Double filtration plasmapheresis maintains normal adhesion molecule levels.

Levels of plasma soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1), and von Willebrand factor (vWF) increase in patients with peripheral vascular or ischemic heart disease. These factors are related to the progression of atherosclerosis. Furthermore, these substances and thrombomodulin (TM) are indicators for assessing the degree of damage to the endothelium. To evaluate the effect of double filtration plasmapheresis (DFPP) on these molecules, the plasma levels of vWF, sICAM-1, sVCAM-1, and TM were measured in 4 familial hypercholesterolemia (FH) patients who underwent treatment with DFPP at 2 week intervals for more than 3 years. The levels of sVCAM-1 and sICAM-1 in hypercholesterolemia patients with ischemic heart disease as a control was 773 +/- 109 and 334 +/- 82 ng/ml. These values were higher than the normal value. In the FH patients who underwent DFPP treatment, the average sICAM-1 levels were 221 +/- 47 and 197 +/- 36 ng/ml before and after, respectively. The average sVCAM-1 levels were 601 +/- 87 and 486 +/- 60 ng/ml. There were no significant differences between the pre- and post-DFPP values. The activities of plasma vWF before and after DFPP treatment were 158 +/- 23 and 45 +/- 9%. The levels of plasma TM before and after treatment were 3.0 +/- 0.3 and 3.4 +/- 0.5 FU/ml. From these results, it is suggested that DFPP treatment does not damage the endothelium and may prevent the progression of atherosclerosis by removing the substances that induce the production of sICAM-1 and sVCAM-1 due to long-term treatment.

Evaluation of double filtration plasmapheresis, thermofiltration, and low-density lipoprotein adsorptive methods by crossover test in the treatment of familial hypercholesterolemia patients.

A comparative assessment has been made regarding efficacy and safety of the double filtration plasmapheresis (DFPP), thermofiltration (TFPP), and low-density lipoprotein (LDL) adsorptive (PA) methods by making a crossover test on heterozygous familial hypercholesterolemia patients. Treatments by DFPP, TFPP (secondary membrane Evalux 5A), and PA (Liposorber LA-40) were carried out 5 times each, with a 2-week interval, in 5 patients with heterozygous familial hypercholesterolemia. The same plasma separator (Plasmacure PS-60, polysulfone) was used in all cases, and the volume of plasma processed was set at 4 L. High removal rates were obtained of total cholesterol, LDL cholesterol, triglycerides TG, and apolipoprotein B (apoB) by all three methods, and no differences were observed. Lipoprotein (a), apoA-2, apoC-3, fibrinogen, and immunoglobulin M (IgM) showed significantly high removal rates by the DFPP and TFPP methods compared with the PA method. The sieving coefficient of albumin and high-density lipoprotein (HDL) cholesterol at 2 and 4 L of plasma processed exhibited high permeabilities using all three methods. Supplementing albumin was not necessary. An increase of the transmembrane pressure was observed in 1 case treated by DFPP but was not observed when using the TFPP or PA method. No changes were observed in serum interleukin 1beta (IL-1beta) or tumor necrosis factor-alpha (TNF-alpha) before and after treatment by any of the three methods. No remarkable side effects were observed using either the DFPP or TFPP method. The DFPP and TFPP methods showed efficacy and safety that was not inferior to the PA method in conventional LDL apheresis, and the dead-end method of the filter operation without the discarding of plasma was shown to be possible.

High-performance liquid chromatographic separation and spectral identification of the photoreaction products of methyl 5,8-epoxyretinoate.

Photoreaction of methyl 5,8-epoxyretinoate was investigated. Irradiation of methyl 5,8-epoxyretinoate in acetonitrile with a light from a high-pressure mercury lamp or a daylight fluorescent lamp afforded three new products, which were purified by high-performance liquid chromatography. They were characterized on the basis of spectroscopic data as 11-(Z), 13-(Z), and 11,13-di(Z) isomers, respectively.

Increased concentrations of free light chain lambda in sera from chronic hemodialysis patients.

Serum levels of FLc were determined in 5 pre-HD CRF patients, 63 CRF patients receiving HD therapy, 15 CAPD and 40 healthy volunteers. The highest serum FLc concentration was observed in patients receiving HD. Concentrations of kappa- and lambda FLc were higher than normal in patients with CRF, and were about 4-fold and 1.8 fold greater than control values in HD patients, with a predominance of lambda chains. This HD-associated elevation of serum FLc strongly suggests a role for FLc in the etiology of light chain deposit disease and AL-amyloidosis. Lambda-FLc and beta 2-m exhibited similar patterns of change in the serum during the course of HD therapy. Further studies may reveal other pathological conditions other than CRF in which these polypeptides may play a role.

Periosteal microvasculature in the dog alveolar process.

Most periodontal surgery has been performed on the basis of the regenerating capacity of the periosteum. Recently it has been pointed out that the blood supply is important to the osteogenic and fibrogenic activity of the periosteum. The purpose of the present study was three-dimensional observation of blood vessels distributed within the gingival periosteum and the periosteum beneath the alveolar mucosa of adult mongrel dogs. Corrosion cast specimens of vessels were observed from three directions: mucosal side, bone side, and horizontal cut surface. It was revealed that the plexus distributed in the periosteum of the gingiva formed a coarse network structure, which consisted mainly of arterioles and venules. In contrast, in the periosteum of the alveolar mucosa, a dense network structure consisting of arterioles, capillaries, and venules formed a vascular bed. Thus, the mucogingival junction was easily located even in the plexus of periosteum which was distributed beneath the gingiva and the alveolar mucosa, suggesting that the difference in tissue specificity was reflected in the plexus of the periosteum.

The relationship between connective tissue and its microvasculature in the healthy dog gingiva.

The morphological consistency of subepithelial connective tissue and its vascular architecture was studied in the healthy gingiva of adult mongrel dogs. Corrosion-cast specimens of the vasculature and specimens of well-separated connective tissue from the lamina propria were observed by SEM. Specimens injected with india ink also were examined employing light microscopy. Summarizing the results: 1) Beneath the buccal gingival epithelium, short conical papillae were seen in the subepithelial connective tissue. The capillary structure throughout this region was basically of the loop type, the overall appearance of which replicated the papillae. The papilla disappeared at the muco-gingival junction, so that after the transition to the alveolar mucosa, no papillary formation was observed. The vasculature had transformed from loop to network structure. 2) Beneath the sulcular gingival epithelium, the subepithelial connective tissue displayed a smooth concavity with no papillae. In this region, the capillaries formed a flat, dense network in accordance with the morphology of the connective tissue. The capillary network suddenly disappeared at the terminal edge of the inner epithelium. The vessels of the lamina propria located immediately beneath the network reduced their lumina at the margin and formed the plexus of the periodontium, displaying a rather open network.

Microvascularization of the free gingival autograft.

Nobuto has previously reported on the initial anastomosis involved in establishing circulation between a free gingival autograft and the recipient bed. This study will present observations on the maturation of new sinusoidal vessels involved in maintaining circulation to the graft and the resulting histovascular organization. Using 56 mongrel dogs, the ongoing processes were observed periodically over 84 days after grafting. For this purpose, vascular corrosion casts were examined with the scanning electron microscope. At the same time, employing both light microscopy and transmission electron microscopy, histopathological and ultrastructural observation on the developing three-dimensional vascular architecture were recorded with supporting photographs. Thus, the entire process from the development of a vascular plexus parallel to the bone surface on the seventh day to the transformation to a vertical dendritic vascular architecture firmly establishing the circulation to the graft by the 84th day, is provided in both descriptive and pictorial detail.

Ultrastructural changes of subepithelial capillaries following graft epithelialization.

This study investigated architectural changes in the nourishment-providing capillaries beneath the epithelium that accompany graft epithelialization. A total of 77 mongrel dogs underwent free gingival autografts involving the maxillary canine and its attached gingiva. Comparative investigations relating the architectural transformations and endothelial permeability of the capillaries were made histopathologically, with graft epithelialization as an indicator. Microscopic findings revealed that the subepithelial capillaries transformed from loop structure into glomus-like structures. The endothelium changed ultrastructurally from the continuous type to the fenestrated. This occurred during the most active graft epithelialization phase. By the time the epithelium of the graft had matured, the fenestrated microvascular structure reverted to the continuous type and changed from a glomus-like structure to a network capillary system. However, by the 84th postoperative day, the subepithelial capillaries, still exhibiting network structure, had not yet returned to the loop structure indigenous to the gingiva. Observations indicated that transformation of the structure of the nourishment-providing capillaries was attendant to and simultaneous with the changes brought about by graft epithelialization.

Microvascularization of gingival wound healing using corrosion casts.

The healing process in a wound induced by removal of 6 X 6 mm of gingiva and periosteum from the maxillary attached gingiva of 48 adult mongrel dogs was observed to investigate the potential blood supply for grafts placed on denuded bone. Three-dimensional observations were performed over 12 weeks by scanning electron microscopy (SEM) following the manufacture of corrosion capillary casts by acrylic resin injection. Revascularization in the gingival wound was mainly through formation of new capillaries from those existing below the surrounding epithelium with little new capillary formation from the Volkmann canals. Moreover, the periodontium contributed greatly to the vascularization, which was fastest from the gingival margin. Further, simplification of new capillary loops was also fastest from this direction. Regeneration of the periosteum and periosteal vascular plexus was slow, taking about twice the time of connective tissue and capillaries below the epithelium. The results indicated that blood supply to grafts on denuded bone in the early postgraft period would mainly be provided by capillaries below the epithelium surrounding the recipient bed.