Identification and characterization of an adenine to guanine transition within intron 10 of the factor VIII gene as a causative mutation in a patient with mild haemophilia A.

Haemophilia A is caused by various genetic mutations in the factor VIII gene (F8). However, after conventional analysis, no candidate mutation could be identified in the F8 of about 2% of haemophilia A patients. The F8 of a patient with mild congenital haemophilia A, in whom no candidate mutation was found in the exons or their flanking regions, was analysed in detail to identify the patient's aetiological genetic abnormality. We also characterized anti-FVIII antibody (inhibitor) development in this patient. Genomic DNA analysis revealed an adenine to guanine transition deep inside intron 10 (c.1478 + 325A>G) of F8 as a causative mutation. Analysis of the transcripts demonstrated that the majority of the patient's transcript was abnormal, with 226 bp of the intronic sequence inserted between exon 10 and 11. However, the analysis also indicated the existence of a small amount of normal transcript. Semi-quantification of ectopic F8 mRNA showed that about one-tenth of the normal mRNA level was present in the patient. After the use of a recombinant FVIII concentrate, the presence of an inhibitor was confirmed. The inhibitor was characterized as oligoclonal immunoglobulin IgG4 directed against both the A2 domain and light chain of the FVIII molecule with type I reaction kinetics of inhibition of FVIII activity. When no mutations are found by conventional analysis, deep intronic nucleotide substitutions may be responsible for mild haemophilia. The inhibitor development mechanism of the patient producing some normal FVIII was thought to be of interest.

Reduction of tablet coloration at tableting for oily medicine (tocopheryl nicotinate).

The powder (TN-PO) which adsorbed D,L-tocopheryl nicotinate (TN) as an oily medicine was prepared using porous calcium silicate (Florite(R)RE, FLR) as an adsorbing carrier. Tablets (TN-TAB) were produced by compression of TN-PO at different compression pressures. As TN-PO was compressed at the higher TN content in TN-PO and compression pressure, the more TN was exuded from TN-PO, and an increase in the degree of tablet coloration was observed. Therefore, FLR or colloidal silica (AEROSIL(R)200, AER) was newly added to TN-PO at compression to reduce the degree of tablet coloration. Further, the effects of addition of FLR or AER on the crushing strength, friability, porosity and disintegration property of the tablet and the dissolution property of TN from the tablet were studied. After addition of FLR or AER, a similar reduction of tablet coloration was observed. When the addition percentage of FLR to TN-PO exceeded 30%, the crushing strength of the tablet increased significantly. On the other hand, when TN-PO added with AER was compressed, no change was observed in the crushing strength of the tablet. The disintegration time of the tablet with added FLR was shorter than that of the tablet with added AER. At every addition percentage studied, the tablet with added FLR showed a higher releasing ability of TN compared with the tablet with added AER. These results indicate that it is possible to reduce tablet coloration by adding FLR or AER at compression of TN-PO. Further, it is considered that the differences in the crushing strength, disintegration property and dissolution property of TN between the tablets with added FLR or AER resulted in different liquid adsorbing and holding mechanisms of FLR particles and AER particles.

Cytotoxic T cells against a peptide of Yo protein in patients with paraneoplastic cerebellar degeneration and anti-Yo antibody.

Anti-Yo antibodies are present in the sera and cerebrospinal fluid of some patients with paraneoplastic cerebellar degeneration (PCD), but there is no evidence that the presence of anti-Yo antibodies causes the Purkinje cell loss seen in PCD patients. We examined the level of cytotoxic T lymphocyte (CTL) activity against a nine-amino acid peptide of the Yo protein using the Human Leukocyte Antigen- (HLA-) based approach called reverse immunogenetics. Mononuclear cells (MNCs) were isolated from the peripheral venous blood and fibroblasts were obtained from the skin of three patients with PCD with anti-Yo antibody. After activating the MNCs of the three patients with the peptide, it showed CTL activity against the Yo protein peptide expressed on autologous fibroblasts. Therefore, CTLs may be involved in the loss of Purkinje cells in PCD.

Cytotoxic T cells react with recombinant Yo protein from a patient with paraneoplastic cerebellar degeneration and anti-Yo antibody.

Antibodies against autologous tumor cells and neurons are found in the sera or cerebrospinal fluid of patients with paraneoplastic neurological syndromes. Attempts to produce animal models by passive transfer or active immunization, however, have failed, and there is no direct evidence that antibodies cause neuronal damage. Previously, we found that patients with paraneoplastic cerebellar degeneration (PCD) and anti-Yo antibody tested had HLA A24. We now have studied cytotoxic T cell activity in peripheral blood that reacts with recombinant Yo protein when autologous dendritic cells are used as the target. Results suggest that cytotoxic T cells are involved in Purkinje cell loss in PCD.

Application of calcium silicate for medicinal preparation. I. Solid preparation adsorbing an oily medicine to calcium silicate.

Calcium silicate (Florite RE, FLR), a fine porous powder, was recently approved as a medicinal additive. In this study we sought to make a solid preparation by absorbing an oily medicine to FLR; tocopheryl nicotinate (TN) was used as the oily medicine. TN adsorbed to FLR powder (TN-PO) was prepared by adsorbing TN ethanol solution to FLR and granulating with hydroxypropylcellulose (HPC) in order to improve the flowability. The results were as follows. FLR showed an excellent liquid holding ability compared with other excipients, and this was attributed to the high capillarity of the pores. In the adsorbing process, FLR particles were granulated with TN overflowing from the pores or adhering to the particle surface. The angle of repose was decreased with increasing TN content, which was attributed to the process of granulation, and the angle of repose of the granules with a binder (TN-GR) was below 40 degrees at any TN content. These results show that FLR is an useful additive for the solid preparation of an oily medicine.

[Complex formation of ulinastatin with alpha-thrombin].

The inhibition mode of ulinastatin was indicated noncompetitive by the Lineweaver-Burk's double reciprocal plotting method using the production rate of fibrinopeptide A. Consequently Km of alpha-thrombin could be calculated 2.8 mM and its Vmax was reduced from 24 U/l to 15 U/l by the addition of ulinastatin and Ki of ulinastatin was 1.05 x 10(-2) M. The complex of ulinastatin and alpha-thrombin were found. Furthermore, the mixing of alpha-thrombin, AT-III and ulinastatin produced a larger complex on SDS-PAGE at pH 7.0, and it was evident by the use of Western blotting method, that the complex was consisted of alpha-thrombin, AT-III and ulinastatin. Although ulinastatin and thrombomodulin showed multiple similarities in inhibitory functions on alpha-thrombin, still there are some differences functioning on alpha-thrombin, because of the different binding sites of ulinastatin and thrombomodulin on alpha-thrombin, indicating no crossreaction for antithrombomodulin monoclonal antibody relating to alpha-thrombin binding site of thrombomodulin and it could be contributed to form noncompetitive or uncompetitive inhibitors.

Severe acute axonal form of Guillain-Barré syndrome associated with IgG anti-GD1a antibodies.

We report cases of 2 patients with pure motor Guillain-Barré syndrome of explosive onset who required mechanical ventilation for more than 2 months. Their electrophysiologic findings and poor clinical recoveries suggested severe axonal degeneration involving the motor nerves. Enzyme-linked immunosorbent assay and thin-layer chromatogram-immunostaining showed the sera of both patients had high IgG antibody titer against GD1a ganglioside. Their titers decreased with the clinical course of the illness. GD1a as well as GM1, appears to be the target pathogenic antigen in motor axon disorders. Elevated IgG anti-GD1a antibody titer may prove useful for predicting severe GBS.

[Inhibitory effect of ulinastatin on the alpha-thrombin activation of factors V and VIII].

Ulinastatin is a remedy of urine serinprotease inhibitors and also it inhibits enzymatic activities of several blood coagulation factors. The action of ulinastatin on alpha-thrombin shows noncompetitive inhibition with the formation of enzyme-inhibitor complex. In this study, the effects of ulinastatin on the alpha-thrombin activation of factors V and VIII are observed by 5-20% gradient gel SDS PAGE with or without Western blotting method. The addition of ulinastatin to the mixture of factor V and alpha-thrombin inhibits the production of active peptides proceeded in the alpha-thrombin activation process of factor V. Furthermore, using anti-factor VIII 43KDa peptide monoclonal antibody with Western blotting method, the addition of ulinastatin to the mixture of alpha-thrombin and factor VIII indicates to inhibit the release of 43KDa peptide from factor VIII in the process of factor VIII activation induced by alpha-thrombin.

A new method to measure the distribution of motor conduction velocity in man.

A new method of measuring the distribution of conduction velocities in human motor fibers is described. In this method, a modification of Kimura's collision technique is combined with Hopf's technique. This enabled us to determine the collision end-point in Hopf's technique, from which the minimum velocity is derived. The size of the distorted compound muscle action potential (CMAP) measured with Hopf's technique is corrected using the CMAP size with the modified Kimura technique. This resolves the problem of CMAP distortion due to transient change in muscle conduction in Hopf's technique. In addition, a new equation to correct for the refractory period was developed. This can be applied even if there is stimulus spread. Using our method, one can clearly determine the maximum and minimum velocities. The former corresponds to the motor conduction velocity as measured by the conventional method.

[Evaluation of a new enzyme immunoassay method for determination of t-PA-PAI-1 complex].

We evaluated a new enzyme immunoassay for determination of t-PA-PAI-1 complex (PAI-C) and studied the clinical utility of measuring PAI-C. This assay was performed by the capture/tag antibody technique using polystylene beads, in which the beads were coated with monoclonal antibody against PAI-1 and anti-t-PA polyclonal antibody was tagged (TDC-88, TEIJIN-LIMITED, Japan). The assay gave an excellent sensitivity with a detection limit of 0.1 ng/ml, and we were able to detect a trace amount of PAI-C in normal plasma. PAI-C in 6 volunteers showed significant daytime fluctuations. The normal value of PAI-C in plasma was below 13.8 ng/ml (n = 40). PAI-C levels in patients with accelerated fibrinolysis (n = 31) ranged from 2.9 to 66.4 ng/ml and 15 of them were outside the normal range. However, all of patients with DIC (n = 10) showed abnormally high PAI-C levels. In patients with accelerated fibrinolysis, PAI-C values correlated with t-PA antigen (r = 0.838), PAI-1 antigen (r = 0.519), ATIII activity (r = -0.669) (p less than 0.01) and D dimer levels (r = 0.391, p less than 0.05). However, PAI-C values did not correlate with plasminogen and alpha 2PI activity, alpha 2PI-plasmin complex or the FDP-E level in these patients. Our data suggests that PAI-C may be a new molecular marker that reflects t-PA release from endothelial cells and a useful indicator to study hypercoagulable states.

[Auditory brainstem response and somatosensory evoked potential in Machado-Joseph disease in Japanese families].

To clarify physiological aspects of Machado-Joseph disease (MJD), we studied auditory brainstem response (ABR) and somatosensory evoked potential (SEP) in 17 clinically diagnosed patients with MJD aged 32-64 in Japanese families. ABR was recorded in 13 patients. In 8 patients, ABR were abnormal. In 5 patients, the latency of I wave was normal, but other waves could not be evoked. In the other 3 patients, I-III interpeak latency was prolonged. SEP was recorded in 15 patients. In SEP of median nerve, 11 patients had abnormal findings, and SEP of posterior tibial nerve revealed abnormal findings in all 15 patients. In all patients, responses from Erb's point and popliteal fossa were normal in latency, but other peaks were low in amplitude or absent, and the latency and central conduction time (CCT) were prolonged. The result of ABR indicated the involvement of the brainstem auditory pathways in MJD, and the result of SEP suggested that somatosensory pathways, particularly central pathways, would be involved in the disease process. ABR and SEP can be potential diagnostic methods for detection of subclinical abnormality in MJD patients.

A mitochondrial encephalomyopathy with cardiomyopathy. A case revealing a defect of complex I in the respiratory chain.

We describe a 16-year-old Japanese girl with a mitochondrial encephalomyopathy who presented with progressive dementia, limb weakness and atrophy, episodic vomiting, generalized convulsions, myoclonic seizures, and hypertrophic cardiomyopathy. CT scan revealed transient focal low density areas in her occipital and parietal lobes, and cerebellar atrophy. The clinical features were consistent with mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS). Microscopically, most of muscle fibers in the skeletal muscles and heart were occupied by markedly increased mitochondria. Polarographic studies on mitochondria isolated from postmortem heart muscle showed severe impairment of oxidation of NADH-linked substrates in contrast to normal succinate oxidation. The rotenone-sensitive NADH-coenzyme Q reductase activity was markedly decreased in heart, skeletal muscle and liver mitochondria. The biochemical investigations have led to the identification of a defect of complex I in the respiratory chain. Reported cases of a defect of complex I have revealed pure myopathy, encephalopathy or encephalomyopathy. The reason for a varied clinical expression of a single defect remains to be clarified.