Aging, hormones and receptors

Ageing is accompanied by deterioration in physical condition and a number of physiological processes and thus a higher risk of a range of diseases and disorders. In particular, we focused on the changes associated with aging, especially the role of small molecules, their role in physiological and pathophysiological processes and potential treatment options. Our previously published results and data from other authors lead to the conclusion that these unwanted changes are mainly linked to the hypothalamic-pituitary-adrenal axis can be slowed down, stopped, or in some cases even reversed by an appropriate treatment, but especially by a life-management adjustment.

[Immunoendocrine associations in adrenal glands]

Immune and endocrine systems are basic regulatory mechanisms of organism and, including the nervous system, maintain the organism's homeostasis. The main immune system representatives are mononuclear cells, T- and B-cells and their products, in the endocrine system the main representatives are cells of the glands with inner secretion and their products. One of the most important glands for maintaining homeostasis are adrenal glands. It has been proven that either cells of the immune system, either endocrine cells can, although in trace amounts, produce mutually mediators of both systems (hormones, cytokines). Disorders in one system can lead to pathological symptoms in the other system. Also here represent adrenals an important model.

IgE against food and respiratory allergens in healthy and allergic mothers and their children

IgE against mixtures of common food or respiratory allergens were determined by ELISA in healthy (n = 38) and allergic (n = 62) mothers and their children. Significantly higher level of IgE against respiratory allergens was found in sera of allergic mothers and in cord blood of their children. No correlation between antibody level in maternal and newborn's sera was found; this argues against the transfer of IgE from mother to fetus and points rather to offspring's intrauterine sensitization. Specific IgE level in cord blood was higher in children who developed later allergy than in children who did not. Specific IgE level in colostrum was low both in healthy and allergic mothers; there was no correlation between high concentration of IgE against respiratory allergens in sera of allergic mothers and their colostrum, which does not support the idea of IgE transport from blood to mammary gland. Only slightly increased colostral IgE was detected in allergic mothers whose children manifested allergy later. Allergy of the mother and high level of anti-allergen IgE in her serum and in cord blood are the main predictive factors of future occurrence of allergy in the offspring. A combination of several predictive factors could have higher prognostic value.

TRH test in patients with diabetes mellitus type 1 and/or autoimmune thyroiditis. Changes in the pituitary-thyroid axis, reverse T3, prolactin and growth hormone levels

The response of the pituitary- thyroid axis, reverse triiodothyronine (rT3), prolactin, and growth hormone (GH) levels following TRH stimulus (Relefact TRH 200 microg 2 amp. i.v.) was examined in patients with autoimmune diabetes type 1 (DM1, n=30), with autoimmune thyroiditis (AT, n=25), and with concurrent DM1 and AT (n=22) to evaluate the influence of DM1 and AT of autoimmune pathogenesis on the above-mentioned hormonal parameters. Statistical analysis (ANOVA) showed that: a) the response of TSH did not differ from control groups (C); b) free triiodothyronine (fT3), free thyroxine (fT4) and their ratio in DM1, DM1+AT and C rose in 120 and 180 min, while a similar increase was not seen in AT (p<0.000001); c) rT3 was not present in any group, with rT3 levels higher in AT (p<0.00002) and lower in DM1 (p<0.02); d) the response of GH had a paradoxical character in some patients in all groups, most often in DM1 (52 %, DM1 vs C, p <0.01). The characteristic response difference was not in the peak GH level, but the delayed return to basal levels in DM1 (p<0.0001) and an abrupt one in AT (p<0.0001). The major findings in DM1 were the differences in GH response, while significant impairment of pituitary-thyroid axis and PRL response to TRH was absent. AT was associated with impairment of TRH stimulated fT3, fT4, fT3/fT4 response and changes in rT3 levels, in spite of preserved TRH-stimulated TSH secretion. GH response in AT patients was also altered.

Anti-Helicobacter Pylori, anti-thyroid peroxidase, anti-thyroglobulin and anti-gastric parietal cells antibodies in Czech population

Autoimmune thyropathies are frequently linked to many infections, such as Helicobacter pylori, which are also supposed to play a role in their pathogenesis. The aim of this study was to evaluate the relationships between thyroid and gastric autoimmunity and H. pylori infection on a large sample of Czech population (n=1621) by monitoring the autoantibodies against thyroglobulin (anti-Tg) and thyroid peroxidase (anti-TPO) and gastric parietal cell (anti-GPC, representing thyrogastric syndrome) in correlation with antibodies against Helicobacter pylori (anti-H. pylori) of classes IgG and IgA. The interrelation between autoantibodies and H. pylori antibodies was assessed by H. pylori seropositivity. In H. pylori seropositive persons as compared to seronegative irrespective of age and sex, a higher occurrence of anti-TPO (10.4 % vs. 5.8 %, p=0.001) and anti-GPC (6.1 % vs. 1.7 %, p<0.001) was found. Differences in anti-TPO occurrence were significant in both men (7.0 % vs. 3.3 %, p=0.03) and women (12.7 % vs. 8.0 %, p=0.02), differences in anti-GPC occurrence were significant only in women (7.2 % vs. 1.7 %, p<0.001). Results of this study support the idea of a connection between infection of H. pylori and the occurrence of anti-TPO autoantibodies representing thyroid autoimmunity and gastric parietal cells autoantibodies representing the thyrogastric syndrome.

Helicobacter pylori in tonsillar and adenoid tissue and its possible role in oropharyngeal carcinogenesis

Helicobacter pylori is a well-known gastric pathogen. It plays a major role in the pathogenesis of chronic gastritis, duodenal and gastric ulcers, adenocarcinoma and gastric lymphoma. HP infection is one of the most common bacterial infections worldwide. Recently, the oral cavity was proposed as an extragastric reservoir of HP infection. HP was detected by culture and PCR in both dental plaque and saliva. It is supposed that HP infection can cause the same immunological changes in the oropharyngeal mucosa as in gastric mucosa and can also contribute to the progression of oropharyngeal diseases. HP can induce production of different cytokines and regulatory molecules, which are suggested to play a role in carcinogenesis of the oropharynx. Only a few studies have explored the presence of HP in tonsillar and adenoid tissue, where MALT is present similar to the gastric mucosa. The results of these studies were inconsistent. The question of persistence of HP in tonsillar and adenoid tissue and its role in the pathogenesis of oropharyngeal diseases still remains unclear. In this review, recent findings about oral HP are considered. Possibilities of diagnostics of HP in oral specimens are discussed.

[Polyglandular activation of autoimmnunity as a manifestation of subclinical endocrinopathies]

BACKGROUND

Autoimmune thyropathies belong to the most frequently occurring autoimmune endocrinopathies. Autoimmune thyropathies occur either independently or linked to known polyglandular syndromes of type I-III.

METHODS AND RESULTS

During the last decade, we observed a group of patients with autoimmune thyroiditis, in which autoimmune endocrinopathies were mutually associated and named the symptoms of this group "polyglandular activation of autoimmunity". The frequency of the occurrence of autoantibodies against other endocrine organs in this group was determined and the most frequent was the occurrence of the autoantibodies against steroid producing cells - anti-ovary 28 %, anti-adrenal 23 %, anti-testes 12 %. Considering the most frequent occurrence of autoantibodies against steroid producing cells, attention has been paid namely to patients with autoimmune thyroiditis and a concurrent occurrence of anti-adrenal autoantibodies. In the foreground of the clinical picture of these patients were dysregulations on the metabolic and circulation levels together with symptoms of discomfort (subfebrile condition, arthralgia and fatigue). Heavy fatigue of these patients was linked to the changes of levels and mutual ratio of melatonin and serotonin and regarding autoantibodies, mainly autoantibodies against steroid producing cells, namely against the particular cells of the layers of adrenal cortex played a role.

CONCLUSIONS

The presence of autoantibodies influenced also the functional response, namely the ACTH/cortisol ratio. Autoantibodies detected were not anti-21-hydroxylase autoantibodies, typical for autoimmune polyglandular syndrome II, but antibodies against antigens of other molecular weight.

[Endocrine orbitopathy and significance of autoantibodies against 1D protein]

BACKGROUND

Endocrine ophthalmopathy is a chronic eye disease, characterized by inflammation in parabulbar and retrobulbar space, occurring usually in Graves' thyrotoxicosis. Although the pathogenesis of the disease has not been clarified until now, it is accepted that this disease is of an autoimmune nature, where the targets of the autoimmune reaction are the antigens shared by thyroid and orbit-tissue. The autoantibodies against recombinant 1D protein are highly specific and sensitive for the diagnosis of endocrine orbitopathy.

METHODS AND RESULTS

The aim of our study was to establish, whether the autoantibodies against 1D protein are found predominantly in patients with clinically expressed endocrine orbitopathy. We evaluated in 30 patients with clinically expressed endocrine orbitopathy the thickness of the three retrobulbar eye muscles, damaged by endocrine orbitopathy, determined the parameters of thyroid hormones and anti-TSH receptor autoantibodies. In all patients the detection of circulating autoantibodies against recombinant 1D protein was performed. Autoantibodies against recombinant 1D protein were found in all patients with clinically expressed endocrine orbitopathy.

CONCLUSIONS

Immunoreactivity did not depend on the duration or severity of the eye disease, neither on patients' age. We did not find any correlation between the thickness of eye muscles and the titre of anti-TSH receptor autoantibodies, levels of ssTSH and free thyroxine and also any correlation between the thickness of eye muscles and the disease duration.

[Diabetes mellitus in adult patients with type I diabetes shows immunological, functional and clinical differences depending on the presence of autoimmune thyroiditis]

BACKGROUND

Autoimmune diabetes is usually accompanied by other autoimmune endocrinopathies, most often by autoimmune thyroiditis (AIT), but it is not clear whether diabetes in these patients differs from diabetes without AIT.

METHODS AND RESULTS

Eleven-year follow-up of 47 young adult Type 1 diabetic patients with respect to the presence of AIT (group I - positive antibodies against microsomal peroxidase, antiTPO, and tyreoglobulin, antiTgl, group II - only positive antiTPO, group III - without AIT) showed: a) cessation of endogenous insulin secretion (Cpeptide <0.03 nmol/l) in 100 % of patients with AIT (in group I between year 2 and 9, in group II between year 3 and 11, p<0.05), while in group III without AIT only in 55 % of patients (I,II vs. II, p<0.001); b) higher prevalence of antiGAD values > 5 U/ml in group I when compared to patients without AIT (I vs III, p<0.05); c) tendency toward higher doses of insulin needed for diabetes compensation in patients without AIT; d) the highest prevalence of organ-specific and systemic autoantibodies in group I with the most distinct manifestations of AIT, and the lowest prevalence in group III without AIT (statistically significant).

CONCLUSIONS

Autoimmune diabetes in adults with AIT compared to diabetes occurring isolated showed differences in the area of autoimmunity against islets of Langerhans, Langerhans islets' function and in the clinical course of the disease.

Helicobacter pylori isolated from patients with tonsillar cancer or tonsillitis chronica could be of different genotype compared to isolates from gastrointestinal tract

Helicobacter pylori from patients with different diseases, including so-called autoimmune thyroiditis, chronic tonsillitis and tonsillar cancer, was isolated and cultured. It was identified according to the genotype using labeled hybridization probes complementary to six sequences of cagA and vacA genes. Different types of strains were found in isolates from gastrointestinal tract and patients suffering from thyroiditis. Six out of seven genotyped isolates from patients in our Department of Otorhinolaryngology and Head and Neck Surgery exhibited the same genotype, differing from isolates obtained from other patients; the 7th isolate originated from a patient who had undergone surgery for deviatio septi nasi, at the same time suffering from autoimmune thyroiditis, having confirmed gastric infection by H. pylori from biopsy. This data made it possible to formulate the hypothesis on probable association of specific H. pylori genotype with chronic tonsillitis and tonsillar cancer. We assessed commercial transport media and improved nucleic acid isolation techniques and the RT-PCR-based tests, which allowed us to skip a culture step and to test directly the patients' samples; however, for full confirmation of our hypothesis and explanation of possible mechanisms of the contribution of Helicobacter sp. to the pathogenesis of the disease further data are to be collected and evaluated.

[Autoimmune thyroiditis--selected etiopathogenic mechanisms]

Autoimmune thyroiditis occurs as organ specific autoimmune disease not only as an isolated impairment of thyroid gland, but also linked to many autoimmune endocrinopathies. Genetic predisposition in the area of HLA antigens was followed up by patients with autoimmune thyroiditis diagnosed in this way and it appeared that genetic predisposition in isolated autoimmune thyroiditis is different when compared to the occurrence linked to endocrine polyglandular disease. In selected groups of patients with autoimmune disease also the influence of extraneous factors on the development of the autoimmune process was followed up, namely the influence of heavy metals and the influence of infectious agent--Helicobacter pylori. These factors have a different character of activation of autoimmune thyroiditis too, depending on the character of its manifestation as isolated disorder or in link to autoimmune polyglandular syndrome type II, or in link to the group of polyglandular activation of autoimmunity. To conclude, this study leads to the assumption, that autoimmune thyroiditis is a set of clinical syndromes that depends on the activation of the autoimmune process, rather than a strictly genetically and epigenetically characterized nosological unit.

[Thyroid autoimmunity in adults with diabetes mellitus type 1. Own experience gained by 11-year monitoring]

The results of study on thyroid autoimmunity and its clinical importance gained during 11-year follow-up of 47 adults with type 1 diabetes mellitus (DM1) are presented. The study proved the preponderance of women among subject affected with thyroid autoimmunity, the autoantibodies against thyroid gland (T-Ab) were significantly more often detected in women compared to men (68% vs. 32%, p < 0.05). Also, serious forms of thyroid autoimmunity manifested with persistence of both T-Ab, faster development of subclinical hypothyroidism (TSH > 4.5 mIU/l in 100% within 4 years after first detection of T-Ab positivity, and within 8 years after DM1 manifestation, respectively), and diffuse hypoechogenic pattern at thyroid gland ultrasonography (USG) were significantly more often observed in women compared to men (45% vs. 12%, p < 0.01). These patients often had small thyroid gland (77% of subjects had volume below 25th percentile of control subjects at the 11th year of follow-up) and presence of thyreopathy in the first degree relatives. No difference between men and women was observed in persistence of thyroid peroxidase autoantibodies (anti-TPO) solely (20% vs. 23%); milder clinical course of thyroid disease was observed in these subjects (the fist detection of TSH > 4.5 mIU/l in the 9th year of follow-up). These patients had varied findings at USG examination with focally/diffuse hypoechogenic/ non-homogenous thyroid gland, and 50% of subjects had thyroid gland volume above 95th percentile in the 11th year of follow-up. Among subjects without thyroid autoimmunity men prevailed (68% vs. 32% women, p < 0.01), and in the 11th year of follow-up the USG finding was often abnormal (thyroid gland volume above 95th percentile of the controls in more than 60% of subjects, trend towards nodulisation). Except for 1 subject, TSH did not exceed 4.5 mIU/l. These results obtained from the Czech population constitute the basis for our recommendation to screen regularly markers of thyroid autoimmunity in patients with DM1. Ultrasonographic examination, that is able to detect sings of thyroid immunopathy in many subjects before first manifestation of T-Ab, is the most sensitive according to both our experience and the published data. For clinical practice, determination of TSH once a year in all DM1 subjects, and of anti-TPO in DM1 women in fertile age is recommended. Ultrasonographic examination should be carried out in case of pathologic results of these tests.

[Is decreased thyroid echogenity a good indicator of thyroid autoimmune disorder?]

INTRODUCTION

Thyroid gland with mildly decreased or significantly decreased echogenity is indicating possible autoimmune disorder even before first symptoms, i.e. change in laboratory tests measuring the level of thyroid hormones and antibodies to thyroid antigens occur.

TARGET

to consider changes in thyroid gland echogenity suspecting thyroid autoimmune disorder and to determine antibodies to thyroid antigens in the respective type of thyroid echogenity (increased, normal, mildly decreased or significantly decreased) to consider the activity of autoimmune thyropathies related to echogenity and to compare these factors.

METHODS

Echogenity of the thyroid gland was examinated in randomly selected population (n = 1 055, 360 male, 695 female) in 11 regions of the Czech republic, all presented with urinary iodine concentration > 100 microg/L of urine. The echogenity was determined in 4-level scale as increased (1), normal (0), mildly decreased (-1) and significantly decreased (-2). Texture of thyroid was evaluated in 2-level scale as homogenous or non-homogenous. For the evaluation of the relation between echogenity type (1 to -2) and TgAb, and between the type of echogenity and TOPAb frequence analysis (logarithm-linear modules) was used, i.e. the complete module was compared with the measured values.

RESULTS

The selected adults (695 female, 360 male) with urinary iodine concentration > 100 microg/L of urine presented with increased echogenity in 2 females (0.28%) and 1 male (0.28%), normal echogenity in 281 females (40.42%) and 206 males (57.22%), mildly decreased echogenity in 288 females (41.43%) and 128 males (35.56%) and significantly decreased echogenity in 124 females (17.84%) and 25 males (6.95%). The biggest group, both in males and in females, presented with normal and mildly decreased echogenity. Homogenous thyroid gland structure was found in 223 females (32.08%) and 220 males (61.11%). Non-homogenous texture was found in 472 females (67.92 %) and 140 males (38.89%). Frequence analysis both in males and in females was focused on: 1. relation between the echogenity (ECHO) and TgAb: in females with positive TgAb (14.23%), significant relation to ECHO can be seen (p < 0,0001), in contradiction to males; 2. relation between the echogenity (ECHO) and TPOAb: this relation is very significant both in males and in females (p < 0.0001); 3. mutual relation between TgAb and TPOAb: both in males and in females very significant (p < 0.0001); positive relation between antibodies can be seen. Positive presence of antibodies can be found less frequent, negative presence of both antibodies is more frequent; 4. relation between the echogenity, TgAb and TPOAb: no statistic significance was found.

CONCLUSION

Homogenous thyroid gland structure was mainly found in males and, on the contrary, non-homogenous structure in females. In 52.7% of adults with significantly decreased echogenity, autoimmune disorder was confirmed in laboratory tests at the same time. With echogenity increasing, TgAb and TPOAb decreased, vice versa. Sonography, evaluating decreased echogenity, can be an early indicator of serious thyropathies before function parameters and clinical symptoms appear. Detected risky adults with sonographic signs of autoimmune disorder have to be monitored and respective treatment considered and started at the very first occurence of positive antibodies even if the function is still normal.

Immunomodulatory effects ofBacillus firmus on mouse peritoneal cellsin Vitro

The effect of nonpathogenic G+ bacterium B. firmus (BF) on stimulation of mouse peritoneal cells in vitro was evaluated by testing nitric-oxide-synthesis induction and cytokine formation. The reactivity was compared of peritoneal cells from two inbred mouse strains, C57B1/6 and BALB/c, which differ in their immunological reactivity. Peritoneal macrophages from C57B1/6 produced more nitric oxide after a 1-d cultivation with inactivated BF than those of BALB/c mice. In both strains, production can be further increased by adding exogenous IFN-gamma to the culture. There were no significant differences between peritoneal cells of these two mouse strains in cytokine production after optimal in vitro stimulation with BF. BF effectively activated peritoneal cells for the production of TNF-alpha, IL-1beta and IL-10, delipidated bacterium (DBF) being more efficient than BF in induction of IL-10 and TNF-alpha. On the other hand, BF had only small effect on IFN-gamma production and no detectable effect on IL-12 production. Macrophage activation by BF/DBF can represent one of the mechanisms responsible for previously described immunomodulatory activity of BF.

Immunological profiles of patients with chronic myeloid leukaemia. I. State before the start of treatment

In view of the increasing interest in the immunotherapy of CML it seems highly desirable to broaden the present knowledge on the immune reactivity of CML patients. A group of 24 patients and 24 healthy controls were studied for the total of 15 immunological parameters, including the prevalence of antibodies against human herpesviruses and papillomaviruses. To clearly discriminate between changes associated with the disease and those induced by the therapy, all patients were enrolled prior to the start of any anti-leukaemic therapy. Statistically significant differences between patients and controls were found in the levels of IgA, C4 component of complement, CRP and IL-6, the production of Th1 cytokines in stimulated CD3 cells and the E. coli stimulatory index. The analysis of the interrelationship between the results obtained in the individual patients presented some unexpected findings, such as the lack of correlation between the CRP and IL-6 levels. It will be the purpose of a follow-up to determine whether and how the immune status of the patients prior to the treatment correlates with their response to therapy and how the individual immunological profiles change in the course of the disease. These observations will be utilized in the future immunotherapeutic studies to constitute the vaccine- and placebo-treated groups.

Differences in Type I Diabetes Mellitus of Young Adults with and without Thyroid Autoimmunity

This work was intended to study if the coexistence of thyroid and Langerhans islets autoimmunity is associated with a different nature and course of diabetes in young adult diabetic patients. We followed the laboratory and clinical course of diabetes and the thyroid gland status of 47 young adults with Type I diabetes over a 9-year period starting from the onset of diabetes (ranging from 18 to 35 years of age). The patients were divided into subgroup I (with thyroid peroxidase and thyroglobulin antibodies, n = 13), subgroup II (thyroid peroxidase antibody only, n = 10), and subgroup III (without thyroid autoimmunity, n = 24). Out of the 22 females followed, 10 (46 %) and 5 (23 %) were in subgroups with thyroid autoimmunity (TA), I and II, respectively. On the contrary, out of the 25 men followed, 17 (68 %) were in group III. Within the 9 years, insulin secretion nearly ceased (C-peptide < 0.03 nmol/L) in all of the patients of subgroup I and 70 % of subgroup II, but only in 46 % of patients in subgroup III (I : II p < 0.01, I : III, p < 0.01, II : III, p < 0.05). The cumulative incidence of antiGAD > 1 U/mL (CIS, RIA) in subgroup I was higher (92 %) than in subgroups II (80 %) and III (53 %); I : III, p < 0.05. The cumulative incidence of tyrosine phosphatase antibodies (anti-IA2, BRAHMS, RIA) was insignificantly higher in subgroups I and II when compared with subgroup III (62 %, 60 %, and 42 %). The study of organ-specific and systemic autoantibodies showed their highest cumulative incidence in subgroup I, i.e., in patients with the most expressed manifestations of TA and the lowest one in subgroup III, i.e., diabetic patients without TA. Our results suggest that overall thyroid autoimmunity in young adult patients with Type I diabetes was associated not only with female gender, but also with more pronounced Langerhans islets autoimmunity and significantly faster cessation of endogenous insulin secretion; it was associated with therapeutical doses of insulin as well.

Immune response after adjuvant mucosal immunization of mice with inactivated influenza virus

Satisfactory mucosal immunity in the respiratory tract is very important for protection against influenza. It can be achieved only by mucosal immunization. Mucosal vaccination with inactivated influenza virus may not be sufficiently effective and suitable adjuvants are therefore sought. We tested intratracheal immunization of mice with inactivate B type influenza virus in a mixture with formolized G+ bacterium Bacillus firmus, whose adjuvant effects have previously been documented in another system. The treatment resulted in a marked increase of both systemic and mucosal antibody response in IgG and IgA classes. Stimulation of T lymphocytes after adjuvant immunization was very mild, no proliferation taking place after specific stimulation with antigen in vitro. However, slightly increased systemic (spleen) and local (lungs) production of cytokines without perceptible Th1/Th2 polarization was determined. B. firmus is an efficient adjuvant in respiratory tract immunization while with subcutaneous immunization it lowers the antibody response.

Thyroid autoantibodies and their clinical relevance in young adults with type 1 diabetes during the first 12 yr after diabetes onset

In order to obtain prospective data on occurrence of thyroid autoantibodies [against thyroid peroxidase (antiTPO) and against thyroglobulin (antiTgl)] and their clinical relevance, we followed up on 109 young adults with Type 1 diabetes for 12 yr after diabetes onset. The patients were divided into subgroup I [positivity of both thyroid autoantibodies (T-Ab); 25%, women predominantly], subgroup II (isolated antiTPO positivity only, 26%, men and women equally) and subgroup III (thyroid autoimmunity not present, 49%, men mainly). Cumulative incidence of T-Ab during the 12 yr of follow-up was 51% with predominance of women over men (65% vs 38%, p<0.01). At the time of the first T-Ab detection, an ultrasonography pattern of a hypoechogenic thyroid gland was noted in 59% of subgroup I patients and in 25% of subgroup II patients (p<0.05). At the same time, TSH>4.5 mlU/I was shown in 30 and 7% of patients of subgroups I and II, respectively (p<0.05). In the patients with the repeated positivity of both T-Ab (subgroup I) subclinical hypothyroidism developed in all patients within 4 yr after the first detection of T-Ab. On the contrary, the clinical course in patients with isolated antiTPO positivity (subgroup II) was milder with 11% developing subclinical hypothyroidism within 4 yr after the first antiTPO detection (p<0.001). The data shed new light on the relative diagnostic value of thyroid antibodies, ultrasonography and functional examination for an early detection of thyroid autoimmunity of adult diabetic patients.

Comparison of cytokine levels in sera of patients with autoimmune endocrinopathies

Autoimmune endocrinopathies can be divided according to the presence of organ specific autoantibodies and according to the clinical manifestations into isolated autoimmune endocrinopathies, autoimmune polyglandular syndromes (APS) and polyglandular activation of autoimmunity (PAA). Many factors take part in the development of the autoimmune disease: predominantly a genetic predisposition, environmental etiologic causes and dysregulation in the microenvironment of the target organ. Until now it is not completely clear, if manifestations of the clinical disease depend primarily upon external factors and the degree of regulation mechanism disorder (e.g. in Th1/Th2 regulation) or upon the different genetic predisposition. In this work we compared the levels of Th1 and Th2 lymphocyte cytokines in peripheral blood in three groups of patients: group A of 30 patients with autoimmune thyroiditis, group B of 25 patients with PAA, and group C of 10 patients with APS type II. From group of Th1 cytokines IL-2 and IFN-gamma were detected, whereas from group of Th2 cytokines IL-4 and IL-10 were determined by ELISA kit. We did not find any differences in the concentrations of IL-2, IFN-gamma, IL-4 and IL-10 among the groups of patients with autoimmune endocrinopathies.

Serum levels of IGF-I, HGF, TGFbeta1, bFGF and VEGF in thyroid gland tumors

IGF-I, HGF, TGFbeta1, bFGF and VEGF are involved in the pathogenesis of thyroid gland tumors and their growth. We decided to find whether changes in the production of these cytokines by thyroid tumor cells are reflected by changes of their peripheral blood. Using ELISA kits, we measured the concentrations of growth factors in the peripheral blood serum in 28 patients with thyroid gland tumors (14 adenomas, 14 papillary carcinomas) and compared these concentrations with those in healthy people. We found significantly lower serum levels of IGF-I in patients with thyroid adenoma compared to the healthy population. Serum levels of HGF and bFGF were significantly higher in patients with thyroid adenoma and papillary carcinoma compared with those in healthy subjects. Serum concentrations of TGFbeta1 and VEGF were not significantly different in any groups of investigated subjects. Changes in the production of these cytokines by thyroid gland tumor cells are reflected in their peripheral blood levels, but these levels also depend on a number of other physiological and pathological processes in the organism. However, significant differences of HGF and bFGF serum levels can be explained by their very high production by thyroid tumor cells and by their strong effect on the follicular and endothelial cell proliferation.

Anti-GAD-positive patients with type 1 diabetes mellitus have higher prevalence of autoimmune thyroiditis than anti-GAD-negative patients with type 1 and type 2 diabetes mellitus

The aim of our study was to evaluate antibodies against thyroglobulin (anti-TG) and thyroid peroxidase (anti-TPO) - markers of autoimmune thyroiditis - in several groups of adult patients with type 1 and type 2 diabetes mellitus (DM). We were particularly interested whether the presence of thyroid antibodies is related to the positivity of glutamic acid decarboxylase antibodies (anti-GAD). We found elevated anti-GAD in 46 % (97/210) patients with type 1 DM. All patients with type 2 diabetes were anti-GAD-negative. At least one thyroid antibody (anti-TG and/or anti-TPO) was found in 30 % (62/210) patients with type 1 DM and 27 % (22/83) type 2 diabetes patients. The patients with type 1 DM were further grouped according to their anti-GAD status. The anti-GAD-positive patients had a higher prevalence of anti-TG antibodies than the anti-GAD-negative patients (25 % vs. 12 %, p=0.03) as well as anti-TPO antibodies (32 % vs. 12 %, p<0.001). At least one thyroid antibody was detected in 39 % (38/97) of anti-GAD-positive but only in 21 % (24/113) of anti-GAD-negative patients with type 1 DM (p=0.006). No significant difference in the frequency of thyroid antibodies was found between anti-GAD-negative patients with type 1 and type 2 DM (21 % vs. 27 %, p=0.4). The groups with or without thyroid antibodies in both type 1 and type 2 diabetic patients did not differ in actual age, the age at diabetes onset, duration of diabetes, body mass index or HbA1c level. Patients with elevated thyroid antibodies had significantly higher levels of TSH than those without thyroid antibodies (1.86 vs. 3.22 mIU/l, p=0.04 in type 1 DM; 2.06 vs. 4.89 mIU/l, p=0.003 in type 2 DM). We conclude that there is a higher frequency of thyroid-specific antibodies in anti-GAD-positive adult patients with type 1 DM than in anti-GAD-negative patients or in patients with type 2 DM. Patients with or without thyroid antibodies do not differ in age, DM onset and duration, BMI or HbA1c. Thyroid antibodies-positive patients have higher levels of thyroid stimulating hormone (TSH).

HLA antigen expression in autoimmune endocrinopathies

The HLA allelic frequency was determined in three groups of autoimmune endocrinopathies: A) 30 patients with autoimmune thyroiditis, B) 20 patients with polyglandular activation of autoimmunity, and C) 10 patients with the autoimmune polyglandular syndrome type II. The groups were defined by the clinical state and serological parameters. Healthy blood donors of Caucasian population from the US database of HLA frequencies served as the controls. In group A, a higher occurrence of HLA-A24 (21.7 %) was found as compared to group B (5.0 %) and to the controls (8.5 %), of HLA-B27 (15.0 %) and of HLA-DR-11 (20 %) as compared to the controls (4.2 % and 8.5 %). In group B, a higher occurrence of HLA-A3 (25.0 %) was found as compared to group A (10 %) and to the controls (11.8 %), and of HLA-B8 (22.5 %) as compared to group A (8.3 %) and to the controls (8.6 %). In this group the occurrence of HLA-DR3 (30.0 %) was higher as compared to group A (10.0 %) and to the controls (9.8 %) and of HLA-B8 (30.0 %) as compared to group A (8.3 %) and to the controls (8.6 %). Genetic markers indicate a similarity of groups B and C. Patients in these groups could be at different stages of the same disease, however, some distinctions between them lead us to consider the possibility whether different epigenetic factors could extend the difference between these groups in the course of clinical development.

[Specific mucosal immunity in the female reproductive tract: protection against infectious diseases and regulation of fertility (part 2)]

Immune mediated defense against pathogenic microorganisms and maintenance of immune tolerance to allogeneic antigens of sperm and fetus are main function of female reproductive tract mucosal immune system. Specific mechanisms concerning development of mucosal vaccines to sexually transmitted diseases and the immune regulation of fertility are reviewed in this article.

[Specific mucosal immunity in the female reproductive tract: general introduction (part 1)]

Immune mediated defense against pathogenic microorganisms and maintenance of immune tolerance to allogeneic antigens of sperm and fetus are main function of female reproductive tract mucosal immune system. Basic mechanisms of mucosal immune system and the unique features of female reproductive tract immune system are reviewed in this article.

7-Hydroxydehydroepiandrosterone--a natural antiglucocorticoid and a candidate for steroid replacement therapy?

7-Hydroxylated metabolites of dehydroepiandrosterone (DHEA) are believed to be responsible for at least some immunomodulatory and antiglucocorticoid effects of DHEA and hence are considered candidates for hormone replacement therapy. Our experiments in vitro brought the evidence that 3beta, 7beta-dihydroxy-5-androsten-3-one (7beta-OH-DHEA), but not DHEA and its 7alpha-hydroxyisomer, could counteract the immunosuppressive effect of dexamethasone on the formation of plaques in culture of murine spleen lymphocytes. In another experiment, DHEA and after a 3-weeks pause 3beta-hydroxy-5-androstene-7,17-dione (7-oxo-DHEA) were applied transdermally to 6 male volunteers on 5 consecutive days. Blood levels of DHEA, its 7-hydroxylated metabolites, and in the first case also dehydroepiandrosterone sulphate (DHEAS), were measured before, during and one day after the end of treatment. Application of DHEA increased significantly not only DHEA and DHEAS, but also its both 7-hydroxyisomers. Application of 7-oxo-DHEA also led to a significant increase of both 7-hydroxyisomers of DHEA, with 7beta-OH-DHEA being the preferred metabolite the concentration of which was increased more than three times.

Immunomodulatory 7-hydroxylated metabolites of dehydroepiandrosterone are present in human semen

Seminal fluid represents a milieu enabling spermatozoa to break the ovum membrane and suppress its immune response and, at the same time, to protect male germ cells against infection. Among constituents of the seminal fluid, various steroids, including dehydroepiandrosterone (DHEA) and its sulphate, were detected. With respect to immunomodulatory and antioxidative properties of the latter steroid and its 7-hydroxylated metabolites, believed to be at least in some instances the locally active species, their presence in seminal fluid is of particular interest. Here for the first time unconjugated 3beta,7alpha-dihydroxy-5-androsten-17-one (7alpha-OH-DHEA) and its 7beta-hydroxyisomer have been detected and quantified in semen. Eight semen samples were extracted with diethyl ether and following evaporation and solvent partition both isomers were detected by gas chromatography-mass fragmentometry using the ions m/z 358 and 343 for quantification. Another portion was separated by HPLC and in the fractions corresponding to 7-OH-DHEA isomers the steroids were measured by recently developed specific radioimmunoassays (RIA). Mean concentrations of 7-OH-DHEA as measured by RIA amounted 5.75+/-1.29 and 5.39+/-0.75 nmol/l (mean+/-SEM) for 7alpha- and 7beta-OH-DHEA, respectively.

Occurrence of IgA and IgG autoantibodies to calreticulin in coeliac disease and various autoimmune diseases

Calreticulin (CRT), a high-affintiy calcium binding protein and chaperone, was recently identified as one of the targets of autoantibodies in coeliac disease. We evaluated the level of IgA and IgG antibodies to CRT in sera from patients with coeliac disease and various autoimmune diseases. The level of antibodies to gliadin (shown previously to cross-react with CTR), isolated enterocytes and tissue transglutaminase were determined for comparison. The mean level of IgA antibodies to CRT was significantly higher (P< 0.001) in sera from coeliac patients with active disease (139.9+/-11.2 AU/+/-SE) than in healthy controls (20.9+/-1.7 AU). In sera of patients with systemic lupus erythematosus (SLE), insulin dependent diabetes mellitus (IDDM), multiple sclerosis (MS) and autoimmune thyroiditis (AT) or inflammatory bowel disease (IBD) the mean level (25.8+/-3.7 to 38.1+/-5.6 AU) did not exceed the cut-off value. A low level of these antibodies, however, was detected in some sera of patients with MS and IBD. The level of IgG anti-CRT antibodies was increased in coeliac patients (mean 125.4+/-8.0 AU, P< 0.001) when compared to that in healthy controls (33.9+/-2.3 AU). The IgG anti-CRT antibodies were also detected in about 30% of SLE patients sera (54.1+/-3.6 AU, P< 0.001), but the mean level reached only half that detected in coeliac patients.

HLA-association in patients with intolerance to mercury and other metals in dental materials

A group of selected 25 patients with serious intolerance to heavy metals used for dental restoration were examined for HLA antigens. A significant increase for HLA -- B37, B47 and DR4 was found. The value of the relative risk is not significant after correction for the number of antigens tested and therefore further studies of more patients are needed.

7Beta-OH-DHEA counteracts dexamethasone induced suppression of primary immune response in murine spleenocytes

The effect of dexamethasone and of three potential antiglucocorticoids, namely dehydroepiandrosterone (DHEA) and its 7alpha-and 7beta-hydroxylated metabolites, on primary immune response has been studied by measuring the number of plaque forming cells (NPFC) and their viability in a cell culture of murine spleenocytes. As expected, dexamethasone suppressed considerably the NPFC as well as their viability. Surprisingly, DHEA as well as its 7alpha-hydroxylated metabolite decreased significantly the NPFC, while the effect of 7beta-hydroxy-DHEA was different: at low doses it decreased the NPFC, but this effect was less pronounced at higher concentrations. In addition, 7beta-hydroxy-DHEA was able to counteract the effect of dexamethasone on the NPFC. None of the natural steroids affected the cell viability.

[Reactions to metals in patients with chronic fatigue and autoimmune endocrinopathy]

Our study was designed to assess the effect of heavy metals on the severity of fatigue in autoimmune thyroid disease associated with autoantibodies against other endocrine organs. We compared our data with those obtained from other groups of patients. A total of five groups of patients were examined by their medical history, dental examination, and using a modified test of blast transformation of metals (Melisa): a) 10 fatigues female patients with autoimmune thyroidism and polyglandular activation of autoimmunity, b) 12 fatigued patients with autoimmune thyroidism, c) 28 fatigued patients free of endocrinopathy, d) 22 professionals without evidence of autoimmunity, e) 13 controls, a population sample, the individuals did not complain of marked fatigue and their laboratory tests did not show signs of autoimmunity and endocrinopathy. Fatigue regardless of the underlying disease is primarily associated with hypersensitivity to inorganic and organic mercury, nickel, and gold. The groups differed in their hypersensitivity to other metals. In the control group, hypersensitivity--mostly to cadmium and lead--was found in four of the examined individuals only. Statistical analysis of data obtained from professionals and controls revealed a higher incidence of positivity to organic and inorganic mercury and nickel in professionals.

Effect of protein kinase inhibitors on primary antibody induction in tissue cultures

The effects of protein-kinase-inhibitors (PKIs) on protein kinase C (PKCs) i.e., staurosporin, calphostin C, H-7, H-8, H-9, on phosphatidyl inositol 3-proteinkinase (PI3-K) i.e., wortmannin, and on protein tyrosine kinase (PTKs) i.e., genistein, herbimycin A, sanguinarin, lavendustin A and B were tested on the induction phase of the primary Ab-response in vitro. The inhibitory action of PKIs was the highest with herbimycin A, sanguinarin, H-9 and wortmannin. Although wortmannin inhibits the function of T-lymphocytes (Taub et al., 1997, Shi et al., 1997), we believe that this communication is the first report of PKIs immunosuppressive action on the inductive steps of Ab-formation.

[The fatigue syndrome in autoimmune thyroiditis with polyglandular activation of autoimmunity]

The authors compared in a group of 118 patients with autoimmune thyroiditis and a positive antibody titre against ovaries the grade of fatigue with the presence of organ specific and non-specific autoantibodies in the peripheral blood stream, antibodies against EBV and CMV, immunoglobulin concentrations, biochemical parameters of the lipid metabolism, glucose tolerance, ion balance and melatonin and serotonin levels. Patients with autoimmune thyroiditis were differentiated according to the degree of fatigue into three groups: 38 with fatigue typical for CFS, 30 with occasional fatigue and 50 without the feeling of fatigue. Fatigue of the CSF type was characterized by a significantly higher incidence of autoantibodies against the adrenals and a higher cholesterol level. Increased fatigue of the patients was associated with a lower melatonin level, a higher serotonin level and a lower M/S ratio as compared with patients without fatigue. In other indicators no differences were found. Fatigue in CFS could be associated, similarly as in autoimmune endocrinopathies, with impaired immunoendocrine regulation. In autoimmune thyroiditis, regardless of the concomitant presence of fatigue, in addition to antibodies against thyroid peroxidase most frequently antibodies against the ovaries were detected.

The genetic basis of primary, predominantly specific immunodeficiencies

The presented review lists primary immunodeficiencies which essentially involve a mutation in genes coding for functionally important molecules, membrane antigens (e.g., MHC), chains of lymphokine receptors, protein kinases of the signal cascade, transcription factors, and some important regulators of cellular metabolism. Mutations are expressed as early as during embryogenesis (lymphopoiesis-I) as well as during induction of the immune response by antigen ligand binding to cell receptors, TCR, BCR (immunopoiesis-II). Immunodeficiencies are classified by the stage of development (I) or immune response induction (II) in which they occur most markedly, even in clinical terms. It has been pointed out that the same autoactivation stimuli and mechanisms, allowing differentiation-maturation of cells during embryogenesis (action of stem cell factor (SFC), IL-3, IL-7, and activation cascade), serve even later as a functional prerequisite for an adaptive immune response to antigen. As a result, this attempt to classify primary immunodeficiencies by differentiation periods (when they become evident most markedly in terms of their function) has an inherent logical limitation. Some early mutations turn immediately lethal, some express themselves by blocking embryonic lymphopoiesis while other mutations do not become demonstrable until after cell stimulation by antigens. This explains why the developmental differentiation scheme is bound to turn, in the future, into an immunodeficiency classification by localization of gene mutations and their incidence in time, e.g., increased mutation incidence during proliferation following cell stimulation by antigen stimuli.

[Thyroid, ovarian and adrenal antibodies in female patients with autoimmune thyroiditis]

BACKGROUND

In patients with autoimmune thyroiditis confirmed by clinical and laboratory tests frequently complaints associated with ovarian disorders are encountered. In order to verify the polyclonal activation of the autoimmune response of patients with autoimmune thyroid disease the authors investigated the presence of autoantibodies against the thyroid and adrenals.

METHODS AND RESULTS

696 patients were selected (mean age 47.9 years) with autoimmune thyroiditis from a group of 1939 patients examined for the presence of antibodies against thyroid peroxidase (TPO). In these patients also the presence of antibodies against ovaries was assessed (in 183 women, i.e. 26.3%), the adrenals (zona glomerulosa in 136 women, i.e. 19.5%, zona fasciculata in 10 women, i.e. 1.4%, zona reticularis in 114 women, i.e. 16.4%) and the adrenal medulla in 46 women, i.e. 6.6%. The basic group was divided into two sub-groups depending on the presence of ovarian antibodies. In the group of 183 women with positive antibodies against the ovaries and TPO positivity against the zona glomerulosa was found in 93 women, i.e. 50.8%, the zona fasciculata in 7 women, i.e. 3.8%, the zona reticularis in 70 women, i.e. 38.3%, the adrenal medulla in 37% i.e. 20.2%. In the second group of 513 patients with positive TPO and negative antiovarian antibodies against the zona glomerulosa were found in 43 women, i.e. 8.4%, zona fasciculata in 3 women, i.e. 0.6%, zona reticularis in 44 women, i.e. 8.6% and against the adrenal medulla in 9 women, i.e. 1.8%.

CONCLUSIONS

These results confirmed that in organ specific autoimmune thyroid disease also other autoantibodies against endocrine organs may be present, i.e. against the ovaries and adrenals. The relative frequency of a common finding of autoantibodies against organs which comprise steroid producing cells can be explained by the fact that for the ovaries and the adrenals a common antigen of steroid producing cells is typical.

[Extra-thyroid autoantibodies in autoimmune thyroiditis]

Organ specific autoimmune diseases do not occur isolated. In the authors group of 4509 patients with confirmed autoimmune thyroiditis the authors investigated the frequency of extrathyroid organ specific and non-specific autoantibodies. The objective was to draw attention to other autoimmune diseases which may not yet be clinically manifest. The mutual positivity of antibodies against thyroid peroxidase (TPO) and antibodies against the adrenals was: in the zona glomerulosa 21.1%, in the zona fasciculata 3.0%, in the zona reticularis 19.5%, in the adrenal medulla 9.0%. The mutual positivity of antibodies against TPO and ovaries was 28.5%, testes 12.5%, parathyroid 10.2%, islets of Langerhans 8.2%, hair follicles 45.0%, cell nuclei 26.1%, mitochondria 3.1%, smooth muscles 2.4%, striated muscle 0.2%, and gastroparietal cells of the stomach 12.3%. These results draw attention to the importance of polyclonal activation of the autoimmune process in endocrinopathies and the necessity to assess extrathyroid autoantibodies in autoimmune thyroiditis.

[Thyroglobulin and microsome autoantibodies and their clinical significance in adult type I diabetics]

In 34 patients with type 1 diabetes manifested in postadolescent age (mean age at time of diagnosis 25 years, 18 women and 16 men) after the establishment of the diagnosis perspectively the presence of antibodies against thyroglobulin and the microsomal fraction and their relation to affection of the thyroid gland was investigated. During an investigation of 20% of the patients the authors provided repeatedly evidence of the presence of both antibodies, in 23% repeatedly only against microsomes. In 21% some antibodies were detected only once. In the course of the investigation in 65% of the patients thyroid antibodies were found. The clinically most serious affection of the thyroid gland (from the sonographic an functional aspect) was found in groups 1 an 2, while in groups 3 and 4 in the majority of patients the thyroid gland was not affected. A different pathogenesis of the disease in the above groups is suggested in the areas of DR and DQ during HLA typing, the behaviour of other antibodies and differences in dermatoglyphic examinations. Moreover there is a high ratio of women in the first two groups (61%) and conversely of men in groups 3 and 4. In the discussion attention is drawn to the different course of diabetes in patients with thyroid autoimmunity.

[Endocrinopathy in the differential diagnosis of chronic fatigue syndrome]

Fatigue is a frequent and sometimes dominant symptom of some endocrinopathies. It may be associated with other symptoms which are included among the criteria of the chronic fatigue syndrome. These units are not always quite distinct and frequently endocrine diseases and chronic fatigue syndrome (CFS) overlap. From this ensue differential diagnostic problems and ideas on possible causal relations. The authors concentrate in articular on autoimmune endocrinopathies and the polyglandular autoimmune syndrome (APS) with emphasis on the necessity of an accurate endocrinological diagnosis, where is some patients with suspected CFS a defined endocrinopathy was revealed. Attention will be also paid to recent views on the possible participation of disorders of the hypothalamus-pituitary-adrenal axis in the etiopathogenesis of CFS where endocrine and immune regulation overlap and condition each other.

An increase in the blood thyroxine level after methylene blue in rats: the interaction with carbimazole

Anterior pituitary (AP) weight, thyroid weight, the serum thyroxine (T4) level, the thyroid T4 and cAMP content, the serum TSH level and the TSH and cAMP content of the AP and thyroid were measured in control rats, rats given methylene blue (MB) in their food, rats given the thyroid-blocking agent carbimazole (CARB) and rats fed both MB and CARB. AP weight fell slightly after MB in both intact and CARB--fed animals. Thyroid weight rose strongly after CARB, MB partly inhibited this increase. The cAMP content of the thyroid rose after CARB; this increase was likewise blocked by MB, MB alone had no effect on the thyroid cAMP concentration. Previous observations showing that MB produced an increase in the blood T, were confirmed. The T4 level fell, of course, after CARB and the decrease was partly inhibited by MB. The T4 content of the thyroid also fell after CARB, this decrease was completely reversed by MB. The blood TSH level fell slightly after MB and rose 7--fold after a CARB blockade of the thyroid; this increase was completely inhibited by MB. The TSH content of the AP fell after MB in both intact and CARB--fed animals. The cAMP content of the AP fell after MB, it was unaffected by CARB. Thus, in some way, MB raised the blood thyroxine level in both intact and CARB--fed animals and strongly depressed the TSH content in the serum and the AP given alone or with CARB. The mechanism of this action should be a result of MB interaction in thyroid hormone metabolism and their binding activity on specific regulatory elements. It is a problem for future experiments.

[Significance of determination of antibodies to TSH receptors (using TRAK) in the diagnosis and monitoring of therapy in endocrine orbital disease]

The elevated antibody level against receptors for TSH assessed by the commercial set TRAK (Henning Berlin) supports the diagnosis of endocrine orbitopathy (EO) which is important in more complicated cases with unilateral EO or EO in euthyroid or hypothyroid patients. During treatment of EO by elimination of the thyroid with radioiodine 131I (with or without previous thyroidectomy) a decline of originally high TRAK values to normal suggests successful elimination. Persistence of high TRAK values is associated with a poorer therapeutic effect of elimination and reasons for this should be sought. In four of 26 such patients the authors found radioiodine accumulation in the residual thyroid tissue, in 8 patients they found a non-accumulating residue by means of sonography. In 14 patients within two years after administration of the radioiodine elimination dose a residue of the thyroid gland was not found by scintigraphy nor by sonography. Improvement of the therapeutic effect occurred in one of these subjects with a drop of the TRAK value after the 30th month following elimination, in another female patient after a high diagnostic radioiodine dose. Improvement of the protrusion after radioiodine treatment with or without previous incomplete thyroidectomy and was recorded in 33 subjects where a drop of the originally high level of TRAK antibodies occurred was significantly greater than in subjects where the TRAK values did not decline.