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Cyclosporin A 의 일차 임파구 혼합배양의 저해작용에 대한 Interleukin - 2 의 역할
민우성(Woo Sung Min),문한림(Han Lim Moon),김호연(Ho Youn Kim),방병기(Byung Kee Bang),이경식(Kyung Shik Lee),김동집(Dong Jip Kim) 대한내과학회 1986 대한내과학회지 Vol.31 No.1
N/A Cyclosporin A (CsA) was found to have remarkable immune suppressive properties without the usual significant myelotoxicity and clinically very useful agent to prevent rejection of organ transplantation or bone marrow transplantation and Graft-versus-Host disease. Recently, the inhibitory effect of CsA on the production of interleukin-2 (IL-2) and on the development of responsiveness to this lymphokine have been implicated as some of the major reasons accounting for CsA mediated immunosuppression. But the exact mode of CsA accounting for its immunosuppressive effects remains unclear. We studied the influence of CsA and exogenous IL-2 on proliferative response in mixed lymphocyte culture. The results were as follows: 1) There is apparent inhibition of proliferative response in M.L.R. by CsA in a dose-dependent manner, optimal concentration is approximately 0.5-1.0ug/ml. 2) The time-course sequential studies indicated that the lymphocyte response was markedly dependent on the time of addition of CsA to the culture. On-going M.L.R., the inhibitory effect of proliferative response by CsA was markedly abolished after 20 hours of the culture.(mean cpm 12,578±1, 445/28, 324±319) 3) On the beginning of the M.L.R., a addition of both CsA and exogenous IL-2 (human, 2.5 u/ml) was found in the no-appreciable immunosuppressive effect. 4) Exogenous human IL-2 abolished the CsA effect on the M.L.R. but mouse IL-2 could not.
All - trans Retinoic Acid 가 급성전골수성백혈병의 관해유도와 혈액응고장애에 미치는 효과
김성권(Sung Gwon Kim),한치화(Chi Wha Han),김유진(Yoo Jin Kim),김동욱(Dong Wook Kim),진종률(Jong Youl Jin),민우성(Woo Sung Min),박종원(Chong Won Park),김춘추(Choon Choo Kim),김동집(Dong Jip Kim) 대한내과학회 1997 대한내과학회지 Vol.53 No.2
N/A Objectives: APL, which characteristically shows t(15:17), accompanies fatal coagulopathy during remission induction with systemic chemotherapy alone. ATRA, a derivative of vitamin A, can differentiate APL cells as well as HL-60 cells in vitro and induce higher rate of complete remission(CR). Hence, we assessed the effect of ATRA on remission induction and coagulopathy in APL patients. Methods: (1) 42 patients diagnosed histologically in St. mary's hospital from June 1991 to June 1994 were included. (2) We compared the CR rate, the time required for restoration of derranged coagulation profiles, and the amount of coagulation factors including platelets among the chemotherapy group (control) and ATRA group. Results: 1) There was no difference in CR rate between the control group and ATRA group [84.2%(16 out of 19) vs 87.0%(20 out of 23), p>0.05)] and also no difference between two subgroups of ATRA [ATRA with chemotherapy; 83.3%(10 out of 12) vs ATRA without chemotherapy; 90.9%(10 out of 11), p>0.05] 2) In the ATRA group, the CR rate of newly diagnosed patients was 82.4%(14 out of 17). The first relapsed patients (4) and the second (2) were all achieved CR. 3) The mean duration of coagulopathy, time to normalization of PT, aPTT, FDP, fibrinogen level, was 12.0±10.4, 11.1±10.2, 16.5±9.3, 15.4±10.2 days after chemotherapy alone and 4.5±4.4, 3.7±3.7, 8.9±6.1, 8.1±6.5 days in the ATRA group(p<0.05). The amount of fresh frozen plasma used in the ATRA group for the purpose of correction of coagulopathy were significantly lower than the control group(p<0.05). The incidence of profound coagulopathy during the remission induction treatment in the ATRA group was significantly lower than the control group[40% (8 out of 20) vs 96.7%(13 out of 15), p<D.05]. And the amount of platelet transfusion was not different between two groups. 4) During the treatment with ATRA, four patients showed leukocytosis, but no patient developed typical retinoic acid syndrome. Other toxicities attributable to ATRA were headache in one case, increase in transaminase in one case, bone pain in one case. These side effects were mostly short-term and easily controlled by appropriate symptomatic therapy. Conclusion: (1) ATRA is relatively safe drug for inducing CR in patients with APL who are diagnosed freshly and even in relapse. (2) Also it is effective for reducing the severity of coagulopathy associated with APL itself.
증례 : Rituximab으로 치료한 불응성 특발성혈소판감소성자반증 1예
서석민 ( Suk Min Seo ),임창훈 ( Chang Hoon Lim ),최선욱 ( Son Ook Choi ),김희제 ( Hee Je Kim ),이종욱 ( Jong Wook Lee ),민우성 ( Woo Sung Min ),김춘추 ( Chun Choo Kim ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-
ITP는 원인을 찾을 수 없이 혈소판의 수적 감소로 발생되는 질환으로 혈소판이 30,000/μL 이하이거나 출혈이 있는 경우에 치료가 요구된다. 부신피질호르몬, 비장절제술이 대표적인 치료 방법이며 이에 반응이 없을 경우 면역억제제, 혈장반출법, 고용량 면역글로불린, 다나졸, 콜키친 등의 다양한 치료 방법을 시도할 수 있으나 반응이 매우 낮은 반면 부작용이 문제가 된다. Rituxi-mab은 B 림프구의 표면에 발현되는 CD20 항원에 특이적인 인간-생쥐 키메라 단클론항체로 만성 ITP에서 반응이 좋은 것으로 보고되고 있다. 저자들은 기존의 치료에 반응이 없던 불응성 ITP로 계속되는 질출혈과 폐출혈이 있었던 32세의 여자 환자에게서 Rituximab을 사용하여 치료에 성공한 증례를 경험하였기에 보고하는 바이다. Idiopathic thrombocytopenic purpura (ITP) is an immune disorder in which platelets are opsonized by autoantibodies and prematurely destroyed by the reticuloendothelial system. Among adult patients, approximately 25~30% develop a chronic disease that will become refractory to corticosteroids and splenectomy, as well as other available agents. Rituximab is a human-murine chimeric monoclonal antibody specific for the CD20 antigen, found on the surface of B lymphocytes. It acts via complement-dependent cytotoxicity, antibody-dependent cellular cytotoxicity, and induction of apoptosis. We report a case of 32-year-old female with severe, refractory ITP, who presented with generalized petechiae, intractable vaginal bleeding, and pulmonary hemorrhage. After multiple conventional therapeutic trials, the patient was finally placed on weekly infusion of rituximab that resulted in a favorable response. (Korean J Med 69:S934-S938, 2005)
만성 골수성 백혈병과 재생 불량성 빈혈로 진단받은 환자의 치료 전 동결보존된 정자를 이용한 세포질내 정자주입술로 임신에 성공한 2례
한지은,정태규,정미경,민우성,이숙환,윤태기,Han, Jee-Eun,Chung, Tae-Gyu,Chung, Mi-Kyung,Min, Woo-Sung,Lee, Sook-Hwan,Yoon, Tae-Ki 대한생식의학회 2003 Clinical and Experimental Reproductive Medicine Vol.30 No.2
Objective: To report tow cases of successful pregnancies following long term cryopreserved spermatozoa prior to bone marrow transplantation (BMT) for chronic myelogenous leukemia (CML) and severe aplastic anemia (SAA). Materials and Methods: Case report. Results: With the first case, after cryopreservation of semen from 25 year-old man with CML prior to BMT, his wife is being pregnant by intracytoplasmic sperm injection (ICSI) using thawed spermatozoa. With the second case, 28 year-old man with SAA became father by ICSI using banked spermatozoa before BMT. Conclusion: These cases support that men with malignancy have the chance of fathering their own genetic children. It is important therefore, to increase the awareness of clinicians especially oncologists and patients themselves to the new developments in preserving fertility for cancer patients.
새로운 전처치법과 초대량의 CD34 양성 조혈모세포를 이용한 고 위험군 급성 골수성 백혈병 환자의 가족간 HLA 완전 일배체 불일치 이식
김희제 ( Hee Je Kim ),민우성 ( Woo Sung Min ),박윤희 ( Yoon Hee Park ),김유진 ( Yoo Jin Kim ),이석 ( Seok Lee ),김동욱 ( Dong Wook Kim ),이종욱 ( Jong Wook Lee ),김춘추 ( Chun Choo Kim ) 대한내과학회 2003 대한내과학회지 Vol.65 No.1
목적 : 고 위험군 급성 골수성 백혈병 환자의 치료를 위해 가톨릭조혈모세포이식센터에서 새로 개발된 이식전처치법을 이용한 가족간 주조직 적합항원 완전 일배체 불일치 동종 이식의 임상 적용 가능성을 알아보고자 하였다. 방법 : 4예의 급성 골수성 백혈병 환자들이 주조직 적합항원이 정확히 일배체씩만 일치하는 각각의 가족내이식 공여자로부터 조혈모세포 이식을 받았다. 전신 방사선 분할, 조사 부썰판 정주, 항흉선 그로부린, fludarabine을 이식 전처치요법 Background : Haploidentical transplantation has become a considerable clinical choice for acute myeloid leukemia (AML) patients lacking a HLA matched donor. We tried to reveal the possible role of a full haplotype mismatch transplantation. Methods : Four
주조직적합항원이 불일치하는 마우스 동종 조혈모세포이식에서 IL-2로 유도된 CD4+CD25+ T세포를 이용한 이식편대숙주병의 억제
현재호,정대철,정낙균,박수정,민우성,김태규,최병옥,김원일,한치화,김학기,Hyun, Jae Ho,Jeong, Dae Chul,Chung, Nak Gyun,Park, Soo Jeong,Min, Woo Sung,Kim, Tai Gyu,Choi, Byung Ock,Kim, Won Il,Han, Chi Wha,Kim, Hack Ki 대한면역학회 2003 Immune Network Vol.3 No.4
Background: In kidney transplantation, donor specific transfusion may induce tolerance as a result of some immune regulatory cells against the graft. In organ transplantation, the immune state arises from a relationship between the immunocompromised graft and the immunocompetent host. However, a reverse immunological situation exists between the graft and the host in hematopoietic stem cell transplantation (HSCT). In addition, early IL-2 injections after an allogeneic murine HSCT have been shown to prevent lethal graft versus host disease (GVHD) due to CD4+ cells. We investigated the induction of the regulatory CD4+CD25+ cells after a transfusion of irradiated recipient cells with IL-2 into a donor. Methods: The splenocytes (SP) were obtained from 6 week-old BALB/c mice ($H-2^d$) and irradiated as a single cell suspension. The donor mice (C3H/He, $H-2^k$) received $5{\times}10^6$ irradiated SP, and 5,000 IU IL-2 injected intraperitoneally on the day prior to HSCT. The CD4+CD25+ cell populations in SP treated C3H/He were analyzed. In order to determine the in vivo effect of CD4+CD25+ cells, the lethally irradiated BALB/c were transplanted with $1{\times}10^7$ donor BM and $5{\times}10^6$ CD4+CD25+ cells. The other recipient mice received either $1{\times}10^7$ donor BM with $5{\times}10^6$ CD4+ CD25- cells or the untreated SP. The survival and GVHD was assessed daily by a clinical scoring system. Results: In the MLR assay, BALB/c SP was used as a stimulator with C3H/He SP, as a responder, with or without treatment. The inhibition of proliferation was $30.0{\pm}13%$ compared to the control. In addition, the MLR with either the CD4+CD25+ or CD4+CD25- cells, which were isolated by MidiMacs, from the C3H/He SP treated with the recipient SP and IL-2 was evaluated. The donor SP treated with the recipient cells and IL-2 contained more CD4+CD25+ cells ($5.4{\pm}1.5%$) than the untreated mice SP ($1.4{\pm}0.3%$)(P<0.01). There was a profound inhibition in the CD4+CD25+ cells ($61.1{\pm}6.1%$), but a marked proliferation in the CD4+CD25- cells ($129.8{\pm}65.2%$). Mice in the CD4+CD25+ group showed low GVHD scores and a slow progression from the post-HSCT day 4 to day 9, but those in the control and CD4+CD25- groups had a high score and rapid progression (P<0.001). The probability of survival was 83.3% in the CD4+CD25+ group until post-HSC day 35 and all mice in the control and CD4+CD25- groups died on post-HSCT day 8 or 9 (P=0.0105). Conclusion: Donor graft engineering with irradiated recipient SP and IL-2 (recipient specific transfusion) can induce abundant regulatory CD4+CD25+ cells to prevent GVHD.
간기능 이상을 동반한 혈액질환 환자에서 복강경하 간조직검사의 유용성
정규원(Kyu Won Chung),민우성(Woo Sung Min),김부성,김춘추(Chun Choo Kim),최황(Hwang Choi),김병욱(Byung Wook Kim),김보경(Bo Kyoung Kim),이창돈(Chang Don Lee),박재명(Jae Myung Park),최상욱(Sang Wook Choi),조세현(Se Hyun Cho),이영석(Young 대한내과학회 1999 대한내과학회지 Vol.56 No.4
N/A Objective : Hepatic dysfunction frequently occurs in patients with hematologic malignancies and aplastic anemia who receive intensive chemotherapy or bone marrow transplantation (BMT). The role of laparoscopic liver biopsy in patients with hematologic disorders is very important to determine the etiological factors and to make treatment decisions. The aim of the present study was to evaluate the possible causes of liver disease in patients with abnormal liver function tests. Methods : Laparoscopy guided liver biopsy was performed in 38 subjects who were receiving intensive cytotoxic therapy with BMT or without BMT. Two to three pieces of liver tissues were obtained in each patients using Vim-Silverman needle with electrocoagulation on biopsy site. Platelet transfusions were given if platelet count was less than 50,000/mm3. 39 biopsies were obtained in 38 patients. Results : At the time of liver biopsy, platelet count was 170,000±138000/mm3 (range: 42,000 - 798,000/mm3). No procedure-related complications were observed. Biopsy findings after BMT (n=16) revealed graft versus host disease (GVHD) (n=9), drug induced hepatitis (n=6), veno-occlusive disease (n=2), viral hepatitis (n=1), and nonspecific reactive hepatitis (n=1). 3 patients of GVHD associated with other liver diseases such as drug-induced hepatitis, veno-occlusive disease and chronic active hepatitis B. The authors compared histologic diagnosis with laparoscopic findings. Laparoscopic findings of the liver surface were classified by Shimada's code number system. 5 patients who were biopsed before BMT showed cholestasis and fatty changes and it was possible to be treated with allogenic BMT. Histologic diagnosis in patients without BMT (n=18) showed viral hepatitis (n=6), drug induced hepatitis (n=5), non-specific reactive hepatitis (n=1), and others (n=6). In 12 cases (31%) laparoscopic liver biopsy led to a change in medical management. Conclusion : Laparascopic liver biopsy has been proven to be an effective means of assessing the cause of liver dysfunction in patients with hematologic disorders. The diagnosis obtained at laparoscopic liver biopsy could be changed the therapeutic plan in 12 of 39 (31%) patients.