Spectrum of Disorders Associated with Elevated Serum IgG4 Levels Encountered in Clinical Practice

IgG4-related disease (IgG4-RD) is a recently described systemic fibroinflammatory disease associated with elevated circulating levels of IgG4 and manifests a wide spectrum of clinical presentations. Although serum IgG4 level has been described to be the most sensitive and specific laboratory test for the diagnosis of IgG4-RD, it is recognized that an elevated serum IgG4 level can be encountered in other diseases. In this study, we sought to identify the frequency of IgG4-RD and other disease associations in patients with elevated serum IgG4 levels seen in clinical practice. Among 3,300 patients who underwent IgG subclass testing over a 2-year period from January 2009 to December 2010, 158 (4.8%) had an elevated serum IgG4 level (>140 mg/dL). IgG4 subclass testing was performed for evaluation of suspected IgG4-RD or immunodeficiency. Twenty-nine patients (18.4%) had definite or possible IgG4-RD. Among those patients without IgG4-RD, a broad spectrum of biliary tract, pancreatic, liver, and lung diseases, as well as systemic vasculitis, was diagnosed. We conclude that patients with elevated serum IgG4 levels encountered in clinical practice manifest a wide array of disorders, and only a small minority of them has IgG4-RD

Carrier-mediated active transport of the glucuronide and sulfate of 6- hydroxy-5,7-dimethyl-2-methylamino-4-(3-pyridylmethyl) benzothiazole (E3040) into rat liver: quantitative comparison of permeability in isolated hepatocytes, perfused liver and liver i

ABSTRACT The hepatic uptake of glucuronic acid and sulfate conjugates of 6-hydroxy-5,7-dimethyl-2-methylamino-4-(3-pyridylmethyl) benzothiazole (E3040), a dual inhibitor of 5-lipoxygenase and thromboxane A 2 synthetase, was investigated in rats. The biliary excretion clearance values for the glucuronide and the sulfate, obtained after i.v. administration of E3040, were similar and corresponded to approximately 30% of the hepatic blood flow rate. The influx clearance values of E3040 conjugates in the presence of 3% bovine serum albumin, measured by a multiple indicator dilution method in the perfused liver, were 1.20 ml/min/g liver for the glucuronide and 0.74 ml/min/g liver for the sulfate, which were twice and equal to the normal hepatic plasma flow rate, respectively, which suggests the presence of an efficient transport system(s). The uptake of E3040 conjugates into the isolated hepatocytes is mediated by Na ϩ -independent active transport system(s), which is inhibited by dibromosulfophthalein and bile acids. The uptake for the sulfate had high-affinity and high-capacity transport activity (K m ϭ 25 M; V max ϭ 7.8 nmol/min/10 6 cells) compared with that for the glucuronide (K m ϭ 59 M; V max ϭ 2.2 nmol/min/10 6 cells). The uptakes of E3040 conjugates (glucuronide, sulfate) exhibited a mutual competitive inhibition. It is suggested that both conjugates share a multispecific organic anion transporter located on the sinusoidal membrane. Conjugative metabolism, such as glucuronidation and sulfation, is an important pathway for the inactivation or detoxification of xenobiotics. On the other hand, conjugative metabolites of certain drugs with pharmacologically active (such as the 6-glucuronide of morphine; In previous studies, we reported the disposition of glucuronide and sulfate of E3040, a novel dual inhibitor of 5-lipoxygenase and thromboxane A 2 synthetase, after administration Received for publication May 24, 1996. ABBREVIATIONS: E3040, 6-hydroxy-5,7-dimethyl-2-methylamino-4-(3-pyridylmethyl) benzothiazole; [ C]E3040, [2- 14 C]6-hydroxy-5,7-dimethyl-2-methylamino-4-(3-pyridylmethyl) benzothiazole dihydrochloride; SD rats, Sprague-Dawley rats; DBSP, dibromosulfophthalein; HEPES, N-2-hydroxyethylpiperazine-NЈ-2-ethanesulfonic acid; MID method, multiple indicator dilution method; HPLC, high-performance liquid chromatography; BSA, bovine serum albumin; TLC, thin-layer chromatography; AUC ϱ , the area under the plasma concentration-time profiles from zero to infinity; CL bile , the biliary excretion clearance; CL renal , the urinary excretion clearance; CL u,renal , the unbound urinary excretion clearance; X bile , the amount excreted into the bile; X urine , the amount excreted into the urine; CL tot , the total body clearance; PS inf , the influx clearance; PS u,inf , the unbound influx clearance; K inf , the influx rate constant; K eff , the efflux rate constant; K seq , the sequestration rate constant; K m , Michaelis constant; V max , maximal uptake rate; P dif , the nonspecific uptake clearance; LUR, the first-pass liver uptake ratio; UWL, the unstirred water layer; PCMBS, p-chloromercuriphenylsulfonic acid; DIDS, 4,4Ј-diisothiocyanatostilbene-2,2Ј-disulfonic acid; FCCP, carbonyl cyanide-p-(trifluoromethoxy)-phenylhydrazone; C/M, cell-to-medium concentration

A Novel Concept of Fundus-Ovary-Salpinx-Para-Aorta Implantation Promoting Unit during Human Embryo Implantation

Human embryo implantation is mainly regulated by the endocrine system. Since the ovary, fallopian tube, and fundus can directly communicate through the mesosalpinx and ovarian ligament, the local concentration of progesterone in the pathway of the developing embryo is considered to be higher than in systemic blood circulation. The immune system promotes embryo implantation by stimulating progesterone production of the ovary and by inducing endometrial differentiation. The recognition of the developing embryo in the fallopian tube by the immune system is achieved through the para-aortic lymph nodes. On the basis of the above evidence, the autologous immune cells activated in vitro were demonstrated to improve clinical pregnancy rates in patients with repeated implantation failures. In addition, the autonomic nerve system that innervates the fundus, the ovary, and the fallopian tube from the para-aortic region is proposed to regulate the environment of the pathway of the developing embryo. From these findings, we suppose that a unique unilateral functional unit to promote human embryo implantation exists in the pathway of the developing embryo including the para-aortic regions and propose naming this novel functional unit the Fundus-Ovary-Salpinx-Para-aorta Implantation Promoting unit (FOSPa-IP unit)

Relationship Between Orthostatic Blood Pressure Changes and Postural Sway When Standing up from a Chair in Older Adult Females

Background: Orthostatic reductions in blood pressure upon standing are common among the elderly. This orthostatic blood pressure changes may relate to the augmentation of postural sway and may be an important risk factor for falls. Thus, to clarify whether orthostatic blood pressure change on standing up from a chair is relevant to postural sway, we simultaneously measured changes in blood pressure and the movement of a weighted center upon standing. Methods: A total of 63 older adult females were investigated. Blood pressure [systolic blood pressure (SBP), diastolic BP] measured in a sitting position were defined as the baseline levels. The movement of center of pressure (COP) was measured using a stable force platform to quantify postural stability. Participants were instructed to stand up from a chair on the platform and maintain an upright position with their eyes open for 40 seconds. Upon standing, the participant\u27s blood pressure and the movement of COP were recorded. Pearson\u27s correlation was performed to determine relationships between the changes in BP and the movement of COP [distance of the movement of COP (LNG), envelopment area traced by the movement of COP (AREA)]. Results: SBP was reduced while maintaining an upright position for 40 seconds (-5.0 ± 8.6 mmHg), but not diastolic BP (0.6 ± 4.3 mmHg). Moreover, the change in SBP showed a negative relationship with LNG (r = -0.43, p < 0.01) and AREA (r = -0.31, p < 0.05). Conclusion: These results suggested that postural change influenced SBP, and that the drop of SBP was associated with augmentation of postural instability in older adult females