Endoscopic Ultrasonography-guided Fine-needle Aspiration Revealed Metastasis-induced Acute Pancreatitis in a Patient with Adrenocortical Carcinoma.

A 26-year-old woman complained of upper abdominal pain. Computed tomography (CT) showed acute pancreatitis, a left adrenal tumor and solitary right pulmonary metastasis. She underwent left adrenalectomy; the adrenal tumor was diagnosed as adrenocortical carcinoma (ACC). When preparing to resect the pulmonary metastasis, she suffered a second acute pancreatic attack. Magnetic resonance cholangiopancreatography (MRCP) showed that the proximal main pancreatic duct (MPD) was dilated, and the distal MPD was diminished; however, no pancreatic tumor was observed on CT or MRCP. Endoscopic ultrasonography revealed a solitary pancreatic mass, which was diagnosed as pancreatic metastasis from ACC by endoscopic ultrasonography-guided fine-needle aspiration.

The effect and possible clinical efficacy of in vivo inhibition of neutrophil extracellular traps by blockade of PI3K-gamma on the pathogenesis of microscopic polyangiitis.

OBJECTIVE: Neutrophil extracellular traps (NETs) are peculiar structures composed of the externalized chromatin with intracellular proteins and formed by activated neutrophils in a reactive oxygen species (ROS)-dependent manner. Aberrant NETs are considered to be autoantigens for anti-neutrophil cytoplasmic antibodies (ANCAs) underling the development of microscopic polyangiitis (MPA). However, little is known regarding the therapeutic efficacy of in vivo inhibition of NET formation (NETosis) on MPA pathogenesis. This study determines whether reducing NETosis prevents ANCA production and improves characteristic involvement. METHODS: A mouse model of MPA induced by administering a novel extract from Candida albicans was devised. By applying this method to mice lacking phosphoinositide 3-kinase gamma (PI3K-gamma), which is indispensable for ROS production in neutrophils, we investigated the levels of in vivo NETs, ANCA titers and histological damage. RESULTS: Our model exhibited accumulation of NETs in vivo, elevation of ANCA titers and characteristic pathologies mimicking human MPA, including small-vessel vasculitis and crescentic glomerulonephritis. Strikingly, these abnormalities were reduced by genetically and/or pharmacologically blocking PI3K-gamma. Moreover, a pharmacological PI3K-gamma blockade decreased the levels of human NETs. CONCLUSION: Our results suggest that in vivo inhibition of NETosis by blocking PI3K-gamma could be a promising therapeutic strategy for the pathogenesis of MPA.

Cryptic insertion into 11q23 of MLLT10 not involved in t(1;15;11;10)(p36;q11;q23;q24) in infant acute biphenotypic leukemia.

The MLL gene, located on chromosomal band 11q23, is fused to a large number of different partner genes in hematological malignancies. This report describes a case of infant acute biphenotypic leukemia with t(1;15;11;10)(p36;q11;q23;q24). Panhandle polymerase chain reaction (PCR) using cDNA demonstrated the formation of an MLL-MLLT10 fusion transcript, although the 10p12 segment, at which the MLLT10 gene is located, was not involved in the breakpoint of the four-way translocation according to G-banding and spectral karyotyping analyses. Long-distance inverse PCR using genomic DNA revealed that intron 7 of MLL was fused with intron 8 of MLLT10, which was connected with a DNA segment of noncoding region on 15q. In fluorescence in situ hybridization analyses, the duplicated 3' part of MLLT10 was inserted into the component of chromosome 15 on der(11)(q23). In real-time quantitative PCR with primers that recognized the DNA sequence of the two sites of fusion point, the minimal residual disease (MRD) levels changed in parallel with other clinical markers. Furthermore, the level of MRD had already increased before hematologic relapse. The identification and characterization of MLL rearrangement at the genomic DNA level may be useful for MRD quantification.

Dietary restriction in aged mice can partially restore impaired metabolism of apolipoprotein A-IV and C-III.

Dietary restriction (DR) is only one well-established non-genetic experimental means to retard aging in various species of animals. Here we demonstrated that DR in mice for 3 months initiated late in life, at the age of 22 months, partially restores age-related decline of serum apolipoprotein A-IV (apo A-IV) level and the gene expression found in the liver of ad libitum fed young animals as revealed by fasting. In contrast, increase in gene expression of apo C-III by fasting was higher in the aged than that in the young, but it was reduced to the level of young animals in DR counterparts of the aged. In view of the implication that apo A-IV and C-III are involved in the activation and inhibition of lipoprotein lipase, respectively, the adult onset DR can conceivably upregulate the activity of this enzyme that is likely reduced in aged animals and thus improve the lipid metabolism. The present findings suggest that DR initiated even relatively late in life may reduce risk of age-related diseases associated with impaired lipid metabolism.

Impaired lipid metabolism in aged mice as revealed by fasting-induced expression of apolipoprotein mRNAs in the liver and changes in serum lipids.

BACKGROUND: Changes in apolipoprotein (Apo) metabolism can cause an increased incidence of diseases such as cardiovascular disorders and diabetes with advancing age. Limited reports are available on this topic, however. OBJECTIVE: To investigate age-related changes in mobilization of stored lipid, we studied the effects of fasting on the gene expression of Apos in the liver as well as serum triglyceride (TG) and cholesterol levels in the serum. METHODS: Using young (6- to 8-month-old) and old (24- to 28-month-old) fasted and re-fed mice, Northern blots of hepatic mRNAs for Apos A-I, A-IV, C-II, C-III, and liver-type fatty acid-binding protein and HPLC analyses of serum lipids were conducted. RESULTS: Fasting induced 4- and 20-fold increases in the mRNA of Apo C-II and A-IV, respectively, in young mice while only 1.1- and 7-fold increases, respectively, were detected in old mice. In contrast, the Apo C-III gene expression was significantly reduced by fasting in the young mice but the reduction was small in the old. In view of the stimulating effect of Apo C-II and A-IV and the inhibiting effect of C-III on lipoprotein lipase (LPL), these findings suggest that the fasting-induced activation of LPL may be considerably decreased in old mice. The amount of TG in very low-density lipoprotein (VLDL), a major form of the transport of TG to peripheral tissues, was significantly greater in the young than in the old mice. Despite possible activation of LPL by fasting, the amount of TG in VLDL, a major form of the transport of TG to peripheral tissues, was significantly greater in the young mice than in the old. It is indicated that the synthesis of VLDL in the liver is high in the young but low in the old mice, which also may be true for the rate of transport of TG. CONCLUSION: The present findings suggest that mobilization of lipids is impaired in old animals due to decreased gene expression of Apos, possibly leading in the long run to excessive lipid accumulation in tissues such as the liver, adipose tissues and blood vessels even in normal feeding, and resulting in an increased incidence of age-related diseases.

Age-associated changes in the serum level of apolipoproteins A-I and A-IV and the gene expression as revealed by fasting and refeeding in mice.

Alterations of serum apolipoproteins A-I (apo A-I) and A-IV and their mRNAs in young and old mice by fasting and refeeding were investigated by polyacrylamide gel elecrophoresis and Northern blot, respectively. After fasting for three days, serum apo A-I concentration in young mice (6-9 month-old) was increased about 1.5 fold while that of old animals (25-34 month-old) did not change significantly. Apo A-I mRNA was increased about 3-fold and 1.7-fold in the liver and small intestine of the young mice, respectively. The increase in old animals was not more than 1.5-fold in both tissues. The serum apo A-IV was elevated 2-fold and its mRNA was markedly (ca. 50-fold) induced in the liver of fasted young mice, whereas the increase of the mRNA was less than 2-fold in the small intestine. In contrast, induced levels of the protein in serum and its mRNA in both tissues were much less in old mice. In view of the roles of apo A-I and A-IV in triglyceride mobilization and reverse cholesterol transport, the present findings suggest that the reduced induction of the mRNAs for these apolipoproteins in the liver by prolonged fasting and possibly under normal feeding conditions can be an important factor in the impaired immobilization of lipid in old animals, and may, in turn, have implication in age-related diseases such as coronary, cerebral and other vascular disorders.

Dietary restriction initiated in late adulthood can reverse age-related alterations of protein and protein metabolism.

Many reports have been published on the effects of lifelong dietary restriction (DR) on a variety of parameters such as life span, carcinogenesis, immunosenescence, memory function, and oxidative stress. There is, however, limited available information on the effect of late onset DR that might have potential application to intervene in human aging. We have investigated the effect of DR initiated late in life on protein and protein degradation. Two months of DR in 23.5-month-old mice significantly reduced heat-labile altered proteins in the liver, kidney, and brain. DR reversed the age-associated increase in the half-life of proteins, suggesting that the dwelling time of the proteins is reduced in DR animals. In accordance with this observation, the activity of proteasome, which is suggested to be responsible for degradation of altered proteins, was found increased in the liver of rats 30 months of age subjected to 3.5 months of DR. Thus, DR can increase turnover of proteins, thereby possibly attenuating potentially harmful consequences by altered proteins. Likewise, DR in old rats reduced carbonylated proteins in liver mitochondria, although the effect was not observed in cytosolic proteins. Fasting induced apoA-IV synthesis in the liver of young mice for efficient mobilization of stored tissue fats, while it occurred only marginally in the old. DR for 2 months from 23 months of age partially restored inducibility of this protein, suggesting the beneficial effect of DR. Taking all these findings together, it is conceivable that DR conducted in old age can be beneficial not only to retard age-related functional decline but also to restore functional activity in young rodents. Interestingly, recent evidence that involves DNA array gene expression analysis supports the findings on the age-related decrease in protein turnover and its reversion by late-onset DR.