Blast Crisis of Chronic Myelogenous Leukemia with Tumor Formation Characterized by T-cell Features--A Case Report

We report a case of chronic myelogenous leukemia (CML) associatedwith pronounced peripheral lymphadenopathy, with the cells havingthe Philadelphia (Phl) chromosome and T-cell features. A 23-year-oldman who was diagnosed as having CML and treated with busulfanwas admitted to our hospital because of increasing hepatosplenomegalyand pronounced lymphadenopathy. An axillary lymph node biopsydisclosed that the malignant cells formed rosettes with neuraminidase-treatedsheep red blood cells (En) (95.0%) and were positive for Leu1 (91.8%). Of the cytochemical reactions, peroxidase was negativeand periodic acid-Shiff, acid -naphthyl acetate esterase andß-glucuronidase were all positive. The karyotype ofthe bone marrow cells was 46 XY Phl positive (22q–), andthat of the lymph node cells was 51 XY Phl positive +8, +9,+18, +19, +21, 22q–. He was treated with various anti-leukemicagents and irradiation. Despite such treatments, he died ofpneumonia. This is a report of a CML patients with blast crisisand tumor formation characterized by T-cell features.     

Effects of Atrial Tachypacing on Symptoms and Blood Pressure in Severe Orthostatic Hypotension

The treatment of severe orthostatic hypotension (OH) is currently unsatisfactory and usually includes various pharmaceuticals to expand the blood volume and promote peripheral vasoconstriction. This study examined the short- and intermediate-term effects of atrial tachypacing (ATP) in patients with severe OH. We implanted dual chamber pacemakers in five patients (mean age 64 ± 7 years; four men), presenting with drug refractory, recurrent syncope, and OH due to panautonomic failure with severe chronotropic incompetence and absence of rate acceleration upon assuming the upright posture. The blood pressure (BP) was measured in the supine and passive upright postures, during sinus rhythm, and during atrial pacing at 90, 100, and 110 ppm, at 1 week and at discharge and/or 3 months after pacemaker implantation. Alleviation of symptoms and a delay in the fall in upright BP were observed in a single patient at 1 week, while at discharge and/or 3 months, all patients were markedly improved. The mean fall in systolic/diastolic BP between supine and upright position decreased from 73 ± 17/46 ± 13 mmHg before, to 56 ± 27/41 ± 30 mmHg during ATP. Although these changes did not reach statistical significance, the time required for the fall in BP lengthened significantly from 2.1 ± 0.2 minutes during sinus rhythm to 9.3 ± 1.5 minutes during ATP (P < 0.001).
Conclusions: At discharge and/or 3 months of follow-up, ATP conferred beneficial effects on orthostatic BP and alleviated symptoms in patients with severe OH. The short-term effects of ATP did not reflect its longer-term effects in four of the five patients.     

Clinical pharmacological study of a plasma‐derived factor VIIa and factor X mixture (MC710) in haemophilia patients with inhibitors – Phase I trial

Summary. MC710, a combined product of plasma‐derived activated factor VII (FVIIa) and factor X (FX) at a protein weight ratio of 1:10, is a novel bypassing agent for haemostasis in haemophilia patients with inhibitors. In this study, pharmacokinetic (PK), pharmacodynamic (PD) parameters and safety of single doses of MC710 were investigated in 11 male haemophilia patients with inhibitors in a non‐bleeding state. This was a multi‐centre, open‐labelled, non‐randomized, active controlled crossover, dose‐escalation study of five doses (20–120 μg kg⁻¹ of FVIIa) with re‐administration of different MC710 dosages to the same subjects. The active controls were NovoSeven (120 μg kg⁻¹) and/or FEIBA (50 and 75 U kg⁻¹) which were used to compare PD parameters. The area under the curve (AUC) and maximum plasma concentration (C_max) of MC710 active ingredients increased dose‐dependently within the range of 20 and 120 μg kg⁻¹. After administration of MC710, activated partial thromboplastin time (APTT) was dose‐dependently improved and prothrombin time (PT) was shortened to approximately 6 s at 10 min, and APTT improvement and PT shortening effects were maintained until 12 h after administration of MC710 at all doses. No serious or severe adverse event was observed after administration of MC710; furthermore, several diagnostic marker values and those changes did not indicate any signs of disseminated intravascular coagulation (DIC). These results suggest that MC710 would have haemostatic potential equal to or greater than NovoSeven and FEIBA and was be tolerable when given at doses up to 120 μg kg⁻¹.     

A case of Kabuki make-up syndrome with central diabetes insipidus and growth hormone neurosecretory dysfunction

A case of a 6 year old boy with Kabuki make-up syndrome with central diabetes insipidus and growth hormone neurosecretory dysfunction is reported. Magnetic resonance imaging revealed abnormal findings of the pituitary gland and stalk. Good catch-up growth was obtained by treatment with growth hormone. These findings suggest that hypothalamic-pituitary dysfunction might be involved in Kabuki make-up syndrome.     

Induction of Suppressor T Cells by Anti-Globoside Antibodies in Cancer Sera

T cells treated with cancer sera frequently suppressed immunoglobulinproduction by autologous lymphocytes stimulated with pokeweedmitogen. Sera from healthy individuals did not induce suppressoractivity. This suppression is not caused by T_G cells (T cellsbearing receptors for the Fc portion of immunoglobulin G [IgG])interacting with immune complexes, because we used T cells depletedof T_G cells. The suppressor-inducing factors were separatedinto an IgG-containing fraction and a fraction with a smallermolecular weight. IgG fractions from all sera that were positivefor anti-globoside antibody induced suppressor T cells, andelimination of the anti-globoside antibody from these IgG fractionsreduced the ability to induce suppressor T cells. T cells treatedwith rabbit anti-globoside antiserum also activated suppressorT cells. These observations indicate that the antibodies directedto the globoside antigen on suppressor T cells stimulate thesuppressor T cells, and that anti-globoside antibody in cancersera may play a role in causing immunodeficiency in cancer patients.     

Solution structure of the phosphorylated sites of ribosomal protein S6 by 1H NMR spectroscopy

An increase in the rate of protein synthesis is found to be accompanied by phosphorylation of the 40S ribosomal protein S6. Treatment of S6 by cyanogen bromide produced three fragments, and one of the fragments of S6, which is a C-terminal portion of S6 (M_r? 4000), contains all phosphorylation sites of S6. The C-terminal fragment of S6 contains seven serines. S6 kinase phosphorylates S6 specifically, i.e. five serines in the C-terminal of S6 are phosphorylated. The three-dimensional structure of S6 peptide was studied in 50% trifluoroethanol/50% H₂O solution by ¹H NMR with combined use of distance geometry and restrained molecular dynamics calculations. NMR results indicated that it takes an α-helix between Glu5 and Arg21 and a distorted helical structure for the following three residues, but no rigid structure was present from Ser25 through the C-terminus and for the N-terminal region (Lys1-Lys4). The specificity of the phosphorylation of the peptide is discussed from a structural aspect. © Munksgaard 1996.     

Solution structure of a human calcitonin analog elucidated by NMR and distance geometry calculations

Three-dimensional structure of a human calcitonin analog (abbreviated as hCTa) in which the amino acids of the wild type are replaced at positions 12, 16 and 19 by leucine residues and further at position 22 by a tyrosine residue was studied in TFE solution by ¹H-NMR and distance geometry calculations. This analog has a 15-20 times activity as compared with the wild type. The amino acid replacements resulted in formation of an amphiphilic α-helix in the region between the residues 4-20. The overall three-dimensional structure is similar to that of the wild type. The conformational feature of hCTa with a hydrophobic face composed with a Met and four Leu residues may be related to its higher hypocalcemic potency.     

Structural studies on endothelin receptor subtype B specific agonist IRL 1620 (suc-[Glu9,Ala11,15]ET-1(8-21)) and its analogs with dipalmitoyl phosphatidylcholine vesicles by NMR spectroscopy

IRL 1620 {suc-[Glu⁹,Ala^11,15]ET-1(8-21)} is a potent and specific agonist for the ET_B receptor. Five analogs of IRL 1620 were synthesized in this study. These were all C-terminal linear peptides of endothelin 1 (ET-1) comprising 14 amino acid residues and exhibiting highly potent ET_B receptor binding affinities. The peptides consisted of three pairs and each component of the pairs differed from its partner in only the 18th residue, i.e. Asp was replaced by Gly. The replacements resulted in more than a 10-fold increase in affinity to the ET_A receptor. The structures of these peptides were investigated in the presence of phospholipid vesicles (dipalmitoyl phosphatidylcholine) by NMR spectroscopy. By the replacement of Asp by a less bulky Gly, the C-terminal tripeptide region folded back toward the helical region, making it shorter than the Asp-substituted peptide helical region. Such a folded conformational feature may explain the increased binding affinity to ET_A receptor.