Respiration during emergence from anaesthesia with desflurane/N2O vs. desflurane/air for gynaecological laparoscopy

BACKGROUND

The complications related to anaesthesia usually occur in the early postoperative period. Hypercapnia and hypoxaemia may result from any persistent depression of the respiratory drive relative to the metabolic demand. The purpose of this study was to compare the respiratory effects of desflurane anaesthesia with or without nitrous oxide during the period of emergence.

METHODS

Twenty patients scheduled for a standardised surgical procedure, laparoscopic hysterectomy, were randomly allocated to anaesthesia with 1.3 MAC of desflurane/N2O (Group 1) or desflurane alone (Group 2), with 10 patients in each group. Times of resumption of spontaneous breathing and extubation were recorded and elimination rates of carbon dioxide, end-tidal concentrations of desflurane and N2O, and blood gases were measured.

RESULTS

Spontaneous breathing was resumed in both groups when pH had decreased by about 0.07 and PaCO2 increased by about 1.4 kPa compared with the values at the end of 1.3 MAC anaesthesia with controlled normoventilation. There were no significant differences between the groups with regards to extubation time, 6 vs. 13 min, or total MAC value at extubation, 0.20 vs. 0.19 in Group 1 and 2, respectively. Neither did the groups differ in minute ventilation, end-tidal carbon dioxide, oxygen concentrations, or blood gases. CO2 elimination decreased in both groups from about 220 ml 70 kg-1 min-1 at the end of anaesthesia to a lowest value of about 160 ml 70 kg-1 min-1.

CONCLUSION

The respiratory profiles during recovery from gynaecological laparoscopy with either desflurane/N2O or desflurane anaesthesia were similar with fast resumption of spontaneous breathing, short time to extubation, and no signs of CO2 retention.

Anti-TNF treatment of baboons with sepsis reduces TNF-alpha, IL-6 and IL-8, but not the degree of complement activation

The activation of complement and the release of TNF-alpha, IL-6 and IL-8 are important pathogenic factors behind organ dysfunction in sepsis. The aim of this study was to determine whether infusion of anti-TNF antibodies alters complement activation and plasma concentrations of pro-inflammatory cytokines at high doses of Escherichia coli. Six baboons received intravenously 2 x 10(9) live E. coli bacteria per kg body weight (group 1), in addition five received pretreatment with 1 mg per kg body weight anti-TNF antibodies (group 2), and seven received 5 x 10(8) live E. coli bacteria per kg body weight (group 3). Two hours after the start of infusion of the bacteria, plasma concentrations of C3 activation products, C5a and the terminal SC5b-9 complement complex were increased in groups 1 and 2 (P < 0.05), but there was no significant difference between the groups. At 2 h the levels of TNF-alpha, IL-6 and IL-8 were lower in group 2 compared with group 1 (P<0.05). In group 2 compared with group 1 the TNF-alpha concentrations were, however, higher at 4, 8 and 24 h. The explanation for this phenomenon is probably that TNF-alpha binds to the anti-TNF antibody complex and is released slowly after it has been bound. The study showed that infusion of anti-TNF antibodies reduced the concentrations of TNF-alpha, IL-6 and IL-8, without any detectable influence on complement activation.

Pain and pulmonary function following laparoscopic and abdominal hysterectomy: a randomized study

BACKGROUND

The aim of this study was to evaluate pain and pulmonary function the first two days after abdominal and laparoscopic hysterectomy.

METHODS

Women scheduled for abdominal hysterectomy were prospectively randomized to either laparoscopic (n=20) or abdominal (n=20) hysterectomy. Analgesics were self-administered by the patients by means of a programable infusion pump containing morphine. Postoperative pain was evaluated using a visual analog scale. Oxygen saturation was measured with an oxymeter. Pulmonary function was assessed using a peak flow meter measuring peak expiratory flow and a vitalograph measuring forced vital capacity and forced expiratory volume in one second.

RESULTS

Pain scores were lower after laparoscopic hysterectomy at the first (p<0.05) and second postoperative day (p<0.01). Lung function was impaired on days 1 and 2 postoperatively, measured as peak expiratory flow, forced vital capacity and forced expiratory volume in one second, in both groups compared to the preoperative values. The patients undergoing laparoscopic hysterectomy had less impairment of lung function measured by peak expiratory flow (p<0.01), forced vital capacity (p<0.05) and forced expiratory volume in one second (p<0.05) the first postoperative day compared to the patients undergoing abdominal hysterectomy. The second postoperative day differences between the groups remained for peak expiratory flow (p<0.05) and forced expiratory volume in one second (p<0.05).

CONCLUSIONS

Laparoscopic hysterectomy results in less pain and less impairment of respiratory function compared to abdominal hysterectomy.

Effects of intravenous regional administration of methylprednisolone plus mepivacaine in rheumatoid arthritis

To evaluate the subjective and objective response to intravenous regional administration of a glucocorticoid (IVRAG) on rheumatoid arthritis (RA), twenty RA-patients received, in a randomised, double-blind crossover and placebo-controlled fashion, either 50 mg methylprednisolone in mepivacaine 0.25% or mepivacaine (placebo) in one hand only using a Bier-block technique. The other hand was given the opposite. One week later the procedure was repeated but the previous placebo hand was now treated with the glucocorticoid. About 50% of the patients experienced a subjective improvement at 1 and 6 weeks. After one week a significant reduction was recorded in grip diastasis with no difference between the glucocorticoid and the placebo. In the other outcome measures (grip strength, handvolume, rest pain, and movement provoked pain) no differences were recorded between the glucocorticoid and placebo. At six weeks a significant reduction in grip diastasis and movement provoked pain as well as a significant increase in grip strength were noted. Hand volume was unchanged. IVRAG is a safe, easy and well-tolerated technique. The beneficial results are probably due to both a systemic and a regional effect. The findings of benefit in both hands at the end of one week seem to suggest that mepivacaine can give some short term improvement.

Removal of activated complement from shed blood: comparison of high- and low-dilutional haemofiltration

BACKGROUND

Perioperative blood salvage is associated with release of inflammatory mediators. Depending on type of processing, the complement system is activated to some extent in the final blood product. The aim of the present study was to evaluate a haemofiltration technique concerning complement system activation and whether the volume of added saline will have an influence on the elimination of activated complement during processing.

METHODS

Sixteen patients undergoing total hip arthroplasty received wound blood salvaged intraoperatively with a haemofiltration technique. Saline was added to the reservoir for washing in a ratio of 1:1 or 5:1 of estimated blood volume. Samples for determination of the anaphylatoxins C3a and C5a, and the terminal SC5b-9 complement complex (TCC) were drawn from the patients, the collected blood, the ultrafiltrate and the processed blood.

RESULTS

Increased concentrations of C3a, C5a and TCC were found in aspirated and processed blood. Haemofiltration did not reduce the concentrations of these factors, except that of C3a in the group where saline was added in a ratio of 5:1. There were no increased concentrations of C3a, C5a or TCC in the patient plasma after reinfusion. No differences in blood pressure, heart rate, pH, arterial oxygen tension, arterial carbon dioxide tension, or base excess were found in association with reinfusion of the blood.

CONCLUSION

Collected shed blood washed through haemofiltration contained moderately elevated concentrations of C3a, C5a and TCC. Reinfusion of the blood neither led to increased systemic concentrations of complement activation products, nor to disturbances in haemodynamic or biochemical parameters.

Extracorporeal ("ex vivo") connection of pig kidneys to humans. III. Studies of plasma complement activation and complement deposition in the kidney tissue

The complement system is one of the important factors involved in the hyperacute rejection of xenografts. This report deals with the activation of the complement system in a clinical trial where pig kidneys were extracorporeally connected to two volunteer dialysis patients who were pretreated with plasmapheresis in order to substantially reduce anti-pig xenoantibodies. The clinical data of the perfusion experiments and the patients humoral immune response to pig xenoantigens have been reported in detail (Xenotransplantation 1996; 3:328-339, 340-353). Three consecutive daily plasmapheresis treatments of the patients reduced the plasma complement protein (C3, C4, and C5) concentrations to 8-27% of the baseline values. The perfusion of the pig kidney connected to patient 1 was terminated at 65 min due to graft rejection and this patient was not hemodynamically affected by the experiment. The second experiment was terminated at 15 min due to an anaphylactic like reaction of the patient. In patient 1 a slight reduction of plasma C3, C4, and C5 and an increase of C5a and SC5b-9 occurred, while C3a decreased during the perfusion. Patient 2 had an increase of all complement parameters, most prominent for C4d and SC5b-9, which occurred concomitant with the appearance of the anaphylactic like side effects. In general, plasma levels of PMN elastase, IL6 and IL8 increased in both patients during the perfusion. Immunohistochemical investigation of the kidney tissues revealed deposition of human complement factors C1q, C4c, and C3c in a congruent pattern with the vasculature of the kidney in patient 1. In kidney 2 only trace amounts of C1q and C3c were found. Both kidneys were negative for properdin. Therefore, in this experimental set up with extracorporeal connection of pig kidneys to the human circulation the human complement cascade is activated mainly through the classical pathway.

Release of Neopterin, PMN Elastase and Terminal Complement Complexes by Orthotopic Liver Transplantation with and without the Use of Veno-venous Bypass

Aim: The aim of the study was to determine whether orthotopic liver transplantation leads to the activation of macrophages, neutrophils and complement. Patients and methods: Twenty-four patients undergoing orthotopic liver transplantation were studied. 12 were operated on with and 12 without the use of a veno-venous bypass. Blood samples for neopterin, PMN elastase and terminal complement complex (SC5b-9) determinations were drawn preoperatively, 1 minute before perfusion of the grafted liver and 2-5 and 30-60 minutes after the start of perfusion of the grafted liver. Comparisons were made between patients with or withour a veno-venous bypass and with or without postreperfusion syndrome (PRS) . PRS was defined as hypotension with ≥30% reduction of systemic mean arterial blood pressure during at least 1 minute after reperfusion of the grafted liver. Results: Release of neopterin was observed 2-5 and 30-60 minutes after the start of perfusion of the grafted liver in patients operated upon with and without the use of a veno-venous bypass. There were no significant differences in neopterin concentration between patients developing PRS and those without circulatory instability. Increased PMN elastase and SC5b-9 concentrations (p<0.05) were found 2-5 and 30-60 minutes after the start of reperfusion in both patients operated upon with and without a veno-venous bypass. The plasma concentrations of neopterin, PMN elastase and SC5b-9 were higher in patients with PRS compared with those without (p<0.05, respectively). Comments: This study indicates that orthotopic liver transplantation leads to the activation of macrophages, neutrophils and the complement cascade. There is no major difference regarding the activation between patients operated upon with and without the use of a veno-venous bypass.

Pityrosporum orbiculare-reactive T-cell lines in atopic dermatitis patients and healthy individuals

The yeast Pityrosporum orbiculare is one of the factors that may contribute to atopic dermatitis (AD). In the present study we compared the T-cell response to P. orbiculare in 12 AD patients with specific immunoglobulin (Ig)E antibodies (Ab) in serum against P. orbiculare with that of six non-atopic healthy controls. Freshly isolated peripheral blood mononuclear cells (PBMC) were cultured for 3 days in the presence of P. orbiculare extract. The proliferative response as measured by [3H]-thymidine incorporation was significantly higher in the AD patients than in the healthy controls (P < 0.05). Furthermore, significantly higher levels of interleukin (IL)-5 (P < 0.05), as analyzed by ELISA, were produced by PBMC from the AD patients compared to the healthy controls. Pityrosporum orbiculare-reactive T-cell lines (TCL) established by P. orbiculare stimulation of PBMC for 11 days produced significantly higher levels of IL-4 and IL-5 after stimulation with anti-CD3 Ab and showed a higher IL-4/interferon (IFN)-gamma ratio (P < 0.05) in the AD patients compared to the healthy controls. The higher proliferative PBMC response to P. orbiculare and the Th2-like cytokine production by P. orbiculare-stimulated TCL from AD patients indicate that P. orbiculare may play a role in maintaining skin inflammation in AD.

Should nitrous oxide be discontinued before desflurane after anaesthesia with desflurane/N2O?

BACKGROUND

The appearance of hypoxaemia immediately after anaesthesia with nitrous oxide may be partially explained by diffusion hypoxia. This study was undertaken to evaluate circulatory and respiratory variables during emergence after desflurane/nitrous oxide anaesthesia, and whether there are any differences depending on which gas is discontinued first.

METHODS

20 patients were studied after gynaecological laparoscopic surgery. The depth of anaesthesia was reduced 10 min prior to the emergence by stopping the administration of one of the two inhalational agents. Desflurane was discontinued first in Group 1, nitrous oxide in Group 2. Ventilation was controlled with E'CO2 maintained at 5% until the administration of the second anaesthetic gas was discontinued. Thereafter, the patients breathed spontaneously.

RESULTS

The PaCO2 at which the respiratory drive reappeared after controlled normoventilation was similar in both groups, 6.1-6.5 kPa, and extubation was performed after 10-11 min. At extubation, the end-tidal CO2 and total MAC were similar in the groups, about 6.2 vol% and 0.16, respectively. Mean arterial blood pressure was significantly higher in Group 1. The cardiac output increased in both groups from about 6 l/min at the conclusion of anaesthesia to 9.0 and 7.6 l/min at 15 min in the recovery period. End-tidal O2 decreased and CO2 increased in both groups during the first 10 min in the recovery period. pH was reduced at 15 and 30 min in both groups.

CONCLUSION

Irrespective of which agent was discontinued first there was an increase in cardiac output decrease in oxygenation and a modest acidosis in the first 30-min recovery period. The only significant difference between the groups was in mean arterial blood pressure in the early emergence phase with a greater MAP when N2O had been used until the conclusion of anaesthesia.

Emergence from isoflurane/N2O or isoflurane anaesthesia

BACKGROUND

The first goal of anaesthetic recovery is return of the patient's ability to independently maintain respiratory and circulatory functions. Nitrous oxide remains popular due to minor effects on the cardiovascular and respiratory systems. However, diffusion hypoxaemia can occur during recovery and there is a potential advantage of providing the patient with only a potent vaporised agent.

METHODS

This randomised study of 20 gynaecological patients evaluated respiratory and circulatory variables during emergence after anaesthesia with equipotent mixtures of isoflurane/nitrous oxide or isoflurane. Inspired, end-tidal and mixed expired gas concentrations, expired minute volume, pulse oximetry saturation and arterial blood gases were registered. Monitoring of cardiac output was performed by transthoracic bioimpedance.

RESULTS

Patients anaesthetised with isoflurane/N2O resumed their spontaneous breathing 16 min earlier and were extubated 22 min earlier than those anaesthetised with only isoflurane. At extubation, total MAC and end-tidal CO2 were similar in both groups, 0.22-0.26 and 5.5-5.9 vol%, respectively. The isoflurane/ N2O group had greater minute ventilation and CO2 excretion rates than the isoflurane group throughout the emergence period. There were no significant differences between the groups in blood gas variables or in heart rate, mean arterial blood pressure or cardiac index. Cardiac index was between 3.4 and 3.9 l m(-2) min(-1) throughout the emergence period in both groups.

CONCLUSION

Patients anaesthetised with only isoflurane had a longer delay until resumption of spontaneous breathing and extubation in the emergence period. Minute ventilation and carbon dioxide elimination were also significantly more suppressed throughout emergence after anaesthesia with isoflurane as compared with isoflurane/N2O.

Dermal IgG deposits and increase of mast cells in patients with fibromyalgia--relevant findings or epiphenomena?

Skin biopsies from 25 patients with fibromyalgia, 5 healthy controls, 8 patients with rheumatoid arthritis, and 9 patients with local chronic pain after whiplash injury, were examined for the occurrence of IgG deposits and collagen types, using direct and indirect immunofluorescence, and for dermal connective tissue mast cells, using semithin Epon sections. Fibromyalgia skin biopsies had significantly higher values of IgG deposits in the dermis and vessel walls and showed a higher reactivity for collagen III. They also had a higher mean number of mast cells. There was a correlation between the percentage of damaged/degranulated mast cells and the individual IgG immunofluorescence scores. These findings support the hypothesis of neurogenic inflammation involvement in fibromyalgia.

Postoperative inflammatory response after autologous and allogeneic blood transfusion

BACKGROUND

Allogeneic blood transfusions cause immunosuppression. The aim of this study was to determine whether complement anaphylatoxins, cytokines, or both are released in the recipient, after blood transfusions in general, and after autologous blood transfusions in particular.

METHODS

Thirty-one patients having total hip joint replacement surgery were randomized to receive either allogeneic red blood cells (n = 15) or predeposited autologous whole blood transfusion (n = 16). Plasma concentrations of the anaphylatoxins C3a and C5a, the terminal C5b-9 complement complex, and cytokines IL-6 and IL-8 in the recipients were repeatedly analyzed before, during, and after surgery.

RESULTS

Significantly increased concentrations of IL-6 and IL-8 appeared in both groups, with a significantly greater increase in the autologous blood group. Patients in both groups developed a moderate but significant increase of C3a without a significant difference between them. C5a and terminal C5b-9 complement complex were not greatly changed.

CONCLUSIONS

The study showed a greater increase in cytokine concentration after autologous blood transfusion than after allogeneic blood transfusion. The lower response in the latter may result from transfusion-induced suppression of cellular immunity.

Elevated serum levels of soluble CD30 in patients with atopic dermatitis (AD)

The immunopathology of AD is still unclear, but evidence for an immune response polarized towards Th2 activity has been provided. The CD30 molecule belongs to the tumour necrosis factor (TNF) receptor family and is expressed on activated T cells with a sustained expression in Th2 cells. This molecule also exists in a soluble form (sCD30). Elevated serum levels of sCD30 have been found in patients with Hodgkin's disease, chronic hepatitis B infection and HIV infection. Studies were undertaken to compare the serum levels of sCD30 in patients with AD (n=49) and healthy non-atopic controls (n=94). The presence of sCD30 was analysed with ELISA. A significantly higher concentration of sCD30 was noted in AD patients, median sCD30 level 29 U/ml (range 1-708 U/ml), compared with healthy non-atopic controls (P<0.001), where the median level was 11 U/ml with a range of 1-1042 U/ml. No correlation was found between sCD30 levels and total serum IgE, or between the AD patients' SCORAD values and concentration of sCD30. sCD30 levels were also analysed in 20 AD patients, which during ketoconazole treatment had improved their clinical scores and reduced their serum IgE and eosinophil cationic protein levels. However, no significant decrease in sCD30 levels was noted after treatment. The results show that patients with AD have elevated levels of sCD30, but without correlation to total serum IgE or disease activity.

Fibromyalgia--are there different mechanisms in the processing of pain? A double blind crossover comparison of analgesic drugs

OBJECTIVE

Pain was analyzed in patients with fibromyalgia (FM) in a randomized, double blind, crossover study using intravenous (i.v.) administration of different drugs.

METHODS

In 18 patients with FM muscle pain to i.v. administration of morphine (0.3 mg/kg), lidocaine (5 mg/kg), ketamine (0.3 mg/kg), or saline was studied. Spontaneous pain intensity, muscle strength, static muscle endurance, pressure pain threshold, and pain tolerance at tender points and non-tender point areas were followed. Drug plasma concentrations and effects on physical functioning ability score (FIQ) were recorded. A personality inventory (KSP) was used to related pain response to personality traits.

RESULTS

Thirteen patients responded to one or several of the drugs, but not to placebo. Two patients were placebo responders responding to all 4 infusions. Three were nonresponders responding to no infusions. Seven of the responders had a reduction in pain for 1-5 days. Pressure pain threshold and pain tolerance increased significantly in responders. Plasma concentrations were similar in responders and nonresponders. FIQ values improved significantly after the ketamine infusion. Responders scored higher on KSP scales for somatic anxiety, muscular tension, and psychasthenia compared with healthy controls.

CONCLUSION

FM diagnosed according to the American College of Rheumatology criteria seems to include patients with different pain processing mechanisms. A pharmacological pain analysis with subdivision into responders and nonresponders might be considered before instituting therapeutic interventions or research.

Blood spillage during salvage

Recovery of blood components by salvage was evaluated in a randomized laboratory investigation using donor whole blood. Three methods of salvage were studied; conventional red cell salvage, red cell salvage with continuous processing, and salvage by haemofiltration using recirculation through a 30,000-Da filter. Less than 10% of the haemoglobin was wasted during processing by all three methods. About half of the leukocytes were recovered with no significant difference between the techniques. The recovery of platelets was 15, 4 and 41% during salvage with conventional red cell centrifugation, continuous centrifugation processing and haemofiltration, respectively. In contrast with the other methods, haemofiltration gave a major recovery of albumin.

Effects on complement activation of a new continuous autotransfusion system

Allogeneic blood transfusions may subject patients to risks of infection and allergic reactions. Various techniques for transfusion of shed blood have been developed. The aim of this study was to evaluate a new continuous autotransfusion system (Fresenius CATS) as regards its impact on the complement system, and on erythrocytes and leucocytes. Eighteen consecutive patients undergoing hip replacement surgery were studied. Complement variables (C4d, factor Bb, C3a and terminal complement complex, SC5b-9) and free haemoglobin, haemoglobin, leucocytes, platelets, albumin and protein were determined in the patient's blood preoperatively, 1 min before the start of transfusion, 15 and 60 min after transfusion; and in the reservoir, in the waste bag and in the retransfusion blood. Increased concentrations of C3a and SC5b-9 were found in the collected reservoir blood (P < 0.05). The washing and centrifugation procedure reduced these concentrations (< 0.001). High levels of free haemoglobin were found in the collected blood as well as in the processed product. The median haemoglobin level in the processed blood was 260gL-1 (range 104-289gL-1). Inflammatory mediators from the complement cascade are removed by continuous autotransfusion technique. The processed blood contains high levels of free haemoglobin.

Complement activation during storage of whole blood, red cells, plasma, and buffy coat

BACKGROUND

The process of separating whole blood into components and the storage of blood components may cause the release of toxic metabolites from the complement cascade. The aim of this study was to determine whether the storage of blood components leads to the activation of the complement cascade and the release of anaphylatoxins.

STUDY DESIGN AND METHODS

Blood from 12 healthy volunteers was collected and stored either as whole blood or as components: red cells in saline-adenine-glucose-mannitol solution, plasma, and buffy coat. The concentrations of anaphylatoxins and other complement proteins in the various blood components were intermittently analyzed during a 5-week storage period.

RESULTS

Increasing levels of anaphylatoxins were demonstrated during the storage of whole blood and plasma. Elevated concentrations of the anaphylatoxins C3a and C5a were observed during the storage of whole blood. Increased C5a levels were observed after 7 days of storage. High concentrations of C3a were found in plasma after 14 days of storage. Low or non-detectable levels of C3a; C5a, and other complement components were found in red cells stores in saline-adenine-glucose-mannitol solution.

CONCLUSION

The study demonstrated activation of complement during the storage of whole blood and plasma but not in red cells in storage solution. The transfusion of larger volumes of stored whole blood or plasma may contribute to the risk of development of organ dysfunction. Therefore, it is advisable to use red cells in storage solution.

Factor V:Q506 mutation and anticardiolipin antibodies in systemic lupus erythematosus

Inherited resistance to activated protein C (APC resistance) is an important risk factor of venous thrombosis. It is caused by a point mutation in the gene coding for coagulation factor V, called FV:Q506. Arterio-venous thrombosis is a common and serious medical problem in patients with systemic lupus erythematosus (SLE). We studied the prevalence of the factor V mutation associated with APC resistance and IgG anticardiolipin antibodies (aCLs) in an epidemiological cohort of 78 Swedish SLE patients, to determine their roles as risk factors for thrombosis. In addition, a detailed evaluation of the clinical manifestations in these patients was performed. Totally, 19 (24%) of the 78 SLE patients had thrombosis, 11 (14%) had venous thrombosis and 8 (10%) had a cerebral infarction caused by occlusion of cerebral vessels. Twenty-six (33%) SLE patients were aCL positive and 8 (10%) were heterozygous for the factor V mutation. Only one of the patients with venous thrombosis and one of the patients with cerebral thrombosis had the FV:Q506 mutation, whereas 3 patients with venous thrombosis and 5 patients with cerebral infarction were aCL positive. Eleven of 19 patients with heart valve disease were aCL positive, a statistically significant association (P = 0.01). In conclusion, we found no statistically significant association between venous thrombosis and FV:Q506 mutation or venous thrombosis and aCL positivity. There was, however, an association between heart valve disease and aCL positivity.

Detection of Pityrosporum orbiculare reactive T cells from skin and blood in atopic dermatitis and characterization of their cytokine profiles

BACKGROUND

Atopic dermatitis (AD) is associated with increased levels of serum IgE, and T-helper (Th) cells are thought to a play role in the pathogenesis. Individuals with AD often develop IgE antibodies against the yeast Pityrosporum orbiculare, a member of the normal cutaneous flora.

OBJECTIVE

The role of P. orbiculare in atopic dermatitis was investigated by examining the T-cell reactivity for P. orbiculare.

METHODS

Freshly isolated peripheral blood mononuclear cells (PBMC) were isolated from 10 AD patients with serum IgE antibodies against P. orbiculare, and from six healthy controls. The proliferative response after P. orbiculare stimulation, measured by [3H]thymidine incorporation, was examined in the PBMC and in T-cell clones (TCC) obtained from skin and blood of one patient. The cytokine profile of the TCC was determined by enzyme-linked immunosorbent assay (ELISA), radioimmunoassay (RIA) and reverse transcriptase-polymerase chain reaction (RT-PCR) following challenge with either P. orbiculare extract or anti-CD3 antibodies and phytohaemagglutinin.

RESULTS

The PBMC response to P. orbiculare was significantly higher in the AD patients than in the control group (P < 0.05). Twenty-nine out of 36 tested TCC derived from one responding patient were reactive for P. orbiculare. The clones were CD2+ and CD4+, except for one CD8+ blood clone. A majority of the TCC derived from lesional skin showed a Th2- or Th2/Th0-like cytokine profile. A co-expression of interleukin-5 (IL-5) mRNA and IL-13 mRNA was detected in five out of six P. orbiculare-reactive clones analysed for their cytokine gene expression with RT-PCR.

CONCLUSION

Our data suggest that P. orbiculare can induce a T-cell response in AD patients. The Th2-like profile of P. orbiculare-reactive TCC derived from lesional skin indicates that P. orbiculare may play a role in maintaining IgE-mediated skin inflammation in AD.

Interleukin-1 beta and phenytoin reduce alpha 1 (I) procollagen mRNA expression in human gingival fibroblasts

Effects of and interactions between interleukin-1 beta (IL-1 beta) and phenytoin (PHT) on alpha 1 (I) procollagen gene and protein expression in human gingival fibroblasts and its relation to prostaglandin E2 (PGE2) formation were studied. IL-1 beta (300 pg/ ml) reduced the steady-state level of alpha 1 (I) procollagen mRNA by 50% and decreased the amount of procollagen I by 35%. PHT (10 micrograms/ml) reduced the level of alpha 1 (I) procollagen mRNA by 40% but the amount of procollagen I in the medium was unchanged. In combination with IL-1 beta, PHT potentiated the inhibitory effect of IL-1 beta on alpha 1 (I) procollagen mRNA level that was accompanied by an increased PGE2 formation. Preincubation with indomethacin (10(-6) M) partially reduced the inhibitory effect of IL-1 beta as well as of IL-1 beta in combination with PHT on the mRNA level of alpha 1 (I) procollagen. The inhibitory effect of PHT was unaffected by indomethacin treatment. Addition of exogenous PGE2 (> or = 10 nM) dose-dependently reduced steady-state level of alpha 1 (I) procollagen mRNA as well as the amount of procollagen 1. The study indicates that IL-1 reduces the expression of alpha 1 (I) procollagen mRNA in human gingival fibroblasts partly by a prostaglandin endoperoxide (PGH) synthase-mediated pathway and partly by a PGH-synthase independent pathway, whereas PHT reduces alpha 1 (I) procollagen gene expression by a PGH-synthase independent pathway. The potentiation of the inhibitory effect of IL-1 induced by PHT was mediated mainly by a PGH-synthase dependent pathway.

Selective antibody reactivity with peptides from human endogenous retroviruses and nonviral poly(amino acids) in patients with systemic lupus erythematosus

OBJECTIVE

To investigate antibody responses to a broad panel of peptides derived from human endogenous retroviruses (HERVs) among unselected patients with systemic lupus erythematosus (SLE).

METHODS

In sera obtained from 69 patients with SLE and healthy blood donors, immunoassay was used to measure levels of antibody against synthetic peptides derived from HERVs, exogenous retroviruses, and nonviral poly(amino acids).

RESULTS

Measurement by immunoassay revealed increased frequencies of antiretroviral antibodies against 2 peptides derived from the env gene of the type C-like class, which includes ERV-9 and HERV-H, and against 2 peptides from the gag region of human T lymphotropic virus type I-related endogenous sequence 1, in patients with SLE. Antibodies to 2 nonviral peptides, polyhistidine and polyproline, were also overrepresented in patient sera. In 1 patient, longitudinal data obtained over a period of 12 years indicated that the concentrations of certain antiretroviral antibodies varied according to disease activity.

CONCLUSION

Reactivity to certain type C HERV-derived antigens was found among patients with SLE. This reactivity could be explained by increased exposure to cross-reactive epitopes from essentially complete type C HERVs.

Triclosan reduces prostaglandin biosynthesis in human gingival fibroblasts challenged with interleukin-1 in vitro

The effect of the toothpaste ingredient triclosan (2,4,4'-trichloro-2'-hydroxyldiphenyl ether) on the prostaglandins biosynthesis in human gingival fibroblasts challenged with interleukin-1beta (IL-1beta) or tumor necrosis factor alpha (TNFalpha) was studied in vitro. When gingival fibroblasts were treated simultaneously with triclosan and IL-1beta, the stimulatory effect of IL-1beta on prostaglandin E2 (PGE2) and PGI2 formation was reduced in a dose-dependent manner by triclosan. Triclosan also reduced the PGE2 formation induced by TNFalpha. Furthermore, the capacity of IL-1beta to induce release of [3H] arachidonic acid from prelabelled gingival fibroblasts was reduced in the presence of triclosan. Addition of exogenous unlabelled arachidonic acid (AA) to the cells resulted in enhanced PGE2 formation which was reduced by triclosan. The upregulation of the metabolism of AA to PGE2 induced by IL-1beta, was markedly reduced in the presence of triclosan. The study indicates that the stimulatory effect of IL-1beta on prostanoid formation (PGE2, PGI2) in human gingival fibroblasts was diminished in the presence of triclosan partly at the level of phospholipase A2 and partly at the level of cyclooxygenase. The present data that triclosan, in vitro, inhibits the production of inflammatory mediators such as prostaglandins suggests that this can be an aspect of its clinical effect on gingivitis, in addition to its antibacterial effect.

Identification of the allergenic components of kiwi fruit and evaluation of their cross-reactivity with timothy and birch pollens

BACKGROUND

Only a few food allergens have as yet been identified, mainly because of the difficulty of obtaining a sufficient number of patients who are clinically sensitized to a given food. This is more feasible in the case of the oral allergy syndrome (OAS), a common form of food allergy, which is especially prevalent in patients with pollinosis.

OBJECTIVE

We designed a study to identify the allergens of kiwi fruit (Actinidia chinensis) by analyzing the sera of patients with OAS for kiwi and to examine the cross-reactivity of these allergens with timothy and birch pollen allergens.

METHODS

Twenty-seven patients with OAS for kiwi, a positive skin prick test response and serum IgE antibody to kiwi, and a positive open kiwi challenge test result and three patients who had OAS with severe systemic symptoms, which excluded a challenge test, were included in this study. The different polypeptide components of an extract of fresh kiwi were separated by sodium dodecylsulfate-polyacrylamide gel electrophoresis and analyzed by IgE immunoblotting with sera from these patients. Cross-reactivity with the two pollen extracts was assessed by inhibition of the immunoblots with pooled and individual patients' sera.

RESULTS

Twelve IgE-binding components with molecular weights ranging from 12 to 64 kd were identified in the kiwi extract, but only a 30 kd component acted as major allergen, being recognized by sera of 100% of these patients. Inhibition of kiwi immunoblots with timothy and birch pollen extracts demonstrated strong cross-reactivity with some of the kiwi allergens, suggesting complete identity between certain food and pollen allergens; whereas others, particularly the 30 kd allergen, were only partially inhibited, suggesting much weaker cross-reactivity.

CONCLUSIONS

Kiwi fruit contains a large number of allergens widely cross-reacting with allergens in grass and birch pollen extracts. Nevertheless, the major allergen at 30 kd appears to be specific for kiwi.