Matrix metalloproteinase 9 (MMP-9) in patients with rheumatoid arthritis

Matrix metalloproteinase 9 (MMP-9) degrades type IV collagen, gelatin, type V collagen and type XI collagen. We measured proMMP-9 and proMMP-9-TIMP-1 complex in sera and joint fluids by sandwich ELISA, and immunohistochemically examined the expression of this enzyme in joint tissues from patients with rheumatoid arthritis (RA). ProMMP-9 was purified from the culture medium of HT 1080 cells by the three steps of chromatography. Purified proMMP-9 and activated MMP-9 by aminophenylmercuric acetate showed two bands of 92 and 67 kDa on gelatin zymography. We raised two monoclonal antibody clones, named 2G9 and 8G7, against proMMP-9. 2G9 and 8G7 reacted with proMMP-9 in western blotting and these clones reacted not only with proMMP-9, but also with proMMP-9-TIMP-1 complex in sandwich ELISA, respectively. The proMMP-9 concentration in 86 sera (749.4±940.2 ng/ml) and 54 joint fluids (4539.9±7681.5 ng/ml) from patients with RA was significantly higher than those of patients with osteoarthritis (15 sera: 139.0±149.6 ng/ml; 16 joint fluids: 655.0±1982.8 ng/ml) and control (37 sera: 266.7±120.4 ng/ml; three joint fluids: 0 ng/ml). The immunohistochemistry with 2G9 monoclonal antibody showed that proMMP-9 were expressed in the neutrophils and the monocytes-macrophages which diffusely infiltrated in the sublining layer of rheumatoid synovium. In addition, the osteoclasts along subchondral bone were also intensively stained. The proMMP-9 concentration in joint fluids from 39 RA patients was positively correlated to the count of proMMP-9 positive cells in RA synovium (r=0.607) and to the score of diffuse infiltrates of lymphocytes (r=0.720). However, it did not show correlation to the stage and the class defined by Steinbrocker and to the other clinical laboratory data. Our results suggest that proMMP-9 actively participates in joint destruction of RA through the expression of neutrophils and monocytes-macrophages and is regulated by lymphocytes.     

Clinical characteristics and early outcomes of patients newly diagnosed with pulmonary Mycobacterium avium complex disease

Background

The incidence of asymptomatic pulmonary Mycobacterium avium complex (MAC) disease appears to be increasing. This study aimed to determine the clinical characteristics and examine early outcomes of patients newly diagnosed with MAC disease.

Current practice in low-density lipoprotein-cholesterol measurements for the clinical management of hyperlipidemia

OBJECTIVES AND METHODS: Low-density lipoprotein cholesterol (LDL-C) measurements in clinics were evaluated by a multiple-choice questionnaire sent to 146 physicians (78 general practitioners and 68 hospital physicians) in Niigata Prefecture, Japan. RESULTS: Seventy-six percent of the general practitioners and 84% of the hospital staff measured LDL-C, and 60% of all physicians calculated LDL-C using the Friedewald formula. Sixty-two percent of general practitioners and 43% of hospital physicians took blood samples without overnight fasting and 40-50% of whom estimated LDL-C using the Friedewald formula, although the formula is reliable only for samples collected after an overnight fast. Two thirds of the physicians managed patients according to the Japan Atherosclerosis Society Guidelines (1997), whereas 40-50% based diagnoses and treatments on total cholesterol, and only 20-30% used LDL-C-based management. CONCLUSIONS: Direct measurement, education and management of LDL-C not affected by diet are mandatory.     

Strategy for treating elderly Japanese with hypercholesterolemia*

Background: It has been widely accepted that control of serum cholesterol levels is effective for prevention of cardiovascular events. Recent data have suggested that this is also the case in the elderly. Methods: A research group (chaired by T. Kita) was organized as part of the Comprehensive Research on Aging and Health conducted by the Japanese Ministry for Health, Labour, and Welfare in 1999–2002 to determine the best strategy for control of cholesterol levels in elderly Japanese with hypercholesterolemia. In order to do this a review of the literature was conducted. Conclusion: The research group concluded: (i) Japanese patients aged 65–74 years with hypercholesterolemia should be treated by following the Guideline for Diagnosis and Treatment of Atherosclerotic Cardiovascular Diseases by the Japan Atherosclerosis Society (2002), as cholesterol‐lowering therapy would bring a similar, or even larger, preventive effect to the elderly, whose absolute risk of cardiovascular events is higher than that in the younger population; (ii) target cholesterol levels in elderly Japanese aged ≥ 75 years with hypercholesterolemia should be determined individually according to their physical activities. It is noted that the elderly are more susceptible to drug‐related adverse effects than the younger since renal and liver functions, required for metabolizing drugs, in the elderly are relatively weaker.     

Observation of femtosecond X-ray interactions with matter using an X-ray–X-ray pump–probe scheme

Resolution in the X-ray structure determination of noncrystalline samples has been limited to several tens of nanometers, because deep X-ray irradiation required for enhanced resolution causes radiation damage to samples. However, theoretical studies predict that the femtosecond (fs) durations of X-ray free-electron laser (XFEL) pulses make it possible to record scattering signals before the initiation of X-ray damage processes; thus, an ultraintense X-ray beam can be used beyond the conventional limit of radiation dose. Here, we verify this scenario by directly observing femtosecond X-ray damage processes in diamond irradiated with extraordinarily intense (∼10¹⁹ W/cm²) XFEL pulses. An X-ray pump–probe diffraction scheme was developed in this study; tightly focused double–5-fs XFEL pulses with time separations ranging from sub-fs to 80 fs were used to excite (i.e., pump) the diamond and characterize (i.e., probe) the temporal changes of the crystalline structures through Bragg reflection. It was found that the pump and probe diffraction intensities remain almost constant for shorter time separations of the double pulse, whereas the probe diffraction intensities decreased after 20 fs following pump pulse irradiation due to the X-ray–induced atomic displacement. This result indicates that sub-10-fs XFEL pulses enable conductions of damageless structural determinations and supports the validity of the theoretical predictions of ultraintense X-ray–matter interactions. The X-ray pump–probe scheme demonstrated here would be effective for understanding ultraintense X-ray–matter interactions, which will greatly stimulate advanced XFEL applications, such as atomic structure determination of a single molecule and generation of exotic matters with high energy densities.Since W. C. Röntgen discovered X-rays emitted from vacuum tube equipment in 1895, scientists have continuously endeavored to develop brighter X-ray sources throughout the 20th century. One of the most remarkable breakthroughs was the emergence of synchrotron light sources, which were much more brilliant than the early lab-based X-ray sources. Such dramatic increase in X-ray brilliance provided a pathway to obtain high-quality X-ray scattering data. This, in turn, enabled one to solve the structures of complex systems such as proteins, functional units of living organisms, and viruses. However, the increase in the brilliance is also accompanied by a severe problem of X-ray radiation damage to the samples being examined (1). X-rays ionize atoms and generate highly activated radicals that break chemical bonds and cause changes in the structures of the samples. To achieve structure determination precisely, a sufficient scattering signal should be recorded before the samples are severely damaged. Radiation damage was considered to be an intrinsic problem associated with X-ray scattering experiments, which imposed a fundamental limit on the resolution in X-ray structure determination (2).The recent advent of X-ray free-electron lasers (XFELs) (3–5), which emit ultraintense X-ray pulses with durations of several femtoseconds, may totally avoid the problem of radiation damage. The irradiation of intense XFEL pulses generates highly ionized atoms, and the strong Coulomb repulsive force leads to evaporation of the samples. Meanwhile, it has been predicted theoretically (6) that atoms do not change their positions before the termination of the femtosecond X-ray pulse owing to inertia, thus enabling the use of X-ray radiations beyond the conventional X-ray dose limit. This innovative concept, called a “diffraction-before-destruction” scheme (6, 7), has paved a clear way to high-resolution structure determinations of weak scattering objects, including nanometer-sized protein crystals (8), noncrystalline biological particles (9), and damage-sensitive protein crystals (10).Despite the potential impact of XFELs, detailed understanding of the ultrafast XFEL damage processes has been missing. As a pioneering work, Barty et al. (11) measured the diffraction intensities of protein nanocrystals by changing the XFEL pulse durations from 70 to 300 fs at intensities of ∼10¹⁷ W/cm². They found that the diffraction intensities greatly decrease for longer durations, clearly indicating sign of structural damage, i.e., X-ray–induced atomic displacements within the XFEL pulse durations. For further understanding of ultraintense X-ray interactions with matter, we need to directly measure the temporal changes of the structural damage. In particular, measuring the ignition time of the atomic displacements is crucial for realizing advanced applications with greatly intense XFELs. Although improving our knowledge of the X-ray damage processes is essential for all aspects of XFEL science, the experimental verifications have been missing because of the extreme difficulty in observation with ultrahigh resolutions in space (ångstrom) and time (femtosecond).As a new approach to investigate the femtosecond X-ray damage processes, we here propose an X-ray–X-ray pump–probe experiment using double X-ray pulses; a pump X-ray pulse excites a sample and a probe X-ray pulse with a well-controlled time delay characterizes the change in the sample. In this approach, it is highly useful to exploit two-color double pulses with tunable temporal separations (12–15), which have been developed at SPring-8 Angstrom Compact free-electron LAser (SACLA) (4) and Linac Coherent Light Source (3). In this article, we measured the X-ray damage processes of diamond by using an X-ray–X-ray pump–probe diffraction experiment at SACLA. As the carbon–carbon bond is one of the most fundamental bonds in biomolecules, our results should provide a benchmark for XFEL-induced damage to practical samples.     

Safety,reliability, and operability of cochlear implant electrode arrays coated with biocompatible polymer

Conclusion: Polymer-coated electrodes can reduce surgically-induced trauma associated with the insertion of a cochlear implant (CI) electrode array. Objectives: To evaluate if insertion trauma in CI surgery can be reduced by using electrode arrays coated with 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer. Methods: We analyzed characteristics of the Contour Advance® electrode arrays coated with MPC polymer. To assess surgical trauma during electrode insertion, polymer-coated or uncoated (n = 5 each) animal electrode arrays were implanted in guinea pig cochleae and operability and electrophysiological and histological changes were assessed. Results: Under light and scanning electron microscopy, polymer-coated electrodes did not appear different from uncoated electrodes, and no change was observed after mechanical stressing of the arrays. Electrode insertion was significantly easier when polymer-coated electrodes were used. Auditory brainstem response (ABR) thresholds did not differ between groups, but p1-n1 amplitudes of the coated group were larger compared with the uncoated group at 32 kHz at 28 days after surgery. The survival of outer hair cells and spiral ganglion cells was significantly greater in the polymer-coated group.     

Rectal submucosal tumor-like lesion originating from intestinal tuberculosis

We present the case of a 55-year-old man who underwent transsacral local excision for a rectal submucosal tumor-like lesion suspected to originate from tuberculosis. The lesion, 2 cm in size, was found incidentally in the posterior wall of the lower rectum during anal fistulectomy. The lesion was apart from the primary crypt of the anal fistula. Barium enema and colonoscopy revealed a protuberant submucosal growth with a shallow depression of the overlying mucosa. Although computed tomography and magnetic resonance imaging showed a well defined round mass within the rectal wall, digital rectal examination suggested extramural origin. Since repeated endoscopic biopsies were negative, we selected the transsacral approach for excisional biopsy to achieve histological diagnosis. The lesion was confined to the rectal wall and the full-thickness rectal wall was excised. Histologically, a foreign-body granuloma with acute inflammation was the main component of the lesion. Caseating granulomas and Langhans' giant cells, consistent with tuberculosis, were also found.