Hideki Teshima

ALOPECIA UNIVERSALIS TREATED WITH ORAL CYCLOSPORINE A AND PREDNISOLONE: IMMUNOLOGIC STUDIES

Alopecia universalis is a refractory condition. Although the cause of this disease is unknown, immunologic abnormalities have recently been suspected. Thus, we treated six cases of refractory alopecia universalis with immunotherapy. Oral administration of cyclosporine A (2.5 mg/kg) and prednisolone (5 mg/day) resulted in marked symptomatic improvement. Cyclosporine A did not produce any side effects because the administered dosage was relatively low. At present, more than 6 months after the cessation of treatment, recurrence of alopecia has not been seen. Oral administration of low‐dose cyclosporine A and prednisolone is considered to be an effective treatment for this disease. Immunologic examination of peripheral blood demonstrated improvement of immunologic function. In particular, cos‐positive T cells, NK cells, and C3, which had been reduced, were increased. A reduction in active CD4 cells, eosinophils, and circulating immune complexes was observed. Histology with fluorescent antibodies showed T‐cell infiltration around the hair matrixes. This phenomenon was no longer observed after treatment. These improvements in immunologic function were seen in parallel with the resolution of the clinical symptoms, indicating that immunologic abnormalities are related to this disease.

Psychosomatic aspects of skin diseases from the standpoint of immunology.

The psychosomatic aspects of skin disease were studied both clinically and experimentally, from the standpoint of immunology. We found that emotional stress has a great influence on the immune system, as was manifested in skin disease. Skin test in allergic patients significantly improved with autogenic training and relaxation. For clarification of the effects of autogenic training and relaxation, various parameters were simultaneously assessed during the treatment. The serum levels of histamine and dopamine-beta-hydroxylase fluctuated, as determined by the microvibration test. The levels of IgE and findings on the PK test varied only slightly. Before the onset of urticaria, there were changes in the life-style and considerable stress in daily life as well as exposure to an allergen. Using mice subjected to stress, the functions of T cells and macrophages were evaluated. Stress appeared to have a definite influence on the functions of these cells, as related to the important role of the immune system and skin. Thus, the role of stress in clinical disease must always be given consideration.

Application of psychoimmunotherapy in patients with alopecia universalis.

Mental stress and immunological abnormality have recently been listed as causes of alopecia universalis. This disease is difficult to treat with only ordinary pharmacotherapy. Thus, from the standpoint of psychoneuroimmunology, stress was relieved by relaxation and image therapy, and administration of small doses of a strong immunosuppressant was effective, leading to clinically favorable results. In addition, changes were recognized in the subpopulation of peripheral lymphocytes and in beta-endorphin before and after relaxation and image therapy. The treatment of alopecia universalis favorably changed the subpopulations of T cells. A patient suffering from alopecia is always under stress. Alleviating this stress facilitates recovery of immunological competence. Our method was effective in 5 of 6 cases with refractory alopecia universalis.

Cold urticaria associated with immunoglobulin M serum factor.

A case of cold urticaria, thought to be due to IgM, is presented. Passive transfer (PT) activity was manifested in cryoglobulin-free serum and in up to 20-fold dilutions of fraction I, the IgM-containing fraction obtained by Sephadex G-200 column chromatography. PT test results were positive with serum absorbed with cold agglutinins, and with heat-treated (56 degrees C, 4 hr) serum. These results were negative with cryoglobulin and after absorbing the supernatant of fraction I with anti-IgM. Skin adhesion time was within 24 hr. The in vivo histamine release during cold stimulation was recorded and in this patient, antihistamine administration proved the best method to alleviate the symptoms.

Influence of stress on the maturity of T-cells.

Stress is known to influence the immune function via an effect on the central nervous system. We previously presented data showing that stress alters the population of T-cell subsets in mice. The variations of T-cell subsets in the thymus, peripheral blood, and spleen in mice similarly stressed by immobilization or by unavoidable and opioid-dependent stress were measured by flow cytometry using the monoclonal antibodies anti-L3T4, anti-Lyt 1, anti-Lyt 2 and anti-Thy 1, 2. Immobilization stress was applied for three days and T-cell subsets were measured on the days 1, 2 and 3, as well as on day 7 after release from immobilization. Lyt 2-positive cells in the thymus were the most sensitive to stress, showing significant variations. The proportion of immature T-cells increased in the thymus, blood and spleen of the stressed mice. When diazepam or naloxone were administered 30 min before the initiation of stress, these variations tended to decrease. Thus, the ratio of T-cell subsets varied with the duration of immobilization stress. This appeared to be partly mediated by the opioid system and the central nervous system.

Prevention of immunosuppression in stressed mice by neurotropin(NSP)

It is well known that the immune function can be compromised by stress. To investigate immune function in mice stressed by experimental restraint or unavoidable and opioid dependent stress, we evaluated the changes in total body weight and in organ weights (liver, spleen and thymus) of these animals, as well as the phagocytic activity of macrophages, the cytotoxicity of T cells and inhibitory effects on tumor growth and changes in T cell subset populations. At the same time we evaluated the effects of Neurotropin (NSP), a substance extracted from the inflamed skin of rabbits inoculated with the vaccinia virus and which appears to possess neuroimmunomodulating activity. The experimentally stressed group exhibited a reduction of phagocytic activity of macrophages, cytotoxicity of T cells and inhibitory effects on tumor growth. In addition there were changes in the population of T cell subsets. In those animals pretreated with NSP, the immunosuppression induced by stress was ameliorated. As compared with several agents which influence phagocytosis, neurotropin exhibited effects similar to that of agents that blocked the adrenaline receptor and an opioid antagonist rather than tranquilizer (diazepam) and a cholinergic receptor blocker. The pharmacologic effects of neurotropin support a relationship between the actions of the central nervous system and the immune system.

A Comparative Study on Somatic Treatment and Comprehensive Treatment of Bronchial Asthma

Asthmatic patients who were treated at our hospital for at least 3 months and for whom a follow-up was conducted were divided into 2 groups according to their attitudes toward psychotherapy: Group I who accepted psychotherapy and Group II who did not accept it as part of our comprehensive approach. We examined the differences in therapeutic results in these two groups obtaining the following information: (1) No significant differences was found between Groups I and II as to the onset age, family history, type, severity, laboratory findings, etc. (2) In Group I, no significant difference was found in therapeutic results as to the onset age, type of asthma, its severity, etc. (3) In Group II, a significant difference was observed in the therapeutic results as to the onset age, type of asthma and its severity. These findings were almost identical to the literature of the internal medicine field. (4) The difference in therapeutic results of Groups I and II was assumed to be related to the use of psychotherapy when psychological factors were present. (5) Although psychotherapy was shown to be effective in the treatment of bronchial asthma, we need to be aware that there is often initial resistance to the process and a tendency for patients to terminate prematurely.

Plasminic Activity and Emotional Stress

Hereditary angioneurotic edema (HANE) is clearer in the etiology than the other types of angioneurotic edema. It shows abnormal serum complemental activity and various clinical signs. It has been repo

Atopic Disposition and Bronchial Reactivity to Inhaled Acetylcholine in Young Adults with a History of Asthma in Childhood

The atopic disposition, indicated by positive skin reactions and IgE antibody titers etc., and the bronchial reactivity to inhaled acetylcholine were examined on the following three groups: (1) 20 young adults with a history of childhood asthma who have been symptom-free for more than 4 yr; (2) 20 current asthmatics, and (3) 20 healthy young adults. Young adults with a history of childhood asthma remained atopic in their disposition even after complete clinical remissions of their childhood asthma. However, they had a lower bronchial reactivity as compared with current asthmatics, although the bronchial reactivities of both groups were apparently higher than the control group.

Specificity Concepts in Japan

In this study, the authors discuss whether there are any differences in the acquired factors, such as psychosocial factors, related to the age at the onset of psychosomatic disorders, and whether or not there are any characteristics which can be considered unique to Japanese asthmatic patients. Many firstborns were found in those whose onset age was below 10 or in their teens. In those patients who had the onset of asthma in their 20s or 30s many women suffered problems with their mother-in-law after marriage or with their husbands who were interested only in work. We have also discussed that behind these phenomena, problems of parent-child relationship in early childhood were hidden.