Placenta accreta spectrum in early and late pregnancy from an imaging perspective. A scoping review

Placenta accreta spectrum (PAS) disorders (with increasing order of the depth of invasion: accreta, increta, percreta) are quite challenging for the purpose of diagnosis and treatment. Pathological examination or imaging evaluation are not very dependable when considered as stand-alone diagnostic tools. On the other hand, timely diagnosis is of great importance, as maternal and fetal mortality drastically increases if patient goes through the third phase of delivery in a not well-suited facility. A multidisciplinary approach for diagnosis (incorporating clinical, imaging, and pathological evaluation) is mandatory, particularly in complicated cases. For imaging evaluation, the diagnostic modality of choice in most scenarios is ultrasound (US) exam; patients are referred for MRI when US is equivocal, inconclusive, or not visualizing placenta properly. Herewith, we review the reported US and MRI features of PAS disorders (mainly focusing on MRI), going over the normal placental imaging and imaging pitfalls in each section, and lastly, covering the imaging findings of PAS disorders in the first trimester and cesarean section pregnancy (CSP).

O-185 Cryopreservation of Human Spermatozoa: Utilization of L-Proline as a Novel Additive to Improve Sperm Quality Following Freezing-Thawing Process

Study question

Does supplementation of human sperm freezing media with L-Proline improve sperm quality and DNA Integrity following the freezing-thawing process?

Summary answer

The inclusion of L-proline as a novel additive to human sperm cryopreservation media improves sperm parameters and DNA integrity via mitigating oxidative stress.

What is known already

Sperm cryopreservation is an essential aspect of assisted reproductive technique (ART) and male fertility preservation. Although frozen-thawed semen has great practical benefits for reproduction, it is widely reported that the cryopreservation process induces physical and chemical detrimental changes in sperm functions. Indeed, freezing induces nitro-oxidative stress, lipid peroxidation, DNA fragmentation, and apoptosis. L-proline plays versatile roles in osmotic protection and oxidative stress, cell signaling, programmed cell death, and nutrient adaptation. This multifunctional amino acid is a natural osmoprotectant and the protective effect of L-proline against freezing-thawing-induced damages in stallion and donkey spermatozoa have been reported.

Study design, size, duration

Thirty normozoospermic semen samples were collected by masturbation after 3–5 days of sexual abstinence from men who were referred to the IVF clinic of Kermanshah Motazedi Hospital from December 2020 to June 2021. Each prepared semen sample was aliquoted to 4. In aliquots 1 to 4, experimental concentrations of L-proline (0, 1, 2, and 4 mmol/L), were included in the freezing medium.

Participants/materials, setting, methods

30 normozoospermic, healthy, non-smoker men were enrolled. Sperm parameters (progressive motility, viability, and morphology) were assessed. Sperm chromatin quality was measured by Aniline blue (AB), Toluidine blue (TB), and Chromomycin A3 (CMA3) staining. DNA integrity was evaluated by the Sperm chromatin dispersion (SCD) test. Furthermore, the levels of reactive oxygen species (ROS), lipid peroxidation (LPO), and total antioxidant capacity (TAC) were determined in sperm freezing media. All assessments were conducted before cryopreservation and after thawing.

Main results and the role of chance

Our findings showed that sperm progressive motility and viability were significantly higher in the 4 mmol/L L-proline treated groups compared to the control groups (p = 0.003, p = 0.0200) respectively. The percentage of normal morphology was improved in L-Proline-treated groups. However, this improvement was not considerable (p > 0.5). Moreover, the level of ROS production significantly diminished in the 4 mmol/L L-proline group compared to the control group (p < 0.001). Besides, the level of TAC was significantly enhanced in the 4 mmol/L L-proline group by comparison to the control group (p < 0.001). Furthermore, the results of AB and TB tests demonstrated that chromatin packaging after supplementation with 4 mmol/L L-proline significantly improved compared to the control group (p < .0001). In this regard, there was a significant improvement between the 4 mmol/L   L-proline group and the control group in terms of CMA3 evaluation (p < .0001). Also, there was a difference between the 4 mmol/L L-proline group and the control group in reducing the level of fragmented DNA. Although 4 mmol/L of Praline could diminish the SCD level compared to the control group, this amelioration was not statically significant (p = 0.053).

Limitations, reasons for caution

We were not able to perform further studies to verify the effects of L-proline on mitochondrial activity and membrane potential, and sperm apoptosis as well as to confirm the efficiency and safety of L-proline in terms of more indicators such as the in vitro embryonic development and live birth rate.

Wider implications of the findings

These findings can draw attention to the potential role of L-proline as a novel additive and antioxidant to human freezing medium in preserving sperm quality and protecting spermatozoa against ROS attack during sperm cryopreservation in infertility clinics.

Trial registration number

N/A

Umbilical cord mesenchymal stem cells as well as their released exosomes suppress proliferation of activated PBMCs in multiple sclerosis

Multiple sclerosis (MS) is a central nervous system (CNS) degenerative disorder which is caused by a targeted autoimmune-mediated attack on myelin proteins. Previously, mesenchymal stem cells were considered as a novel and successful treatment of MS. One of the underlying mechanisms behind their immunomodulatory function is the release of extracellular vesicles, particularly exosomes. In this study, we aimed to evaluate the suppressive efficacy of MSCs and their exosomes on the proliferation of peripheral mononuclear blood cells (PBMC) in relapsing-remitting MS (RRMS) patients and healthy subjects. To do, mesenchymal stem cells were derived from human umbilical cord tissues and used for exosome isolation through ultracentrifugation. Suppressive function of MSCs and MSC-derived exosomes was examined in a coculture with CFSE-labelled PBMCs in vitro. PBMC proliferation of the patients and healthy individuals was measured using flow cytometry. We first demonstrated that proliferation of PBMCs decreased in the presence of MSCs and suppression was more efficient by MSC-derived exosomes, with a minimum alloreaction rate. However, suppression capacity of MSCs and their exosomes significantly decreased during extensive sub-culturing. The present study showed that MSC-derived exosomes as an effective cell-free therapy could prevent proliferation of PBMCs. However, further evaluations are need to move towards a functional approach that can be translated to the clinic.

[Inflammation and osteoarthritis-related pain]

Osteoarthritis (OA) is one of the major causes of chronic pain. Although OA has long been considered a non-inflammatory "wear and tear" disease leading to loss of articular cartilage, recent findings provide convincing evidence that inflammatory mechanisms play a pivotal role in the pathophysiology of OA. In OA mononuclear cells (e. g. T‑cells and macrophages) infiltrate the synovial membrane and the levels of pro-inflammatory cytokines in peripheral blood and synovial fluid samples are elevated. Increased release of inflammatory mediators including interleukin (IL) IL-1β, IL-6, IL-8, IL-15 und tumor necrosis factor alpha (TNF‑α) induces the expression of proteolytic enzymes such as matrix metalloproteinases resulting in cartilage breakdown. Molecular and cellular interactions between the immune and nervous system are also involved in the development of OA-related pain. Inflammatory mediators including IL-6 und TNF‑α lead to peripheral sensitization of joint nociceptors and growth factors (e. g. NGF) trigger the expression of TRPV1 channels in primary afferents. Moreover, neuropeptides reduce the threshold of nociceptors of OA joints. The current review highlights the role of inflammatory mechanisms in OA-induced joint pain considering clinical signs of inflammation and major inflammatory pathways.

A predominant Th1 polarization is present in synovial fluid of end-stage osteoarthritic knee joints: analysis of peripheral blood, synovial fluid and synovial membrane

Thorough understanding of the complex pathophysiology of osteoarthritis (OA) is necessary in order to open new avenues for treatment. The aim of this study was to characterize the CD4⁺ T cell population and evaluate their activation and polarization status in OA joints. Fifty-five patients with end-stage knee OA (Kellgren-Lawrence grades III-IV) who underwent surgery for total knee arthroplasty (TKA) were enrolled into this study. Matched samples of synovial membrane (SM), synovial fluid (SF) and peripheral blood (PB) were analysed for CD3⁺ CD4⁺ CD8^- T cell subsets [T helper type 1 (Th1), Th2, Th17, regulatory T cells] and activation status (CD25, CD69, CD45RO, CD45RA, CD62L) by flow cytometry. Subset-specific cytokines were analysed by cytometric bead array (CBA). SM and SF samples showed a distinct infiltration pattern of CD4⁺ T cells. In comparison to PB, a higher amount of joint-derived T cells was polarized into CD3⁺ CD4⁺ CD8^- T cell subsets, with the most significant increase for proinflammatory Th1 cells in SF. CBA analysis revealed significantly increased immunomodulating cytokines [interferon (IFN)-γ, interleukin (IL)-2 and IL-10] in SF compared to PB. Whereas in PB only a small proportion of CD4⁺ T cells were activated, the majority of joint-derived CD4⁺ T cells can be characterized as activated effector memory cells (CD69⁺ CD45RO⁺ CD62L^- ). End-stage OA knees are characterized by an increased CD4⁺ T cell polarization towards activated Th1 cells and cytokine secretion compared to PB. This local inflammation may contribute to disease aggravation and eventually perpetuate the disease process.

Toxocara eggs in public places worldwide - A systematic review and meta-analysis

Toxocariasis is a neglected tropical disease of humans. Although many studies have indicated or shown that environmental contamination with Toxocara species eggs is a major risk factor for toxocariasis in humans, there has been no comprehensive analysis of published data or information. Here, we conducted the first systematic review and meta-analysis of current literature to assess the global prevalence of Toxocara eggs in public places (including beaches, parks and playgrounds). We conducted searches of the PubMed, Embase, Scopus and Science Direct databases for relevant studies published until 20 April 2018, and assessed the prevalence rates of Toxocara eggs in public places. We used the random effects model to calculate pooled prevalence estimates, with 95% confidence intervals (CIs), and analysed data in relation to WHO geographical regions. Subgroup analysis and meta-regressions regarding the geographical and environmental variables were also performed. Of 2384 publications identified, 109 studies that tested 42,797 soil samples in 40 countries were included in the meta-analysis. The pooled global prevalence of Toxocara eggs in public places was 21% (95% CI, 16-27%; 13,895/42,797). The estimated prevalence rates in the different WHO regions ranged from 13% to 35%: Western Pacific (35%; 95% CI, 15-58%), Africa (27%; 95% CI, 11-47%), South America (25%; 95% CI, 13-33%), South-East Asia (21%; 95% CI, 3-49%), Middle East and North Africa (18%; 95% CI, 11-24%), Europe (18%; 95% CI, 14-22%), and North and Central Americas (13%; 95% CI, 8-23%). A high prevalence was significantly associated with high geographical longitude (P = 0.04), low latitude (P = 0.02) and high relative environmental humidity (P = 0.04). This meta-analysis of data from published records indicates that public places are often heavily contaminated with eggs of Toxocara. This finding calls for measures to reduce the potential risk of infection and disease in humans.

Unicompartmental and bicompartmental knee osteoarthritis show different patterns of mononuclear cell infiltration and cytokine release in the affected joints

It is still controversial which cell types are responsible for synovial inflammation in osteoarthritic (OA) joints. The aim of this study was to quantify the mononuclear cell populations and their cytokines in patients with different knee OA subtypes. Synovial membrane (SM), synovial fluid (SF) and peripheral blood (PB) were harvested from patients with unicompartmental (UC) and bicompartmental (BC) knee OA. Frequencies of mononuclear cells were assessed by flow cytometry in PB and SM. Naive SF samples were analysed for a broad variety of cytokines by multiplex analysis. SM of both groups displayed a distinct mononuclear cell infiltration, with CD14(+) macrophages being the major cell population, followed by CD4(+) T cells and only small numbers of CD8(+) T, CD19(+) B and CD16(+) CD56(+) natural killer (NK) cells. Between the two groups, SM of BC OA showed significantly higher amounts of mononuclear cells (135·7 ± 180 versus 805 ± 675 cells/mg, P = 0·0009) and higher CD4(+) T cell presence (3·4 ± 4·6 versus 9·1 ± 7·5%, P = 0·0267). SF of BC OA displayed significantly higher concentrations for a number of proinflammatory cytokines [CXCL1, eotaxin, interferon (IFN)-γ, interleukin (IL)-7, IL-8, IL-9, IL-12]. UC and BC OA show significant differences in their synovial inflammatory pattern. Whereas in UC OA CD14(+) macrophages are the predominant cell population, BC OA has a higher inflammatory profile and seems to be driven by CD14(+) macrophages and CD4(+) T cells. Inclusion of clinical information into the analysis of cellular and molecular results is pivotal in understanding the pathophysiology of OA.

FGF-2 addition during expansion of human bone marrow-derived stromal cells alters MSC surface marker distribution and chondrogenic differentiation potential

OBJECTIVES

Although clinical applications using mesenchymal stromal cells (MSCs) are becoming more frequent, procedures for their in vitro culture are far from standardized. Growth factors such as FGF-2 are frequently added during expansion to improve population growth and differentiation characteristics. However, up to now its influence on surface marker distribution of MSCs has been close to unknown. The purpose of this study was therefore to analyse effects of FGF-2 supplementation on pre-selection of MSC subpopulations.

MATERIALS AND METHODS

Mesenchymal stromal cells were harvested from bone marrow of six patients and expanded in alpha-MEM or DMEM-LG. Starting in passage 2, 10 ng/ml FGF-2 was administered and non-supplemented media were used as controls. Growth indices were calculated from P0 to P4. After P4, fluorescence cytometry for common MSC surface markers was performed and standard chondrogenic, adipogenic and osteogenic differentiation protocols were applied.

RESULTS

Cell population growth indices were higher for those in FGF-2 supplemented media. Significant differences in surface marker distribution were observed for CD13, CD14, CD49, CD90, CD340 and STRO-1 depending on respective culture conditions. FGF-2 suppressed CD146 expression in both alpha-MEM and DMEM-LG. No differences in adipogenic and osteogenic differentiation potential could be observed, while FGF-2 significantly improved chondrogenic differentiation in DMEM-LG.

CONCLUSIONS

While holding the benefit of improving MSC chondrogenic differentiation potential, FGF-2 pre-selects certain MSC subtypes. Our data clearly show that expansion culture conditions have a significant effect on distribution of a number of MSC surface markers.

The influence of bone marrow- and synovium-derived mesenchymal stromal cells from osteoarthritis patients on regulatory T cells in co-culture

There is increasing evidence that inflammation in the synovium plays a major role in the progression of osteoarthritis (OA). However, the immunogenic properties of mesenchymal stromal cells (MSCs), which are considered to regulate immunity in various diseases, remain largely unknown in OA. The purpose of this study was to determine the influence of MSCs from OA patients on regulatory T cells (Tregs ) in an allogeneic co-culture model. Bone marrow (BM) and synovial membrane (SM) were harvested from hip joints of OA patients and co-cultured with lymphocytes enriched in CD4(+) CD25(+) CD127(-) regulatory T cells (Treg (+) LC) from healthy donors. Treg proportions and MSC markers were assessed by flow cytometry. Cytokine levels were assessed after 2 and 5 days of co-cultivation. Additionally, Treg (+) LC cultures were analysed in the presence of interleukin (IL)-6 and MSC-supernatant complemented medium. B-MSCs and S-MSCs were able to retain the Treg proportion compared to lymphocyte monocultures. T cell-MSC co-cultures showed a significant increase of IL-6 compared to MSC cultures. S-MSCs produced higher amounts of IL-6 compared to B-MSCs, both in single and T cell co-cultures. The effect of retaining the Treg percentage could be reproduced partially by IL-6 addition to the medium, but could only be observed fully when using MSC culture supernatants. Our data demonstrate that retaining the Treg phenotype in MSC-T cell co-cultures can be mediated by MSC derived from OA patients. IL-6 plays an important role in mediating these processes. To our knowledge, this study is the first describing the interaction of MSCs from OA patients and Tregs in an allogeneic co-culture model.

Single-nucleotide polymorphisms of TNFA and IL1 in allergic rhinitis

BACKGROUND

Allergic rhinitis is a complex polygenic disorder of the upper respiratory tract. Given that proinflammatory cytokines such as tumor necrosis factor (TNF) and interleukin (IL) 1 seem to play a role in the development of allergic rhinitis, we evaluated the associations between various single-nucleotide polymorphisms (SNPs) of the TNF and IL1 genes in a case-control study.

METHODS

The study population comprised 98 patients with allergic rhinitis. Genotyping was performed using polymerase chain reaction with sequence-specific primers for 2 TNFA promoter variants (rs1800629 and rs361525), 1 variant in the promoter region of IL1A (rs1800587), 2 SNPs in the IL1B gene (rs16944 and rs1 143634), 1 variant in the IL1 receptor (rs2234650), and 1 in IL1RA (rs315952).

RESULTS

Patients who were homozygous for the T allele of rs16944 in IL1B had an 8.1-fold greater risk of allergic rhinitis than those with the C allele. In TNFA, a significant relationship was also detected between rs1800629 and rs361525 and allergic rhinitis. Except for rs1800587 in IL1A and rs315952 in IL1RA, significant differences were found between the patient and control groups for all other SNPs.

CONCLUSIONS

We found that allelic variants in the TNFA and IL1 genes were not only associated with the risk of developing allergic rhinitis, but also affected disease course and severity.

Regulation of aggrecanases from the ADAMTS family and aggrecan neoepitope formation during in vitro chondrogenesis of human mesenchymal stem cells

Aggrecanases from the ADAMTS (A Disintegrin And Metalloproteinase with ThromboSpondin motifs) family are important therapeutic targets due to their essential role in aggrecan depletion in arthritic diseases. Whether their function is also important for matrix rearrangements during chondrogenesis and thus, cartilage regeneration, is however so far unknown. The aim of this study was to analyse the expression and function of ADAMTS with aggrecanase activity during chondrogenic differentiation of human mesenchymal stem cells (MSCs). Chondrogenic differentiation was induced in bone marrow-derived MSC pellets and expression of COL2A1, aggrecan, ADAMTS1, 4, 5, 9, 16 and furin was followed by quantitative RT-PCR. Formation of the NITEGE (ADAMTS-cleaved) and DIPEN (MMP-cleaved) aggrecan neoepitopes was detected by immunohistochemistry. While the expression of ADAMTS4, 9, 16 and furin was up-regulated during chondrogenesis, ADAMTS1 and 5 were down-regulated. Despite this regulation of ADAMTS, no formation of NITEGE neoepitopes occurred in MSC pellets, indicating no ADAMTS-induced cleavage of aggrecan. In contrast, MMP-induced cleavage of aggrecan appeared at 14 d after induction of chondrogenesis. Submission of differentiated MSC pellets to IL1β treatment for 3 d resulted in strong upregulation of ADAMTS1, 4 and 5, rapid proteoglycan depletion, and stimulation of ADAMTS-induced but not MMP-induced cleavage of aggrecan. Thus, there is no evidence for ADAMTS-induced aggrecan cleavage during chondrogenesis, but proteoglycan turnover is rapidly inducible under inflammatory signals. Therapeutic aggrecanase inhibition for treatment of arthritic disease may thus not impede regenerative self-healing pathways based on chondrogenesis of local progenitor cells in the joint.

[What are the young academics in O und U doing?]

The shortage of junior doctors is a very important and acute issue. One reason is the impending shortage of doctors and the lack of young medical professionals.

Professional societies take this very seriously and are working hard on a solution. One of the many offerings that are designed for students of medicine is the annual "Summer School” of the German DGOU (German Society for Orthopaedics and Trauma Surgery).

This article focuses on the SummerSchool of the DGOU and the feedback by the students who attended this Summer School 2010 in Homburg. Its particular interest lies in the question of whether such events are effective in creating an interest for young doctors.

For the evaluation of the course, a questionnaire was created, which had a total of 14 questions. The questionnaire gave the students an opportunity to provide both positive and negative feedback through the use of a sliding scale, 1 being the best and 10 the worst.

The evaluation showed that the overall perception was positive, with some excellent ratings given. In particular personal interaction was an outstanding point. Also the subject Orthopaedics and Trauma Care was better communicated to the students and thus left a longer-lasting impression.

Overall it can be said that formats such as the DGOU Summer School are an important tool in the development of young health care professionals, and that they play a vital part in the attraction of young health care professionals.What seemed of great importance in this context was the close contact and exchange of experience with the teachers.

More time and observations are still required to determine whether or not these efforts had the desired effect on influencing students to choose Orthopaedics and Trauma Care.

[Position Paper of the Youth Forum DGOU 2010 - part 2]

The aim of the "Youth Forum of the DGOU" during the Convention 2010 in Heidelberg was to place a statement concerning the professional politics in the field of Orthopaedic and Trauma Surgery. The Bologna Process realizes a standardization of the academic training within the European Union. For medicine this concept would raise the opportunity to opt out after three years with a bachelor degree applying for alternative occupations within the health care system. However, these alternative occupations are rarely defined and, in addition, the current structure of medical school in Germany provides the highest possible education for doctors in a direct and very well established way. Thus, reforming medical school in Germany into a Bachelor-master's system is an ambivalent approach, which considers a thorough reappraisal. There is currently no necessity for an speciality training in emergency medicine. The rapid and qualified treatment by the specific subspecialty provides a high standard of care for the patient. The high frequency exposure of the trauma and orthopaedic resident with emergency cases is an essential part of the current professional training.The "Junge Forum der DGOU" continues to understand the speciality training "Facharzt für Orthopädie und Unfallchirurgie" as the basic module of the profession. After that it should be possible to continuing subspecialty training and obtaining "spezielle Unfallchirurgie" bzw "spezielle orthopädische Chirurgie". After that further subspecialty training should be encouraged.

[Position Paper of the Youth Forum DGOU 2010 - part 1]

The aim of the "Youth Forum of the DGOU" during the Convention 2010 in Heidelberg was to place a statement concerning the professional politics in the field of Orthopaedic and Trauma Surgery. The emigration of young German physicians, the occupational image of the Physician Assistant and the quality of the German residency programs in Orthopaedic and Trauma Surgery we discussed as main topics. The main reason for young German physicians to go abroad is, besides better work conditions and less bureaucracy, the better structured education during residency. Therefore the "Youth Forum" generally supports the concept of the "physician assistant" as "a relief from non-physician duties rather than discussing the delegation of true physician duties". The "Youth Forum" is looking forward to collaborating on the improvement of the ongoing education of residents. In this regard, Orthopaedic and Trauma Surgery needs to become more attractive for young academics. We also support a uniform and nationwide curriculum, which guarantees a structured education to improve the theoretic, practical and academic skills of the future specialist in orthopaedic and trauma surgery. Additional surveys and interviews among the current generation of residents are needed to further specify the potential goals of such a curriculum. We would like to discuss the future of our speciality with our colleagues. Therefore different communication platforms including our website http://www.jf-dgou.de have been created.

Proinflammatory cytokine gene single nucleotide polymorphisms in common variable immunodeficiency

Common variable immunodeficiency (CVID) is a heterogeneous group of primary immunodeficiency diseases. Cytokine production could be affected in CVID patients, whereas its alteration could be due to genetic polymorphisms within coding and promoter regions of the cytokine genes. This study was performed to analyse the proinflammatory cytokine single nucleotide polymorphisms in CVID. The allele and genotype frequencies of a number polymorphic genes coding tumour necrosis factor (TNF)-alpha, interleukin (IL)-1alpha, IL-1beta, IL-1R, IL-1RA and IL-6 were investigated and compared between two groups of CVID patients and controls. The IL-6 GA genotype at position nt565 was significantly over-represented in the patient group (P<0.001), while the IL-6 GG genotype at position -174 (P=0.006) and the GG genotype at position nt565 (P<0.001) were significantly lower than controls. The TNF-alpha AG genotype at position -308 in the patient group was increased significantly in comparison with controls (P=0.027), but the GG genotype at the same position was significantly decreased (P=0.011). IL-6 CA and GA haplotypes were the most frequent haplotypes in the patients (P<0.005), whereas TNF-alpha GA (P=0.002) and IL-6 GG (P<0.001) haplotypes were decreased significantly in the patients in comparison with controls. Cytokine single nucleotide polymorphisms could have a role in pathophysiology of CVID. High production of TNF-alpha is expected in some CVID patients based on the frequency of genotypes/haplotypes of these cytokine gene polymorphisms.

Polymorphisms in IL4 and iLARA confer susceptibility to asthma

BACKGROUND

Asthma is a complex disease that is caused by genetic and environmental factors. The production of interleukin (IL)-4, which can influence mast cell responsiveness to immunoglobulin (Ig) E--mediated signaling, could be modified by genetic variants in the IL-4 promoter.

OBJECTIVE

To investigate the association between the IL-4 and IL-4RA promoter polymorphisms and asthma in a sample of Iranian patients.

METHODS

We used polymerase chain reaction with sequence-specific primers to investigate the allele and genotype frequencies of 2 polymorphic genes coding for IL-4 and IL-4RA in 59 Iranian patients with asthma and 139 healthy controls.

RESULTS

The most frequent genotypes in the patient group were IL-4TC (-590), IL-4TC (-33), IL-4 GT (-1098), and IL-4RA GA (+1902). In contrast, the frequencies of IL-4 CC (-590), IL-4 CC (-33), IL-4TT (-1098), and IL-4RAAA (+1902) were significantly lower in the patient group than in the control group. The most frequent haplotypes in our patients were IL-4 TCT and GTC at positions -1098,-590,-33. The mean total serum IgE level in patients with the TTT/GCC genotype was 258.8 IU/mL, which was significantly higher than the 95.4 IU/mL observed for other genotypes.

CONCLUSION

We showed a strong association between the polymorphisms of the IL-4 gene promoter at positions -590, -33 and -1098 and bronchial asthma. We also demonstrated an association between their haplotypes and serum total IgE.

[Pharmacological treatment of fibromyalgia syndrome]

BACKGROUND

An interdisciplinary guideline for the treatment of fibromyalgia syndrome (FMS) and chronic widespread pain (CWP) was developed in cooperation with ten German medical and psychological associations and two patients' self-help organizations.

METHODS

Using the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-2006), PsychInfo (1966-12/2006), and Scopus (1980-12/ 2006) a systematic literature search was performed, which included all randomised controlled trials (RCT) evaluating multicomponent therapy in FMS and CWP. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. The strength of recommendation was graded according to the German program for disease management guidelines. Consensus was achieved using a multi-step nominal group procedure.

RESULTS

The short-term use of amitriptyline is strongly recommended (grade A) and the short-term use of fluoxetine und duloxetine is recommended (grade B).

CONCLUSIONS

The recommendations regarding pharmacological treatment of FMS are limited by the short duration of the RCT, the lack of follow-ups and absence of cost-effectiveness studies.

Association of HLA class II allele and haplotype frequencies with chronic myelogenous leukemia and age-at-onset of the disease

Chronic myelogenous leukemia (CML) is characterized by the presence of Philadelphia chromosome resulting from bcr/abl translocation. To clarify the association between HLA class II allele and haplotype frequencies in CML, 50 patients referred to Hematology Oncology and Bone Marrow Transplantation (BMT) center, Shariaty Hospital, Tehran, Iran, were randomly selected and compared with a group of 80 unrelated healthy blood donor subjects. HLA class II alleles were determined by PCR-SSP method. The results showed that the frequencies of DQB1*03011 (P=0.01) and DQA1*0505 (P=0.05) were higher, while that of DQB1*03032 (P=0.04) was lower in patients than in the controls. Regarding age-at-onset, the frequency of HLA-DRB1*07 (P=0.03) and -DQA1*0201 (P=0.03) alleles were higher in patients younger than 35 years. The most frequent haplotypes in our CML patients were HLA-DRB1*11/-DQB1*03011/-DQA1*0505 (P=0.01) and HLA-DRB1*04/-DQB1*0302/-DQA1*03011 (P=0.02). In conclusion, it is suggested that positive and negative association in certain HLA alleles and haplotypes exist in Iranian patients with CML.

Th1 and Th2 cytokine gene polymorphisms in two indigenous ethnic groups in Iran

Cytokines are important immunomodulatory molecules in immune responses against microorganisms and also have an important role in the setting of disorders affecting immune system. Cytokine single nucleotide polymorphisms have been extensively studied in different normal populations as well as in relation to diseases. Some of these polymorphisms (SNP) affect cytokine gene transcription and expression. The polymorphisms of cytokine genes are potentially important as genetic predictors of the disease susceptibility and clinical outcome or as a tool for anthropological studies. In this study, samples have been collected from 261 healthy individuals located in two different regions of Iran (Tehran and Yazd). The allele and genotype frequencies of Th1 and Th2 cytokines SNP including interleukin (IL)-2, IL-4, IL-6, IL-10, tumour necrosis factor (TNF)-alpha and interferon (IFN)-gamma have been investigated, using the polymerase chain reaction-sequence-specific primer method. The allele and genotype frequencies in Tehran and Yazd populations were similar except for the IL-2, IL-4, IL-6 and IL-10. The IL-4 C allele, C/C -33 and T/T -1098 genotype were significantly more frequent in Tehran than in Yazd population (P = 0.04, P = 0.004 and P = 0.001, respectively). The G/A genotype of the IL-6 (nt565) and IL-10 (-1082) was significantly less frequent in Tehran than in Yazd population (P = 0.01 and P = 0.003, respectively). The GT haplotype of the IL-2 (-330, +166) was significantly less frequent in Tehran than in Yazd population (P = 0.0002). We have also compared our whole samples with the reported data from other countries showing that Iranian population have cytokine gene polymorphism profile similar to that of Caucasians, especially Italian population.

Cytokine gene polymorphism in Iranian patients with chronic myelogenous leukaemia

Chronic myelogenous leukaemia (CML) is a disorder of the haematopoietic stem cell that results in malignant expansion of myeloid cells with a cytogenetic abnormality, and translocation between chromosomes 9 and 22, known as the Philadelphia chromosome. It has been hypothesized that genetic factors other than histocompatibility disparity may play a role in predisposition to developing CML. In this regard, T helper types 1 and 2 (Th1 and Th2) cytokines and their gene polymorphism seem to be important. Overall expression and secretion of cytokines are dependent, at least in part, on genetic polymorphism (nucleotide variations) within the promoter region or other regulatory sequences of cytokine genes. The majority of polymorphisms described are single nucleotide polymorphism (SNPs). The objective of this study was to analyse the genetic profile of Th1 and Th2 cytokines in 30 Iranian patients with CML and 40 healthy subjects. In the patients and control subjects, the allelic and genotype frequencies were determined for the cytokine genes. All typing were performed with a polymerase chain reaction-sequence-specific primers (PCR-SSP) assay. Allele and genotype frequencies were calculated and compared with those of normal controls. The results showed that the most frequent genotypes in our patients were transforming growth factor (TGF)-beta TG/TG, interferon (IFN)-gamma AT, interleukin (IL)-4 CC at position -590, TT at position -33, and IL-10 ACC/ACC and ATA/ATA. In contrast, the genotypes TGF-beta CG/CG, IL-2 TT at position -330, IL-4 CT at position -590, CT at position -33, and IL-10 GCC/ACC were seen at much lower frequencies. The results suggest that production of TGF-beta in CML patients is higher and production of IL-4 and IL-10 is lower than in normal subjects.

Influence of HLA on progression of optic neuritis to multiple sclerosis: results of a four-year follow-up study

BACKGROUND

Genetic predisposition in multiple sclerosis (MS) has always been a critical concern in aetiology and progress of the disease. The present study looks into the relations between human leukocyte antigen (HLA), optic neuritis (ON) and MS in the Iranian population.

METHODS

Patients with potential diagnosis of acute ON underwent a standardized clinical examination for confirming the diagnosis. Selected patients were gathered for HLA typing and clinical follow up.

RESULTS

Of the 55 patients, 46 (83.6%) were female. The mean age was 25(+/-7.3) with a range of 12-43. Twenty of the 55 (36%) were confirmed for the diagnosis of clinically definite MS (CDMS). Results show that A23, B21, A11 and B51 alleles were present in 4 (20%), 6 (30%), 2 (10%) and 1 (5%) of the CDMS patients, respectively. Ten (50%) and 17 (85%) CDMS patients were positive for HLA class II alleles, DR2 and DQ1, correspondingly.

CONCLUSIONS

The study strongly suggests the association among DR2, A23 and B21 allele and the evolution of ON to MS. High prevalence of A23 and DR2 alleles in CDMS patients compared with the normal population may suggest an important role for these alleles in the development of MS. The study suggests B51 as a protective factor against development of ON in the normal population. In addition, results do not confirm previous studies considering A11 as a predisposing factor. The present study finally evokes that different classes of HLA have different roles in susceptibility to MS and confirms disease heterogeneity as an important emerging concept in MS.

Optic neuritis, multiple sclerosis and human leukocyte antigen: results of a 4-year follow-up study

In the present study the relation between human leukocyte antigen (HLA), optic neuritis (ON) and multiple sclerosis (MS) has been investigated in 56 Iranian patients (46 females and 10 males). HLA-A and -B typing by microlymphocytotoxicity method and HLA-DRB, DQA and DQB by polymerase chain reaction based on sequence specific primers method was performed for the selected patients with ON. The diagnosis of clinically defined MS (CDMS) was confirmed in 15 of them (26.7%) during their follow-up. HLA-A24 was significantly higher in ON patients, whilst A23, A26, and A30 showed a significant decrease in these patients. HLA-A10 and A26 were absent in CDMS patients and A2 and A11 were significantly decreased in ON and CDMS patients. HLA-B5, B51, B38, B27, and B35 were significantly increased in ON patients compared with control subjects. HLA-B44, B16 and B38 alleles were not present in CDMS patients. Regarding DR locus, the frequency of HLA-DRB1*15 and DRB1*04 has been increased in CDMS patients, whilst the frequency of HLA-DRB1*07 and *11 was much higher in ON patients. In DQA region, the most frequent allele in the MS patients was DQA1*0102, which was significantly higher than ON patients, and control group. The frequency of DQA1*0103 was significantly increased in both patients group. In DQB1, the frequency of DQB1*0602 increased significantly in the MS patients. In conclusion existence of common genetic basis for early manifestations of MS could be suggested.

The association of HLA-DRB, DQA1, DQB1 alleles and haplotype frequency in Iranian patients with pulmonary tuberculosis

OBJECTIVES

To investigate HLA-DRB1, DQA1 and DQB1 allelic polymorphism in Iranian patients with pulmonary tuberculosis (PTB).

METHODS

Forty patients with smear-positive PTB and 100 healthy individuals as a control group were studied for MHC class II allelic polymorphism by polymerase chain reaction with sequence-specific primers (PCR-SSP). The primer was supplied by biotest in the standard kit. DRB low resolution SSP and DQA, DQB intermediate resolution SSP was applied.

RESULTS

The comparison of the patients and the control group showed a significant increase in the frequency of the HLA-DRB1*07 and DQA1*0101 alleles (OR 2.7, 95%CI 1.19-6.13, P = 0.025 and OR 2.66, 95%CI 1.15-6.44, P = 0.04, respectively) in the patient group. The frequency of DQA1*0301 and DQA1*0501 was also significantly decreased (OR 0.254, 95%CI 0.075-0.865, P = 0.033 and OR 0.53, 95%CI 0.3-0.95, P = 0.045, respectively) in the PTB patients. Concerning haplotype frequency, DRB1*11501, QDQA1*0103 and DQB1*0601 were increased, but this difference was not statistically significant. In the DQB1 locus, DQB1*0501 was non-significantly over-represented.

CONCLUSIONS

HLA-DRB1*07 and HLA-DQA1*0101 appeared to be the predisposing alleles and HLA-DQA1*0301 and 0501 the protective alleles in our patients with TB.