[Goodpasture syndrome associated with p-ANCA microscopic vasculitis: a rare entity to recognize]

Some autoimmune diseases may be found presenting simultaneously antibodies (Abs) against basal membrane and anti-neutrophil cytoplasm (ANCA). The clinical picture is that of the Goodpasture syndrome with anti-basement membrane Abs associated with an ANCA-associated small-vessel vasculitis (micro-PAN). The arisen of these two pathological entities is nevertheless too frequent to be the fruit of the only fate. The pathophysiological hypothesis remains that of the micro-PAN initially creates lesions of the basement membrane facilitating the formation of Abs against some constituents of this latter. The prognosis remains controversial, leaving open this issue. This article aims to present a recent literature revue dealing with the simultaneous presence of these two auto-immune diseases.

Catalytic inhibition of topoisomerase II by a novel rationally designed ATP-competitive purine analogue

Background

Topoisomerase II poisons are in clinical use as anti-cancer therapy for decades and work by stabilizing the enzyme-induced DNA breaks. In contrast, catalytic inhibitors block the enzyme before DNA scission. Although several catalytic inhibitors of topoisomerase II have been described, preclinical concepts for exploiting their anti-proliferative activity based on molecular characteristics of the tumor cell have only recently started to emerge. Topoisomerase II is an ATPase and uses the energy derived from ATP hydrolysis to orchestrate the movement of the DNA double strands along the enzyme. Thus, interfering with ATPase function with low molecular weight inhibitors that target the nucleotide binding pocket should profoundly affect cells that are committed to undergo mitosis.

Results

Here we describe the discovery and characterization of a novel purine diamine analogue as a potent ATP-competitive catalytic inhibitor of topoisomerase II. Quinoline aminopurine compound 1 (QAP 1) inhibited topoisomerase II ATPase activity and decatenation reaction at sub-micromolar concentrations, targeted both topoisomerase II alpha and beta in cell free assays and, using a quantitative cell-based assay and a chromosome segregation assay, displayed catalytic enzyme inhibition in cells. In agreement with recent hypothesis, we show that BRCA1 mutant breast cancer cells have increased sensitivity to QAP 1.

Conclusion

The results obtained with QAP 1 demonstrate that potent and selective catalytic inhibition of human topoisomerase II function with an ATP-competitive inhibitor is feasible. Our data suggest that further drug discovery efforts on ATP-competitive catalytic inhibitors are warranted and that such drugs could potentially be developed as anti-cancer therapy for tumors that bear the appropriate combination of molecular alterations.

[Retinal detachment in children: differential diagnosis and current therapy]

The number of retinal detachments in children is very low in comparison to the number of retinal detachments in adults, only 3.2 - 6.6% occur in children. The main predisposing factors are trauma, associated conditions, myopia and retinopathy of prematurity (ROP) i. e., stage 4 and 5 and late stage of ROP. Furthermore, retinal detachment in children can be idiopathic. These eyes are not associated with any identified ocular or systemic comorbidity. Associated conditions include hereditary vitreoretinal disorders (e. g., morbus Stickler, X-linked juvenile retinoschisis, Marfan syndrome, familiär exsudative vitreoretinopathy), malformations (e. g., persistent hyperplastic primary vitreous, coloboma) and retinal detachment following cataract surgery. In a few cases retinal detachment is caused by uveitis and by Coats disease. Delayed presentation and proliferative vitreoretinopathy are a common problem and in most eyes primary pars plana vitrectomy is necessary. It is important to perform consequent postoperative follow-up. The functional and anatomic outcomes of retinal detachment in children are less successful than in adults. Further surgical innovations and aetiology-specific treatment strategies are required to improve the outcome in this group. Recent results show that the intravitreal use of VEGF inhibitors to treat proliferative retinopathy (ROP) in children is effective, but we need further information about safety and side-effects.

Development of a compliant device for minimally invasive surgery

A peristaltically actuated device for minimally invasive surgery (PADeMIS) is being developed at Technical University of Ilmenau. PADeMIS will be manufactured from silicone rubber and its design is being optimized by finite element analysis (FEA). Due to the small dimensions of the device an extensively automated fabrication technology, based on lithography, is developed. Furthermore, a controlling unit is built up.

[Primary vitrectomy with intraocular antibiotic application in postoperative endophthalmitis]

PURPOSE

Pars plana vitrectomy with intravitreal antibiotic application is an established procedure for treating postoperative endophthalmitis. The presented study analyzes our own results with this treatment as well as the role of adjuvant systemic steroid treatment.

METHOD

We analyzed the data of 34 consecutive patients with postoperative endophthalmitis from January 2000 to March 2006. Thirty-two patients underwent vitrectomy and intravitreal application of antibiotics, and two patients received intravitreal antibiotics only. All patients received intravitreal dexamethasone and systemic antibiotics, and 12 patients received the systemic treatment with prednisolone. The effect of vitrectomy with respect to final visual acuity and the rate of postoperative complications were analyzed. The vitreous was microbiologically examined. Postoperative follow-up time ranged from 2 weeks to 24 months.

RESULTS

Endophthalmitis followed cataract surgery with intraocular lens implantation in 30 patients (89%) and followed pars plana vitrectomy in four patients (11%). Positive cultures were obtained in 19 (56%) patients. Visual acuity improved in 31 (91%) patients. At their final examinations, 27 (79%) patients had gained visual acuity of 0.05 or better.

CONCLUSIONS

CONCLUSION

Immediate vitrectomy in combination with intraocular antibiotics and steroid administration resulted in preservation of ambulatory vision in most of the patients. Systemic postoperative therapy with steroids seems to be associated with better final visual acuity.

[Primary vitrectomy with intravitreal antibiotic application in postoperative and posttraumatic endophthalmitis]

AIM

The aim of our study was to evaluate the results of the treatment of postoperative and posttraumatic endophthalmitis by means of primary vitrectomy with intravitreal antibiotic application.

METHODS

In 42 patients treated for postoperative and posttraumatic endophthalmitis during the period January 2000-March 2006 at the University Department of Ophthalmology in Leipzig, Germany, EU, the postoperative visual acuity was followed-up. Furthermore, the results of microbial cultivation of the vitreous sample and the correlation between the final visual acuity and the causing etiological agent were evaluated. The treatment of endophthalmitis in 39 patients consisted of the primary vitrectomy with intravitreal antibiotics application; in three patients, solely the intravitreal injection of antibiotics was performed. In all patients, the antibiotics were administered locally and intravenously as well. The postoperative follow-up period lasted between 2 weeks to 24 months (median, 4.5 months).

RESULTS

The cause of endophthalmitis was in 31 (73%) patients the cataract surgery or secondary implantation of the intraocular lens; and in 4 (10%) patients the previous pars plana vitrectomy was performed. In 2 patients (5%) the endophthalmitis developed after trabeculectomy and in 5 (21%) patients, the endophthalmitis followed after perforating eye trauma. By means of microbiological cultivation, the agent was proved in 20 patients. The most common cause of endophthalmitis was Staphylococcus epidermidis. The postoperative improvement of the visual acuity we noticed in 39 patients. The final visual acuity better than 1/50 was reached by 88% of patients, thereof in 52% we proved at the end of the follow-up period the visual acuity better than 0.5.

CONCLUSION

The primary vitrectomy with intravitreal application of antibiotics combining with local as well as intravenous applications of antibiotics is a successful method of endophthalmitis treatment; in our study, in 88% of patients, the partial (orientational) vision was maintained.

The antiapoptotic activity of insect IAPs requires activation by an evolutionarily conserved mechanism

Apoptosis represents a fundamental biological process that relies on the activation of caspases. Inhibitor of apoptosis (IAP) proteins represent a group of negative regulators of both caspases and cell death. The current model dictates that IAPs suppress apoptosis by blocking the catalytic pocket of effector caspases thereby preventing substrate entry. Here, we provide evolutionary evidence for the functional interplay between insect IAPs and the N-end rule-associated ubiquitylation machinery in neutralising effector caspases and cell death. We find that IAPs require 'priming' in order to function as antiapoptotic molecules. Consistently, we demonstrate that the antiapoptotic activity of diverse insect IAPs is activated by effector caspases, providing the cell with a sensitive strategy to monitor and neutralise active caspases. Almost 300 million years of evolutionary selection pressure has preserved a caspase cleavage site in insect IAPs that, following processing by a caspase, exposes a binding motif for the N-end-rule-associated degradation machinery. Recruitment of this ubiquitylation machinery into the 'cleaved-IAP:caspase' complex provides a mechanism to negatively regulate effector caspases and block apoptosis. Furthermore, comparisons between cellular and several viral IAPs suggest differences in their modes of action, as OpIAP3, CpGV-IAP3 and HcNPV-IAP3 fail to associate with several effector caspases. Evolutionary conservation of the N-end-rule degradation pathway in IAP-mediated regulation of apoptosis further corroborates the physiological relevance of this ubiquitylation-associated process.

[Lercanidipine, a third generation calcium antagonist. Which advantages?]

Lercanidipine is a new highly lipophylic dihydropyrdine derivative of the third generation with equal efficacy but an improved tolerability profile. Comparative therapeutic trials have shown that it is as effective as other dihydropyridines, in particular amlodipine, beta-blockers, and angiotensin-converting enzyme inhibitors. Lercanidipine is well tolerated, with most treatment-emergent events related to vasodilation. Lercanidipine produces less reflex tachycardia and peripheral oedema. Common adverse events included headache and flushing. Because of its efficacy and favorable safety profile, lercanidipine has the potential to improve blood pressure control in a wide range of patients, including those who have not responded to, or who have been unable to tolerate other antihypertensive agents.

[Leucocoria in childhood]

BACKGROUND

There are a number of conditions in infants and young children which produce a white reflex in the pupillary area, termed leucocoria. In cases of leucocoria, retinoblastoma has to be excluded without delay.

METHODS

We analysed data from consecutive children who were presented to our hospital because of leucocoria between January 1999 and June 2005. The analysis was performed by methods of descriptive statistics.

RESULTS

Leucocoria was found in 83 eyes of 58 children. Leucocoria was caused in most cases by congenital cataract (35 %), followed by malformations (18 %) (persistent hyperplastic primary vitreous, coloboma, disc anomaly, combined developmental abnormalities), hereditary vitreoretinal disorders (13 %), retinopathy of prematurity (12 %), trauma-associated diseases (8 %). Five children suffered from retinoblastoma (6 %). Following in frequency were inflammatory disorders (5 %) and Coats' disease (2 %).

DISCUSSION

Several ocular conditions of childhood can clinically cause leucocoria. Knowledge of the clinical features that serve to differentiate retinoblastoma from simulating lesions may assist the clinician in arriving at the correct diagnosis.

Systematic in vivo RNAi analysis of putative components of the Drosophila cell death machinery

Despite the identification of numerous key players of the cell death machinery, little is known about their physiological role. Using RNA interference (RNAi) in vivo, we have studied the requirement of all Drosophila caspases and caspase-adaptors in different paradigms of apoptosis. Of the seven caspases, Dronc, drICE, Strica and Decay are rate limiting for apoptosis. Surprisingly, Hid-mediated apoptosis requires a broader range of caspases than apoptosis initiated by loss of the caspase inhibitor DIAP1, suggesting that Hid causes apoptosis not only by antagonizing DIAP1 but also by activating DIAP1-independent caspase cascades. While Hid killing requires Strica, Decay, Dronc/Dark and drICE, apoptosis triggered by DIAP1 depletion merely relied upon Dronc/Dark and drICE. Furthermore, we found that overexpression of DIAP2 can rescue diap1-RNAi-mediated apoptosis, suggesting that DIAP2 regulates caspases directly. Consistently, we show that DIAP2 binds active drICE. Since DIAP2 associates with Hid, we propose a model whereby Hid co-ordinately targets both DIAP1 and DIAP2 to unleash drICE.

[Do selective COX-2 inhibitors have adverse renal and cardiovascular effects?]

Selective cyclooxygenase-2-inhibitors (COX-2) were developed as an alternative to the non-steroidal anti-inflammatory drugs (NSAID) in order to reduce their known gastrointestinal and renal toxicity. Several recent studies have shown the complex mechanism of the cyclooxygenase-2. The inhibition of the COX-2 has effects on renal hemodynamics, renal salt and water retention and may increase the thromboembolic and therefore the cardiovascular risk. The renal toxicity of the COX-2 inhibitors is similar to that of traditional NSAID. Regarding these data, COX-2 inhibitors should be prescribed with much caution to high risk patients, that is, patients with renal failure and/or cardiovascular diseases.