Luteotropic effects of tamoxifen in infertile women.

Tamoxifen at a dose of 10 mg/day for 5 days was given to five infertile women in the luteal phase. Daily serum samples were obtained during the luteal phase for radioimmunoassay of progesterone (P), estradiol (E2), follicle-stimulating hormone, luteinizing hormone (LH), and prolactin levels. The integrated luteal phase concentrations of serum P and E2 before and after cycles of tamoxifen treatment increased from 87.8 +/- 16.2 ng/ml and 1120 +/- 164.4 pg/ml to 131.6 +/- 18.9 ng/ml and 1461 +/- 205.2 pg/ml, respectively (P less than 0.01 and P less than 0.05). No apparent increase in circulating LH levels was seen in one of the five cases, but this patient's serum P and E2 levels rose nonetheless. This suggests that the significant increase in circulating P and E2 induced by tamoxifen is not consistently associated with an increase in serum LH concentration.

Endocrine profiles in tamoxifen-induced conception cycles.

Twenty-five infertile women conceived while taking tamoxifen (TMX). Daily serum profiles of 5 of the 25 TMX-induced conception cycles were elucidated and compared with those found in 5 normal cycles. In spite of lower levels of follicle-stimulating hormone and luteinizing hormone during the follicular phases, estradiol concentrations were higher in the TMX-induced conception cycles. It is suggested that this may be due to a direct ovarian effect of TMX as one of its major mechanisms in the course of folliculogenesis. On the other hand, progesterone concentrations on days 6 and 7 during the luteal phases were also higher in the TMX-induced conception cycles. It is suggested that this may be due to a luteotropic influence at the blastocyst stage.

Endocrine profiles in tamoxifen-induced ovulatory cycles.

A group of 22 women with anovulatory cycles was treated with tamoxifen in 46 cycles. We elucidated daily hormone profiles in 5 of the 33 tamoxifen-induced ovulatory cycles in order to make a comparison with those found in 5 normal cycles. Serum follicle-stimulating hormone and luteinizing hormone (LH) rose during or a few days after the tamoxifen therapy, and thereafter serum estradiol levels rose gradually over the normal ranges during the follicular phase and reached an extremely high preovulatory peak which triggered an LH surge. This increased estradiol production exerted its usual negative feedback on LH secretion. Following ovulation, serum progesterone rose and fell in a manner similar to that in the normal cycles, with occasional values that exceeded the normal range. The endocrine significance of these findings is discussed.

Tamoxifen in the treatment of infertility associated with luteal phase deficiency.

A group of 17 patients with suspected luteal phase deficiency was treated with tamoxifen. Tamoxifen therapy was found to lengthen the luteal phase in all patients and resulted in pregnancy in 6 of 17 patients. The integrated luteal phase progesterone (P) concentration in the nontreatment cycle of seven patients was significantly lower (P less than 0.01) than that of five normal women. Therapy with tamoxifen increased the P concentration to 186.0 +/- 24.4 ng/ml/cycle (mean +/- standard error of the mean), i.e., twice that of the control cycle. The mean estradiol (E2) concentration at the midcycle peak was about twice that observed during the nontreatment cycle. The glycogen content of the endometrial tissue at the midluteal phase in the tamoxifen cycle was significantly higher (P less than 0.025) than that of endometrial tissue in the nontreatment cycle, indicating improvement of the endometrial function.

Potent antinociceptive effects of TRK-820, a novel kappa-opioid receptor agonist.

TRK-820, a new type of 4,5-epoxymorphinan derivative, was investigated in vivo for antinociceptive activities and its selectivity on various opioid receptors in mice. TRK-820 given s.c. or p.o. was found to be 351- and 796-fold more potent than U50,488H with acetic acid-induced abdominal constriction test. The duration of the antinociceptive effect produced by TRK-820 was longer than that produced by mu-opioid receptor agonist morphine or other kappa-opioid receptor agonists. In addition, with four other antinociceptive assays, low temperature hot plate (51 degrees C), thermal tail flick, mechanical tail pressure and tail pinch tests, TRK-820 was also found to be 68- to 328-fold more potent than U-50488H, and 41- to 349-fold more potent than morphine in producing antinociception, as comparing the weight of the different compound. However, TRK-820 was less active in inhibiting the high temperature (55 degrees C) hot plate response. The antinociceptive effects produced by TRK-820 were inhibited by nor-BNI, but not by naloxone or naltrindole (NTI) with the abdominal constriction test, indicating that the antinociception is selectively mediated by the stimulation of kappa-, but not mu- or delta-opioid receptors. Co-administration of TRK-820 with morphine slightly enhanced the antinociception induced by morphine in the mouse hot plate test. On the other hand, pentazocine significantly reduced the morphine-induced antinociception. TRK-820 produced sedation at doses, which are much higher than the doses for producing antinociception. These results indicate that the potent antinociception induced by TRK-820 is mediated via the stimulation of kappa-, but not mu- or delta-opiod receptors.

[Fundamental and clinical studies on T-1982 (cefbuperazone) in the field of obstetrics and gynecology].

Fundamental and clinical studies on T-1982 (cefbuperazone), a new cephamycin antibiotic, were carried out in the field of obstetrics and gynecology, and the following results were obtained. In a fundamental study, T-1982 was given to 7 patients with postpanhysterectomy at a dose of 1 g by intravenous drip infusion, and T-1982 concentrations in uterine artery and elbow vein serum and each uterine tissue (fallopian tube, ovary, endometrium, corpus uteri, cervix uteri and portio) were serially determined. The concentration in the endometrium (though the range of values was wide) was found higher than that in the other tissues. In a clinical study, T-1982 was given to 5 patients; 2 patients with parametritis and each one patient with right salpingitis, pyometra and metroendometritis. The efficacy rate was 80%. No side effects nor remarkable abnormalities in hematology, urinalysis and renal and hepatic function were observed during the therapy.

[Evaluation of sensitivity and specificity of confirmatory assays for lupus anticoagulant (LA) detection].

To evaluate the sensitivity and specificity of confirmatory assays for LA detection, we performed the platelet neutralization procedure (PNP), diluted Russell's viper venom time (dRVVT) confirmatory assay (the ratio of LA-screen and LA-confirm:S/C), and specific hexagonal phase neutralization test (StaLA) on, plasma samples 43 LA-positive in either the ratio of dilute APTT and APTT(dAPTT/APTT) or dRVVT(LA-screen). The sensitivity and the specificity were evaluated by 4 different analyses based on, 1) maximal plasma dilution, 2) correlation between the screening assays and these confirmatory assays, 3) ratio of LA-positive in the confirmatory assays, and 4) receiver operation characteristic (ROC) method. All 4 analyses showed that sensitivity was in the order of PNP > S/C > Staclot-LA. However, the order of the specificity evaluated by the ROC method was Staclot-LA > S/C > PNP. The APTT-based confirmatory assay, PNP can detect LA of the plasma samples that were all positive in the dAPTT/APTT ratio, while the LA-positive plasma samples in dRVVT-confirm were all positive in the dRVVT-screen assay. Our findings suggest that confirmatory assays should be based on the method giving an abnormal screening assay. Accordingly, we recommend the following combinations of screening and confirmatory assays in terms of specificity; 1) dAPTT/APTT ratio and Staclot-LA as the APTT-based assay, and 2) LA-screen and LA-confirm as the dRVVT-based assay.

[Combined administration of futraful and esquinone for the treatment of advanced ovarian cancer].

Thirty-seven patients with advanced ovarian cancer were treated with futraful (FT-207) and esquinone (CQ). These patients had infiltrated tumors to the pelvic and peritoneal cavity and also distant metastasis, so they were not operated perfectly. There were evaluable 12 patients out of 37. FT-207 + CQ is an effective drug combination against advanced ovarian cancer with an overall response rete of 40.9%, a complete response rate of 4.5% (1/22), partial response rate of 36.4% (8/22), no change rate of 27.3% (6/22) and progressive rate of 31.8% (7/22). Patients with adenocarcinoma showed a response rate of 66.7% (8/12). According to the stage, the patients in stage III showed response rate of 50.0% (6/12), in stage IV showed a response rate of 37.5% (3/8). The total dose of FT-207 used in the study was 38.3g in the progressive disease group and 177.6 in the good response group. The group of long term administration of FT-207 and CQ included many patients with good response.

[Role of progesterone in the ovulatory process of PMSG/hCG treated immature female rats].

To determine exactly when progesterone (P) acts as a most important mediator in the ovulatory process, a dose of 10mg/kg of RU486, an antiprogesterone, was administered to PMSG/hCG treated immature female rats (22 days old) at 0 (RU0 groups), 2 (RU2 group), 4,6,8 or 10 hours after an hCG injection, respectively. In the RU0 groups, the ovulatory effect of P was investigated at 0.2 (P2 group), 4 (P4 group), 6 or 8 hours after the hCG injection. Ovulation rates were calculated 24 hours after the hCG injections. Serum P and estradiol (E2) concentrations in the RU0 groups, the P2 group and the control rats (C group), were determined. The results were as follows. 1) The numbers of ova in the RU0, RU2 and RU4 group rats were significantly (p less than 0.01, p less than 0.01 and p less than 0.01) lower than that in the C group rats. 2) In the P2 and P4 groups, the numbers of ova were significantly (p less than 0.01 and p less than 0.01) increased compared with the RU0 group and returned to the control range. 3) In the RU0 group, the serum P and E2 concentrations within 8 hours after an hCG injection did not show any significant differences compared with the C group. In contrast, in the P2 group, the P concentrations at 4 and 6 hours after hCG increased significantly (p less than 0.01 and p less than 0.01) compared to the corresponding RU0 group. These results clarified an indispensable role of P in the ovulatory process within 6 hours after an hCG injection.

[Sex difference of free erythrocyte protoporphyrin (FEP) level. III. Effect of estradiol on porphyrin metabolism, especially in FEP, in lead poisoned rats].

An experimental study of sex hormone on FEP level in rats was conducted to clarify sex difference of FEP level. A total of 42 male Donryu rats were divided into 7 groups; group I (control 1; olive oil injection without castration), group II (control 2; olive oil alone), group III (EL; estradiol in olive oil, 50 micrograms/kg.BW), group IV (EH; estradiol in olive oil, 250 micrograms/kg.BW), group II' (Pb; Pb 5 mg/kg.BW), group III' (PbEL; Pb 5 mg/kg.BW + estradiol in olive oil, 50 micrograms/kg.BW) and group IV' (PbEH; Pb 5 mg/kg.BW+estradiol in olive oil, 250 micrograms/kg.BW). Excluding group I, all rats of the 6 groups were castrated. After one week from castration, estradiol was subcutaneously injected 4 times a week, and lead was intraperitoneally injected once a week for 6 wk. Estradiol suppressed growth, Ht, Hb value and liver function, but did not show any evident effect on FEP, ALA-U and CP-U. Erythrocyte ALA-D activity in group IV' (Pb+estradiol at high dose) showed a level higher than that in group II' (Pb-treatment alone).

Clinical significance of immunoglobulin A antiphospholipid antibodies: possible association with skin manifestations and small vessel vasculitis.

OBJECTIVE: To clarify whether immunoglobulin A (IgA) antiphospholipid antibodies (aPL) are an independent risk factor for specific manifestations of collagen vascular diseases. METHODS: We determined IgG, IgM, and IgA anticardiolipin antibodies (aCL) and lupus anticoagulant (LAC) in 77 patients with various collagen diseases. Fifty-four patients who had positive results for either or both antibody classes were compared to 23 patients with systemic lupus erythematosus who had none of these antibodies. The association between the antibodies and clinical manifestations (thrombosis, fetal loss, thrombocytopenia, biological false positive test for syphilis, cutaneous manifestations, central nervous system involvement, and renal involvement) was analyzed. RESULTS: Of 54 patients with aPL, 33 showed significantly high levels of IgA aCL. Among them, IgA aCL coexisted with other aCL isotypes or LAC in 24 patients. The 9 patients with IgA aCL alone frequently had vasculitis associated manifestations, although thrombotic events and recurrent fetal loss were rare. Multivariate linear regression analysis showed that IgA aCL were independently associated with thrombocytopenia, skin ulcers, chilblain lupus, and vasculitis. There was also an association between IgM aCL and skin ulcers or chilblain lupus. CONCLUSION: Clinical manifestations of patients with IgA aCL differ from those of patients with IgG aCL. Determination of all 3 aCL isotypes and LAC is important to assess the risk of specific clinical manifestations in patients with aPL.

Development of skill of children in the performance of the family computer game "Super Mario Brothers".

The development of skill of children in the performance of a family computer game (Super Mario Brothers) was investigated among three groups of different age: kindergarten children (6 years old) and primary school children (9 and 12 years old). The skill to perform the game with either hand was evaluated by the mean scores gained by the children. In the normal (right and dominant) situation, the mean score improved significantly with advancement of age. Similar was true in the reversed (left hand dominant) situation, but more distinctly. The mean scores were significantly higher in the normal than in the reversed situations. The experienced children were superior to the inexperienced children in playing the game. The correlation between the reaction time and the game score was also investigated with the same subjects for the 9- and 12-year-old school children. Almost no correlation could be elucidated.

[Effect of RU 486 on glycogen metabolism in endometrium].

To elucidate the effect of the antiprogesterone steroid RU 486 (RU) on endometrial glycogen metabolism, a dose of 30 mg/kg of the agent was administered to pregnant rats on Day 2 (group 1) or Day 4 (group 2) of pregnancy, and glycogen content, glycogen synthetase (GS) and glycogen phosphorylase (GP) activities in the endometrium were investigated on Day 6. In addition, serum ovarian steroid hormones and the number of implantation sites were evaluated. The glycogen content in the endometrium in group 1 and group 2 decreased significantly (p less than 0.02 and p less than 0.05) compared with the control group. The total GS activity in the endometrium in group 1 decreased significantly (p less than 0.05). On the other hand, the independent GS activity in group 2 increased significantly (p less than 0.05) compared with the control group. The active GP activity in group 1 increased markedly, and the total GP activity increased significantly (p less than 0.05) compared with the control value. In group 2, the active and total GP activities increased significantly (p less than 0.01 and p less than 0.02) compared with the control values. Serum progesterone (P) concentrations in group 1 and group 2 were significantly (p less than 0.05 and p less than 0.05) lower than those in the control groups 2 days after the RU administration, and implantations were significantly (p less than 0.01 and p less than 0.01) inhibited. These results suggest that RU 486 affects endometrial glycogen metabolism, resulting in the prevention of implantation.

[Midluteal progesterone/estradiol ratio as an indicator of pregnancy potential].

In an effort to determine the reliability of the midluteal progesterone(P)/estradiol(E2) ratio as an index of the potential for conception, we measured the midluteal P and E2 levels in 76 infertile women who had been treated at our infertility clinic. This parameter in conception cycles was compared with that in non-conception cycles. Eighty cycles of the 76 women were classified into two groups, depending upon whether pregnancy occurred or not. Group 1 and group 2 were composed of 31 conception cycles and 49 drug-induced cycles, respectively. Midluteal concentrations of P and E2 did not show any significant differences between the two groups. The P/E2 ratios were 106.4 +/- 71.3 (mean +/- SD) and 71.5 +/- 44.16, respectively. This difference was statistically significant (p less than 0.05). Discriminant function analysis showed that the smallest probability of misclassification between the two groups decreased from 44% when using P only to 36% when using the combined P and E2. The following equation: Y = 0.0727X1 - 0.00456X2 - 0.130 was obtained (when X1 = P, X2 = E2). These results suggest that the midluteal P/E2 ratio gives clinicians the best indication of luteal function for the achievement of pregnancy.

Effect of RU 486 on luteal function in the early pregnant rat.

A dose of 30 mg RU 486/kg, an antiprogesterone, was administered to pregnant rats on Day 2 (Group 1) or Day 4 (Group 2) of pregnancy. RU 486 significantly changed serum progesterone and oestradiol concentrations and luteal 3 beta-HSD and 20 alpha-HSD activities in Group 1, and implantation was significantly inhibited. The luteal 3 beta-HSD activity in Group 2 rats on Day 6 was significantly (P less than 0.01) lower than the control value (7.5 +/- 0.6 and 10.1 +/- 0.6 mU/mg protein respectively). This decline in the 3 beta-HSD activity was followed by a marked decrease in the serum progesterone concentration, resulting in a significant decrease of the progesterone/oestradiol ratio and implantation was completely inhibited. The 20 alpha-HSD activity, which could not be detected on Day 6 in the control rats, was twice as great in Group 2 than in Group 1 rats (17.5 +/- 1.2 and 7.4 +/- 3.1 mU/mg protein respectively). Ultrastructural examination of corpora lutea of Group 2 rats confirmed luteolysis. These results suggest that RU 486 has a luteolytic effect and its anti-implantation effect is concomitant with luteolysis of the corpora lutea of pregnancy.

Up-regulation of the alpha2,6-sialyltransferase messenger ribonucleic acid increases glycoconjugates containing alpha2, 6-linked sialic acid residues in granulosa cells during follicular atresia of porcine ovaries.

The sugar chains in cellular glycoconjugates have many biological functions. Extensive morphological development and remodeling occur in the ovary of female animals. This caused us to study glycobiological characteristics of ovarian cells, particularly granulosa cells that undergo apoptosis during follicular atresia. The lectin Sambucus sieboldiana agglutinin (SSA) specific for Siaalpha2,6Gal/GalNAc showed positive staining for granulosa cells only in atretic follicles of porcine ovaries by lectin histochemistry. Lectin blot analysis for SSA demonstrated specific glycoproteins only in atretic follicles. Furthermore, we performed analysis of backbone structures of SSA-positive glycans carried by granulosa cell glycoproteins increased during atresia by glycosidase treatment. Most of these structures were Siaalpha2,6Galbeta1,4GlcNAc on complex-type N-glycans, suggesting that only ST6Gal I of four distinct alpha2,6-sialyltransferases catalyzes alpha2,6-sialic acid transfer in most of the increased glycoproteins of granulosa cells during follicular atresia. Reverse transcription-polymerase chain reaction analysis demonstrated that the expression of ST6Gal I mRNA was up-regulated in granulosa cells during atresia. These results suggested that the alteration of glycoconjugates by ST6Gal I in granulosa cells during atresia is involved in some processes of ovarian follicular atresia and granulosa cell apoptosis.

[Clinical relapse of rheumatoid arthritis (escape phenomenon) during low-dose methotrexate therapy].

OBJECTIVE: To clarify the incidence and background of clinical relapse (escape phenomenon) during low-dose methotrexate therapy for rheumatoid arthritis. METHODS: Seventy one patients with rheumatoid arthritis (RA) were analyzed. They were started on therapy with methotrexate (MTX) between April 1, 1991 and May 30, 1995. Among them, 60 patients showed clinical improvement within 6 months after the start of the therapy and were subjected to the analysis for clinical relapse (escape phenomenon). RESULTS: Twelve patients showed an initial improvement followed by a relapse with increased serum CRP and number of painful joints despite the MTX therapy was continued. Two types of the relapses were seen; (1) early, escape (relapse after an initial brief improvement) in 7 patients, and (2) late escape (relapse after a long-term improvement with MTX therapy) in 5 patients. The early escape was seen at 9.0 +/- 0.7 months after the start of therapy while the late escape was seen at 23.3 +/- 4.8 months. Patients with both types of escape phenomenon had the longer duration of the disease and more advanced stage. There was no relationship between clinical relapse and age, baseline RA activity, MTX dose, or concurrent use of corticosteroids and other disease modifying anti-rheumatic drugs. The efficacy of MTX for RA was restored by increasing dose of MTX in 11 patients. CONCLUSION: These results suggest that clinical relapse is not rare in RA patients during low-dose methotrexate therapy, but could be improved by increasing dose.

Elevation of serum hepatic aminotransferases during treatment of rheumatoid arthritis with low-dose methotrexate. Risk factors and response to folic acid.

Sixty-six rheumatoid arthritis (RA) patients were analyzed retrospectively to assess the incidence and risk factors for elevation of serum hepatic aminotransferases during methotrexate (MTX) therapy. The effect of folate supplementation on serum ALT and RA activity was evaluated prospectively in 14 patients who showed a sustained high serum level of ALT. The frequency of elevation of serum AST or ALT was 4-5 times greater than in patients taking other DMARDs. Multivariate linear regression analysis demonstrated that elevation of ALT was independently associated with sex (female), obesity, baseline ALT, MTX dose, and gastrointestinal side effects. Folate supplementation caused ALT levels to decrease in all patients within 3 months. Eleven patients showed no change of RA activity, but 3 patients dropped out of the study because of the exacerbation of RA. These results suggest that careful monitoring of serum hepatic aminotransferases is necessary in patients with predisposing factors, especially those receiving more than 0.15 mg/kg of MTX weekly. Folate supplementation can reverse the sustained elevation of ALT, but might cause exacerbation of RA in some patients.

Discovery of a structurally novel opioid kappa-agonist derived from 4,5-epoxymorphinan.

A new type of kappa-agonist, 17-cyclopropylmethyl-3, 14 beta-dihydroxy-4,5 alpha-epoxy-6 beta-[N-methyl-trans-3-(3-furyl) acrylamido]morphinan hydrochloride (1, TRK-820), was discovered by a new working hypothesis. The "message-address concept" for opioid antagonists and the "accessory site" for general antagonists were applied to design TRK-820. A unique structural feature of TRK-820, which is different from other prototypical kappa-opioid receptor agonists, is the existence of the 4,5-epoxymorphinan structure with a tyrosine-glysine moiety for endogenous opioid peptides such as dynorphins. TRK-820 exhibited high potency and high kappa-selectivity in guinea pig ileum (GPI) and mouse vas deferens (MVD) preparations. In the mouse acetic-acid-induced writhing model and mouse tail flick model of antinociception, TRK-820 was 85-140 times more potent than morphine and 85-350 times more potent than U-50488H. This structurally novel kappa-agonist showed neither aversion nor preference in the Conditioned Place Preference test, in spite of the fact that prototypes of kappa-agonists (U-50488H derivatives) demonstrated aversion.