Th e role of CDK12 in tumor bio logy

BACKGROUND

Physiological function of cyclin-dependent kinase 12 (CDK12) is crucial for several cellular processes, including regulation of transcription, RNA splicing, transcription termination and polyadenylation. It is well documented by now that CDK12 controls transcription of the unique set of genes involved in DNA-damage response, replication of DNA and response to cellular stress. Just recently, a key function of CDK12 in the induction of tandem duplication of specific DNA sequences within the metastatic castrate resistant prostate tumors has been documented. Therefore, it is possible to recognize CDK12 as a tumor suppressor; nevertheless, there is a growing body of evidence that CDK12 can support tumor growth under specific circumstances and thus act as a tumor oncogene. CDK12 therefore represents an alternative dia-gnostic approach for breast, ovarian and prostate tumors, especially when conventional treatment is not active and there is a need for more effective approaches, such as concept of synthetic lethality.

METHODS

The discussed scientific papers can be reached at the PubMed and Scopus databases before 1th of April 2020.

PURPOSE

The aim of the review is to summarize current knowledge relevant to the function of CDK12 as a tumor suppressor or oncogene in various tumors and to discuss the use of specific CDK12 inhibitors for patient treatment. At the end of the article, we discuss the potential use of CDK12 in the treatment of specific tumors by its targeted inhibition in monotherapy or in combination with poly (ADP ribose) polymerase 1 (PARP1) and checkpoint kinase 1 (CHK1) inhibitors. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Hematological findings in non-treated and gamma-irradiated mice deficient for MIC-1/GDF15

Several members of the TGF-beta family are known to effectively regulate the fate of hematopoietic progenitor cells in a complex and context-dependent manner. Growth differentiation factor-15 (GDF15) is a divergent member of the TGF-beta family. This stress-induced cytokine has been proposed to possess immunomodulatory functions and its high expression is often associated with progression of a variety of pathological conditions. GDF15 is also induced by chemotherapy and irradiation. Very few fundamental studies have been published regarding the effect of GDF15 in hematopoiesis. In this study, we analyzed the hematological status of untreated and gamma-irradiated mice deficient for GDF15 as a result of genetic knock-out (KO), in order to clarify the regulatory role of GDF15 in hematopoiesis. Significant differences between GDF15 KO mice and their pertinent WT controls were found in the parameters of blood monocyte numbers, blood platelet size, and distribution width, as well as in the values of bone marrow granulocyte/macrophage progenitor cells. Different tendencies of some hematological parameters in the GDF15 KO mice in normal conditions and those under exposure of the mice to ionizing radiation were registered. These findings are discussed in the context of the GDF15 gene function and its lack under conditions of radiation-induced damage.

[High-Resolution MR Examination of the Scapholunate Ligament using a Microscopic Coil: Comparison with Direct MR Arthrography and Arthroscopy Findings]

PURPOSE OF THE STUDY Scapholunate dissociation is a clinically most frequently diagnosed form of carpal instability. The aim of this study was to compare high resolution MRI using a microscopic coil with direct MRI arthrography in patients with suspected scapholunate ligament lesions and compare the results with arthroscopy findings and Geissler's arthroscopy classification. MATERIAL AND METHODS A prospective study was carried out in 47 patients (average age, 30.7 years) with clinical symptoms of wrist instability from 2013 to 2014. The patients were examined with the MR device Philips Achieva 1.5T using a microscopic coil and subsequently by direct MR arthrography. The results of examination were evaluated independently by two groups of physicians using a modified arthroscopic classification. The results were verified arthroscopically. For evaluation, an adjusted Geissler's classification was used. The study was approved by the Multicentre Ethics Committee of the Faculty of Medicine in Brno and informed consent was obtained from each patient. RESULTS A total of The MRI examination was evaluated and included in the study in 44 patients (three were excluded for the presence of motion artefacts). Only 20 patients underwent arthroscopy. Examination with a microscopic coil correctly classified 14 of them; an accuracy of 70 % (95 % CI: 45.7 % - 88.1 %) and p = 0.021. Direct MR arthrography correctly classified 16 of 20 injured ligaments, i.e., an accuracy of 80 % (95 % CI: 56.3 % - 94.3 %) and p = 0.002. DISCUSSION Currently, the diagnosis of pathological changes in the wrist is made by routine MRI especially when there is the possibility of using sequences with high spatial resolution. Even though we achieved poorer results by native examination using these techniques, when they were compared with the results of direct MR arthrography, they were still better than those reported in the recent literature. CONCLUSION The optimal method for an examination algorithm of scapholunate ligament lesions is direct MR arthrography. In our study correct findings of direct MR arthrography using Geissler's classification were shown in 80 % of the patients. Key words: scapholunate ligament, scapholunate ligament lesion, direct MR arthrography, microscopic coil, Geissler's classification.

[Differential diagnosis of the viral etiology of suspected mumps in a population with high vaccine coverage]

AIM

In this study, buccal swabs from patients with the clinical picture of parotitis epidemica in whom mumps virus (MV) infection was not confirmed by direct detection or serologically were tested. The aim was to detect by molecular methods nucleic acids (NAs) of other respiratory viruses possibly involved in salivary gland swelling. At the same time, paired sera, if available, were tested.

MATERIAL AND METHODS

The study group consisted of 72 buccal swabs from patients of the Clinic of infectious, tropical, and parasitic diseases, Na Bulovce Hospital. Paired sera were available from ten patients. Samples were collected in 2013 to 2015. Buccal swabs were tested by PCR for the presence of NAs of adenoviruses (AdV), bocaviruses (hBoV), parainfluenza viruses of types 1-4 (HPIV), human metapneumovirus (hMPV), coronaviruses (HCoV: NL63, OC43, HKU1, and 229E), respiratory syncytial virus (RSV), influenza A virus, influenza B virus, and Epstein-Barr virus (EBV). Paired sera were screened by the complement fixation test (AdV and influenza A and B viruses), hemagglutination inhibition test (HPIV types 2 and 3), ELISA (AdV, EBV), and immunofluorescence (EBV).

RESULTS

NAs from viruses other than the mumps virus were detected in 27 of 72 patients with clinical symptoms of parotitis epidemica, and serological tests revealed etiological links with parainfluenza viruses in three more cases. Overall, 30 (41.7%) of 72 patients with suspected mumps tested positive for one or more viruses from the study panel. The most commonly detected viruses were AdV 11/72 (15.3%), EBV 9/72 (12.5%), and HPIV 3/72 (4.2%), but influenza A virus (H3N2) 1/72 (1.4%) was also found. Some patients tested positive for more than one virus: 2/72 (3%) for AdV plus hBoV and 1/72 (1.4%) for HPIV plus HCoV. In addition, examination of paired sera revealed HPIV positivity in three more patients. PCR and serology detected etiological link with HPIV in six (8.3%) of 72 patients tested.

CONCLUSION

In our study group, nearly 42% of patients with the clinical picture of parotitis epidemica in whom mumps virus (MV) infection was not confirmed by direct detection or serologically tested positive for viruses other than the mumps virus. Thorough laboratory diagnosis of suspected mumps in vaccinated persons is important not only for the treatment of patients and adoption of isolation and other measures, but also for a better understanding of the epidemiology of the disease and outcomes of the immunisation programmes.

[Occurence, etiology and clinical significance of trombocytopenia in pregnancy]

OBJECTIVE

The principal objective of the study is to compare results from the experimental group of pregnant women suffering from thrombocytopenia in pregnancy with results from the control group of pregnant women with normal physiologic blood platelet count.

SETTING

Department of Obstetrics and Gynaecology of the Tomas Bata Regional Hospital Zlín, Obstetrics and Gynaecology Clinic, Haematology and Oncology Clinic of the Palacky University Teaching Hospital and Medical School in Olomouc, Obstetrics and Gynaecology Clinic of the Ostrava Teaching Hospital.

METHODOLOGY

A group of 200 pregnant women suffering from thrombocytopenia underwent thorough medical tests. The level of platelets, presence of anti-platelets agents, liver function (LFT), anti-phospholipid antibodies, complete blood count with differential, specific antibodies for hepatitis B and C, Lyme borreliosis and cytomegalovirus were determined from venous blood using the EIA, ELISA methods.

RESULTS

Medical articles and books about thrombocytopenia divide the causes for thrombocytopenia as follows: 79.5% benign gestational thrombocytopenia, 16% preeclampsia, 2.5% HELLP syndrome, 1% immune thrombocytopenia, 1% HVC. The number of women who developed physiological anaemia in pregnancy and were overweight is identical in the experimental group of pregnant women suffering from thrombocytopenia and in the control group of pregnant women with normal physiologic blood platelet count, and the proportion of the different age groups in the two groups of pregnant women is also identical.

CONCLUSION

32% of pregnancies in the experimental group ended in a caesarean section, of which 13.5% in a group of 127 pregnant women suffering from mild thrombocytopenia, 17.5% in a group of 71 pregnant women suffering from moderate thrombocytopenia and 1% in a group of 2 pregnant women suffering from severe thrombocytopenia. 20.5% pregnancies in the control group ended in caesarean section.

[Preeclampsia and thrombin generation test]

OBJECTIVE

Acquiring new information to allow prediction of the development of diseases associated with impaired coagulation. Design effective preventive measures most serious diseases (TEN) in the fields of gynecology and obstetrics. For pregnant women with preeclampsia, hypertension compared with women with normal pregnancies could lead to increased thrombin generation due to the synergistic effect of thrombotic risk factors. Based on the results and found statistically significant differences between the groups among pregnant can select for a higher risk of developing deep vein thrombosis. This risk group could then greatly benefit from more stringent follow-up and possible preventive treatment prophylactic doses of LMWH in reducing maternal and perinatal morbidity and mortality.

DESIGN

Prospective study.

SETTING

Department of Obstetrics and Gynecology, University Hospital Olomouc.

METHODS

In early pregnancy - during pregnancy standard samples (up to the end of the first trimester) patients venous blood was sampled and they completed information questionnaire. A second sampling was carried out between 24 to 28 week, the third sample and between 36th to 40th week. Obtained blood samples were subsequently processed in the coagulation laboratory Hemato-Oncology Clinic and Olomouc. The blood samples were investigated protein C and S, antithrombin, FVIII level, FII, Leiden, and plasma endothelial microparticles, and lupus anticoagulant and APC resistance standardized methodologies. Thrombin generation was determined thrombin generation test. Thrombin generation was measured fully automatically using a kit (Technothrombin TGA, Technoclone, Vienna, Austria) and analyzer Ceveron Alpha (Technoclone, Vienna, Austria) with fully automatic analysis software. As the main parameter is evaluated by the maximum thrombin generation, at the same time, however, was also detected in the total amount of thrombin and the time until the beginning of the formation of thrombin.

RESULTS

In the period 2008-2011 were analyzed blood samples of 303 healthy pregnant women. 215 women, ie 71% were nuliparas, 60 women, ie 19.8% were primiparas, 28 women, 9,2% were secundiparas. The average age of pregnant women was 28.6 years(± 3.8 years). The average maternal weight at the beginning of pregnancy was 63.6 kg (± 7.8 kg). Of the 303 women in 18 (6%) developed slight to moderate degree of preeclampsia or HELLP syndrome with varying severity of clinical manifestations. 20 mothers (6.6%) gave birth prematurely terminated before 37 week of pregnancy. 3 pregnancies (0.9%) were discontinued due to genetic indication for fetal birth defect. The complete study protocol (sampling in all three trimesters) thus completed 280 pregnancies. Of the three evaluated, parameter Lag time, ETP and peak we observed significant differences when comparing physiological pregnancies and pregnancies with preeclampsia (Table 3 and Figure 5-7), the statistical level of p < 0.01. In pregnancies with chronic hypertension, these differences were not significant. Comparison of 18 pregnancies, in which the III. trimester developed preeclampsia with other pregnant with physiological pregnancy did not show statistically significant differences in I. and II. trimester. The results suggest the activation of coagulation through the late stages of pregnancy. Results are influenced by strong clinical variability of disease. In severe and early preeclampsia this activation and significant differences begin much earlier.

CONCLUSION

We demonstrated significantly higher activation of thrombin generation in women with preeclampsia [10]. Changes in preeclampsia are characterized by increased generation of thrombin in plasma. This fact may explain the partial success of the clinical use of aspirin in preeclampsia. In the third trimester, during the manifestation of the disease, patients with preeclampsia have significantly higher ETP compared to patients with a normal pregnancies. Pregnant women with chronic hypertension also show a slight increase in the activation of thrombin. However, these results are not statistically significant. Examination of coagulation in the first and second trimester in women who later developed preeclampsia, showed no statistically significant differences and thus can not be used in this case as predictive, but only as a diagnostic test.

[Endothelial dysfunction in pregnancies with chronic hypertension]

AIM OF THE STUDY

To establish endothelial activation markers which could uncover endothelial damage during hysiological pregnancy and pregnacies with chronic hypertension.

SETTINGS

Department of Hemato-oncology, Obstetrics and Gynecology and Department of Medical Genetics and Fetal Medicine Medical Faculty of Palacký University Olomouc, Department of Obstetrics and Gynecology Medical Faculty Ostrava.

METHODS

We examined 298 pregnant women with a physiological pregnancy. Venous blood samples were collected from the women in both arms at the beginning of the pregnancy, a second sample was collected in the interval 24-28 weeks gestation, the third sample was colected about the 36 weeks of gestation. Parameters were examined using methods: t-PA - ELISA, PAI-1 - ELISA, vWF - EIA, ePCR - ELISA, MMP-2,9 - ELISA with fluorogenic detection, TIMP-2 - ELISA, endothelial microparticles - flow cytometry.

RESULTS

In accordance with the literature, we have observed in our study significantly increased endothelial activatition in hypertensive pregnancies compared with women with physiological pregnancy, as evidenced by significant increases in vWF activity and antigen, thrombomodulin and PAI-1 in all trimesters. In the other investigated parameters statistically significant changes were not observed.

CONCLUSION

We have found significant signs of endothelial dysfunction in the group of women with pre-existing hypertension, a wide range of parameters examined markers indicating an significantly increased endothelial activation pregnant women with pre-existing hypertension, confirming the need for strict follow-up of pregnant women with hypertensive disease.

[Myopia or hyperopia?]

INTRODUCTION

The study describes cases of patients screened for worse vision and headaches. We are trying to point out we can measure minus diopters even at latent hypemetropes. These patients come to a doctor for a variety of problems that may be caused by inadequate correction of ametropia. It is necessary to know about this possibility, and rather perform cycloplegia in sporadic cases.

METHODS

Patients were measured at autorefractometer without mydriasis, and then after using UNITROPIC 1% or CYCLOGYL 1%. Both of these substances induce cycloplegia. Visual acuity with the best correction was tested with and without cycloplegia.

RESULTS

After cycloplegia, a significant change in both objective and subjective refraction was detected in most of the selected patients. This change was within the meaning of a shift to hyperopia. Subsequent adjustment correction led to resolving of problems.

CONCLUSION

The work should highlight the necessity of an individual approach of prescription of the best correction. Not always an autorefractometer gives correct information, the real-needed correction is completely different in some cases.

[Bleeding disorders in pregnancy]

Bleeding disorders in pregnancy represent heterogenous and often serious group of diseases. Solving of this problems and proper treatment of the patiens requires close cooperation between obstetricians and hematologists. There are disorders specific for pregnancy (HELLP syndrom) and disorders occurring independently in pregnancy, but these can be modified in pregnancy as well. Bleeding and postpartum haemorrhage still remain the leading cause of maternal mortality.

KEYWORDS

bleeding - pregnancy - thrombocytopenia - coagulopathy.

Post-translational modifications regulate signalling by Ror1

AIM

In this study, we analysed the post-translational modification of receptor tyrosine kinase-like orphan receptor (Ror1). Ror1 is highly upregulated in B cells of patients with chronic lymphocytic leukaemia (CLL). Molecularly, Ror1 acts as the Wnt receptor in the non-canonical Wnt pathway.

METHODS

The level of Ror1 glycosylation in HEK293 cells and in primary human CLL cells was analysed by treatment of inhibitors interfering with different steps of glycosylation process and by direct treatment of cell lysates with N-glycosidase. Ror1 ubiquitination was determined by ubiquitination assay. Functional consequences of post-translational modifications were analysed by immunohistochemistry and by analysis of cell surface proteins. Differences in Ror1 glycosylation were confirmed by analysis of 14 samples of B cells from CLL patients.

RESULTS

We demonstrate that Ror1 is extensively modified by N-linked glycosylation. Glycosylation produces several variants of Ror1 with electrophoretic migration of approx. 100, 115 and 130 kDa. Inhibition of glycosylation interferes with cell surface localization of the 130-kDa variant of Ror1 and prevents Ror1-induced formation of filopodia. Moreover, we show that 130-kDa Ror1 is mono-ubiquitinated. Furthermore, individual CLL patients show striking differences in the electrophoretic migration of Ror1, which correspond to the level of glycosylation.

CONCLUSION

Our data show that Ror1 undergoes complex post-translational modifications by glycosylation and mono-ubiquitination. These modifications regulate Ror1 localization and signalling, and are highly variable among individual CLL patients. These may suggest that Ror1 signals only in a subset of CLL patients despite Ror1 levels are ubiquitously high in all CLL patients.

[Course and delivery outcomes of 34 pregnancies complicated by HELLP syndrom]

OBJECTIVE

To analyze the course and delivery outcomes of pregnancies complicated by HELLP syndrom and compare them to previously published data.

DESIGN

Retrospective cohort study.

SUBJECT AND METHOD

We analyzed pregnancy outcomes of 34 pregnancies complicated by HELLP syndrom of women who delivered at our hospital between years 2004 and 2009.

SETTING

Department of Obstetrics and Gynecology, University Hospital Ostrava.

RESULTS

There were 34 pregnancies and deliveries complicated by HELLP syndrom between the years 2004 and 2009 (64 months). The average age of mothers was 28.5 years, the average gestational age at delivery time was 33 weeks and 4 days. Only 2 women delivered vaginaly, the other 32 delivered by cesarean section and the average weight of the newborn was 1930 g. There were 3 twin pregnacies. Twenty two (65%) patients had laboratory abnormalities in coagulation parameters but clinical signs of coagulation disorder were noted in 8 patients only (23.5%). Six patients recevied blood transfusions (18 units in total) and 9 patients received plasma transfusions (20 units in total). The average length of stay of mothers at intensive care unit was 3.2 days. There was no maternal mortality. One fetus was stillborn and 12 newborns (33.3%) had their early postnatal period complicated by severe morbidity.

CONCLUSION

Early diagnosis and active management is a major factor for the prevention of severe forms of HELLP syndrom which still remains one of the most severe complications of pregnancy.

[Monitoring of endothelial activation markers during physiological pregnancy]

AIM OF THE STUDY

To establish endothelial activation markers which could uncover endothelial damage during physiological pregnancy.

TYPE OF STUDY

Prospective study.

METHOD

We examined 403 pregnant women with a physiological pregnancy. Venous blood samples were collected from the women at the beginning of the pregnancy, a second sample was collected in the interval 24-28 weeks gestation. Parameters were examined using methods: t-PA--ELISA, PAI-1--ELISA, vWF Ag--EIA ePCR--ELISA, MMP-2,9--ELISA with fluorogenic detection, TIMP-2--ELISA, endothelial microparticles - flow cytometry.

RESULTS

The level of vWF antigen increased during the entire course of pregnancy (in the I. trimester the average level was 152.32%, in the II. and III. trimester 173.34% and 216.20% respectively). At the same time, vWf activity also increased (I. trimester average level 130.20%, II. and III. trimester 150.09% and 181.91% respectively). The level of thrombomodulin significantly increased during pregnancy (I. trimester average level 19.05 ng/ml, II. and III. trimester 28.47 ng/ml and 39.86 ng/ml respectively). The level of soluble form of EPCR increased during pregnancy (I. trimester average level 201.76 ng/ml, II. and III. trimester 274.68 ng/ml and 324.07 ng/ml respectively). The level of PAI-1 increased during the entire course of pregnancy (I. trimester average level 36.14 ng/ml, II. and III. trimester 50.07 ng/ml and 60.12 ng/ml respectively). The level of t- PA did not change significantly during the course of pregnancy (I. trimester average level 2.48 ng/ml, II. and III. trimester 2.97 and 3.34 ng/ml respectively). The levels of MMP-2 (I. trimester average level 9043.76 RFU, II. and III. trimester 9315.38 and 8800.27 RFU respectively), MMP-9 (I. trimester average level 8371.90, II. and III. trimester 8290.81 and 7470.50 respectively), TIMP-2 (I. trimester average level 92.5 ng/ml, II. and III. trimester 98.5 and 96.5 ng/ml respectively) or endothelial microparticles (I. trimester average level 3838.38 particles/microl, II. and III. trimester 3836.59 and 3650.59 particles/microl respectively) did not change significantly throughout the individual trimesters.

CONCLUSION

We confirmed the hypothesis regarding the significant influence pregnancy has on changes in levels of these markers.

[Antithrombotic therapy in pregnancy]

Despite the fact of low prevalence of maternal death, deep venous thrombosis remains one of the most serious complication in pregnancy and puerperium. Virchows triad--vascular stasis, hypercoagulability, and vascular trauma plays the main role in the pathogenesis of deep vein thrombosis in pregnancy. Low molecular weight heparins and unfractionated heparins are the best treatment option. The aim of the treatment is to be effective in extension of thrombus and prevention of the postthrombotic syndrome and pulmonary embolism. Management of pregnant women with increased risk of venous thromboembolism can be stratified by determining whether the prior episode VTE was unprovoked or associated with a transient risk factor and the presence or absence of an inherited thrombophilia.

Leukaemia inhibitory factor inhibits cardiomyogenesis of mouse embryonic stem cells via STAT3 activation

The leukaemia inhibitory factor is a cytokine that exhibits pleiotropic activities in a wide range of cell types. There are evidences that leukaemia inhibitory factor-regulated signalling pathways are involved in cardiomyogesis and maintenance of cardiomyocytes. In the present work we studied the effect of leukaemia inhibitory factor on cardiomyogenesis of embryonic stem cells together with the role of serum-born factors. We showed that leukaemia inhibitory factor had an inhibitory effect during both the induction and progression phases of cardiomyogenesis of embryonic stem cells. The leukaemia inhibitory factor-mediated inhibition of cardiomyogenesis was abolished by inhibitors of STAT3 activity. These results suggest that leukaemia inhibitory factor- activated STAT3 is responsible for the inhibition of cardiomyogenesis in embryonic stem cells.

[Endotelial activation markers--possibilities of their detection and clinical signification in gynaecology and obstetric]

OBJECTIVE

Summary of the current knowledge of the role of endotelial activation markers in the pathogenesis of the selected diseases and high-risk pregnancy.

DESIGN

Review article.

METHODS

Compilation of the published data from scientific literature.

CONCLUSIONS

The endothelium functions in a multitude of physiological processes including the control of cellular trafficking, the regulation of vasomotor tone and maintenance of blood fluidity. Preeclampsia is compared by the the insufficient trofoblastic invasion to the maternal spiral arteries. This changes lead to the insufficiency of the fetoplacental blood flow. The ischaemia of the fetoplacental unit cause the release of specific factors into maternal vessels and subsequent activation of the endothelium and vasoconstriction. We present a short summary of the clinically important endothelial markers and current possibilities of laboratory testing.

[Molecular methods in thrombophilic states diagnostics]

Molecular genetic methods passed into the field of investigation of thrombophilic states in 90th years of last century, along with the first discoveries of coagulation inhibitors (AT III, protein C and protein S). They have acquired a widespread use above all with the detection of the molecular basis of activated protein C (APC) resistance in 1994 by prof. Bertina. At the present time, a wide range of molecular genetic markers, linked with a clearly documented increased risk of thrombophilia are adapted. They include mutations of factor V Leiden 506R/Q, of protrombin 20210G/A, MTHFR 677C/T in homozygous form, mutation of PAI-1 4G/5G, mutations of different coagulation inhibitors and finally a range of polymorphisms with still not precisely defined increased risk for thrombophilia (F XIII Val34leu, platelets glycopeproteins, endothelial protein C receptor and trombomodulin). From the methodological viewpoint, all these techniques are based on the principle polymerase chain reaction (PCR). In the last period of time, however there was a rapid evolution, allowing a significant improvement in their laboriousness. Nowadays, splitting with the aid of restriction endonucleases, real time PCR or allel specific primers for PCR. The second, where molecular genetic methods are currently under use, is pathophysiological investigation of the single coagulation processes. Here, in a fact, most significant progress has been in the field of APC resistance made elucidation. Although still in the 90th years of the past century the genetical cause of these coagulation disturbance was unequivocally documented its clinically heterozygous appears not yet fully understood at the moment. Similarly, in prothrombin mutation, only the latest investigations have outlined the probable mechanism of expression. Concerning the future evolution of molecular genetic methods, there can be observed a clear cut tendency to better understanding the pathophysiologic cause of thrombophilia in comparison with the searching for new coagulation defects which consecutively bear lesser a relative risk of thrombosis.

[Cataract surgery without preoperative mydriasis]

Preoperative mydriasis is usually obtained by means of using combinations of sympatomimetics and parasympatolytics. The disadvantages of this method are: longer preoperative preparing time, toxic effect of eye drops and adverse systemic effects in some patients. The alternative to the standard dilating drops is use of intracameral lidocaine during the surgery. In our study, we used intracameral lidocaine 1% to achieve the mydriasis during the cataract surgery. By using this method, we operated on 38 eyes of 33 patients, 12 men and 21 women. The age ranged between 54 years and 85 years (mean, 72.2 years). The mean pupil diameter before dilation was 3.04 +/- 0.62 mm. The time necessary to dilate the pupil was 8.82 +/- 2.54 sec and the mean pupil diameter after the dilation was 7.11 +/- 0.74 mm. The pupil enlarged even more after the instillation of the ophthalmic viscoelastic material. At the end of the surgery, the diameter of the pupil was 7.12 +/- 0.62 mm. The mydriatic effect of intracameral lidocaine application is adequate and longstanding enough. This surgical method is wholly safe.

The influence of galvanic currents and voltage on the proliferation activity of lymphocytes and expression of cell surface molecules

Release of metal ions from dental metal fillings supported by galvanism can cause local or general pathological problems in sensitive and genetically susceptible individuals. We aimed to investigate in vitro lymphocyte responses and expression of surface molecules influenced by galvanic currents and voltage. Human peripheral blood lymphocytes were influenced by galvanic currents and voltages and lymphocyte proliferation was measured. Control samples were not exposed to the influence of galvanism. We also studied the expression of surface molecules by the FACS analysis. A 15-h and shorter influence of almost all tested currents and voltages caused a significant decrease in lymphocyte proliferation and the 15-h influence of 20 microA currents significantly increased expression of surface molecules CD 19, 11a/18, 19/69 and 19/95. An influence of 10 and 3 microA currents led to a significant decrease in the expression of surface molecules CD 3, 11a/18, 3/69 and 3/95 and to a significant increase in CD 19 expression. An 80 mV voltage influence led to a significant decrease in the expression of surface molecules CD 3, 11a/18, 3/69, 3/95, 19/69 and 19/95, and 200 and 300 mV voltages significantly decreased the expression of surface molecules CD 3, 19, 11a/18, 3/95 and 19/95 and significantly increased CD 19/69 expression. A long-lasting influence of galvanism can, in sensitive and genetically susceptible individuals, influence lymphocyte proliferation and surface molecule expression. The threshold for pathological values of 5 microA for galvanic currents and 100 mV for galvanic voltage was confirmed.

[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.

[Coagulation factor VIII in the early postpartum period]

OBJECTIVE

Pregnancy is accompanied by changes in the coagulation and fibrinolytic systems. There is a marked increase in some of the coagulation factors, particularly fibrinogen and factor VIII. A high plasma levels of coagulation factor VIII is an important risk factor for thrombotic complications during pregnancy and puerperium. The aim of the study was to determine changes of the VIII:C in the early postpartum period.

SETTING

Dept. of Obstetrics and Gynaecology, Medical Faculty of Palacký University, Olomouc.

DESIGN

A longitudinal prospective study of 197 healthy women. Primi or multigravidas whose pervious pregnancies had been uncomplicated, aged 18-41 years. All of the deliveries were spontaneous and vaginal. First samples were taken between 24-72 hours postpartum. Women whose factor VIII plasma levels were higher than 150 (percentage of standard) were tested again after 6 weeks. Factor VIII:C was investigated by the one-step coagulation method. Statistical evaluation was done by Statsoft, Inc. (2001) Statistika Cz (Software system data analysis), version 6.

RESULTS

Pregnancy is associated with increased levels of VIII:C. Mean value was 194.09 percentage of standards. 119 (60.4 %) of the tested women had VIII:C higher than 150%. The post-puerperal tests were done in 59 women and showed values similar to those from formerly published data in age-matched non-pregnant group. Mean value was 139.76%.

CONCLUSION

Normal pregnancy is connected with increased levels of factor VIII. However elevated plasma levels of VIII:C is not associated with poor pregnancy outcome. The highest level of the clotting factor VIII was associated with patient's blood group A. Post-puerperal data showed distinct decrease of factor VIII. There is a necessity to rule out thrombophilia, in the case of the outlasting elevation of the factor VIII.

[Effect of heavy metals on immune reactions in patients with infertility]

BACKGROUND

Heavy metals can negatively influence reproduction because in sensitive persons they are able to alter the immune reactions including autoantibodies production. The altered immune reaction can then cause infertility.

METHODS AND RESULTS

The in vitro lymphocyte reaction after stimulation with metals, the production of interferon (IFN-gamma) and antisperm antibodies in supernatants after lymphocyte stimulation in patients with infertility and with the antisperm antibodies present in their serum were investigated. The cause of antisperm antibodies presence was not determined. The diagnosis of metal intolerance was performed by the proliferation method modified for metals (Melisa). In supernatants of tissue cultures of lymphocytes without the antigen stimulation and after stimulation with mercury chloride, the in vitro production of gamma interferon and antisperm antibodies was studied by Elisa. More than 50% of patients did not tolerate mercury, iron, aluminium and silver. When the lymphocyte reaction was compared in patients with and without mercury intolerance we found that lymphocytes of patients with mercury intolerance produced less gamma interferon and more antisperm antibodies in supernatants after mercury stimulation of lymphocytes.

CONCLUSIONS

In patients with metal intolerance diagnosed by the Melisa test, metal ions released from the dental materials can represent a factor, that does not cause infertility but is able to influence it negatively.

[Sperm antibodies and immunologic intolerance to metals in infertile couples]

OBJECTIVE

Verification of the hypothesis of a relationship between the presence of antibodies against sperm cells and immunological reactivity to some metals in infertile couples by the MELISA test.

SETTING

Department of Obstetrics and Gynecology, Medical Faculty, Charles University and Faculty Hospital, Plzen.

METHOD

From 23 female patients and 21 men (a total of 44 subjects treated for infertility) with confirmed serum antibodies against sperm cells the authors isolated lymphocytyes from the peripheral blood stream, divided them into individual cultures and investigated them by the MELISA test using different metal compounds.

RESULTS

The outcome of the MELISA test are values of the stimulation index (SI) by means of which the authors investigated the reactivity of the organism to the given metal. Special attention was devoted to compounds of organic and inorganic mercury. The SI values were subsequently compared with different data obtained from a detailed anamnestic questionnaire which was focused specially on contact with metals and on allergic reactions. In the investigated group of patients the authors detected a positive immune reactivity to inorganic mercury, Ag, Al, Fe. In some subjects they found a very high positive immune reactivity to inorganic mercury, Ni, Al, Cd and Ti. The control groups were formed by healthy fertile subjects without antibodies against sperm cells and with physiological SI values.

CONCLUSION

The authors did not prove a direct relationship between the intensity of the laboratory reactivity to metals and the presence of antibodies against sperm cells which cause deterioration of fertility. An exogenous load of metals could in case of genetic predisposition be only one of the factors which participate in the formation of antibodies against sperm cells. The investigation proved that its is not essential, contrary to the view of many stomatologists, to eliminate metal compounds completely from dental practice.

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.

Th1 and Th2 cytokine profile in patients with early onset periodontitis and their healthy siblings

Early onset periodontitis (EOP) is a chronic inflammatory periodontal disease with a strong genetic link affecting individuals aged 17 to 25. In the familial studies we tested the hypothesis about the role of Th1 and Th2 cytokines in the pathogenesis of EOP disease. The study involved 6 individuals with EOP disease and their 6 siblings with healthy periodontium. Actinobacillus actinomycetemcomitans (A. a), a bacterium typical for EOP, was detected in all people studied. Th1 and Th2 cytokine production was measured after in vitro stimulation. Peripheral blood mononuclear cells (PBMC) were isolated and cultivated for 24 h and 7 days with PWM, A. a. or Escherichia coli. The levels of IL-4, IFN-gamma, IgA, IgG and IgM were measured by ELISA methods. After in vitro stimulation of PBMC, a significantly higher production of IL-4 and significantly lower production of IFN-gamma were found in the group of patients compared with their healthy siblings. The increased level of IL-4 in patients was in good agreement with an increased level of IgM after stimulation of lymphocytes with E. coli. These results support Seymour's hypothesis according to which patients with progressive disease primarily activate Th2 lymphocytes while non-susceptible individuals activate Th1 lymphocytes.

The role of the apoptosis and the genes regulating apoptosis in the early differentiation of human embryo

Apoptosis (programmed cell death) is an important process participating in the formation of organs and tissues during embryogenesis. Our aim of the work is studying the role of the apoptosis during the human embryonic differentiation. We tend to give acquired findings into the correlation with expression of proteins Bcl-2 and Bax (products of genes regulating apoptosis). Detection of the apoptosis was carried out on 25 routinely processed human embryos by means of TUNEL technique. The level of expression of Bcl-2 and Bax was determined using standard three-step immunohistochemical procedure. Results were achieved by the comparison of apoptoic index and the level expression of Bcl-2 and Bax was semiquantitatively evaluated. The low value of apoptotic index was mostly accompanied by the high expression of Bcl-2 and the Bax expression was not proportionally related to the value of apoptic index.

[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.

Long-term monitoring of the immune reactivity of stainless steel welders

The immune reactivity of stainless steel welders (n = 22-53) was evaluated in a three year's study. The results (phagocytic activity, cellular and humoral immunity) were statistically compared with those in control group of non-exposed persons from the same plant (n = 14-23) and with long-term laboratory reference values (LRV) (n = 14-311). In welders several changes were found when compared to the LRV: in humoral response there were higher prealbumin, lysozyme, circulating immune complexes and lower IgG. In phagocytic tests there were lower ingestion, bactericidal activity and higher metabolic activity of peripheral mononuclear leucocytes. In cellular immunity the marked lymphocytosis, higher counts of T-lymphocytes, CD4+ and CD8+ lymphocytes were noticed. After lowering the concentrations of metals in the working area there were trends to normal values in some parameters [relative numbers of T-lymphocytes, relative number of CD4+ lymphocytes, phagocytic activity, metabolic activity of leucocytes (INT index), IgA, complement C3, transferrin]. The extent and the length of the exposure to welding fumes, smoking and changed conditions at working place were followed as well.

Immunological monitoring of dry-cleaning shop workers--exposure to tetrachloroethylene

A panel of immunological parameters has been examined in a group of dry-cleaning workers (n = 21) and in a control group of administrators (n = 16) from the same plant. The results were also compared to long-term laboratory reference values (LRV) (n = 14-311). External exposure to tetrachloroethylene (PER) was represented by TWA (8 h) values in the range 11-752 mg PER/m3. Biological monitoring showed an amount from 9 to 344 mg PER/m3 in exhaled air by the end of workshift. 1. The exposed dry-cleaning workers compared to the controls from the plant had statistically significant changes in metabolic activity of phagocytes, alpha 2-macroglobulin, C3 and C4 complement component, salivary secretory IgA, and blastic transformation test. Most of the values were within the range of normal values. 2. The exposed dry-cleaning workers had several abnormal immune parameters compared to the long-term laboratory values (LRV) especially in the alpha 2-macroglobulin, C3 and percentage of T-lymphocytes. Most of the changes, even those that were statistically significant, were still within the range of normal values, but they might be classified as trends or shifts away from normal (spontaneous blastic transformation, absolute number of phagocyting cells, coeruloplasmin, circulating immunocomplexes, serum lysozyme). 3. The non-exposed controls from the same plant showed both quantitative and qualitative differences when compared to the LRV. Changes were seen in IgG, C4, CSI and in increased spontaneous metabolic activity of leucocytes, total leucocyte count, absolute number of phagocyting cells, alpha 2-macroglobulin, prealbumin, C4, circulating immunocomplexes and serum lysozyme. 4. The distribution analysis of all results detected a large number of abnormal values in both groups, more in the at-risk group. 5. As inhalation was the main route of PER exposure it was concluded that the changes might represent aspects of the response of the respiratory immune system, mainly of the alveolar macrophages. Additional postinfection effects could not be excluded in both studied groups. Individual differences in immune reactivity as well as individual range of exposure should be taken into consideration.

Expression of the LFA-1 beta molecule on peripheral blood leukocytes of patients with early-onset periodontitis: effects of dental plaque microbes

The effect of dental plaque bacteria on LFA-1 beta expression on peripheral blood leukocytes was studied in 20 patients with early-onset periodontitis and in 10 healthy controls. Stimulation of PMN with selected dental plaque bacteria which play a role in the pathogeny of periodontitis significantly increased the expression of LFA-1 beta in the group of patients as compared with the controls.

Craniofacial morphology as a marker of predisposition to isolated cleft palate

The etiology and pathogenesis of isolated cleft palate (CP) is largely unknown. Undoubtedly, bot genetic and environmental factors play a role in initiating this malformation. Although the predictions of the multifactorial threshold model have never been satisfied when subjected to statistical analysis, there is no a priori reason to dismiss the possibility that multiple genes may be segregating in CP families that give rise to specific and predictive phenotypes in the parents of CP offspring. We examined a sample composed of 52 parent pairs whose children were born with CP, as well as 75 normal controls with no family history of CP. Using anthropometric and roentgencephalometric methods, along with discriminant function analysis, we searched for craniofacial variables predictive of parents who were ¿at risk¿ for CP offspring. For fathers of CP children, 32 of the studied variables differed significantly from controls; for mothers of CP children 25 variables differed significantly from controls. These results support the hypothesis that there are characteristic morphometric signs in the craniofacies of the parents of children with CP. To confirm these findings, it will be necessary to prospectively ascertain the incidence of CP in the offspring of ¿at risk¿ parents and ¿not at risk¿ parents from families with and without a history of CP in other family members.

Contribution of "in vitro" assays to preclinical and premarketing testing in immunotoxicology

An attempt to replace the "in vivo" testing by "in vitro" exposure of cells to drugs is discussed from the point of view of the limitations of these artificial test conditions. The critical reminders are evaluated, the most important ones being the pharmacokinetics, pharmacodynamics and metabolism of drugs in the body what may be a cause of the discrepancy between "in vivo" and "in vitro" exposure assays. Various sensitivity of different cell types and of different phases of the generation cycle represent the crucial importance in the immune response and in the drug-cell interactions. The "in vitro" assays are technically sophisticated and mostly based on the tissue-culture techniques. However, both in immunology and immunotoxicology standardization, validation and usage of rules of Good Laboratory Practice are required. Finally, possibilities and contribution of "in vitro" assays to immunotoxicology are listed. It is apparent that for establishment of common rules these studies require intensive international and interlaboratory cooperation and coordination.

Effect of acyclovir on selected immune functions

The toxicity of acyclovir (ACV) produced by Lachema, Brno was compared with that of Zovirax, Wellcome. The in vitro suppressive effect of both substances was found equal and concentration dependent. The primary humoral antibody response was more sensitive to ACV than the cellular (blast transformation) response. However, spleen cells of drug-treated mice (either with the domestic compounds or Wellcome origin) differed neither in blast transformation test nor in the secretory antibody response. None of the drugs when given in adequate therapeutic dose did significantly influence the cell mediated response or antibody formation by spleen cells. Summing up, the acute immunotoxicity of both compounds was low; in this respect acyclovir Lachema did not differ from Zovirax Wellcome.

Analysis of the immunotoxic effects of xenobiotics

1. Current problems in immunotoxicology are reviewed with special attention to the sensitivity of the immune system to the effects of xenobiotics. 2. Sensitivity of target cells, route of exposure, dosage, mechanism of action and response of the immune system are discussed as the main factors responsible for the ultimate effects of drugs and chemicals. 3. The methodology of immunotoxicology is divided into two main steps: preclinical screening and the monitoring of exposed persons. 4. Conclusions are prescribed about future tasks in human immunotoxicology.

[The effect of hydrogenated ergot alkaloids on immune functions. II. The primary antibody response and proliferative activity in mouse spleen cells in vitro]

The present paper investigated the proliferative response of murine splenic cells in the tissue culture after stimulation with the polyclonal activators PHA, ConA and PWM. Proliferation of cells and DNA synthesis were measured by means of radioactively labelled thymidine. Furthermore, the primary antibody response of murine splenic cells in the tissue culture after activation with sheep red blood cells was examined. The response was measured by determining the number of plaque forming cells (PFC). The number of PFC's was determined by the plaque method of local haemolysis, in modification by the drop method. In these tests the ergot alkaloids dihydroergocornine, dihydroergocristine, dihydro-alpha-ergocryptine and dihydro-beta-ergocryptine were evaluated in two doses, 600 and 1200 micrograms/kg/day p. o. for the period of 14 days. Dihydroergocornine in these tests increased the primary antibody response in a statistically significant manner; on the other hand, after its administration in the higher dose decreased proliferation after PHA was found. The finding after dihydroergocristine administration was of interest. This ergot alkaloid slightly increased proliferation of cells after PHA and PWM as well as the primary antibody response of murine cells. After the administration of dihydro-alpha-ergocryptine increased proliferation after stimulation with PWM and increased primary antibody response, and after the administration of dihydro-beta-ergocryptine increased proliferation of cells after stimulation with PHA were found.

[Use of in vivo methods in the immunotoxicologic evaluation of drugs]

The immunity system is structurally and functionally multiform; in immunotoxicological screening therefore a larger number of manifestations of immunity response must be examined. Administration of drugs must be chosen in such a way as to enable studying the influence on the functions of immunity in the period prior to immunization, simultaneously with it, and after it. From this aspect the effect of subtoxic doses of cisplatinum, carboplatinum, oxoplatinum and iproplatinum administered to mice at different times with regard to the antigen was evaluated. In the case of antibody response (the cells forming antibodies in the spleen, serum haemagglutinins) as well as in the manifestations of cellular immunity (reaction of delayed hypersensitivity) the largest inhibition was registered on the administration from days 2 to 6 after the first contact with the antigen. Administration prior to immunization or simultaneously with it produced either mild stimulation or insignificant inhibition. The drugs most probably act by alkylating mechanism and the time course of the effect is similar to that in cyclophosphamide. The antibody response is inhibited most by oxoplatinum, cellular immunity by carboplatinum. When investigating phagocytic activity (Indian ink clearance from the blood circulation) only insignificant deviations were found. Immunity processes not requiring immediately cell division are substantially less influenced by platinum complexes.

[Use of in vitro methods in the immunotoxicologic evaluation of drugs]

The present paper proposes a model of in vitro tests examining the effect of drugs on the immunity system. The tests include the proliferation response of T cells (blastic transformation test of murine spleen cells and human peripheral mononuclear cells after stimulation by phytohaemagglutinin) and the antibody response (primary antibody response of murine spleen cells in the tissue culture after stimulation with sheep erythrocytes--demonstration of plaque-forming cells, formation of immunoglobulins by human peripheral mononuclear cells in the tissue culture after stimulation with pokeweed-mitogen--demonstration of immunoglobulins by ELISA test). Cytostatic agents derived from platinum were selected as the model group of drugs: cisplatin, oxoplatin and carboplatin in the concentrations ranging from 10(-4) to 10(-9) mol/l. In all tests IC50, i.e., the concentration of the drug producing 50% inhibition of response, was compared. The present authors have demonstrated that murine spleen nuclear cells are more sensitive to platinum cytostatics than human peripheral mononuclear cells; smaller concentrations of drugs are sufficient for 50% inhibition of immunity response of murine cells. Platinum cytostatics influence more the proliferative response of T cells than the antibody response. Platinum cytostatics act more on the cells in the stage of proliferation, or differentiation, i.e., after antigenic and mitogenic stimulation, than on the cells in a relative rest.