Advantages and disadvantages on the conventional semiquantitative CRP tests are discussed. Quantitative methods of determining serum CRP levels include radioimmuno assay, radio-electroimmuno-precipitation and laser immuno-nephelometry. Laser immunonephelometry has been most frequently applied in recent years. Some important problems related to laser immuno-nephelometry are discussed.
The authors recommend that polyethylene glycol is not to be added, that purified CRP standards are to be dissolved in absorbed human serum, and that inactivation of serum samples is preferable.

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Under the condition of invasion by bacteria or foreign particles, immediate activation of alternative pathway or complement cascade of classical pathway will be induced as primary immune defense system. Neutrophils and macrophages also attack invading agents by chemotaxis and phagocytosis. Inflammation means pathological behaviours of factors and cells mobilized to be engaged in primary immune reaction, and immunopathological changes of the tissues adjacent to the sites of infection induced by injuring factors released by activated phagocytes. As the inflammation developed, the secondary immune defense system begin to operate, in which lymphocytes and macrophages play an important role.
As for the effect of phagocytes in primary defense system, lysosomal enzymes and oxygen radicals released by activated phagocytes to attack invading agents, give rise to tissue injury adjacent to the sites of infection. Prostaglandins secreted from activated-neutrophils and, histamine and serotonine from mast cells and basophils increase the permiability of the vessels, leading to enhancement of inflammation. Recently, oxygen radicals have been demonstrated to show more intense tissue damage than lysosomal enzymes, resulting in hemolytic dnemia, attenuated neutrophilic function etc. The authors further elucidated that the disturbed lymphocyte functions, decreased T cell counts and/or T-r cell counts, and tissue injury in SLE, RA and/or Behcet's disease are due to amplyfied neutrophils.
As regard with the effect of lymphocytes, lymphokine including chemotactic factor secreted secreted from lymphocytes activates the inflammation cells, attracts them to the sites of infection and, as the result, enhances the inflammation.
In many types of cells, phosphatidylethanolamine (PE) located in the inside of the membrane has been varified to be transmethylated by S-adenosyl methionine through the mediation of methyltransferase enzymes. During methylation, translocation of phospholipids from the inside to the out-side of the membrane is induced, resulting in the reduction of membrane viscosity, which facilitates the functions of the cells such as chemotaxis, movement of microfilament (phagocytosis) microtubule assembly (lysosomal enzyme release) etc. The binding of catecholamine, lectins, immunoglobulins or chemotactic peptides to the cell surface, or IgE bridging stimulates the translocation and reduces membrane viscosity. The release of arachidonic acid, prostaglandin, his-tamine and serotonin, the generation of cyclic AMP, mitogenesis in lymphocytes and chemotaxis in neutrophils are closely associated with biochemical changes in the membrane. Therefore, assessment of transmethyltion of PE to PC, and enzymes of transferase I, II and further metabolizer, phospholipase A2 should also be made for parameter of inflammation.

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BCG, protein-bound polysaccharide Kureha (PS-K) and levamisole which have been used in tumor immunotherapy were studied for the effect on the rejection of male skin grafts by female mice. The graft rejection was significantly accelerated by one s.c. injection of BCG (5×10⁵ microorganisms/mouse) into recipients on the day of transplantation. PS-K injected 250 mg/kg s.c. or i.p. once every other day from the day of transplantation significantly stimulated the graft rejection. Oral administration of 1000 mg/kg PS-K by the same schedule was also effective. Levamisole 20 mg/kg injected s.c. once on the day of transplantation was without any effect.
From these results it is concluded that PS-K has an immunostimulant action similar to that of BCG. This property may be important to the antineoplastic activity of PS-K.

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A new immuno-modulator, CCA [N- (2-carboxyphenyl) -4-chloroanthranilic acid disodium salt] has been shown to effectively inhibit the thymic atrophy in both cortisone acetate-treated mice and EtOH-treated rats.
In this work, CCA was also effectve on the thymic atrophy of dexamethasone-treated mice, while it was ineffective on that which is considered to be a physiologi-cally inducing change in young aged mice (4-7 weeks old) . It seems to be highly interesting to consider these results in connection with the enhancing effects of CCA on the intra-thymic levels of both c-GMP and thymosin α₁.

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D-penicillamine (D-PA) enhanced the plaque forming cell (PFC) response to sheep red blood cells (SRBC) in mice, when mice were immunized with 2-4×10⁶ SRBC. However, when they were immun-ized with 4×10⁸ SRBC, D-PA acted suppressively. The enhancing effect of D-PA on PFC response was observed when the drug was injected 2 hr after the immunization. Stress loading which was given by oral consecutive administrations of saline for 3 weeks or by restraint with the adhesive plaster from 3 days before the primary immunization reduced the IgE antibody formaion to egg albumn (EA) in mice. D-PA restored the reduced IgE antibody formation to EA after the secondary immunization. The mitogenic response to concanavalin A of normal rat spleen cells was slightly enhanced by D-PA at a concentration of 10 μM and inhibited at 100-10000 μM. However, the response of spleen cells of adjuvant arhritic rats, which remained essentially normal, was slightly inhibited even at 1μM of D-PA. These results suggest that D-PA shows an immunomodulatory activity on humoral and cellular immunity.

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A jelly-type ointment containing 1% indomethacin, ID gel, was prepared, and the anti-infla-mmatory effects and percutaneous absorption of ID gel were studied. ID gel inhibited carrageenin-induced paw edema concentration-dependently by topical application and showed significant effect at concentratin over 1%. ID gel inhibited inflammation only in the applied foot, but did not influence the edema of non-applied foot in car-rrageenin-induced edema experiments. It was shown that percutaneous absorption of indomethacin was markedly more into the exudate and muscle of the applied foot than those of non-applied foot and systemic blood. ID gel showed also anti-inflam-matory erects on adjuvant arthritis in rats and ultraviolet-induced erythema in guinea pigs.

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Despite of the general agreement that immunological disorder plays an important role in rheumatoid arthritis (RA), it is still uneasy to assess the immunological condition of patient clinically. In this report, I discuss first some aspect of cellular immunity of RA patient by aid of delayed hypersensitive skin tests (PHA, PPD, SK-SD, Candida) . Patients with extra-articular symptoms, including so-called malignant rheumatoid arthritis (10/56) showed statistically decreased skin reaction comparing with ordinary RA and healthy control. In the second part, I discuss about the effect of immunomodulating agents, such as Levamisole and Dpenicillamine on the hypersensitive reaction by using picryl-chloride techniqe for C 57 or BL/6, BALB/c mice. After treatment with Levamisole (10 mg, 25 mg/Kg daily, i.p.), D-penicillamine (50 mg, 500 mg/Kg daily, i.p.) for 3 days, statistically increased ear thicknes was observed. But in the case of thymectomized mice, such enhanement of ear thickness was not observed. Finally I treated RA patients (7 cases) with Levamisole according to various administration's schedule. Increased or restored skin reaction was related with clinical improvement in 4 cases of them after treatment for 2-8 months.

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36 y-o male patient who had had quite usual clinical course of palindromic rheumatism was reported. Immune complexes were present and the complement activity was low both in the serum and synovial fluid at the acute phase. although it was within normal range during remission. Serum Cl esterase inhibitor was normal. Cold activation was noted in the complement system, though the mechanism was not analyzed precisely. Immune complexes were suggested to play a role in the pathogenesis of the arthritis in this patient.

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It has been widely accepted that systemic lupus erythematosus is one of the diseases in which necrotizing angitis is frequently observed. In the present study, necrotizing angitis was found in 6 of 25 autopsy cases but not found in any of 80 biopsy specimens of lupus nephritis. Clinical characteristics of those with necrotizing angitis are central nervous system involvement, abdominal pain with tarry stool, and rapidly progressive renal failre (RPRF) . Necrotizing angitis in kidney may cause RPRF, however, ther were many patients who showed RPRF with no evidence of histologically defined necrotizing angitis. The deposition of immunoglobulins and/or complements were frequently found in the vessel wall (of biopsy kidneys) . None of those with positive vascular immune deposit showed necrotizing angitis. The possibility raised is that there may be some factors causing angitis other than deposition of immune complexes into vessel wall.

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