A systemic lupus erythematosus gene expression array in disease diagnosis and classification: a preliminary report.

Systemic lupus erythematosus (SLE) is a clinically heterogeneous disease diagnosed on the presence of a constellation of clinical and laboratory findings. At the pathogenetic level, multiple factors using diverse biochemical and molecular pathways have been recognized. Succinct recognition and classification of clinical disease subsets, as well as the availability of disease biomarkers, remains largely unsolved. Based on information produced by the present authors' and other laboratories, a lupus gene expression array consisting of 30 genes, previously claimed to contribute to aberrant function of T cells, was developed. An additional eight genes were included as controls. Peripheral blood was obtained from 10 patients (19 samples) with SLE and six patients with rheumatoid arthritis (RA) as well as 19 healthy controls. T cell mRNA was subjected to reverse transcription and PCR, and the gene expression levels were measured. Conventional statistical analysis was performed along with principal component analysis (PCA) to capture the contribution of all genes to disease diagnosis and clinical parameters. The lupus gene expression array faithfully informed on the expression levels of genes. The recorded changes in expression reflect those reported in the literature by using a relatively small (5 ml) amount of peripheral blood. PCA of gene expression levels placed SLE samples apart from normal and RA samples regardless of disease activity. Individual principal components tended to define specific disease manifestations such as arthritis and proteinuria. Thus, a lupus gene expression array based on genes previously claimed to contribute to immune pathogenesis of SLE may define the disease, and principal components of the expression of 30 genes may define patients with specific disease manifestations.

[A case of ovarian cancer with liver metastasis successfully treated by PAC therapy].

Surgery was attempted in a case of stage IV ovarian cancer with a hepatic metastatic lesion measuring 119 x 96 mm. However, radical surgery was impossible and the operation ended up as no more than exploratory laparotomy. Before closing, Cisplatin 100 mg and Etoposide 200 mg were instilled into the intraperitoneal cavity. Two courses of systemic chemotherapy with PAC (Cisplatin 50 mg, Pirarubicin 40 mg, Cyclophosphamide 400 mg) were instituted. To examine shrinkage of the hepatic metastasis and the peritoneal tumors, A "Second look" operation was conducted. Abdominal simple total hysterectomy, bilateral salpingo-oophorectomy, omentectomy and partial sigmoidectomy resulted in no residual lesions in the peritoneal cavity with the exception of the hepatic metastatic lesion (69 x 57 mm). Two additional courses of PAC therapy were administered after the "Second look" operation. The hepatic metastatic lesion shrank to 45 x 41 mm; a decrease of 83.8% compared to the pre-therapy in size. Liver function tests and tumor chemical markers (TPA, CA 125, SLX) revealed decreased values that were consistent with a tumor size reduction. Good PR was achieved with only a systemic chemotherapy; i.e., without resorting to local injections of chemotherapeutic agents into the liver.

[Separation of free and bound radiolabeled antigen using protein A-sepharose CL-4B in hCG radioimmunoassay (author's transl)].

Protein A isolated from Staphylococcus aureus can bind the Fc portion of IgG of several species. We used Protein A coupled to Sepharose CL-4B (Protein A-S) for the separation of antibody-bound and free radiolabeled hCG in the radioimmunoassay, and the results were compared to the double antibody method. One gram of Protein A-S containing 7 mg of Protein A was dissolved in 17.5 ml of 1/15M phosphate buffer saline pH 7.4. Two hundred fifty microliters of this suspension were added to the assay tubes 24 hours after mixing 125I-hCG, anti-hCG and hCG standards or serum samples. After further incubation for 10 minutes at room temperature, the tubes were centrifuged and the radioactivity in the precipitates was measured by a gamma spectrometer. The standard curve obtained by the Protein A-S method was virtually identical to that obtained using the double antibody method. The intra- and interassay coefficients of variation in the hCG radioimmunoassay using the Protein A-S method ranged from 6.6 to 8.2% and from 7.2 to 11.9% respectively, which were close to those obtained by the double antibody method. IgG in serum inhibited the binding of Protein A-S to anti-hCG, and thus it was necessary to dilute the samples more than one-hundred fold. Under these conditions a good correlation exists in the serum hCG levels determined by either the Protein A-S method or the double antibody method. Thus, Protein A-S permitted the rapid separation of antibody-bound and free radiolabeled hCG in the radioimmunoassay and could be substituted for the second antibody.