Assessment of antisperm antibodies in a sample of Egyptian patients with hepatitis C virus infection

Association of hepatitis C virus (HCV) with autoimmune phenomena and impaired semen parameters has been previously reported. The aim of this study was to investigate the influence of HCV infection on the development of antisperm antibodies (ASAs) in HCV-positive males. The study was conducted on 30 HCV-infected individuals and 30 healthy control subjects. In both patients and control groups, liver enzymes and reproductive hormones were measured; computer-assisted semen analysis (CASA) was performed; HCV-RNA in serum was measured and IgG and IgA ASAs in semen were determined. Free testosterone, sperm concentration, progressive and total motility were significantly lower in HCV patients than in the control group, whereas ASAs of the IgG and IgA classes were significantly higher in HCV patients. However, correlations between viral load and the examined semen parameters and ASAs were nonsignificant. In conclusion, HCV may be responsible for the increased ASAs detected in HCV patients in the present study, possibly providing another plausible explanation for the decreased sperm motility reported in HCV patients. These findings could be of value in fertility management of HCV patients.

The role of NADPH-derived reactive oxygen species production in the pathogenesis of endometriosis: a novel mechanistic approach

Endometriosis is defined as endometriotic tissue growing outside the uterine cavity. It is a common gynecological disorder in women of reproductive age and is associated with chronic pelvic pain and infertility. Despite several studies and theories to explain its cause, the exact pathogenesis of endometriosis remains unclear. Retrograde menstruation is the most plausible theory, however, it is not exclusive. The disparity between the actual prevalence of retrograde menstruation and the prevalence of endometriosis suggests that other factors may determine the susceptibility to endometriosis development. Oxidative stress has been associated with endometriosis. This study aimed to explore the role of NADPH oxidase family in the production of reactive oxygen species (ROS) and to determine whether ROS induce the proliferation of endometriotic implants via mammalian target of rapamycin (mTOR) signaling. Anonymous endometriotic tissue samples were collected from women undergoing laparoscopy for endometriosis. The samples were stained with dihydroethidium and fluorescent images of the slides were taken to detect ROS production. After extraction of RNA from the samples and c-DNA generation, quantitative real-time PCR, protein extraction and Western blot were performed to study gene and protein expression of NADPH oxidase 1 (NOX 1), mTOR and fibronectin. The results showed an increase in ROS levels and NOX 1 gene and protein expression in the endometriotic tissues compared to the normal surrounding tissue control. Also, mTOR and fibronectin, gene expression was found to be increased. Up regulation of NOX at gene and protein level leads to increased production of ROS in the endometriotic tissue, which in turn causes proliferation of the ectopic tissue via alteration of the mTOR signaling pathway. Increased fibronectin gene expression points towards tissue injury in endometriosis as compared to the normal surrounding tissue. This manuscript adds a new insight into the pathogenesis of endometriosis and serves as a background for development of new treatments for the disease-associated pain and infertility.

Involvement of renal cytochromes P450 and arachidonic acid metabolites in diabetic nephropathy

Diabetic nephropathy (DN) is one of the most serious complications of type I and type II diabetes. DN is characterized by hyperfiltration, hypertrophy, extracellular matrix accumulation, and proteinuria. This advances into renal fibrosis and loss of renal function. Reactive oxygen species (ROS) and TGF-beta have been implicated in the pathogenesis of diabetic nephropathy. Early stages of diabetic nephropathy are also associated with alterations in renal sodium handling as well as hypertension; both are processes linked by involvement of the arachidonic acid (AA) metabolites, 20-hydroxyeicosatetraenoic acid (20-HETE, produced by cytochrome P450-4a, (CYP4A) and epoxyeicosatrienoic acids (EETs). Indeed, metabolism of AA is increased in a rat model of diabetes. In this study, we demonstrate that rats with streptozotocin-induced diabetes of 1 month duration develop renal hypertrophy and increased fibronectin and TGF-beta1 expression/cortical levels concomitant with an increase in CYP4A expression and 20 HETE production. These results were also paralleled by an increase in reactive oxygen species (ROS) production and NADPH oxidase activity. Treatment of diabetic rats with HET0016, selective inhibitor of CYP 4A, prevented all these changes. Our results suggest that diabetes-induced induction of CYP4A and 20-HETE production could be a major pathophysiological mechanism leading to activation of ROS through an NADPH dependent pathway and TGF-beta1 thus resulting in major renal pathology. Inhibitors of 20-HETE production could thus have an important therapeutic potential in the treatment of diabetic nephropathy.

Immature vessel percentage (IVP) as a potential predictive factor for anti-angiogenic therapeutics

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Background: As opposed to mature blood vessels, the early sprouts (lacking the pericyte coverage) are selectively obliterated after Vascular Endothelial Growth Factor (VEGF) antagonists (e.g. Bevacizumab BV). Microvessel density (MVD) has been widely used to assess tumor vasculature however; it does not give an indication of the degree of vessel maturity since it assesses endothelial cells irrespective to the pericyte coverage. With the introduction of BV for treatment of metastatic colon, lung and breast cancers, predictive markers to guide patient selection are desirable but lacking. Methods: To assess the maturity of tumor vascular beds we used double-labeling immunohistochemistry to colocalize endothelial cells (CD31+) and pericytes (aSMA+) in archived material from colorectal liver metastasis (n=13). None of these subjects received BV or chemotherapy prior to sampling. To represent various regions within a section, counts were performed in designated-low, and -high vascular regions. IVP, the main study endpoint, was estimated in both regions, and then averaged by two independent pathologists without particular training in angiogenesis. Results: There was a considerable degree of heterogeneity in the IVP within this group (SD 12.5, mean 26.6). However, the agreement between the 2 pathologists was relatively high with an intra-class correlation coefficient of 0.655. Conclusions: Considerable tumoral vascular heterogeneity exists in colorectal liver metastasis. IVP may predict therapeutic benefits from BV. In this era of anti-angiogenic therapy and in view of the toxicity and the financial burden of these agents, better patient selection using biologically relevant techniques such as the one described here need to be considered. IVP is a candidate tool with multiple advantages; it utilizes abundantly available material (subject to reconfirmation or testing in different settings), does not require particular training and appears reproducible.

No significant financial relationships to disclose.

Inflammatory response and body composition in chronic obstructive pulmonary disease

Weight loss in chronic obstructive airways disease (COPD) is associated with an increased energy cost of breathing. To determine an association between body composition and the inflammatory response we studied 80 clinically stable patients. Body composition was determined anthropometrically and skeletal muscle mass was determined as the creatinine-height index (CHI). Forty patients had their nitrogen balance determined. Circulating concentrations of interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha), and their soluble receptors were determined for 68 patients. Body mass index (BMI) was normal (> 20 kg/m(2)) in 55 patients, of whom 17 (31%) had a low CHI (< 80% predicted). A reduced CHI was associated with increased circulating levels of IL-6 (p = 0.001), TNF-alpha (p = 0.032) and their soluble receptors IL-6sr (p = 0.002), TNF-alpha sr1 (p = 0.03), and TNF-alpha sr2 (p = 0.001). Patients with a normal BMI and low CHI had inflammatory mediator levels similar to patients with a low BMI and CHI; both were significantly greater than in those with a normal BMI and CHI. Nitrogen balance was similar between normal and low CHI groups, although nitrogen excretion was significantly increased in the low CHI group. Skeletal muscle loss in COPD is probably multifactorial in origin, but our data suggest a link with systemic inflammation, even when weight loss is inapparent.

Hypoalbuminemia as a cause of pleural effusions

BACKGROUND

Alterations in Starling forces that favor pleural fluid formation include an elevation in capillary hydrostatic pressure and a fall in plasma oncotic pressure. Although venous hypertension is a well-recognized cause of pleural effusion, the frequency with which hypoalbuminemia in the absence of volume expansion leads to pleural effusion is unclear.

STUDY OBJECTIVE

We determined the frequency with which unexplained pleural effusions occur in patients with normal and low plasma oncotic pressures.

DESIGN

A 2-month prospective screen of all admission patients to the University of Oklahoma Hospital and the Oklahoma City Veterans Administration (VA) Medical Center identified 152 patients who had chest radiographs and serum protein determinations on admission, but did not have an admission diagnosis that was a recognized cause of pleural effusion. In order to include more patients in the study with extremely low serum albumin levels, 20 additional study patients with serum albumin levels of < 2.0 g/dL were identified by a retrospective review of patients admitted during the previous 12 months. On the radiograph, pleural effusions were identified as a new blunting of the costophrenic angles. Study patients were divided into the following three groups: group 1 had serum albumin levels of > 3.5 g/dL; group 2 had serum albumin levels between 2.1 and 3.5 g/dL; and group 3 had serum albumin levels of < or = 2.0 g/dL. Finally, the frequencies with which pleural effusions occurred were compared among the three groups.

RESULTS

Seven of 104 patients in group 1, 2 of 45 patients in group 2, and 3 of 21 patients in group 3 had pleural effusions. Within each group, there were no significant differences in serum albumin concentration or plasma oncotic pressure between patients with and without pleural effusions. In all but two study patients, a careful review of records and a prospective follow-up of the patients' clinical course identified a potential cause for the effusions other than hypoalbuminemia. None of the 68 study patients with serum albumin levels of < or = 3.5 g/dL had an unexplained pleural effusion.

CONCLUSION

We conclude that hypoalbuminemia, per se, is an uncommon cause of pleural effusion. The recognition of pleural effusions in patients with low serum albumin levels should prompt careful clinical evaluations to identify other potential causes for the effusions.