Escherichia coli O-157-induced hemolytic uremic syndrome: Usefulness of SCWP score for the prediction of neurological complication.

BACKGROUND: Hemolytic uremic syndrome (HUS) is commonly caused by hemorrhagic colitis with Shiga toxin-producing Escherichia coli O-157. Central nervous system (CNS) involvements, including seizures, encephalopathy and brain infarction, are serious complications, but there are no useful scores for the prediction of CNS complications. METHODS: Routine laboratory data at onset of HUS were re-evaluated in 14 patients to find useful parameters for the prediction of CNS complication. RESULTS: Serum sodium and total protein were significantly lower and C-reactive protein (CRP) and white blood cell counts were significantly higher in patients with CNS complications than in patients without. A cumulated score, SCWP score (sodium, CRP, white blood cell count, and total protein) discriminated better between patients with/without CNS complications than individual values. CONCLUSIONS: SCWP score would be useful for prediction of CNS complications.

Various expression patterns of alpha1 and alpha2 genes in IgA deficiency.

BACKGROUND: IgA deficiency (IgAD) is the most common immunodeficiency, however the pathogenesis in most cases of IgAD is unknown. There are 2 subclasses of IgA, IgA1 and IgA2, and its heavy chains are encoded by 2 different genes, the alpha1 and alpha2 genes. To investigate the molecular pathogenesis of IgA deficiency, it is important to evaluate each of the expressions of IgA1 and IgA2 separately. METHODS: In this study, we report on the reverse transcriptase (RT)-PCR method in which alpha1 and alpha2 mRNAs can be separately evaluated. This method is based on electrophoretic separation using the difference of 39 bases between alpha1 and alpha2 mRNAs. Three selective, 5 partial and 2 secondary IgAD patients were examined. RESULTS: In the 3 selective IgAD patients, no alpha1 or alpha2 mRNA expression was detected. In the 5 partial IgAD patients, various alpha1 and alpha2 mRNA expression patterns were found. One of the partial IgAD patients showed only alpha2 gene expression, but not alpha1 gene expression, and was found to show an alpha1 gene deletion together with gamma 2 and epsilon gene deletions. His plasma IgA2 level was within the normal range. CONCLUSIONS: Patients with an alpha1 gene deletion can be considered as having partial IgAD. Using this method, we identified the second case of alpha1 gene deletion in Japan, and classified IgAD patients on the basis of alpha1 and alpha2 expression.

Induction of α1 and α2 gene expression in selective immunoglobulin A deficiency.

Immunoglobulin A deficiency (IgAD) is the most common immunodeficiency, but the pathogenesis of most cases of IgAD is poorly understood. The gene and protein expression levels of members of the IgA subclasses in IgAD patients were analyzed by a reverse transcriptase (RT)-PCR method that could differentiate between α1 and α2 gene expression. Three selective, 5 partial and 2 secondary IgAD patients were examined. Peripheral blood mononuclear cells which were unstimulated or stimulated with TGF-ß1 and PMA for 24 h were cultured. The IgA1/IgA2 expression ratios were measured by zone densitometry. Three bands appeared (the α1 and α2 genes and a hetero-duplex formation), owing to the difference of 39 bases between α1 and α2 mRNAs. In the controls, there were no significant differences in the IgA1/IgA2 ratios between unstimulated and stimulated cells. In selective IgAD patients, both α1 and α2 gene expression was induced following stimulation, and α1 gene expression was induced more dominantly than in the other IgAD patients following stimulation. Based on our results, suppression of α1 gene expression may be related to the pathogenesis of IgAD.

Development of the Handy Bio-Strand and its application to genotyping of OPRM1 (A118G).

We previously developed a three-dimensional microarray system, the Bio-Strand, which exhibits advantages in automated DNA analysis in combination with our Magtration Technology. In the current study, we have developed a compact system for the Bio-Strand, the Handy Bio-Strand, which consists of several tools for the preparation of Bio-Strand Tip, hybridization, and detection. Using the Handy Bio-Strand, we performed single nucleotide polymorphism (SNP) genotyping of OPRM1 (A118G) by allele-specific oligonucleotide competitive hybridization (ASOCH). DNA fragments containing SNP sites were amplified from genomic DNA by PCR and then were fixed on a microporous nylon thread. Thus, prepared Bio-Strand Tip was hybridized with allele-specific Cy5 probes (<15mer), on which the SNP site was designed to be located in the center. By optimizing the amount of competitors, the selectivity of Cy5 probes increased without a drastic signal decrease. OPRM1 (A118G) genotypes of 23 human genomes prepared from whole blood samples were determined by ASOCH using the Handy Bio-Strand. The results were perfectly consistent with those determined by PCR direct sequencing. ASOCH using the Handy Bio-Strand would be a very simple and reliable method for SNP genotyping for small laboratories and hospitals.

Suppression of IFN-gamma production in atopic group at the acute phase of RSV infection.

Several studies have suggested that respiratory syncytial virus (RSV) bronchiolitis induced the change of cytokine production profile in childhood. We sought to determine whether the RSV-induced cytokine production was affected by the patient's atopic background. We quantified interferon-gamma (IFN-gamma) and interleukin (IL)-4 in the supernatant of peripheral blood mononuclear cells (PBMCs) cultured for 24 h and in the presence of phytohemaglutinin (PHA), IL-12, or IL-18, from 14 infants who were divided into two groups, those who are non-atopic and an atopic group. In RSV-infected infants with atopic diseases, IFN-gamma production from IL-12- or especially IL-18-stimulated PBMCs was subtotally suppressed in the acute phase, whereas in RSV-infected infants without atopic diseases IFN-gamma production was not suppressed on acute phase. The IFN-gamma suppression observed in the atopic group is not caused by the immaturity of an infant's immune system since reduced IFN-gamma production to RSV is not observed in the infants of non-atopic group. IFN-gamma suppression in regard to RSV infection might be caused by some genetic factor involved in the development of atopic disease such as IL-18 signal cascade.

Autologous peripheral blood stem cell transplantation in a patient with relapsed pleuropulmonary blastoma.

Pleuropulmonary blastoma (PPB) is a rare and aggressive primary intrathoracic neoplasma of children. The prognosis is extremely poor with frequent metastasis to the brain and bone. We present a 4-year-old girl with a tumor mass in the right hemithorax initially diagnosed as pneumoniae. Tumor resection was performed and the histologic report indicated the diagnosis of PPB. The patient received chemotherapy comprising vincristine, actinomycin D, doxorubicin, cisplatin, and cyclophosphamide. Irradiation was performed with total 45 Gy at the right lower pulmonary lobe. She relapsed 29 months later at the pleura between the right middle and lower pulmonary lobe. Tumor resection and total 45 Gy of irradiation were performed again. High-dose chemotherapy comprising cisplatin, adriamycin, and cyclophosphamide was performed followed by autologous peripheral blood stem cell transplantation (PBSCT). The patient achieved complete hematologic recovery. Thirty-one months after PBSCT, no signs of relapse have been observed. Although it might be that the patient could have been cured with second surgery alone or by the surgery and subsequent chemotherapy, high-dose chemotherapy and PBSCT should be considered for the treatment of relapsed PPB.

Kinetic study of thermal Z to E isomerization reactions of azobenzene and 4-dimethylamino-4'-nitroazobenzene in ionic liquids [1-R-3-methylimidazolium bis(trifluoromethylsulfonyl)imide with R = butyl, pentyl, and hexyl].

Thermal Z to E isomerization reactions of azobenzene and 4-dimethylamino-4'-nitroazobenzene were examined in three ionic liquids of general formula 1-R-3-methylimidazolium bis(trifluoromethylsulfonyl)imide (R = butyl, pentyl, and hexyl). The first-order rate constants and activation energies for the reactions of azobenzene measured in these ionic liquids were consistent with those measured in ordinary organic solvents, which indicated that the slow isomerization through the inversion mechanism with a nonpolar transition state was little influenced by the solvent properties, such as the viscosity and dielectric constant, of ionic liquids. On the other hand, the rate constants and the corresponding frequency factors of the Arrhenius plot were significantly reduced for the isomerization of 4-dimethylamino-4'-nitroazobenzene in ionic liquids compared with those for the isomerization in ordinary organic molecular solvents with similar dielectric properties. Although these ionic liquids are viscous, the apparent viscosity dependence of the rate constant could not be explained either by the Kramers-Grote-Hynes model or by the Agmon-Hopfield model for solution reactions. It is proposed that the positive and the negative charge centers of a highly polar rotational transition state are stabilized by the surrounding anions and cations, respectively, and that the ions must be rearranged so as to form highly ordered solvation shells around the charge centers of the reactant in the transition state. This requirement for the orderly solvation in the transition state results in unusually small frequency factors of 10(4)-10(7) s(-1).

Hyper-IgM syndrome with putative dominant negative mutation in activation-induced cytidine deaminase.

BACKGROUND: Hyper-IgM immunodeficiency is an immunologic disorder characterized by normal or increased serum IgM levels and reduced serum IgG and IgA levels caused by the disruption of Ig class switching in B cells. The gene encoding activation-induced cytidine deaminase (AID) is responsible for the autosomal recessive form of hyper-IgM syndrome. OBJECTIVE: To investigate the relationship between the AID gene mutation and the clinical phenotype, we analyzed the AID gene in a female Japanese patient with the autosomal recessive form of hyper-IgM syndrome. METHODS: Genomic DNA and cDNA were extracted from neutrophils and analyzed by means of PCR. The AID gene was expressed as a glutathione S-transferase fusion protein. RT-PCR was performed after stimulation of the patient's PBMCs with phorbol myristate acetate and TGF-beta. RESULTS: Despite significantly low serum IgG levels, our patient had not shown a predisposition to any severe infections, even without Ig replacement therapy. We identified a point mutation resulting in the stop codon in exon 5 of the AID gene (R190X) in the patient. No other mutations of the AID gene were detected in the patient. The same mutation was not detected in other members of her family. The mutant allele fused with the glutathione S-transferase protein was expressed stably at the same level as the normal allele. The AID gene expression in the patient was induced by phorbol myristate acetate and TGF-beta. CONCLUSION: The mutation of the AID gene is assumed to be of the dominant negative form. This is the first report of a dominant negative form of the mutation in vivo.

[Evaluation before and after pranlukast administration with the QOL questionnaire (revised version 2001) for pediatric patients with bronchial asthma and their parents or caregivers].

We conducted a longitudinal investigation with the QOL questionnaire (revised version 2001) before and after the 4-week-administration of a leukotriene receptor antagonist pranlukast. A significant improvement in the < 4 yrs group was observed at week 1, and that in > or = 4 yrs group at week 2. Under these conditions, the overall QOL score, physical domains and mental domains, significantly improved in both the < 4 yrs group and the > or = 4 yrs group. Overall, a slight correlation was observed between ratio changes in QOL scores and differences in symptom scores. However, no correlation was found in part of patients, suggesting that the QOL questionnaire allows measurement of mental changes in the patients themselves and their parents or caregivers for therapeutic effects which cannot be determined with ordinary physical findings only. In "event present" group, a significant difference in physical and mental domains was revealed by the comparison of QOL scores before and after administration. And furthermore in "event absence" group, the p-value for physical domain and mental domain was 0.0505 and 0.0912 in the < 4 yrs group, respectively, 0.0101 and 0.0446 in the > or = 4 yrs group, respectively. The above results led us to consider the QOL questionnaire (revised version 2001) useful for routine medical care. Furthermore, pranlukast was considered useful for improvement not only of physical symptoms of bronchial asthma but also of the patient's QOL, although the placebo effects in this open trial must be considered.