Gene therapy is defined as the treatment of diseases by the transfer of genes into cells. This concept originally emerged as the definitive therapy for genetic disease. However, acquired diseases such as cancer and AIDS are now being considered as its potential targets. The first clinical trial of human gene therapy was in 1990 at the NIH in a 4 year old girl with fatal severe combined immunodeficiency caused by adenosine deaminase deficiency. Blood transfusion with genetically corrected lymphocytes resulted in significant improvement of the function of her immune system. The patient has discharged from hospital and is attending a public school. Immunotherapy for cancer using tumor cells transduced with genes for various cytokines and major histocompatibility antigens (tumor vaccine) has also been initiated at many research hospitals. In addition, gene therapy protocols targeting familial hypercholesterolemia, hemophilia B, cystic fibrosis are underway. Currently, more than 50 clinical protocols have been approved by the Recombinant DNA Advisory Committee at the NIH, and more than 100 patients have already been treated by this innovative therapeutic strategy.

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Summer-type hypersensitivity pneumonitis (SHP) is the most prevalent type of HP in Japan, and the major causative agent of the disease is T. cutaneum. The major antigenic substance of the yeast is serotype-related polysaccharide. Homeenvironmental factors indicate that SHP is a sick house syndrome. Immunologically, both humoral and cellular hypersensitivities are involved in the induction of the disease. The levels of specific IgG and IgA antibodies and complements in BAL fluids from SHP patients are well correlated to the clinical course. On the other hand, BAL lymphocytes in SHP patients are mostly T lymphocytes, mainly due to an increase in CD8⁺ subpopulations of lymphocytes; this leads to a decrease in the ratio of CD4⁺ to CD8⁺. These T cells belong to CD45RO⁺ memory T lymphocytes and LFA-11α high⁺ cytotoxic T lymphocytes as assessed by their cell surface phenotypes. However, functions of these BAL T lymphocytes remain undefined. Host factors such as HLA-DQw3 and cigarette smoking may participate in the development of the disease. In conclusion, the pathogenesis of SHP is considered to be a combination of immune complex disease and cellular hypersensitivity to T. cutaneum.

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Questionnaires were answered by 3, 243 presumably healthy subjects who underwent regular medical checkups in four cities. The prevalences of risk factors for sleep-disordered breathing (SDB) were as follows; habitual snoring was reported by 13-16%, excessive daytime sleepiness by 8-9%, insomnia by 7-13% and systemic hypertension by 5-13%. Polysomnographic studies performed on some possible SDB cases who were selected by the presence of risk factors estimated that the average prevalence of SDB in the present population would be in the range of 1.14-1.94%. Secondly, questionnaires were sent to the main hospitals and institutes involved in the management of patients with SDB, asking about diagnostic criteria, number of SDB patients, management, effectiveness of treatment, etc. The total number of patients registered at those hospitals was 2, 751 in 1991. Of the 132 patients who were followed for more than six months, the efficacies of body weight loss, medications, nasal CPAP and UPPP were compared. Based on the analyses of the 279 patients examined some tentative vriteria for diagnosis and for treatment are proposed.

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