Yoshihito Otsuji

Monocyte-Mediated Suppression of Mitogen Responses of Lymphocytes in Uremic Patients

In the present experiment, we investigated the mechanism of the suppressed mitogen responses of peripheral blood mononuclear cells (PBMC) from uremic patients. We used phytohemagglutinin (PHA) and concanavalin A (Con A) as T cell mitogens, pokeweed mitogen (PWM) as a T cell-dependent B cell mitogen, and Staphylococcus aureus Cowan I (STA) as a T cell-independent B cell mitogen. PBMC from uremic patients showed significantly suppressed responses to PHA (p less than 0.05), Con A (p less than 0.05) and STA (p less tha 0.01) compared with those from healthy controls, but there was no significant difference in PWM response. However, these suppressed responses to PHA and Con A were markedly restored by depletion of phagocytic cells from PBMC. Although STA responses were also restored markedly in uremic patients, some patients still showed lower responsiveness to STA indicating the possibility of functional B cell defects. To further clarify the mechanism of the suppressed responses to mitogens, PBMC or nonphagocytic cells from uremic patients were cocultured with control T cells in the presence of PHA, or the effects of adherent cells from uremic patients on PHA responses of autologous or allogeneic control T cells were studied. From these experiments, it was suggested that the suppressed responses of PBMC to mitogens in uremia were mediated by monocytes.

Erythrocyte Membrane Fluidity Decreased in Uremic Hemodialyzed Patients

Erythrocyte membrane fluidity was studied by means of electron spin resonance in 15 uremic, hemodialyzed patients and 14 normal subjects. Erythrocyte membrane fluidity determined using a 16-nitroxide stearic acid spin label probe was of a significantly lower level in the uremic patients, when compared with normal control subjects. Alterations in molar ratios of membrane free cholesterol to phospholipid are probably not a principal factor contributing to this change in fluidity. Significant decreases of phosphatidylcholine and molar ratios of phosphatidylcholine to sphingomyelin were noted in the erythrocyte membrane of uremic patients, and these alterations may relate to the fluidity change.

Deposition of α1-Antitrypsin and Loss of Glycoconjugate Carrying Ulex europaeus Agglutinin-I Binding Sites in the Glomerular Sclerotic Process

Sclerotic processes of glomeruli in chronic pyelonephritis (CPN) and chronic diffuse proliferative glomerulonephritis (CDPGN) were investigated in a lectin binding study in connection with an immunofluorescent examination of protease inhibitor deposition. Ulex europaeus agglutinin-I (UEA-I), which is specific to a certain terminal α-L-fucosyl residue of glycoconjugates, specifically labelled intact endothelia of glomerular capillaries, peritubular capillaries and blood vessels in human kidneys. Segmental or global loss of the UEA-I binding with glomerular capillaries was observed in the sclerotic areas where αi-antitrypsin (α1AT) deposits were always detected in the glomeruli with segmental or global sclerosis of CPN. This high correlation between loss of UEA-I binding and α1AT deposition was also observed in the affected glomeruli of CDPGN. In considering glomerular sclerosis, it is significant that loss of UEA-I binding and α1AT deposition are common to both CPN and CDPGN, although their original etiologies are quite different.

Ulex europaeus Agglutinin I Staining of Human Glomerular Lesions Using a Highly Sensitive Immunoperoxidase Method in Paraffin Sections

This communication reports on the excellent results achieved with Ulex europaeus agglutinin I staining of glomerular capillary endothelium using a highly sensitive lectin-antilectin immunoperoxidase method in routine paraffin sections. This staining method will be very useful for detailed morphological or retrospective studies of glomerular endothelia in various renal diseases.

A patient treated with peritoneal dialysis for chronic renal failure complicated with hemophilia A

26歳, 男性の血友病Aの患者が腎不全を合併したため, 腹膜透析 (PD) を施行した.PD開始の2ヵ月前に起した右大腿骨骨折が, 腎機能障害の進行に何らかの影響を与えた可能性はあるが, 腎不全のはっきりした原因は不明である.VIII因子濃縮製剤を補充することにより, 特に大きな腹腔内出血を来たすことなく, 突然の脳出血のために死亡するまでに, 111回のPDを施行し得た.

Psychological analysis in long-term dialysis patients

透析療法の進歩, 普及に伴って長期透析患者が増加しているが, 自己管理の良否につながる心理的問題も透析患者の予後の面に関係していると思われる. 私どもは10年以上の長期透析患者を中心に心理学的分析を加え, 長期生存するための心理的因子を明らかにすべく検討を行った.方法: 1) 種々の合併症を克服しながら12年7ヵ月を迎えた1症例の精神的・心理的経過の面接法による分析, 2) 透析患者60名に対するCornell medical index (以下CMI) およびself rating questionnaire for depression (以下SRQ-D) の2種の心理テストによる分析, 3) 長期透析患者に対するsocial adjustment scale (以下SAS) およびdialysis sentense completion test (以下D-SCT) の2種の心理テストによる分析.結果: 本症例の精神的心理的経過の分析により1) 家族の励ましおよび宗教による心の支えが大きい, 2) 合併症に対してそれぞれ複雑な心理的反応を示している, 3) 経済的な問題が大きく関与する, 4) 透析年数の経過とともに力強くなってきている等が明らかになった. 透析患者60名に対するCMI, SRQ-Dの2種の心理テストの結果, 長期生存者ほど神経症的傾向, 抑うつ的傾向が少ないことがうかがえた. SAS, D-SCTの2種の心理テストの結果, 長期生存者ほど発病前の適応も良く, 発病後の療養生活に対しても良い適応を示していることが明らかとなった.

Immune responses to HBs vaccine in hemodialysis patients

血液透析患者8例に不活化HBsワクチンを投与後, 抗HBs抗体産生能を検討し以下の結果を得た. 1) 血液透析患者では抗HBs抗体産生能の低下および抗体の発現時期の遅延傾向がみられた. 2) 免疫学的検索では患者の抗HBs抗体非産生群でT cell subsetsのうちOKT8陽性細胞の比率の増加がみられた. 3) in vitroのmitogenに対するリンパ球増殖能は抗体産生群と非産生群の間で特に差はみられなかった. 4) 血清免疫グロブリン, 補体, 副甲状腺ホルモンおよび血清フェリチン値は抗体産生能と関係がなかった.以上の事実より, 血液透析患者の抗HBs抗体産生能の低下は, suppressor T cellを介した免疫能抑制の機序が関与しているために起こると考えられた.