Epidemiological, Clinical, and Therapeutic Profile of Uveitis in Multiple Sclerosis: A Multicenter Study

INTRODUCTION

Uveitis may occur during approximately 1-3% of MS patients, corresponding to 10 times higher than in the general population. The development of uveitis is not currently considered as an inflammatory relapse of MS. There are no clinical guidelines for treating. MS with concomitant uveitis requiring systemic treatment.

PURPOSES

To analyze clinical and therapeutic characteristics of uveitis in patients with MS and the impact of MS treatment on the progression of uveitis.

MATERIALS & METHODS

We conducted a retrospective, observational, multicenter study in France about 54 patients.

RESULTS

The form of MS most frequently associated with uveitis in our study was the relapsing-remitting form (85%). The mean time of onset of uveitis was 15 months before the diagnosis of MS. The most frequent form of uveitis was bilateral panuveitis (43%), non-granulomatous (61%), synechial (52%) and non-hypertonic (93%) with progressive onset (65%) and chronic course (66%).

CONCLUSION

MS-associated uveitis occurs most frequently before the diagnosis of relapsing-remitting MS in the form of panuveitis or intermediate uveitis, which is mildly inflammatory and whose main complications are macular edema, cataract and venous vasculitis. Despite their chronicity, these uveitis cases have a good visual prognosis and teriflunomide appears to have a positive effect on progression.

Choroidal neovascularization and MEWDS like reaction in a child: A rare case

PURPOSE

To report a case of choroidal neovascularization (CNV) associated with Multiple Evanescent White Dot Syndrome (MEWDS) in a child.

STUDY DESIGN

Case report.

RESULTS

A 13-year-old child visited us with a month-long history of blurred vision in his right eye. His right fundus showed several subretinal white dots and an atrophic macular lesion corresponding to a CNV. Angiography and optical coherence tomography (OCT) were consistent with the diagnosis of MEWDS. The patient's condition poorly improved after an intravitreal injection of anti-vascular endothelial growth factor (anti VEGF) in his right eye.

CONCLUSIONS

We reported the case of CNV associated with MEWDS like reaction. The hypothesis of a triggered-MEWDS was highly suspected but no cause was found, which is often the case in paediatric inflammatory eye disorders. Long-term follow-up is needed to judge the evolution.

A Harungana madagascariensis extract with retinol-like properties - Gene upregulations and protein expressions in human fibroblasts and skin explants

OBJECTIVE

Because they limit, even reverse, age-induced skin alterations, retinoids became a staple in cosmetology. However, their use can result in undesired secondary effects and there is a demand for natural sources of compounds with retinoid like effects. A preliminary screening identified a Harungana madagascariensis plant extract (HME) as possibly inducing genes stimulated by retinol. We analysed its effect on gene and protein expression, comparing it to retinoids.

METHODS

Gene expression was analysed by real-time qPCR on RNA from isolated fibroblasts subjected to retinol or the plant extract for 6, 48 or 96 hours. Skin markers were quantified in fibroblasts cultured with retinol or extract containing medium, and UV-aged skin explants subjected to topical applications of creams containing retinol, retinaldehyde or HME.

RESULTS

Real-time qPCR show that the extract induced all RARs and RXRs, even RXRγ that was not induced by retinol. Eighty-eight percent of the 25 early retinoid reaction genes induced by a concentration of retinol are induced by the extract. In fibroblasts, only the extract increased collagen III labelling, while collagen I and fibronectin labelling are increased by retinol and the extract, with higher levels for the extract. When topically applied to UV-aged skin explants, only the cream containing the HME led to increased labelling of CRABP1 in the epidermis. CRABP2 and Ki67 are induced by all three creams and no effect was detected on RXRs. In the dermis the extract containing cream increased CRABP2, total collagen, procollagen I and collagen I while creams with retinol or retinaldehyde only affected some of these proteins.

CONCLUSIONS

The HME induces an overall retinol-like gene induction profile in isolated fibroblasts and retinoid-like stimulation of protein synthesis in both isolated fibroblasts and photoaged skin explants.

Localization, fate and interactions of Emilin-1 in human skin

OBJECTIVE

Emilin-1 is a versatile protein abundant in tissues where resilience and elastic recoil are prominent and interacting with components of the extracellular matrix. Still, little is known about Emilin-1 in the skin. Therefore, we investigated Emilin-1 in the skin, its localization, its fate upon ageing, its interactions with other proteins and the effect of its knockdown.

METHODS

Skin explants from young or old Caucasian women, immunofluorescently labelled by anti-Emilin-1, anti-Fibrillin-1 and anti-Elastin antibodies, were analysed using confocal microscopy. Skin explants subjected to UV-induced skin ageing were also analysed. Colocalization of Emilin-1 with Collagen IV, Fibrillin-1 and Elastin was studied by multiphoton microscopy and co-immunoprecipitation. Finally, the effect of Emilin-1 extinction was studied by producing small interfering RNA (siRNA) knockdown fibroblasts and by analysing the outcome on selected genes.

RESULTS

In skin sections from young donors, Emilin-1 localizes similarly to Elastin and Fibrillin-1. In the papillary dermis, it shows clear and ramified structures, perpendicular to the dermo-epidermal junction that are reminiscent of the oxytalan fibres. In the reticular dermis, Emilin-1 signal appears identical to that of the elastic fibres network. Upon intrinsic or UV-induced ageing, the signal associated with Emilin-1 is drastically reduced and disorganized. Multiphoton microscopy study shows that, as expected, Emilin-1 colocalizes with Elastin. It also colocalizes with Collagen IV in the basement membrane and within dermal fibroblasts. Interaction of Emilin-1 with Elastin and Collagen IV was also found by co-immunoprecipitation. It also reveals interaction with Laminin-5. Finally, siRNA-mediated knockdown of EMILIN-1 show little effect on the expression level of the 61 genes we studied. The most striking change is a downregulation of fibroblast growth factor receptor 2 that show a decrease similar to that of EMILIN-1 itself and after 8 days a downregulation of COL6A1.

CONCLUSION

In skin, Emilin-1 locates in the dermis, up to the basement membrane, interacting with components of the extracellular matrix but also with the anchoring complex. These interactions are important for cell adhesion, migration, proliferation and would suggest that Emilin-1 might be important for maintaining the 3D structure of the extracellular matrix.

Linkage analysis of candidate myelin genes in familial multiple sclerosis

Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system. A complex genetic etiology is thought to underlie susceptibility to this disease. The present study was designed to analyze whether differences in genes that encode myelin proteins influence susceptibility to MS. We performed linkage analysis of MS to markers in chromosomal regions that include the genes encoding myelin basic protein (MBP), proteolipid protein (PLP), myelin-associated glycoprotein (MAG), oligodendrocyte myelin glycoprotein (OMGP), and myelin oligodendrocyte glycoprotein (MOG) in a well-characterized population of 65 multiplex MS families consisting of 399 total individuals, 169 affected with MS and 102 affected sibpairs. Physical mapping data permitted placement of MAG and PLP genes on the Genethon genetic map; all other genes were mapped on the Genethon genetic map by linkage analysis. For each gene, at least one marker within the gene and/or two tightly linked flanking markers were analyzed. Marker data analysis employed a combination of genetic trait model-dependent (parametric) and model-independent linkage methods. Results indicate that MAG, MBP, OMGP, and PLP genes do not have a significant genetic effect on susceptibility to MS in this population. As MOG resides within the MHC, a potential role of the MOG gene could not be excluded.

[Surgical treatment of Graves' disease (author's transl)]

135 patients with goiter treated for Graves' disease have been followed during 10 years (12) 5 to 1 years (64) 1 to 5 years (59) after surgical treatment. The incidence of hypothyroidism increases with the delay (23 % after 1 year, 32,6 % after 5 years, 37,8 % after 10 years). The incidence of relapses is similar (7,4 % after 1 year, 15,5 % after 5 years, 22,2 % after 10 years). There is no predictive value of clinical and biological data. Only the limits of thyroidectomy and the pathological findings can inform on the post operative evolution : relapses are more frequent after subtotal bilateral thyroidectomy, hypothyroidism is more frequent after one total lobectomy + subtotal lobectomy on the other side and in the case of large lymphocytic infiltration.

Sex differences in the adrenergic response to hypoglycemic stress in human

We have found different patterns of adrenergic response to insulin-induced hypoglycemia in men and women. The differences involve the readiness of adrenergic reactivity, the magnitude of the responses, and the nature of secreted amines. In men, a strong and transient discharge of epinephrine (E) is observed in plasma, corresponding to a great increase in the urinary level of this amine in the 2 h period following insulin. In women, the adrenergic response is delayed and consists of moderately increased amounts of E and norepinephrine (NE) which persist in plasma for a longer period. From the correlations observed between urinary amount and the increase of plasmatic catecholamines after 30, 45, and 60 min, it may be assumed that urinary data may reflect the cumulative plasma levels of catecholamines in the corresponding period, but not the precise pattern of plasmatic changes. Our findings show that the differences in adrenergic behavior previously observed in men and women under the effect of psychological stress, may also be induced by a metabolic stimulus such a insulin hypoglycemia; however, women, but not men, exhibit a mild release of NE under this metabolic stress.