Significant associations of metabolic syndrome and its components with silent lacunar infarction in middle aged subjects.

BACKGROUND: Metabolic syndrome (MetS) is associated with an increased risk of ischaemic stroke, including silent brain infarction. No study has examined its association with the lacunar subtype. The present cross sectional study examined the relationship between MetS, its components and silent lacunar infarction (SLI) in middle aged subjects. METHODS: We studied 2076 subjects aged 40-59 years with no history of stroke or clinical symptoms, who visited a health care facility for a routine health checkup and underwent brain MRI. MetS was defined according to the National Cholesterol Education Programme Adult Treatment Panel III report. A multiple logistic regression model was used to examine the associations between MetS and SLI while adjusting for age, gender, a past history of ischaemic heart disease and current smoking. RESULTS: MetS was strongly associated with the presence of SLI (adjusted OR 6.52; 95% CI 4.30 to 9.90). Regarding MetS components, elevated blood pressure, impaired fasting glucose, hypertriglyceridaemia and large waist circumference were significantly associated with SLI, independent of an interrelationship between the components, while low high density lipoprotein cholesterol was not significantly associated. CONCLUSIONS: MetS was significantly associated with the prevalence of SLI in middle aged persons. Independent risk factors for SLI not only included elevated blood pressure and impaired fasting glucose, which are well known risk factors, but also hypertriglyceridaemia and large waist circumference.

Prognostic significance of CDC25B expression in gliomas.

BACKGROUND: CDC25B is a cell-cycle regulatory protein, which is considered to be related to tumorigenesis and progression of tumours. AIMS: To elucidate the role of CDC25B in glioma, the expression of CDC25B and the association of the CDC25B expression with the clinicopathological parameters were investigated. METHODS: Fifty seven gliomas, which included 21 low-grade astrocytomas, 17 anaplastic astrocytomas and 19 glioblastomas, were studied. Protein expressions of CDC25B were evaluated by immunohistochemical methods. Semiquantitative and real-time RT-PCR analyses for the expression of CDC25B mRNA were also carried out. Disease-free survival (DFS) data were analysed by using the Kaplan-Meier method. RESULTS: High expression of CDC25B was identified in 18 of the 19 glioblastomas, in 10 of the 17 anaplastic astrocytomas, but not in any of the 21 low-grade astrocytomas. The CDC25B mRNA expression increased with the rise in histological grade. Increased CDC25B expression was correlated significantly with a shorter period of DFS, as shown by multivariate analysis. CONCLUSIONS: Patients with an unfavourable clinical outcome are characterised by the increased expression of CDC25B in their glioma samples. Useful clinical information, especially on its relevance as a prognostic indicator, is provided by the evaluation of CDC25B expression in gliomas.

Glucocorticoid stimulates primate but inhibits rodent alpha-fetoprotein gene promoter.

Glucocorticoids inhibit rodent alpha-fetoprotein (AFP) gene activity but stimulate expression of the human homologue. Like human, activity of the AFP promoter from other primates was stimulated by the synthetic glucocorticoid dexamethasone (Dex) in various cell lines. A glucocorticoid responsive element (GRE) is located within 180 bp upstream of the transcription initiation site of all AFP genes examined. Comparative analysis of the GRE in the two different groups of promoters revealed a common 3' hexamer, 5'-TGTCCT-3', but the 5' hexamers were different. This difference converts the rodent GRE to a DR-1 motif. DR-1 is a binding site for members of the nuclear receptor superfamily including the orphan receptor hepatocyte nuclear factor-4 (HNF-4). The presence of DR-1 in the rodent but not human may underlie the opposite actions of Dex on the AFP promoter. We tested this hypothesis using a transient transfection assay. In hepatoma cells that expressed GR and HNF-4, reporter-activity was inhibited by Dex. The same construct in nonhepatoma cells was strongly induced by over expression of HNF-4 and the induced activity was inhibited by Dex. The findings show that Dex induction of human AFP is mediated by a GRE. But Dex repression of the rodent promoter requires a DR-1 motif that interacts with GR and HNF-4.

Immunohistochemical analyses of cell cycle-related proteins, apoptosis, and proliferation in pituitary adenomas.

To analyze the cell cycle regulatory mechanisms in the growth of pituitary adenomas, we investigated immunohistochemically the expression of the cell cycle-related proteins cyclin A and p27 in 48 pituitary adenomas. The frequency of apoptosis and the proliferative potential were also examined. The percentage of apoptotic cells was evaluated by immunohistochemical analysis using the anti-single-strand DNA antibody. The proliferative potential was assessed using the anti-Ki-67 antibody. The mean cyclin A labeling index (LI) for the non-recurrent group was 1.03% and for the recurrent group 2.31%. A positive linear correlation between cyclin A LI and Ki-67 LI was found. The mean p27 LI for the non-recurrent group was 67.4% and for the recurrent group 47.0%. There were significant differences in cyclin A LI and p27 LI between the non-recurrent group and the recurrent group. The mean apoptotic rate for the non-recurrent group was 0.87% and for the recurrent group 1.05%. There was no significant difference. Multivariate regression analysis revealed that high cyclin A LI and high Ki-67 LI were significant factors for shorter progression-free survival. The results suggest that the cyclin A LI is a useful prognostic factor in pituitary adenomas. (J Histochem Cytochem 49:1193-1194, 2001)

[A case of familial cerebral cavernous angioma and review of Japanese cases].

We present one pedigree of familial cerebral cavernous angioma (FCCA). Case 1 was a 52-year-old male with right hemiplegia. When he was 37 years old, a left occipital lesion was excised and histologically diagnosed as cavernous angioma. MR image showed many cavernous angiomas in the right temporal lobe, the right paraventriclar white matter, the right frontal lobe, the left basal ganglia, and the left parietal lobe. Stereotactic radiosurgery was undertaken for all the lesions. Although the size of each lesion was unchanged, neither hemorrhage nor neurological deterioration were recognized after radiosurgery. Case 2 was a 24-year-old male, a son of the patient in case 1. He has manifested tonic-clonic type epilepsy since the age of 2. MR image showed cavernous angiomas in the pons, the right frontal, and the left intra-Sylvian regions, and many paraventricular cysts with rims indication of previous hemorrhages. Two de novo lesions were observed on subsequent annual MR screening. Surgical excision for the left intra-Sylvian lesion and stereotactic radiosurgery for all lesions were undertaken. Histological diagnosis was cavernous angioma. In the literature, there were 17 pedigrees and 37 cases of FCCA in Japan. The incidence of both multiple lesions and hemorrhage were less than in found in Spanish or French cases. Stereotactic radiosurgery is considered an useful treatment for FCCA, because lesions are multiple and de novo lesions occur.

Alpha-fetoprotein producing gastric cancer lacks transcription factor ATBF1.

Alpha-fetoprotein (AFP) producing gastric cancer (AFP-GC) is very malignant and highly metastatic compared with common gastric cancer. However, the causal relationship between AFP production and the high malignancy of AFP-GC is unclear. We investigated AFP gene regulation in AFP-GC by an active transcription factor, HNF1 (hepatocyte nuclear factor 1) and a repressive transcription factor, ATBF1 (AT motif binding factor 1). RNase protection assays revealed that the production of AFP in gastric cancer cells did not directly associate with HNF1 expression. An inverse relation between the expressions of ATBF1 and AFP was clearly observed in gastric cancer cells. CAT assays showed the direct inhibition of AFP gene expression by ATBF1. Methylation analysis of the AFP promoter region in gastric cancer cells suggested that methylation itself could not explain the silencing of the AFP gene. Immunohistochemistry of resected clinical samples revealed that AFP producing cells lacked ATBF1 immunoreactivity. Our data suggests that the absence of ATBF1 is responsible for AFP gene expression in gastric cancer, and the absence of ATBF1 is a distinct characteristic of AFP-GC and might be important for its highly malignant nature.

Nonfunctioning islet cell carcinoma of the pancreas with high serum CEA & CA19-9, K-ras codon 12 mutation, and microsatellite instability.

A 55-year-old man with nonfunctioning islet cell carcinoma showing elevation of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels is described with genetic analyses. Pathological examination of the resected specimen revealed two independent islet cell carcinomas, one in the body and the other in the tail of the pancreas. It was proved immunohistochemically that the tumor cells, particularly those in the tail, were immunoreactive to CEA and CA 19-9 and had the property of duct cells, as well as endocrine cells. Gastrin was demonstrated immunohistochemically in these tumor cells, although its level in serum was not elevated. Genetic analyses of the fresh specimens from the tumor in the body revealed K-ras codon 12 mutation and microsatellite instability. These findings are consistent with its progressive clinical course and strongly suggest that these tumors originate, not from the islet cells of Langerhans, but from protodifferentiated cells, capable of giving rise to all the pancreatic cell types.

The hepatic vagal reception of intraportal GLP-1 is via receptor different from the pancreatic GLP-1 receptor.

Glucagon-like peptide-1 (7-36)amide (tGLP-1), a representative humoral incretin, released into the portal circulation in response to a meal ingestion, exerts insulinotropic action through binding to the tGLP-1 receptor known to be a single molecular form thus far. We previously reported that the hepatic vagal nerve is receptive to intraportal tGLP-1, but not to non-insulinotropic full-length GLP-1-(1-37), through a mechanism mediated by specific receptor to the hormone. In the present study, we aimed to examine how modification of the receptor function alters this neural reception of tGLP-1, by using the specific agonist, exendin-4, and the specific antagonist, exendin (9-39)amide, of the receptor at doses known to exert their effects on the insulinotropic action of tGLP-1. Intraportal injection of 0.2 or 4.0 pmol tGLP-1, a periphysiological and pharmacological dose, respectively, facilitated significantly the afferent impulse discharge rate of the hepatic vagus in anesthetized rats, as reported previously. However, unexpectedly, intraportal injection of exendin-4 at a dose of 0.2 or 4.0 pmol, or of even 40.0 pmol, did not facilitate the afferents at all. Moreover, intraportal injection of exendin (9-39)amide at 100 times or more molar dose to that of tGLP-1, either 5 min before or 10 min after injection of 0.2 or 4.0 pmol tGLP-1, failed to modify the tGLP-1-induced facilitation of the afferents. The present results suggest that the neural reception of tGLP-1 involves a receptor mechanism distinct from that in the well-known humoral insulinotropic action.

Molecular cloning and functional characterization of the mouse mafB gene.

The Maf family of the transcription factors plays a pivotal role in controlling development and cellular differentiation. To clarify the molecular mechanisms controlling mafB expression, a genomic clone of the mouse mafB gene was isolated and analyzed. RNase protection analysis determined the transcription initiation site at 389 bp upstream from the translation initiation site. The 3' end of the gene is located at 946 bp downstream from the termination codon. The gene lacks intron structure. Sequence analysis showed a TATA-like sequence (5'-GATAAAA-3') and an inverted CCAAT-box (5'-ATTGG-3') in the promoter region. Upstream of these sequences, there are several potential regulatory elements, including two GC-boxes (5'-GGGCGG-3'), and a palindromic sequence (5'-GTCAGCTGAC-3') which contains two Maf recognition elements (MARE, 5'-GCTGAC-3') and an E-box (5'-CAGCTG-3'). Transient transfection analysis with the 5'-flanking region of the mafB gene demonstrated that these elements are important for mafB gene expression. In addition, cotransfection analysis indicated that the MyoD activates the mouse mafB promoter and the gene is positively auto-regulated by its own product.

Aneuploidy of sex chromosomes in basal cell carcinoma: its clonality and involvement in the development of carcinogenesis.

Although basal cell carcinoma (BCC) is a major skin cancer, the mechanism of carcinogenesis with regard to cytogenetic abnormalities has not been fully investigated. In the present study, we carried out cytogenetic analyses of 18 patients (9 male and 9 female) with BCC. Aneuploidy was seen by Q-banding method in more than half of the cases and was mostly loss of the sex chromosome. We also performed FISH to the interphase nuclei of various tissues and short-term cultured BCC cells. The frequency of sex chromosomal aneuploidy was significantly higher in all samples from BCC patients (peripheral blood lymphocytes, non-lesional tissues, BCC tumor tissues and cultured BCC cells) than in age-matched normal controls. In addition, we analyzed clonality of BCC tissues using a human androgen receptor gene assay and found uniparental pattern of inactive X-chromosomes. This indicates that BCC cells were monoclonal in origin and the development of BCC might be correlated with sex chromosomal aneuploidy, which acquired accumulation of genetic mutations.

Expression of HNF-1 alpha and HNF-1 beta in various histological differentiations of hepatocellular carcinoma.

Hepatic nuclear factor 1 (HNF-1) regulates genes in a hepatocyte-specific manner. It has been previously reported that the ratio of HNF-1 alpha and HNF-1 beta mRNA is related to histological differentiation hepatocellular carcinoma (HCC). In this study, the expression levels of the HNF-1 alpha and HNF-1 beta proteins were analysed relatively and quantitatively in various histologically differentiated HCC and surrounding non-cancerous tissues, and HNF-1 alpha binding activity for the AT element of the B domain of the human alpha-fetoprotein enhancer was examined. Western blot analysis demonstrated that HNF-1 alpha protein was expressed at a higher level in well-differentiated HCC tissues than in the surrounding non-HCC tissues; on the other hand, the HNF-1 alpha protein was expressed at lower levels in moderately and poorly differentiated HCCs than in the surrounding non-HCC tissues. The levels of HNF-1 beta expression in well-differentiated and poorly differentiated HCCs were similar to and higher than those found in the respective surrounding non-cancerous portions. In binding assays, HNF-1 binding activity was high in well-differentiated HCC and lower in moderately and poorly differentiated HCCs. Most well-differentiated HCC cases showed immunohistochemical expression of HNF-1 alpha. These findings show that poor histological differentiation of HCC correlates with decreases in the level and activity of HNF-1 alpha proteins.

Enhanced and specific gene expression via tissue-specific production of Cre recombinase using adenovirus vector.

A tissue-specific promoter is potentially valuable for the study of specific gene function and for gene therapy, as it permits a linked cytotoxic or any other gene to be expressed specifically in target cells. The expression levels of such promoters are generally low, and we have therefore developed a novel and general method to enhance the expression level of a tissue-specific promoter while maintaining specificity. We constructed a "regulator" recombinant adenovirus (rAd) producing the site-specific recombinase Cre under the control of the hepatocarcinoma-specific alpha-fetoprotein (AFP) promoter. The rAd was infected to AFP-producing cells together with a "target" rAd containing a Cre-activating potent expression unit. In in vitro experiments, the double infection method gave about 50-fold higher expression than the single rAd infection directly driven by the AFP promoter, while maintaining strict specificity to AFP-producing cells. The enhanced and specific expression was also observed in in vivo tumor models. This method may contribute not only to the establishment of specific gene therapies but also to basic study for elucidating cell-type specific gene functions.

Meningioma associated with acute subdural hematoma--case report.

A 48-year-old woman presented with sudden left hemiplegia with headache, which deteriorated two days later. CT scan showed repeated intratumoral and subdural hemorrhages. Magnetic resonance imaging showed a parasagittal tumor infiltrating into the superior sagittal sinus, with intratumoral hemorrhage and acute subdural hematoma in the interhemispheric fissure. The intratumoral hematoma had several different intensities, which indicated repeated hemorrhages. The subdural hematoma and the tumor were removed via frontoparietal craniotomy. The histological diagnosis was fibrous-type meningioma with a high Ki-67 labeling index (6.7). As there were tumor cells within the subdural hematoma, it seemed to have resulted from tumoral hemorrhage. A high index of cell proliferation may indicate some mechanism responsible for hemorrhage in malignant tumor.

In vivo gene therapy for alpha-fetoprotein-producing hepatocellular carcinoma by adenovirus-mediated transfer of cytosine deaminase gene.

The alpha-fetoprotein (AFP) gene is normally expressed in fetal liver and is transcriptionally silent in adult liver but overexpressed in human hepatocellular carcinoma (HCC). Here, we demonstrate that replication defective recombinant adenoviral vectors, containing the human AFP promoter/enhancer, can be used to express the Escherichia coli cytosine deaminase (CD) gene (AdAFPCD) and the beta-galactosidase gene (AdAF-PlacZ) in AFP-producing HCC cell lines. Expression of the CD gene by adenovirus from the AFP promoter/enhancer (AdAFPCD) induced cells sensitive to 5-fluorocytosine (5FC) in the AFP-producing cells but not in the AFP-nonproducing cells. Transduction by an adenoviral vector harboring an ubiquitous strong promoter and CD gene showed enzymatic activity and 5FC killing in all cell lines. When AdAFPlacZ was injected into the s.c. established hepatoma in vivo, expression of the beta-galactosidase gene was confined to AFP-producing HCC xenografts. Moreover, HCC xenografts regressed by transduction with AdAFPCD and subsequently with 5FC treatment in vivo. These findings suggest that utilization of the AFP promoter/enhancer in an adenoviral vector can confer selective expression of a heterologous suicide gene in hepatocellular carcinoma cells in vitro and in vivo.

The hepatic vagal nerve is receptive to incretin hormone glucagon-like peptide-1, but not to glucose-dependent insulinotropic polypeptide, in the portal vein.

To examine whether incretin hormones, truncated glucagon-like peptide-1 (tGLP-1) and glucose-dependent insulinotropic polypeptide (GIP), are recognized by the hepatic vagal nerve, changes of the impulse discharge rate in the afferent vagus upon their intraportal administrations were measured in situ in rats anesthetized with urethan and chloralose. One-min injection of tGLP-1 at a periphysiological dose of 0.2 pmol or a pharmacological dose of 4.0 pmol, but not of the vehicle, significantly facilitated the hepatic vagal afferents. However, the injection of GIP at either a physiological dose of 0.2 pmol, a periphysiological dose of 4.0 pmol, or an even much larger dose of 40.0 pmol did not change the afferents at all. The present results indicate that the hepatic vagus specifically recognizes an intraportal appearance of tGLP-1 in the hepatoportal area, suggesting that the vagal monitoring system for intraportal levels of the incretin hormone operates on ingestion of a mixed meal.

Vagal hepatopancreatic reflex effect evoked by intraportal appearance of tGLP-1.

Among proglucagon-derived peptides, the truncated form of glucagon-like peptide-1, GLP-1(7-36)amide (tGLP-1), is known as the most likely physiological humoral incretin. To examine whether there exists any relationship between tGLP-1 levels in the portal vein and activities of the hepatic and pancreatic vagal system, changes of the impulse discharge rate in the hepatic afferent vagus and the pancreatic efferent vagus upon intraportal tGLP-1 injection were measured in situ in rats anesthetized with urethan and chloralose. First, a 1-min bolus tGLP-1 injection at a periphysiological dose of 0.2 pmol or a pharmacological dose of 4.0 pmol, but not the vehicle injection, significantly facilitated the hepatic vagal afferents for > 90 min, showing weaker facilitation at the 0.05 pmol dose. Notably, the injection of noninsulinotropic full-length GLP-1 failed to facilitate the afferents at the 4.0 or 40.0 pmol dose. Second, the intraportal tGLP-1 injections at the 0.05 and 0.2 pmol dose facilitated marginally and significantly the pancreatic vagal efferents in normal rats, respectively, but had no effect on the hepatic vagotomized rats, even at the 40.0 pmol dose. The present results indicate that an intraportal appearance of tGLP-1 is specifically recognized by the hepatic vagal nerve, and this recognition further augments the pancreatic vagal efferent activity in a reflex way, suggesting another nature of tGLP-1 as neuroincretin in the enteroinsular axis.

Expression ratio of hepatocyte nuclear factor-1 to variant hepatocyte nuclear factor-1 in differentiation of hepatocellular carcinoma and hepatoblastoma.

BACKGROUND/AIMS: Liver-specific protein genes have multiple cis-/trans-acting elements, but those accountable for hepatocytic differentiation are unclear. An AT-rich core sequence (AT motif) is essential as a cis-acting element for the hepatic transcription. Homologous proteins hepatocyte nuclear factor-1 (HNF-1) and variant HNF-1 (vHNF-1) bind to this motif. The ratio of HNF-1 to vHNF-1 mRNA was examined in various liver tissues with respect to their differentiation. METHODS: The competitive reverse transcriptional polymerase chain reaction was employed to amplify HNF-1 and vHNF-1 mRNA simultaneously and to examine their expression ratio in total RNA extracted from frozen liver tissues of 37 patients with hepatocellular carcinoma, five patients with hepatoblastoma, and 15 non-neoplastic liver tissues. RESULTS: The ratio of HNF-1 to vHNF-1 mRNA was higher in well-differentiated cases than in poorly-differentiated and undifferentiated cases, except that one poorly-differentiated hepatoblastoma displayed a high ratio. Non-neoplastic liver tissues had low ratios similar to poorly-differentiated hepatocellular carcinoma, the reason for which remained unknown. However, chronic hepatitis and liver cirrhosis cases also demonstrated low ratios, and hence degenerative changes themselves displayed no obvious influence on such ratios. Thus, the gene expression of HNF-1 and vHNF-1 seemed to be differentially regulated in neoplastic and non-neoplastic hepatocytes. CONCLUSIONS: These results suggested that the ratio of HNF-1 to vHNF-1 mRNA correlated with histological differentiation of HCC and hepatoblastoma.

A possible common cell surface autoantigen in islet beta-cells and thyroid follicular cells in patients with non-insulin dependent diabetes mellitus and chronic thyroiditis.

By an indirect immunofluorescence method with In-111 cells (hamster insulinoma cell line), circulating islet cell surface antibodies (ICSA) were detected in 7 (20%) out of 36 patients with non-insulin dependent diabetes mellitus (NIDDM), 9% of 68 chronic thyroiditis (CT) patients, or 16% of 19 NIDDM patients associated with CT, but not in 18 normal subjects. Sera from five out of nine ICSA-positive patients examined further also showed cell-surface immunofluorescence on TPC-1 cells (human thyroid papillary adenocarcinoma cell line), and prior absorption of the sera with In-111 cells abolished the immunofluorescence. The 64 kDa protein from In-111 cells or human thyroid follicular cells was immunoprecipitated with ICSA-positive sera. In one case of NIDDM associated with CT, 64 kDa protein was detected in both cells. The results indicate that some ICSA in NIDDM patients recognize the same or a very closely-related autoantigen(s) in both islet beta-cells and thyroid follicular cells, suggesting an explanation, at least in part, for the autoimmune mechanism(s) in clinical association of NIDDM and CT.

[Regulation of tumor marker gene expression].

Tumor marker is a group of proteins that specifically expressed in association with carcinogenic processes. Thus, studies of regulation mechanisms of the tumor marker genes are important for understanding the possible alteration of gene expression during neoplastic transformation. In this article, we described the molecular mechanisms of the regulation of two major tumor marker genes, i.e. human alpha-fetoprotein (AFP) gene and rat glutathione transferase P(GST-P) gene. Positive and negative mechanisms of each gene regulations are discussed.

Gene therapy for alpha-fetoprotein-producing human hepatoma cells by adenovirus-mediated transfer of the herpes simplex virus thymidine kinase gene.

We have developed a recombinant replication-defective adenovirus containing human alpha-fetoprotein (AFP) promoter/enhancer to direct cell type-specific expression of the herpes simplex virus thymidine kinase (HSVtk) gene to AFP-producing hepatocellular carcinoma (HCC) cells. After an in vitro infection by a recombinant adenovirus carrying the lacZ gene under the control of human AFP promoter/enhancer (AdAFPlacZ), an expression of the lacZ gene was demonstrated efficiently in AFP-producing HuH-7 and HepG2 cell lines, but not in AFP-nonproducing HLE and HLF cell lines, although lacZ gene expression was demonstrated in all these cell lines when infected with adenovirus vector carrying lacZ gene driven by the beta-actin-based promoter. Expression of the HSVtk gene by adenovirus, from AFP promoter/enhancer (AdAFPtk) induced the cells sensitive to ganciclovir (GCV) in the AFP-producing cell line efficiently, but not in AFP-nonproducing HLF hepatoma cells. An in vitro bystander effect was observed when only 10% of the cells were infected with AdAFPtk. These findings suggest that the AFP promoter/enhancer sequence can provide the tumor-specific activity for the therapeutic gene expression, and that the AdAFPtk vector induces the selective growth inhibition by GCV in the adenovirus-infected human hepatoma cells in vitro. Recombinant adenovirus transfer of the HSVtk gene under the control of tumor-specific promoter followed by GCV may have promise as a targeted in situ treatment for solid neoplasms.