Mycophenolate mofetil (MMF) following penetrating high-risk keratoplasty: long-term results of a prospective, randomised, multicentre study

BACKGROUND

The purpose of this prospective, randomised, multicentre study was to prove the efficacy and safety of mycophenolate mofetil (MMF) in preventing graft rejection and in improving clear graft survival following high-risk keratoplasty.

METHODS

In all, 98 of 140 scheduled patients were included in this study (57 MMF, 41 control). Recruitment was stopped prematurely due to a statistically significant result. The patients in the MMF group received MMF orally 2 x 1 g daily for 6 months. All of the patients received fluocortolone 1 mg/kg/day tapered over 3 weeks and topical prednisolone acetate 5 x /day tapered over 5 months. Main criteria were immune reaction-free and clear graft survival, and the occurrence of side effects.

RESULTS

The mean follow-up time was 34.9+/-16.3 (mean+/-SD) months. Eleven patients withdrew from the study (nine patients due to protocol deviation, two because of side effects). Six reversible and two irreversible graft rejections occurred in the MMF group, and five reversible and seven irreversible rejections in the control group. The Kaplan-Meier analysis revealed an immune reaction-free graft survival after the mean follow-up time of 83% in the MMF group and 64.5% in the control group (P=0.044). Graft failure occurred in 10 MMF-treated patients (two due to rejection) and in nine patients in the control group (seven due to rejection). A total of 36 of 57 MMF-treated patients experienced mostly reversible adverse events.

CONCLUSIONS

Systemic immunosuppression with MMF over 6 months is relatively well tolerated and improves rejection-free graft survival following high-risk keratoplasty statistically significant, even in the long run.

Impact of Adhesive Application and Moisture on the Mechanical Properties of the Adhesive Interface Determined by the Nano-indentation Technique

The vigorous rubbing action of acetone and ethanol/water-based adhesives into dry demineralized dentin resulted in high nanohardness and Young's modulus in the hybrid layer, and moisture increased the nanohardness and Young's modulus of Adper Single Bond Plus in the adhesive layer.

Biopsied and vitrified bovine embryos viability is improved by trans10, cis12 conjugated linoleic acid supplementation during in vitro embryo culture

Bovine embryos cultured in serum-containing media abnormally accumulate lipids in the cytoplasm. This is well known to contribute to their higher susceptibility to cryopreservation and biopsied embryos are even further susceptible. We aimed to improve in vitro produced (IVP) embryos resistance to micromanipulation and cryopreservation by supplementing serum-containing media with trans-10, cis-12 conjugated linoleic acid (t10, c12 CLA). The effect of t10, c12 CLA on lipid deposition and embryonic development was also tested. After in vitro maturation and fertilization (IVF day=D0), zygotes were cultured on granulosa cells+M199+10% serum+100microM GSH supplemented with 100microM of t10, c12 CLA (CLA group, n=1394) or without supplementation (control group, n=1431). Samples of D7/D8 embryos were observed under Nomarsky microscopy for lipid droplets evaluation while others were biopsied and vitrified (group B-Control, n=24; group B-CLA, n=23). Non-biopsied embryos were also frozen (group NB-Control, n=49; group NB-CLA, n=45). Biopsied cells were used for embryo sex determination. Postwarming embryo survival and viability were determined at 0 and 24h of culture, respectively. Supplementation of t10, c12 CLA did not influence cleavage, embryo sex ratio, D7/D8 embryo rate or morphological quality. CLA embryos had higher number of small lipid droplets (P<or=0.003) and a smaller (P<0.001) fat embryo index being leaner (P=0.008) than control embryos. Embryo postwarming survival was higher in B-CLA than in B-control group (95.0+/-7.0% versus 62.5+/-7.9%; P<0.001). After 24h of culture, the viability (expansion rate) of biopsied embryos and nonbiopsied embryos, cultured with t10, c12 CLA was higher than control embryos (B-CLA=64.6+/-4.4% and B-control=27.5+/-2.5%, P=0.01; NB-CLA=86.0+/-3.5% and NB-Control=68.6+/-7.0%, P=0.05). Results showed that supplying t10, c12 CLA to serum-containing media decreases embryo cytoplasmic lipid deposition during in vitro culture and significantly improves resistance of IVP embryos to micromanipulation and cryopreservation.

[Long-term results of FK 506 eye drops following corneal transplantation]

BACKGROUND

Immunological graft rejection is the main reason for graft failure following corneal transplantation despite the use of topical and systemic steroids. As steroids are associated with side effects, alternative therapeutic strategies are needed.

PATIENTS AND METHODS

In this clinical trial patients undergoing corneal transplantation have been prospectively randomised to receive either prednisolone acetate 1 % eye drops 5 x /day, tapering off by one drop every month (n = 20), or to receive FK 506 eye drops 3 x /day for six months (n = 20). Patients in both groups received additionally systemic steroids for three weeks (fluocortolon 1 mg/kg body weight). Primary endpoints were the number of immune reactions and the clear graft survival, the secondary endpoint was the number of side effects.

RESULTS

Three immune reactions in the steroid group and one immune reaction in the FK 506 group were seen within the follow-up time of three years. No irreversible graft rejections occurred in either group. Eight patients in the FK 506 group concluded the study early due to local side effects.

CONCLUSIONS

In this long-term follow-up the use of FK 506 eye drops following corneal transplantation resulted in a lower number of immune reactions when compared to topical steroids. With a change in the galenic formulation FK 506 might be a powerful therapeutic option for preventing immunological graft rejection.

[Basiliximab following penetrating risk-keratoplasty--a prospective randomized pilot study]

BACKGROUND

Until now cyclosporin A (CSA) and mycophenolate mofetil (MMF) are the only available systemic immunosuppressants for patients undergoing risk keratoplasty. Basiliximab is a chimeric monoclonal interleukin 2-receptor antibody, which inhibits T-cell proliferation. Basiliximab is approved for the treatment in patients after kidney transplantation. The aim of this study was to prove the efficacy and safety of Basiliximab after penetrating risk keratoplasty.

PATIENTS AND METHODS

20 patients undergoing risk keratoplasty received as postoperative medication fluocortolon 1 mg/kg/d (tapered off within three weeks) and prednisolone acetate eye-drops 5x/d (tapered off within five months). In addition, 10 patients received 20 mg basiliximab immediately following surgery and four days postoperatively. 10 patients in the control group received oral CSA adapted to the blood-trough level (120-150 ng/mL) for six months.

RESULTS

After a mean follow-up time of 477 +/- 263 days 4 patients of the basiliximab group showed corneal immune reactions (2 irreversible), while no side effects were observed. In the CSA group 2 immune reactions occurred (1 irreversible). In 2 CSA-treated patients the CSA administration had to be stopped due to side effects.

CONCLUSIONS

Basiliximab has a lower efficacy in preventing immune reactions after risk keratoplasty than CSA. However, the side effect profile of basiliximab is more favourable than that of CSA.

Effect of Double-application or the Application of a Hydrophobic Layer for Improved Efficacy of One-step Self-etch Systems in Enamel and Dentin

The double-application and placement of a hydrophobic resin coat can improve the performance (μTBS) of one-step self-etch systems to tooth substrates, mainly in dentin.

Detecção de cepas patogênicas pela PCR multiplex e avaliação da sensibilidade a antimicrobianos de Escherichia coli isoladas de leitões diarréicos

Avaliou-se a freqüência dos genes de fímbrias (K88, K99, 987P, F18 e F41) e toxinas (LT, Stb, StaP e Stx2e) de cepas de E. coli isoladas de leitões com diarréia usando a técnica de PCR multiplex com primers específicos para esses genes, e estudou-se o padrão de sensibilidade das cepas patogênicas pelo método de difusão em disco ao florfenicol, ceftiofur sódico, colistina, fosfomicina, neomicina, norfloxacina, sulfa + trimetoprim, doxiciclina, tetraciclina e lincomicina. Foram utilizadas 144 amostras de E.coli isoladas de leitões com diarréia, provenientes de granjas localizadas no estado de Minas Gerais. Dessas, 42 (29,2%) foram positivas para pelo menos um dos fatores de virulência testados. Dentre essas 42 amostras, 23 (54,8%) apresentaram genes de fímbria e toxina, sete (16,6%) apresentaram somente genes de toxinas e 12 (28,6%) amostras somente genes de fímbria. O resultado do teste de sensibilidade aos antimicrobianos demonstrou que o florfenicol (89,5 %) e o ceftiofur sódico (84,2%) foram as drogas de melhor eficácia in vitro sobre cepas de E. coli com fatores de virulência.

Loss-of-function mutations in the filaggrin gene: no contribution to disease susceptibility, but to autoantibody formation against citrullinated peptides in early rheumatoid arthritis

OBJECTIVES

Autoantibody formation to citrullinated (pro)filaggrin has proven to be a highly specific serological marker for rheumatoid arthritis (RA). To test the potential relevance of mutations of the filaggrin (FLG) gene for disease susceptibility and elicitation of humoural autoimmunity in RA, a case-control association study of three loss-of-function FLG variants was performed.

METHODS

DNA was obtained from 282 patients with early RA (mean disease duration: 6.5 months) and from 376 control individuals. Three loss-of-function variants of the FLG gene (*R501X, *2282del4 and *3702del1) were genotyped.

RESULTS

No significant differences in genotype frequencies were observed between control probands and the population of RA patients. The FLG*3702del1 allele was not identified in any of the patients nor controls, and none of the probands was homozygous or compound heterozygous. In the RA cohort, heterozygous carriers of either of the FLG variants exhibited a significantly elevated prevalence of autoantibodies to citrullinated peptides (CCP-2) (80%) compared to non-carriers (51.9%) (p = 0.018, odds ratio: 3.71 (1.20-11.46)).

CONCLUSIONS

The investigated FLG variants do not confer an overall risk for the development of RA. However, loss-of-function mutations in the FLG gene may contribute to the development of humoural autoimmunity, targeting citrullinated determinants in early RA.

[Systemic immunosuppressives after penetrating keratoplasty]

Immunologic rejection is the main cause of corneal graft failure. If corneal transplantation is performed in a high-risk situation without the use of systemic immunosuppression, corneal graft failure has to be expected in over 50% of patients within the first postoperative year. The clonal expansion of graft-specific lymphocytes occurs in lymphoid tissues. As topical steroids do not reach the secondary lymphoid organs, and even systemic steroids do not interfere sufficiently with the clonal expansion of activated T cells, it is essential to administer systemic immunosuppressives in order to achieve clear graft survival. As corneal transplantation is not a life-saving procedure, the profile of side-effects is a central issue when choosing an immunosuppressive medication.

A 2-year evaluation of moisture on microtensile bond strength and nanoleakage

OBJECTIVES

This study evaluated the effect of moisture on the resin-dentin mu-bond strength (BS) and silver nitrate uptake (SNU) of three adhesive systems (Single Bond, One-Step and Syntac Single Component) soon after bonding (IM) and after 2 years of water storage (2Y).

METHODS

Dentin surfaces were bonded on a dry (D), moist (W) or over-wet surfaces (OW). After restorations were constructed, specimens were stored in water (37 degrees C/24h). Resin-dentin sticks were prepared (0.8mm(2)) and they were divided for immediate (IM) and 2-year storage (2Y) testing. Half of the specimens from each period of time were tested in tension at 0.5mm/min and the other half was immersed in silver nitrate and examined by SEM-EDX. The data was analyzed by three-way repeated measures ANOVA and Tukey's tests (alpha=0.05).

RESULTS

The overall BS (MPa) in the IM group under W condition was higher than in D and OW groups. After 2Y, the BS in W was lower than in the IM group, however higher than in the D and OW for OS and SB. The overall silver nitrate deposition (%) in the IM group under D, W and OW were similar. In the 2Y groups, the nanoleakage was higher than IM groups, however the increase was less pronounced in the W condition.

SIGNIFICANCE

Higher BS and a significantly lower nitrate uptake were observed for IM groups, for OS and SB. Under W conditions, the BS reduction over time was less pronounced and less nitrate uptake occurred.

Lokale Immunsuppressiva nach perforierender Keratoplastik

Topical steroids are routinely used in the postoperative treatment following penetrating keratoplasty. Due to the known side effects such as steroid-response glaucoma, cataract, and surface disorders, a broader armamentarium of topical immunomodulating drugs with comparable efficacy, better tolerance and less side effects is desirable. Cyclosporine A and FK506 eye drops are a promising alternative. A new approach involves subconjunctival drug delivering implants and locally applied antiangiogenic substances, which still have to be tested in clinical studies.

The new malononitrilamide immunosuppressant FK778 prolongs corneal allograft survival in the rat keratoplasty model

PURPOSE

Aim of this study was to prove the efficacy and safety of the new malononitrilamide immunosuppressive FK778 in prolonging clear graft survival following allogeneic orthotopic keratoplasty in rats.

METHODS

Sixty-seven penetrating keratoplasties were performed using Fisher and Lewis rats as donors and recipients, respectively: group 1 (n=11), allogeneic control without therapy; group 2 (n=12), syngeneic control; group 3 (n=11), mycophenolate mofetil (MMF) 40 mg/kg bodyweight; group 4 (n=12), FK778 5 mg/kg bodyweight; group 5 (n=12), FK778 10 mg/kg bodyweight; and group 6 (n=9), FK778 20 mg/kg bodyweight. Four animals in each group were killed for immunohistological evaluation on day 14. Therapy was administered orally for 18 days. The grafts were evaluated every three days by means of a scoring system including opacity, oedema, and vascularization. Time to rejection was analysed with the Kaplan-Meier survival analysis and compared with the log-rank test. The densities of infiltrating immune cells were compared statistically using the non-parametric Mann-Whitney test.

RESULTS

Mean rejection-free graft survival was 11.4 days in group 1 (allogeneic control), 100 days (total follow-up time) in group 2 (syngeneic control), 24.0 days in group 3 (MMF 40 mg/kg), 15.7 days in group 4 (FK778 5 mg/kg), 19.1 days in group 5 (FK778 10 mg/kg), and 25.4 days in group 6 (FK778 20 mg/kg) (P<0.005).

CONCLUSIONS

Systemic immunosuppression with FK778 prolongs graft survival in the rat keratoplasty model. FK778's efficacy is comparable with that of MMF in preventing immunologic graft rejection.

Mutations in the gene encoding the Wnt-signaling component R-spondin 4 (RSPO4) cause autosomal recessive anonychia

Anonychia is an autosomal recessive disorder characterized by the congenital absence of finger- and toenails. In a large German nonconsanguineous family with four affected and five unaffected siblings with isolated total congenital anonychia, we performed genomewide mapping and showed linkage to 20p13. Analysis of the RSPO4 gene within this interval revealed a frameshift and a nonconservative missense mutation in exon 2 affecting the highly conserved first furin-like cysteine-rich domain. Both mutations were not present among controls and were shown to segregate with the disease phenotype. RSPO4 is a member of the recently described R-spondin family of secreted proteins that play a major role in activating the Wnt/ beta -catenin signaling pathway. Wnt signaling is evolutionarily conserved and plays a pivotal role in embryonic development, growth regulation of multiple tissues, and cancer development. Our findings add to the increasing body of evidence indicating that mesenchymal-epithelial interactions are crucial in nail development and put anonychia on the growing list of congenital malformation syndromes caused by Wnt-signaling-pathway defects. To the best of our knowledge, this is the first gene known to be responsible for an isolated, nonsyndromic nail disorder.

Efeito da estrutura ovárica e da idade de bovinos da raça Holstein Friesian na quantidade e qualidade de ovócitos e de embriões produzidos in vitro

O objetivo do presente trabalho, foi o estudo dos efeitos da idade e da fase do ciclo estral dos bovinos na quantidade e qualidade de ovócitos e de embriões produzidos in vitro. Para isso, foram utilizados ovócitos de 63 vacas da raça Holstein-Friesian abatidas em matadouro, com idades compreendidas entre 1 e 15 anos, as quais foram divididas em 5 lotes de acordo com a idade. Cada lote foi subdividido de acordo com a fase do ciclo estral em que o animal se encontrava no dia do abate, pela presença ou não de corpo lúteo funcional na superfície do ovário. Os lotes referentes à idade foram: ;8 anos. Após punção dos folículos, os ovócitos foram divididos nas classes A, B, C e D, tendo em conta o seu aspecto morfológico, em que apenas os de classe A e B foram usados para a FIV. Observou-se que o número de ovócitos produzidos foi diretamente proporcional à idade das vacas (R=0,99 - P<0,001). Quanto à fase do ciclo estral, as vacas em fase luteínica, produziram maior número de ovócitos que as vacas em fase folicular (P<0,001), respetivamente 7,05 ± 0,11 e 10,87 ± 1,01. Relativamente à qualidade dos ovócitos em função da idade das vacas, observou-se uma correlação positiva (R = 0,94 p<0,01) até aos [7, 8] anos, começando a baixar a partir desta idade. As vacas em fase luteínica produziram ovócitos de melhor qualidade relativamente às vacas em fase folicular (6,77 ± 0,64 e 3,84± 0,64; respetivamente). Quanto à quantidade de zigotos que clivaram, esta foi superior para os lotes de vacas em fase luteínica em comparação com os de vacas em fase folicular (59,03% e 45,52%; respetivamente), observando-se ainda que as vacas em fase luteínica produziram igualmente, em geral, maior número de embriões aos 7 dias após FIV que as vacas em fase folicular(44,23% e 31,48%; respetivamente). Os resultados do presente trabalho permitem concluir que existe uma estreita relação entre a idade e a fase do ciclo estral das vacas e a quantidade e qualidade dos ovócitos e de embriões produzidos in vitro.

Cost of illness of malignant lymphoma in Germany

Cancer causes a high economic burden. The purpose of this study is to determine and compare the direct, indirect and societal costs of illness for Hodgkin's Disease (HD), Non-Hodgkin's Lymphoma (NHL), Plasmocytoma and Chronic Lymphatic Lymphoma (CLL). We used a database of 1.9 million individuals enrolled in a statutory sickness fund in Germany to identify 4,172 patients treated for malignant lymphoma in 2000. Direct, indirect and societal costs were calculated using a case-control design and the human capital approach. Direct cost (in Euro) for patients with HD was 3604, for NHL patients 6,149, for Plasmocytoma 8,400, and for CLL patients 3,226. Total indirect cost for HD was 69 million, for NHL patients 404 million, for Plasmocytoma 144 million, and for CLL patients 52 million. Totalling 1.7 billion Euro in economic cost for Germany in 2000, with 44,000 productive years lost, malignant lymphomas are a relatively costly disease group. As life expectancy increases, costs for malignant lymphoma are likely to rise due to the high prevalence among the elderly. Further research employing disaggregated, incidence-based cost is needed.

The CAG repeat within the androgen receptor gene and its relationship to cryptorchidism

PURPOSE

We examined the significance of the CAG repeat polymorphism in the pathogenesis of cryptorchidism.

MATERIALS AND METHODS

Genomic deoxyribonucleic acid (DNA) was extracted from blood samples from 42 cryptorchid boys and from 31 non-cryptorchid control subjects. In the cryptorchid group, 7 had bilateral cryptorchidism and 6 had patent processus vaginalis in the contralateral side. To determine the number of CAG repeats, the DNA was amplified by polymerase chain reaction and sequenced.

RESULTS

The mean CAG repeat length in the AR gene was 22.5 (range 16 to 28) in patients and 21.5 (range 17 to 26) in controls (non-significant). Patients with bilateral cryptorchidism had a mean length of 24.3 (range 21 to 26) and patients with unilateral cryptorchidism and patent processus vaginalis in the contra lateral side had a mean of 25.2 (range 21 to 28), which was statistically different from controls (p = 0.015 and p = 0.005 respectively).

CONCLUSION

CAG repeat length of the AR gene does not seem to play a major role in patients with unilateral cryptorchidism. However, in patients with bilateral undescended testis, a less functional androgen receptor through a longer polyglutamine chain may have a role in its pathogenesis. In the same way, patients with unilateral cryptorchidism a contralateral patent processus vaginalis have longer CAG repeats that might be responsible for a slower testicular descent and incomplete closure of the processus vaginalis.