Clinical characteristics and therapy exploration of active human cytomegalovirus infection in 105 lupus patients

Systemic lupus erythematosus (SLE) has protean clinical manifestations of varying severity over the course of its onset, exacerbation, remission and flare that could often pose significant challenges for clinicians in their decision making as to whether to treat aggressively or to look for concurrent conditions such as infection with opportunistic pathogens. Human cytomegalovirus (HCMV) is one of those pathogens and is frequently encountered in our daily management of lupus patients. To investigate the clinical characteristics and therapeutic options of active HCMV infection in patients with SLE, we retrospectively reviewed clinical data of 105 inpatients in our department of Rheumatology and Clinical Immunology of Peking Union Medical College Hospital (PUMCH) diagnosed with both SLE and active HCMV infection from January 2006 to January 2012. Three groups were designated that included 42 cases of HCMV triggering SLE, 31 cases of HCMV exacerbating SLE, and 32 cases of HCMV mimicking SLE flare based on the relationship of HCMV infection and SLE. 1) Hematocytopenia (81%), fever (73.3%) and liver dysfunction (54.3%) were the most common clinical manifestations. The differences among the three groups with regard to butterfly erythema, cutaneous vasculitis, arthritis, serositis, central nervous system involvement and renal involvement were statistically significant (p < 0.05). 2) Positive rate of HCMV-pp65, compared with HCMV-IgM and HCMV-DNA, was the highest (84.9%) in patients with SLE and active HCMV infection. 3) Following 14-21 days of inductive treatment with ganciclovir, a total of 26 out of 56 patients were still positive with HCMV-IgM (nine of 19, 47.6%) and pp65 (17/37, 45.9%). Among them, seven cases suffered HCMV relapses in three months with six cases of sustained HCMV-pp65 antigenemia. In conclusion, hematocytopenia, fever and liver dysfunction should remind us to consider HCMV infection. Butterfly erythema, cutaneous vasculitis, arthritis, serositis, central nervous system involvement and renal lesion were relatively characteristic symptoms of lupus activity. HCMV-pp65 is a sensitive indicator to guide antiviral therapy. Induction therapy using ganciclovir with a duration of 14∼21 days is not sufficient, and continued HCMV-pp65 positivity may require prolonged antiviral treatment in lupus patients.

Involvement of adrenomedullin in spinal glial activation following chronic administration of morphine in rats

BACKGROUND

Adrenomedullin (AM) belongs to the calcitonin gene-related peptide (CGRP) family. Our previous studies show that chronic exposure to morphine increases spinal AM bioactivity, contributing to the development and maintenance of morphine tolerance. This study investigated the possible involvement of AM in morphine-evoked gliosis.

METHODS

Real-time polymerase chain reaction was performed to determine interleukin-1β (IL-1β), IL-6 and tumour necrosis factor-α (TNF-α) mRNAs in the spinal dorsal horn and cultured sensory ganglion explants. Immunohistochemistry was performed to identify spinal microglia and astrocytes.

RESULTS

Repetitive intrathecal (i.t.) injection of morphine (20 μg) increased the expression of IL-1β, IL-6 and TNF-α mRNAs in the spinal dorsal horn. The co-administration of the selective AM receptor antagonist AM22-52 (36 μg) markedly attenuated chronic morphine-evoked increase in IL-1β and IL-6, but not TNF-α, mRNA levels. Exposure of cultured dorsal root ganglion (DRG) explants to morphine (3.3 μmol/L) for 6 days up-regulated IL-1β and IL-6 mRNA expressions. The depletion of AM gene using small interfering RNA (siRNA) approach abolished morphine-evoked increase in IL-1β and IL-6 syntheses in the cultured DRG. The blockade of AM receptors by i.t. AM22-52 also inhibited chronic morphine-evoked cell hypertrophy of microglia and astrocytes as well as an increase in OX-42 and GFAP (glial fibrillary acidic protein) immunoreactivities. Furthermore, the 6-day treatment with AM (10 μg, i.t.) induced morphological changes of microglia and astrocytes as well as an increase in IL-1β, IL-6 and TNF-α mRNA levels in the spinal dorsal horn.

CONCLUSION

The present study supports the idea that up-regulation of the pronociceptive mediator AM can recruit spinal glial cells, resulting in an increase in cytokines during chronic use of morphine.

Chinese SLE Treatment and Research group (CSTAR) registry: II. Prevalence and risk factors of pulmonary arterial hypertension in Chinese patients with systemic lupus erythematosus

Objectives

To estimate the prevalence of pulmonary arterial hypertension (PAH) and risk factors for PAH in patients registered in the Chinese SLE Treatment and Research group (CSTAR) database, the first online registry of Chinese patients with systemic lupus erythematosus (SLE).

Methods

A prospective cross-sectional study of patients with SLE was conducted using the CSTAR registry. Resting transthoracic echocardiography was used to estimate pulmonary artery pressure (PAP); PAH was defined as systolic PAP (PASP) ≥40 mmHg. Patients with interstitial lung disease, valvular disease or cardiomyopathy were excluded because of disease influence on PAP. We explored potential risk factors for PAH including patient characteristics, organ involvement, laboratory findings and SLE disease activity.

Results

Of 1934 patients with SLE, 74 had PASP with 54.2 ± 17.1 (40,106) mmHg and were diagnosed with probable PAH. The incidences of lupus nephritis, pleuritis, pericarditis, hypocomplementemia, anti-SSA, and anti-ribonucleoprotein (RNP) were significantly higher in patients with PAH than in those without ( p<0.05). SLE disease activity was significantly higher in patients with PAH than in unaffected patients ( p<0.05). Multivariate analysis indicated that pericarditis (odds ratio (OR) = 4.248), pleuritis (OR = 3.061) and anti-RNP (OR = 2.559) were independent risk factors for PAH in patients with SLE ( p<0.05).

Conclusions

The possible prevalence of PAH was 3.8% in Chinese patients with SLE in the CSTAR registry. The significant association of pericarditis, pleuritis and anti-RNP positivity with PAH suggests that higher disease activity and vasculopathy may both contribute to the development of PAH in SLE, which need be treated aggressively to improve prognosis.

1/f noise in external-cavity InGaN diode laser at 420 nm wavelength for atomic spectroscopy

We have extensively studied the frequency noise and relative intensity noise spectra in a tunable external-cavity InGaN diode laser at blue (420 nm) wavelengths. We report flicker (1/f) frequency-noise behavior at low Fourier frequencies measured using offset frequency-absorption spectroscopy on 85Rb vapor cells, which yields an estimated lasing linewidth of 870 kHz. From considerations of high-dislocation density in III nitride epitaxy, 1/f noise and linewidth were expected to be larger than in conventional III-V lasers. Surprisingly, the measured noise characteristics are comparable to or better than those of near-infrared distributed feedback lasers and external-cavity diode lasers. The noise-reduction mechanism is attributed to the wavelength dependence of 1/f noise. We discuss challenges in atomic spectroscopy applications caused by defects and mode-clustering effect in GaN lasers. Using the Hakki-Paoli analysis in an aged laser diode, we provide possible explanation about the origin of observed mode clustering.

Association of vitamin D receptor gene polymorphisms with systemic lupus erythematosus: a meta-analysis

OBJECTIVES

Vitamin D receptor gene polymorphisms has been shown to be associated with systemic lupus erythematosus (SLE). Several studies have been published which have investigated the association between VDR gene polymorphisms with SLE risk, but the results have been inconclusive. The study was designed to investigate whether the vitamin D receptor gene polymorphisms are associated with the risk of SLE.

METHODS

A meta-analysis was conducted on associations between the vitamin D receptor gene polymorphisms and SLE using (1) allele contrast and (2) the recessive, (3) the dominant, and (4) the additive models.

RESULTS

A total of 11 case-control studies of 1683 patients and 1883 unrelated healthy individuals were included. The results of meta-analysis indicated that the BsmI and FokI polymorphisms are associated with increased risk of SLE. The overall ORs are 2.14 [95%CI (1.20-3.82), p=0.01] ( BB + Bb vs. bb) and 1.75 [95%CI(1.03-2.97), P=0.04]( FF + Ff vs. ff), respectively, while the ApaI and TaqI polymorphism were not associated. In subgroup analysis by ethnicity, the increased risk of SLE remained in the Asian subgroup for the BsmI and FokI polymorphism, whereas no significant association was found in other populations for other polymorphisms.

CONCLUSIONS

The current study suggested that the BsmI and FokI polymorphism are associated with increased risk of SLE, especially in the Asian population, but further studies are needed to confirm our results.

Lupus vasculopathy: Diagnostic, pathogenetic and therapeutic considerations

A rare form of vascular disease in systemic lupus erythematosus (SLE), lupus vasculopathy is characterized by necrosis and accumulation of immunoglobulins (IGs) and complements in the wall of arterioles and small arteries resulting in luminal narrowing. Lupus vasculopathy often accompanies lupus nephritis and portends a poor prognosis. Although there is general agreement on the treatment of lupus nephritis, effective treatment strategies for lupus vasculopathy remain to be defined. We report a 20-year-old woman with SLE who presented with generalized tonic-clonic seizure. Her immunosuppressive regimen consisted of mycophenolate mofetil, prednisone and hydroxychloroquine. On physical examination, she was Cushingoid in appearance and hypertensive. Laboratory tests indicated renal disease. Coagulation studies disclosed de novo lupus anticoagulant. Magnetic resonance imaging of the brain demonstrated acute focal cerebral hemorrhage. Echocardiography revealed reduced ejection fraction and severe mitral regurgitation. Despite high-dose glucocorticoids and mycophenolate mofetil, renal function remained poor. Kidney biopsy demonstrated lupus vasculopathy and glomerulonephritis. Plasma exchange therapy and intravenous cyclophosphamide were administered. Over the ensuing four weeks, renal function improved, complement levels increased, autoantibody titers decreased and lupus anticoagulant disappeared. In conclusion, lupus vasculopathy can occur in SLE despite a heavy immunosuppressive regimen. Antiphospholipid antibodies might be involved in the pathogenesis of lupus vasculopathy. Plasma exchange therapy in conjunction with intravenous cyclophosphamide may represent an effective treatment strategy for lupus vasculopathy.

Recombinant human arginase induced caspase-dependent apoptosis and autophagy in non-Hodgkin's lymphoma cells

Arginase, an arginine-degrading enzyme, has gained increased attention recently as a new experimental therapeutics for a variety of malignant solid cancers. In this study, we found that recombinant human arginase (rhArg) could induce remarkable growth inhibition, cell cycle arrest, and caspase-dependent apoptosis in Raji and Daudi non-Hodgkin's lymphoma (NHL) cells through arginine deprivation. Interestingly, rhArg-treatment resulted in the appearance of autophagosomes and upregulation of microtubule-associated protein light chain 3 II, indicating that rhArg induced autophagy in lymphoma cells. Further study suggested that mammalian target of rapamycin/S6k signaling pathway may be involved in rhArg-induced autophagy in NHL cells. Moreover, blocking autophagy using pharmacological inhibitors (3-methyladenine and chloroquine) or genetic approaches (small interfering RNA targeting autophagy-related gene 5 and Beclin-1) enhanced the cell killing effect of rhArg. These results demonstrated that rhArg has a potent anti-lymphoma activity, which could be improved by in combination with autophagic inhibitors, suggesting that rhArg, either alone or in combination with autophagic inhibitors, could be a potential novel therapeutics for the treatment of NHL.

Chinese SLE Treatment and Research group (CSTAR) registry: I. Major clinical characteristics of Chinese patients with systemic lupus erythematosus

The Chinese systemic lupus erythematosus (SLE) treatment and research group (CSTAR) provides major clinical characteristics of SLE in China and establishes a platform to provide resources for future basic and clinical studies. CSTAR originated as a multicentre, consecutive, and prospective design. The data were collected online from 104 rheumatology centers, which covered 30 provinces in China. The registered patients were required to meet four or more of the American College of Rheumatology (ACR) criteria for the classification of SLE. All CSTAR centers use the same protocol-directed methods to provide uniform evaluations, which included demographic data, clinical features, laboratory examinations, and disease activity evaluations. The patient samples, including DNA samples and sera, were also collected for further quality controls and additional studies. Preliminary analysis from 2104 baseline evaluations was available for this analysis. Of 1914 female and 190 male patients (F:M=10.1), the mean age at onset was 29.2 y with confirmed diagnosis one year later at the age of 30.3 y. Eighty four (4.2%) of 2002 patients had a family history of rheumatic diseases, including 34 (1.7%) cases with SLE. In addition, one hundred and seven (5.2%) abnormal pregnancies were recorded among 2026 experiences. The characteristics of the CSTAR cohort were compared to similarly sized cohorts from other studies. We found that 56.1% of patients presented with concurrent hematological disorders compared to only 18.2% of European patients. Moreover, 47.4% of patients presented with nephropathy compared to 27.9% of European patients. Conversely, neurological manifestations were only seen in 4.8% of Chinese SLE patients compared to 19.4% of European patients, 12.1% of U.S. patients, 22.8% of Malaysian patients and 26.4% of Latin Americans. Pulmonary arterial hypertension and interstitial lung diseases were complications identified in 3.8% and 4.2% of Chinese lupus patients, respectively. The CSTAR registry has provided epidemiological data and phenotypes of Chinese patients with SLE, and has demonstrated several differences between ethnicities. Clinical data and biologic samples would be valuable resources for future translational studies with national and international collaboration.

Focal dermal hypoplasia: updates

Focal dermal hypoplasia (FDH), or Goltz-Gorlin syndrome, is a rare syndrome and may result in multisystem disorders. Several reviews of FDH have been published. However, the last comprehensive review of this disorder appeared more than 20 years ago. To date, a number of new clinical manifestations have been reported and considerable knowledge has accumulated regarding etiology and pathogenetic mechanisms. The purpose of this review is to gather these more recent data and to provide organized and reliable information. So we reviewed 159 cases of FDH that had been reported from 1990 to 2012, summarized the new discoveries, and suggested a potential standard for the diagnosis of FDH. We also reported on a Chinese girl with FDH, who was clinically and histologically in accord with FDH, as an example.

Sensitivity analysis of multilayer perceptron to input and weight perturbations

An important issue in the design and implementation of a neural network is the sensitivity of its output to input and weight perturbations. In this paper, we discuss the sensitivity of the most popular and general feedforward neural networks--multilayer perceptron (MLP). The sensitivity is defined as the mathematical expectation of the output errors of the MLP due to input and weight perturbations with respect to all input and weight values in a given continuous interval. The sensitivity for a single neuron is discussed first and an analytical expression that is a function of the absolute values of input and weight perturbations is approximately derived. Then an algorithm is given to compute the sensitivity for the entire MLP. As intuitively expected, the sensitivity increases with input and weight perturbations, but the increase has an upper bound that is determined by the structural configuration of the MLP, namely the number of neurons per layer and the number of layers. There exists an optimal value for the number of neurons in a layer, which yields the highest sensitivity value. The effect caused by the number of layers is quite unexpected. The sensitivity of a neural network may decrease at first and then almost keeps constant while the number increases.

Antioxidant capacity and mineral contents of edible wild Australian mushrooms

Five selected edible wild Australian mushrooms, Morchella elata, Suillus luteus, Pleurotus eryngii, Cyttaria gunnii, and Flammulina velutipes, were evaluated for their antioxidant capacity and mineral contents. The antioxidant capacities of the methanolic extracts of the dried caps of the mushrooms were determined using a number of different chemical reactions in evaluating multi-mechanistic antioxidant activities. These included the Trolox equivalent antioxidant capacity, ferric ion reducing antioxidant power, and ferrous ion chelating activity. Mineral contents of the dried caps of the mushrooms were also determined by inductively coupled plasma-optical emission spectroscopy. The results indicated that these edible wild mushrooms have a high antioxidant capacity and all, except C. gunnii, have a high level of several essential micro-nutrients such as copper, magnesium, and zinc. It can be concluded that these edible wild mushrooms are good sources of nutritional antioxidants and a number of mineral elements.

Analysis of properties and proinflammatory functions of cockroach allergens Per a 1.01s

Cockroaches have been identified as one of the major indoor allergens inducing perennial rhinitis and asthma. Per a 1s are a group of the major allergens from American cockroach. Although Per a 1s are major allergens from American cockroach, factors contributing to the allergenicity of Per a 1s are still poorly defined. To investigate the effects of Per a 1s on the expression of PARs and the release of proinflammatory cytokines from mast cells. Per a 1.0101 and Per a 1.0104 were cloned from American cockroach and then expressed in Eschericia coli. The purified allergens were used to stimulate P815 mast cells, and the expression of protease-activated receptors (PARs) was determined by real-time RT-PCR and flow cytometry. The levels of IL-4 and IL-13 in culture media were detected with ELISA. Sera from 80 and 77.3% of cockroach allergy patients reacted to recombinant Per a (rPer a) 1.0101 and rPer a 1.0104, confirming they are major allergens. Both rPer a 1.0101 and rPer a 1.0104 had no enzymatic activity, but rPer a 1.0101 upregulated the expression of PAR-1 and PAR-2, and rPer a 1.0104 enhanced the expression of PAR-1 and PAR-4 proteins. Both recombinant allergens were able to increase the release of IL-4 and IL-13 from P815 mast cells. This is the first study aiming to investigate functions of group 1 allergens of American cockroach. rPer a 1.0101 and rPer a 1.0104 have the capacity to upregulate the expression of PARs and to enhance Th2 cytokine production in mast cells.