Risk factors for persistent positive anticardiolipin antibodies in women with recurrent pregnancy loss.

Antiphospholipid syndrome (APS) is an established cause of recurrent pregnancy loss (RPL). It is necessary to detect persistently positive antiphospholipid antibodies to diagnose APS. This study aimed to explore risk factors for persistent anticardiolipin (aCL) positivity. Women with a history of RPL or with a history of one or more intrauterine fetal deaths after 10 weeks underwent examinations to determine the causes of RPL, including antiphospholipid antibodies. If aCL-IgG or aCL-IgM antibodies were positive, retests were performed at least 12 weeks apart. Risk factors for persistent aCL antibody positivity were retrospectively investigated. The number and percentage of cases above the 99th percentile were 74/2399 (3.1%) for aCL-IgG, and 81/2399 (3.5%) for aCL-IgM. Of the initially tested cases, 2.3% (56/2399) for aCL-IgG and 2.0% (46/2289) for aCL-IgM were ultimately positive above the 99th percentile in retests. Retest values after 12 weeks were significantly lower than the initial values for both IgG and IgM immunoglobulin classes. Initial aCL antibody titers were significantly higher in the persistent-positive group than in the transient-positive group for both IgG and IgM immunoglobulin classes. The cut-off values for predicting persistent positivity of aCL-IgG antibodies and aCL-IgM antibodies were 15 U/mL (99.1 percentile) and 11 U/mL (99.2 percentile), respectively. The only risk factor for persistently positive aCL antibodies is a high antibody titer during the initial test. When the aCL antibody titer in the initial test exceeds the cut-off value, therapeutic strategies can be defined in subsequent pregnancies without waiting for 12 weeks.

Is routine chemical thromboprophylaxis after total hip replacement really necessary in a Japanese population?

Prophylaxis against venous thromboembolism after elective total hip replacement is routinely recommended. Our preference has been to use mechanical prophylaxis without anticoagulant drugs. A randomised controlled trial was performed to evaluate whether the incidence of post-operative venous thromboembolism was reduced by using pharmacological anticoagulation with either fondaparinux or enoxaparin in addition to our prophylactic mechanical regimen. A total of 255 Japanese patients who underwent primary unilateral cementless total hip replacement were randomly assigned to one of three postoperative regimens, namely injection of placebo (saline), fondaparinux or enoxaparin. There were 85 patients in each group. All also received the same mechanical prophylaxis during and after the operation, regardless of their assigned group. The primary measurement of efficacy was the presence of a venous thromboembolic event by day 11, defined as deep-vein thrombosis detected by ultrasonography, documented symptomatic deep-vein thrombosis or documented symptomatic pulmonary embolism. The duration of follow-up was 12 weeks. The rate of venous thromboembolism was 7.2% with the placebo, 7.1% with fondaparinux and 6.0% with enoxaparin (p = 0.95 for the comparison of all three groups). Our study confirmed the effectiveness and safety of mechanical thromboprophylaxis without the use of anticoagulant drugs after total hip replacement in Japanese patients.

Hyporesponsiveness of peripheral blood lymphocytes to streptococcal superantigens in patients with guttate psoriasis: evidence for systemic stimulation of T cells with superantigens released from focally infecting Streptococcus pyogenes.

Throat infection with Streptococcus pyogenes is the most important trigger for acute guttate psoriasis. We examined the in vitro responses of peripheral blood mononuclear cells (PBMC) to streptococcal superantigens, SPEA and SPEC, and staphylococcal superantigens, SEB and TSST-1, in patients with guttate psoriasis, in patients with chronic plaque psoriasis, and in healthy subjects. PBMC from patients with guttate psoriasis responded poorly to SPEA and SPEC at concentrations of 0.1 and 1 ng/ml as compared with those from patients with plaque psoriasis, but showed high responses to SEB and TSST-1. The hyporesponsiveness recovered after improvement of the skin eruption. There was no significant difference between guttate and chronic types of psoriasis in the percentage of circulating T-cell receptor BV2 or BV8-bearing T cells, responsive to streptococcal superantigens, indicating that T-cell clonal anergy was a mechanism underlying the hyporesponsiveness. Our results suggest that superantigens released from focally infecting S. pyogenes induce a transient activation of relevant T cells, leading to the development of skin eruption and, subsequently, temporary T-cell anergy to these toxins.

Effects of central and peripheral injection of leptin on food intake and on brain Fos expression in the Otsuka Long-Evans Tokushima Fatty rat with hyperleptinaemia.

Hyperleptinaemia is observed in obese animals and humans, suggesting that leptin resistance rather than leptin deficiency is a characteristic feature of obesity. This study was designed to determine whether peripherally or centrally administered leptin is effective on the short-term food intake and expression of Fos protein in the hypothalamus in the Otsuka Long-Evans Tokushima Fatty (OLETF) or Long-Evans Tokushima Otsuka (LETO) rat, as a control. The OLETF rat exhibits a polygenic syndrome of hyperphagia, obesity, hyperinsulinaemia, and hyperglycaemia. Male OLETF rats of 5, 8, and 14 weeks of age became heavier than LETO rats. Serum leptin concentrations were not significantly different between LETO and OLETF rats at the age of 5 weeks, but in 8- and 14-week-old OLETF rats were increased to 3.4 and 2.9 times those of LETO rats, respectively. The 8-week-old OLETF and LETO rats were given intraperitoneal (i.p.) injections with recombinant mouse leptin to measure the kinetics. There was a dramatic increase in plasma leptin concentration at 1 h, a decline by 3 h, and the concentrations 6 h after injection were similar to the basal levels. There were no significant difference between OLETF and LETO rats. In LETO rats at 5, 8 and 14 weeks of age, i.p. injection of leptin significantly decreased food intake. Whereas 5-week-old OLETF rats responded to leptin with a decrease in food intake, 8- and 14-week-old OLETF rats became resistant to peripherally administered leptin. In contrast, intracerebroventricular (i.c.v.) injections of leptin were very effective in inhibiting food intake in both OLETF and LETO rats at 14 weeks of age. Intraperitoneal injection of leptin in the LETO rats at each age increased the number of Fos-positive nuclei detected in the ventromedial hypothalamic (VMH), the dorsomedial hypothalamic (DMH) and arcuate nuclei, whereas there was no significant increase in the number of cells expressing c-fos protein in the hypothalamus of the 8- and 14 week-old OLETF rats with hyperleptinaemia. On the other hand, increased expression of c-fos protein in the VMH, DMH and arcuate nuclei following i.c.v. injection of leptin was observed in both OLETF and LETO rats at 5, 8 and 14 weeks of age. These data demonstrated that obese OLETF rats are peripherally leptin resistant, while they retain sensitivity to centrally administered leptin.

Photosensitive drug eruption induced by flutamide.

We describe a 68-year-old man who showed a photosensitive drug eruption induced by flutamide. The minimal erythema dose with ultraviolet A light was reduced to 2 J/cm2 under administration of flutamide, which recovered to over 16 J/cm2 after cessation of the medication, without changing the reactivity to ultraviolet B. The absorption spectrum of flutamide was not altered after ultraviolet A irradiation, suggesting that flutamide is photostable with regard to ultraviolet A. In addition, bovine serum albumin was not covalently photocoupled with flutamide under ultraviolet A. Thus, flutamide seems to have low potency to act as a photohapten, and it is likely that a non-photohaptenic mechanism operates in this photosensitivity or its active metabolite may work as a photosensitizer.

Regulation of peripheral blood mononuclear cell responses to Dermatophagoides farinae by substance P in patients with atopic dermatitis.

Neuropeptides mediate stress-induced cutaneous inflammation such as atopic dermatitis. The effect of substance P on proliferation and cytokine mRNA expression of peripheral blood mononuclear cells in response to Dermatophagoides farinae (Der f) was studied in atopic dermatitis patients with positive RAST scores to Der f. Upon stimulation with Der f peripheral blood mononuclear cells from patients proliferated in a B7-dependent (CD80- and CD86-dependent) manner, while those from the patients with negative scores, nonatopic eczematous dermatitis patients or normal individuals, did not. Based on the reactivity of normal individuals, atopic dermatitis patients with a stimulation index greater than 1.8 were tentatively defined as high responders, who comprised two-thirds of the patients. Proliferation in high responders was associated with upregulation of IL-2 mRNA expression and induction of IL-5 mRNA expression. Substance p at 10(-10) to 10(-8) M promoted the Der f-induced proliferation when added at the start of culture and upregulated IL-10 MRNA expression while downregulating IL-5 mRNA expression. Our results suggest that substance P modifies immune responses of atopic T cells to Der f by promoting proliferation and altering cytokine profiles, and thus modulates the clinical manifestations of atopic dermatitis.

Molecular cloning and gene expression of growth hormone-releasing peptide receptor in rat tissues.

We cloned a fragment of the rat GH-releasing peptide (GHRP) receptor homologue and examined the tissue distribution of GHRP receptor mRNA in rats. Sequence analysis showed that the open reading frame is well conserved between rat and human with 96% identity in a 364-amino acid overlap. By reverse transcription-polymerase chain reaction we detected GHRP receptor mRNAs in the rat brain including the hypothalamus, anterior pituitary, and renal pelvis in twenty-eight tissues tested. Microdissection revealed that GHRP receptor mRNAs were localized predominantly in the arcuate nucleus and ventromedial hypothalamus.

Detection of a novel nonsense mutation of the MEN1 gene in a familial multiple endocrine neoplasia type 1 patient and its screening in the family members.

We identified a novel nonsense mutation(R29X) of the MEN1 gene in a familial multiple endocrine neoplasia type 1 (MEN1) patient. Molecular analysis of the MEN1 gene was performed in the family members by a restriction digestion method. The same mutation pattern was seen in both the proband's younger brother and cousin diagnosed as MEN1, and was also observed in the son of the cousin who showed signs of normal levels of serum PTH associated with mild hypercalcemia and hypophosphatemia. These findings suggest that mutation analysis of the MEN1 gene is very useful in identifying the subclinical state of MEN1 as well as clinical MEN1.

Malignant hemangioendothelioma.

BACKGROUND: The administration of interleukin-2 (IL-2) has recently been reported to be favorable for treating malignant hemangioendothelioma (MHE). METHODS: Two patients with MHE responded well to intralesional injections of recombinant IL-2 (rIL-2) without major side effects. The purpose of this study was to characterize cells infiltrating the regressing tumor following rIL-2 treatment. Immunohistochemical studies were performed on biopsy specimens taken from rIL-2-injected lesional skin. RESULTS: It was shown that CD8+ lymphocytes and CD56+ natural killer (NK) cells infiltrated at the rIL-2-injection sites, suggesting that these cells contributed to the tumor regression. In addition, MHE cells bore intercellular adhesion molecule-1 (ICAM-1) whose expression was augmented by rIL-2 injections. CONCLUSIONS: These findings suggested, that rIL-2 not only induces lymphokine-activated killer (LAK) cells and NK cells, but also facilitates these cytotoxic cells to adhere to MHE cells by enhancing ICAM-1 expression of tumor cells.

Differences in the expression of pemphigus antigens during epidermal differentiation.

Epidermal desmogleins with molecular weights of 130/140 kDa (Dsg3 or PVA) and 150/160 kDa (Dsg1 or DGI) are recognized by autoantibodies from patients with pemphigus vulgaris (PV) and pemphigus foliaceus (PF), respectively. In order to understand the histogenesis of both types of pemphigus, we studied the expression patterns of Dsg1 and Dsg3 during stratification of cultured keratinocytes. Monolayers of cultured normal human keratinocytes demonstrated uniform intercellular staining with PV sera. The staining pattern was distinct from the focal staining with PF sera observed only in the stratified areas. Both Dsg1 and Dsg3 proteins and their mRNA were expressed by the monolayers, whereas no production of Dsg2 (HDGC) mRNA was found. The relative ratio of Dsg3 to the total desmogleins, as determined by density on immunoblotting, decreased as the cultured keratinocytes stratified. In the completely stratified keratinocytes cultured on collagen membrane, Dsg1 became predominant, with subsequent reduction of PV antigen expression. The relative decrease of Dsg3 (PVA) during epidermal differentiation might be responsible for the induction of suprabasal acantholysis in PV.

Cutaneous colonization with staphylococci influences the disease activity of Sézary syndrome: a potential role for bacterial superantigens.

It has previously been shown that circulating Sézary cells respond in vitro to superantigenic staphylococcal exotoxins in a manner that is restricted by their V beta usage. This study was conducted to examine whether cutaneous colonization with Staphylococcus aureus influences the activity of the skin lesions of Sézary syndrome, and whether S. aureus isolated from patients with Sézary syndrome stimulates circulating Sézary cells in vitro. Two patients with Sézary syndrome, whose skin was colonized with S. aureus, were treated with antibacterial agents, and the relation between the severity of the skin disease and the degree of S. aureus colonization was assessed. In addition, the patients' peripheral blood mononuclear cells were cultured in the presence of mitomycin C-treated S. aureus or superantigenic staphylococcal toxins. The antibacterial treatment improved the skin disease, and eliminated S. aureus in both patients. In one patient, 98% of the peripheral blood mononuclear cells bore V alpha 2V beta 17 of the T-cell receptor, indicative of the presence of an extremely high percentage of circulating Sézary cells. The peripheral blood lymphocytes from this patient responded well in vitro to superantigenic staphylococcal enterotoxin (SE), but not to SEA or toxic shock syndrome toxin-1, or to mitomycin-treated S. aureus isolated from the same patient. Cutaneous colonization by S. aureus influences the disease activity of CTCL, possibly by activation of Sézary cells by bacterial superantigenic exoproteins.

Susceptible responsiveness to bacterial superantigens in peripheral blood mononuclear cells from patients with psoriasis.

We investigated the in vitro responses to bacterial superantigens of peripheral blood mononuclear cells taken from patients with psoriasis (one arthropathic, two guttate and four chronic plaque type). We also analysed the relationship between the magnitude of the responses of peripheral blood mononuclear cells to bacterial exotoxins and the number of circulating T cells bearing V beta 2 and V beta 3 regions. The proliferative response of peripheral blood mononuclear cells to Staphylococcal enterotoxin B and toxic shock syndrome toxin-1 was significantly higher in patients with active psoriasis than in normal subjects. An improvement in skin eruption was associated with a decrease in the lymphocyte response to one-half or one-third that of the active phase. There was no significant difference between patients with psoriasis and normal subjects in the percentage of V beta 2- and V beta 3-positive circulating T cells. The percentages of V beta 2-positive and V beta 3-positive cells were not correlated with the levels of responsiveness to toxic shock syndrome toxin-1 and to Staphylococcal enterotoxin B, respectively. These findings suggest that the magnitude of responses of peripheral blood mononuclear cells to bacterial toxins does not depend on the number of T cells reactive with the relevant superantigen, but depends on the extent of skin lesions in psoriasis.

Lymphomatoid papulosis associated with acquired ichthyosis.

We describe a 64-year-old man with lymphomatoid papulosis associated with acquired ichthyosis. The papulonodular lesions were composed of large atypical lymphocytes positive for CD3, CD4, and Ki-1. The ichthyosiform eruption also occurred on the extremities and had the histologic features of ichthyosis vulgaris. Although monoclonality of infiltrating cells could not be demonstrated, acquired ichthyosis appears to be induced in patients with lymphomatoid papulosis by the same pathomechanism underlying other lymphoproliferative diseases.

Light stimulation of the hypothalamic neuroendocrine system.

This paper demonstrates that, in the mediation of light, the suprachiasmatic nucleus (SCN) functionally associates with the anterior periventricular and parvocellular paraventricular neuron systems in rats. Intact rats (group 1) and rats undergoing a hemicomplete cutting of the SCN (group 2) were housed in a dark room (2-3 weeks) and killed after an exposure to light for 10, 30 or 60 min. Other intact animals (group 3) kept in a dark room (2 weeks) were exposed to light for 10 min, then stored 60 min in the dark room, and killed in darkness. The SCN, anterior periventricular nucleus, and parvocellular paraventricular nucleus were examined immunohistochemically using antisera for vasoactive intestinal polypeptide (VIP), arginine vasopressin, somatostatin, rat corticotropin releasing factor (rCRF), and c-fos protein. In comparison with animals kept in darkness, animals exposed for 10 and 30 min to light indicated a remarkable reduction of VIP immunoreactivity in the SCN and some increase of CRF immunoreactivity in the parvocellular paraventricular nucleus. The diminution of VIP immunoreactivity did not occur in the isolated SCN of group 2 animals. In group 3, a 10 min-light exposure induced a remarkable enhancement of nuclear c-fos immunoreactivity in neurons in the ventrolateral region of the SCN, in the anterior periventricular nucleus, and in the parvocellular paraventricular nucleus, most strongly in the SCN. Double immunolabeling methods have shown that VIP, somatostatin, and CRF neurons in the respective nuclei were c-fos positive.

Further evidence of the presence of rat embryonic hypothalamic factors that induce the differentiation of gonadotrophic hormone-releasing hormone-containing secretory neurons.

We examined the presence of factor(s) in the embryonic medial basal hypothalamus (MBH) that may influence nasal placode (NAP)-derived luteinizing hormone-releasing hormone (LHRH) neurons in determining their secretory phenotype. In this study, we performed organotypic culture and transplantation of the NAP from 12.5-day-old embryos of rats and vomeronasal organ (VNO) from 14.5-day-old embryos. Surgical operations, however, were performed on 16.5-day-old embryos. The NAP and VNO were cultured singly or with the MBH obtained from the embryos of the same age and, further, in a medium with a nerve growth factor or fibroblast growth factors. Although LHRH neurons were derived from the NAP and VNO in all the cultures, judging from numbers and cellular morphologies, the MBH was most effective. The VNO was transplanted into the third ventricle of adult female rats singly or with the cerebral cortex, the mesencephalon-myelencephalon complex, or the MBH from 14.5-day-old embryos. All the grafts gave rise to LHRH neurons, but the number of the neurons was far greater in the grafts cotransplanted with the MBH, in which the neurons projected long processes to blood capillaries and formed neurovascular complexes, the feature of which may suggest the occurrence of the secretory activity in the fibers. The animals were examined 5 days after the surgical operations. In rhinoectomized embryos, LHRH neurons were distributed throughout the brain in the same pattern as found in intact rats, showing normal cellular morphology. In the encephalectomized rats, immunoreactive LHRH cells were present only in the terminal ganglia. These findings indicate that the embryonal MBH has a factor (s) that is essential to the development of secretory LHRH neurons.

Immunohistochemical localization of glucocorticoid receptors in anterior pituitary cells of rats.

Adenohypophysial cells having a glucocorticoid receptor were immunohistochemically determined in rats. For detecting the presence of the glucocorticoid receptor, we used the monoclonal antibody for a glucocorticoid receptor (BuGR-2), and immunohistochemically examined the phenotypes of the cells that exhibited BuGR-2-immunoreactivity. The immunoreaction for the glucocorticoid receptor was confined to the nuclei of the majority of corticotrophs (70%) and of some somatotrophs in intact animals. Following adrenalectomy, all corticotrophs became significantly hypertrophic, losing their immunoreactivity for the glucocorticoid receptor. In contrast, somatotrophs that had also lost the immunoreactivity for the glucocorticoid receptor in the nuclei greatly diminished in size. Intraperitoneal administration of corticosterone was performed in adrenalectomized animals to supplement glucocorticoids. This treatment restored BuGR-2-immunoreactivity in the nuclei of some corticotrophs. In intact rats, immunolabeled corticotrophs were classified into two types, stellate and polyhedral. However, the immunoreaction for the glucocorticoid receptor was equally evident in the cell nuclei of these different types of cells. It is concluded that, in rats, both corticotrophs and somatotrophs are target cells of glucocorticoids, although these cell types display opposite growth responses to the removal of glucocorticoids.

The familial occurrence of bullous mastocytosis (diffuse cutaneous mastocytosis).

We studied four patients (a mother, her two daughters, and her son) with bullous mastocytosis, or diffuse cutaneous mastocytosis, whose genetic inheritance suggested an autosomal dominant pattern. The clinical characteristics included extensive bullae, numerous urticaria, pruritus, flushing, and pseudolichenified skin over all body surfaces without systemic organ involvement. The histopathologic findings disclosed a pronounced accumulation of mast cells in the dermis. Electron microscopic studies of lesional skin obtained in infancy showed round or spindle-shaped mast cells with numerous fingerlike villous protrusions. The cytoplasmic granules varied in size and shape, and the appearance of degranulation was markedly noted. In the adult, most mast cells had markedly decreased numbers of granules and cytoplasmic villi. Some cells displayed degenerative or necrotic appearances. These findings correlated well with the clinical course of these cases, which improved spontaneously over time.

Development of the dorsal pancreatic primordium transplanted into the third ventricle of rats.

The dorsal pancreatic primordia of 12.5-day-old rat embryos transplanted into the third ventricle of adult female rats were immunohistochemically examined 10, 20 and 40 days after transplantation. On day 10, the grafts grew into an epithelial sacculus (S) with a thick subepithelial tissue (ST). Tubular and vesicular structures with a single cuboidal epithelium were found within the wall of the S, but they underwent thereafter a regression without allowing the primordia to differentiate into the exocrine acinar tissues. In contrast with this, pancreatic hormone-containing cells existed in the ST, and were arranged like the islands of a mature animal. The tissue also has smooth muscle fibers and neurons. When the primordium was grafted along with its root connected to the duodenum, gut-like tubular structures differentiated, showing mucosa with villi and crypts, submucous mesenchymal tissue and muscle layers. The mucosa possesses epithelial cells immunoreactive for the pancreatic hormones, and the muscle layers have the myenteric plexuses. These findings seem to provide further evidence that in the rat pancreas, pancreatic-hormone-containing cells differ from the acinar cells in origin.

Appearance of neurons with glucocorticoid receptors and neurovascular links in the embryonal rat hypothalamus grafted in the third ventricle.

We have investigated the appearance of the transmitter phenotypes of hypothalamic neurons in grafts transplanted into the third ventricle of adult female rats. The grafts were the mediobasal hypothalamus and the preoptic area of 12.5-day-old rat embryos, and were examined 40-100 days later. Wheat germ agglutinin (WGA) was injected into the jugular vein of several animals for the examination of the existence of neurovascular associations. Three days after the injection, WGA appeared to have been incorporated into the neurons in the paraventricular, periventricular, and arcuate nuclei of the host animals. In the grafts, WGA was also seen incorporated in certain neurons which were found immunoreactive for tyrosine hydroxylase (TH), rat corticotropin-releasing factor (rCRF), substance P (SP), or somatostatin (SRIH). Neurons immunoreactive for neuropeptide Y (NPY) and ACTH did not seem to incorporate WGA. These findings suggest that the neurons containing TH, rCRF, SP, or SRIH link with fenestrated capillaries developed in the grafts. The immunoreactivity for glucocorticoid receptor (GR) was detected mainly in the nucleus of certain neurons and glial cells in the grafts as well as in the host hypothalamic neurons. In the grafts, strong GR immunoreactivity was detected in the cells immunoreactive for TH, NPY, and rCRF as in the host animals. It is concluded that the undifferentiated hypothalamic neurons differentiate to synthesize GR as well as definitive peptides and TH in the grafts.