other than SSc who had given birth to at least one son and/or had experienced fetal loss. The intensity of the PCR bands on negatives of gel photographs was quantified with a video densitometer linked to a computer analysis system. Positive Y chromosome DNA was found in 20 healthy women, 14 SSc patients and 6 patients with connective tissue diseases other than SSc. The occurrence rate of DNA equivalents of male cells among the three groups showed no significant differences. The number of male cell DNA equivalents per 80 ng tissue DNA in SSc patients (4.59+/-9.63), however, was significantly higher than in healthy women (1.83+/-4.96; P < 0.05) and in patients with connective tissue diseases other than SSc (0.27+/-0.64; P < 0.01). The occurrence rate of fetal loss in male cell DNA-positive SSc (eight) was significantly higher than in male cell DNA-negative SSc patients (four; P < 0.01). No correlation was found between the number of male cell DNA equivalents and birth of sons or clinicolaboratory findings. These results indicate that the elevated amount of male cell DNA in SSc skin tissue may contribute to the pathogenesis of SSc.

Upregulation of histidine decarboxylase mRNA expression in scleroderma skin

The involvement of histamine in the pathogenesis of systemic sclerosis (SSc) has been suggested. Possible involvement of histamine and histidine decarboxylase (HDC), the synthesizing enzyme for histamine, in the formation of the skin abnormalities in SSc was studied. Skin histamine concentrations in SSc were significantly lower than in normal controls (P < 0.02). In situ hybridization with an HDC probe revealed that the expression of the HDC gene in SSc was greater than in normal controls. The number of cells and the mean grain number per cell expressing HDC mRNA were both significantly greater in SSc than in normal controls (both P < 0.01). These results show a reduction in histamine concentration and an elevated HDC gene expression in SSc skin, indicating an increase in both histamine release and HDC gene expression. The upregulation of histamine turnover appears to be involved in the formation of the skin abnormalities of SSc.

Lipodystrophia centrifugalis abdominalis infantilis-- immunohistochemical demonstration of an apoptotic process in the degenerating fatty tissue

We report a case of lipodystrophia centrifugalis abdominalis infantilis (LCAI) showing apoptosis during the lipoatrophic process by immunohistochemical staining. A 3-year-old boy was seen with a 3-month history of a centrifugally spreading depressed eruption without pain and pruritus on his abdomen. He had fever, diarrhea and vomiting for a week at the beginning of his eruption. Physical examination revealed a palm-sized well-demarcated atrophic plaque on his lower abdomen and left inguinal fold. His plaque showed fine erythema peripherally. A skin biopsy specimen showed remarkably decreased subcutaneous fatty tissue. Inflammatory cell infiltration including lymphocytes and histiocytes was noted in the degenerating fatty tissue. In the degenerating subcutaneous fatty tissue, positive staining for HLA-DR, Fas, bcl-2, p53 and transferase-mediated uridine nick end labeling in mononuclear cells were observed. He was diagnosed as having LCAI. The present case showed the possible involvement of apoptosis in the fatty tissue degeneration in LCAI.

Correlation between diffuse pigmentation and keratinocyte-derived endothelin-1 in systemic sclerosis

BACKGROUND

The precise mechanism of diffuse pigmentation in systemic sclerosis (SSc) is still unknown. We suspected the participation of endothelin-1 (ET-1), which is produced by keratinocytes, in the hyperpigmentation in SSc. The aims of this study are to demonstrate the hyperproductivity of ET-1 from epidermal cells in SSc by in situ hybridization histochemistry, and to show a correlation between the hyperproductivity of ET-1 in keratinocytes and skin hyperpigmentation.

METHODS

In situ hybridization histochemistry was performed on nine SSc specimens (five cases of diffuse scleroderma (dSSc), four cases of acrosclerosis (lSSc)), and compared with four normal control specimens. We counted the grains on 10 x 10 microm(2) of epidermis and microvessels in each histology and examined the degree of skin pigmentation using the skin reflectance factor (Y).

RESULTS

In the specimens of the SSc patients, the number of grains on the epidermis was remarkably higher than those of the control specimens (P < 0.01). We found a close correlation between the number of grains and the skin reflectance factor in dSSc patients (P = 0.02). Correlations were not identified between serum ET-1 and skin pigmentation and between serum ET-1 and the frequency of grains on the epidermis. As for grains on microvessels, lSSc patients showed a greater frequency than dSSc patients.

CONCLUSIONS

The findings of this study suggest that an increase in the ET-1 productivity of keratinocytes is experienced in SSc patients, especially in dSSc patients. The results suggest a strong correlation between the ET-1 productivity of keratinocytes and skin pigmentation in severe cases of SSc. We conclude from these results that keratinocyte-derived ET-1 plays an important role in the pathogenesis of the hyperpigmentation of the skin in SSc patients.

[A case of acute urticaria from hydroxyzine hydrochloride used for preanesthetic medication]

We report a case of acute urticaria probably caused by hydroxyzine hydrochloride. A 66-year-old male was scheduled for cardiac cystectomy by thoracic endoscopy. The patient was premedicated with atropine and hydroxyzine intramuscularly 30 min before arrival in the operating room. Abrupt general exanthema was observed when intravenous infusion was started. Although his general condition was stable, the operation was postponed. Three days later, the skin test was performed using several drugs. Only hydroxyzine hydrochloride gave positive result. It is assumed that hydroxyzine hydrochloride may have caused his urticaria.

Digital ulcers and necroses: novel manifestations of angiocentric lymphoma

We describe a patient with angiocentric lymphoma whose presenting features were multiple areas of digital ulceration and necrosis, including deep ulcers on both great toes. He lacked the lateral halves of both earlobes because of multiple ulcers. Skin biopsy revealed a patchy and diffuse infiltrate of lymphoid cells with nuclear atypia in the dermis and subcutaneous tissue. Angiocentric and angiodestructive features of the lymphoid cells, a prominent histiocytic infiltrate and some epithelioid cell granulomas were found. The results of immunohistochemical staining showed a T-cell phenotype, and showed positive staining for apoptosis. He died in July 1999. Peripheral vascular disturbances including Raynaud's phenomenon, digital skin ulcers and necroses are novel clinical symptoms in patients with angiocentric lymphoma, which should be added to the differential diagnosis in patients with peripheral vascular disturbances.

Simultaneous analysis of [3H]-thymidine uptake and alpha 1(I) procollagen mRNA expression in systemic sclerosis skin fibroblasts--an in situ hybridization study

Heterogeneity of DNA synthesis and collagen synthesis has been reported in skin fibroblasts from systemic sclerosis (SSc) patients. The uptake of [3H]-thymidine and expression of alpha 1(I) procollagen mRNA by cultured skin fibroblasts from four normal controls and four SSc patients was analyzed simultaneously. The grains overlying the cytoplasm representing alpha 1(I) procollagen mRNA and overlying the nucleus representing [3H]-thymidine uptake were counted using computer-aided image analysis. The results were analyzed statistically. Procollagen mRNA expression by SSc fibroblasts was significantly greater than by control fibroblasts (P < 0.01). The distribution curve of [3H]-thymidine uptake showed two peaks representing low- and high-uptake cells. Significantly more SSc fibroblasts than control fibroblasts showed high [3H]-thymidine uptake (P < 0.05). The number of SSc fibroblasts expressing low amounts of alpha 1(I) procollagen mRNA was significantly lower than the number of control fibroblasts (P < 0.05). [3H]-thymidine uptake by SSc fibroblasts expressing high amounts of alpha 1(I) procollagen mRNA was significantly lower than by those expressing low amounts (P < 0.05). These results indicate that elevated DNA synthesis and elevated collagen mRNA synthesis in SSc skin fibroblasts are due to different clones with high DNA-synthesizing ability and high collagen-producing ability.

Quantitative analysis of alpha 1(I) and alpha 1(III) procollagen mRNA expression in systemic sclerosis skin tissue--an in situ hybridization study

Human alpha 1(I) and alpha 1(III) procollagen mRNA expression in skin tissue from 15 systemic sclerosis (SSc) patients and from 7 normal control subjects was quantitatively analyzed using in situ hybridization. The grains accumulating in each area, representing procollagen mRNA expression per cell, were counted. To normalize the results from each subject, the number of cells and the number of grains per cell were divided by the area of the skin specimen (in square millimeters). The number of cells per square millimeter expressing alpha 1(I) and alpha 1(III) procollagen mRNA in SSc skin was significantly elevated compared with normal control skin (both P < 0.01). The number of grains per cell per square millimeter expressing alpha 1(III) procollagen mRNA in SSc skin was also significantly elevated compared with normal control skin (P < 0.01). The relationship between procollagen mRNA expression and the histological findings in SSc was also studied. The numbers of cells and grains per cell per square millimeter expressing alpha 1(I) procollagen mRNA in fibrotic zone SSc skin were significantly elevated compared with normal control skin (both P < 0.01). The numbers of cells and grains per cell per square millimeter expressing alpha 1(III) procollagen mRNA in SSc skin were significantly elevated compared with normal control skin (both P < 0.01) and with border zone SSc skin (number of cells P < 0.01, number of grains P < 0.05). These results indicate an increase in the number of cells showing elevated expression of alpha 1(I) and alpha 1(III) procollagen mRNA, and a close relationship between alpha 1(I) and alpha 1(III) procollagen mRNA expression and the histological findings in SSc.

A case of prurigo and lichenified plaques successfully treated with proton pump inhibitor

A case of prurigo and lichenified plaques successfully treated with proton pump inhibitor is presented. She presented with pruritic eruptions, which showed marked lichenification and prurigo nodules, on her trunk and extremities. She had been treated with steroid ointment and H1-histamine receptor antagonist without success. Laboratory examinations revealed increased eosiophils and elevated lactate dehydrogenase. The skin biopsy specimen showed moderate acanthosis with spongiosis and lymphocytic and eosinophilic infiltration into the upper dermis. Because of vomiting and epigastralgia, endoscopical examination was performed, and an ulcer was found at the angle of her ventricle. A biopsy specimen disclosed a benign gastric mucosa with moderate inflammation within the lamina propria, and organisms consistent with Helicobacter pylori. Treatment for gastric ulcer with proton pump inhibitor (omeprazole) and aluminium hydroxide gel improved her eruptions and her pruritus resolved. She was discharged with complete cure of her eruption and ventricular ulcer. Our case indicates that gastric lesions induced by Helicobacter pylori infection may play an important role in dermatological diseases. Proton pump inhibitors including omeprazole are one of the choices for the treatment of some dermatological diseases including prurigo and lichenified plaques.

Dermal mucinosis and musculoskeletal symptoms simulating polymyositis as a presenting sign of hypothyroidism

A case of dermal mucinosis and musculoskeletal symptoms simulating polymyositis as a presenting sign of hypothyroidism is presented. The patient presented muscle weakness and edema of the face including the eyelids. Laboratory examination revealed elevated creatinine phosphokinase, decreased free-T4, decreased free-T3, elevated TSH, positive anti-microsome antibody and positive anti-TSH receptor antibody. The skin biopsy specimen revealed swelling of the collagen bundles with the bundles splitting up into individual fibers, with some blue threads and granules of mucin interspersed. Alucian blue stain demonstrated vast amounts of mucin throughout the whole dermis, which was completely removed on incubation with Streptomyces hyaluronidase. The patient was diagnosed as having hypothyroidism due to Hashimoto's disease with possible polymyositis complications. After two months of thyroid hormone replacement therapy, she was euthyroidic and discharged. These results indicate that our case was a rare case of severe generalized myxoedema due to hypothyroidism of Hashimoto's disease simulating the musculoskeletal symptoms of polymyositis.

Elevated expression of epidermal ornithine decarboxylase mRNA in scleroderma

Using in situ hybridization techniques, we examined the expression of ornithine decarboxylase (ODC) mRNA in the skin of five patients with systemic sclerosis (SSc) and five normal controls. Sections treated with an anti-sense probe showed concentrated grains exclusively in the epidermis of SSc patients, but not in that of normal controls. Because our subcloned anti-sense probe specifically hybridizes with ODC mRNA, these findings indicate that the expression of ODC mRNA is elevated in SSc epidermis. Possibly polyamines have an important part to play in the skin changes of SSc.

The predictive value of quantitative nailfold capillary microscopy in patients with undifferentiated connective tissue disease

The present prospective study was undertaken to follow the natural history of patients with Raynaud's phenomenon and to document in these patients the frequency with which secondary disorders develop. Seventeen patients with primary Raynaud's phenomenon (PRP) and 43 patients with undifferentiated connective tissue disease (UCTD) were examined after 6-8 years to see whether they had developed into UCTD or systemic sclerosis (SSc), respectively. Their nailfold capillary parameters were analysed statistically to ascertain whether they would predict for the development of the diseases into UCTD or SSc. Two patients with PRP(12%) developed into UCTD, and 10 patients with UCTD (23%) into SSc. In PRP, all three parameters of the patients who developed into UCTD showed a tendency to be larger than in those who did not develop UCTD. In UCTD, the apical limb width (P < 0.02), capillary width (P < 0.01) and capillary length (P < 0.01) of the subjects who developed SSc were significantly larger than those who did not. Of the clinicolaboratory findings in patients with UCTD, the occurrence rate of abnormal apical limb width (relative risk 20. 7, P < 0.01), abnormal capillary width (relative risk 10.7, P < 0. 01), abnormal capillary length (relative risk 9.2, P < 0.02) and antinuclear antibody (relative risk 9.6, P < 0.05) showed a significant predictive value for the development of UCTD into SSc. These results indicate that quantitative nailfold capillary microscopy, as well as antinuclear antibody, will provide exact predictive information in patients with UCTD in clinical practice.

Bandlike melasma mimicking linear morphea ("en coup de sabre" type)

A case of bandlike melasma on the median line of the forehead of a middle-aged woman is described. It was an atypical case for its clinical shape and distribution. At initial examination, it was diagnosed as linear morphea. Epidermal nevus was another differential diagnosis. Based on the presence of minor protuberance and the absence of atrophy, clinically, and the presence of sebaceous glands and the absence of swelling of collagen fibers, documented histologically, we revised our diagnosis to that of an atypical type of melasma.

Cutaneous localization of endothelin-1 in patients with systemic sclerosis: immunoelectron microscopic study

BACKGROUND

Endothelin-1 (ET-1) has some relation to the pathogenesis of systemic sclerosis (SSc) and Raynaud's phenomenon. This study was performed to determine the localization of ET-1 in patients with SSc.

METHODS

The localization of ET-1 on the specimen by skin biopsies from nine patients with SSc, was observed with immunoelectron microscopic techniques.

RESULTS

High-density deposits existed on the ribosomes and on the rough endoplasmic reticulum in the endothelial cells of microvessels of the upper dermis. The same findings were also seen in the fibroblasts of the dermis, but not found in the skin of normal controls. The level of deposits in the endothelial cells and dermal fibroblasts seemed to have a positive correlation with the serum levels of ET-1 of patients with SSc.

CONCLUSIONS

From these results, it can be seen that ET-1 is produced much more from the endothelial cells and fibroblasts of the dermis in the skin of SSc patients than from the normal controls. It is suspected that ET-1 is one of the pathogenetic factors of SSc.

Nailfold capillary abnormality and pulmonary hypertension in systemic sclerosis

BACKGROUND

Patients with systemic sclerosis (SSC) show a capillary abnormality of nailfolds with controversial correlation with organ involvement. Our purpose was to study the correlation between this nailfold capillary abnormality and pulmonary hypertension in patients with SSC.

METHODS

We studied the nailfold capillaries, using capillary microscopy, and the pulmonary arterial pressure, using right-heart catheterization, in 44 patients with SSC. Canonical discriminant analysis was used to define the capillary abnormality in patients with SSC, which was then compared with that of 40 normal controls. The correlations between the patterns of nailfold capillaries and the cardiopulmonary findings, including the pulmonary arterial pressure, were examined using Fisher's test.

RESULTS

Thirty-two of 44 patients with SSC could be differentiated from normal controls by our definition of the SSC pattern. The SSC pattern correlated significantly with elevated pulmonary vascular resistance, as well as with pulmonary fibrosis, electrocardiographic abnormalities, decreased vital capacity, and decreased diffusing capacity for carbon monoxide. All SSC patients with pulmonary hypertension showed this SSC pattern. In patients with elevated pulmonary arterial pressure, capillary microscopy and diffusion capacity for carbon monoxide (DCCM) showed the highest rate of abnormalities. A limited-type SSC significantly correlated with DCCM and with anticentromere antibody, and the diffuse-type SSC with pulmonary fibrosis and anti-sci-70 antibody.

CONCLUSION

Our data suggest that in patients with SSC, nailfold capillary abnormalities correlate with pulmonary arterial hypertension as well as with clinical and laboratory findings indicating pulmonary hypertension.

Electron-microscopic study of sclerodermatous chronic graft-versus-host disease

BACKGROUND

Sclerodermatous chronic graft-versus-host disease (SC-GVHD) resembles systemic scleroderma (SSD) closely, both clinically and histologically. Our purpose was to try to define the morphologic differences of collagen fibers between SC-GVHD and SSD.

MATERIALS AND METHODS

Using electron microscopy, we compared the morphology of collagen fibers in a 15-year old girl with SC-GVHD with those of three patients with SSD.

RESULTS

In SC-GVHD, sclerosis is located in the superficial dermis and collagen fibers of irregular diameter are seen in the subepidermal area. In SSD, sclerosis is seen in the lower dermis and subcutaneous fatty tissue, and collagen fibers of irregular diameter are located in the deep dermis. Some of the collagen fibers were degenerative in the superficial dermis in SC-GVHD. We observed low-density, round structures in cross sections of collagen fibers.

CONCLUSIONS

The difference in initial location and morphologic appearance of collagen fibers may indicate a different pathogenesis in SC-GVHD compared to SSD.

Image analysis of nailfold capillaries in patients with undifferentiated connective tissue syndromes

Several studies have reported patients that show nailfold capillary abnormality without fulfilling any of the criteria for rheumatic diseases. Our objective was to define how many patients with undifferentiated connective tissue syndrome (UCTS) have nailfold capillary abnormalities and to determine the correlation between capillary abnormality and clinical findings. We analyzed videograph images of nailfold capillaries in 75 patients with UCTS, comparing them with 22 normal controls (NL) and 55 patients with systemic sclerosis (SS), using standardized canonical discriminant analysis. Sixty patients with UCTS showed the SS type pattern and 15, the NL type pattern. The SS type pattern in patients with UCTS significantly correlated with Raynaud's phenomenon, telangiectasia, and anti-nuclear antibody. The UCTS patients with nailfold capillary abnormalities correlated with symptoms of SS have a possibility of progressing to SS. The follow up study of these patients will show whether progression to SS occurs.

Elevated levels of platelet derived growth factor and transforming growth factor-beta 1 in bronchoalveolar lavage fluid from patients with scleroderma

OBJECTIVE

Systemic sclerosis (scleroderma, SSc) frequently affects the lungs, and interstitial pulmonary fibrosis is one of its major complications. The pathophysiology of SSc lung disease s poorly understood, but recent studies document an inflammatory process resembling that of idiopathic pulmonary fibrosis with increased numbers of activated alveolar macrophages and granulocytes in bronchoalveolar lavage (BAL) fluid). We determined levels of 2 potentially important mediators of fibroproliferative repair in BAL fluid from patients with SSc.

METHODS

Using Western blot and ELISA techniques we measured levels of platelet derived growth factor (PDGF) and transforming growth factor-beta (TGF-beta in BAL fluid from patients with SSc and healthy controls. The mitogenic effect of these cytokines on SSc lung myofibroblasts was determined by [3H]thymidine incorporation.

RESULTS

SSc BAL fluid contains significantly elevated levels of PDGF-AA and PDGF-BB. Where TGF-beta 1 was significantly elevated in SSc lavage fluid, the amount of TGF-beta 2 was significantly less than that observed in normal lavage fluid. Myofibroblasts cultured from SSc lavage fluid exhibited enhanced [3H]thymidine incorporation upon exposure to the growth factors present in SSc BAL fluid: PDGF and TGF-beta 1. SSc lung myofibroblasts pretreated with TGF-beta 1 exhibited an enhanced mitogenic effect upon stimulation by PDGF, due in part to the induction of the PDGF alpha receptor.

CONCLUSION

Our studies support a role for PDGF and TGF-beta 1 in the pathogenesis of SSc lung disease.

Image analysis of nail fold capillaries in patients with Raynaud's phenomenon

Videograph images of nail fold capillaries in patients with Raynaud's phenomenon were analyzed, and capillary patterns were defined using standardized canonical discriminant analysis. Of sixty-eight patients with Raynaud's phenomenon, forty-nine (72 percent) showed a systemic sclerosis pattern and nineteen (28 percent) showed a normal pattern. The systemic sclerosis type capillary pattern significantly correlated not only with secondary Raynaud's syndrome but also with sclerodactyly, telangiectasia, and antinuclear antibody. This study confirms the value of nail fold capillary microscopy as a noninvasive technique for the examination of the cutaneous microcirculation in vivo. We should continue to evaluate the patients with Raynaud's phenomenon who showed systemic sclerosis pattern abnormality to determine if these patients would show a progression to systemic sclerosis or not.

A case of lichen myxedematosus with clearly exacerbated skin eruptions after UVB irradiation

We report a 48-year-old male with typical lichen myxedematosus, liver dysfunction, and diabetes mellitus. His skin eruptions were clearly exacerbated after accidental over-irradiation by UVB. These findings were clinically and histologically confirmed. The pathogenesis is still unknown, but we consider it to be due to Koebner phenomenon.

Statistical definition of nailfold capillary pattern in patients with psoriasis

BACKGROUND

The microvasculature plays an important role in the pathogenesis of psoriatic skin lesions. Our purpose was to try to define a psoriatic pattern in the nailfold capillary, to clarify the relationship between nailfold capillary microscopic changes and nail involvement and to note the general clinical features of psoriasis.

METHODS

Image analysis of nailfold capillaries was performed in 62 patients with psoriasis. The capillary pattern was defined statistically comparing it with that of 51 healthy volunteers. We attempted to differentiate the psoriatic pattern from normal controls with "canonical discriminant analysis."

RESULTS

Forty-nine of 62 patients with psoriasis could be differentiated from normal controls by our definition of psoriatic pattern that was significantly correlated with periungual psoriatic plaque, nail pitting, onycholysis, and the extent of the involved area.

CONCLUSIONS

Our data suggest that nailfold capillary changes reflect microvascular changes of psoriasis and that the nailfold capillary pattern is a useful tool in evaluating nail involvement and the severity of psoriasis.

[Scleroderma, dermatomyositis]

Systemic sclerosis (scleroderma, SSc) is a progressive and often fatal disorder characterized clinically by sclerotic changes in the skin, joints and internal organ systems such as the gastrointestinal tract, heart, lungs and kidneys, moreover pathologically by abnormalities of mucopolysaccharides, fibrous tissue deposition, atrophy of parenchymal structures in skin and various internal organs, and by vascular insufficiency. Little is known of its etiology and pathogenesis. Transforming growth factor-beta (TGF-beta), platelet derived growth factor-AA (PDGF-AA) and PDGF-alpha receptor interaction may play an important role in the pathogenesis of scleroderma. Furthermore, many of the proteoglycans act as modulators of growth factor activities. Dermatomyositis is also a complex connective tissue disease of unknown etiology, in which inflammatory change in the skin, muscle, and lung in association with vascular insufficiency and internal malignancy.

Diabetic scleredema and scleroderma-like changes in a patient with maturity onset type diabetes of young people

A 21-year-old housewife with maturity onset type diabetes of young people developed scleredema diabeticorum, scleroderma-like skin thickness on forearms and dorsum of hands, digital sclerosis and cheiroarthropathy. She had diabetes mellitus since the age of 11 years. Her grandfather on the mother's side, her mother and 3 of 5 her mother's brothers and sisters have diabetes mellitus. Blood glucose was 295 mg/dl. Urinary glucose was 5.3 g/day. Nail fold capillary microscopy revealed a progressive systemic sclerosis pattern. Histologically, hematoxylin and eosin sections from back and forearm skin demonstrated broad collagen bundles separated by widened clear spaces throughout the thickened dermis.

Lipodystrophia centrifugalis abdominalis infantilis occurring in the neck

We report a Japanese girl with atypical lipodystrophia centrifugalis abdominalis infantilis. The initial lesion developed on the neck as an area of erythema which showed centrifugal spread to the nape, submandibular area and upper breast and central fading to leave a residual depression and purplish brown pigmentation symmetrically. A central depression on the neck, nape, submandibular area and upper breast was surrounded by a distinctive erythematous, slightly elevated and indurated border. Histological examination of the erythematous border revealed inflammatory changes in the subcutaneous fat. Although this patient was affected in an unusual site, we concluded that she had lipodystrophia centrifugalis abdominalis infantilis, because of the overall features of the lesions.

Differential modulation of bFGF receptors by TGF-beta in adult skin, scleroderma skin, and newborn foreskin fibroblasts

Effects of transforming growth factor beta (TGF-beta) on proliferative responses to basic fibroblast growth factor (bFGF) were studied in human diploid fibroblasts cell strains derived from three different sources: adult skin, scleroderma, and newborn foreskin. All three types of cell strains were similarly responsive to TGF-beta, whereas adult skin fibroblasts were significantly more responsive to bFGF. Incubation of cells with TGF-beta prior to bFGF addition substantially increased responsiveness of adult skin fibroblasts to this latter cytokine, slightly increased that of scleroderma fibroblasts, and decreased that of foreskin fibroblasts. Modulation of bFGF receptors by TGF-beta correlated positively with these mitogenic effects. Adult skin fibroblasts showed increases of both high- and low-affinity receptors and scleroderma fibroblasts showed small increases of high-affinity receptors only, whereas foreskin fibroblasts showed no changes. Heparitinase treatment of adult skin fibroblasts during TGF-beta pre-incubation resulted in reduced bFGF binding to low-affinity receptors and reduced mitogenic response to bFGF, suggesting that the TGF-beta-stimulated increase of low-affinity receptors in these cells contributes to the observed enhanced mitogenic effects of bFGF. Abnormal responses of scleroderma fibroblasts to TGF-beta/bFGF stimulation, particularly failure to synthesize low-affinity receptors in response to TGF-beta, adds a new characteristic to the fibrotic phenotype of scleroderma fibroblasts.

Selective upregulation of platelet-derived growth factor alpha receptors by transforming growth factor beta in scleroderma fibroblasts

Transforming growth factor beta (TGF-beta), a multifunctional cytokine, is an indirect mitogen for human fibroblasts through platelet-derived growth factor (PDGF), particularly the A ligand-alpha receptor arm of that system. TGF-beta effects on PDGF alpha receptor expression were studied in vitro using ligand binding techniques in three human dermal fibroblast strains: newborn foreskin, adult skin, and scleroderma (systemic sclerosis, SSc). Each cell strain responded differently to TGF-beta. In newborn foreskin fibroblasts, PDGF alpha receptor number decreased in a dose-dependent manner after exposure to low concentrations of TGF-beta (0.1-1 ng/ml). Responses of normal skin fibroblasts were varied, and mean net receptor number was unchanged. Increases in PDGF alpha receptor number by TGF-beta occurred consistently with SSc fibroblasts and low concentrations of TGF-beta (0.1-1 ng/ml) were particularly stimulatory. Increased surface expression of alpha receptor subunit by TGF-beta in SSc fibroblasts correlated with increased new PDGF alpha receptor synthesis as demonstrated by radioimmunoprecipitation analysis of metabolically labeled cells and with increased steady-state levels of corresponding mRNAs. In normal adult skin fibroblasts, TGF-beta had no effect on either synthesis or mRNA expression of alpha receptor subunits. Proliferative responses to PDGF-AA after pretreatment with TGF-beta correlated positively with effects of TGF-beta on expression of alpha receptor subunit. Decreased mitogenic responses to PDGF-AA were observed in foreskin fibroblasts, small changes in responses in adult fibroblasts, and significant increases in SSc fibroblasts. Thus, costimulation with PDGF-AA and TGF-beta selectively enhanced proliferation of fibroblasts with the SSc phenotype. Immunohistochemical examination of SSc and control skin biopsies revealed the presence of PDGF-AA in SSc skin. Data obtained by ligand binding, immunoprecipitation, mRNA, and mitogenic techniques are consistent with the hypothesis that activation of the PDGF-AA ligand/alpha receptor pathway is a characteristic of the SSc fibroblast and may contribute to the expansion of fibroblasts in SSc.

Persistent effect of TGF-beta 1 on extracellular matrix gene expression in human dermal fibroblasts

TGF-beta, a potent inducer of the extracellular matrix, is also known to stimulate its own synthesis. In this report we have analyzed long term effects of TGF-beta 1 on its own expression and on the expression of extracellular matrix genes. We demonstrated that 24 hours of incubation of human dermal fibroblasts with TGF-beta 1 (1 ng/ml) under serum free conditions resulted in an elevated expression of TGF-beta 1, collagen alpha 2(I) and fibronectin mRNAs that persisted at least 96 hours after removal of TGF-beta 1. These data suggest the possibility of persistent in vivo activation of target cells following exposure to TGF-beta 1.

Generalized morphea-like scleroderma occurring in people exposed to organic solvents

Adult patients having systemic scleroderma with generalized morphea-like skin lesions, whom we had examined during the past 7 years, were reexamined because their clinical features were somewhat similar to those of occupational scleroderma described hitherto. Out of 9 patients, 7 patients had been engaged in occupations exposing them to organic solvents for a long time before or after Raynaud’s phenomenon appeared. A skin sclerosis was also induced experimentally with some aliphatic hydrocarbons of organic solvents.

Occupational scleroderma-like disorder occurring in men engaged in the polymerization of epoxy resins

A new occupational disorder characterized by skin sclerosis is described. This disease developed acutely in workmen exposed to the vapor of epoxy resins. Based on animal experiments, an amine [bis(4-amino-3-methyl-cyclohexyl) methane] is suspected of being the causative agent of the skin sclerosis.

Detection of sclerosis-inducing glycosaminoglycan in the skin of an amine-induced experimental skin sclerosis

The presence of sclerosis-inducing glycosaminoglycan in the skin was confirmed in an experimental skin sclerosis induced by a chemical compound. An experimental skin sclerosis was first produced in the mouse with bis(4-amino-3-methylcyclohexyl)methane. Out of glycosaminoglycans isolated from the slightly changed skin of this experimental skin sclerosis, the one having a heparan sulfate-like structure was able to again induce sclerotic skin changes in another mouse. The chemical composition of this sclerosis-inducing glycosaminoglycan was somewhat similar to that of the scleroderma-inducing glycosaminoglycan isolated previously from the urine of patients with systemic scleroderma.