Platelet-released supernatant induces osteoblastic differentiation of human mesenchymal stem cells: potential role of BMP-2

Platelet-rich preparations have recently gained popularity in maxillofacial and dental surgery, but their beneficial effect is still under debate. Furthermore, very little is known about the effect of platelet preparations at the cellular level, and the underlying mechanisms. In this study, we tested the effect of platelet-released supernatant (PRS) on human mesenchymal stem cell (MSC) differentiation towards an osteoblastic phenotype in vitro. Cultures of MSC were supplemented with PRS and typical osteoblastic markers were assessed at up to 28 days post-confluence. PRS showed an osteoinductive effect on MSC, as shown by an increased expression of typical osteoblastic marker genes such as collagen Ialpha1, bone sialoprotein II, BMP-2 and MMP-13, as well as by increased ⁴⁵Ca²+ incorporation. Our results suggest that the effect of PRS on human MSC could be at least partially mediated by BMP-2. Activated autologous PRS could therefore provide an alternative to agents like recombinant bone growth factors by increasing osteoblastic differentiation of bone precursor cells at bone repair sites, although further studies are needed to fully support our observations.

Atherosclerotic vascular events in a multinational inception cohort of systemic lupus erythematosus

OBJECTIVE

To describe vascular events during an 8-year followup in a multicenter systemic lupus erythematosus (SLE) inception cohort and their attribution to atherosclerosis.

METHODS

Clinical data, including comorbidities, were recorded yearly. Vascular events were recorded and attributed to atherosclerosis or not. All of the events met standard clinical criteria. Factors associated with atherosclerotic vascular events were analyzed using descriptive statistics, t-tests, and chi-square tests. Stepwise multivariate logistic regression was used to assess the association of factors with vascular events attributed to atherosclerosis.

RESULTS

Since 2000, 1,249 patients have been entered into the cohort. There have been 97 vascular events in 72 patients, including: myocardial infarction (n = 13), angina (n = 15), congestive heart failure (n = 24), peripheral vascular disease (n = 8), transient ischemic attack (n = 13), stroke (n = 23), and pacemaker insertion (n = 1). Fifty of the events were attributed to active lupus, 31 events in 22 patients were attributed to atherosclerosis, and 16 events were attributed to other causes. The mean +/- SD time from diagnosis to the first atherosclerotic event was 2.0 +/- 1.5 years. Compared with patients followed for 2 years without atherosclerotic events (n = 615), at enrollment, patients with atherosclerotic vascular events were more frequently white, men, older at diagnosis of SLE, obese, smokers, hypertensive, and had a family history of coronary artery disease. On multivariate analysis, only male sex and older age at diagnosis were associated factors.

CONCLUSION

In an inception cohort with SLE followed for up to 8 years, there were 97 vascular events, but only 31 were attributable to atherosclerosis. Patients with atherosclerotic events were more likely to be men and to be older at diagnosis of SLE.

ICF Core Set for patients with musculoskeletal conditions in the acute hospital

PURPOSE

The aim of this consensus process was to decide on a first version of the ICF Core Set for patients with musculoskeletal conditions in the acute hospital.

METHODS

The ICF Core Set development involved a formal decision-making and consensus process integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients.

RESULTS

Twenty-one experts selected a total of 47 second-level ICF categories. The largest number of categories was selected from the ICF component Body Functions (17 categories or 36%). Nine (19%) of the categories were selected from the component Body Structures, 11 (23%) from the component Activities and Participation, and 10 (21%) from the component Environmental Factors.

CONCLUSION

The Acute ICF Core Set for patients with musculoskeletal conditions provides all professionals with a clinical framework to comprehensively assess patients in the acute hospital. This first ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.

[Towards the Swiss systemic lupus erythematosus cohort study (SSCS)]

Systemic lupus erythematosus (SLE) is a rare disease mainly affecting women of childbearing age. It is characterized by a very large spectrum of clinical manifestations accompanied by prototypic abnormalities of the immune system. While recent advances in therapeutic approaches have taken place, SLE still has a profound impact on the quality of life and life expectancy of affected persons. The Swiss cohort for longitudinally studying SLE named SSCS responds to the necessity of better understanding the history of the disease, the mechanisms involved in its pathogenesis, to identify and apply new therapeutic and prevention strategies, as well as to analyze the impact that SLE has at the social and personal levels in Switzerland. SSCS is a tool to be used by all researchers interested to provide answers to the many open questions in SLE.

Systemic lupus international collaborating clinics renal activity/response exercise: development of a renal activity score and renal response index

OBJECTIVE

To develop a measure of renal activity in systemic lupus erythematosus and use it to develop a renal response index.

METHODS

Abstracted data from the medical records of 215 patients with lupus nephritis were sent to 8 nephrologists and 29 rheumatologists for rating. Seven nephrologists and 22 rheumatologists completed the ratings. Each physician rated each patient visit with respect to renal disease activity (none, mild, moderate, or severe). Using the most commonly selected rating for each patient as the gold standard, stepwise regression modeling was performed to identify the variables most related to renal disease activity, and these variables were then used to create an activity score. This activity score could then be applied to 2 consecutive visits to define a renal response index.

RESULTS

The renal activity score was computed as follows: proteinuria 0.5-1 gm/day (3 points), proteinuria 0.5-1 gm/day = 3 points, proteinuria >1-3 gm/day = 5 points, proteinuria >3 gm/day = 11 points, [corrected] urine red blood cell count > = 5/hpf = 3 points, [corrected] urine white blood cell count > or = 5/hpf = 1 point. [corrected] The chance-adjusted agreement between the renal response index derived from the activity score applied to the paired visits and the plurality physician response rating was 0.69 (95% confidence interval 0.59-0.79).

CONCLUSION

Ratings derived from this index for rating of renal response showed reasonable agreement with physician ratings in a pilot study. The index will require further refinement, testing, and validation. A data-driven approach to create renal activity and renal response indices will be useful in both clinical care and research settings.

Systemic lupus international collaborating clinics renal activity/response exercise: comparison of agreement in rating renal response

OBJECTIVE

To assess the degree to which physicians agree with each other and with ratings obtained with 3 existing responder indices, in rating the response to treatment of lupus nephritis.

METHODS

Lupus nephritis patient medical records from 125 pairs of visits (6 months apart) were used to create renal response scenarios. Seven nephrologists and 22 rheumatologists rated each scenario as demonstrating complete response, partial response, same, or worsening. The plurality (most frequent) rating of renal response by the physicians was compared with the calculated score from the renal component of the British Isles Lupus Assessment Group (BILAG) index (original and updated [2004] version) and of the Responder Index for Lupus Erythematosus (RIFLE). The degree of agreement among the physicians was assessed by calculating intraclass correlation coefficients (ICCs). The degree of agreement between the plurality physician rating and ratings obtained with the established response indices was assessed using the kappa statistic.

RESULTS

The ICC among all physicians was 0.64 (0.62 for nephrologists and 0.67 for rheumatologists). The chance-adjusted measure of agreement (kappa coefficient) between the plurality physician rating and the calculated score obtained using established indexes was 0.50 (95% confidence interval [95% CI] 0.38-0.61) for the RIFLE, 0.14 (95% CI 0.03-0.25) for the original BILAG, and 0.23 (95% CI 0.21-0.44) for the BILAG 2004.

CONCLUSION

These findings indicate that rheumatologists as a group and nephrologists as a group have equal agreement in their rating of renal response. There was moderate agreement between plurality physician ratings and ratings obtained using the renal component of the RIFLE. Ratings of response using an index based on the original BILAG did not have good agreement with the plurality physician rating.

[Are there associations of health status, disease activity and damage in SLE patients?---Results of a study of a cohort of a Swiss specialized outpatient clinic]

AIM

To study the relationship between self assessed health status of patients with Systemic Lupus Erythematosus (SLE), lupus activity, damage, patients' age and disease duration in a cohort of a Swiss specialized outpatient clinic.

PATIENTS AND METHODS

A cross sectional study of 38 patients fulfilling the classification criteria for SLE. The patients visited a rheumatology outpatient clinic in Switzerland between January 2002 and December 2004. The last assessment during this period was used for the study. The assessment included, besides demographic data, the measurement of disease activity using the BILAG index, the measurement of disease damage using the SLICC/ACR damage index (SDI), as well as the patient's self assessed health status using the patient's questionnaire Medical Outcome Survey Short Form 36 (SF-36).

RESULTS

A total of 36 women and 2 men were included in the study (median age: 43 yrs, median disease duration: 11 yrs). Increased disease activity (total BILAG) was shown to be significantly correlated with reduced physical function. A greater damage (total SDI) correlated significantly with reduced role function due to emotional limitations. Neither age nor disease duration showed any significant correlation with health status in this study.

CONCLUSION

The present study, which is based on internationally accepted assessment tools for SLE patients, shows a significant relationship between increased disease activity and reduced physical function. This result emphasizes the importance of optimizing treatment aiming at reducing disease activity.

[Back pain and acne conglobata: SAPHO syndrome]

We report on a young woman suffering from SAPHO syndrome with back pain and arthritis of the sternoclavicular joints. This inflammatory disorder of the osteoarticular system (synovitis, osteitis, and hyperostosis) is associated with severe acne or palmoplantar pustulosis. The patient was treated with pamidronate, NSAID and physiotherapy which improved the musculoskeletal symptoms completely. The acne was treated with isotretinoin.

Bone loss after total hip arthroplasty

The aim of the present study is to evaluate periprosthetic bone loss and to compare it with the bone loss in other areas of the body. We also aim to shed light on the course of bone mineral density (BMD) in patients with cemented femoral prosthesis in comparison with those with uncemented ones. We analyzed the BMD using dual-energy X-ray absorptiometry (DEXA) in a consecutively recruited convenience sample of 50 patients with cemented and uncemented total hip arthroplasty (THA). BMD was measured within the first month after surgery as well as 1 year later. In ten of the patients (20%) previously undiagnosed osteoporosis was revealed. Osteoporosis was significantly more frequently detected in patients with cemented compared to those with uncemented femoral stem. We found a significant loss in BMD in the periprosthetic femoral region compared with no losses in other body regions (lumbar spine, radius, contralateral hip). The magnitude of this loss was the highest in Gruen-Zone 7 (mean 15.2% per year). We found no BMD loss difference between patients with cemented and uncemented prosthesis in the Gruen-Zone 2-7. In conclusion these periprosthetic losses may be due to local factors such as periprosthetic bone remodeling, as they contrast with the course of BMD in the lumbar spine, radius and not operated hip.

ICF Core Set for patients with musculoskeletal conditions in early post-acute rehabilitation facilities

PURPOSE

The aim of this consensus process was to decide on a first version of the ICF Core Set for patients with musculoskeletal conditions in early post-acute rehabilitation facilities.

METHODS

The ICF Core Set development involved a formal decision-making and consensus process integrating evidence gathered from preliminary studies including focus groups of health professionals, a systematic review of the literature and empiric data collection from patients.

RESULTS

Fifteen experts selected a total of 70 second-level categories. The largest number of categories was selected from the ICF component Body Functions (23 categories or 33%). Seven (10%) of the categories were selected from the component Body Structures, 22 (31%) from the component Activities and Participation, and 18 (26%) from the component Environmental Factors.

CONCLUSION

The Post-acute ICF Core Set for patients with musculoskeletal conditions is a clinical framework to comprehensively assess patients in early post-acute rehabilitation facilities, particularly in an interdisciplinary setting. This first ICF Core Set will be further tested through empiric studies in German-speaking countries and internationally.

[The role of PCR for the diagnosis of Lyme arthritis]

OBJECTIVE, PATIENTS AND METHODS

We studied retrospectively four patients with Lyme arthritis of the knee, the role of PCR for the detection of B. burgdorferi DNA and its influence on further therapeutic decisions.

RESULTS

All four patients with Lyme arthritis suffered from knee pain and effusions. None of them remembered having had a tick bite or an erythema migrans. The diagnosis was confirmed by positive serology and in three cases by detection of B. burgdorferi DNA by PCR analysis of the joint fluid. In one patient, PCR was also positive in the synovial tissue. Because of persistent symptoms after adequate antibiotic therapy, PCR was repeated in the joint fluid of two patients. In one patient a positive PCR suggested an ongoing infection. Thus, the antibiotic treatment was changed. A further PCR was negative. Symptoms resolved slowly in all patients over a time of two to seven months after the end of the antibiotic treatment.

CONCLUSION

PCR to detect B. burgdorferi DNA in synovial fluid or tissue respectively is a helpful tool for the diagnosis of Lyme arthritis. Moreover, in patients with refractory Lyme arthritis PCR may be helpful in monitoring the course of the disease.

ICF Core Sets for osteoporosis

OBJECTIVE

To report on the results of the consensus process integrating evidence from preliminary studies to develop the first version of a Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set and a Brief ICF Core Set for osteoporosis.

METHODS

A formal decision-making and consensus process integrating evidence gathered from preliminary studies was followed. Preliminary studies included a Delphi exercise, a systematic review, and an empirical data collection. After training in the ICF and based on these preliminary studies, relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds.

RESULTS

The preliminary studies identified a set of 239 ICF categories at the second, third and fourth ICF levels with 72 categories on body functions, 41 on body structures, 81 on activities and participation, and 45 on environmental factors. Fifteen experts from 7 different countries attended the consensus conference on osteoporosis. Altogether 67 second-level and 2 third-level categories were included in the Comprehensive ICF Core Set with 15 categories from the component body functions, 7 from body structures, 21 from activities and participation, and 26 from environmental factors. The Brief ICF Core Set included a total of 22 second-level categories with 5 on body functions, 4 on body structures, 6 on activities and participation, and 7 on environmental factors.

CONCLUSION

A formal consensus process integrating evidence and expert opinion based on the ICF framework and classification led to the definition of ICF Core Sets for osteoporosis. Both the Comprehensive ICF Core Set and the Brief ICF Core Set were defined.

Validity and sensitivity to change of the NASS questionnaire for patients with cervical spine disorders

STUDY DESIGN

Study of two cohorts with a differing severity of disease before and after treatment.

OBJECTIVES

The aim of this study was to examine the validity and sensitivity to change of the German version of the cervical NASS patient questionnaire.

SUMMARY OF BACKGROUND DATA

To the authors' best knowledge, there are no data revealing the psychometric properties of the cervical NASS patient questionnaire.

PATIENTS AND METHODS

The validity and sensitivity in patients with cervical spine disorders who were referred by their physician either to an inpatient rehabilitation program or to an outpatient physiotherapy were examined. They were consecutively recruited. Their functioning and health status were assessed when entering the study and after the treatment by the NASS questionnaire and the Medical Outcome Survey Short Form-36 (SF-36).

RESULTS

Criterion validity was demonstrated by the statistically significant correlations between the NASS subscores and all subscores of SF-36. As expected, the SF-36 subscores Physical Function and Pain showed the strongest associations to the NASS subscore Pain and Disability (rho = 0.75 and 0.65, respectively), demonstrating construct validity of the latter. Discriminative validity of NASS subscores was shown in two ways. First, a statistically significant difference was found between functional and health status of the two cohorts with better scores in the patients referred to outpatient physiotherapy as compared with those sent to an inpatient rehabilitation program. Second, statistically significant and clinically important improvements recorded by the NASS subscores were demonstrated in both patient groups after the treatment in accordance with improved SF-36 subscores. Moreover, the NASS subscores demonstrated good sensitivity to change (Pain and Disability with a standard response mean ranging from 0.64 to 1.24).

CONCLUSIONS

The German version of the cervical NASS patient questionnaire (NASS) is a valid instrument for patients with cervical spine health problems. As this instrument is also sensitive to change, it is recommended for use. Moreover, the present study gives evidence for the validity of the original cervical NASS questionnaire in English.

ICF Core Sets for chronic widespread pain

OBJECTIVE

To report on the results of the consensus process integrating evidence from preliminary studies to develop the first version of a Comprehensive ICF Core Set and a Brief ICF Core Set for chronic widespread pain.

METHODS

A formal decision-making and consensus process integrating evidence gathered from preliminary studies was followed. Preliminary studies included a Delphi exercise, a systematic review and an empirical data collection. After training in the ICF and based on these preliminary studies relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds.

RESULTS

The preliminary studies identified a set of 365 ICF categories at the second, third and fourth ICF levels with 143 categories on body functions, 45 on body structures, 125 on activities and participation and 125 on environmental factors. Thirty experts attended the consensus conference on chronic widespread pain (16 physicians with at least a specialization in physical and rehabilitation medicine, 4 rheumatologists, 2 psychiatrists, 5 physical therapists, one psychologist, one occupational therapist and 1 social worker). Altogether 65 second-level and 2 third-level categories were included in the Comprehensive ICF Core Set with 23 categories from the component body functions, one from body structures, 27 from activities and participation and 16 from environmental factors. The Brief ICF Core Set included a total of 24 second-level categories and 2 third-level categories with 10 on body functions, 10 on activities and participation and 6 on environmental factors. No body structures were included in the Brief ICF Core Set.

CONCLUSION

A formal consensus process integrating evidence and expert opinion based on the ICF framework and classification led to the definition of ICF Core Sets for chronic widespread pain. Both the Comprehensive ICF Core Set and the Brief ICF Core Set were defined.

ICF Core Sets for obstructive pulmonary diseases

OBJECTIVE

To report on the results of the consensus process integrating evidence from preliminary studies to develop the first version of the Comprehensive ICF Core Set and a Brief ICF Core Set for obstructive pulmonary diseases.

METHODS

A formal decision-making and consensus process integrating evidence gathered from preliminary studies was followed. Preliminary studies included a Delphi exercise, a systematic review and an empirical data collection. After training in the ICF and based on these preliminary studies relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds.

RESULTS

The preliminary studies identified a set of 287 ICF categories at the second, third and fourth ICF levels with 97 categories on body functions, 33 on body structures, 104 on activities and participation, and 53 on environmental factors. Seventeen experts from 8 different countries attended the consensus conference on obstructive pulmonary diseases. Altogether 67 second-level and 4 third-level categories were included in the Comprehensive ICF Core Set with 19 categories from the component "body functions", 5 from "body structures", 24 from "activities and participation" and 23 from "environmental factors". The Brief ICF Core Set included a total of 17 second-level categories with 5 on "body functions", 3 on "body structures", 5 on "activities and participation" and 4 on "environmental factors".

CONCLUSION

A formal consensus process integrating evidence and expert opinion based on the ICF framework and classification led to the definition of ICF Core Sets for obstructive pulmonary diseases. Both the Comprehensive ICF Core Set and the Brief ICF Core Set were defined.

Analysis of the relationship between disease activity and damage in patients with systemic lupus erythematosus--a 5-yr prospective study

OBJECTIVE

To determine whether initial damage, disease duration, age, initial health status, average disease activity over the 5 yr or an average medication score covering the follow-up period would predict an increase in damage in patients with systemic lupus erythematosus (SLE) within the next 5 yr.

METHODS

A 5-yr prospective longitudinal study of a cohort of 141 consecutive patients with SLE attending a specialist lupus out-patient clinic in London from their first assessment between July 1994 and February 1995. Disease activity was assessed using the BILAG system, initial health status by the Medical Outcome Survey Short Form 20 with an extra question about fatigue (SF-20+) and damage by the SLICC/ACR Damage Index (SDI). Damage was reassessed 5 yr later. Statistical analysis was carried out using multiple logistic regression analysis (logXact).

RESULTS

One hundred and thirty-three female and eight male SLE patients (97 Caucasians, 16 Afro-Caribbeans, 22 Asians and 6 others) were included, their age at inclusion was 41.1 +/- 12.5 yr and their disease duration 10.2 +/- 6.3 yr. The mean measures at inclusion were: total BILAG 5.2 (range 0-17), total SDI 1.2 (0-7) and medication score 1.2 (0-3). Six patients were lost to follow-up because they had moved. Of the remaining 135 patients total damage had increased in 40 patients and 10 patients had died. At the end of the study, at 4.63 +/- 0.19 yr, the total SDI had increased to 1.6 +/- 1.7. Multiple logistic regression analysis revealed that death and increase in damage were strongly predicted by a high total disease activity over the entire study period (P<0.001) as we had hypothesized. When the total BILAG score was replaced by the average number of A-flares the prediction of accrual of damage during the study period was again highly significant (P = 0.004).

CONCLUSIONS

In this first prospective study of its type a highly significant impact of total disease activity, as measured over 5 yr using the BILAG system, on the development of total damage was revealed. Moreover, these results provide further proof of the validity of the SDI and support the BILAG concept of the A-flares.

Cross-section measurements of the nuclear reactions natZn(d,x)64Cu, 66Zn(d,alpha)64Cu and 68Zn(p,alphan)64Cu for production of 64Cu and technical developments for small-scale production of 67Cu via the 70Zn(p,alpha)67Cu process

The radionuclides 64Cu (T1/2=12.7h) and 67Cu (T1/2=61.9h) are useful in internal therapy. In connection with production of 64Cu, excitation functions of the reactions natZn(d,x)64Cu, 66Zn(d,alpha)64Cu and 68Zn(p,alphan)64Cu were measured radiochemically using the stacked-foil technique. From the measured data, the thick target yields of 64Cu were calculated and compared with experimental data available in the literature. The three investigated processes are discussed in comparison to the commonly used 64Ni(p,n)64Cu reaction for the production of 64Cu. As regards 67Cu production, the technical feasibility of the 70Zn(p,alpha)67Cu process was investigated. An electroplated isotopically enriched 70Zn target was developed which can withstand slanting beams of 20MeV protons of currents up to 20 microA. Methods for chemical separation of 67Cu and efficient recovery of the enriched target material were worked out. The method is suitable only for small-scale production of 67Cu.

Definition and treatment of lupus flares measured by the BILAG index

OBJECTIVES

The BILAG index is a clinical measure of lupus disease activity. It is valid, reliable and sensitive to change. Scoring in the BILAG index is based upon the physician's intention to treat. A flare of active lupus is defined as a new A or B score in at least one system. The main aim of this study was to determine whether patients with a lupus flare are treated as expected from the principles upon which the scoring system was devised. Secondly we wanted to establish whether patients with a new B score preceded by a C should be considered to have flared, as with patients scoring B following a D or E score.

METHODS

Over a 12-month period, 250 patients regularly attending lupus clinics in Birmingham and London were assessed using the BILAG index at each visit.

RESULTS

A new A or B score was observed in 154 (61.6%) patients. An A flare was observed in 26 (10.4%) patients. A B flare (in which the B score was preceded by a D or E score) was observed in 65 (26.0%) patients. There were 63 (25.2%) patients in whom there was a B score in a system in which a C score was previously recorded. Steroids were started or increased in 20 (77%) patients with an A flare. Almost all (92%) patients with a new A score had some increase in therapy. For the patients with new B scores, 53 (41%) had some increase in therapy, but multiple reasons were found for no change in therapy in 75 (59%) of these patients. There was no difference in the treatment of new B scores arising after a previous C score compared with previous D or E scores. Non-Caucasians were more likely to have a lupus flare than Caucasians.

CONCLUSIONS

These results are consistent with the principles upon which the BILAG index was devised and suggest that a moderate disease flare can be defined as a new B score following a C, D or E score according to the BILAG index.

Subclinical disease activity in systemic lupus erythematosus: immunoinflammatory markers do not normalize in clinical remission

OBJECTIVE

To correlate various laboratory measures in systemic lupus erythematosus (SLE) with the British Isles Lupus Assessment Group (BILAG) disease activity index, to search for organ-specific laboratory patterns and to compare with a control population.

METHODS

A cohort of 57 Caucasian outpatients fulfilling the American College of Rheumatology criteria for SLE and a control population of 17 patients admitted for coronarography were examined. Disease activity was assessed with BILAG index. Plasma samples were investigated for sCD44, interleukin 6 (IL-6), IL-10, IL-12, tumor necrosis factor-a (TNF-a), soluble TNF receptor-55 (sTNFR-55), sTNFR-75, IL-1-receptor antagonist, soluble intercellular adhesion molecule (sICAM), soluble vascular cell adhesion molecule (sVCAM), E-selectin, and neopterin as well as for C3, C4, dsDNA, and other conventional indicators.

RESULTS

Thirty-nine patients had inactive disease (total BILAG score < or = 5), 18 patients had active SLE. Surprisingly, except for C-reactive protein (p < 0.001), no statistically significant difference of the laboratory indicators was found between patients with active and those with inactive SLE. However, there was a significant difference between SLE patients and controls for sTNFR-75 (p < 0.008). We found significant correlations between laboratory markers and some BILAG organ system scores, such as between IL-1ra and the musculoskeletal score (p < 0.003) and between sTNFR-55/sTNFR-75 and renal BILAG (p < 0.001, p < 0.004, respectively). Significant nonparametric correlations were revealed between C3 and C4 (p < 0.0001), and between sTNFR-75 and dsDNA, neopterin, sVCAM, sICAM and sTNFR-55 concentrations (p < 0.0001 for all), and between sTNFR-75 and IL-1ra (p < 0.006).

CONCLUSION

Patients with SLE in clinical remission show ongoing systemic immunoinflammatory activity measured with a variety of cytokines, adhesion molecules, and other inflammatory markers. This indicates that laboratory measures may provide qualitatively different additional information to validated disease activity indexes such as the BILAG. Different laboratory markers correlate with disease activity in different organ systems. This suggests differences in pathogenic mechanisms in SLE depending on the organ system involved.

Quantitative determination of saturated oligogalacturonic acids in enzymatic digests of polygalacturonic acid, pectin and carrot pomace by on-line LC-ESI-MS

A method for the quantitative determination of oligogalacturonic acids (OGAs) by on-line high-performance liquid chromatographic (HPLC) separation and mass spectrometric detection via an electrospray interface (ESI-MS) without additional desalting steps was developed. Saturated OGAs up to a degree of polymerization (dp) of 3 were quantified by comparison with reference compounds. The calibration plots showed high linearity (R(2)>0.99), and the detection limits for dp 1, 2, and 3 were 11, 28, and 6 ng per injection, respectively. Non- and partially methyl-esterified OGAs with a dp of 3 and 4 were calculated semi-quantitatively as dp 3. The analytical system was used for the quantification of OGAs of digests obtained by incubation of polygalacturonic acid, pectin, and carrot pomace with commercial enzyme preparations. Furthermore, methyl-esterified OGAs up to a dp of 12 containing up to 4 methyl esters were detected in a pectin digest.

High-performance liquid chromatographic separation and on-line mass spectrometric detection of saturated and unsaturated oligogalacturonic acids

A method for the simultaneous determination of saturated and unsaturated oligogalacturonic acids up to degree of polymerization (dp) of 7 by high-performance liquid chromatography (HPLC) is presented. For this purpose, a Cyclobond I 2000 column and a volatile mobile phase consisting of ammonium formate and methanol were used, allowing direct coupling of HPLC to a mass spectrometer via an electrospray interface (ESI-MS) without additional desalting. The analytical system was used for the characterization of digests obtained by incubation of polygalacturonic acid with commercial enzyme preparations.