The Role of Molecular Chaperones (Hspas/Hsp70S) in Oral Health and Oral Inflammatory Diseases: A Review

Heat shock proteins of the 70kDa family (HSPAs/HSP70s) are major molecular chaperones and cytokines of most cells and microbes, extracellular and interstitial fluids, blood, synovial fluids and secretory body fluids like saliva. The induction of human HSPAs plays an important role at cellular level under most stress conditions; whereas microbial HSPAs improve microbial tolerance to environmental changes, and improve virulence and resistance against antimicrobial peptides. Extracellular HSPAs reveal cytoprotective properties and are involved in numerous physiological and pathological events, including modulation of cytokine release and immunity. Accordingly, HSPAs play a role in the maintenance of pulpal health, and the repair of injured dental hard tissues. HSPAs also play a role in stress adaptation of periodontal tissues, and in the maintenance of periodontal and mucosal health including defense against microbes, prevention of mucosal allergic reactions, and facilitation of healing of ulcers and wounds. Despite their advantageous effects maintaining health of several oral tissues, HSPAs are likely to play a role in the disadvantageous amplification of pulpal inflammatory response to bacteria, and in the formation of several periapical inflammatory lesions. HSPAs may also induce gingivitis under certain conditions, and play a role in the progression of periodontal bone defects. HSPAs may also play a role in atopic-type allergic reactions, autoimmune disorders, and haptenation in certain cases. Based on the above data, it can be assumed that HSPAs play an important role in oral defense under healthy conditions; however, their role is somewhat “Janus-faced” under pathological conditions.

Removal of nonspecific binding proteins from cell and tissue extracts using 2-aminobenzimidazole-tethered affinity resin

Cellular drug target identification through affinity chromatography is often hindered by the quantity of nonspecific binders, such as cytoskeletal and heat shock proteins. Thus, we prepared a 2-aminobenzimidazole-tethered depletion resin designed for removal of these proteins, and tested it on human lung carcinoma cell and rat tissue extracts. Column-bound proteins were identified by two-dimensional gel electrophoresis and MS. Among others, tubulins, actins and heat shock proteins were successfully depleted. Due to the reduction of these highly abundant proteins detection of potential drug targets is considerably facilitated in the pre-purified samples.

Microalbuminuria in inflammatory bowel diseases using immunoturbidimetry and high-performance liquid chromatography

BACKGROUND AND STUDY AIMS

To measure urinary albumin excretion using immunoturbidimetry (IT) and high-performance liquid chromatography (HPLC) in inflammatory bowel diseases.

PATIENTS AND METHODS

A cross-sectional study was carried out on 60 selected patients with Crohn's disease (CD), 57 with ulcerative colitis (UC) and 22 healthy volunteers, as controls. Urinary albumin excretion was measured by IT and HPLC, and albumin-creatinine ratio was calculated. This ratio was compared in patients with active and inactive CD and UC and in healthy volunteers.

RESULTS

Patients with CD and UC had higher albumin-creatinine ratio compared to controls using both IT and HPLC (p < 0.05). We measured higher albumin-creatinine ratio in patients with active compared to inactive CD (p < 0.05). Albuminuria did not correlate with disease duration of CD or UC, but patients with more extended CD according to the Montreal classification had higher HPLC-albumin-creatinine ratio. In CD, we found a significant correlation between HPLC-albumin-creatinine ratio and some inflammatory markers i.e. white blood cells (p < 0.05) and erythrocyte sedimentation rate (p < 0.05). In UC, there was no significant correlation between HPLC-albumin-creatinine ratio and the above markers of systemic inflammation or activity of UC. Albumin-creatinine ratio measured by HPLC was higher in both active and inactive CD and UC groups than albumin-creatinine ratio measured by IT. Using a receiver operating characteristics curve analysis, in case of HPLC-albumin-creatinine ratio cut-off values of the activity of CD were 2.46 mg/mmol for men, 5.30 mg/mmol for women.

CONCLUSIONS

HPLC-urinary albumin-creatinine ratio is associated with the clinical and laboratory disease activity indices in CD, but not in UC. Using HPLC we found a more sensitive method compared to IT to measure albuminuria that would be a sensitive activity marker in CD.

[Osteomalacia with fatal outcome in an elderly patient]

HISTORY AND ADMISSION FINDINGS

A 63-year-old woman was admitted with diffuse bone pain, chest deformity and orthopnea. She had previous prolonged periods of bed rest and decreased sunlight exposure after several bone fractures.

INVESTIGATIONS

Laboratory tests showed hypocalcemia, hypophosphatemia with secondary hyperparathyroidism. The 25-hydroxy-D-vitamin level was too low for measurement. Radiological investigations raised the possibility of metabolic bone disease with secondary fracture. (99m)Tc-MDP bone scintigraphy demonstrated pathological isotope accumulation in places typical for osteomalacia. The histological investigation of the bone showed a thickening of the osteoid substance.

DIAGNOSIS, TREATMENT AND COURSE

Osteomalacia was diagnosed. Two weeks of administering of daily 3000 I.U. vitamin D and 1500 mg calcium normalised the serum level of calcium and phosphate. Because of orthopnea and bone pain the patient stayed in the bed, and had to be given her nadroparin calcium. After six weeks heart and respiratory failure occurred. The patient died from a subtotal pulmonary embolism, which was a consequence of a deep vein thrombosis of the leg.

CONCLUSION

In elderly people chronic and serious vitamin D deficiency can cause a life-threatening condition which can be prevented by vitamin D and calcium administration.

Chronic morphine-induced changes in mu-opioid receptors and G proteins of different subcellular loci in rat brain

Prolonged exposure to opioid agonists can induce adaptive changes resulting in tolerance and dependence. Here, rats were rendered tolerant by subcutaneous injections of increasing doses of morphine from 10 to 60 mg/kg for 3, 5, or 10 consecutive days. Binding parameters of the mu-opioid receptor in subcellular fractions were measured with [(3)H]DAMGO ([D-Ala(2),N-Me-Phe(4),Gly(5)-ol]-enkephalin). Although the density of surface mu-sites did not change after the 5-day morphine treatment, up-regulation of synaptic plasma membrane binding was detected after the 10-day drug administration. In contrast, the number of mu-binding sites in a light vesicle or microsomal fraction (MI) was elevated by 68 and 30% after 5 and 10 days of morphine exposure, respectively. The up-regulated MI mu-sites displayed enhanced coupling to G proteins compared with those detected in saline-treated controls. Pertussis toxin catalyzed ADP ribosylation, and Western blotting with specific antisera was used to quantitate chronic morphine-induced changes in levels of various G protein alpha-subunits. Morphine treatment of 5 days and longer induced significant increases in levels of Galpha(o), Galpha(i1), and Galpha(i2) in MI fractions that are part of an adaptation process. Up-regulation of intracellular mu-sites may be the result of post-translational changes and in part de novo synthesis. The results provide the first evidence that distinct regulation of intracellular mu-opioid receptor G protein coupling and G protein levels may accompany the development of morphine tolerance.

Fatal scleroderma renal crisis caused by gastrointestinal bleeding in a patient with scleroderma, Sjögren's syndrome and primary biliary cirrhosis overlap

A 57-year-old female patient presented with a long history of overlapping autoimmune disease, including limited cutaneous systemic sclerosis, Sjögren's syndrome and primary biliary cirrhosis. Another unusual finding was that the mild skin involvement (limited cutaneous systemic sclerosis, subcutaneous calcinosis) was combined with serious internal organ involvement, including honeycombing and finally scleroderma renal crisis. The most important finding was, that two decades later she developed severe telangiectasia of the gastrointestinal and urinary tract. Furthermore, a specific type of vascular malformation, i.e. gastric watermelon stomach was also found. The chronic gastrointestinal bleeding primarily derived from a watermelon stomach caused protein overload, which provoked the onset of the scleroderma renal crisis that finally led to the patient's death.

Inserting a percutaneous endoscopic gastrostomy tube via a cervical fistula formed after major surgery on a patient with a head and neck tumor

SUMMARY

Several percutaneous endoscopic gastrostomy techniques have been devised so far to provide enteral nutrition for patients with head and neck cancer, because no single technique is adequate for all. Anatomic and functional deficits caused by advanced tumor extension or by surgery or irradiation often hinder traditional peroral gastroscopy. Transnasal, laryngoscopically guided, or intraoperative gastroscopic procedures are useful technical methods for percutaneous endoscopic gastrostomy placement. This article introduces a new method of gastroscopy, as yet unpublished. After total laryngectomy and partial pharyngectomy, the remaining narrow hypopharyngeal lumen often is insufficient for peroral gastroscopy. However, coexisting cervical pharyngocutaneous fistula can provide an approach and route for percutaneous endoscopic gastrostomy. The procedure was carried out successfully with no complications.

[The "watermelon" stomach as a rare cause of upper gastrointestinal bleeding]

The watermelon stomach is a rare subtype of the gastric vascular malformations of unknown origin. It can usually be observed with autoimmune diseases, but in can be associated with other conditions. It is significant, since it can cause chronic iron-deficiency anaemia or sometimes serious acute blood loss. The typical endoscopic picture is linear red streaking of the antrum with convergence at the pylorus with visible tortuous small vessels. Histological examination is frequently not diagnostic. It demonstrates specific features including dilated mucosal capillaries with focal thrombi, dilated submucosal venous plexus and fibromuscular hyperplasia of the lamina propria. Therapy mostly is endoscopic, but some medical possibilities are also known. In their paper they report two cases of watermelon stomach, the lesions were successfully treated with oestrogen-progesterone compounds.

[Granular cell tumor of the esophagus]

Granular cell tumor is a relatively rare, mostly benign lesion, that can be found in almost every organ, however, only 2% of the cases is oesophageal. It is named after the eosinophilic S-100 protein positive granula in the cytoplasm of the tumor cells. Since patients with oesophageal granular cell tumor are mostly symptomless, the tumor is usually found accidentally. Even in patients with dysphagia, contrast radiograph and gastroscopy show an atypical picture, therefore, the diagnosis is based on the histological examination. Therapy is usually conservative, but surgical treatment might be necessary sometimes. A patient with severe dysphagia is reported here. She was diagnosed with a granular cell tumor in the oesophagus, and the tumor was surgically removed.

[Barrett esophagus in systemic sclerosis]

Systemic sclerosis is a generalized systemic autoimmune disorder frequently involving the oesophagus causing reflux oesophagitis in the majority of patients. Barrett's oesophagus is one of the most serious complication of the reflux oesophagitis, in which the normal oesophageal squamous epithelium is partially replaced by metaplastic columnar epithelium. The clinical significance of Barrett's oesophagus is the significantly increased risk of developing the adenocarcinoma. In our paper, the authors present 5 cases with Barrett's oesophagus among their 52 examined patients with scleroderma.

[Frequency of supernumerary teeth and possibilities of treatment]

According to dental literature, the frequency of supernumerary teeth is 1-3%. The authors analyzed the orthopantomograms of 1875 children and adolescents aged between 6 and 18 years to determine the frequency of supernumerary teeth at the Department of Dentistry for Children and Orthodontics. The frequency was found to be 1.92%. The sequence of frequency of supernumerary teeth was: mesiodens, lateral incisor, central incisor. 77.8% of the supernumerary teeth occurred in the maxilla, 97.2% in the frontal region. Besides the data found, two successful cases of surgical and orthodontic treatment are also presented.

[Some aspects of the orthodontic-prosthetic approach for adult patients. A case report]

Authors present a case report of an adult patient treated with the combination of orthodontic and prosthetic treatment methods. The importance of periodontal and psychological management of such patients is pointed out.

[The use of photo-acoustic stimulation in dental practice]

Photo-acoustic stimulation provides a powerful stimulation of the central nervous system, whereas it relaxes the body. Authors found it useful to eliminate simple anxiety, and to reduce salivary secretion in the oral cavity. The combination of photo-acoustic stimulation with hypnotic techniques has been found as an excellent method to treat oro-facial psychogenic symptoms and denture intolerance. In the case of odonto-phobic patients, the combined method has been found less effective than hypnotic techniques alone.

Watermelon-stomach as a cause of chronic iron deficiency anemia in a patient with systemic sclerosis

Watermelon-stomach is a rare cause of gastrointestinal bleeding. There has been an increasing number of reports on the association of this lesion with diseases of the scleroderma group, causing chronic, sometimes severe gastrointestinal blood loss. The present report presents the case of a 75-year-old female with limited cutaneous systemic sclerosis and watermelon-stomach, which was the cause of her long-standing sideropenic anemia.

Expression of G-protein subtypes in cultured cerebral endothelial cells

This paper describes Western-blotting evidence for the presence of various guanine nucleotide binding proteins, G-proteins in cultured rat cerebral endothelial cells (CECs) and two immortalized cerebral endothelial cell lines, RBE4 and GP8. By using specific antibodies raised against known sequences of appropriate G-protein types that were previously characterized, we demonstrated the presence of Gsalpha, Gi2alpha, Gi3alpha, Gq/11alpha, Goalpha and Gbeta in cell lysates of primary cultures of CECs, and plasma membranes of RBE4 and GP8 cells. The appearance of Goalpha proteins in CECs might be of special importance, since they were not detected in peripheral endothelial cells in previous studies. Isoproterenol and bradykinin displayed significant, dose-dependent stimulation of [35S]GTPgammaS binding above basal values. This assay, reflecting the GDP-GTP exchange reaction on Galpha-subunits by receptor agonists, suggested that there were functional, G-protein coupled beta-adrenergic and bradykinin receptors in these systems. No significant stimulation of [35S]GTP7gammaS binding was noted with serotonin under our experimental conditions. Since stimulation of [35S]GTPgammaS binding by isoproterenol and bradykinin was additive, it was concluded that different Galpha proteins were activated by these two ligands. In analogy to other systems, activation of Gs is most likely by isoproterenol, while Gi and/or Gq/11 proteins might be activated by bradykinin receptors. The possible significance of the receptors and G-proteins detected is being discussed in the functioning of cerebral endothelium, and thus the blood-brain barrier.

Receptor-mediated activation of G-proteins by kappa opioid agonists in frog (Rana esculenta) brain membranes

This study delineates the heterotrimeric guanine nucleotide binding regulatory protein (G-protein) types in frog (Rana esculenta) brain membranes and their activation by kappa opioid agonists. Ethylketocyclazocine (EKC), trans-(+/-)-3,4-dichloro-N-methyl-N-(2-[1-pyrrolidinyl]cyclohexyl)b enzeneacetamide (U-50,488) and bremazocine displayed dose-dependent, norbinaltorphimine-reversible stimulation of guanosine-5'-O-(3-[35S]thio)triphosphate ([35S]GTPgammaS) binding in crude membrane preparations. G-proteins were identified by Western-blotting using previously characterized specific antisera that were generated against mammalian G-protein alpha-subunits and beta-subunits. A photoreactive guanosine 5'-triphosphate (GTP) analog, [alpha-32P]GTP azidoanilide ([alpha-32P]AA-GTP) irreversibly labeled four proteins in the molecular weight range of 39-43 kDa. Ethylketocyclazocine and U-50,488 stimulated photolabelling of these proteins among which the 39 kDa band comigrated with the protein specifically labelled with the alpha(i2) antibody and the 40 kDa band was identified as alpha(o1). The other two bands were also stained with the alpha(common) antibody, but were not further identified. These results suggest that the endogenously expressed kappa opioid receptors that are present in frog brain interact with multiple G-proteins in situ. Furthermore, the structure of most G-proteins seems to be well preserved during phylogenesis.

[Introduction of the concept of Dental Anxiety Scale in Hungary. Epidemiologic studies on the Hungarian population]

Authors translated the Corah's "Dental Anxiety Scale" (DAS) into Hungarian. 143 dental patients, and 74 dental student's, were investigated and the DAS values were compared to the State-Trait Anxiety Invertory (STAI-S and STAI-T) values. Mean values were: DAS: 9.92, STAI-S: 39.17, STAI-T: 41.34. Authors found lower scores in the case of dental students comparing to patients (p < 0.001), and women comparing to men (p < 0.001). DAS values increased slowly with age, and decreased at 60 years old, or older patients. Married patients had higher DAS and STAI-S scores, but lower STAI-T scores comparing to the unmarried and divorced patients.

Thermodynamic parameters of opioid binding in the presence and absence of G-protein coupling

We have investigated the thermodynamic parameters of various opioid ligands interacting with their receptors in rat brain membranes. Affinity constants (Ka), enthalpy and entropy values were obtained from homologous displacement experiments performed at 0, 24 and 33 degrees C. It was found that all the opioid agonists tested ([3H]dihydromorphine (DHM) mu alkaloid; [3H]DAMGO mu peptide; [3H]deltorphin-B delta peptide) display endothermic binding accompanied with a large entropy increase, regardless of their chemical structure (alkaloid or peptide), or of their mu or delta receptor selectivity. In contrast, binding of the antagonist naloxone is exothermic, mainly enthalpy driven. Na+ or Mg2+ results only in quantitative changes of the thermodynamic parameters. In the presence of the GTP-analog Gpp(NH)p; or Gpp(NH)p + Na+; or Gpp(NH)p + Na- + Mg2+ the affinity of DHM binding dramatically decreases which might reflect functional uncoupling of the receptor-ligand complex and G-proteins. This altered molecular interactions are also indicated by curvilinear van't Hoff plot and entropy increase. It is concluded that the thermodynamic analysis provides means of determining the underlying driving forces of ligand binding and helps to delineate its mechanism.

[Chronic IgM mesangioproliferative glomerulonephritis]

In their ten years renal biopsy material authors found nine cases of chronic glomerulonephritides with predominantly IgM deposition in the mesangium which reach the diagnosis of IgM nephropathy. This paper on the basis of a typical case deal with the immunopathology, diagnosis, prognosis and therapy of the disease.

[Immunologic studies in myelodysplastic syndrome]

Myelodysplastic syndrome is a clonal stem-cell disease, which predominantly involves myeloid cell lines. However, several observations refer to a possible pathological condition of the lymphoid system as well. Because of these controversial data, we investigated 25 patients with MDS at our clinic. Absolute lymphocyte counts, lymphocyte subpopulations (using methods of mAT, OKT 3, 4, 8, Leu7), T and B rosette tests and quantitative tests of immunoglobulins were made possibly during diagnosis or breaks in treatment. A significant ratio of our patients had lymphopenie. Using both rosette tests or mAT methods, the ratio of T-cells (primarily of T4-cells) reduced, and the decrease of NK-cells characterized with Leu7 mAT was also marked. Polyclonal hypergammaglobulinaemia could frequently and significantly be observed during immunoglobulin identification. All the observed abnormalities were rather marked in the group of patients with excess of blasts.

[T-lymphocyte subgroups and the activity of human natural killer cells in non-Hodgkin lymphoma of moderate and high malignancy]

T-lymphocyte subgroups and the percentage and the activity of Human Natural Killer cells (HNK) were investigated by the authors in their 24 patients suffering with low grade and 24 with high grade malignancies of non-Hodgkin lymphoma (NHL). According to their observations, the ratio of CD3, CD4, Leu-7, and HNK cells as well as the release by HNK cells of 51Cr bound to target cells decreased, depending on the pathological stage. The tests were performed with monoclonal antibodies. A significant change could also be observed in the reactivity of bone marrow cells to monoclonal sera, which showed complete correspondence in character with the behavior of lymphocytes isolated from peripheral blood. No significant changes could be observed in the quantitative relations of immunoglobulins. Discussing the supposed immunological relation in detail, the role of plasma factor that reduces the formation of T-lymphocytes, is assumed to have primary importance in this phenomenon.