Increased levels of NF-kappaB inhibitors (IkappaBalpha and IkappaBgamma) in the intestinal mucosa of Crohn's disease patients during infliximab treatment

The treatment with infliximab is employed successfully in Crohn's disease (CD) but predictors of efficacy are lacking. Activation of the transcription factor NF-kB has been demonstrated in CD and its inhibition is one of the mechanisms by which anti-inflammatory agents exert their effects. We evaluated the production of TNFalpha by peripheral blood mononuclear cells (PBMC) and the levels of NF-kappaB family molecules in the intestinal mucosa during infliximab therapy in 12 patients. TNFalpha was assayed on supernatants of PBMC culture stimulated with PHA or LPS. Immunohistochemistry was also done on intestinal biopsies. In six patients, Western blot analysis of the NF-kappaB subunit Rel-A, and its inhibitors IkappaBalpha and IkappaBgamma was performed on intestinal biopsies and PBMC. The TNFalpha production by LPS stimulated PBMC showed mild changes, while it was increased by PHA-stimulated PBMC after treatment. The number of inflammatory cells in the intestinal mucosa was reduced (p<0.002) by the treatment. In five out of six cases we detected an increase of the IkappaBalpha and IkappaBgamma)inhibitor levels in intestinal biopsies after treatment. An increase of IkappaB inhibitors levels could be one of the mechanisms by which infliximab decreases NF-kappaB activity and exerts its anti-inflammatory effects.

Interleukin-6 release in the hepatic blood outflow during normothermic liver ischaemia in humans

BACKGROUND

Liver surgery techniques have consistently improved and normothermic ischaemia of the liver is considered to be a safe procedure to reduce intraoperative haemorrhage. Hepatic failure, however, remains a significant complication. In liver ischaemia-reperfusion injury, cytokines play a key proinflammatory role. Cytokines may be part of the intercellular signalling that leads to recovery or to failure after major surgery. Moreover, they could be potential predictors of the outcome. Modulation of the pattern of cytokine response in the early postsurgery period could represent a new approach to minimise the impact of these procedures.

AIMS

The aim of our study was to analyse the cytokine pattern in the hepatic blood outflow in patients undergoing surgical intervention of partial liver resection with clamping of the hepatic pedicle and liver ischaemia, and to correlate the cytokine behaviour with clinical parameters.

PATIENTS

We studied eight patients (mean age 55 years) who underwent surgical intervention of liver resection during vascular exclusion of the hepatic pedicle. Patients were monitored for haemodynamic and haematological parameters during the pre-, infra- and postoperative period.

METHODS

IL-I alpha, IL-6, TNF-alpha and IFN-gamma were assayed from peripheral and central vein blood at different times. Blood samples for cytokine assays were also drawn from the supra-hepatic veins after clamping of the porta hepatis.

RESULTS

We found a significant increase of the IL-6 levels in the supra-hepatic samples during liver ischaemia, while the trend with IL-1alpha was less clear; IFN-gamma and TNF-alpha were undetectable with the methods used. IL-6 levels appeared to correlate positively with bilirubin and gamma-GT levels and negatively with the degree of acidosis.

CONCLUSIONS

Our study confirms that during surgical ischaemic stress there is an increase of IL-6 serum levels more relevant in supra-hepatic vein blood. Cytokines could contribute to modulate the inflammatory response to liver ischaemia.

Modulation of X-ray-induced damage recognition and repair in ageing human peripheral blood mononuclear cells by an interleukin-6-type cytokine

We have investigated the effects of an interleukin (IL)-6-type cytokine on the DNA-binding activity of ku and on unscheduled DNA repair in X-ray-treated peripheral blood mononuclear cells (PBMC) from human subjects of different ages. The cytokine used, called K-7/D-6, is an IL-6 variant with increased in vivo and in vitro biological activity compared to the wild type molecule. Ku is the DNA-binding component of the DNA-dependent protein kinase (DNA-PK). It binds the ends of various types of DNA discontinuity and is involved in the repair of DNA breaks caused by V(D)J recombination, isotype switching, physiological oxidation reactions, ionizing radiation and some chemotherapeutic drugs. The ku-dependent repair process, called non-homologous end joining, is the main DNA double strand break repair mechanism in irradiated mammalian cells. Results show that K-7/D-6 significantly increases DNA-binding activity of ku in irradiated PBMC from young but not from elderly subjects. However, K-7/D-6 is able to induce unscheduled DNA repair in irradiated PBMC from both young and elderly subjects. These effects of K-7/D-6 are relevant to the mechanisms of the cellular response to DNA damage.

Psychoneuroimmunology and aging

BACKGROUND

The senescence of the immune system is a complex phenomenon, characterized by impairment of several lymphocyte activities and generally considered a state of immune dysregulation. Aging is a condition associated with many social changes likely to induce psychological stress, which is often perceived as uncontrollable and can lead, in some cases, to clinically relevant depression. In the recent years a growing interest has been raised for the study of bidirectional interactions between the central nervous system and the immunological network (psychoneuroimmunology).

OBJECTIVE AND METHODS

We analyzed the possibility that chronic psychological distress and depression could worsen some immune functions in the aged. We postulate the neuroendocrine mechanisms of psychoimmune interaction, analyzing both the human and animal studies focused on aging.

RESULTS

The data from the literature reviewed suggest a significant impact of affective disorders on immune functions in the elderly subjects. This psychoimmune imbalance appears particularly important when the studies are carried out in otherwise healthy aged people.

CONCLUSIONS

Here we reviewed the relationships between psychological stress and depression and immunological functions, with particular regard to those aspects pertinent to the aging process. The clinical relevance of these interactions remains to be elucidated, but the high frequency in the aged of autoimmune, infectious, and neoplastic diseases suggests to focus on the psychoneuroimmune interactions in the old age. We also propose some outlines for future studies concerning psychoneuroimmunology and aging.

Neuropeptide Y plasma levels and immunological changes during academic stress

Academic stress is a good model of psychological stress in humans for studying psychoneuroimmune correlations. We looked for correlations between psychological scores, immune tests and plasma levels of cortisol and neuropeptide Y (NPY). A group of medical students were evaluated at the beginning of the academic year (Baseline) and the day before an examination (Stress). They underwent evaluation by The Profile of Mood States (POMS), The Malaise Inventory, The Self Efficacy Scale and A Global Assessment of Recent Stress (GARS). The lymphocyte subsets, the lymphocyte proliferative response and the cytokine production were also evaluated. We detected modifications of some psychological test scores between the Baseline and Stress evaluation, a significant reduction of lymphocyte proliferation, IL-2 production and percentage of the lymphocyte CD19, and an increase in plasma cortisol levels during stress. The lymphocyte proliferation negatively correlated with the POMS score as well as the percentage of CD16+ cells with NPY plasma levels. NPY levels were not different from Baseline. The emotional and mood states seem to influence immunity. Copyrightz1999S.KargerAG,Basel

Effect of age on DNA binding of the ku protein in irradiated human peripheral blood mononuclear cells (PBMC)

DNA binding of the ku protein was investigated in peripheral blood mononuclear cells (PBMC) from 24 subjects of different ages (20-89 years old) displaying age-related changes in DNA repair, mitotic responsiveness, and cytokine production. Ku is an heterodimeric protein composed of two subunits of 70 and 80 kDa, which is involved in the earliest steps of DNA damage recognition. DNA binding of ku 70/80 was found unchanged in normal PBMC from aging subjects but progressively declined in x-ray-irradiated PBMC from young to adult, and elderly subjects. This finding was concomitant with the age-related fall of DNA repair in the whole population.

Characteristics of gastric-vein lymphocytes with regard to the immune response to Helicobacter pylori

BACKGROUND

Between peripheral blood and tissue-infiltrating lymphocytes there is an intermediate compartment, the blood of the organ-draining vessels, which could show unusual features. The aim of the present study was to analyse the characteristics of the lymphocytes from the stomach-draining vessels and the cytokine secretion by these lymphocytes. The CagA-mediated lymphocyte activation in Helicobacter pylori-infected subjects and the humoral response to this antigen were evaluated and correlated with clinical data.

METHODS

We studied lymphocyte proliferation either with mitogens or with the CagA antigen and cytokine production and IgG anti-CagA by means of an enzyme-linked immunosorbent assay in peripheral blood and gastric-vein blood obtained during surgical intervention.

RESULTS

We showed higher proliferative response and cytokine production in lymphocytes from the gastric vein. The mitogenic response to the CagA antigen was highly specific but poorly sensitive for the H. pylori infection in both the compartments. The overall cytokine profile in our patients affected by non-ulcer disease was of the Th0 type.

CONCLUSIONS

Gastric-vein-derived lymphocytes seem to show unusual features, as they behave like peripheral blood lymphocytes but show higher responses to all the tested stimuli. It is possible that the interaction of the lymphocytes with the mucosal environment could activate the synthetic mechanisms, making the cells more 'responsive' to the stimulation. The CagA antigen is able to induce a specific T-lymphocyte response and is therefore a valid candidate antigen for the development of a vaccine.

Changes in the amount and level of phosphorylation of p56(lck) in PBL from aging humans

The effects of aging on the activation of the cytoplasmic tyrosine protein kinase p56(lck) have been investigated in PBL from adult and elderly subjects upon activation with mitogens or different co-stimuli. Results show that the amount and phosphorylation of p56(lck) are reduced in PBL from elderly as compared to adult subjects. This finding suggests that alterations in p56(lck) may contribute to the age-associated loss of some T cell functions, such as proliferation and IL-2 production, which are found decreased in PBL from old individuals. However, p56(lck) seems irrelevant to the production of IFN-gamma and IL-4 which were both found increased in the PBL from old subjects, as expected from the relative expansion of memory versus naive T cell subpopulations in aging.

Cell proliferation and ku protein expression in ageing humans

Previous studies on DNA repair in ageing have demonstrated increased frequencies of single and double strand breaks in lymphocytes from elderly subjects and, as a consequence, decreased efficiency in DNA replication. We have investigated the relationship between cell proliferation and the nuclear expression of ku protein in a human population of 43 subjects of different ages. Ku is an heterodimeric protein composed of two subunits of 70 and 80 kDa, which is involved in the early steps of DNA damage recognition. In the present study, PBL from subjects of different ages were PHA-activated to evaluate the stimulation index and the production of Th1- and Th2-type cytokines. Moreover, nuclear extracts were obtained from activated lymphocytes to evaluate by a gel retardation assay the presence and the functional activity of the heterodimer ku 70/80. Our results indicate that ageing affects the mitotic responsiveness and cytokine production to a significant extent, but only marginally the expression of ku 70/80. These findings suggest that the age-related impairment in DNA repair mechanisms are only in part related to the reduced expression of ku protein able to recognize DNA damage.

The effect of zinc and vitamin A supplementation on immune response in an older population

OBJECTIVE

To determine if either supplemental vitamin A, zinc, or both increases cell-mediated immune response in an older population.

DESIGN

A double-blind, randomized, controlled trial of supplementation with vitamin A and zinc.

SETTING

Casa Di Riposo Roma III, a public home for older people in Rome, Italy.

SUBJECTS

The health and nutritional status of 178 residents were evaluated. One hundred thirty-six residents agreed to participate in the trial and were randomized into four treatment groups, and 118 of these residents completed the trial.

INTERVENTION

The four treatments consisted of: (1) Vitamin A (800 micrograms retinol palmitate); (2) Zinc (25 mg as zinc sulfate); (3) Vitamin A and Zinc (800 micrograms retinol palmitate and 25 mg as zinc sulfate); (4) Placebo capsules containing starch.

MAIN OUTCOME MEASUREMENTS

Immune tests-counts of leucocytes, lymphocytes, T-cell subsets, and lymphocyte proliferative response to mitogens-were measured before and after supplementation.

RESULTS

Zinc increased the number of CD4 + DR + T-cells (P = .016) and cytotoxic T-lymphocytes (P = .005). Subjects treated with vitamin A experienced a reduction in the number of CD3 + T-cells (P = .012) and CD4 + T-cells (P = .012).

CONCLUSIONS

These data indicate that zinc supplementation improved cell-mediated immune response, whereas vitamin A had a deleterious effect in this older population. Further research is needed to clarify the clinical significance of these findings.

Adverse drug reaction to rifampin: a case with long lasting antiplatelet antibodies

Rifampin is a drug able to induce adverse reactions involving both the kidney and the hematological system. We observed a case, throughly studied and we deemed worth-while to report it, for some important features that were evident. Transient hemolytic anemia, recoverable acute renal failure, persistent increased titer of anti-platelet antibody lasting also after 3 weeks from the withdrawal of the drug and in spite of corticosteroid therapy, could be explained by the immune mechanisms that are, therefore, postulated.

Plasma thrombin-antithrombin complexes, latent coagulation disorders and metastatic spread in lung cancer: a longitudinal study

In patients affected with different tumours, disorders concerning clotting are frequently observed. The biological processes leading to coagulation are probably involved in the mechanisms of metastasis. We studied plasma levels of thrombin-antithrombin III complexes (TAT) in 90 patients affected with lung tumours subgrouped in small cell and non-small cell (NSC) lung cancer: 17 patients had no evidence of disease after surgery (NE); the remaining 73 patients were divided according to the absence (LOC) or the presence (META) of metastases. All the patients were followed up for several months. In all the lung cancer patient groups, at the beginning of the study we detected TAT levels that were higher than in controls. During the follow-up period, the NSC-NE patients with no recurrence of the disease as well as the NSC-LOC patients responding to the treatment had a decrease in TAT levels (p < 0.01 and p < 0.05, respectively). The NSC-META patients with progression of their disease had, in contrast, an increase in TAT levels (p < 0.01). Our data reveal the presence of 'latent coagulation disorders' as assessed by the presence of high TAT levels in the majority of lung cancer patients. The follow-up study indicates that in the NSC group, a relation exists between coagulation activation and rate of tumour progression and/or response to treatment. In cancer patients the early detection of coagulation disorders could also allow, therefore, the prevention of thromboembolism and/or haemorrhage by administration of appropriate treatment.

Neuroimmunomodulation and psychoneuroendocrinology: recent findings in adults and aged

In recent years the relationships among immune, endocrine and nervous systems have been extensively studied, and grouped in a new research field: psychoneuro-immunoendocrinology. Since ancient times its has been known that, in humans, mood as well as environmental influences could affect health. In the late '70s, only, evidence of bi-directional pathways has been achieved, first in animal models and, later on, in humans. We reviewed current knowledge on neuroimmunomodulation, concerning the influence of stress and psychological status on immunity as well as neuroendocrine modulation by the immune system, reporting some data obtained from our studies. Particularly, having detected a relevant impairment concerning most of the parameters studied, we emphasized the effects of depressive disorders on immune function in the elderly.

Assay, isolation and characterization of circulating immune complexes from serum of gastrointestinal cancer, stage III and IV melanoma and chronic inflammatory bowel disease patients

Circulating immune complexes (CIC) have been detected in several autoimmune diseases, and studies have also suggested that CIC provide a useful tool as tumor markers. In order to identify differences or similarities in antigenic composition, CIC from 23 patients with gastrointestinal (GI) tumors, from 20 patients with stage III and IV melanoma and from 6 patients with inflammatory bowel disease (IBD) were studied. Serum from all GI, melanoma and IBD patients showed higher levels of CIC than controls. SDS/PAGE electrophoresis under reducing conditions revealed some differences between cancer and IBD patients as far as the CIC protein composition was concerned. In melanoma patients, two fast-migrating bands, in the regions of 71-74 and 30-49 kD, were found, consistent with previously isolated and characterized antigens described in the literature.

The efficacy of chemotherapy with mebendazole in human cystic echinococcosis: long-term follow-up of 52 patients

Sixty patients with Echinococcus granulosus infection of the liver, lungs, bone and/or soft tissues were treated for several months with oral mebendazole (50-60 mg kg-1 day-1), in divided doses after fat-rich meals, either without surgery (WS), post-surgery (PS) or pre- and post-surgery (PPS). Long-term follow-up, possible for 52 of the patients, showed that WS, PS and PPS patients have so far remained disease-free following treatment for (means +/- standard deviations) 65.5 +/- 37.7, 82.5 +/- 37.0 and 84.1 +/- 28.3 months, respectively. Ultrasound and computed tomography scans were similar in WS and PPS patients post-treatment. Blood eosinophil levels, which were sometimes elevated initially, returned to normal in all patients and this decrease indicated cyst degeneration before this was evident on the scans. Treatment of patients with cystic echinococcosis may no longer require surgery.

Latent coagulation disorders evaluated by the assay of plasma thrombin-antithrombin III complexes in a large series of 'solid tumours'

Coagulation disorders are frequently detected in patients affected by different tumours even though clinical symptoms occur in a very small percentage of such subjects. Coagulation processes are probably involved in the mechanism of metastatic spread. We assayed the plasma levels of thrombin-antithrombin III (TAT) complexes in a group of 276 patients with several tumours in different stages in order to achieve a better understanding of the complex interactions between coagulation disorders and either tumour growth or metastatic spread. High levels of TAT complexes were found in 51% of localized, 66.3% of metastatic and 58.3% of patients with no evidence of disease; a statistically significant difference was observed comparing metastatic cancer either with localized (p < 0.00015) or with free-of-disease (p < 0.004) groups. Gastrointestinal tract neoplasms showed higher levels of TAT complexes in the metastatic than in the localized group. No difference was seen between small-cell and non-small-cell lung-localized cancer. Our results confirm the frequent coexistence of cancer and subclinical blood coagulation disorders. The evidence of higher levels of TAT complexes in metastatic cancer than in the other groups could be related to the mechanisms involved in tumour spread.

Immune parameters in a population of institutionalized elderly subjects: influence of depressive disorders and endocrinological correlations

Twenty-six institutionalized elderly subjects, selected as healthy according to the SENIEUR protocol, were compared to adult controls to establish correlations between affective disorders and immune abnormalities and to investigate underlying neuroendocrine mechanisms. After an extensive psychodiagnostic examination, 35% of the aged subjects were classified as depressed. Cutaneous delayed hypersensitivity tests showed reduced responses in the aged, but no correlation was found with the psychological status. Examination of the peripheral blood lymphocyte subsets revealed no imbalance in the percentages of CD3+, CD4+, CD8+ cells in the aged. A slight reduction in the CD4+/CD8+ cell ratio could however be detected in the non-depressed aged, as compared to adult controls. The CD4+/CD45R+ cell subset was reduced in non-depressed aged. The percentage of B lymphocytes was reduced in the aged, mostly in the non-depressed subjects. No changes were detected in the percent of OKDR+ cells. The percentage of CD16+ cells was found unchanged, while that of Leu7+ cells was significantly higher in the aged than in the adults and in the non-depressed than in the depressed aged. Leu7+ cell levels were negatively correlated with the depression score. On double labelling, the percent of CD16+/Leu7+ cells appears increased in the subgroup of depressed aged and positively correlated with age. Plasmatic and urinary cortisol levels were both positively correlated with depression score. Urinary cortisol level was higher in the depressed aged. These parameters, as well as plasmatic ACTH, beta-endorphin and urinary catecholamines, were not correlated with immune responses. Based on these findings, we recommend that the neuroendocrinological conditions should be taken into account when healthy subjects are examined in studies of immune senescence.

Impairment of lymphocyte activities in depressed aged subjects

Lymphocyte activities were determined in a population of 26 institutionalized aged subjects, selected as healthy according to the SENIEUR protocol and previously reported to display immunological and endocrinological abnormalities correlated with depressive disorders. The lymphocyte mitotic response to PHA, which was reduced in aged as compared to adult subjects, was found to be significantly lower and negatively correlated with the depression score in the elderly subjects. In supernatants of PHA-stimulated lymphocyte culture from aged subjects, IL-2, IL-4 and gamma-IFN levels were very low and more severely affected in the depressed aged group. Each cytokine production was negatively correlated with age and depression score. NK activity was lower in the aged and it could be augmented by the addition of IL-2 or alpha-IFN, even though to a lesser extent than in the adult subjects. The nondepressed aged displayed higher levels of IL-2 inducible NK activity than the depressed aged subjects. IL-2 and alpha-IFN stimulated NK activities were negatively correlated with depression score. The present work indicates that the psychological status could affect lymphocyte reactivity in the aged. Given the relatively high frequency of affective disorders in these subjects, the psychological status should be considered in studies of immune senescence.

Psychological status and immunological parameters of institutionalized aged

In the elderly, an impairment of the immune system could lead to increased incidence of infectious, neoplastic and autoimmune diseases; on the other hand, depression, which is the most common psychiatric problem in aged people, seems to be linked with alterations in immunological function. Thirteen institutionalized elderly subjects were studied to investigate the relationship between depression and immunological parameters. These subjects were selected as "healthy" according to the SENIEUR-EURAGE protocol and they belonged to a population already evaluated by our group--one year before--for psychological, endocrinological and immunological parameters. The lymphocyte mitotic response to PHA was greatly diminished in aged subjects, when compared to the adult controls. Depressed elderly showed impaired immunological function as compared with nondepressed ones, either "in vitro" or "in vivo". Lymphocyte stimulation with phytohemagglutinin (PHA), T cell growth factor (TCGF) production (induced by stimulation with PHA) and cutaneous delayed hypersensitivity (CDH) were reduced in depressed aged subjects. As far as lymphocyte proliferation with PHA in the whole group were concerned, no differences were found comparing the present results with those obtained in a former study. Although it is difficult to understand the significance of the immune imbalance associated with depression in the elderly, our results suggest that psychological status could influence the immunological functions in old people.

[Evaluation of latent changes in blood coagulation by the determination of plasma thrombin-antithrombin complex in gastrointestinal neoplasms]

The relationship between cancer and coagulation disorders is widely accepted. Such disorders can contribute to the metastatic spreading of the primary tumor. Aim of our study was to evaluate the alterations of thrombin-antithrombin III complex (TAT) measured by an ELISA plasma assay in a population of 78 patients suffering from various gastrointestinal tumors. We found high levels of TAT in 68.6% of the patients. Our data show that assay of TAT plasma levels may be a useful test in detecting early coagulation disorders in cancer patients.

Circulating immune complexes detected by a direct nephelometric assay and acute phase proteins in malignant tumors

Circulating immune complexes (CIC) were previously reported to be higher in extended cancer rather than in localized one, by a few groups of investigators as well as by ourselves. The techniques employed were quite different in each study. We described a "direct" laser nephelometric assay. At the same time we determined the serum levels of 4 acute phase proteins (AFP)--alpha 2 macroglobulin, C reactive protein, haptoglobin, alpha 1 acid glycoprotein--by conventional light scattering method, in order to investigate on other possible "immune-modulating" factors. The possible correlations either with prognosis or clinical stage are looked for; the hypothetical behaviour of CIC as one of the serum "blocking factors" and of acute phase reactant as "immune modulating" proteins are discussed. The data concerning the techniques able to remove CIC from the blood stream of the cancer patients were also showed (plasmapheresis and immunoadsorption).

[Medical therapy with mebendazole in hydatid cyst disease. A follow-up of 40 cases]

Mebendazole (50-60 mg/kg/day in 7-8 divided doses after fatty rich meals for at least 6 months) was given to 44 patients with cystic hydatid disease of the liver and other organs, about 1/3 having suffered from recurrences, even multiple, before beginning the pharmacological treatment. Fifteen patients underwent operation after a course of mebendazole, and macroscopic and histological degeneration of hydatid cysts was always documented; sixteen subjects were not operated due to their severe general and/or local conditions but ultrasound, radiologic (CT) and clinical evidence of cyst regression was obtained, and was closely comparable to that in the aforementioned group. Some of the patients (13) began the treatment only after conservative surgery. The mean real follow-up available at the moment is for 40 subjects because 2 patients did not show adequate compliance for the drug and in 2 additional cases it was withdrawn because of an increase in serum transaminases. The rate of recurrence was 7.5% and occurred in high-risk patients (multiple, bone, lung locations) who had, however, an additional and longer course of mebendazole with good results. The detachment of membranes and the increase of internal echoes, observed by means of ultrasonography, which was successfully applied to liver and soft tissue sites as well as the decrease in blood eosinophils when elevated before therapy, were observed to be the most sensitive indicators of early success in the medical treatment for hydatid disease, as far as the viability of parasite cysts was concerned.

[Soluble factors with immunosuppressive activity in human neoplasms]

A number of the mechanisms implicated in the phenomenon of immunosuppression present in tumour-carrying patients are described. In particular, stress is laid on factors soluble to immunosuppressive activity identified in the serum or in other biological fluids of these patients. From among these are analysed the circulating immunocomplexes, the proteins of the acute phase (alpha-globulins) and other inhibiting substances derived from tumour cells. The nature and origin of these substances are discussed as well as their effects on the cancer patient's immune system and the therapeutic type implications that arise in some cases.

Ketanserin combined with a beta-blocker or diuretic in essential hypertension. A multicentre study

The antihypertensive effect of ketanserin 40 mg b.d. in combination with a beta-adrenergic blocking agent or a diuretic was assessed in an open study in 35 patients with essential hypertension, who had not responded to treatment with beta-blockers, diuretics or their combination. The ketanserin/beta-blocker combination decreased mean sitting systolic/diastolic blood pressure (SBP/DBP) from 169/107 mmHg to 156/91 mmHg at the end of the 12-week active treatment period. The decrease in systolic blood pressure was significant only at Week 8, while the decrease in diastolic blood pressure was highly significant at all times. A significant reduction in heart rate by 10 beats.min-1 was observed with the ketanserin + beta-blocker combination. The ketanserin/diuretic combination led to a significant reduction in mean SBP/DBP from 164/106 mmHg to 146/92 mmHg after 12 weeks, with no significant change in heart rate. Body weight slightly increased in both groups. There were significantly fewer adverse reactions with the ketanserin/diuretic combination than with the ketanserin/beta-blocker combination. The results indicate a potentially useful therapeutic role for ketanserin in combination with beta-blockers or diuretics.

[Rheumatoid factors, C-reactive protein and circulating immunocomplexes: laser-nephelometric determination using the latex aggregation method. Preliminary evaluation in rheumatoid arthritis]

C-reactive protein and rheumatoid factor assays are relevant laboratory parameters, among the most used in the clinical practice, being very useful in diagnosing and "monitoring" rheumatic diseases. A quantitative test to detect these two serum proteins is an important, more specific, new tool for clinical medicine. In our study we evaluated two new laser nephelometric assays, both quantitative, based on the agglutination of polystyrene latex particles, able to show serum concentration of CRP and RF. With a similar technique we tested the presence of circulating immune complexes. We performed our tests in a group of patients with rheumatoid arthritis, other autoimmune diseases, and healthy blood bank donors assaying simultaneously, whenever possible, the "classic" Rose-Waaler and RA tests. We found both methods easy to perform, well correlating with the semi-quantitative techniques and highly reproducible.

Immune complexes and acute phase proteins in human cancer: preliminary evaluation by laser nephelometric techniques

The serum levels of circulating immune complexes (IC) were evaluated by a new 'direct' laser nephelometric assay, concomitantly with four acute phase proteins (APP), in 167 patients with various neoplasms at different stages. The present study confirms the presence of IC in the sera of cancer patients and, in the breast cancer group, there is a significant correlation with the progression of the disease. Among the APP, in several cancer groups, C-reactive protein, haptoglobin and alpha 1-acid glycoprotein are more elevated than in controls, and a trend to display higher values is observed in the subjects with metastatic disease; particularly, the frequency of patients with 3 or more proteins above the normal levels is significantly higher in metastatic than in localized cancers (p less than 0.09).

Factor VIII complex in myelomatosis and related disorders

The behaviour of the factor VIII/von Willebrand factor complex (VIII:C, VIIIR:Ag and VIIIR:RCof) was investigated in 23 patients with secretory myeloma, in 2 patients with non-secretory myeloma and in 5 patients with macroglobulinemia. In most patients (21 of 25 patients with plasma cell myeloma and 2 of 5 patients with macroglobulinemia) VIIIR:Ag was increased usually without corresponding increases in VIII:C and VIIIR:RCof. There was no correlation between the VIIIR:Ag levels and paraprotein Ig type or level nor with the presence or the absence of Bence Jones proteins in serum and urine. Furthermore, increased levels of VIIIR:Ag were found in patients with non-secretory myeloma. In general, VIIIR:Ag was higher in patients with extensive bone lesions and there was a significant correlation between cell mass and the VIIIR:Ag level. The crossed-immunoelectrophoresis of plasmas with discrepant VIIIR:Ag and VIIIR:RCof showed variation from the normal pattern.

Waldenström's macroglobulinemia and myasthenia gravis

Until now, three patients with IgG and only one with IgM class monoclonal gammopathy (without the classical features of Waldenström's macroglobulinemia) have been reported in subjects with myasthenia gravis. A case of Waldenström's macroglobulinemia which occurred before thymectomy in a myasthenic patient is described in this paper. Both neuromuscular disease and the lymphocyte dyscrasia worsened after operation and before starting steroid treatment. No evidence of circulating immune complexes nor of anti-acetylcholine receptor antibodies belonging to the IgM class was found. The patient's HLA type shared A2 and B15 antigens with an IgG-lambda monoclonal gammopathy previously reported in a myasthenic woman, and his genotype included the Bw15 specificity which has been described to be frequent in Waldenström's macroglobulinemia. It appears that a persistent thymic abnormality, responsible for myasthenia gravis, may be associated with a lymphoreticular neoplasm.

Circulating immune complexes in myasthenia gravis: a study in relation to thymectomy, clinical severity and thymus histology

Circulating immune complexes were assayed employing the method recently described by Barnett and Chia in a group of patients with myasthenia gravis. The subjects were classified according to clinical severity and immune complexes were sought before and after thymectomy. The operated subjects were further divided into those with thymoma or thymic hyperplasia. Antigen-antibody complexes were higher before thymectomy than after, in hyperplasias than in thymomas, and in severe myasthenia gravis than in mild disease. Circulating immune complexes and anti-acetylcholine receptor antibodies did not correlate.

IgD (kappa) "nonsecretory" multiple myeloma: report of a case

A case of IgD "nonsecretory" multiple myeloma in a 46-yr-old woman is reported. Despite the presence of disseminated osteolytic lesions, both serum protein electrophoresis and serum and urine immunoelectrophoresis were normal. In addition, bone scintigraphic study was normal. Bone marrow biopsy and aspirate obtained from the left femur lytic lesion showed only myelomatous proplasmocytes; when examined by immunofluorescence with monospecifc antisera, the cytoplasm showed only the presence of delta and kappa chains, suggesting that the neoplastic plasma cells might belong to a single clone. Lymphocyte studies indicated the presence of a normal amount of both B and T cells.

Immunochemical and ultrastructural study of multiple myeloma with a heavy chain protein in the serum

A patient with multiple myeloma had antigenically related monoclonal Fc-gamma fragments and complete IgG-kappa molecules in the serum. The urine contained only Fc-gamma fragments in the absence of Bence-Jones protein. The two distinct M-components in the serum showed electrophoretic identity but could be separated by chromatography. The simultaneous presence of complete monoclonal IgG molecules and Fc-gamma fragments, though difficult to detect, could be a frequent occurrence in multiple myeloma, and it could be defined as 'double paraproteinaemia'. A detailed ultrastructural study was performed in this case and showed fibril bundles being released from the malignant plasma cells; such fibrils could be the supramolecular organisation of the neosynthesised heavy chain fragments.

Myasthenia gravis, thymectomy, and antiacetycholine receptor antibody

The antiacetylcholine receptor antibody was titered in the serum of 63 patients with myasthenia gravis (MG) and 20 control healthy subjects. The titer was significantly high in 92% of MG patients in contrast with none of the controls and no correlation was found with the thymus pathology and the severity of the disease. The titer decreased after thymectomy almost steadily with the improvement of the myasthenic signs. The role of the antibody in the pathogenesis of the disease is discussed.

Non-Hodgkin lymphoma associated with double monoclonal immunoglobulin

We describe an unusual case displaying the features of double monoclonal gammapathy (IgM-kappa plus IgG-lambda) associated with non-Hodgkin lymphoma (NHL). In the last years monoclonal gammapathies have been sometimes found to be associated with NHLs; it is a very peculiar occurrence the association between a different class double monoclonal gammapathy and NHL, as the case reported in this paper.

Effects of phenobarbital and 3-methylcolanthrene treatment on microsomes of Morris hepatoma 3924-A, tumour-bearing and normal rat liver

Microsomal cytochromes and some oxidative activities were determined in normal rat liver, tumour-bearing rat liver and Morris hepatoma 3924-A. Except for a moderate lowering of cytochromes and enzymes in host livers, the relation between TPNH-cytochrome c reductase activity and cytochrome P-450 TPNH reduction, both increased by phenobarbital (PB) and decreased by 3-methylcolanthrene (3-MC) treatment, is noteworthy. In tumour cytochromes b5 and P-450 are absent and TPNH-cytochrome c reductase is unmeasurable and not induced by PB or 3-MC treatment. Aminopyrine demethylase activity, instead, is comparable with normal or host liver and it is modified by PB or 3-MC treatment in the same way, despite the microsomal enzymes pathway disorganization. Microsomal enzymatic defect selectivity in tumours may be due to a deranged microsome-linked growth control.

Hoffman's syndrome: a peculiar case

The Authors describe the case of a 50-yr-old woman with painful muscular cramps and high muscular enzymes level secondary to adult-onset myxedema, and where no histological and ultrastructural muscle alterations could be detected, probably owing to the early observation of the patient.