Muscle pathology in Marinesco-Sjogren syndrome: a unique ultrastructural feature.

The light- and electron-microscopical findings in the skeletal muscle of a patient with Marinesco-Sjogren syndrome (MSS) are presented. Muscle biopsy specimens showed myopathy with slightly dystrophic changes including variation in fiber size, muscle fiber necrosis, regeneration and rimmed vacuole formation. Fiber type analysis with myosin ATPase staining showed a mild increase in type 2C fibers. Electron microscopy revealed autophagic vacuoles with numerous myeloid bodies, and a unique dense membranous structure associated with nuclei. We consider that this unique membranous structure is an important feature in the muscle pathology of MSS.

A case of carbamylphosphate synthetase-I deficiency associated with secondary carnitine deficiency--L-carnitine treatment of CPS-I deficiency.

We describe a male infant with congenital hyperammonaemia due to partial carbamylphosphate synthetase-I (CPS-I) deficiency. At 21 days of age, he had convulsions and at 53 days of age hyperammonaemic coma. Therapy with sodium benzoate, L-arginine, essential amino acids, L-carnitine and peritoneal dialysis lowered the blood ammonia levels, and his clinical manifestations improved. The CPS-I activity in liver tissue obtained by open biopsy was about 25.6% of normal values. The serum and urine free carnitine levels in the patient decreased during the hyperammonaemic crisis and were low at 7 months of age. After oral administration of L-carnitine (10 mg/kg per day) at 7 months of age, the mean blood ammonia levels decreased significantly, accompanied by an increase in serum and urine free carnitine levels. We propose the use of L-carnitine therapy to prevent secondary carnitine deficiency in patients with CPS-I deficiency as well as ornithine transcarbamylase (OTC) deficiency.

Immunoglobulin A antibody response to respiratory syncytial virus structural proteins in colostrum and milk.

Immunoglobulin A (IgA) antibody response to respiratory syncytial virus (RSV) structural proteins in colostrum and milk was investigated by a radioimmunoprecipitation assay. By using [35S]methionine-labeled RSV-infected HEp-2 cells and antiserum to human IgA as the capture antibody, IgA antibody responses to large glycoprotein, fusion protein, nucleoprotein, phosphoprotein, and matrix protein were demonstrated in colostrum and milk. The IgA antibody response was mainly directed against fusion protein, whereas IgA activity against matrix protein was more variable and was not comparable to the antibody responses to other structural proteins. Maternal mammary IgA response after RSV infection in the infant was monitored in four cases, and the appearance of anti-RSV IgA activity against several RSV structural proteins was observed in convalescent-stage milk samples of two mothers in whom RSV infection was demonstrated.

Antigenic variation of human RSV strains isolated in Japan.

Antigenic variations of respiratory syncytial virus (RSV) strains were analyzed using a collection of nine, seven, two, and one monoclonal antibodies (MAbs), respectively, raised against the fusion protein (F), large glycoprotein (G), nucleoprotein (NP), and phosphoprotein (P) components of the Long strain of RSV. Competitive binding assay by these MAbs demonstrated eight, four, and two distinct epitopes on F, G, and NP components, respectively. Comparison of prototype Long with ten field strains isolated in Sapporo, Japan, during a 9-year period from 1980 to 1988 by radioimmunoprecipitation (RIP), immunofluorescence (IF), and enzyme-linked immunosorbent assay (ELISA) test revealed four different patterns of reaction to these MAbs. Thus, prototype Long reacted to all 19 MAbs. Six field strains have shown a different reactivity to one of nine anti-F and to one of seven anti-G antibodies (subgroup A). Three of the remaining isolates failed to react with three of nine anti-F and with all of seven anti-G antibodies (subgroup B). One strain (58-104) isolated in 1983 was similar to subgroup A except for a lack of reaction with two anti-G antibodies. All field strains reacted with two anti-NP and one anti-P antibodies. The numbers of altered epitopes in subgroup A were 1/8 and 1/4; in subgroup B, 3/8 and 4/4; and in 58-104, 1/8 and 2/4 on the F and G components, respectively. No other variations have been observed among field isolates tested.

Complementation analysis of beta-galactosidase deficiency by means of histochemical method.

Cultured skin fibroblasts from 4 beta-galactosidase-deficient patients with different clinical features were hybridized and beta-galactosidase activities were measured using 4-methylumbelliferyl (4MU)-derivate and by means of indigogenic method. Compared with the assays of beta-galactosidase activity using 4MU-derivate, more clear-cut evidence was obtained in the indigogenic method for a judgement of complementation.

Comparative enzymology of eleven acid hydrolases in cultured amniotic fluid cells, skin fibroblasts and embryonic lung fibroblasts, and the respective changes with the increasing age of the cell cultures.

Assay conditions were studied for eleven lysosomal enzymes (beta-D-galactosidase, alpha-D-mannosidase, beta-hexosaminidase, beta-D-glucuronidase, alpha-D-galactosidase, alpha-D-glucosidase, arylsulfatase, beta-D-glucosidase, alpha-L-fucosidase, alpha-D-neuraminidase and alpha-L-iduronidase) in cultured amniotic fluid cells (CAFC), cultured skin fibroblasts (CSF) and cultured embryonic lung fibroblasts (CELF), and the properties of the enzymes were compared among these cultured cells. In addition, changes in these enzymes from the three cell types were investigated between 4-6 earlier passages and 24-26 later passages. With the exception of alpha-D-glucosidase, alpha-D-neuraminidase and alpha-L-fucosidase, all enzymes assayed for the 4-6 earlier passages and the 24-26 later passages had the same Km values and the same pH optima, and were also unchanged with the increasing age of cell cultures, with regard to their points. The specific activities of beta-D-glucuronidase, arylsulfatase, alpha-D-glucosidase and beta-D-glucosidase for the 4-6 earlier passages increased significantly with development, though no change was observed with development in the specific activities of other enzymes. Variations were observed between the levels of these enzymes in the three cell types with the increasing age of cell cultures, such as increases in some, decreases in others and no change in still others.

Heparan sulfate and dermatan sulfate from the liver of a patient with Hurler syndrome: high performance liquid chromatography of their degradation products after incubation with alpha-L-iduronidase-deficient fibroblasts.

Using a high performance liquid chromatography method, degradation products of heparan sulfate (HS) and dermatan sulfate (DS) were investigated after incubation of control and alpha-L-iduronidase-deficient fibroblasts with HS or DS. Characteristic elution profiles of the degradation products were obtained from the respective alpha-L-iduronidase-deficient fibroblasts. Moreover, alpha-L-iduronidase in control fibroblasts was resolved into two distinct components, forms A and B, on DEAE-cellulose column chromatography. Form A alpha-L-iduronidase could degrade HS, but not DS. Conversely, form B alpha-L-iduronidase could not degrade HS, but could degrade DS.

Properties of alpha-L-iduronidase in cultured skin fibroblasts from alpha-L-iduronidase-deficient patients.

On DEAE cellulose column chromatography, alpha-L-iduronidase in cultured skin fibroblasts was resolved into two distinct components, forms A and B. They had similar Km values for 4-methylumbelliferyl-alpha-L-iduronide, but differed in pH optima and thermal stability. Form B was more heat-stable than form A. Residual alpha-L-iduronidase activity in Hurler fibroblasts was heat-stable, while that in Scheie fibroblasts was heat-labile, and moreover, that in Hurler-Scheie compound fibroblasts lay intermediate between Hurler and Scheie syndromes. These findings demonstrated that Hurler syndrome, Scheie syndrome and Hurler-Scheie compound were enzymatically distinguishable.

Activities of sulfatases for the degradation of acidic glycosaminoglycans in cultured skin fibroblasts from two siblings with multiple sulfatase deficiency.

Cultured skin fibroblasts from two siblings with multiple sulfatase deficiency (MSD) were assayed for the activities of sulfatases known to degrade acidic glycosaminoglycans (AGAG). There were iduronate sulfatase, arylsulfatase B, heparan sulfate (HS) sulfatase, N-acetylgalactosamine-6-sulfate sulfatase, HS-derived N-acetylglucosamine-6-sulfate sulfatase, and two keratan sulfate (KS)-derived N-acetylglucosamine-6-sulfate sulfatases. The activities of sulfatases required for the degradation of HS were reduced to a greater extent than those for the degradation of dermatan sulfate (DS), and those of sulfatases associated with basic defect of Morquio disease type A were moderately decreased or normal. On the other hand, urinary excretion of AGAG in both patients was increased about 10-fold compared to controls, and especially, the excretion of HS and DS was increased about 150-fold and 50-fold, respectively. Keratan sulfate was not detected. The results suggest that in patients with MSD the degradation of HS might be affected to a greater extent than that of DS.

Characterization of keratan sulfate isolated from liver affected by Morquio syndrome.

Chemical structures of keratan sulfate (KS) isolated from the liver affected by Morquio syndrome type A (classical type) were investigated. In the KS from Morquio syndrome liver, the molar ratios of hexose, total sulfate, N-sulfate and sialic acid to hexosamine were 5.07, 0.90, 0.18 and 0.08, respectively, and about 10% of hexosamine consisted of galactosamine. The KS resulted in a production of oligosaccharides of relatively larger size after digestion with keratanase, as compared with bovine corneal KS. These findings strongly suggest that KS accumulated in the liver affected by Morquio syndrome may be derived from bony KS.

A case of pyruvate carboxylase deficiency with later prenatal diagnosis of an unaffected sibling.

A severely mentally retarded infant with congenital lactic acidosis due to pyruvate carboxylase deficiency is reported. The patient suffered from vomiting and convulsions soon after birth and developed severe mental and motor retardation at 3 months of age. The persistent elevation of pyruvate and lactate in both blood and cerebrospinal fluid and hyperalanaemia suggested an impairment of pyruvate oxidation. The enzyme activities of pyruvate carboxylase in both liver tissues and cultured skin fibroblasts of the patient revealed values of about 5% of controls. However, pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase activities in liver tissues were within normal limits. The patient had no response to administration of large doses of thiamine, lipoic acid and biotin, clinically and biochemically. A prenatal diagnosis was performed in the second pregnancy and the pyruvate carboxylase activities of the cultured amniotic fluid cells obtained by amniocentesis were within normal limits.

[Clinical studies on cefadroxil in the field of pediatrics].

The newly developed cefadroxil (CDX) dry syrup in a mean daily dose of 32.9 mg/kg t.i.d. or q.i.d. was administered to children for a period of 8 days on the average; viz. a total of 64 cases consisting of 39 cases of tonsillitis, 2 of tonsillitis complicated with otitis media, 1 of bronchitis, 1 of pneumonia, 14 of scarlet fever, and 7 of urinary tract infections; and its clinical and bacteriological effects, and adverse reactions were examined, leading to the following results. 1. The clinical effects were "good" or "excellent" in any of 39 cases of tonsillitis, 2 of tonsillitis complicated with otitis media, 1 of pneumonia, 14 of scarlet fever, and 7 of urinary tract infections, and "fair" only in a case of bronchitis, showing the high efficacy of 98.4%. 2. The clinical effects by daily dose were compared only in the great cases of tonsillitis between the 2 daily dose groups of 30 mg/kg or below and 31 to 40 mg/kg, and both groups showed "good" or "excellent" results, but the latter group revealed that the excellent rate was greater by 20.8% than that of the former group. 3. The frequency of daily administration was 3 times or 4 times and the cases of 4 times administration were few in any disease. In comparison of clinical effects between the 3 times group and the 4 times group in the whole cases, no significant difference was observed between both groups but it is desirable to make the 4 times administration in view of the pharmacokinetics. 4. The bacteriological effects could be judged in 15 cases, namely bacteria were eradicated in 14 cases and unchanged in 1 case, showing a good result of the eradication rate as 93.3%. 5. No adverse reaction was observed and the laboratory test values showed eosinophilia in 7 cases (15.9%) and abnormal elevations of GPT in 1 case (4.5%), of GOT and GPT in 2 case (9.1%), of LDH in 1 case (4.8%) and of BUN in 1 case (4.8%), but 4 of the 7 cases with eosinophilia seemed attributable to underlying diseases or objective diseases. From the above it can be said that this preparation is a useful drug in mild bacterial diseases.

A new type of hypermethioninemia in neonates.

Eleven hypermethioninemic patients were found by mass screening tests of neonates. Three of these had persistent hypermethioninemia while in the others it was transient. Serum concentrations of methionine were constantly higher than those of controls, especially in the persistent group. The enzyme activities of methionine adenosyltransferase in the liver tissues of both groups of patients were within normal limits. Serum concentrations of total folate in the persistent group were strikingly elevated and fatty degeneration of the liver tissues was a constant feature. It improved after several months under a low-methionine diet. The hypermethioninemia reported here is not associated with any clinical or biochemical finding reported previously.