Analysis of RAG expression by peripheral blood CD5+ and CD5- B cells of patients with childhood systemic lupus erythematosus

BACKGROUND

The assembly of immunoglobulin genes during B cell development in the bone marrow is dependent on the expression of recombination activating genes (RAG) 1 and 2. Recently, RAG expression in peripheral blood IgD+ B cells outside the bone marrow has been demonstrated and is associated with the development of autoimmune diseases.

OBJECTIVE

To investigate RAG expression in the CD5+ or CD5- IgD+ B cell compartment in childhood systemic lupus erythematosus (SLE).

METHODS

Using a combination of flow cytometric cell sorting and reverse transcriptase polymerase chain reaction analysis of cDNA libraries generated from individual cells, the expression of RAG, VpreB, and CD154 mRNA by individual peripheral blood B cells of three paediatric SLE patients was examined in detail.

RESULTS

While only one patient had a significantly increased frequency of RAG+ B cells in the CD5- B cell population, all patients showed higher frequencies of RAG+ B cells in the CD5+IgD+ B cell population. The frequency of RAG+ IgD+CD5+/- B cells was reduced during intravenous cyclophosphamide treatment. In healthy age matched children, RAG expressing IgD+ B cells were hardly detectable. Coexpression of RAG and VpreB or CD154 mRNA could only be found in SLE B cells.

CONCLUSIONS

RAG expression in peripheral blood B cells of SLE patients is particularly increased in the IgD+CD5+ B cell population. CD5+ and CD5- B cells in SLE have the potential to undergo receptor revision leading to the generation of high affinity pathogenic autoantibodies.

Biochemical and molecular markers in renal cell carcinoma: an update and future prospects

Cancer is a big problem in the developed world as well as in developing countries. Renal cell carcinoma (RCC) accounts for approximately 3% of adult malignancies and 90-95% of neoplasms arising from the kidney. RCC is more common in men than in women (2:1), and it most often occurs in patients between the ages of 50-70 years. In all cancers the cancerous cells release particular kind of proteins (called tumour markers) and blood tests are used to detect the presence of these markers. These tumour markers nowadays are an area of interest for oncologists who search for a possible solution in the detection and treatment of RCC. Different kinds of biochemical and molecular markers such as ferritin, MN/CA9, apoptotic index, p53, IL-2, gamma-enolase, CD44, CD95, chromosome instability and loss of heterozygosity have been tested in RCC, but so far no marker fulfils one or the other criteria to be considered as an ideal marker for RCC. This review gives basic and updated information about the different kinds of biomarkers studied in RCC and about the role implementation of genomics and proteomics in RCC.

Pituitary adenomas in childhood

Pituitary adenomas are common tumors composed of adenohypophysial cells. Although they usually arise in the sella turcica, they may occasionally be ectopic. Pituitary adenomas are rarely diagnosed in childhood and adolescence, but their mass effect and endocrine abnormalities can compromise both quality and length of life. Many signs or symptoms of pituitary adenoma, complained of in adulthood, not became evident during adolescence, suggesting true prevalence of this tumor in teenagers is higher than expected. Pititury adenoma occuring during adolescence are associated with features or therapeutic needs sometimes different from those occuring in adulthood. At the onset of disease, delay in growth was rarely observed in teenagers with pituitary adenomas. Many girls complain of oligoamenorrhoea and galactorrhoea, while headache and delay in pubertal development are the most commons features in boys. Hypopituitarism is occasionally encountered in adolescence. Early diagnosis and appropriate choice of therapy are necessary to avoid permanent endocrine complications of disease and its treatment.

Prevalence of GAD65 antibodies in lean subjects with type 2 diabetes

While type 2 diabetic subjects in developed countries are predominantly obese or overweight, those in India are often nonobese or lean. The reasons for leanness in these subjects has not been well understood. We assessed the prevalence of pancreatic islet autoimmunity in 83 lean adult subjects (BMI < 18.5 kg/m(2)) with type 2 diabetes by measuring antibodies to glutamic acid decarboxylase-65 (GAD Abs). Positivity to GAD Ab was present in 21 (25.3%) subjects. In addition, subjects with GAD Ab positivity were younger and had lower beta cell function (homeostasis model assessment, HOMA) as compared to the GAD Ab-negative group. This suggests that the antibody-positive group could have a slowly progressive form of type 1 diabetes.

Differential expression of chemokines in synovial cells exposed to different Borrelia burgdorferi isolates

OBJECTIVE

Lyme borreliosis is characterized by strong inflammatory reactions probably due to the presence of Borrelia burgdorferi in the joint. It has been suggested that Borrelia induces the immunological mechanisms that either can amplify the inflammatory response or can suppress it. To reveal the underlying mechanisms of chemoattraction and activation of responding leukocytes, we investigated the induction of chemokines in human synoviocytes exposed to two different B. burgdorferi sensu stricto isolates (strain Geho and B31).

METHODS

Synoviocytes were exposed in vitro up to 5 days. Semiquantitative reverse transcription polymerase chain reaction (RT-PCR) was used to assess the relative chemokine mRNA expression of RANTES/CCL5, SDF-1alpha/CXCL12 alpha, SDF-1beta/CXCL12 beta, MCP-1/CCL2, MCP-2/CCL8, IL-8/CXCL8 and MIP-1alpha/CCL3, and enzyme-linked immunosorbant assay (ELISA) was used to assess the protein expression of RANTES, SDF-1, MCP-1, and MIP-1alpha in the culture supernatant.

RESULTS

MCP-1 gene expression was not changed by strain B31 but MCP-1 gene expression along with protein concentration was suppressed by strain Geho. Both strains induced RANTES mRNA and protein concentration. SDF-1 gene expression was suppressed, whereas protein concentrations were unchanged by both strains. IL-8 gene expression was unchanged by using strain Geho but significantly upregulated by strain B31. Both strains induced MCP-2 mRNA expression. MIP-1alpha mRNA expression was induced, but chemokine concentration was suppressed by both strains.

CONCLUSION

This study suggests that the orchestra of chemokines plays an important role in the immunopathogenesis of early Lyme arthritis.

Mutation C677T in the methylenetetrahydrofolate reductase gene is associated with male infertility in an Indian population1

A mutation (C677T) in the gene, MTHFR, is known to increase susceptibility to various multifactorial disorders. In order to assess this single nucleotide polymorphism (SNP) as risk factor for idiopathic male infertility, a case-control study was done on an Indian population. DNA from 151 cases of non-obstruction, idiopathic oligo-/azoospermia and 200 fertile males (controls) was polymerase chain reaction amplified using site-specific primers, and analysed for the mutation following HinfI-digestion. Our results show a significantly increased frequency of CT heterozygotes among infertile patients (p value <0.04). More importantly, while there were no T homozygotes in the control population, six of 151 infertile cases were T homozygous. Considering that T allele occurs in very low frequency in the control population, 677T is clearly a risk factor for infertility in the Indian population. We contend that the same could also be true for African and Southeast Asian populations where the frequency of 677T is very low. The lack of similar association in western populations could be because of the overall dietary enrichment of folates, which could nullify or minimize the effect of this polymorphism.

Beneficial effects of probiotics and prebiotics on human health

The primary role of a diet is not only to provide enough nutrients to fulfill metabolic requirements of the body but also to modulate various functions of the body. Probiotics, prebiotics and synbiotics are either beneficial microorganisms or substrates that facilitate the growth of these microorganisms which can be suitably harnessed by the food manufacturers and holds considerable promise for health care industry. Regardless of sufficient health benefits of these, there is a need to carry a multidisciplinary approach on safety evaluation as the conventional toxicological approach has various limitations. This article gives an overview of probiotics and prebiotics, their health effects, mode of action, growth and survival in GIT, quality assurance criteria and safety including future prospects.

A high throughput approach for simultaneous estimation of multiple synthetic trioxane derivatives using sample pooling for pharmacokinetic studies

The present study describes the application of concept of sample pooling to increase the throughput of pharmacokinetic screening at drug discovery and development stage. An HPLC-UV method for the simultaneous estimation of three synthetic antimalarial compounds 99/357, 99/408 and 99/411 has been developed and validated in rat serum with internal standard for pharmacokinetic profiling. Drug compounds in serum were extracted by two-step liquid-liquid extraction with 2% isopropyl alcohol in n-hexane and quantitated using a validated gradient HPLC-UV method, which was made feasible for all compounds using gradient elution scheme. The method was validated in terms of HPLC reproducibility, linearity, specificity, recovery, accuracy and precision, freeze thaw stability and long-term storage stability. Excellent linear relationships (r>0.99) were obtained for calibration as well as analytical standards over a concentration range of 25-1000 ng/ml for three analytes. Recoveries were fond to be >85% for 99/408 and 99/357 and >70% for 99/411. The method developed for three analytes was found to be accurate and precise as bias and percent relative standard deviation (% R.S.D.) values were within limits (<20%). By employing sample pooling approach, plasma level - time profile following single intravenous dose of all three compounds were obtained in a fraction of the time required by conventional single compound dosing and analysis.

Urethrovasocutaneous Fistula in a Case of Anterior Urethral Stricture

The occurrence of an urethrovasocutaneous fistula is an extremely rare event. We report the first case of such a fistula in a patient with anterior urethral stricture. The patient had epididymo-orchitis preceding the occurrence of the fistula. Increased intravesical and intraurethral pressure during voiding and the patulous ejaculatory ducts were the predisposing factors in this case. The patient was managed successfully by visual internal urethrotomy, bilateral vasectomy and excision of the fistula.

The burden of diabetes and impaired glucose tolerance in India using the WHO 1999 criteria: prevalence of diabetes in India study (PODIS)

This random multistage cross-sectional population survey was undertaken to determine the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in subjects aged 25 years and above in India. The study was carried out in 77 centers (40 urban and 37 rural). 18363 (9008 males and 9355 females) subjects were studied. 10617 (5379 males and 5238 females) were from urban areas and 7746 (3629 males and 4117 females) from rural areas. Blood samples were taken after a fast of 10-12 h and 2 h after 75 g of oral glucose. Subjects were categorized as having IGT or DM using the World Health Organisation (WHO) (1999) criteria. The standardized prevalence rate for DM in the total Indian, urban and rural populations was 4.3, 5.9 and 2.7%, respectively. The corresponding IGT rates in the three populations was 5.2, 6.3 and 3.7%, respectively. The urban prevalence of DM and IGT was significantly greater than in the rural population (P < 0.001 in both instances). The prevalence of DM was significantly, more than that of IGT (P < 0.001) within both the rural and urban populations. Type 2 diabetes is a major health problem is India.

Differential expression of matrix metalloproteinases and cyclooxygenases in synovial cells exposed to Borrelia burgdorferi

OBJECTIVE AND DESIGN

Lyme arthritis is characterized by strong inflammatory reactions probably due to the presence of Borrelia burgdorferi in the joint. It has been suggested that Borrelia adopts different molecular mechanisms that either can amplify the host's inflammatory response or can suppress it. In the present study we analyzed the induction of matrix metalloproteinases (MMPs) and cyclooxygenases (COXs) in human synoviocytes exposed to different B. burgdorferi sensu stricto isolates (Geho and B31).

MATERIALS AND METHODS

Synoviocytes were exposed in vitro for 12 h up to 5 days. Semiquantitative reverse transcription polymerase chain reaction was used to assess the mRNA expression of MMP-1 to 13, COX-1 and COX-2. Prostaglandin E2 (PGE2) production was assessed by ELISA.

RESULTS

MMP-1 was unchanged in synovial cells exposed to strain Geho, whereas it was downregulated by strain B31. MMP-13 was downregulated by both strains. COX-2 was upregulated by strain B31, which resulted in increased PGE2 concentration in the supernatant. In contrast, COX-1 was slightly upregulated and COX-2 tended to be downregulated by Geho resulting in a decreased PGE2 concentration.

CONCLUSIONS

The differential expression of MMPs and COXs suggests that different B. burgdorferi strains influence different molecular mechanisms leading to chronic inflammation. This might be reflected in the clinical variability among Lyme arthritis patients.

Comparing the ADA 1997 and the WHO 1999 criteria: Prevalence of Diabetes in India Study

This random multistage cross-sectional population survey was undertaken to determine the prevalence of type 2 diabetes mellitus (DM) in subjects aged 25 years and above in India. The study was carried out in 77 centres (42 urban and 35 rural) to reflect the size and heterogeneity of the Indian population. 18,363 (9008 male and 9355 female) subjects were studied. 10,617 (5379 males and 5238 females) were from urban areas and 7746 (3629 males and 4117 females) from rural areas. Blood samples were taken after a fast of 10-12 and 2 h after 75 g of oral glucose. Subjects were categorized as having impaired fasting glycemia (IFG) or DM using the 1997 ADA or having impaired glucose tolerance (IGT) or DM using the 1999 WHO criteria. The age- and gender-standardized prevalence rate for DM using the ADA criteria was 3.6% whilst that using the WHO criteria was 4.3% (P < 0.001). The respective standardized prevalence of DM, using the two criteria was, 4.7 and 5.6%, respectively (P < 0.001) in the urban Indian population and 2.0 and 2.7% (P < 0.02) in the rural Indian population. Using the WHO criteria, 581 subjects were newly diagnosed whilst the ADA criteria newly diagnosed 437 subjects. The respective numbers for the urban population were 425 and 323, and for the rural population were 146 and 114, respectively. The ADA criteria could diagnose 75.2, 76.0 and 73.0% of the subjects who had DM as per the WHO criteria. Of 739 Indian subjects who had IFG, 106 (14.3%) were diagnosed as having DM by the WHO criteria whilst 505 (68.3%) had values compatible with a diagnosis of IGT. Of the 536 urban subjects with IFG, 74 (13.8%) had DM and 350 (65.3%) had IGT using the WHO criteria. Of the 302 rural subjects with IFG, 32 (15.8%) had DM and 155 (76.3%) had IGT using the WHO criteria. 505 (49.9%) of 1012 Indian subjects with IGT as per the WHO criteria had IFG. 350 (47.7%) of 733 urban subjects and 155 (55.5%) of 279 rural subjects with IGT had values compatible with IFG as per the ADA criteria. Type 2 diabetes is a major health problem is India. The use of the ADA criteria would underestimate the prevalence of DM by not diagnosing subjects showing a poor response to a glucose challenge. This along with the discrepancies between subjects showing IGF or IGT could be a challenge to any prevention program.

Toxicological effect and biochemical alterations induced by different fractions of Euphorbia royleana latex in freshwater harmful vector snail Lymnaea acuminata

Laboratory evaluation was made to assess the molluscicidal activity of different fractions of Euphorbia royleana (Family- Euphorbiaceae) latex obtained through sephadex gel column against freshwater snail Lymnaea (Radix) acuminata Lamarack. This snail is the vector of liver fluke, Fasciola hepatica Linnaeus and Fasciola gigantica Cobbold, which causes endemic fascioliasis in cattle and livestock. The toxic effect of the different fractions was time dependent and fifth fraction obtained through benzene: ethyl acetate (5:5) had maximum molluscicidal activity against Lymnaea acuminata. There was a significant negative correlation between LC values and exposure periods thus increase in exposure time, the LC50 value of V fraction of Euphorbia royleana latex was decreased from 14.28 mg/l (24 hr) to 9.28 mg/l (96 hr) against Lymnaea acuminata. After exposure to sub-lethal concentrations of this fraction there were significant time and dose dependent alterations observed in pyruvate, lactate levels, ALAT, AAT, AChE and cytochrome oxidase enzyme activities in different body tissues of Lymnaea acuminata. It is proposed that the fifth fraction of E. royleana latex can be used as a molluscicide for controlling the harmful snail population from aquatic ecosystem without any harm due to their reversible toxic action.

Polyglandular autoimmune endocrinopathy in type 2 diabetes

Polyglandular autoimmunity (PGA) type 2 presenting in childhood is extremely rare. We report a case of type 2 PGA who had hypothyroidism, followed by diabetic ketoacidosis and was later diagnosed to have adrenal insufficiency also.

The burden of diabetes and impaired fasting glucose in India using the ADA 1997 criteria: prevalence of diabetes in India study (PODIS)

This random multistage cross sectional population survey was undertaken to determine the prevalence of diabetes mellitus (DM) and impaired fasting glycemia/glucose (IFG) in subjects aged 25 years and above in India. The study was carried out in 108 centers (49 urban and 59 rural) to reflect the size and heterogeneity of the Indian population. 41,270 (20,534 males and 20,736 females) subjects were studied. 21,516 (10,865 males and 10,651 females) were from urban areas and 19,754 (9669 males and 10,085 females) from rural areas. Blood samples were taken after a fast of 10-12h and the subjects were categorized as having IFG or DM using the 1997 American Diabetes Association criteria. The age and gender standardized prevalence rate for DM and IFG in the total Indian population was 3.3 and 3.6% respectively (P < 0.001). The standardized prevalence of DM and IFG in urban areas was significantly higher than that for the rural population (urban DM prevalence 4.6% versus rural DM prevalence 1.9%, P < 0.001; urban IFG prevalence 4.8% versus rural IFG prevalence 2.5%, P < 0.001). There was no statistically significant difference in the prevalence between DM (4.6%) and IFG (4.8%) in the urban population. The rural prevalence of IFG (2.5%) was significantly (P <0.001) more than the rural prevalence of DM (1.9%). Type 2 diabetes is a major health problem is India.

Three-legged pair of pants anastomosis: a rare technique for renal transplantation

Because of the shortage of donors, kidneys previously judged to be unsuitable are now accepted for transplantation. Successful engraftment of kidneys with multiple renal arteries is one of the challenges and requires meticulous vascular surgical technique. In one of our case of renal allograft with three renal arteries, we created a single lumen by suturing three arteries together, like a three-legged pair of pants. The end of the single lumen was anastomesed to the side of external iliac artery. There was brisk diuresis on table after transplantation. Postoperatively, the patient had an uneventful course and normal graft function.

HPLC-UV method for assaying 99/357, a synthetic trioxane antimalarial derivative in rat and rabbit serum

In the present study an accurate and precise HPLC-UV assay method in rat and rabbit serum has been developed and validated for determination of 99/357--a new synthetic analogue of artemisinin developed by Central Drug Research Institute (CDRI), of the class of trioxane derivative. Separation was achieved using a C-18 reversed phase column with a mobile phase comprising of acetonitrile and deionized water (80:20%, v/v) using a UV detector, set at a wavelength of 266 nm. The method, applicable to 200 microl serum, involved double extraction of the samples with 20% isopropyl alcohol (IPA) in n-hexane. The recovery of 99/357 in the two matrices was >90%. The method was sensitive with a limit of quantitation of 25 ng/ml in both rat and rabbit matrices. Precision and accuracy were within the acceptable limits, as indicated by relative standard deviation (accuracy) varying from -12.7 to 5.7% and bias (precision) values ranging from 0.6 to 11.8%. Moreover, 99/357 was stable in serum up to 30 days of storage at -60 degrees C and after being subjected to three freeze/thaw cycles. The method will be applied to perform pharmacokinetic studies of 99/357.

Lyme borreliosis: from infection to autoimmunity

Lyme borreliosis in humans is an inflammatory disease affecting multiple organ systems, including the nervous system, cardiovascular system, joints and muscles. The causative agent, the spirochaete Borrelia burgdorferi, is transmitted to the host by a tick bite. The pathogenesis of the disease in its early stages is associated largely with the presence of viable bacteria at the site of inflammation, whereas in the later stages of disease, autoimmune features seem to contribute significantly. In addition, it has been suggested that chronic persistence of B. burgdorferi in affected tissues is of pathogenic relevance. Long-term exposure of the host immune system to spirochaetes and/or borrelial compounds may induce chronic autoimmune disease. The study of bacterium-host interactions has revealed a variety of proinflammatory and also immunomodulatory-immunosuppressive features caused by the pathogen. Therapeutic strategies using antibiotics are generally successful, but chronic disease may require immunosuppressive treatment. Effective and safe vaccines using recombinant outer surface protein A have been developed, but have not been propagated because of fears that autoimmunity might be induced. Nevertheless, new insights into the modes of transmission of B. burgdorferi to the warm-blooded host have been generated by studying the action of these vaccines.

Concentration of a potent calcium oxalate monohydrate crystal growth inhibitor in the urine of normal persons and kidney stone patients by ELISA-based assay system employing monoclonal antibodies

Standardized calcium oxalate monohydrate (COM) crystal growth assay system was employed to study the ability of various test samples to influence growth rates of COM crystals. The inhibitory activity (IA) of various samples was expressed in terms of inhibitory units. Urine samples obtained from normal persons and kidney stone patients were found to have IA of 3.18 +/- 0.62 and 1.02 +/- 0.08, respectively. A potent inhibitor having molecular weight between 14.2 and 16.2 kDa was found to be primarily responsible for the differences observed in the urinary IAs between normal persons and kidney stone patients. The potent inhibitor was found to be tightly associated with a chromophore resembling Urobilirubin. An ELISA based assay system, using monoclonal antibodies against the above most potent inhibitor confirmed the difference observed in the urinary IA between the normal persons and kidney stone patients. This assay system has the potential to be routinely used to screen human beings for potential stone formers.

Frequency of leptospirosis in patients of acute febrile illness in Uttar Pradesh

OBJECTIVE

This study was performed to asses the disease burden of leptospirosis in and around Lucknow among patients presenting with acute febrile illness and conforming to the case definition of leptospirosis.

METHODS

A total of 346 serum samples (mostly paired) and an equal number of urine samples were collected from patients presenting with acute febrile illness and fulfilling the criteria of clinical diagnosis of leptospirosis from January 2001 to December 2001. Patients attending a tertiary care hospital as well as from various communities in and around Lucknow were included in this study. All sera and urine samples were tested for the presence of IgM antibody by Leptodipstick test and by dark-field microscopy (DFM) respectively. All positive and 10% negative sera were tested at national leptospirosis reference centre at Andaman and Nicobar Islands for microagglutination test (MAT).

RESULTS

IgM antibody was detected in 25/346 (7%) patients ranging in age from 9-65 years. DFM was positive in only in one case. MAT was positive in 4/17 cases tested and the prevalent serogroups were L. grippotyphosa and L. pomona in two each. Common presenting features in these patients were fever (25/25) and jaundice (17/25). History of contact with animal or water contaminated with animal urine was present in 96% cases.

CONCLUSION

Leptospirosis is not uncommon in Uttar Pradesh. However larger epidemiological studies are required to know the actual disease burden. Dark-field microscopy is an insensitive method for the diagnosis of leptospirosis and is not suitable for surveillance.

Idiopathic cases of male infertility from a region in India show low incidence of Y-chromosome microdeletion

Chromosomal and Y-chromosomal microdeletion analysis has been done in cases of idiopathic infertility with the objective of evaluating the frequency of chromosomal and molecular anomaly as the causal factor of infertility. Barring a few cases of Klinefelter syndrome (XXY or XY/XXY mosaics), no chromosomal anomaly was encountered. Y-microdeletion was analysed by PCR-screening of STSs from different regions of the AZF (AZFa, AZFb, AZFc) on the long arm of the Y, as well as by using DNA probes of the genes RBM, DAZ (Yq), DAZLA (an autosomal homologue of DAZ) and SRY (Yp; sex determining gene). Out of 177 cases examined, 9 (azoospermia - 8 and oligoasthenospermia - 1) showed partial deletion of AZF. The size of deletion varied among patients but AZFc was either totally or partially removed in all of them. In contrast, no deletion was detected in AZFa. Testis biopsy done on a limited number of cases (50) showed diverse stages of spermatogenic arrest with no specific correlation with the genotype. The frequency of Y-chromosome microdeletion in our samples (approximately 5%) is much lower than the frequency (approximately 10%) reported globally and the two previous reports from India. We contend that the frequency may be affected by population structures in different geographical regions.