T Kobayashi

Kochi Medical School, Kôti, Kōchi, Japan

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Publications (21)46.29 Total impact

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    ABSTRACT: The effectiveness of granulocyte colony-stimulating factor (G-CSF) for granulocytopenia has been widely recognized. However, although granulocyte counts rapidly increase after a few injection of G-CSF, a large proportion of the increased granulocytes disappear from peripheral blood within a few days following G-CSF withdrawal. Where do they go? In this report, the answer can be seen at a glance. Using MitoCapture and a CCD camera-equipped fluorescence microscope, we succeeded in demonstrating that G-CSF withdrawal induced loss of mitochondrial membrane potential, i.e., an early stage of apoptosis, in human peripheral granulocytes increased by G-CSF.
    No preview · Article · Sep 2001 · Oncology Reports
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    ABSTRACT: We examined sequential changes in post-irradiated peripheral blood T cells taken from normal volunteers, by using targeted Atlas cDNA Expression Arrays and mitochondrial membrane potential assay. At 1 and 3 hours after 5 Gy irradiation, changes of gene expression were examined by targeted Atlas cDNA Expression Arrays using Apoptosis Array. The Atlas Human Apoptosis Array includes 205 key genes that are known to control apoptosis, including extracellular and cytoplasmic effectors. Concerning Fas, no significant changes of spot intensities were identified between irradiated T cells and non-irradiated ones at both 1 h and 3 h after 5 Gy irradiation. Caspase families, including caspases 9 and 3 also showed no changes between these two groups. An apoptosis regulator bclw showed a remarkable decrease in irradiated T cells. These results suggested that irradiation induced direct apoptosis of T cells by changing the membrane potential of mitochondria. Using a CCD camera-equipped fluorescence microscope and MitoCapture, a mitochondrial membrane potential indicator, we demonstrated 5 Gy radiation induced loss of membrane potential, i.e., an early stage of apoptosis, in human peripheral blood T cells at 10 hours after irradiation.
    No preview · Article · Jul 2001 · International Journal of Molecular Medicine
  • T Kobayashi · S Tsunawaki · H Seguchi
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    ABSTRACT: We present an up-to-date insight into the function of NADPH oxidase in human neutrophils, the signalling pathways involved in activation of this enzyme and the process of association of its components with the cytoskeleton. We also discuss the functional implications of morphological studies revealing localization of the sites of NADPH oxidase activity. An original model of the process of superoxide (O2*-) production in human neutrophils is shown. Organization of NADPH oxidase is associated with several components. Upon stimulation, tri-phox cytosolic components of NADPH oxidase (p40-phox, p47-phox and p67-phox) bind to actin filaments. This process involves other actin-binding proteins, such as cofilin and coronin. Activated protein kinase C, translocated from the plasma membrane, phosphorylates cytosolic components at a scaffold of cytoskeleton. Subsequently, p40-phox, responsible for maintaining the resting state of NADPH oxidase, is separated from other two cytosolic phox proteins following an attachment of the active form of small GTP-binding protein Rac to p67-phox. Cytosolic duo-phox proteins (p47-phox and p67-phox) conjugate with membrane components (gp91-phox, p22-phox and Rapla) of NADPH oxidase residing within membranes of intracellular compartments. This chain of events triggers production of O2*-. Then, oxidant-producing intracellular compartments associate with the plasma membrane. Eventually, intracellularly produced O2*- is released to the extracellular environment through the orifice formed by fusion of oxidant-producing compartments with the plasma membrane. Intracellular movement of the oxidant-producing compartments may be regulated by myosin light chain kinase. The review emphasizes that functional assembly of NADPH oxidase and, therefore, generation of O2*- is accomplished essentially within the intracellular compartments. Upon neutrophil stimulation, intracellularly generated O2*- is transported to the plasma membrane to be released and to ensure host defense against infection.
    No preview · Article · Feb 2001 · Redox Report
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    ABSTRACT: Rebamipide, an antiulcer agent, has been shown to be able to prevent gastric mucosal injury resulting in part from activation of neutrophils. The mechanism of its suppressive action, however, remains to be established. The present study aimed to determine the effect of rebamipide on activation of isolated human neutrophils and to identify the signal transduction pathway involved in its regulation. In unstimulated cells, alkaline phosphatase activity was found residing in short rod-shaped intracellular granules. Upon stimulation with a chemotactic peptide formyl-methionyl-leucyl-phenylalanine, the granules fused to form elongated tubular structures and spherical vacuoles. Rebamipide inhibited reorganization of alkaline phosphatase-containing granules along with upregulation of alkaline phosphatase activity and CD16, a marker of the granules. It also suppressed chemotaxis, an increase in intracellular calcium ion concentration, and NADPH oxidase activation in cells stimulated with formyl-methionyl-leucyl-phenylalanine. In contrast, the drug showed no inhibitory action toward upregulation of alkaline phosphatase activity and CD16, and activation of NADPH oxidase in cells stimulated with phorbol myristate acetate, an activator of protein kinase C. These findings demonstrate that rebamipide exerts a broad spectrum of suppressive actions toward biological functions of human neutrophils stimulated with formyl-methionyl-leucyl-phenylalanine, but not with phorbol myristate acetate, and suggest that the upstream point of protein kinase C is the signal transduction pathway involved in its regulation.
    No preview · Article · Nov 2000 · Histology and histopathology
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    ABSTRACT: Superoxide anion production in neutrophils plays an important role in the microbicidal defense system in the body. In this study, isolated rat neutrophils were stimulated experimentally and examined by electron microscopy to determine the site of superoxide production and its subsequent translocation during different cell stimulation time periods. Blood and peritoneal neutrophils were incubated for periods of 5, 10, and 15 min with phorbol 12-myristate 13-acetate (PMA), N-formyl-Met-Leu-Phe (fMLP), and combinations of PMA and cytochalasin B (CB) and fMLP and CB. Ultracytochemical detection of O(2)(-) was performed with the 3, 3'-diaminobenzidine-manganese (DAB/Mn) cytochemical method and cationized ferritin (CF) particles were added to stimulation media to monitor endocytotic events that occurred during neutrophil stimulation. Unstimulated neutrophils were devoid of O(2)(-) activity in cytoplasmic granules and at the plasma membrane surface. After 5 min stimulations with PMA, PMA + CB, or fMLP + CB, electron-dense DAB/Mn reaction product was detected in small, centrally located tubular compartments within the neutrophils. CF particles which were added to the stimulation media became internalized in endocytotic vesicles after 5 min stimulation; these vesicles were devoid of O(2)(-) activity. At 10 min stimulation with PMA, O(2)(-)-positive granules subsequently fused with each other and translocated to sub-plasma membrane regions where they either contacted the plasma membrane or fused with CF-containing endocytotic vesicles. Little reaction product was observed on the surface of the neutrophils. Spectrophotometric comparison of the stimulatory effects of PMA, fMLP, and fMLP + CB revealed different rates and yields of O(2)(-) production. Results from this study suggest that the O(2)(-)-producing sites of rat neutrophils originate intracellularly and translocate to the plasma membrane surface following stimulation with PMA, PMA + CB, and fMLP + CB, but not with fMLP or CB alone. Furthermore, these compartments appear to possess the ability to fuse with endocytotic vesicles, a process that may be linked to intracellular microbicidal activity in circulating and tissue neutrophils.
    No preview · Article · Mar 2000 · The Anatomical Record
  • T Okada · V S Zinchuk · T Kobayashi · H Seguchi
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    ABSTRACT: We studied cytochemical localization of ectoadenosine triphosphatase in the rat liver during development from 15-day-old fetus to 4-week-old and adult animal. First signs of the enzyme activity were found in some of the primitive bile canaliculi of 15-day-old fetuses. The majority of canaliculi, however, did not reveal any reaction product. Although intensity of the cytochemical reaction increased at 20 days of gestation, it still remained relatively low. Intensity of the reaction increased significantly and its product became readily detectable in the liver of newborn rats. Liver of 1-, 2-, and 4-week-old animals showed strong reaction for ecto-ATPase at the luminal surface of the plasma membrane of the bile canaliculi. Liver of adult rats contained a prominent reaction product similar to that seen in newborns, 1-, 2-, and 4-week-old animals. At all stages of fetal development, as well as in postnatal and adult rats, reaction was found only within the hepatic bile canalicular system and exclusively at the luminal surface of the canalicular plasma membrane. Using diethyl pyrocarbonate (DEPC), a specific inhibitor of ecto-ATPase activity, cytochemical reaction was blocked in all examined samples. Results of the present study, taken together with established biochemical and immunological data, provide conclusive morphological evidence in support of the view that canalicular ecto-ATPase is involved in bile acid efflux.
    No preview · Article · Jan 2000 · Cell and Tissue Research
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    T Kobayashi · J M Robinson · H Seguchi
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    ABSTRACT: In this study, we show that superoxide production is carried out within intracellular compartments of human neutrophils and not at the plasma membrane following stimulation with phorbol myristate acetate. Oxidant production was not observed in unstimulated cells. Stimulated cells exhibited superoxide production in two distinct types of intracellular organelles. Initially, activity was detected in slender rod-shaped granules and in spherical or elliptical granules. The oxidant-producing granules fused directly with the plasma membrane or fused to form larger intracellular vesicles which then became associated with the plasma membrane. Longer periods of stimulation with PMA resulted in a decrease in the number of vesicles containing oxidant reaction product only, and an increase in structures containing both the oxidant-reaction product and ferritin particles; the latter was used herein as a marker for endocytosis. Thus a complex pattern of intracellular vesicular trafficking occurs in stimulated neutrophils. Alkaline phosphatase activity, a marker enzyme for a type of intracellular neutrophil granule was co-localized in the oxidant reaction-positive intracellular compartments. The time course of up-regulation of alkaline phosphatase activity to the cell surface parallelled the release of superoxide from stimulated cells. Results from this study demonstrate for the first time cytochemical and morphological evidence that superoxide is released from stimulated neutrophils through exocytosis of an oxidant-producing intracellular granule.
    Preview · Article · Feb 1998 · Journal of Cell Science
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    ABSTRACT: Alkaline phosphatase (ALPase) activity was examined by cerium-based ultracytochemistry in isolated rat neutrophils following stimulation with phorbol myristate acetate (PMA) or N-formyl-methionyl-leucyl-phenylalanine (fMLP). In control neutrophils, low levels of ALPase activity were detected in small tubular and spherical compartments distributed throughout the cytoplasm. Neutrophils stimulated for 2.5, 5, 15, and 30 min with 50 ng/ml PMA or 10(-7) M fMLP displayed a time-dependent increase in ALPase activity. At 2.5 min, an increase in activity was first identified in compartments that were aggregated in the central regions of the cell. By 15 min, a dense precipitate was seen in tubular or elongated bead-like structures that extended to and made contact with the plasma membrane. Large enzyme-positive vacuoles were also observed in regions near the plasma membrane. At the longer stimulation times, a fine precipitate was present on the cell surface of the neutrophil in regions where subplasmalemmal ALPase activity was present. The results of this study indicate that an increase in activity and a redistribution of ALPase-positive structures occurs in neutrophils in response to stimulation with PMA and fMLP. It is likely that these compartments are latent pools of ALPase which, upon stimulation, fuse and mobilize the enzyme activity to the cell surface.
    No preview · Article · Feb 1998 · Histology and histopathology
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    ABSTRACT: Alkaline phosphatase (ALPase) activity in neutrophils was examined by enzyme ultracytochemistry at sites of experimentally induced acute inflammation in the rat lung and compared with those in non-inflammatory regions. Neutrophil accumulations in the lung were stimulated by intraperitoneal (IP) injection and intratracheal (IT) instillation of lipopolysaccharide (LPS), an endotoxin from Escherichia coli. Microsliced sections of fixed lung were incubated in a cerium-based reaction medium for the detection of ALPase activity. As cytochemical controls, sections were incubated in a substrate-free medium or in a medium containing 2 mM levamisole for inhibition of ALPase activity. Both IP and IT injections resulted in a significant accumulation of neutrophils in the lung, however, their histological distributions differed, the former stimulating high accumulations within the capillaries and interalveolar spaces, and the latter within the confines of the alveolar spaces. In neutrophils from controls and non-inflamed regions of the lung, ALPase activity was detected as an electron-dense reaction product localized predominantly to small spherical and tubular membrane-bounded cytoplasmic compartments. In the IP-injected rats, prominent ALPase activity was observed at their plasma membrane surfaces, most notably at sites of endothelial cell contact. Following IT instillation of LPS, neutrophils suspended in the alveolar spaces showed a reduced plasma membrane reactivity, however, at type I pneumocyte contact regions, enzyme activity was significantly increased. In all cases, ALPase activity was not detected at the endothelial plasma membranes. Some reaction, however, was seen on the microvilli of the type II surfactant-producing cells. These results indicate that ALPase activity of rat neutrophils in the lung can be increased by LPS injection and that its activity may also be related to the sites of cell-cell interaction and cell surroundings.
    No preview · Article · Jul 1996 · Kaibogaku Zasshi
  • I Watanabe · H Seguchi · T Okada · T Kobayashi · Q S Jin · X D Jiang
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    ABSTRACT: Parenchymal and stromal components of the rat parotid and submandibular glands were examined by conventional and high resolution scanning electron microscopy (HRSEM). Freeze-fractured specimens were subjected to HCl and NaOH extraction procedures to better differentiate connective tissue and cellular components. In addition, the internal three-dimensional morphology of the secretory acinar cells and duct cells was revealed by maceration with a dilute osmium tetroxide solution to selectively remove some of the cytoplasmic components. SEM and HRSEM examination of the HCl-treated samples of both glands revealed a fine filamentous network immediately surrounding each acinus. Coarser bundles of collagen that linked neighboring acini were also observed. NaOH-extracted samples selectively removed the cellular components and showed more clearly the three-dimensional structure of the connective-tissue stroma. A dense-collagenous network surrounded each lobule while more internal regions consisted of a honeycomb-like pattern of evacuated spaces previously occupied by secretory acini. These spaces were smoothened in appearance and often interconnected. Apically-located secretory granules and profiles of the rough endoplasmic reticulum and Golgi apparatus in perinuclear regions were encountered in the acinar and duct cells of macerated samples by HRSEM. In addition, a phenylephrine-induced experimental condition performed in some rats resulted in a significant increase in secretory granule size and density of the serous cells.
    No preview · Article · Feb 1996 · Histology and histopathology
  • N Kanoh · T Kumoi · T Minatogawa · T Kobayashi · T Okada · H Seguchi

    No preview · Article · Jan 1995 · Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde
  • S Nishiyama · T Okada · T Kobayashi · E Garcia del Saz · H Seguchi
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    ABSTRACT: The effect of endolymphatic hydrops on the Na-K-ATPase activity in the guinea pig stria vascularis was electron microscopically and enzyme cytochemically investigated one year after experimental induction. The morphological observations revealed intercellular dropsy in the basal infoldings of the marginal cells, and shrinkage and disappearance of intermediate cells. Moreover, shrinkage of the marginal cells, especially of the basal infoldings, was occasionally observed. In spite of these morphological alterations, the Na-K-ATPase activity was still detected on the plasma membrane of the basal infoldings of most marginal cells. No remarkable differences were found among the cochlear turns of the specimens examined. However, no reaction product was detected on the basolateral plasma membrane of severely degenerated marginal cells. The present results indicate that the Na-K-ATPase of the plasma membrane of the basal infoldings of the marginal cells plays an important role in the maintenance of the unique ion concentration of the endolymph even in the endolymphatic hydropic condition, and that the Na-K-ATPase activity is attenuated in severely atrophic cells.
    No preview · Article · May 1994 · Histology and histopathology
  • N Kanoh · T Kobayashi · T Okada · H Seguchi
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    ABSTRACT: Ouabain-sensitive, K(+)-dependent, p-nitrophenylphosphatase (K-NPPase) is the second dephosphorylative property of the Na-K ATPase complex. Localization of its activity in the horizontal portion of the facial nerve in 11 normal cats was studied ultracytochemically using a cerium-based method. The fine granular reaction product of the K-NPPase activity was observed on the cytoplasmic side of the axolemma of the axon cylinder. Enzyme activity was also detected on the cytoplasmic side of the plasma membrane of Schmidt-Lanterman incisures and nodes of Ranvier. No reaction product was detected on the periaxonal and outermost plasma membrane of Schwann cells and in the myelin sheath. In control tissue samples, enzyme activity was almost completely inhibited by 10 mM ouabain, and no reaction was noted in medium without K+. The present findings indicate that localization of Na-K ATPase in the cat facial nerve simulates that of other peripheral and cranial nerves.
    No preview · Article · Feb 1994 · Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde
  • T Hosokawa · T Okada · T Kobayashi · K Hashimoto · H Seguchi
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    ABSTRACT: The three-dimensional configuration and chemical composition of leptomeres in the mouse ventricular cardiac muscle fibre were electron microscopically and immunocytochemically investigated using semithin sections and specific antibodies against actin, the intermediate filament proteins desmin and vimentin, and the actin-binding proteins alpha-actinin, filamin and vinculin. The leptomeres appeared columnar in shape and periodically segmented by electron-dense disc-like septa. The electron-lucent areas between these septa were composed of fine interlinked filaments running obliquely to the major axis of the leptomere. Actin was localized in the electron-dense lines of the leptomeres but not in the fine filaments. No reaction was, however, detected for desmin, vimentin, vinculin, filamin and alpha-actinin. The present results suggest, therefore, that the leptomeres may not have a contractile function.
    No preview · Article · Feb 1994 · Histology and histopathology
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    T J Cain · Y Liu · T Kobayashi · J M Robinson
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    ABSTRACT: Alkaline phosphatase (APase) belongs to a growing family of membrane-associated proteins tethered to the lipid bilayer via a glycosyl-phosphatidylinositol (GPI) anchor. Human neutrophils contain an intracellular pool of APase associated with a novel membrane-bound compartment. Stimulation of neutrophils with the chemotactic peptide formyl-Met-Leu-Phe (fMLP) leads to rapid up-regulation of essentially all of the APase to sites in continuity with the extracellular medium. Pre-treatment of neutrophils with cytochalasin B (cyto B) followed by fMLP likewise leads to expression of the enzyme on the cell surface and a dramatic alteration in cell morphology, but subsequent internalization of the plasmalemma is minimized. Pre-treatment with cyto B and fMLP has been used for isolation and purification of neutrophil APase. Specifically, neutrophils were treated with phosphatidylinositol-specific phospholipase C to release GPI-anchored proteins from the cell surface. APase was purified from supernatants of these preparations by electrophoresis in a non-denaturing gel system and subsequent electroelution. With this approach we rapidly purified neutrophil APase to homogeneity; this protein was then used for immunization. Immunoblotting, ELISA, and immunocytochemical localization were used to characterize the resulting antibodies.
    Full-text · Article · Oct 1993 · Journal of Histochemistry and Cytochemistry
  • S X Zhang · T Kobayashi · T Okada · E Garcia del Saz · H Seguchi
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    ABSTRACT: Acid phosphatase and trimetaphosphatase activities have been demonstrated cytochemically in the transitional epithelium of the rat urinary bladder. Acid phosphatase activity was examined by the method of Robinson and Karnovsky (1983), and trimetaphosphatase activity was examined by the method of Kobayashi et al. (1988). Intense positive reaction for acid phosphatase activity was observed with both beta-glycerophosphate and p-nitrophenyl phosphate as substrates, in lysosomes, Golgi complex, GERL, multi-vesicular bodies and wrapping lysosomes. The reaction product of the trimetaphosphatase activity was visualized as fine particulated deposits along the limiting membrane of some lysosomes, and of tubular structures located in the basal cytoplasm. There seems to be a fine distinction and reciprocal complementary functional relationship between two kinds of lysosomes containing either acid phosphatase or trimetaphosphatase activity.
    No preview · Article · Aug 1991 · Journal of submicroscopic cytology and pathology
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    S X Zhang · T Kobayashi · T Okada · E García del Saz · H Seguchi
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    ABSTRACT: The cerium-based method was used to demonstrate cytochemically the ultrastructural localization of alkaline phosphatase (ALPase), 5'-nucleotidase (5'-Nase) and magnesium-dependent adenosine triphosphatase (Mg-ATPase) on the transitional epithelium of the rat urinary bladder. The reaction product for ALPase was found on the plasma membrane of all epithelial cells, except the luminal surface of superficial cells. The activity of 5'-Nase appeared on the plasma membrane of all bladder transitional epithelial cells, including the free surface of superficial cells. The Mg-ATPase reaction product was seen on the plasma membrane of superficial, intermediate and basal cells, but never on the luminal surface of superficial cells and it was only occasionally seen on the basal surface. The possible functions of these phosphatases have been discussed, and it was emphasized that the 5'-Nase activity present on the luminal surface of superficial cells may play a special role in the membrane movement of these cells in the transitional epithelium.
    Preview · Article · Aug 1991 · Histology and histopathology
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    T Kobayashi · J M Robinson
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    ABSTRACT: Human neutrophils contain a novel intracellular compartment that is distinct from the previously characterized azurophil and specific granules. This compartment is distinguished by the presence of cytochemically detectable alkaline phosphatase activity. The alkaline phosphatase-containing compartments are short rod-shaped organelles that rapidly undergo a dramatic reorganization upon cell stimulation with either a chemoattractant or an active phorbol ester. Biochemical analysis shows that in unstimulated neutrophils the majority of the alkaline phosphatase activity is intracellular, but after stimulation essentially all of this activity becomes associated with the cell surface. The exocytotic pathway is unusual in that these small organelles fuse to form elongated tubular structures before their association with the plasmalemma.
    Preview · Article · Jun 1991 · The Journal of Cell Biology
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    T Kobayashi · H Seguchi
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    ABSTRACT: We employed a modification of our previously reported cerium-based cytochemical method for ouabain-sensitive, K-dependent p-nitrophenylphosphatase (Na-K ATPase) activity to detect ouabain-insensitive, K-stimulated p-nitrophenylphosphatase (K-pNPPase) activity in rat gastric glands. Biochemically, the enzyme activity of gastric glands incubated in a medium containing 50 mM Tricine buffer (pH 7.5), 50 mM KCl, 10 mM MgCl2, 2 mM CeCl3, 2 mM p-nitrophenylphosphate (pNPP), 2.5 mM levamisole, 10 mM ouabain, and 0.00015% Triton X-100, was optimal at pH 7.5-8.0 and decreased above pH 8.5. The amount of p-nitrophenol after incubation increased linearly in proportion to the amount of tissue in the medium. The enzyme activity was inhibited by omeprazole, sodium flouride (NaF), N-ethylmaleimide (NEM), and dicyclohexylcarbodiimide (DCCD). Heat-treated specimens had no enzyme activity. The enzyme activity increased with addition of K ions up to the concentration of 50 mM, and became constant above 50 mM. Cytochemically, the parietal cells of the gastric glands reacted positively for ouabain-insensitive K-pNPPase activity. Intense reaction was observed at the microvilli of the luminal surface and the intracellular canaliculi. The tubulovesicular system showed weak enzyme activity. The reaction products were found as fine, granular, electron-dense deposits in the cytoplasm just beneath the plasma membrane. The ouabain-insensitive K-pNPPase activity detected in this study appears, therefore, to be associated with that of H-transporting, K-stimulated adenosine triphosphatase (H-K ATPase).
    Preview · Article · Jan 1991 · Journal of Histochemistry and Cytochemistry
  • H Seguchi · Y Yagyu · T Kobayashi
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    ABSTRACT: The nerve endings of normal hair of the rat's snout, partially digested with trypsin and hydrochloric acid, were studied by scanning electron microscopy. Each lanceolate structure measured ca. 10 microns in length and was arranged around the hair follicle. These palisade-shaped nerve endings were situated almost beneath the sebaceous glands, ran upward, parallel to the axis of the hair follicle, and terminated in pointed shape. 2 kinds of cells, Teloglia cell Type I showing flat profile, and Teloglia cell Type II showing spherical profile and possessing numerous caveolae in its surface were observed at the basal portion of the palisade-shaped endings. The axon was enclosed by Schwann cells in its course to the hair follicle, and was covered with Type I cells at the beginning, and with Type II cells at the end, and constituted the palisade-shaped nerve endings. The palisade structure in silver impregnated tissues observed by backscattered electron microscopy and X-ray analyzer was characterized as comprising neuronal elements. Cytochemically, the nerve endings showed cholinesterase and Mg-ATPase activities. They may be involved in the reception of the mechanical stimulation of the hair. The palisade nerve endings thus possessed appropriate 3-dimensional structure as mechanoreceptor.
    No preview · Article · Feb 1989 · Anatomischer Anzeiger

Publication Stats

376 Citations
46.29 Total Impact Points


  • 1989-2000
    • Kochi Medical School
      Kôti, Kōchi, Japan
  • 1996
    • Faculdade de Ciências Biomédicas de Cacoal
      San Paulo, São Paulo, Brazil
  • 1995
    • Hyogo College of Medicine
      • Department of Otorhinolaryngology
      Nishinomiya, Hyogo-ken, Japan
  • 1991
    • The Ohio State University
      Columbus, Ohio, United States