Abnormal flow in the cavernous sinus caused by an asymptomatic dural arteriovenous fistula of the contralateral transverse-sigmoid sinus.

A 53-year-old asymptomatic man underwent cranial MR imaging to rule out cerebrovascular disease. On T2-weighted axial images abnormal flow voids were detected at the right cavernous sinus, suggesting a dural carotid-cavernous fistula (CCF). On the MR angiogram, abnormal high intensity signals were observed at the right cavernous sinus and the left transverse-sigmoid (T-S) sinus, suggestive of coexisting right dural CCF and dural arteriovenous fistula (AVF) of the left T-S sinus. Selective cerebral angiography of the left external carotid artery revealed abnormal flow in the right cavernous sinus caused by the dural AVF of the left T-S sinus via the right inferior petrosal sinus due to occlusion of both the distal left sigmoid sinus and proximal right internal jugular vein.

Adoptive immunotherapy for malignant brain tumors using human peripheral blood mononuclear cells activated by the Streptococcal preparation OK-432.

Adoptive immunotherapy using OK-432-activated mononuclear cells (OK-MCs) offers cell-mediated and cytokine-mediated pathways for antitumor activity. The effectiveness of direct intratumoral administration of OK-MCs via a catheter/reservoir system was studied in patients with malignant brain tumors. Seventeen patients, 12 with malignant glioma, four with metastatic adenocarcinoma, and one with primary sarcoma of the brain, were treated by OK-MC therapy (1.0 to 11.2 x 10(7) cells/person) between June 1989 and April 1999. The OK-MC therapy was given to patients with tumors progressing despite previous cytoreductive surgery, radiation, or chemotherapy. Adverse effects seen after the therapy were fever in 10 patients, seizure in two patients, and hypotension in one patient. Evaluation by computed tomography or magnetic resonance imaging revealed that seven patients showed no change including three with minor response, and 10 showed progressive disease. Adoptive immunotherapy using OK-MC was safe and well tolerated, but the therapeutic potential is limited.

[Brown-Séquard syndrome and cervical CSF leakage due to a knife injury: a case report].

We report a case of Brown-Séquard syndrome and cervical CSF leakage caused by a knife injury. A 34-year-old man was involved in a fight and was stabbed on his occiput and back with a knife. Neurological examination on admission showed right hemiparesis, right hemihypesthesia and left hemihypalgesia, indicating Brown-Séquard syndrome. Furthermore, cerebrospinal fluid was leaking from the occipital stab wound. Head CT scan showed massive accumulation air in the subarachnoid space. Cervical MRI showed that the injury tract reached to the space between the occipital bone and the atlas. One week after admission, suboccipital craniectomy and duraplasty were performed because of continuous CSF leakage. Although, the CSF leakage recurred due to the wound infection, it disappeared naturally as the patient's general condition improved. Follow-up MRI studies demonstrated the cervical spinal lesion as hyperintensity on T2WI, which localized at the right side of the spinal cord. The patient's hemiparesis gradually improved and he underwent rehabilitation. Spinal cord injury due to a stab wound by a knife is rare in Japan. In this case, we suppose that the mechanism of spinal cord injury was due to direct injury by a knife avoiding the lateral corticospinal tract because his right hemiparesis obviously improved.

Fas ligand expression and depletion of T-cell infiltration in astrocytic tumors.

Fas (APO-1/CD95) ligand (FasL) and its receptor, Fas, play a key role in the regulation of apoptosis in the immune system. FasL acts as a cytotoxic effector molecule to Fas-expressing malignant tumor cells; however, it has recently been suggested that FasL also acts as a possible mediator of tumor immune privilege. We studied FasL expression in glioblastoma cell lines and a series of human glioma specimens by Western blotting and immunohistochemistry. In addition, quantitative analysis of T-cell infiltration in these tumors was performed. FasL expression was seen in all cell lines and in 9 of 14 specimens by Western blotting and immunohistochemistry. The distribution of FasL was recognized in the cytoplasm of tumor cells (5 of 9) and in the vascular endothelium (4 of 9). Both types of FasL expression were associated with a significant reduction (p < 0.05) in T-cell infiltration when compared with FasL-negative areas within the same tumor or FasL-negative specimens. Since T-cell apoptosis could be induced by FasL-expressing tumor cells, the present findings suggest that apoptosis induction by FasL expressed on tumor cells and/or vascular endothelium might be one mechanism for T-cell depletion in astrocytic tumor tissues.

Expression of ICAD-l and ICAD-S in human brain tumor and its cleavage upon activation of apoptosis by anti-Fas antibody.

ICAD / DFF is a downstream molecule of caspases, participating in nuclear DNA fragmentation during apoptosis. ICAD / DFF binds CAD / DFF40 and inhibits its DNase activity. ICAD / DFF has two alternative isoforms, long isoform (ICAD-L / DFF45) and short isoform (ICAD-S / DFF35). We have studied the presence and functional status of ICAD / DFF in human glioma cell lines. All cell lines tested expressed both ICAD-L and ICAD-S. When the cultured glioma cells were exposed to anti-Fas antibody, these isoforms were degraded prior to the fragmentation of the nuclear DNA, indicating that the ICAD / DFF expressed in cultured glioma cells was potentially functional. In primary brain tumors and normal brain tissues, there was a difference in the expression level between ICAD-L and ICAD-S. In glioblastomas, ICAD-S was more abundant than ICAD-L. In contrast, ICAD-L was more abundant than ICAD-S in medulloblastomas. The present findings suggest that primary brain tumors and normal brain constitutively express ICAD / DFF, and that there is a difference between the expression levels of ICAD-L and ICAD-S.

Development of active catheter, active guide wire and micro sensor systems.

SUMMARY: Active catheters and active guide wires which move like a snake have been developed for catheter-based minimally invasive diagnosis and therapy. Communication and control IC chips in the active catheter reduce the number of lead wires for control. The active catheter can be not only bent but also torsioned and extended. An ultra minature fiber-optic pressure sensor, a forward-looking ultrasonic probe and a magnetic position and orientation sensor have been developed for catheters and guide wires. These moving mechanisms and several sensors which are fitted near the tip of the catheter and the guide wire will provide detailed information near the tip and enable delicate and effective catheter intervention.

Induction of apoptosis in glioma cells by recombinant human Fas ligand.

OBJECTIVE: Fas ligand (FasL) belongs to the tumor necrosis factor family and has the ability to induce apoptosis in susceptible target cells by binding to its receptor, Fas. It has been demonstrated recently that the FasL/Fas system plays a pivotal role in the cytocidal activity of T lymphocytes in the immune system. FasL may act as a cytotoxic effector molecule to Fas-expressing malignant tumor cells. We reported previously that Fas is commonly expressed in human brain tumor cells. In this study, we examine the possible application of FasL to therapy for malignant brain tumors. METHODS: To develop an expression system yielding large amounts of FasL, we constructed a baculovirus vector containing complementary deoxyribonucleic acid of human FasL under the control of a polyhedrin promoter. We produced human FasL in Spodoptera frugiperda (Sf9) insect cells infected by the recombinant baculovirus carrying FasL complementary deoxyribonucleic acid and studied the cytocidal activity of FasL against the T98G human glioblastoma cell line. RESULTS: FasL expression in Sf9 cells was confirmed immunocytochemically with rabbit antibody raised against the cytoplasmic domain of human FasL. The FasL released into the supernatant of cultured Sf9 cells was also verified by Western blotting, and it specifically induced apoptosis in T98G cells. The induced apoptosis by recombinant human FasL was confirmed by annexin V-fluorescein isothiocyanate staining. CONCLUSION: The present results suggest that the induction of apoptosis by the Fas/FasL system could be a new strategy for the treatment of malignant brain tumors, which are resistant to conventional therapies.

Identification of a novel DNA-binding protein from Mycobacterium bovis bacillus Calmette-Guérin.

A novel DNA-binding protein expressed (8-10% in total protein) in Mycobacterium bovis bacillus Calmette-Guérin was observed. This protein was designated mycobacterial DNA-binding protein 1 (MDP1). MDP1 recognized bases, sugar moieties, phosphate-backbone on DNA and preferentially bound to DNA guanine and cytosine. In the gel retardation assay, MDP1 preferentially bound to closed circular plasmid DNA than open circular and linear form plasmid DNA and also bound to RNA. MDP1 formed a highly polymerized structure and localized not only in the nucleoid but also at the 50S ribosomal subunits and cell surface. MDP1 was conserved in Mycobacterium thus far examined and the expression was enhanced in stationary growth phases. These results will provide a reasonable basis for further study of the function of MDP1 in living mycobacteria.

Attenuated, replication-competent herpes simplex virus type 1 mutant G207: safety evaluation of intracerebral injection in nonhuman primates.

This study examined the safety of intracerebral inoculation of G207, an attenuated, replication-competent herpes simplex virus type 1 (HSV-1) recombinant, in nonhuman primates. Sixteen New World owl monkeys (Aotus nancymae [karyotype 1, formerly believed to be A. trivirgatus]), known for their exquisite susceptibility to HSV-1 infection, were evaluated. Thirteen underwent intracerebral inoculation with G207 at doses of 10(7) or 10(9) PFU, two were vehicle inoculated, and one served as an infected wild-type control and received 10(3) PFU of HSV-1 strain F. HSV-1 strain F caused rapid mortality and symptoms consistent with HSV encephalitis, including fever, hemiparesis, meningitis, and hemorrhage in the basal ganglia. One year after G207 inoculation, seven of the animals were alive and exhibited no evidence of clinical complications. Three deaths resulted from nonneurologic causes unrelated to HSV infection, and three animals were sacrificed for histopathologic examination. Two animals were reinoculated with G207 (10(7) PFU) at the same stereotactic coordinates 1 year after the initial G207 inoculation. These animals were alive and healthy 2 years after the second inoculation. Cerebral magnetic resonance imaging studies performed both before and after G207 inoculation failed to reveal radiographic evidence of HSV-related sequelae. Despite the lack of outwardly observable HSV pathology, measurable increases in serum anti-HSV titers were detected. Histopathological examination of multiple organ tissues found no evidence of HSV-induced histopathology or dissemination. We conclude that intracerebral inoculation of up to 10(9) PFU of G207, well above the efficacious dose in mouse tumor studies, is safe and therefore appropriate for human clinical trials.

Combination therapy of fasudil hydrochloride and ozagrel sodium for cerebral vasospasm following aneurysmal subarachnoid hemorrhage.

Fasudil hydrochloride is a new type of intracellular calcium antagonist, different from the calcium entry blockers that are commonly employed for clinical use. Since September 1995, the combination of fasudil hydrochloride and ozagrel sodium, an inhibitor of thromboxane A2 synthesis, has been used to treat 60 patients at risk of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. The effectiveness of this combination therapy was investigated by comparison with the outcome of 57 patients previously treated with only ozagrel sodium. The combination therapy was significantly more effective (p < 0.01) in reducing the incidence of low density areas on computed tomography scans, and reduced, but not significantly, the occurrence of symptomatic vasospasm. The combination therapy of fasudil hydrochloride and ozagrel sodium has superior effectiveness over only ozagrel sodium in treating patients at risk of vasospasm after aneurysmal subarachnoid hemorrhage.

Distribution of cathepsin E in the larval and adult organs of the bullfrog with special reference to the mature form in the larval fore-gut.

The distibution of cathepsin E in several organs of the bullfrog, Rana catesbeiana, was analyzed at pre- and post-metamorphic stages by the acid proteinase assay, by visualization of enzyme activity on polyacrlamide fore-gut gels after electrophoresis and by immunoblotting with anti-cathepsin E serum. Cathepsin E was mainly distributed in the foregut at the larval stage and in the stomach, duodenum, large intestine and gall bladder at the post-metamorphic stage. In the larval fore-gut, a higher amount of the mature form of cathepsin E was observed in addition to the proform, but in other organs, including the stomach at the post-metamorphic stage, the mature form was barely detected. Developmental changes in the amount of cathepsin E were found in the digestive tract and the gall bladder by quantitative immunoblotting analysis. Finally, the larval fore-gut was stained immunohistochemically with anti-cathepsin E serum and the surface epithelium gave a strong immunoreactive signal.

Differential display cloning of a novel rat cDNA (RNB6) that shows high expression in the neonatal brain revealed a member of Ena/VASP family.

We have used the differential display method to identify genes that control the neural cell development in CNS. Screening of the differential display bands that showed higher expression at neonate than at adult age enabled us to identify a novel rat cDNA (RNB6) coding for a protein of 393 amino acid residues. Database search revealed this gene as a rat homologue of the murine EVL, a member of Ena/VASP protein family that is implicated to be involved in the control of cell motility through actin filament assembly by their GP5 motifs. Although the precise characterization of EVL was not reported, our Northern blot and immunoblot analyses demonstrated that RNB6 expression in the brain gradually increases during embryonic development, reaches maximum at postnatal day 1 and decreases thereafter. Studies of tissue distribution revealed the expression of RNB6 not only in the brain but also in the spleen, thymus and testis. Histochemical analyses showed that RNB6 protein is mainly expressed in neurons and may be expressed in neural fibers. Our analyses suggest that RNB6 is critically involved in the development of CNS probably through the control of neural cell motility and/or including neuronal fiber extension.

Gene therapy: targeting tumor cells for destruction.

Human gene therapy involves the transfer of genetic material into cells of a patient, either in vitro or in situ, for the therapeutic purpose of correcting or ameliorating genetic defects, alleviating disease, inhibiting infectious agents or destroying cancer cells. After identification of an appropriate disease target (inherited or acquired) for treatment, a number of basic technical issues underlie any gene therapy strategy. These include the choice of genetic material to be transferred, target cell or organ for gene modification, delivery systems and representative animal models of the targeted human disease. Tumor gene therapy represents a somewhat special category for gene therapy because its intended goal is the destruction of tissue rather than its correction or preservation. For an experimental therapeutic, cancer represents a useful target due to the paucity of effective treatments and the terminal nature of the disease. Viral vectors, currently the most widely used agents for gene delivery, generally fall into two classes; defective, which are unable to replicate; and replication-competent, which are able to replicate and spread within defined cell types. The strategies employed for cancer gene therapy range from cytotoxicity, either direct or through a 'suicide' gene-producing, to induction of a host antitumor immune response. Gene therapy is rapidly moving into the clinic, yet its efficacy remains to be demonstrated. Research into the underlying fundamentals of gene therapy discussed in this review will be critical to the ultimate success of this therapeutic modality.

The cytocidal activity of OK-432-activated mononuclear cells against human glioma cells is partly mediated through the Fas ligand/Fas system.

We have been applying an adoptive immunotherapy protocol to patients with malignant brain tumors using OK-432-activated peripheral blood mononuclear cells (OK-MCs). In order to elucidate the mechanism of OK-MCs' cytotoxicity, we examined the expression of Fas ligand mRNA in OK-MCs and the cytocidal activity of these cells against a human glioma cell line, T98G which expresses a high level of Fas. The expression of Fas ligand mRNA was low in non-treated peripheral blood mononuclear cells and was elevated by treatment with OK-432, irrespective of the dose employed. Apoptosis of T98G cells induced by OK-MCs was unequivocally inhibited by the pretreatment of T98 G cells with ZB4 monoclonal antibody, which binds to Fas and blocks the binding of Fas ligand to Fas. These data indicate that the cytotoxic activity of OK-MCs via apoptosis seems to be at least partly mediated by the Fas ligand/Fas system. Adoptive immunotherapy using the Fas ligand/Fas system could be a new treatment modality for human malignant brain tumors.

[Correlation of interleukin-2 (IL-2) responsiveness by egg white-stimulated lymphocytes with hen egg oral provocation test in atopic children].

One hundred and twenty five cases of atopic children such as atopic dermatitis and bronchial asthma were orally provocated with rare hen egg every 20 minutes one by one upto the whole amount. In one week observation 75 cases showed any symptoms of allergy including eruption and exacerbation of atopic eczema in an immediate, late, and/or delayed responses. Frequency of positive egg white-induce IL-2 responsiveness test in patients with positive oral provocation was 90.7% (68 out of 75 cases; sensitivity). That of negative test in patients with negative provocation was 84.0% (42 out of 50 cases; specificity). In contrast, specificity of IgE RAST for egg white were 88.0% comparable to the value of antigen-specific IL-2 responsiveness (AIR) test, but the specificity was lower value (37.3%) for screening the etiological antigens as compared to that of AIR test. High frequency of positive egg white-induced IL-2 responsiveness test was observed over an immediate, late and delayed responses, while low frequency of positive IgE RAST for hen egg was observed largely in patients showing delayed but not immediate response. The results indicate that IgE RAST in this study reflects IgE-mediated immediate type hypersensitivity, whereas AIR test reflects, in addition to immediate responses, late and delayed type hypersensitivity. The combined results suggest that AIR test in hen egg allergy is a useful method in vitro for both screening and determining etiological allergens, and might be able to substitute for provocation test in vivo for which many times, labours, expenses, and patients' risks are required, and to cover IgE RAST which fails to determine etiological allergens in 62.7% of patients with positive oral provocation.

Attenuated multi-mutated herpes simplex virus-1 for the treatment of malignant gliomas.

We have created a double mutant of the herpes simplex virus (HSV) type 1 (termed G207) with favourable properties for treating human malignant brain tumours: replication-competence in glioblastoma cells (and other dividing cells), attenuated neurovirulence, temperature sensitivity, ganciclovir hypersensitivity, and the presence of an easily detectable histochemical marker. G207 has deletions at both gamma 34.5 (RL1) loci and a lacZ gene insertion inactivating the ICP6 gene (UL39). G207 kills human glioma cells in monolayer cultures. In nude mice harbouring subcutaneous or intracerebral U-87MG gliomas, intraneoplastic inoculation with G207 causes decreased tumour growth and/or prolonged survival. G207 is avirulent upon intracerebral inoculation of mice and HSV-sensitive non-human primates. These results suggest that G207 should be considered for clinical evaluation in the treatment of glioblastomas.

Inhibition of angiogenesis and growth of human non-malignant and malignant meningiomas by TNP-470.

Meningiomas are relatively common (22%) vascular brain tumors. 3-11% of meningiomas are malignant, and defy currently available therapy. Inhibition of neovascularization is one potential strategy for treating these hypervascular tumors. Inhibition of tumor-induced angiogenesis by TNP-470 (previously termed AGM-1470), a synthetic analogue of fumagillin, was tested on the growth of human non-malignant and malignant meningiomas in nude mice. TNP-470 significantly inhibited tumor neovascularization and tumor growth of both non-malignant and malignant meningiomas. TNP-470 is now in human trial and should be tested for efficacy in treating malignant or recurrent aggressive meningiomas.

Antisense expression of protein kinase C alpha inhibits the growth and tumorigenicity of human glioblastoma cells.

To investigate the role of protein kinase C (PKC) in the growth of astrocytic brain tumors, human glioblastoma cell line U-87 was stably transfected with the antisense complementary deoxyribonucleic acid encoding PKC alpha. The effect of selectively down-regulating the alpha isoform on other PKC isoforms, as well as serum-dependent proliferation and in vivo tumorigenicity, was determined. U-87 cells expressed high levels of PKC alpha and lesser amounts of the gamma, epsilon, and zeta isoforms, and a similar PKC isoform pattern was observed in two other human glioblastoma cell lines. Expression of the antisense PKC alpha complementary deoxyribonucleic acid resulted in no detectable PKC alpha by immunoblotting and a 95% reduction in total Ca2+/phospholipid-dependent PKC activity. U-87 cells expressing antisense PKC alpha exhibited an increase in doubling time in vitro, less serum-dependent growth, and reduced sensitivity to a selective PKC inhibitor, Ro 31-8220. The transplantation of U-87 cells expressing antisense PKC alpha into nude mice resulted in no tumor formation. These observations suggest that the inhibition of PKC alpha may be an important chemotherapeutic target for arresting the growth of glioblastomas.