The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT): initial aims and impact of the family history of type 1 diabetes mellitus in Japanese children.

The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT) was established in July 1994 with the chief aim to improve the quality of therapy for type 1 diabetes in children, an entity far less common in Japan than in Europe. We proposed four initial research topics: (i) to determine the current status of medical care and glycemic control in Japanese children with type 1 diabetes mellitus; (ii) to standardize the measurement of hemoglobin A1c; (iii) to establish a registry of a large cohort of patients in order to enable prospective studies to improve the quality of therapy for children with type 1 diabetes in Japan; and (iv) to enable participants of the JSGIT to hold a workshop twice annually. We registered a total of 736 patients from 45 hospitals throughout Japan. Intervention via insulin treatment was instituted after 2 yr for those patients whose hemoglobin A1c level was more than 8.1%. The proportion of patients receiving multiple insulin injections increased after intervention; however, average hemoglobin A1c in females remained significantly higher than in males. We identified two forms of diabetes in Japanese children: a rapidly progressive form and a more slowly progressive form. There was a significantly higher prevalence of a family history of diabetes in first-degree relatives in the slowly progressive form. These preliminary findings are the result of the first collaborative study of childhood diabetes in Japan.

The prevalence of mitochondrial gene mutations in childhood diabetes in Japan.

To investigate the prevalence of mitochondrial DNA mutations among Japanese children with IDDM as well as in those with NIDDM, a total of 155 patients with IDDM and 30 patients with NIDDM who were younger than 15 years of age at onset were studied for the following mtDNA mutations: 1) the A-->G mutation at position 3243 of mitochondrial leucine transfer RNA (3243 mutation); 2) the G-->A mutation at position 3316 of mitochondrial leucine transfer RNA (3316 mutation), and 3) The T-->C mutation at position 3394 of the mitochondrial NADH dehydrogenase subunit (3394 mutation). None of the 155 IDDM patients had the 3243 mutation. Although two of the 155 IDDM patients had homoplasmy of 3316 and five had 3394 mutations, these frequencies were not significant compared with healthy controls. None of the 30 NIDDM patients had the 3243, 3316 or 3394 mutation. The presence of these mutations even in control subjects suggests that the effect of the 3316 or 3394 mutation on mitochondrial function is relatively mild. It seems that 3316 and 3394 mutations contribute to the manifestation of diabetes together with other genetic and/or environmental factors.

Physical linkage of the B29/Ig-beta (CD79B) gene to the skeletal muscle, sodium-channel, and growth hormone genes in rat and human.

In the region between the polyadenylation site of the rat skeletal muscle (SkM) Na-channel gene and the 5' end of the growth hormone (GH) gene, a gene coding for B-cell-specific membrane protein B29/Ig-beta was found and noted to have the same orientation as the Na-channel and GH genes. Rat B29/Ig-beta gene was 3.1 kb in length with six exons and was separated by 3.3 and 9.3 kb from Na-channel and GH genes, respectively. Rat B29/Ig-beta protein comprised 228 amino acids, and its amino acid sequence was 85 and 69% identical with the mouse and human counterparts, respectively. With the long-area PCR method, genomic DNA connecting human SkM Na-channel (SCN4A) and B29/Ig-beta (CD79B) genes and CD79B and GH (GH1) genes was amplified, and the physical linkage of SCN4A/CD79B/ GH1 genes in the human genome was established. The human CD79B gene was separated by 6.3 and 10.5 kb from the SCN4A and GH1 genes, respectively.

Gene coding for the transcription factor, SUG/proteasome, p45 is located nearly 40 kb downstream from the rat growth hormone gene.

About 40 kilobases (kb) downstream of the rat growth hormone gene, a gene was found to be expressed in the liver and placenta as 1.5 kb poly(A)-rich RNA. Using the genomic DNA fragment as a probe, the corresponding cDNA clone containing a 1.3 kb insert was isolated from the rat liver cDNA library. The deduced amino acid sequence having 406 residues was identical with that of the mouse transcription factor, SUG and human proteasome subunit, p45. The gene was thus identified as the rat SUG/p45 (rSUG/p45) gene. The 5' end of the gene was determined by the primer-extension analysis and the exon was noted to comprise 1409 bases. The rSUG/p45 gene, 6.0 kb in length and possessing 12 exons, started at 42.8 and ended at 36.8 kb downstream from the transcription start site of the GH gene. From exon 2 to 11, the size of each rSUG/p45 exon was identical with the corresponding exon of the 4.4 kb pig gene. Rat SUG/p45 mRNA was similarly expressed in seven different tissues and one cell line.

The mechanisms of transient hypothyroxinemia in infants born to mothers with Graves' disease.

Transient hypothyroxinemia in infants born to mothers with Graves' disease is a unique disorder first reported by us in 1988. Most mothers of these infants have had no treatment, are diagnosed as having thyrotoxicosis during the last trimester, or were not well controlled during pregnancy. These infants are believed to have transient central hypothyroidism, the mechanisms of which have not been elucidated. We measured TSH-receptor antibody activities in maternal serum and blood thyroxine (T4) (free thyroxine, FT4) and TSH levels in blood dried on filter paper at 1, 3, and 5 d of age in 114 infants born to mothers with Graves' disease. The 114 infants were retrospectively divided into three groups according to the clinical course and thyroid function data: group G, neonatal thyrotoxicosis; group T, transient hypothyroxinemia; and group E, euthyroid. In group T, the dried blood T4 (FT4) level from cord blood and/or 1 d of age blood was 6.0 +/- 2.3 microg/dL (0.92 +/- 0.52 ng/dL), a value significantly higher than that at 5 d of age (3.6 +/- 1.0 microg/dL; 0.38 +/- 0.18 ng/dL) (p = 0.025 in T4, p = 0.042 in FT4). In contrast, these levels were significantly lower at birth relative to 5 d in group G (p = 0.0001 in T4) and not significantly changed in group E. The TSH level of cord blood and/or 1-d-old blood in group T was significantly lower than that of group E (p = 0.0006). Moreover, the TSH levels in response to thyrotropin-releasing hormone were blunted in most infants in group T. Bone maturation was not delayed in group T, compared with euthyroid infants. The higher blood T4 (FT4) levels at birth, relative to 5 d in group T, suggested that the fetal T4 level was higher than that of the newborn period. The fetal T4 level might have been elevated owing to transfer of T4 from mother to fetus during the last trimester when the mother's thyroid function was elevated and consequently the fetal pituitary-thyroid axis was suppressed. Although the serum T4 (FT4) levels were decreased after birth, TSH levels were not elevated, probably because the pituitary-thyroid axis was suppressed. This may be the reason for the transient hypothyroxinemia with a normal TSH level in infants born to mothers with poorly controlled Graves' disease. Weak maternal thyroid-stimulating antibody activities and differences in sensitivity of the thyroid gland to TSH-receptor antibodies may contribute to this unique disorder.

Chromatin structure of the rat somatotropin gene locus and physical linkage of the rat somatotropin gene and skeletal-muscle sodium-channel gene.

Cosmid clones from -32 kb to +74 kb region of the rat somatotropin gene locus were isolated for examination of the chromatin structure in the region from -39 kb to +47 kb by DNase I-sensitivity analysis using rat pituitary-derived GC (somatotropin+, prolactin-), and 235 (somatotropin-, prolactin+) cells, and liver-derived BRL (somatotropin-, prolactin-) cells. DNase I-hypersensitive sites (DHS) specific for somatotropin-producing cells were previously shown to be located exclusively in the -2 kb to +9 kb region [Aizawa, A., Yoneyama, T., Kazahari, K. & Ono, M. (1995) Nucleic Acids Res. 23, 2236-2244]. No other DHS having this specificity was found in the region examined in this study. Except for these and two other DHS located in a cluster in this region, no DHS could be found from -23 kb to +22 kb. DHS having no or less cell-type specificity were scattered about in the -39 kb to -23 kb and +22 kb to +47 kb regions. The polyadenylation site of the human skeletal-muscle Na-channel alpha-subunit gene has been shown present 22 kb upstream from the somatotropin gene [Bennani-Baiti, I. M., Jones, B. K., Liebhaber, S. A. & Cooke, N. E. (1995) Genomics 29, 647-652]. Polyadenylation site of the rat skeletal-muscle Na-channel gene was shown in this study to be at -15.7 kb. The skeletal-muscle Na-channel gene was specifically expressed in skeletal-muscle cells but not in somatotropin-producing cells, and thus the boundary region that ensures the cell-type-specific expression of each gene would appear to be situated between two genes. The region prerequisite for cell-type-specific expression of the rat somatotropin gene was estimated based on the present findings.

Gene structure of rat BAF60b, a component of mammalian SW1/SNF complexes, and its physical linkage to the growth hormone gene and transcription factor SUG/proteasome p45 gene.

In the +27.6 to +36.7 kb downstream region from the transcriptional start site of the rat growth hormone (GH) gene, a gene encoding BAF60b, a component of mammalian SWI/SNF complexes, was found to have the same transcriptional orientation as the GH gene. The 5' end of the BAF60b gene was heterogeneous and the longest gene was 9060 bp long with 13 exons. The largest of all exons was estimated to be 2774 bases. Deduced rat BAF60b protein was made of 531 amino acids and its amino acid sequence was 97% identical with the human counterpart. No TATA box was found up to the -100 bp region but five GC boxes corresponding to the Sp1 binding site were observed up to 640 bp upstream from the transcriptional start site. Sixty-three bases downstream from the BAF60b gene, the polyadenylation site of the gene encoding transcription factor SUG/proteasome p45, whose expression is constant in many tissues, was identified. The BAF60b gene was expressed as 3.0 kb poly(A)-rich RNA in seven tissues and one cell line from rat but its expression varied considerably according to the tissue.

Significance of the chromatin structure in expression of the rat prolactin gene.

To elucidate the mechanisms underlying cell type-specific expression of the growth hormone (GH) and prolactin (PRL) genes, we used rat pituitary-derived cell lines producing exclusively GH (GC cells) or PRL (235 cells), and examined the following: expression of transcription factors essential for GH and/or PRL gene expression; promoter/enhancer activity of the GH and PRL genes transiently introduced by transfection; and chromatin structures of the GH and PRL genes. Even in PRL-nonproducing GC cells, the PRL promoter/enhancer was more active than the GH promoter, and the transcription factors, Pit-1 and estrogen receptor (ER), essential for PRL gene expression were functional. The PRL promoter/enhancer of GC cells was normal. On DNase I sensitivity analysis of the chromatin structure, two hypersensitive sites were detected in PRL gene chromatin of PRL-producing 235 cells but none in that of GC cells. It thus follows that the major reason for absence of the expression of the endogenous PRL gene in GC cells is neither the lack of transcription factors necessary for PRL gene expression nor an anomaly of the PRL gene itself, but that the chromatin structure of the PRL gene differs in PRL-nonproducing and -producing cells. It was shown in this study that neither Pit-1 nor ER is required for conversion of the structure of PRL gene chromatin to a DNase I-hypersensitive state.

DNase I-hypersensitive sites in the chromatin of rat growth hormone gene locus and enhancer activity of regions with these sites.

In this study, a determination was made of the chromatin structure of the rat growth hormone (GH) gene locus by DNase I sensitivity analysis using GC [GH+, prolactin (PRL)-], 235 (GH-, PRL+), GH3 (GH+, PRL+) and liver (GH-, PRL-) cells. From 7 kb upstream from the transcription start site to 19 kb downstream from the polyadenylation site, two major DNase I-hypersensitive sites (M-DHS; UIA, UIIA) and three M-DHS (DIA, DII, DIII) were found within 2 kb upstream and 7 kb downstream regions, respectively. Two minor DHS (m-DHS; UIB, UIIB) in the upstream region and one m-DHS (DIB) downstream were shown to be associated with M-DHS. Thus, a total of five M-DHS and three m-DHS were mapped on the rat GH gene locus. Among these, five (UIIB, UIA, UIB, DIB, DIA) including two (UIA, DIA) M-DHS were specific for GH-producing cells. UIIA and DIII were M-DHS only in PRL-producing 235 cells while the major hypersensitivity of DII was detected in GH-producing cells and liver cells. Assessment of the enhancing activity of the DHS regions indicated novel enhancers in one upstream and two downstream regions that function well with the GH promoter in GC cells. These enhancers, each appearing different, coincided with m-DHS but not M-DHS in GC cells, and were not activated by Pit-1. Based on these observations, the following functions of five M-DHS and three m-DHS regions were defined: enhancer; locus control region (LCR); switch region serving for conversion from GH/PRL-producing cells to PRL-producing cells; and a region having a structural function in chromatin.

Congenital euthyroid goitre with impaired thyroglobulin transport.

A case of congenital goitre with defective thyroglobulin (Tg) synthesis was studied from the clinical, biochemical and morphological perspectives. The patient, 5.5-year-old boy, who was clinically euthyroid, showed a positive perchlorate discharge test (37.2%). However, the iodination system seemed to be normal since radioiodine uptake into the thyroid was very high, and inspection of the H2O2-generating system using thyroid slices and an assay for peroxidase activity in microsomes showed no abnormalities. On the other hand, virtually no Tg was detected in the serum, and the amount of Tg in thyroid tissue, estimated with gel electrophoresis, was below 10% of the normal value, the quality of Tg being unchanged. Morphological observations demonstrated the presence of Tg in the markedly distended rough endoplasmic reticulum of the cytoplasm of follicular cells and a lack of Tg in the colloid of the follicular lumen. These results suggest that the thyroid is defective in Tg synthesis, probably associated with impaired transport of Tg from the cells to the lumen.