[The value of quantitative analysis of procalcitonine in diagnostics of septic complications in patients with autoimmune rheumatic diseases]

The infections very often complicate the course of autoimmune rheumatic diseases. In diagnostic of septic complications in rheumatic patients the new biomarkers of infections can have a decisive importance. The procalciotonine test is one of them. The issue was to evaluate the diagnostic informativity of this test. The sample included 93 patients. The examination was applied to 65 patients with rheumatic diseases. Among them, 13 patients had bacterial infections. The group consisted of 33 patients with rheumatoid arthritis, 11 patients with systemic lupus erythematous, 6 patients with systemic angiitis, and 15 patients with other rheumatic diseases. The comparative group included 27 patients of cardio-therapeutic profile and 8 of these patients had bacterial infections. The procalcitonine test was applied with quantitative electrochemiluminescent technique. In patients with rheumatoid arthritis the mean levels of procalciotonine test consisted 0.10 +/- 0.13 ng/ml; with systemic lupus erythematous--0.08 +/- 0.06 ng/ml; with systemic angiitis--0.22 +/- 0.2 ng/ml; with other rheumatic diseases--0.12 +/- 0.15 ng/ml; of cardio-therapeutic profile without infections--0.08 +/- 0.06 ng/vl/ With threshold of procalcitonine test higher than 0.5/ml the sensitivity to diagnostic of infections consisted of 58%, specificity--94% in the group with rheumatic diseases. The procalciotonine test in case of no infection process with values higher than 0.5 ng/ml was detected in three patients. The evaluation of dependence of sensitivity and specificity for procalciotonine test and C-reactive protein the area under curve of procalcitonine test was larger in patients with rheumatic diseases (0.85 against 0.79) and in patients of cardio-therapeutic profile (0.92 against 0.90). The quantitative procalcitonine test is the best technique to detect septic complications in rheumatic patients.

Functional gene polymorphism of matrix metalloproteinase-1 is associated with benign hyperplasia of myo- and endometrium in the Russian population

AIMS

Estrogen-dependent hyperplasia of myo- and endometrium manifests as uterine leiomyoma or adenomyosis. We studied possible associations between common polymorphisms of matrix metalloproteinase (MMP) genes and clinical features of uterine hyperplasia.

PATIENTS AND METHODS

One hundred seventy female patients with uterine leiomyoma (46.6±0.5 years) were observed. Clinical diagnosis was based on physical examination, ultrasonography, and histological data. MMP-1 (-1607 1G/2G, rs1799750) and MMP-3 (-1171 5A/6A, rs3025058) were genotyped with allele-specific polymerase chain reaction (PCR) of leukocyte DNA. Clinical and genetic data were evaluated using nonparametric statistics.

RESULTS

Distributions of MMP-1 and MMP-3 promoter alleles among patients and population controls were similar and corresponded to the Hardy-Weinberg equilibrium (HWE). Detectable tumor growth and adenomyosis were observed, respectively, in 71% and 55% of cases. Steady-state leiomyoma correlated with a higher prevalence of the MMP-1 1G/1G genotype (p=0.02 by χ(2) test). Accelerated tumor growth correlated with higher frequency of the MMP-1 2G allele [odds ratio (OR)=2.048, p=0.039, χ(2)=4.2611, confidence interval (CI)=(1.032-4.062)]. MMP-1 2G was also associated with multinodular growth [OR=3.561, p=0.01249, χ(2)=6.24, CI=(1.261-10.058)]. The MMP-1 2G allele tended to increase in patients with adenomyosis [OR=1.525, p=0.054, χ(2)=3.71, CI=(0.992-2.345)].

CONCLUSION

Our pilot study suggests that the 2G (-1607)MMP-1 genotype may be a potential risk marker of myo- and endometrial hyperplasia.

[Intrathecal immunoglobulin production in the diagnosis and differential diagnosis of multiple sclerosis]

The evaluation of diagnostic significance of different immunological tests for intrathecal immunoglobulin production is summarized on the historical basis of investigation of patients with inflammatory, demyelinating and other neurological disorders. The assessment of cerebrospinal fluid lost its previous significance in the 2010 revision of diagnostic criteria for multiple sclerosis. Nowadays, it is used only for the diagnosis of primary progressive multiple sclerosis. Nevertheless, the requirements of the analysis of the cerebrospinal fluid are increasing due to subtle, subclinical and atypical cases of multiple sclerosis as well as undetermined demyelinating disorders. Intrathecal humoral immune response may be pathogenic in multiple sclerosis as suggest immunological data and effectiveness of anti-B cells treatment. Based on these tests, it is useful, to differentiate subgroups of patients and to evaluate different effects of treatment in perspective.

[The optimization of techniques complex of serologic diagnostics of connective tissue systemic diseases]

The connective tissue systemic diseases originate from pathologic process following with antinuclear antibodies emergence. To detect these antibodies a significant number of diagnostic tests and techniques has been applied. Besides that, there is no conventional algorithm of antinuclear antibodies diagnostic. To detect antinuclear antibodies a two-fold diagnostic algorithm was applied In the capacity of screening techniques the indirect immunofluorescence technique was applied to the cells of line Hep-2 (antinuclear factor) and detection of antibodies to extractable nuclear antigen. The second stage of diagnostic included the detection of content of more specific antinuclear antibodies using the Lineblott method and the double-helical DNA antibodies. The blood serum from 981 patients with suspected connective tissue systemic diseases, 115 patients with systemic lupus erythematous and 57 healthy individuals was analyzed. The levels of antinuclear factor, nuclear antigen antibodies and double-helical DNA antibodies were detected. The antinuclear factor was detected in 84% and 86% of cases, double-helical DNA antibodies in 55% and 39% of cases depending of reagents using in detecting these characteristics. Among healthy individuals, antinuclear factor was detected in 5% (1/20) of blood serum samples in titers less than 1:160. In the group of patients with suspected connective tissue systemic diseases, antinuclear factor was detected in 48% (474/981) of cases and extractable nuclear antigen in 20% (326/981) of cases. The Lineblott test was positive in 33% (326/981) of patients with suspected connective tissue systemic diseases. Among antinuclear factor positive patients nuclear antigen antibodies were detected in 36% (171/474) and the Lineblott test was positive in 63% (298/474) of cases. Among antinuclear factor negative patients but positive under anti-nuclear antigen identification, the Lineblott test was positive in 6% (28/507) of cases. The two-fold algorithm of nuclear antigen testing is an effective technique to be applied in the clinical diagnostic laboratory. The results of effectiveness of this algorithm demonstrated that this method can ensure 33% of cost savings of testing individuals with higher incidence of diseases.

[The analytic and diagnostic characteristics of the national test system detecting cyclic citrullinated peptide antibodies]

The clinical signifcance of serodiagnostic assay of rheumatoid arthritis increased nowadays. This is a reason to include the citrullinated antigens' antibodies into the new criteria of diagnostics ACR/EULAR 2010. The approbation of national test system detecting the cyclic citrullinated peptide antibodies was implemented. The analysis was applied to 211 blood serum samples taken of 50 blood donors, 60 patients with rheumatoid arthritis, 66 patients with other rheumatoid diseases. In addition, 35 samples were concurrently analyzed with the comparative test system (CCP2 Euroimmun, Germany). The referential meanings of standard limits were established on the basis of results of study of samples taken from healthy blood donors. When the standard limit was less than 10 arbitrary units the sensitivity made up 75% and the specificity--87.9%. In the case of higher values of citrullinated antigens' antibodies which are more than 15 arbitrary units, the sensitivity made up 68% and the specificity--93.1%. The results of comparing with the comparative test system characterized by high convergence made up 94% (33 out of 35), but the comparative test system detected citrullinated antigens' antibodies in 2 samples. The positive qualitative results of both methods analysis of autoantibodies weakly correlated with one another (r = 0.14). The results testify that the parameters of national test system correspond to the publication data concerning the second generation methods of cyclic citrullinated peptide antibodies detection though yield to the best foreign analogues.

[A method for differential identification of group C and G streptococci with PCR]

The paper describes a rapid method for PCR identification of Groups C and G streptococci (Streptococcus dysgalactiae subspecies equisimilis, Streptococcus constellatus, and Streptococcus anginosus) that cause human disease. Species-specific regions of the cpn60 gene encoding heat shock protein GroEL (HSP60) were chosen as markers for PCR diagnosis; three pairs of primers were constructed for these regions, each of which was peculiar to the specific type. The method was tested on a large collection of pathogenic streptococci of different serogroups isolated from man and animals; its specificity was shown to identify S. dysgalactiae subsp. equisimilis, S. constellatus, and S. anginosus. The proposed method has all benefits of PCR-based techniques, which enables it to be used for the purposes of molecular epidemiology.

[Symptomatic epilepsy in inflammatory demyelinating diseases]

Based on the own observations, we have summarized the features of symptomatic epilepsy in multiple sclerosis and conducted a clinical analysis of the most diagnostically difficult cases of inflammatory and demyelinating diseases in which epilepsy was the major clinical syndrome. The cases of post-infectious acute disseminated encephalomyelitis, idiopathic cerebral angiitis, Rasmussen's encephalitis are reviewed. Peculiarities of MRI structural brain lesions in these patients are discussed. The use of additional laboratory studies, including a study of cerebrospinal fluid, is considered.

[Recombinant fragments of conservative proteins of group B streptococci as a basis of specific vaccine]

AIM

The study devoted to problem of using of recombinant fragments of group B streptococci (GBS) conservative proteins for induction of immune response against streptococcal infections. Two recombinant polypeptides (ScaAB and-ScpB1) corresponding to immunogenic epitopes of two surface GBS proteins ScaAB and C5a-peptidase, which are presented in other streptococcal species, were studied. The objective of the study was to assess specificity and protective activity of mentioned polypeptides against homologous and heterologous strains of pathogenic streptococci from different groups.

MATERIALS AND METHODS

Strains of Streptococcus pyogenes, Streptococcus pneumoniae, Streptococcus agalactiae were used in the study. Array of used methods included opsonophagocytic test as well as active and passive protection of experimental animals against streptococcal infection.

RESULTS

It was shown that antibodies specific to studied polypeptides opsonized several strains of group A and B streptococci as well as pneumococci. Immunization of mice with ScpB1 polypeptide resulted in more rapid recovery of animals from challenge systemic group B streptococcal infection. Antisera specific to both polypeptides provided passive protection of animals from infection caused either GBS or GAS.

CONCLUSION

Obtained data confirm the feasibility to use recombinant fragments of several GBS conservative proteins in vaccine for induction of protection against infections caused by different species of pathogenic streptococci.

[Molecular-genetic comparison of Streptococcus pyogenes strains types emm1 and emm12 on prophage genes repertoire]

AIM

Molecular analysis of Streptococcus pyogenes types emm1 and emm12 genomes on the presence of genes belonging to prophage DNA.

MATERIALS AND METHODS

Thirty-one strains of S. pyogenes type emm1 and 22 strains of S. pyogenes type emm12 were objects of the study. Polymerase chain reaction with special primers for detection of 24 phage genes was used in the study.

RESULTS

Prevalence of phage genes in strains of different emm types was assessed. The following phage genes were most frequently detected: speA, speC, ssa genes for emm1 type and speC and speH for emm12 type. On the basis of the study, 19 different profiles of phage genes were identified.

CONCLUSION

The study allowed to identify not only differences but also similarities between strains of emm1 and emm12 types on prophage gene repertoire in bacterial genome. Presence of similarities allows to assume the possibility of circulation in the studied region similar or identical bacteriophages between streptococci group A (SGA) strains of different emm types.

[Clinical significance of functional variants of matrix metalloproteinase genes in thyroid cancer]

Under analysis were results of genetic investigations of 105 patients with thyroid cancer (TC) treated from 2004 through 2007 in the St. Petersburg City Center of surgery and oncology of the endocrine system organs. The patients' age was from 17 to 80 years (mean age 51.6 +/- 1.9 years). The influence of functional variants of matrix metalloproteinase genes in TC was determined. A reliable correlation was noted between certain gene markers and TC patients' age. An association was revealed between matrix metalloproteinase-3 5A (more active allele) and size of the tumor. A reliably decreased frequency of hyperactive genotype MMP-1 2G was detected in a group of women with metastatic forms of papillary cancer as compared with patients without metastases. It was shown that MMP genes could be a substantial factor of slowing down the rate of malignant growth and invasive properties of cancer of the thyroid gland.

Bacterial markers of periodontal diseases and their practical significance in dentistry

The incidence and prevalence of Actinobacillus actinomycetemcomitans, Porphyronmonas gingivalis, and Tannerella forsythensis in specimens of subgingival dental deposit were evaluated in 495 residents of St. Petersburg aged 6-82 years. The microorganisms were detected by gene-specific PCR of 16S rDNA. In accordance with age-specific increase in the incidence of gingival diseases, the percentage of samples containing T. forsythensis and P. gingivalis was significantly higher in adult and elderly patients in comparison with adolescents. The presence of T. forsythensis significantly correlated with the presence of gingivitis and dental deposit. In addition, the incidence of T. forsythensis was significantly higher in tobacco smokers. These results attest to a relationship between T. forsythensis infection and more frequent periodontal diseases associated with aging and tobacco smoking.

[Detection of infectious agents in heart valves during endocarditis using PCR technique]

Infectious endocarditis can be caused by various microorganisms. Diagnostics of local infection by microbiological methods is not always effective. For that reason we performed a study aimed for direct detection of potential infectious agents by polymerase chain reaction in patients' heart valve tissue. DNA of infectious agents was revealed in 72% of heart valve tissue samples from patients with septic endocarditis; in studied samples, along with bacterial DNA, herpesviruses' DNA was detected. Obtained results confirm the presence of infection, which allows to perform specific diagnostics of infectious complications after implantation of prosthetic cardiac valves.

[Chronic HCV-infection and expression of mRNA of CC-chemokines and their receptors]

The aim of this study was to evaluate some patterns in expression of CC-chemokines (MIP-1alpha, MIP-1beta, MCP-1, RANTES) and their receptors (CCR1, CCR2, CCR3, CCR5) in peripheral blood leukocytes and liver biopsy samples from 21 patients with chronic hepatitis C. 10 healthy subjects were included in the control group. In patients with chronic HCV-infection significant increase of MCP-1 mRNA in liver tissue was observed as the disease progressed. Moreover, content of MCP-1 mRNA was significantly higher in liver as compared with blood. Level of MCP-1 mRNA in liver was directly related with histological changes. Levels of mRNA of CCR1, CCR2, CCR3, and CCR5 in blood of patients with minimal histological manifestations of chronic HCV-infection were significantly lower than in patients with more marked lesions. Expression of CCR1 and CCR5 mRNA in blood was directly correlated with histological activity index and degree of fibrosis. Conducted study demonstrates that progression of chronic hepatitis C is realized through local activation of MCP-1 mRNA synthesis leading to systemic response which manifested by increase of expression of CCR1, CCR2, CCR3, and CCR5 in peripheral blood leukocytes.

[Efficacy of local use of recombinant interferon alpha-2 preparations in combined treatment of recurrent respiratory papillomatosis]

Clinical-immunological examination of 41 patients with recurrent respiratory papillomatosis (RRP) included determination of phenotype CD3, CD4, CD8, CD16, CD25, CD56, HLA-DR in peripheral blood by flow cytofluorimetry, the levels of IFN-gamma, TNF-alpha, GM-CSF, IL-2, IL-4, IL-5, IL-10, IL-12, IL-13 in the laryngeal secretion by multiplex immunoassay. Interferon inhalation therapy was conducted to prevent recurrence in 23 patients after surgical treatment and in 18 patients as monotherapy. The efficacy of the monotherapy was 45.5%. Treatment with IFN-alpha raised the levels of cytokines modulating an immune response by Th1-type (IFN-gamma, IL-12, IL-2) and GM-CSF, and reduced the levels of IL-4, IL-10 and IL-13. Local treatment with recombinant IFN-alpha is effective in aggressive RRP. As prognostic markers of the treatment efficacy may serve baseline high levels of TNF-alpha and IL-4/IFN-gamma index in laryngeal secretion. Treatment efficacy can be assessed by raise of IFN-gamma, IL-2 and IL-12 in combination with reduction of IL-4/IFN-gamma index.

[PCR detection of periodontal bacteria and Streptococcus mutans in the biological samples from the oral cavity]

The paper describes an optimized technique for DNA isolation from the Streptococcus mutans cultures and from the clinical samples including proteinase K treatment and detergent lysis, followed by sorbent-based enrichment. This technique was employed for isolating DNA from the periodontal bacteria Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, and Bacteroides forsythus. A multiplex PCR technique was adapted for large-scale studies of clinical samples. An original PCR method was developed for the semiquantitative detection of Str. mutans, showing the sensitivity of 100 genome copies per reaction. Extensive studies of approximately 2,000 individuals have demonstrated that these methods are applicable to the study of the dental and gingival microflora in the biological sample from the oral cavity of persons with dental diseases from various age groups.

[Immunogenicity of modified by dextran recombinant fragment of Bac protein of group B streptococci]

Opportunity to increase of immunogenicity of recombinant polypeptide P6 constructed on the basis of surface protective Bac protein by its chemical conjugation with dextran (D) 40 was studied. 3 preparations with different quantity of protein and polysaccharide components were obtained. Their testing with standard serum showed that antigenic determinants of the polypeptide were preserved although partly enclosed and structure of antigenic determinants did not significantly changed. On the model of subcutaneous immunization of mice it has been shown that two preparations--P6D2 and P6D3--have improved immunological characteristics. Conjugation of polypeptide P6 with dextran let to increase of immune response to P6 and affinity of P6-specific antibodies. Injection of nonconjugated P6 and dextran mixture showed that free dextran is not immunogenic and it suppress synthesis of P6-specific antibodies without effect on their affinity. Intranasal administration of nonconjugated P6 did not lead to P6-specific IgG in serum. After conjugation with dextran polypeptide P6 was recognized as an antigen and stimulated production of small quantity of antibodies. Technological process of chemical binding of protein antigen with polysaccharides, which let to regulate protein and polysaccharide components ratio, can be the effective method to increase immunogenicity of recombinant polypeptides.

[Streptococcus agalactiae sak0192 gene contains direct repeats and spacers that are genetic markers for characterizing the strains]

A new approach to differentiation of the Streptococcus agalactiae strains was suggested. The approach is based on the nucleotide polymorphism of the sak0192 gene containing variable number of 16 bp direct repeats and 44 bp spacer regions in different S. Agalactiae strains. In general, the direct repeats were identical, while the spacers were variable. Overall, the structure of the sak0192 gene of S. Agalactiae was analogous to direct repeat cluster of Mycobacterium tuberculosis and Streptococcus pyogenes. The applicability of the sak0192 gene polymorphism as a novel genetic marker to identification of S. Agalactiae and differentiation of the strains was demonstrated.

[Optimization of a method for determination of complement activity from 50% hemolysis of sensibilized red blood cells]

The method for determination of compliment activity from 50% hemolysis of sensitized blood cells (CH5) was modified in accordance with the recommendations of the International Clinical Chemistry Association, which could reduce the consumption of reagents, enhance the accuracy and reproducibility of results. The activity of CH50 was calculated for each serum sample by regression analysis, by graphically reflecting the results and by assessing the quality of each performance. The sigma-deviation method was used to calculate the normal CH50 ranges (55-160 conventional units) whose values were in compliance with the international standards. A series of experiments were made to assess the reproducibility of results. To evaluate the diagnostic informative value, the authors analyzed serum samples from 119 persons: 49 apparently healthy individuals, 74 patients with allergic diseases that are generally unattended by hypocomplementemia (Group 1) and 76 with disease the risk of which is increased in the presence of complement system defect (Group 2). Group 1 patients were those who had bronchial asthma or utricaria; Group 2 patients were those who had systemic lupus erythematosus, scleroderma, rheumatoid arthritis, chronic glomerulonephritis, acute glomerulonephritis, chronic furunculosis, chronic tonsillitis, or necrotic vasculitis. In Group 1, the value of CH50 was similar to that in the group of donors (108.0 +/- 3.1 and 105.1 +/- 3.8, respectively; p = 0.565), but it significantly differed from its mean value (91.6 +/- 5.1) in Group 2 (p = 0.00724). The difference in CH50 was also significant in the group of donors and Group 2 (p = 0.0349).

[Peculiarities of diagnosis and treatment of patients with hyposialosis]

33 patients with complaints of hyposalivation (21 in a 33 with syaloadenopatya and 12 in a 33 with syalosis out of the acute stage of disease) were examined. Complex examination of the saliva glands, analysis of the haemokynes in the various mediums of organism and thyoles compounds in the blood plasma was carried out. Tendency to increase in contents of haemokynes in the mixed saliva and in the tissue samples (from low in the syaloadenopatya to expressed in the syalosis) was revealed. Reduction of thyosulfide index in the blood plasma of these patients was determined. Use of antioxidant remedy in complex treatment of syaloadenopatya and syalosis was substanciated in this paper.