AB0653 The association of autoantibodies with morbidity and mortality of scleroderma renal crisis in Japan

Background

The morbidity of scleroderma renal crisis (SRC) and autoantibodies in systemic sclerosis (SSc) vary by races and regions. Anti-RNA polymerase III is associated with SRC in America and European countries. However, the association of autoantibodies with SRC had not been elucidated in Japan.

Objectives

We aimed to investigate the association of autoantibodies with morbidity and mortality of SRC in Japan.

Methods

The clinical characteristics and mortality of 330 patients with systemic sclerosis (SSc) at Kyoto University Hospital were retrospectively analyzed, focusing on anti-centromere, anti-RNA polymerase III, anti-topoisomerase I, and anti-U1-RNP. Logistic regression analyses were performed to examine the association of autoantibodies with the development and mortality of SRC. Kaplan-Meier survival analysis was performed comparing the groups classified by autoantibodies.

Results

Anti-centromere (n = 177/318, 56%), anti-topoisomerase I (n = 80/311, 26%), anti-RNA polymerase III (n = 27/204, 13%), and anti-U1-RNP (n = 24/305, 8%) were found in SSc patients (n = 330). SRC was observed in 24 out of 330 SSc patients, including anti-topoisomerase I (n = 12/24, 50%), anti-RNA polymerase III (n = 7/24, 29%), anti-U1-RNP (n = 5/24, 21%), and anti-centromere (n = 3/24, 13%). Anti-U1-RNP (odds ratio [95% confidence interval], 3.63 [1.11–10.2]), anti-RNA polymerase III (3.29 [1.16–8.70]), and anti-topoisomerase I (3.22 [1.37–7.57]) were associated with the development of SRC. All patients with SRC were treated with ACE inhibitors and the 1-year survival rate was 54%. Anti-topoisomerase I was associated with the 1-year mortality of SRC (6.00 [1.11–41.1]). When the survival rate was compared between the patients positive for anti-topoisomerase I (n=12) and negative for anti-topoisomerase I (n=12), the 1-year survival rate was 33% vs 75% (p=0.041), respectively (Figure 1A). Furthermore, the 1-year survival of anti-centromere (100%), anti-RNA polymerase III (83%), and others/not detected (50%) were shown in patients negative for anti-topoisomerase I (Figure 1B).

Figure 1.

Overall survival of patients with SRC according to the type of autoantibodies.

(A) The survival rates in SRC patients who were positive for anti-topoisomerase I (solid line, n = 12) and those who were negative for anti-topoisomerase I (dotted line, n = 12).

(B) SRC patients negative for anti-topoisomerase I were classified as patients with anti-RNA polymerase III (dotted line, n = 6), anti-centromere (broken line, n = 2), and others/not detected (chain line, n = 4).

Conclusion

Specific SSc-related autoantibodies were associated with the morbidity and mortality in SRC.

References

[1]Nihtyanova SI, et al. Arthritis Rheumatol 2020;72(3):465-76.

[2]Hamaguchi Y, et al. Arthritis Rheumatol 2015;67(4):1045-52.

Table 1.

Univariate logistic regression analysis for mortality in SRC (n = 24).

VariablesOdds ratio (95% CI)P valueAge1.07 (0.99, 1.16)0.08Female sex3.00 (0.32, 66.6)0.38Diffuse/limited (diffuse %)0.25 (0.04, 1.36)0.12BMI0.67 (0.41, 0.93)0.049Modified Rodnan skin score0.95 (0.88, 1.02)0.15Digital ulcer0.52 (0.10, 2.63)0.43Reflux esophagitis0.60 (0.02, 17.1)0.73Pulmonary hypertension7.50 (1.17, 69.2)0.046Pleural effusion7.20 (1.23, 62.0)0.04Glucocorticoid use3.86 (0.65, 32.4)0.16Hemoglobin0.55 (0.25, 1.01)0.09Platelet1.00 (0.98, 1.01)0.44Total protein0.17 (0.02, 0.69)0.04Creatinine0.95 (0.67, 1.24)0.69CRP0.90 (0.67, 1.17)0.46Anti-topoisomerase I6.00 (1.11, 41.1)0.048Anti-centromere7.4x10-9 (--, 0.93)1.00Anti-RNA polymerase III0.36 (0.04, 2.18)0.29Anti-U1-RNP0.74 (0.08, 5.49)0.77

Disclosure of Interests

None declared

AB0470 THE ASSOCIATIONS OF ANTI-DNA ANTIBODIES WITH DISEASE ACTIVITY INDICES AND PATIENT REPORT OUTCOME PARAMETERS OF SLE IN KYOTO LUPUS COHORT

Background

Since the goals of remission or low disease activity are becoming more realistic with advances in treatment for SLE, there is a need to examine the measurements for SLE especially in patients with low disease activity. It has been known that disease activities in SLE are correlated with anti-DNA antibodies (Abs). However, it was not clear which measurements of disease activities or patient reported outcomes correlate better with anti-DNA Abs.

Objectives

To examine the association between parameters for SLE and anti-DNA Abs measured with RIA in Kyoto Lupus Cohort, a SLE registry in Kyoto University Hospital from 2019 to 2021.

Methods

1)Correlations between anti-DNA Abs with SLEDAI, M-SLEDAI (SLEDAI without anti-DNA Abs), VAS, LupusPRO, SF-36, and Systemic lupus erythematosus Symptom Checklist (SSC) were evaluated cross-sectionally (n = 310).

2)The alterations in SLE parameters and anti-DNA Abs between two visits were examined (n = 106). Further, the correlations within 3 months were examined in cases with flare-ups of SLE (the alteration in SLEDAI > 0 and anti-DNA Abs≧0, n = 39). The associations of the alterations of anti-DNA Abs with each item of SLEDAI classified by organs were also examined.

Results

1)31 percent of the cases in the entire registry was classified as remission or low disease activity (Table 1). SLEDAI (mean±SD) was higher in patients positive for anti-DNA Abs (7.94±5.20) than that in patients negative for anti-DNA Abs (4.56±4.65) (p < 0.0001). Anti-DNA Abs were weakly correlated with SLEDAI (R = 0.24 [p < 0.0001]), M-SLEDAI (R = 0.15 [p = 0.014]), and Physician-VAS (R = 0.19 [p = 0.0016]). On the other hand, there were no significant correlations between anti-DNA Abs and LupusPRO and SSC. Some dimensions in SF-36 had weak correlations with anti-DNA Abs, while no component summary scores had significant correlations with anti-DNA Abs.

Table 1.

Patients’ demographics and disease characteristics in the cohort (n = 310).

VariableResultsAge (years)47.7 (39.4, 57.5)Female sexn = 284 (91.6%)Disease duration (years)15.9 (9.4, 24.5)Anti-DNA Ab positivity†n = 106 (34.2%)Anti- DNA Ab titer (U/mL)4 (0, 8)SLEDAI4 (2, 8)SLEDAI<=4n = 162 (52.1%)SSC31 (16.2, 52.5)Remission or LDAn = 95 (30.7%)Patient-VAS38 (15, 52)Physician-VAS13.3 (3.3, 23.3)SF-36 PCS45.4 (36.6, 52.4)SF-36 MCS48.2 (41.5, 53.6)SF-36 RCS51.3 (42.6, 58.6)LupusPRO HQOL70.2 (54.8, 86.5)LupusPRO NHQOL41.7 (31.3, 51.0)Glucocorticoid (mg/day)5 (4, 8)

* Data are n (%) or median (Q1, Q3).

† Anti-DNA Ab positivity at the time of the cross-sectional observation.

2)No significant correlations were observed between the alterations of SLEDAI and anti-DNA Abs (R = 0.00 [95% CI: -0.23 – 0.22, p = 0.95]) in the total of patients with various range of observation periods (Figure 1A). In contrast, a significant correlation was observed (R = 0.32, p = 0.04) within 3 months after the flare-ups of SLE (Figure 1B). No significant correlations were found between the alterations in VAS and anti-DNA Abs, or the alterations of SSC and anti-DNA Abs. They showed the following organ symptoms: renal involvement, 62.8%; musculoskeletal, 17.1%; neuropsychiatric, 11.4%; hematological, 5.7%; mucocutaneous, 11.4%; serositis, 2.9%, and fever, 2.9%.

Figure 1.

The associations between the alteration in anti-DNA Ab and SLEDAI

Conclusion

The associations between anti-DNA Abs with several parameters of SLE were examined. Anti-DNA Abs correlated with disease activities (SLEDAI) in SLE patients, especially when observed in the condition of flare-up.

References

[1]Ho A, et al. Arthritis Rheum. 2001;44:2342-9.

Disclosure of Interests

None declared

POS0345 CLINICOGENETIC STUDY OF FIVE NOVEL SUSCEPTIBILITY LOCI FOR TAKAYASU ARTERITIS: SUSCEPTIBILITY LOCI IN THE IL12B AND PTK2B REGION, BUT NOT THE LILRA3, DUSP22, KLHL33 REGIONS, ARE ASSOCIATED WITH VASCULAR DAMAGE IN TAKAYASU ARTERITIS

Background:

We have previously identified single nucleotide polymorphism (SNP) rs6871626 in IL12B, rs103294 in LILRA3, rs17133698 in DUSP22, rs2322599 in PTK2B, and rs1713450 in KLHL33 as non-HLA susceptibility loci in Takayasu arteritis (TAK) [1, 2]. However, the association of these SNPs with clinical features has scarcely investigated.

Objectives:

In this study, we aimed to examine how these SNPs contribute to clinical features and vascular damage in TAK.

Methods:

We enrolled 99 TAK patients who were enrolled in our previous genome-wide association study (GWAS) [2]. To assess vascular damage, Takayasu Arteritis Damage Score (TADS) and Vasculitis Damage Index (VDI) were measured at the last visit before November 2020. As for organ damages, the presence or absence of aortic regurgitation (AR), hypertension, ischemic heart disease, cerebrovascular event, visual loss, end-stage renal failure, and inflammatory bowel disease were evaluated. Treatment profiles including immunosuppressive drugs and vascular interventions were also reviewed.

Results:

The incidence of AR was positively associated with the risk allele of IL12B rs6871626 (p=0.0052; odds ratio (OR) 2.45, 95% confidence interval (CI) 1.27-4.73), and so was the proportion of patients who underwent aortic valve replacement (p=0.023; OR 3.64, 95% CI 1.08-12.24) (table 1). The incidence of hypertension was associated with the risk allele of IL12B rs6871626 (p=0.049; OR 1.82, 95% CI 0.99-3.36) and PTK2B rs2322599 (p=0.044; OR 2.52, 95% CI 0.97-6.54) (table 1). The proportion of biologic users tended to be higher in the risk genotypes of IL12B rs6871626 (p=0.15; OR1.80, 95% CI 0.79-3.99). Regarding vascular damage, there was positive correlation between TADS and the risk allele of IL12B rs6871626 (p=0.0035; β= 1.35) (Figure 1). Moreover, VDI was also positively correlated with the allele (p=0.0054; β= 0.96) (Figure 1). No other clinicogenetic associations were observed between five SNPs and vasculitis-associated damages.

Table 1.

The association of the five SNPs with aortic regurgitation and hypertension

Aortic regurgitationHypertensionOR (95% CI)p valueOR (95% CI)p valueIL12B rs68716262.45 (1.27-4.73)0.0052*1.82 (0.99-3.36)0.049*PTK2B rs23225991.21 (0.51-2.86)0.672.51 (0.97-6.54)0.044*LILRA3 rs1032941.16 (0.52-2.61)0.711.20 (0.55-1.64)0.64DUSP22 rs171336980.56 (0.28-1.13)0.0900.87 (0.46-1.63)0.66KLHL33 rs17134500.89 (0.42-1.91)0.771.48 (0.68-3.22)0.31

SNP, single nucleotide polymorphism; OR, odds ratio; CI, confidence interval

Conclusion:

In the present study, IL12B rs6871626 was closely correlated with vascular damage. We also found association between PTK2B rs2322599 and hypertension. There was no significant relevance between vascular damage and LILRA3 rs103294, DUSP22 rs17133698, or KLHL33 rs1713450.

References:

[1]Terao C et al. Am J Hum Genet. 2013;93(2):289-97.

[2]Terao C et al. Proc Natl Acad Sci U S A. 2018;115(51):13045-50.

Disclosure of Interests:

Keiichiro Kadoba: None declared, Ryu Watanabe Speakers bureau: I have received speaker’s fee from Mitsubishi Tanabe Pharma, Pfizer, Sanofi, AbbVie, Asahi Kasei, Eisai, Eli Lilly, Bristol-Myers Squibb, and Janssen., Takeshi Iwasaki: None declared, Koji Kitagori Grant/research support from: KK has received research grants from GlaxoSmithKline., Syuji Akizuki: None declared, Kosaku Murakami Speakers bureau: I have received speaking fees from Eisai Co. Ltd, Chugai Pharmaceutical Co. Ltd., Pfizer Inc., Bristol-Myers Squibb, Mitsubishi Tanabe Pharma Corporation, UCB Japan Co. Ltd, Daiichi Sankyo Co. Ltd. and Astellas Pharma Inc., Ran Nakashima: None declared, Motomu Hashimoto Speakers bureau: I have received a research grant and/or speaker fee from Bristol-Myers, Eisai, Ely Lilly, Mitsubishi Tanabe Pharma., Grant/research support from: I have received a research grant and/or speaker fee from Bristol-Myers, Eisai, Ely Lilly, Mitsubishi Tanabe Pharma., Masao Tanaka Speakers bureau: I have received research grants and/or speaker fees from AbbVie GK, Asahi Kasei Pharma Corporation, Astellas Pharma Inc., Bristol-Myers Squibb, Chugai Pharmaceutical Co., Ltd., Eisai Co., Ltd., Eli Lilly and Company, Pfizer Inc., UCB Japan Co., Ltd., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Corporation, Novartis Pharma K.K., Taisho Pharma Co., Ltd, and Takeda Pharmaceutical Company Limited., Koichiro Ohmura Speakers bureau: I have received speaker’s fee from Abbvie, Actelion, Asahikasei Pharma, Astellas, AYUMI, Bristol-Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, GSK, Janssen, JB, Mitsubishi Tanabe, Nippon Kayaku, Nippon Shinyaku, Novartis, Sanofi and Takeda., Grant/research support from: I have received research grants from GlaxoSmithKline., Akio Morinobu Speakers bureau: I have received speaking fees from Chugai Pharmaceutical Co. Ltd., Grant/research support from: I have received research grants from Chugai Pharmaceutical Co. Ltd., Chikashi Terao: None declared, Hajime Yoshifuji Speakers bureau: I have received lecture fees from Chugai., Consultant of: I have been an advisory board for a clinical trial conducted by Janssen.

SAT0349 CTLA4-IG DECREASES TH17 CELL LEVELS BUT MAINTAINS ILC3S WITH AN INCREASE IN THE ILC3/ILC1 RATIO IN THE GUT OF SKG MICE AS A MODEL OF SPONDYLOARTHRITIS

Background:

SKG mice have been known for their autoreactive Th17 cells resulting from the insufficient thymic negative selection due to a Zap70 mutation1,2). Under specific pathogen-free conditions, they acquire features of spondyloarthritis (SpA) by intraperitoneal injection of curdlan, a (1,3)-β-glucan3). Several reports have shown that Th17 cells also increase in human SpA4). However, CTLA4-Ig, which ameliorates rheumatoid arthritis by suppressing pathogenic cells such as effector T cells, was unable to show adequate efficacy as much as expected in SpA patients5). Around the same time, innate lymphocytes began to be focused on, in the pathogenesis of SpA, including innate lymphoid cells (ILCs), which abundantly reside in the gut6).

Objectives:

This study aimed to clarify the effects of CTLA4-Ig on the pathogenesis of SpA by using curdlan-treated SKG mice, focusing on type 3 immunity such as Th17 cells and ILC3s.

Methods:

Two- to three-month-old female SKG mice were injected intraperitoneally with 3mg of curdlan or PBS at the beginning and with 500 µg of CTLA4-Ig or PBS every other week (n=5 per group). The body weight and arthritis score were measured weekly for a month. Then, the changes in the proportion of T cells and ILCs in the spleen and Peyer’s patches (PPs) were analysed by flow cytometry (FCM). BALB/c mice, without treatment, were also examined by FCM as a control cohort. In addition, a next-generation analysis of their feces was performed on 16S ribosomal coding genes before curdlan and CTLA4-Ig treatment.

Results:

SKG mice contained not only more Th17 cells but also more ILC1s and ILC3s than BALB/c mice, in their guts (the PPs). The feces of SKG mice intrinsically showed a decrease in the number of bacterial species, suggesting a dysbiosis. Then, in curdlan-treated SKG mice, CTLA4-Ig administration decreased the proportion of both Th17 cells and ILC3s in the spleen, but did not decrease the proportion of ILC3s in the PPs. Moreover, the ILC3/ILC1 ratio in the PPs was from low to high in the order of SKG mice without treatment, SKG mice injected with curdlan, and SKG mice injected with both curdlan and CTLA4-Ig. The phenotype corresponding to SpA features, in curdlan-treated SKG mice, continued after repeated CTLA4-Ig administration.

Conclusion:

Curdlan provoked SpA features in SKG mice with an intrinsic dysbiosis. Additional CTLA4-Ig injection decreased the proportion of Th17 cells but maintained that of ILC3s with increased ILC3/ILC1 ratio in the gut. This result supports the hypothesis that in the SpA pathophysiology, a weakened acquired immunity in the gut might lead to ILC3 activation, via dysbiosis, and its continuous disease progression, suggesting that ILC3s are a promising therapeutic target in SpA.

References:

[1]Sakaguchi N, Sakaguchi S, et al. Altered thymic T-cell selection due to a mutation of the ZAP-70 gene causes autoimmune arthritis in mice.Nature2003;426:454-460.

[2]Hirota K, Sakaguchi S, et al. T cell self-reactivity forms a cytokine milieu for spontaneous development of IL-17+ Th cells that cause autoimmune arthritis.J Exp Med2007;204:41-47.

[3]Ruutu M, Thomas R, et al. β-glucan triggers spondylarthritis and Crohn’s disease–like ileitis in SKG mice.Arthritis Rheum2012;64:2211-2222.

[4]Shen H, Gaston JS, et al. Frequency and phenotype of peripheral blood Th17 cells in ankylosing spondylitis and rheumatoid arthritis.Arthritis Rheum2009;60:1647-1656.

[5]Song I-H, Sieper J, et al. Treatment of active ankylosing spondylitis with abatacept: an open-label, 24-week pilot study.Ann Rheum Dis2011;70:1108-1110.

[6]Ciccia F, Triolo G, et al. Type 3 innate lymphoid cells producing IL-17 and IL-22 are expanded in the gut, in the peripheral blood, synovial fluid and bone marrow of patients with ankylosing spondylitis.Ann Rheum Dis2015;74:1739-1747.

Disclosure of Interests:

Yuya TABUCHI Paid instructor for: Astellas Pharma, GlaxoSmithKline, Mitsubishi Tanabe Pharma, and Nippon Shinyaku., Speakers bureau: AbbVie, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Nippon Shinyaku, and Novartis Pharma., Motomu Hashimoto Grant/research support from: Bristol-Myers Squibb, Eisai, and Eli Lilly and Company., Speakers bureau: Bristol-Myers Squibb and Mitsubishi Tanabe Pharma., Syuji Akizuki: None declared, Ran Nakashima Grant/research support from: Takeda Pharmaceutical. (Outside the field of the present study.), Speakers bureau: Astellas Pharma, Medical & Biological Laboratories, AstraZeneca, and Boehringer Ingelheim. (Outside the field of the present study.), Kosaku Murakami Speakers bureau: AbbVie, Eisai, and Mitsubishi Tanabe Pharma., Hajime Yoshifuji Grant/research support from: Astellas Pharma. (Outside the field of the present study.), Speakers bureau: Chugai Pharmaceutical. (Outside the field of the present study.), Masao Tanaka Grant/research support from: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Ayumi Pharmaceutical, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, Taisho Pharmaceutical, and UCB Japan.

, Speakers bureau: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, Pfizer, Taisho Pharmaceutical, Takeda Pharmaceutical, and UCB Japan., Koichiro Ohmura Grant/research support from: Astellas Pharma, AYUMI Pharmaceutical, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, Japan Blood Products Organization, Mitsubishi Tanabe Pharma, Nippon Kayaku, Nippon Shinyaku, Sanofi, and Takeda Pharmaceutical., Speakers bureau: AbbVie, Actelion Pharmaceuticals Japan, Asahi Kasei Pharma, AYUMI Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, GlaxoSmithKline, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, and Sanofi.

THU0285 ANALYSIS OF THE RELATIONSHIP BETWEEN ORGAN DAMAGE AND QUALITY OF LIFE IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Systemic lupus erythematosus (SLE) is an autoimmune disease that can not only cause systemic symptoms, such as fever and arthritis, but can also damage important organs, such as those of the central nervous system and the kidneys. Prevention of irreversible organ damage is important for better prognosis [1]. Additionally, the importance of maintaining the quality of life (QOL) of patients has recently been emphasized. However, only a few studies have examined the relationship between irreversible organ damage and patient QOL.

Objectives:

To assess the relationship between organ damage and QOL, and to survey which organs have more significant effects on QOL.

Methods:

We conducted a questionnaire-based survey of 183 patients with SLE at Kyoto University Hospital from September to December 2019. We used the SLICC/ACR Damage Index (SDI) to evaluate organ damage [2]. The following five scales were employed to evaluate QOL: the physical (PCS) and mental component summary (MCS) of the Medical Outcome Study (MOS) 36-Item Short-Form Health Survey version 2.0 (SF-36v2) [3], health (HRQOL) and non-health-related QOL (N-HRQOL) of LupusPRO [4], and SLE Symptom Checklist (SSC) [5].

Results:

Linear regression analysis showed significant correlation between the SDI score and all QOL scales except for N-HRQOL, suggesting negative effects of organ damage on QOL (Table 1). Next, we analysed whether there was a significant difference in the SF-36 score between those who were positive and negative for each SDI item (41 in total), using the Wilcoxon rank sum test. Muscle atrophy or weakness (p= 3.0×10-10), osteoporosis with fracture or vertebral collapse (p= 9.7×10-8), claudication (p= 7.4×10-5), and cognitive impairment or major psychosis (p= 9.9×10-5) significantly correlated (p< 1.2×10-3) with PCS, and scarring chronic alopecia (p= 3.4×10-4) with MCS (Table 2). In addition, the five SDI items significantly correlated with the remaining three QOL scales (HRQOL, N-HRQOL, and SSC;p< 0.05).

Table 1.

Relationship between the SDI score and QOL

SF-36LupusPROSSCPCSMCSHRQOLN-HRQOLp-value<2.0×10-161.7×10-32.2×10-110.231.9×10-8Table 2.

Relationship between each SDI item and the SF-36 score (p< 1.2×10-3

SDI itemPCS scorep-valuePositive(Median (IQR))Negative(Median (IQR))Muscle atrophy/weakness33 (19-45)50 (43-54)3.0×10-10Osteoporosis with fracture/vertebral collapse24 (12-32)49 (38-54)9.7×10-8Claudication31 (19-35)49 (38-54)7.4×10-5Cognitive impairment/psychosis27 (17-33)49 (38-54)9.9×10-5SDI itemMCS scorep-valuePositive(Median (IQR))Negative(Median (IQR))Scarring chronic alopecia42 (29-51)49 (39-54)3.4×10-4

Conclusion:

We demonstrated that organ damage has negative effects on patient QOL, indicating the importance of preventing irreversible organ damage for maintaining QOL. Moreover, muscle atrophy/weakness, osteoporosis with fracture/vertebral collapse, claudication, cognitive impairment/major psychosis, and scarring chronic alopecia significantly correlated with QOL deterioration, suggesting that these items should be examined with special care in clinical practice.

References:

[1]Lopez R, et al. Rheumatology (Oxford). 2012; 51:491-498.

[2]Gladman D, et al. Arthritis Rheum. 1996; 39:363-369.

[3]Fukuhara S, et al. J Clin Epidemiol. 1998; 51:1037-1044.

[4]Inoue M, et al. Lupus. 2017; 26:849-856.

[5]Grootscholten C, et al. Qual Life Res. 2003; 12:635–644.

Disclosure of Interests:

Yudai Takase: None declared, Hiroshi Doi: None declared, Takeshi Iwasaki: None declared, Motomu Hashimoto Grant/research support from: Bristol-Myers Squibb, Eisai, and Eli Lilly and Company., Speakers bureau: Bristol-Myers Squibb and Mitsubishi Tanabe Pharma., Ryuta Inaba: None declared, Tomohiro Kozuki: None declared, Masashi Taniguchi: None declared, Yuya Tabuchi Paid instructor for: Astellas Pharma, GlaxoSmithKline, Mitsubishi Tanabe Pharma, and Nippon Shinyaku., Speakers bureau: AbbVie, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Nippon Shinyaku, and Novartis Pharma. (Outside the field of the present study.), Koji Kitagori: None declared, Syuji Akizuki: None declared, Kosaku Murakami Speakers bureau: AbbVie, Eisai, and Mitsubishi Tanabe Pharma., Ran Nakashima Grant/research support from: Takeda Pharmaceutical. (Outside the field of the present study.), Speakers bureau: Astellas Pharma, Medical & Biological Laboratories, AstraZeneca, and Boehringer Ingelheim. (Outside the field of the present study.), Hajime Yoshifuji Grant/research support from: Astellas Pharma. (Outside the field of the present study.), Speakers bureau: Chugai Pharmaceutical. (Outside the field of the present study.), Wataru Yamamoto: None declared, Masao Tanaka Grant/research support from: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Ayumi Pharmaceutical, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, Taisho Pharmaceutical, and UCB Japan.

, Speakers bureau: AbbVie, Asahi Kasei Pharma, Astellas Pharma, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, Pfizer, Taisho Pharmaceutical, Takeda Pharmaceutical, and UCB Japan., Koichiro Ohmura Grant/research support from: Astellas Pharma, AYUMI Pharmaceutical, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, Japan Blood Products Organization, Mitsubishi Tanabe Pharma, Nippon Kayaku, Nippon Shinyaku, Sanofi, and Takeda Pharmaceutical., Speakers bureau: AbbVie, Actelion Pharmaceuticals Japan, Asahi Kasei Pharma, AYUMI Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Eli Lilly and Company, GlaxoSmithKline, Janssen Pharmaceutical, Mitsubishi Tanabe Pharma, Novartis Pharma, and Sanofi.

Utility of osteopontin in cerebrospinal fluid as a diagnostic marker for neuropsychiatric systemic lupus erythematosus

The whole protein of osteopontin (OPN full) and its cleaved form (OPN N-half) are involved in the immune response and the migration of immune cells to an inflammatory lesion. We have reported that serum OPN full and urine OPN N-half are elevated in lupus nephritis (LN). Neuropsychiatric systemic lupus erythematosus (NPSLE) is a refractory complication of SLE. To investigate whether OPN full and OPN N-half could serve as diagnostic markers for NPSLE, and to elucidate their role in NPSLE pathogenesis, the concentrations of OPN full and OPN N-half in cerebrospinal fluid (CSF) were measured in NPSLE and non-NPSLE patients. We found that the concentration of OPN full in the CSF was significantly higher in NPSLE than in non-NPSLE, and it decreased after treatment. When the cutoff value of OPN full in CSF was set to 963.4 ng/ml, the sensitivity and specificity for the diagnosis of NPSLE were 70% and 100%, respectively. The correlation analysis of OPN full, OPN N-half and various cytokines/chemokines suggested that the cytokines/chemokines could be divided into two clusters: cluster A, which contains OPN full and cluster B, which contains interleukin-6. OPN full in CSF could be a novel diagnostic marker for NPSLE.

An anaerobic-aerobic sequential batch process with simultaneous methanogenesis and short-cut denitrification for the treatment of marine biofoulings

Although combination of denitritation and methanogenesis for wastewater treatment has been widely investigated, an application of this technology to solid waste treatment has been rarely studied. This study investigated an anaerobic-aerobic batch system with simultaneous denitritation-methanogenesis as an effective treatment for marine biofoulings, which is a major source of intermittently discharged organic solid wastes. Preliminary NO₂^--exposed sludge was inoculated to achieve stable methanogenesis process without NO₂^- inhibition. Both high NH₄⁺-N removal of 99.5% and high NO₂^--N accumulation of 96.4% were achieved on average during the nitritation step. Sufficient CH₄ recovery of 101 L-CH₄ kg-COD^-1 was achieved, indicating that the use of NO₂^--exposed sludge is effective to avoid NO₂^- inhibition on methanogenesis. Methanogenesis was the main COD utilization pathway when the substrate solubilization occurred actively, while denitritation was the main when solubilization was limited because of substrate shortage. The results showed a high COD removal efficiency of 96.0% and a relatively low nitrogen removal efficiency of 64.4%. Fitting equations were developed to optimize the effluent exchange ratio. The estimated results showed that the increase of effluent exchange ratio during the active solubilization period increased the nitrogen removal efficiency but decreased CH₄ content in biogas. An appropriate effluent exchange ratio with high anaerobic effluent quality below approximately 120 mg-N L^-1 as well as sufficient CH₄ gas quality which can be used as fuel for gas engine generator was achieved by daily effluent exchange of 80% during the first week and 5% during the subsequent 8 days.

The long-term outcome of high tibial osteotomy: a ten- to 20-year follow-up

We carried out a prospective study of 132 patients (159 knees) who underwent closed-wedge high tibial osteotomy for severe medial compartment osteoarthritis between 1988 and 1997. A total of 94 patients (118 knees) was available for review at a mean of 16.4 years (16 to 20). Seven patients (7.4%) (11 knees) required conversion to total knee replacement. Kaplan-Meier survival was 97.6% (95% confidence interval 95.0 to 100) at ten years and 90.4% (95% confidence interval 84.1 to 96.7) at 15 years. Excellent and good results as assessed by the Hospital for Special Surgery knee score were achieved in 87 knees (73.7%). A pre-operative body mass index > 27.5 kg/m(2) and range of movement < 100 degrees were risk factors predicting early failure. Although our long-term results were satisfactory, strict indications for osteotomy are required if long-term survival is required.

High-resolution analysis of DNA copy number alterations and gene expression in renal clear cell carcinoma

We analysed chromosomal copy number aberrations (CNAs) in renal cell carcinomas by array-based comparative genomic hybridization, using a genome-wide scanning array with 2304 BAC and PAC clones covering the whole human genome at a resolution of roughly 1.3 Mb. A total of 30 samples of renal cell carcinoma were analysed, including 26 cases of clear cell carcinoma (CCC) and four cases of chromophobe renal cell carcinoma (ChCC). In CCCs, gains of chromosomes 5q33.1-qter (58%), 7q11.22-q35 (35%) and 16p12.3-p13.12 (19%), and losses of chromosomes 3p25.1-p25.3 (77%), 3p21.31-p22.3 (81%), 3p14.1-p14.2 (77%), 8p23.3 (31%), 9q21.13-qter (19%) and 14q32.32-qter (38%) were detected. On the other hand, the patterns of CNAs differed markedly between CCCs and ChCCs. Next, we examined the correlation of CNAs with expression profiles in the same tumour samples in 22/26 cases of CCC, using oligonucleotide microarray. We extracted genes that were differentially expressed between cases with and without CNAs, and found that significantly more up-regulated genes were localized on chromosomes 5 and 7, where recurrent genomic gains have been detected. Conversely, significantly more down-regulated genes were localized on chromosomes 14 and 3, where recurrent genomic losses have been detected. These results revealed that CNAs were correlated with deregulation of gene expression in CCCs. Furthermore, we compared the patterns of genomic imbalance with histopathological features, and found that loss of 14q appeared to be a specific and additional genetic abnormality in high-grade CCC. When we compared the expression profiles of low-grade CCCs with those of high-grade CCCs, differentially down-regulated genes tended to be localized on chromosomes 14 and 9. Thus, it is suggested that copy number loss at 14q in high-grade CCC may be involved in the down-regulation of genes located in this region.

Survival analysis of a cementless, cruciate-retaining total knee arthroplasty

We performed a prospective study of 54 patients (76 knees) who underwent Osteonics series 3000 cruciate-retaining cementless total knee arthroplasty between December 1990 and June 1993. Five patients (seven knees) were lost to follow-up (90.7% completion). One patient required revision at 10.5 years after operation.

The rate of survival was 100% at ten years and 96.7% at 13 years. The mean ten-year knee and function scores were 79 and 59 respectively. Both were significantly better than the pre-operative scores. The range of movement also improved. Although a radiolucent line around the tibial component enlarged in six knees (20.7%) at ten years, the clinical outcome was generally good. In a patient who died after 5.5 years, post-mortem examination of the knee showed no bony ingrowth into the tibial component. Despite poor bony ingrowth, press-fit fixation was satisfactory and good results can be obtained with this cementless, cruciate-retaining prosthesis.

Fixation of a hydroxyapatite-tricalcium phosphate-coated cementless knee prosthesis

Miller-Galante II total knee arthroplasty (MG II TKA) was performed on 32 knees in 30 patients. On both the femoral and tibial components, the fibre-metal area was plasma-sprayed with hydroxyapatite-tricalcium phosphate (HA-TCP). The clinical and radiographic outcome was evaluated. A mean pre-operative knee score of 26.0 ± 18.6 (SD) increased to 97.5 ± 3.5 and a mean pre-operative functional score of 21.7 ± 15.0 (SD) increased to 83.4 ± 12.4 at follow-up of seven years. Clear zones were common around the components at one month post-operatively but had completely disappeared after six months. An autopsy of a patient who underwent MG II TKA with HA-TCP two years previously, showed osteogenesis in all parts of the fibre-metal, and bone tissue comprised 77.7% of the interface. This coated prosthesis has good early fixation which is maintained at seven years with good clinical and radiographic outcomes.

Pharmacokinetics and adverse events following 5-day repeated administration of lenograstim, a recombinant human granulocyte colony-stimulating factor, in healthy subjects

Recombinant human granulocyte colony-stimulating factor (rhG-CSF) (lenograstim) was administered to healthy subjects at doses of 2, 5 and 10 micrograms/kg/day for 5 days (twice a day subcutaneously) to examine the optimal dose and schedule of lenograstim in mobilizing peripheral blood progenitor cells (PBSC) for allogeneic transplantation. Lenograstim administration significantly increased CD34+ cells in a dose-related manner. A significant correlation was observed between the maximal post-dosing counts and the pre-dosing baseline counts of CD34+ cells. Peripheral neutrophils increased markedly by seven to 13 times from the baseline to a peak of approximately 40,000/microliter on day 5 for the 5 and 10 micrograms/kg/day doses. After peak serum concentration (Cmax) was attained 4 h following administration, serum G-CSF declined with time in a log-linear fashion. The Cmax and 12 h area-under-the-curve increased dose dependently, but minimum drug level increased up to day 2 and then decreased until day 5. Clearance decreased with increasing dosage at the first dose, and increased significantly at the last dose. We found a highly significant correlation between absolute neutrophil counts and clearance for each dose. Adverse events most frequently occurred on day 6, with increases of alkaline phosphatase and lactate dehydrogenase and onset of bone pain. Increases of aspartate aminotransferase and alanine aminotransferase occurred as delayed events. Platelet count gradually decreased after the end of drug administration to 57% of the pre-dosing count on day 10, but was still within the normal range. These preliminary results suggest that repeated doses of lenograstim induce mobilization of PBSC in a dose-dependent manner and the pre-dosing baseline count of PBSC may predict the post-dosing maximal mobilization. The drug treatment may cause delayed-onset moderate thrombocytopenia and increased transaminase, and the drug clearance changes in a complex manner during repeated dosing.

Endometrioid adenocarcinoma arising from adenomyosis

In spite of many references to carcinoma arising from endometriosis at extrauterine sites, there are few documented cases of carcinoma developing in association with adenomyosis. We present 2 rare cases of adenocarcinoma arising from adenomyosis. The relationship between prior frequent estrogen use and carcinogenesis and the possible effects of chemotherapy and radiation therapy are reviewed.

[A case of systemic lupus erythematosus with interstitial myocarditis leading to sudden death]

A 29-year-old female with systemic lupus erythematosus (SLE) was admitted because of exertional dyspnea in January, 1996. The diagnosis of SLE was made on the basis of malar rash, discoid rash, polyarthritis, leukopenia, positive antinuclear antibody and focal glomerulonephritis in 1991. She did not have any cardiac symptoms in 1994, when the electrocardiogram (ECG) abnormalities, such as poor R wave progression and right axis deviation, were present. On admission, she developed congestive heart failure without any signs of active SLE. Laboratory findings were unremarkable. There were new ECG abnormalities, such as left atrial overload and low voltage in limb leads. Chest roentgenogram showed mild pulmonary congestion and marked cardiomegaly. Echocardiography showed enlargement and diffuse hypokinesis of the left ventricle. Cardiac catheterization confirmed that the coronary arteries were normal and that the left ventricular function was poor (ejection fraction, 21%). Myocardial biopsy obtained from left ventricle revealed interstitial fibrosis. After furosemide, digoxin and captril were administered with predonisolone (PSL), her symptoms gradually improved. Since the Holter monitoring showed nonsustained ventricular tachycardia, the doses of PSL and mexiletine were increased up to 20 mg and 300 mg daily, respectively. Unexpectedly, she was found dead in her hospital room in May, 1996. The postmortem findings of the heart revealed mild infiltration of inflammatory cells, predominantly lymphocytes, and plasma cells, and interstitial fibrosis, which were consistent with interstitial myocarditis. In this case ECG abnormalities preceded cardiac symptoms, which may suggest that myocarditis subclinically developed. Serum creatinine kinase levels had not been elevated throughout the entire course. While several cases of acute myocarditis associated with a flare of SLE have been reported, there were few cases regarding interstitial myocarditis that chronically progress and can be fatal. This case is thought to be suggestive of elucidating the pathogenesis of lupus myocarditis.

[Dibucaine number (DN) and fluoride number (FN) of L330 I mutant recombinant cholinesterase by use of various substrates]

Dibucaine number (DN) and fluoride number (FN) of the recombinant 330 I mutant ChE (r330 I) expressed in human kidney cells (293 cell) were compared with recombinant usual ChE (rUU), by several assay kits and substrates. All of them showed lower the values compared with rUU. However, the r330 I/rUU ratios about FN determined by several substrates were higher than that determined by propionyl thiocholoneiodide (PTCI), which was recommended by American Association for Clinical Chemistry. In conclusion, commercially available assay kits may not be suitable for the determination of L330 I.

[A case of pulmonary fat embolism and cardiac arrest after prosthetic replacement of the femoral stem]

We experienced a case of cardiac arrest which occurred after prosthetic replacement of the femoral stem. The patient died three hours and fifty minutes after the end of operation, following hypouresis, pulmonary edema and hypoxia. According to the autopsy, extensive and severe fat embolism was documented in the lung and kidney, and this is considered to be the cause of the death. When prosthetic replacement of the femoral head is performed, we have to keep in mind the danger of fat embolism.

A novel in-frame deletion mutation in a case of lactate dehydrogenase (LD) H subunit deficiency showing an atypical LD isoenzyme pattern in serum and erythrocytes

OBJECTIVE

We report a case showing an atypical lactate dehydrogenase (LD) isoenzyme pattern involving deficiency only of LD-1 and LD-2 in serum and erythrocytes. LD activity in serum from this patient was extremely low, similar to complete LD-H deficiency, and also that in erythrocytes was low.

DESIGN

The DNA fragment containing exon 1 through 7 of the LD-H gene were amplified by PCR and directly sequenced. Total RNA was prepared from venous blood and the proportion of LD-H cDNA to total LD cDNA was semiquantified.

RESULTS

Genetic analysis by DNA sequencing detected a three base deletion (AAT) at codon 220 of exon 5, which caused a deletion of one asparagine. The present case did not show reduced LD-H expression at the mRNA level in whole blood. Residue 220 is involved in turning beta-J to alpha1-G and is not buried in the interior of the protein. The novel homozygous in-frame deletion mutation at codon 220 may cause a three-dimensional change of the subunit-binding domain.

CD14 transgenic mice expressing membrane and soluble forms: comparisons of levels of cytokines and lethalities in response to lipopolysaccharide between transgenic and non-transgenic mice

Two different metallothionein promoter-mouse CD14 fusion genes were constructed. The membrane form of the CD14 fusion gene, designated M14M, contained the full-length CD14 cDNA sequence, whereas the soluble form of the fusion gene, designated M14S, was truncated to lack the sequence for the phosphatidylinositol-anchoring site. Expression of transgenic RNA in M14M and M14S mice on the basal diet was abundant in the liver. After maintenance with water containing ZnSO4 (50 mM) for 4 days, expression of transgenic RNA in M14M and M14S mice was strong in the small intestine. Immunohistochemical analysis demonstrated CD14 expression in these organs in M14S and M14M mice. Levels of CD14 in sera from M14S mice after zinc administration were significantly higher than these animals maintained with normal water, M14M mice after zinc administration and non-transgenic mice. Sera from M14S and M14M mice after stimulation with lipopolysaccharide LPS (LPS) demonstrated significantly lower levels of tumor necrosis factor-alpha and IL-6 than those from non-transgenic mice. Lethality in endotoxin shock produced by i.p. injection of 30-40 microg/g body wt LPS was not different between M14S, M14M and non-transgenic mice. However, survival rates in the lethal Shwartzman reaction induced by priming and challenge injections of LPS were significantly higher in M14M and M14S mice than in non-transgenic mice.

Familial neurilemoma of the spinal cord in a mother and daughter

Neurilemoma of the spinal cord occurred in a mother and daughter. Case 1 was a 75-year-old woman with gait disturbance. Examination revealed weakness of the lower extremities, and magnetic resonance (MR) imaging showed an intradural extramedullary tumor at T12. After laminectomy, the histologic diagnosis was mixed Antoni type A and B neurilemoma. Case 2 was a 48-year-old woman (daughter of case 1). She presented with cervical pain and numbness of both hands. Examination revealed weakened intrinsic muscles of the right hand and paresthesia of the right upper arm. MR imaging showed a giant hourglass-shaped extradural tumor at C2 and C3. The histologic diagnosis was Antoni type A neurilemoma. Only six families with neurilemoma have been reported, including our patients. Gene analysis of such patients may clarify the etiology of neurilemoma.

[Diminution of the number of gamma delta T lymphocytes in hepatocellular carcinoma patients treated with transcatheter arterial embolization]

gamma delta T lymphocytes, which are CD3+ lymphocytes that express gamma delta chains of the T-cell antigen receptor (TCR) on their surface, are functionally distinct from alpha beta T lymphocytes, which express alpha beta chains of the TCR. gamma delta T lymphocytes are thought to differentiate in mouse hepatic sinusoids, to play a role in antitumor action, and to act as natural killer cells. The purpose of this study was to examine whether gamma delta T lymphocytes in the peripheral blood are suppressed when hepatic sinusoids are damaged during transcatheter arterial embolization (TAE). The numbers of alpha beta T lymphocytes and gamma delta T lymphocytes in the peripheral blood were examined with monoclonal antibodies and flow cytometry before and after TAE in 32 patients (from 46 to 78 years of age) with liver cirrhosis and hepatocellular carcinoma. The number of alpha beta T lymphocytes before and after TAE was unchanged. However, the number of gamma delta T lymphocytes and the ratio of gamma delta T lymphocytes to CD3+ lymphocytes were significantly decreased for 3 weeks after TAE treatment. This decrease suggests that TAE suppresses the supply of gamma delta T lymphocytes to the peripheral blood. In addition, TAE may weaken a patient's antitumor immunity, because gamma delta T lymphocytes that have antitumor activity decrease after TAE.

Clinicopathologic characteristics of the lungs of patients with human T cell lymphotropic virus type 1-associated myelopathy

Lung autopsy specimens were evaluated histologically in the six patients with human T cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy (HAM). The results revealed two histologic changes. First, lymphoid infiltrates were distributed widely in peribronchiolar and perivascular regions, subpleural regions, and the alveolus. Lymphoid infiltrates were also observed in bronchial mucosal glands in relatively large bronchi, in which the acinar epithelium was sometimes degenerated. Second, chronic inflammatory changes, such as smooth muscle hypertrophy, fibrosis, or squamous cell metaplasia, were increased significantly in the membranous bronchioles of HAM patients compared with specimens from lung cancer control patients. Such histologic changes were subclinical in most cases, but one case had an abnormal chest shadow, and two cases had recurrent pneumonia. In HAM patients, high levels of HTLV-1-specific cytotoxic T lymphocytes are believed to attack the HTLV-1-bearing cells in the lung, resulting in inflammatory reactions.

Foreign body gonitis caused by a broken poly-L-lactic acid screw

Poly-L-lactic acid (PLLA), a biodegradable polymer, is generally considered to be gradually degraded without causing any severe tissue reaction. However, we encountered a patient who developed foreign body gonitis caused by screw breakage after fixation of an intercondylar prominence fracture with PLLA screws. This case suggests that care should be taken when PLLA materials are used to fix intraarticular fractures.

A new method of hemostasis for cementless total knee arthroplasty

Heavy bleeding often occurs following cementless total knee arthroplasty (TKA) and it is difficult to control. We devised a new method of hemostasis after cementless TKA. In brief, the implant was inserted after coating the exposed surface of the cancellous bone with fibrin glue. Before removal of the tourniquet after completion of the operation a cocktail of hemostatic agents (containing 25 mg of carbazochrome sodium sulfonate and 250 mg of tranexamic acid) in 50 ml of physiological saline was injected into the joint cavity via the drain tube and the drain was clamped for about 30 min after removal of the tourniquet. After removal of the clamp, standard negative pressure suction was performed. This method was used on 84 knees in 42 patients who underwent simultaneous bilateral cementless TKA and 64 knees in 64 patients who underwent unilateral TKA. The mean total amount of blood loss during and after the operation was 235 +/- 178 ml in the unilateral TKA patients and 402 +/- 208 ml in the bilateral TKA patients. No patient required blood transfusions postoperatively. This method was effective for achieving hemostasis after cementless TKA.

Human butyrylcholinesterase L330I mutation belongs to a fluoride-resistant gene, by expression in human fetal kidney cells

We noticed a Japanese male showed low serum butyrylcholinesterase (BCHE) activity on health examination. The phenotyping analysis revealed a reduced dibucaine number (DN) and an especially low fluoride number (FN), similar to an FS phenotype. A homozygous missense mutation, a T to A transversion at nucleotide 988, was identified in his BCHE gene. This mutation resulted in the replacement of leucine by isoleucine at codon 330 (L330I). DN and FN of recombinant BCHE(L330I) secreted by human fetal kidney cells were compared to recombinant wild-type(usual gene) BCHE and normal serum BCHE. These results showed this amino acid substitution of BCHE, Leu330 to Ile, really caused the abnormal DN and FN. We conclude that the BCHE L330I mutation is a fluoride-resistant gene, a Japanese type fluoride-resistant gene.

[Cystic lymphangioma of the tunica vaginalis testis. A case report]

A 42-year-old man who complained progressive enlargement of an intrascrotal mass visited to our hospital. Preoperative sonography revealed multiple cystic masses adjacent to the left testis. Total surgical excision was performed. The cystic masses were arising from tunica vaginalis testis. Histopathologically, a cystic lymphangioma was diagnosed because of the morphological features and the immunohistochemical stainings of CD34 and Factor VIII related antigen which were observed positive reactions in endothelial cells of the cysts.

[A pathological study of cytomegalovirus infections in autopsied cases with adult T-cell leukemia]

In this study, cytomegalovirus (CMV) infection was found in eleven of 21 autopsied cases (52.4%) with adult T-cell leukemia (ATL). Seven cases (63.6%) revealed disseminated infection in more than three organs. The lungs were involved in all eleven cases (100%), adrenal glands in eight cases (72.7%), esophagus in four cases (36.4%), and stomach, small intestine and urinary bladder in three cases (27.3%). Histopathological findings suggested that lung involvement was the cause of death in five of the 11 cases, the small intestine were involved in two of the 3 cases, and the adrenal glands were involved in one of the 8 cases. In summary, CMV infection was found to be the main cause of death in five (45.5%) of the 11 ATL patients.

Does arthroscopic abrasion arthroplasty promote cartilage regeneration in osteoarthritic knees with eburnation? A prospective study of high tibial osteotomy with abrasion arthroplasty versus high tibial osteotomy alone

The purpose of this prospective study was to determine whether or not abrasion arthroplasty promotes cartilage regeneration in osteoarthritic (OA) knees with eburnation. Patients with OA knees were divided into a group of 51 knees treated by osteotomy with abrasion arthroplasty (Group A) and another group of 37 knees treated by osteotomy alone (Group B). Regeneration of cartilage was compared between the groups both arthroscopically and histologically. The Outerbridge classification was used for arthroscopic grading with Grade 0 being normal and Grade IV representing eburnation. On arthroscopic examination, around 12 months after surgery, Group A showed a significantly higher incidence of Grade II repair (a smooth articular surface and small fissures) and a lower incidence of Grade IV repair than Group B on both the femoral (P < .001) and tibial (P < .01) joint surfaces. Age was the only factor influencing the grade of tibial cartilage in Group A. Histological examination showed that 64% of the regenerated tissue studied consisted of fibro-cartilage at around 12 months after surgery. There was no difference in the clinical outcome at 2 to 9 years postoperatively between Groups A and B.

No association between c-fos gene polymorphisms and sporadic Alzheimer's disease

Although ApoE epsilon 4 is a major risk factor for sporadic Alzheimer's disease (AD), 20-30% of sporadic AD patients do not have this allele. This indicates that other risk factors are involved in the pathogenesis of sporadic AD. Studies of the genetic association between AD and polymorphisms in the c-fos gene, a candidate gene for AD, were conducted. The polymorphisms of DsaI in exon 2 and Sau3 AI in intron 2 were examined in 89 patients diagnosed as sporadic cases of probable AD clinically and radiologically according to the NINCDS-ADRDA criteria. This was also undertaken in 96 controls. There was no significant difference between the groups in allele frequencies or genotype counts. Although c-fos gene as a locus conferring susceptibility to sporadic AD cannot be ruled out, these data could not support the hypothesis that a c-fos allele should be another risk factor for sporadic AD.

Relationship between impairment of prenatal brain growth and family history of psychosis in schizophrenia

Recently McNeil et al. (1993b), showed that schizophrenics had smaller head circumference (HC) at birth than controls. This small head size at birth was observed more commonly among schizophrenics without a family history of psychosis than among familial schizophrenics, suggesting that some prenatal environmental factors, rather than genetic factors, are related to the impaired brain growth in utero. We attempted to replicate this finding in 100 Japanese schizophrenics (DSM-III-R), using contemporaneous data on body measures at birth. Conversely, in the current study, HC at birth was found to be significantly smaller in schizophrenics with a family history of psychosis (N = 19) than those without (N = 81). A multiple regression analysis, controlling for gender, gestational age, maternal age, birth order and year of birth, yielded an overall reduction of about 1 cm in HC at birth among familial schizophrenics compared with non-familial schizophrenics. When HC at birth in family history positive and negative groups was compared separately with the local population norms with adjustment for gender and gestational age, familial and non-familial schizophrenics were both found to have significantly smaller HC at birth, although the difference was less marked for the latter. These results suggest that schizophrenics have delayed cerebral development in utero, and that genes which operate on prenatal neurodevelopment may play an important role in the aetiology of schizophrenia, although it is possible that some environmental factors may also be involved in the impaired brain growth.

Monitoring of cerebrospinal fluid pressure during embolization of AVM

We experienced that therapeutic embolization of a large cerebral arteriovenous malformation (AVM) led to venous outflow obstruction resulting in intracranial hypertension in a patient who had undergone external decompression. To evaluate hemodynamic changes after embolization, we monitored the cerebrospinal fluid pressure in the next four patients who underwent endovascular treatment. The embolization of a medium AVM resulted in a slight increase in the cerebrospinal fluid pressure. In two medium AVMs, embolization produced slight decreases in the cerebrospinal fluid pressure. In a small AVM, we did not observe any changes in the cerebrospinal fluid pressure during the endovascular treatment. We discuss the mechanism of changes in the intracranial pressure after embolization and conclude that monitoring of the cerebrospinal fluid pressure immediately yields useful information for hemodynamic changes during endovascular treatment.

Three different point mutations in the butyrylcholinesterase gene of three Japanese subjects with a silent phenotype: possible Japanese type alleles

OBJECTIVE

To investigate genetic mutations in three Japanese subjects homozygous for silent butyrylcholinesterase mutations.

METHODS AND RESULTS

One of them was compound heterozygous for two mutations; GGA(Gly) to CGA(Arg) at codon 365 (G365R) and CAA(Gln) to TAA(Ter) at codon 119 (Q119X). The other two subjects were homozygous for different missense mutations: CGT(Arg) to TGT(Cys) at codon 515 (R515C) and G365R, respectively. Simple identification methods for all of the mutations were developed and applied for family analysis and to control individuals. Two mutations, G365R and R515C, have been reported in the Japanese population, while the nonsense mutation Q119X was discovered in the present study. Genetic heterogeneity between human populations with regard to the butyrylcholinesterase gene was suggested.

CONCLUSIONS

Among the three mutations found in this investigation, one was novel, and none of these mutations have been reported outside Japan.

Importance of hepatovenous back-perfusion for maintenance of liver viability during the Pringle manoeuvre

The role of hepatovenous back-perfusion in maintaining hepatic viability was investigated during inflow occlusion (Pringle manoeuvre) of the pig liver. The study compared two ischaemia procedures of 60 min duration: hepatic inflow occlusion and inflow plus outflow occlusion (vascular exclusion). Each procedure was carried out in six pigs and liver tissue perfusion, energy metabolism, lipid peroxidation and 7-day survival were assessed. Although all pigs survived after inflow occlusion, five of six died after vascular exclusion (P < 0.01). Exclusion induced a significant decrease in perfusion to 15.3 per cent of the value before ischaemia compared with 32.4 per cent after hepatic inflow occlusion alone (P < 0.01). Although cellular adenosine 5'-triphosphate levels were significantly decreased by ischaemia in both groups, the fall was less in pigs with inflow occlusion alone (to 55 per cent of the preclamp value) than in those with exclusion (to 24 per cent of the preclamp value) (P < 0.01). The plasma phosphatidylcholine hydroperoxide level rose immediately after reperfusion in pigs with exclusion, while the level remained constant after inflow occlusion alone. There is a fundamental difference between the two ischaemia procedures: back-perfusion from the vena cava contributes to the maintenance of liver function during inflow occlusion.

Structure of the osteopontin gene and its promoter

We cloned the hOPN gene and its 5' upstream region, and analyzed its exon-intron structure and potential regulatory sequences of the promoter region in comparison with those of mouse and porcine homologues. The hOPN gene consists of 7 exons that are similar to those of the mouse gene, although the hOPN gene is longer than the mouse homologue. This difference is attributable to an insertion of about 1750 bp immediately before exon 4 in the hOPN gene. A region of approximately 285 bp immediately upstream of the hOPN transcription initiation site was highly conserved and contained a number of potential cis regulatory consensus sequences. CAT analysis using SCC-3 cells demonstrated that nucleotides at positions -439 to -270, -124 to -80, and -55 to -39 contained cis-acting enhancing elements, in which the -124 to -80 element was much more active than the others. Deletion of the sequences between -474 and -270 localized the cis elements to the sequence at position -439 to -410, whereas the deletion between -124 to -80 localized it to -124 to -115, and -94 to -80 (data not shown). Gel shift analysis using synthesized double-stranded oligonucleotides corresponding to the 30 bp at position -439 to -410 (data not shown), and 10 and 15 bp regions at positions -124 to -115 and -94 to -80, respectively, as probes revealed that each probe formed one or two bands complexed with a nuclear protein prepared from SCC-3 cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Expression of wild-type and mutated rabbit osteopontin in Escherichia coli, and their effects on adhesion and migration of P388D1 cells

Recombinant wild-type rabbit osteopontin (rOP) and the protein with an aspartate-to-glutamate transposition induced by a point mutation in the rabbit OP cDNA within the Gly-Arg-Gly-Asp-Ser (GRGDS) sequence were expressed in Escherichia coli and purified to homogeneity. P388D1 cells bound rOP in a saturable manner. rOP induced adhesion and haptotaxis of P388D1 cells, whereas mutated rabbit OP (rOPmut) did not. Anti-rOP IgG F(ab')2 and synthetic GRGDS peptide inhibited rOP-mediated adhesion and haptotaxis of P388D1 cells. Fibronectin (FN)-mediated adhesion of P388D1 cells was markedly inhibited in the presence of fluid-phase rOP. Adhesion of P388D1 cells to rOP was significantly inhibited by anti-[alpha-subunits of VLA4 (alpha 4) and VLA5 (alpha 5)] monoclonal antibodies (mAbs), but not by anti-[alpha-subunit of vitronectin (VN) receptor (alpha V) or Mac-1 (alpha M)] mAb. Adhesion of P388D1 cells to FN and VN was significantly inhibited by anti-alpha V mAb but not anti-alpha 4, -alpha 5 or -alpha M mAb. Haptotaxis of P388D1 cells to rOP was significantly inhibited by anti-alpha V mAb, but not by anti-alpha 4, -alpha 5 and alpha M mAbs, whereas that to FN showed no inhibition with all three mAbs. Haptotaxis of P388D1 cells to VN was significantly inhibited by anti-alpha 5 and -alpha V mAbs but not by anti-alpha 4 and -alpha M mAbs. Similar features of inhibition of adhesion and haptotaxis of P388D1 cells to human OP were observed by mAbs. rOP had no chemotactic effect on P388D1 cells. Significant polymorphonuclear leucocyte migration was observed 3-12 h after intradermal injection of rOP into rabbits.

Mechanical detachable coil as a therapeutic alternative for cerebral aneurysm

Endovascular treatment for unruptured cerebral aneurysms has been recognized as a useful alternative. Various types of intravascular materials embolizing aneurysms were classified into one of two groups. One was retrievable after the placement, whereas the other was irretrievable. The former which has involved detachable coils is preferred, because it can be repositioned repeatedly, while it forms the most effective arrangement. In this report, we present a compromised patient who was a 68 year-old female suffering angina pectoris and was treated with an interlocking detachable coil. Technical points are discussed here compared with Guglielmi's detachable coil.

Cloning and characterization of the human osteopontin gene and its promoter

We isolated the human osteopontin (hOP) gene and the 5' upstream region, and analysed its exon-intron structure and potential regulatory sequences of the promoter region in comparison with those of the mouse and porcine gene. The coding sequence is split into 7 exons which are similar to those of the mouse gene, although the hOP gene is longer than the mouse gene. The difference in length is mainly due to variations in intron 3, which is approximately 2.7-fold longer than that of the mouse OP gene. The 5' upstream region of the hOP, which is highly conserved up to nucleotide -250, contains a number of potential cis regulatory consensus sequences. A series of sequentially 5'-deleted chimeric clones was tested for the ability to stimulate chloramphenicol acetyltransferase (CAT). Initial CAT analysis demonstrated that nucleotides at positions -474 to -270, -124 to -80, and -55 to -39 contained cis-acting enhancing sequences in a human monocyte cell line, SCC-3, although the -124 to -80 region was much more active than other regions. Deletion of the sequences between -474 and -270 localized this cis region to the sequence at positions -439 to -410, whereas the deletion between -124 to -80 localized the regions to -124 to -115, and -94 to -80. Gel-shift analysis using as probes synthesized double-stranded DNA corresponding to the 10 and 15 bp region at positions -124 to -115 and -94 to -80 respectively revealed that each probe formed a major band complexed with nuclear proteins prepared from SCC-3 cells.

Detection of human T lymphotrophic virus type I (HTLV-I) proviral DNA and analysis of T cell receptor V beta CDR3 sequences in spinal cord lesions of HTLV-I-associated myelopathy/tropical spastic paraparesis

Identification of the localization of human T lymphotrophic virus type I (HTLV-I) proviral DNA in the central nervous system (CNS) is crucial to the understanding of the pathogenesis of HTLV-I-associated myelopathy (HAM)/tropical spastic paraparesis (TSP) pathogenesis. We have developed a sensitive detection method, called two-step polymerase chain reaction (PCR) in situ hybridization, which enabled us to detect the HTLV-I proviral DNA in paraffin-embedded spinal cord tissue sections from HAM/TSP patients. HTLV-I proviral DNA was detected only in the nucleus of lymphocytes that had infiltrated into the spinal cord. However, no proviral DNA was amplified in any neuronal cells, including neurons and glial cells. This indicates that the demyelination of the spinal cord by HTLV-I as a result of viral infection of oligodendrocytes or neuronal cells is unlikely. The T cell receptor V beta gene sequence from lymphocytes in the spinal cord lesions taken from the same HAM/TSP autopsy cases revealed unique and restricted CDR3 motifs, CASSLXG(G) (one-letter amino acid. X is any amino acid), CASSPT(G), and CASSGRL which are similar to those described in T cells from brain lesions of multiple sclerosis (MS) and in a rat T cell clone derived from experimental allergic encephalomyelitis (EAE) lesions. The present results suggest that T cells containing restricted V beta CDR3 motifs, which are also found in MS and EAE, become activated upon HTLV-I infection and infiltrate into the spinal cord lesions of HAM/TSP patients.

Premature termination mutations in two patients with deficiency of lactate dehydrogenase H(B) subunit

Two patients with low lactate dehydrogenase (LD) activity were discovered during healthcare examinations and were found to be homozygous for LD-H (heart) subunit deficiency by electrophoretic isoenzyme analysis of serum and erythrocyte hemolysate. The molecular nature of the genetic mutations was characterized by amplification by the polymerase chain reaction and DNA sequencing. In one case, a single-base substitution (T--&gt;G transversion) at codon 147 of the LD-H(B) gene resulted in a nonsense mutation; in the other case, a deletion of 2 base pairs had occurred at codon 139, resulting in a frameshift translation and premature termination.

Premature termination mutations in two patients with deficiency of lactate dehydrogenase H(B) subunit

Two patients with low lactate dehydrogenase (LD) activity were discovered during healthcare examinations and were found to be homozygous for LD-H (heart) subunit deficiency by electrophoretic isoenzyme analysis of serum and erythrocyte hemolysate. The molecular nature of the genetic mutations was characterized by amplification by the polymerase chain reaction and DNA sequencing. In one case, a single-base substitution (T-->G transversion) at codon 147 of the LD-H(B) gene resulted in a nonsense mutation; in the other case, a deletion of 2 base pairs had occurred at codon 139, resulting in a frameshift translation and premature termination.

Sequence heterogeneity of HTLV-I proviral DNA in the central nervous system of patients with HTLV-I-associated myelopathy

The nucleotide sequence of human T-lymphotropic virus type I (HTLV-I) in central nervous system tissue was determined in 3 autopsy cases with HTLV-I-associated myelopathy (HAM)/tropical spastic paraparesis (TSP) and 1 seropositive carrier without HAM/TSP but with multiple sclerosis. All HAM/TSP samples (3 spinal cords and 2 brains) and the sample from the seropositive carrier without HAM/TSP (brain) were positive for HTLV-I env (5146-6681), pX5' (6549-7494), and pX3' (7354-8276) regions by the two-step polymerase chain reaction method. A nucleotide sequence analysis of the pX5' and pX3' polymerase chain reaction products from nucleotides 6631 to 8259 revealed heterogeneity of the HTLV-I genome in all cases. It is notable that 13 of 50 clones derived from the pX3' polymerase chain reaction products were defective in the tax open reading frame while 7 were defective in the rex open reading frame in the HAM/TSP samples. All 17 clones from 1 HAM/TSP case were defective in the pX open reading frame II. One nucleotide insertion at 7784 creating a frame shift in both tax and rex was seen in all 3 HAM/TSP cases but not in the HTLV-I carrier without HAM/TSP. The pX-defective mutants found frequently in the central nervous system may contribute to the neural damage, since the pX gene products are essential for the transactivation of various cellular genes as well as for viral replication.