Irisin improves delayed bone repair in diabetic female mice

INTRODUCTION

Irisin is a proteolytic product of fibronectin type II domain-containing 5, which is related to the improvement in glucose metabolism. Numerous studies have suggested that irisin is a crucial myokine linking muscle to bone in physiological and pathophysiological states.

MATERIALS AND METHODS

We examined the effects of local irisin administration with gelatin hydrogel sheets and intraperitoneal injection of irisin on the delayed femoral bone repair caused by streptozotocin (STZ)-induced diabetes in female mice. We analyzed the femurs of mice using quantitative computed tomography and histological analyses and then measured the mRNA levels in the damaged mouse tissues.

RESULTS

Local irisin administration significantly blunted the delayed bone repair induced by STZ 10 days after a femoral bone defect was generated. Local irisin administration significantly blunted the number of Osterix-positive cells that were suppressed by STZ at the damaged site 4 days after a femoral bone defect was generated, although it did not affect the mRNA levels of chondrogenic and adipogenic genes 4 days after bone injury in the presence or absence of diabetes. On the other hand, intraperitoneal injection of irisin did not affect delayed bone repair induced by STZ 10 days after bone injury. Irisin significantly blunted the decrease in Osterix mRNA levels induced by advanced glycation end products or high-glucose conditions in ST2 cells in the presence of bone morphogenetic protein-2.

CONCLUSIONS

We first showed that local irisin administration with gelatin hydrogel sheets improves the delayed bone repair induced by diabetic state partially by enhancing osteoblastic differentiation.

Renal failure suppresses muscle irisin expression, and irisin blunts cortical bone loss in mice

BACKGROUND

Chronic renal failure induces bone mineral disorders and sarcopenia. Skeletal muscle affects other tissues, including bone, by releasing myokines. However, the effects of chronic renal failure on the interactions between muscle and bone remain unclear.

METHODS

We investigated the effects of renal failure on bone, muscle, and myokines linking muscle to bone using a mouse 5/6 nephrectomy (Nx) model. Muscle mass and bone mineral density (BMD) were analysed by quantitative computed tomography 8 weeks after Nx.

RESULTS

Nephrectomy significantly reduced muscle mass in the whole body (12.1% reduction, P < 0.05), grip strength (10.1% reduction, P < 0.05), and cortical BMD at the femurs of mice (9.5% reduction, P < 0.01) 8 weeks after surgery, but did not affect trabecular BMD at the femurs. Among the myokines linking muscle to bone, Nx reduced the expression of irisin, a proteolytic product of fibronectin type III domain-containing 5 (Fndc5), in the gastrocnemius muscles of mice (38% reduction, P < 0.01). Nx increased myostatin mRNA levels in the gastrocnemius muscles of mice (54% increase, P < 0.01). In simple regression analyses, cortical BMD, but not trabecular BMD, at the femurs was positively related to Fndc5 mRNA levels in the gastrocnemius muscles of mice (r = 0.651, P < 0.05). The weekly administration of recombinant irisin to mice ameliorated the decrease in cortical BMD, but not muscle mass or grip strength, induced by Nx (6.2% reduction in mice with Nx vs. 3.3% reduction in mice with Nx and irisin treatment, P < 0.05).

CONCLUSIONS

The present results demonstrated that renal failure decreases the expression of irisin in the gastrocnemius muscles of mice. Irisin may contribute to cortical bone loss induced by renal failure in mice as a myokine linking muscle to bone.

Role of plasminogen activator inhibitor-1 in muscle wasting induced by a diabetic state in female mice

Muscle wasting is a complication in patients with diabetes and leads to a reduced quality of life. However, the detailed mechanisms of diabetes-induced muscle wasting remain unknown. Plasminogen activator inhibitor-1 (PAI-1), a serine protease inhibitor that suppresses plasminogen activator activity, is involved in the pathophysiology of various diseases, including diabetes. In the present study, we examined the role of endogenous PAI-1 in the decrease in muscle mass and the impaired grip strength induced by the diabetic state by employing streptozotocin (STZ)-treated PAI-1-deficient female mice. The analyses of skeletal muscles and grip strength were performed in PAI-1-deficient and wild-type mice 4 weeks after the induction of a diabetic state by STZ administration. PAI-1 deficiency did not affect muscle mass in the lower limbs measured by quantitative computed tomography or tissue weights of the tibialis anterior, gastrocnemius and soleus muscles of female mice with or without STZ treatment. On the other hand, PAI-1 deficiency significantly aggravated grip strength decreased by STZ in female mice. PAI-1 deficiency did not affect the mRNA levels of Pax7, MyoD, myogenin or myosin heavy chain in either the tibialis anterior or soleus muscles of female mice with or without STZ treatment. In conclusion, we revealed for the first time that PAI-1 deficiency aggravates grip strength impaired by the diabetic state in female mice, although it did not affect diabetes-decreased muscle mass.

Role of tissue factor in delayed bone repair induced by diabetic state in mice

Background

Tissue factor (TF) is the primary activator of the extrinsic coagulation protease cascade. Although TF plays roles in various pathological states, such as thrombosis, inflammatory diseases, cancer, and atherosclerosis, its involvement in bone metabolism remains unknown.

Materials and methods

The present study examined the roles of TF in delayed bone repair induced by a diabetic state in mice using wild-type (WT) and low TF-expressing (LTF) male mice. A diabetic state was induced by intraperitoneal injections of streptozotocin (STZ).

Results

A prolonged diabetic state significantly reduced total and trabecular bone mineral densities (BMD) as well as cortical bone thickness in WT and LTF mice; these BMD parameters were similar between WT and LTF mice treated with or without STZ. The diabetic state induced in WT mice delayed the repair of the femur following injury. The diabetic state induced in LTF mice was associated with further delays in bone repair. In in vitro experiments, TF significantly decreased receptor activator of nuclear factor-κB ligand-induced osteoclast formation and osteoclastogenic gene expression in RAW264.7 cells. However, it did not affect the gene expression levels of runt-related transcription factor 2 and osterix as well as alkaline phosphatase activity in mouse primary osteoblasts.

Conclusion

Low TF state was associated with enhanced bone repair delay induced by diabetic state in mice. The TF-induced suppression of bone remodeling may be a contributing factor to the protective effects of TF against delayed bone repair in a diabetic state.

Lateral Approach With a Mouth Corner Incision for the Molar Part of Mandibulectomy

OBJECTIVES

The aim of the present study was to evaluate the functional and esthetic results of marginal mandibulectomy for mandibular cancer using a lateral approach with a simple, straightforward mouth corner incision.

STUDY DESIGN

Six mandibular cancer patients (2 men, 4 women; age range: 65-80 years; mean age, 73.1 years; all stage I) were treated using this approach. With this approach, the surgical field was widely exposed, and mandibulectomy was performed with sufficient surgical margins. Intraoperative frozen specimens of remaining tissues showed no malignancy in all cases. In all 6 patients, follow-up imaging assessments were obtained, with no local recurrence after 12 to 78 months.

RESULTS AND CONCLUSIONS

An overall functional, physical, and esthetic assessment of oral behavior and oral appearance was made of all patients by the FACT-H&N questionnaire, which showed that functional lip behavior and esthetic lip appearance were not much affected by the present surgical approach, and good quality of life was maintained. Thus, the lateral approach with the mouth corner incision is an effective and useful alternative for the molar part of mandibulectomy.

Mechanisms of the antimetastatic effect in the liver and of the hepatocyte injury induced by alpha-galactosylceramide in mice

The role of mouse liver NK1.1 Ag(+) T (NKT) cells in the antitumor effect of alpha-galactosylceramide (alpha-GalCer) has been unclear. We now show that, whereas alpha-GalCer increased the serum IFN-gamma concentration and alanine aminotransferase activity in NK cell-depleted C57BL/6 (B6) mice and B6-beige/beige mice similarly to its effects in control B6 mice, its enhancement of the antitumor cytotoxicity of liver mononuclear cells (MNCs) was abrogated. Depletion of both NK and NKT cells in B6 mice reduced all these effects of alpha-GALCER: Injection of Abs to IFN-gamma also inhibited the alpha-GalCer-induced increase in antitumor cytotoxicity of MNCS: alpha-GalCer induced the expression of Fas ligand on NKT cells in the liver of B6 mice. Whereas alpha-GalCer did not increase serum alanine aminotransferase activity in B6-lpr/lpr mice and B6-gld/gld mice, it increased the antitumor cytotoxicity of liver MNCS: The alpha-GalCer-induced increase in survival rate apparent in B6 mice injected intrasplenically with B16 tumor cells was abrogated in beige/beige mice, NK cell-depleted B6 mice, and B6 mice treated with Abs to IFN-gamma. Depletion of CD8(+) T cells did not affect the alpha-GalCer-induced antitumor cytotoxicity of liver MNCs but reduced the effect of alpha-GalCer on the survival of B6 mice. Thus, IFN-gamma produced by alpha-GalCer-activated NKT cells increases both the innate antitumor cytotoxicity of NK cells and the adaptive antitumor response of CD8(+) T cells, with consequent inhibition of tumor metastasis to the liver. Moreover, NKT cells mediate alpha-GalCer-induced hepatocyte injury through Fas-Fas ligand signaling.

[Rupture of intrascrotal epidermoid cyst complicated by bacterial infection: a case report]

A 63-year-old male visited our hospital with the chief complaint of right scrotal pain. The right scrotum was swollen to the size of a small egg, and its skin was reddish. The mass was palpable independent of the right testis and epididymis. We diagnosed an intrascrotal abscess. The pus spontaneously issued from the scrotal mass. Sequentially, the abscess was extracted under spinal anesthesia. Membrane-like tissue assumed as the abscess wall was removed. Histologically, the abscess wall was composed of epidermal structure with epidermal keratinization, and horny material was found inside the wall. In the scrotal epidermis overlying the abscess, infiltration of neutrophils, lymphocytes, and multinucleated giant cells were observed. Anaerobic bacteria were detected in the pus of the abscess. Consequently, we diagnosed this case as rupture of an intrascrotal epidermoid cyst complicated by bacterial infection.

Increased activity and intranuclear expression of phospholipase D2 in human renal cancer

We examined the PLD activities of human renal cancers and found that the PLD2 activity was greatly elevated in almost all cases examined as compared with the adjacent normal region. Western blot analysis showed the increased levels of PLD2 protein, but the PLD1 was not discernible. The oleate-dependent PU) activity was very low but appeared to increase in most cases. Interestingly, the immunohistochemical observations indicated the high expression of PLD2 in the nuclei of clear carcinoma cells. This is the first demonstration which suggests the possible involvement of PLD2 in tumorigenesis of renal cancer.

Step by step filter based program for calculations of highly informative derivative curves

We have developed a microcomputer program, based on a recently described approach called step by step filter (SBSF), for calculation of derivative curves directly from spectra recorded as a function of wavelength. This program avoids the long wavelength attenuation featured at conventional method for derivative curves calculation, and in this extent could be very helpful for daily spectroscopy practice. The features of the SBSF program include: easy treatment of data through a windowed environment, calculating of both conventional and step by step filter derivatives, possibilities for selection of the mathematical conditions for smoothing and differentiation simultaneous plotting of the original curve and its derivative and a mouse pointer. Several examples from different branches of the molecular spectroscopy (absorption UV-VIS, CD and fluorescence) are provided and discussed in the terms of advantages of SBSF.

[A clinical study on active vitamin D pulse therapy in hemodialysis patients with secondary hyperparathyroidism]

The oral active vitamin D pulse therapy was performed for 20 chronic hemodialysis patients with secondary hyperparathyroidism (2 degrees HPT). Before pulse therapy, all patients showed high-turnover bone diseases, elevated serum alkaline phosphatase (Alp) and elevated serum parathyroid hormone (PTH). They had at least one parathyroid gland detected by ultrasonography. In one patient, serum PTH level did not decrease during three months. In five patients, hypercalcemia was observed so that the pulse therapy was with drawn. Another patient was resistant to the second pulse therapy for recurrence of 2 degrees HPT. Total parathyroidectomy and autotransplantation was performed in these seven patients. The size of parathyroid gland in patients undergoing surgical treatment was significantly larger than those estimated by ultrasonography in patients successfully treated with pulse therapy (p < 0.005). In all patients with surgical treatment, the conventional oral active vitamin D therapy was performed with caution to hypercalcemia preoperatively. The preoperative Alp levels decreased compared with those of at the beginning of the pulse therapy. Postoperatively, the total amount of intravenous administered calcium decreased, and serum calcium levels were easily controlled.

Loss of tissue immunoreactive androgen receptor in prostate cancer presenting initially as an intracranial tumor

We report a case of prostate cancer that presented initially as an intracranial tumor. Biopsy specimens of the prostate before endocrine treatment were nearly negative immunohistochemically for prostate-specific antigen and the androgen receptors. All metastases including those in the brain expressed neither androgen receptor nor prostate-specific antigen at the protein and mRNA levels. The tumor, which did not respond to the anti-androgen therapy, had an aggressive course. In this case, the androgen-independent growth and rapid progression might be associated with the initial loss of the antigen and androgen characteristics of the prostate.

Effects on growth of rat offspring born from dams treated subcutaneously with a surfactant, polyoxyethylene(10)nonylphenyl ether(NP-10), during lactational period

A surfactant NP-10 was administered subcutaneously to Jcl:Wistar female rats at dose levels of 5, 20 and 80 mg/kg/day from date of birth to day 21 after birth of F1 offspring to assess its effects on the growth, behavior and functions of the offspring. For F0 dams, scab formation and loss of hair at the test substance administration site were observed in all treatment groups and induration of the skin at the test substance administration site in the 20 and 80 mg/kg groups in general condition and necropsy findings at the end of the dosing period. In necropsy findings, in addition to these changes, hemorrhage and whitish change of the subcutis at the test substance administration site were seen in all treatment groups, adhesion to the somatic muscles and granulation of the subcutis at the test substance administration site in the 20 and 80 mg/kg groups, and swelling of the spleen and adrenals in the 80 mg/kg group. Reduction or a tendency for reduction in food consumption was also detected from the initial day of dosing (day 0) to day 17 after birth F1 offspring in the 80 mg/kg group. Body weight or the findings on the day after birth and day of weaning failed to reveal any evidence of an effect that could be ascribed to the test substance. In F1 born offspring, a decrease or tendency for decrease in body weight was observed from day 7 after birth in both sexes and for females during the gestation period in the 80 mg/kg group. However, body weight gains based on the weights at 4 weeks after birth or on day 0 of gestation in the 80 mg/kg group failed to reveal any difference from that in the control group. The observation on the day of birth and during the period of lactation, physical development test, reflex test, general condition, open-field test, water-maze test, reproductive ability test, observations at cesarean section, necropsy findings, organ weights, histopathological findings of females or males that did not achieve successful gestation, skeletal examination, and the observations at cesarean section and external examination of F2 fetuses failed to reveal any evidence that could be ascribed to the test substance. These results indicate that NP-10 had no effect on the behavior or functions of the offspring, although it affected the growth of the offspring born, under the conditions of this study. The non-effective dose level is considered to be 20 mg/kg for general toxicity of the dams and for their offspring.

A case in the spectrum of the oculo-encephalo-hepato-renal syndrome

An 18-year-old male is presented with unprecedented central nervous system findings (cerebral dysplasia and sacral meningocele) possibly in the spectrum of the oculo-encephalo-hepato-renal syndrome. He had severe mental retardation, triplegia, epilepsy, retinitis pigmentosa, and chronic renal failure. Magnetic resonance imaging demonstrated cerebral dysplasia (left dominant abnormal gyri, hypoplastic white matter, basal ganglia, and thalamus, and absence of the septum pellucidum) and the hypoplastic cerebellum and brainstem. A sacral meningocele was observed first at 16 years of age. His renal function gradually worsened after 11 years of age. His liver function was normal. The previously reported 72 cases with the oculo-encephalo-hepato-renal syndrome are reviewed.

[Bacillus Calmette-Guerin intravesical instillation treatment for carcinoma in situ of the bladder. Gifu BCG Instillation Therapy Research Group]

We performed a retrospective long-term study to evaluate the efficacy of intravesical instillation of Tokyo 172 strain Bacillus Calmette-Guerin (BCG) on carcinoma in situ (CIS) of the bladder. Between 1989 and 1998, 42 patients with CIS of bladder underwent intravesical instillation of BCG. In the follow-up period from 6 to 116 months (mean: 37.3 months), the efficacy rate of intravesical BCG instillation for CIS of the bladder was 81.0%. Two patients died from the bladder cancer. The non-recurrence rate in patients with grade 2 carcinoma (19 cases) was not significantly different from that in those with grade 3 carcinoma (23 cases). However, the recurrence rate in patients with secondary CIS (15 cases) was significantly higher than in those with primary CIS (27 cases). The recurrence of CIS was observed in 7 of 42 cases. In 6 of 7 patients, CIS recurred within one year after treatment. Total cystectomy was performed in 10 of 42 patients, and pathological findings of muscle layer invasion were detected in 8 patients. Although side effects occurred in 33 patients (77.5%), no clinically significant side effects were observed. Our results suggest that intravesical BCG therapy may be useful for the treatment of CIS of the bladder.

Synthesis of NBD-alpha-galactosylceramide and its immunologic properties

[formula: see text] A representative alpha-galactosylceramide (alpha-GalCer), KRN7000, can activate NKT cells through CD1d molecules, which play an essential role in the generation of the strong antitumor activity of KRN7000. Our previous study has demonstrated that alpha-GalCer binds directly to CD1d molecules. However, it is controversial whether CD1d binds alpha-GalCer in endosomal compartments. To address this question, we synthesized NBD-alpha-GalCer, which has strong fluorescent properties. We found that the NBD-alpha-GalCer has immunostimulatory activity that is stronger than that of KRN7000.

[The current status of molecular detection of micrometastatic prostate cancer cells]

We summarized and reviewed published reports, including our studies, on the reverse transcription-polymerase chain reaction (RT-PCR) detection of micrometastatic prostate cancer cells in lymph nodes, bone marrow and peripheral blood. Some published data preliminarily suggest that the RT-PCR assay of micrometastatic prostate cancer cells may allow a more accurate assessment of lymph node and bone metastases of prostate cancer, and offer a presurgical prediction of the pathological stage of clinically localized disease. In addition, the RT-PCR assay may have a unique prognostic value in prostate cancer. However, controversy remains over the clinical significance of the RT-PCR assay. This assay could potentially develop into a diagnostic procedure for the clinical decision making in patients with prostate cancer. To establish the clinical significance of the RT-PCR assay, further optimized and standardized RT-PCR assay studies are needed, investigating large populations and involving long-term follow-up for the determination of any association between the results of the RT-PCR assay and specific clinical outcome.

Neuroleptic malignant syndrome and methylphenidate

A 1-year-old female presented with neuroleptic malignant syndrome probably caused by methylphenidate. She had defects in the supratentorial brain including the basal ganglia and the striatum (multicystic encephalomalacia) due to severe perinatal hypoxic-ischemic encephalopathy, which was considered to be a possible predisposing factor causing neuroleptic malignant syndrome. A dopaminergic blockade mechanism generally is accepted as the pathogenesis of this syndrome. However, methylphenidate is a dopamine agonist via the inhibition of uptake of dopamine, and therefore dopaminergic systems in the brainstem (mainly the midbrain) and the spinal cord were unlikely to participate in the onset of this syndrome. A relative gamma-aminobutyric acid-ergic deficiency might occur because diazepam, a gamma-aminobutyric acid-mimetic agent, was strikingly effective. This is the first reported patient with neuroleptic malignant syndrome probably caused by methylphenidate.

Epidemiology of spina bifida in Tottori Prefecture, Japan, 1976-1995

The authors studied the epidemiology of spina bifida in Tottori Prefecture, Japan, from 1976 to 1995. Thirty-four patients (16 men and 18 women) were registered in this study. Consanguineous marriages, familial occurrence, and abnormalities in prenatal history were not observed. The incidence rate in the entire prefecture and in the eastern, central, and western regions was 0.234, 0.148, 0.425, and 0.230 per 1,000 live births, respectively. The incidence rate in the central region was greater than that in the eastern region with statistical significance (P < 0.05), but the cause of the cluster is unknown. The incidence rate of 0.234 per 1,000 live births for 20 years is compatible with the previous two studies of 1922-1940 and 1948-1954 in Japan. Such apparently stable trends suggest that environmental factors have affected the Japanese less than genetic factors. Seasonal variations are not demonstrated.

New syndrome with the Sakoda complex, bilateral anophthalmia, and cortical dysgenesis

An 8-year-old Japanese boy had Sakoda complex (basal encephalomeningocele, agenesis of the corpus callosum, and cleft lip and/or palate) associated with bilateral anophthalmia, dysgenesis of the cerebral cortex, severe mental retardation, and intractable epilepsy as core symptoms and hemiparesis, microcephalus, short stature, and hemivertebra. Tada and Nakamura described the first case of the Sakoda complex associated with bilateral anophthalmia, cortical dysgenesis, neonatal-onset seizures, and severe mental retardation. Fourteen patients with the Sakoda complex with or without ocular dysplasia were reviewed. It is proposed that these cases belong to a clinical entity that is distinguishable from the remaining 12 patients because of bilateral anophthalmia, cortical dysgenesis, and its resulting severe mental retardation and intractable epilepsy. There is a possibility that these two cases are one severe end of certain spectrum disorders in which certain common gene(s) might be implicated.

[Clinical efficacy of post-TUR prophylactic chemotherapy for superficial bladder cancer--the result of co-operative prospective randomized trial]

We have performed a prospective randomized clinical trial of post-operative prophylactic therapy for superficial bladder cancer since October in 1991. The criteria were as follows; age < or = 80 y.o., Ta/T1, TCC G1/G2, without CIS lesion and resectable cancer by TUR. The therapeutic arm was divided into three as follows: arm A intracystic instillation with Epirubicin; arm B: oral administration with 5-FU; arm C: combination of arm A and arm B. The number of registered patients were 20 in arm A, 18 in arm B, and 18 in arm C. The patient characteristics in every group were not significantly different. The prophylactic efficacy of arm A was superior to that in the other two groups.

New autosomal-recessive syndrome of Leber congenital amaurosis, short stature, growth hormone insufficiency, mental retardation, hepatic dysfunction, and metabolic acidosis

We report on a new autosomal-recessive syndrome in 4 Japanese children in 2 families. The key manifestations are Leber congenital amaurosis, short stature, growth hormone insufficiency, mental retardation, hepatic dysfunction, metabolic acidosis, and autosomal-recessive inheritance. There were no consanguineous marriages. Abnormal eye movements were noticed neonatally, and ophthalmological examinations showed no visual acuity, pigmentary retinal degeneration, and nonrecordable electroretinograms in all cases. Inadequate weight gain and short stature gradually became apparent after birth, and at present the height range is -4.6 - -7.2 SD (standard deviations). Developmental delay was noted at age 4 months, and the developmental quotient is 50-70 at present. Deterioration of development and convulsions were not recognized. Elevated serum aminotransferase levels and metabolic acidosis were also found at age 4 months. Proximal renal tubular acidosis was clarified by bicarbonate tolerance tests in 1 case, and may have caused metabolic acidosis. Growth hormone secretion was insufficient by insulin tolerance test in 3 cases. One year of growth hormone therapy in 2 cases did not affect growth velocity. Hepatic dysfunction and metabolic acidosis ameliorated later. No renal cysts were found. A cranial computed tomographic scan and magnetic resonance imaging showed normal findings. Amino acids, organic acids, and very long chain fatty acid levels in plasma were all normal in the 3 cases examined. Histopathological and mitochondrial DNA analyses showed no evidence of mitochondrial disorders.

Detection of micrometastatic prostate cancer cells in the bone marrow of patients with prostate cancer

Thirty-five patients with prostate cancer were examined for micrometastases to the bone marrow using reverse transcription-polymerase chain reaction (RT-PCR) with primers specific for the prostate-specific antigen (PSA) gene. Of nine patients with bone metastases detectable by bone scan imaging, five patients had PSA mRNA expression in the bone marrow detectable by RT-PCR. Of 26 patients with negative bone scan findings, seven patients had PSA mRNA expression detectable in the bone marrow. RT-PCR could detect micrometastatic prostate cancer cells in the bone marrow that were not detectable by bone scan imaging. Of 16 patients with a serum PSA concentration of 25 ng ml(-1) or greater, only nine (56.3%) had bone metastases detected by bone scans. Of the remaining seven patients, five had micrometastases to the bone marrow detected by RT-PCR. Overall, 14 of 16 patients (87.5%) with a serum PSA concentration of 25 ng ml(-1) or greater had metastatic bone diseases including bone marrow micrometastases. Of 19 patients with a serum PSA concentration of less than 25 ng ml(-1), two (10.5%) had only micrometastatic disease detected by RT-PCR. A significant correlation was observed between the incidence of bone involvement and the serum PSA concentration. This study suggests that RT-PCR will potentially develop into a relevant tool to assess bone involvement including bone marrow micrometastases and establish a precise correlation between serum PSA concentration and metastatic bone disease in patients with prostate cancer.

[Transitional cell carcinoma of the renal pelvis with cystic formation: a case report]

A 75-year-old man consulted our hospital complaining of gross hematuria. Retrograde pyelography revealed a filling defect and deformity of the upper calix of the left kidney. Abdominal echography and computed tomography revealed a left renal cystic tumor with irregular wall thickness measuring 7 by 5 cm. As left renal pelvic tumor or left renal cell carcinoma was suspected, left total nephroureterectomy was performed. Macroscopically, the cystic tumor contained a papillary tumor connected to the renal pelvis and histopathological diagnosis was grade 1 transitional cell carcinoma. Cystic formation caused by obstruction of the upper calix was suspected. After adjuvant chemotherapy, he has been well without recurrence or metastasis for 19 months after the operation. This is the 15th case of renal pelvic tumors with cystic formation including tumors in the pyelocaliceal diverticulum reported in Japan.

[Molecular approach to detection of micrometastatic prostatic cancer cells in the lymph nodes and the bone marrow]

We detected micrometastatic prostate cancer cells in lymph nodes and bone marrow using reverse transcriptase-polymerase chain reaction (RT-PCT) specific for prostate-specific antigen (PSA). RT-PCR revealed PSA mRNA in two lymph nodes obtained from two patients with negative histological and immunohistochemical analyses for lymph node metastases. Of 26 patients with negative bone scan imaging, 7 had PSA mRNA detected in the bone marrow by RT-PCR. The RT-PCR will be a relevant tool to allow a more accurate clinical assessment of lymph node and bone metastases in patients with prostate cancer.

[Enhancement of cytotoxic effect of anticancer agents of renal cell carcinoma]

BACKGROUND

Human renal adenocarcinomas do not adequately respond to cancer chemotherapy. Their multidrug resistance is mainly conferred by the P-glycoprotein (P-gp). In this study, we analyzed effects of P-gp modulators on enhancement of anticancer activities against human renal cell carcinomas.

METHODS

ACHN/ADM human renal adenocarcinoma cells with a high level expression of P-gp and 28 surgical specimens of renal cell adenocarcinomas were recruited. Adriamycin (ADM) and vinblastin (VLB) were used as anticancer drugs, and verapamil (Ver) and cyclosporin A (CsA) were as P-gp modulators. The chemosensitivity was determined by the ATP-assay.

RESULTS

Ver and CsA exhibited 1.5-fold and 6-fold increase, respectively, in the anticancer activities of ADM against ACHN/ADM cells. The anticancer activities of VLB were also enhanced by the modulators; 7-fold for Ver and 11-fold for CsA. In the chemosensitivity test of clinical specimens, the cancer for which the viability of the cells assessed by the ATP-assay was 50% or less than 50% after exposure to the anticancer drug with or without a P-gp modulator was defined as sensitive to the drug. Of the 14 clinical specimens exposed to anticancer drugs without Ver, only 3 tumors and 1 tumor were sensitive to ADM and VLB, respectively, whereas with Ver, 6 tumors and 4 tumors were sensitive to ADM and VLB, respectively. Of the other 14 clinical specimens exposed to anticancer drugs without CsA, only 3 tumors and no tumor were sensitive to ADM and VLB, respectively, whereas, with CsA, 9 tumors and 6 tumors were sensitive to ADM and VLB, respectively.

CONCLUSION

This study indicate that Ver and CsA have effects on enhancement of the anticancer activities of ADM and VLB against human renal adenocarcinomas. The addition of Ver or CsA to chemotherapy will be a potential circumvention of P-gp-mediated multidrug resistance of renal cell adenocarcinomas.

Expression of estrogen receptor in diseased human prostate assessed by non-radioactive in situ hybridization and immunohistochemistry

To understand the role of estrogen in the pathogenesis of benign prostatic hyperplasia, expressions of estrogen receptor (ER) mRNA and ER protein by in situ hybridization and by immunohistochemistry, respectively, were investigated in human prostatic tissues. In non-malignant region, ER mRNA and ER protein were found in cytoplasm and nucleus, respectively, of stromal cells, but not in glandular epithelial and basal cells. In benign regions, ER mRNA/ER protein positive cells were found in fibromyoadenomatous and myoadenomatous hyperplasia, but not in adenomatous hyperplasia. A striking feature was periacinar arrangement of ER mRNA/ER protein positive stromal cells in all prostate carcinoma treated with androgen withdrawal. The ER mRNA/ER protein positive cells were immunohistochemically identified as fibroblasts, myoblasts, and smooth muscle cells. These results indicate that stromal cells are the primary target of estrogen in prostate, and that androgen withdrawal upregulates the expression of ER gene.

[A case report of prostate cancer resistant to endocrine therapy successfully treated with intra-arterial chemotherapy]

A 73-year-old male with low abdominal pain on urination and frequent urination was diagnosed as poorly differentiated adenocarcinoma of prostate. He received endocrine therapy with DESD and bilateral orchiectomy. This treatment was not effective, so he was given intra-arterial infusion chemotherapy with MTX, ADM and CDDP using the reservoir system. After 2 courses of this chemotherapy the regression rate was 75%, and the pathological examination after the chemotherapy revealed no cancer cells. There is no established chemotherapy for prostate cancer at present. Thus this case is very suggestive for the treatment of prostate cancer.

Frequency of the Prader-Willi syndrome in the San-in district, Japan

Nineteen cases of the Prader-Willi syndrome were collected in the San-in district, in the western part of Japan, and an epidemiological study was carried out. The male to female ratio was 1:1.11. Deletion of chromosome 15q11-13 was found in seven of 16 patients examined by means of high-resolution chromosome banding. The incidence among live-births was estimated to be 6.64 x 10(-5) (1 in 15,060 live-births) in 1980-1989, and the mutation rate was 3.32 x 10(-5) per gene per generation, as determined by a direct method. The prevalence was estimated to be 5.72 x 10(-5) (1 in 17,483) in patients under 15 years old, which was higher than that in other autosomal dominant diseases (tuberous sclerosis and congenital myotonic dystrophy) also studied in the San-in district. A birth-order effect was revealed and a slightly significant difference was found as to the fathers' age between the patients and their normal siblings. The results of these two tests are in accord with the recent discovery that this syndrome is caused by paternal chromosomal aberrations.

[A study on predicting factors of the effect of intra-arterial infusion chemotherapy in patients with bladder cancers: the usefulness of in-vitro chemisensitivity test measuring intracellular ATP contents (ATP assay)]

We studied a relationship between in vitro sensitivity of the tumors to anti-cancerous drugs and histopathological effectiveness of an intra-arterial infusion chemotherapy in 15 patients with bladder cancers. The in vitro sensitivity test was performed by measuring intra-cellular ATP contents (ATP assay). The intra-arterial chemotherapy were performed by injecting methotrexate (MTX), adriamycin (ADM) and eisplatin (CDDP) from the internal iliac artery. When the intra-cellular ATP contents of the tumor cells treated with an anti-cancerous drug decreased to less than 50% of the untreated tumor cells, the tumor was evaluated as sensitive to the drug. The effectiveness of the chemotherapy were histopathologically evaluated by a pathologist according to the response criteria for bladder cancer treatment. When the histopathological responses of higher than grade 2 were observed in the tumor, the chemotherapy was evaluated as effective. In 8 of 9 tumors sensitive to ADM, chemotherapy were effective histopathologically and in all 6 tumors resistant to ADM, histopathological response of the chemotherapies were poor. The overall coincidence ratio between sensitivity to ADM and the histopathological effectiveness of the chemotherapy was 93%, showing statistically significant correlation. In 7 of 12 tumors sensitive to CDDP, the chemotherapies were effective and in 2 of 3 tumors resistant to CDDP, the chemotherapies were ineffective. Although the overall coincidence ratio between the sensitivities to CDDP and chemotherapeutic effectiveness was 60%, there was no significant correlation between them. In 7 of 8 tumors sensitive to both of ADM and CDDP, the chemotherapies were effective and in 6 of 7 tumors resistant to at least one of them, the chemotherapies were ineffective. (ABSTRACT TRUNCATED AT 250 WORDS)

Detection of micrometastatic prostate cancer cells in lymph nodes by reverse transcriptase-polymerase chain reaction

We have developed a highly sensitive method for detecting prostate cancer cells using reverse transcriptase-polymerase chain reaction (RT-PCR) with primers specific for prostate-specific antigen gene. Forty-four lymph nodes obtained from 22 patients with prostate cancers were analyzed by RT-PCR to detect metastatic prostate cancer cells. RT-PCR could detect prostate-specific antigen mRNA in five lymph nodes with histologically and/or immunohistochemically identifiable metastases and in four lymph nodes with negative histological and immunohistochemical analyses for metastases. RT-PCR was a more sensitive method than histology and immunohistochemistry in detecting metastatic prostate cancer cells and could be applied for diagnosing micrometastases of prostate cancer to lymph nodes. This highly sensitive RT-PCR will be a relevant tool to allow a more accurate clinical assessment of lymph node metastases of prostate cancer and to understand lymphatic dissemination of prostate cancer biologically.

Growth and developmental patterns in Prader-Willi syndrome

Eleven Japanese patients with Prader-Willi syndrome were studied from infancy, and examined with respect to their growth and development. The chromosomal aberration was observed in 40% of the patients using a high-resolution chromosome banding technique. The birth weight in 10 out of the 11 patients was below the mean and the rate of body weight gain was severely retarded by 6 months in all cases, which suggested an insufficient utilization of nutrients in uterine life and in early infancy. The rate of height increase as well as that of body weight increase were also transiently retarded from 10 to 18 months of age in eight cases, and the body weight gain increased dramatically after 10-18 months due to hyperphagia. The patients' mean milestones of development were delayed (the mean developmental quotient was 50) in comparison with those of control patients; there was no difference between the developmental milestones of the two groups with and without the chromosomal aberration.

[Study on chemosensitivity test of urogenital tumors by ATP assay]

In order to improve the efficacy of chemotherapy against urogenital cancers, we developed a chemosensitivity test by measuring intracellular ATP in cancer cells. In the fundamental experiments using HeLa cells, a significant correlation was observed between intracellular ATP levels and numbers of viable cells. We employed 8 drugs, ADM, VCR, VLB, MTX, 5-FU, PEP, MMC, and CDDP for the assay Thirty-four renal tumors, 68 urothelial tumors and 19 testicular tumors were tested, and evaluable results were obtained in 25 specimens of renal tumors (76%) 55 specimens of urothelial tumors (80%) and 17 specimens of testicular tumors (98%). According to the ATP assay, renal tumors were sensitive to ADM and MMC, urothelial tumors to ADM, MMC and CDDP and testicular tumors to ADM and MMC. The ATP assay to determine the chemosensitivity to clinical specimens was sensitive and efficient. Thus the ATP assay could be applied for selection of anticancer drugs in the chemotherapy of urogenital cancers.

Primary localized amyloidosis of the bladder: an immunohistochemical study of a case

We report a case of primary localized amyloidosis of the bladder causing renal failure. Immunohistochemically, amyloid fibril protein originated from the lambda type light chain of immunoglobulin.

The carbohydrate deficient glycoprotein syndrome in three Japanese children

We describe 3 children (from two families) with a multisystemic disorder characterized by mental retardation, nonprogressive ataxia, polyneuropathy, hepatopathy during infancy and growth retardation. Due to the clinical similarities to a recently recognized disorder associated with carbohydrate-deficient transferrin, we examined serum transferrin by means of isoelectric focusing, and found increases in disialo transferrin and asialotransferrin. Removal of sialic acid with neuraminidase revealed the same transferrin phenotypes as in their parents. Similarly, carbohydrate-deficient fractions of serum alpha 1-antitrypsin were also detected. Therefore, the diagnosis was made of the recently identified carbohydrate-deficient glycoprotein syndrome. This is a genetic disorder with distinctive clinical features and multiple carbohydrate-deficient glycoproteins. These seem to be the first reported Japanese patients with this syndrome.

[Clinical study of urinary fungal infection: survey of patient background and fungal strains from the urine]

Clinical features of urinary fungal infections were analyzed in 152 patients in whom fungi were cultured from urine and mycologically identified between February, 1989 and June, 1990. The average age was 66 years old, and approximately 70% of the patients were 60 years old or older. Systemic and urinary tract underlying diseases were observed in 145 patients (95.4%) and 70 patients (46.1%) had urinary indwelling catheters. Previous use of antimicrobial agents before isolation of urinary fungi was recorded in 103 patients (67.8%), the 2nd and 3rd generation cephems and new quinolones being most frequent. A mixture of fungi and bacteria was observed in 68 patients (44.7%). Gram-positive cocci were isolated from 50% of them. Of 173 strains of fungi, C. glabrata was the most frequent (31.2%), followed by C. albicans (27.8%), C. tropicalis (17.3%) and T. beigelii (15.0%). All strains of C. glabrata, C. albicans, C. tropicalis and T. beigelii were highly sensitive to flucytosine (5-FC), miconazole (MCZ) and amphotericin B (AMPH), except for 3 strains which were resistant to 5-FC. The consecutiveness was confirmed by repeated culture in 59.4% of the patients. Fungi in the urine, however, spontaneously disappeared in the other patients.

[Secondary tumor of the prostate: a case report]

We report a case of a 62-year-old man with secondary prostatic tumor, which manifested postrenal renal failure. Although pathological examination of the transurethral biopsy specimen and rectal biopsy specimen revealed no malignancy, transperineal prostatic biopsy specimen demonstrated signet ring adenocarcinoma. Post-mortem examination suggested that cancer cells had transferred from the stomach or the gallbladder to the prostate and other organs.

Localization of prostaglandin endoperoxide synthase in neurons and glia in monkey brain

The localization of prostaglandin endoperoxide synthase in monkey brain was investigated by the immunoperoxidase method using the monoclonal antibody (PES-7) raised against the enzyme purified from bovine seminal vesicle. The frozen sections with 30-microns thickness were employed after the brain was fixed with perfusion of 2% paraformaldehyde in phosphate-buffered saline. The immunoreactivity was most intense in the neurons of cerebral cortex and hippocampus, and was moderate in the neurons of caudate nucleus, putamen, globus pallidus and amygdala, while it was relatively weak in glial cells in the whole brain regions including the white matter. The majority of neurons showed the immunoreactivity in the somata and proximal dendrites, but exceptionally in the pyramidal cells of the hippocampus, positive staining was also observed in the apical dendrites. In the cerebellum, the immunoreactivity in both neurons and glia was rather faint as compared with that in other regions. Positive staining was not significantly observed in the vasculatures and arachnoid membranes. These findings indicate that most of neuronal and glial cells in monkey brain contain the enzyme of the rate-limiting and initial step of the biosynthesis of prostaglandins which regulate a variety of neural functions.

[Flucytosine in the treatment of urinary fungal infections. Clinical efficacy and background factors]

Flucytosine (5-FC), an oral antifungal agent, was used in the treatment of 37 patients with urinary tract infections due to fungi. Criteria for treatment included pyuria of greater than or equal to 5 WBCs/HPF, fungal colony counts in urine greater than 10(3) CFU/ml and the presence of candiduria in 2 consecutive urine culture with interval of 7 days. Patients received 2 approximately 8 g/day of 5-FC for 7 to 14 days. The clinical efficacy was evaluated in 27 patients with 14 day-treatment and overall efficacy rate was 77.8%. In patients with indwelling catheter, overall efficacy rate was lower than that in patients without catheter. Twenty-two of 30 strains (73.3%) were eradicated by the treatment. The MIC of 5-FC for isolates was less than 0.78 micrograms/ml except for 5 strains. The secondary resistance during 5-FC treatment was observed in early phase in 6 patients whose clinical efficacy was poor. The loss of appetite and mild leukocytopenia were observed as adverse effects. From the results of our study, 5-FC appears to be effective and safe in the treatment of urinary tract infection due to fungi.