Immunopharmacological studies of qingkaining, a Chinese blended medicine: effects on experimental autoimmune uveoretinitis in the rat

Qingkaining, a blended Chinese medicine, is reported to be effective in treating patients with uveitis in China. In this study, the immunomodulatory effectiveness of this drug was evaluated on experimental autoimmune uveoretinitis (EAU) induced by S-antigen (S-Ag). Rats treated with high (2.5 cc/kg/day) and low (1 cc/kg/day) doses of Qingkaining, high (10 mg/kg/day) and low (3 mg/kg/day) doses of Cyclosporine A (CsA) and a combination of high or low dose of Qingkaining and low dose CsA were compared by the following parameters: clinical manifestations, histopathology, skin delayed-type hypersensitivity (DTH) reactions, lymphocyte proliferative responses and serum anti-S-antigen antibody production. The incidences of clinically and histopathologically determined EAU were 14.29% and 28.57% respectively in the rats treated with high and low doses of Qingkaining in comparison to 57.14% and none in the rats treated with low and high doses of CsA. EAU did not develop in the rats treated with the combination of low dose CsA and low or high doses of Qingkaining. The skin DTH reaction showed a diminished response in the rats treated with either Qingkaining or CsA. However, the lymphocyte proliferative responses and anti-S-Ag antibody were not effected in the rats treated with Qingkaining alone. This study demonstrates that Qingkaining is a potent immunosuppressive agent in this model for human disease. The experimental data support the clinical effectiveness of Qingkaining in the treatment of patients with uveitis.

Iris inflammatory cells, fibronectin, fibrinogen, and immunoglobulin in various ocular diseases

Using immunohistochemical techniques, we analyzed the inflammatory cell subpopulation and the presence of fibronectin and immunoglobulin in iridectomy specimens from 50 patients with cataracts, glaucoma, and uveitis, and from ten normal eyes. The irises from patients with uveitis showed the highest numbers of T-lymphocytic infiltration compared with all other groups. Concentrations of fibronectin, fibrinogen, and immunoglobulins were significantly higher in the uveitic group compared with other diseases and normal controls. The irises from patients with glaucoma showed fewer infiltrating cells and less fibronectin and fibrinogen. Enhancement of major histocompatibility complex class II antigen HLA-DR expression was observed in all disease groups compared with controls. These findings suggest that in patients with uveitis and acute glaucoma the infiltrating T lymphocytes and the presence of fibronectin, fibrinogen, and immunoglobulins may contribute to the greater risk of postsurgical inflammation, leading to such problems as closure of the iridectomy. The enhancement of HLA-DR antigen expression in the iris may indicate abnormalities of iris resident cells seen in various diseases.

Immunohistochemical markers in the normal human epibulbar conjunctiva from fetus to adult

Monoclonal antibodies were used for the study of inflammatory cellular subtypes, Langerhans' cells, and major histocompatibility complex class II antigens on the epibulbar conjunctiva obtained from individuals ranging in age from fetus to the seventh decade to compile basic data for comparison with other inflammatory and proliferative conjunctival diseases. In the fetal conjunctiva, there were significantly fewer T cells and Langerhans' cells than in adult conjunctiva. In the adult conjunctiva, a mild T-cell infiltration was observed. Expression of HLA-DQ in the 20- to 50-year-old age group was significantly lower compared with fetal and other age groups.

Serotonergic activity in man as a function of pain, pain mechanisms, and depression

Lumbar cerebrospinal fluid levels of 5-hydroxyindoleacetic acid, which are used as indicators of central nervous system serotonergic neuronal activity, were significantly higher in 67 patients with chronic pain and in 32 patients with acute pain (23.6 +/- 3.3 and 23.1 +/- 3.8, respectively) than in 30 patients (8.8 +/- 1.7) who had no pain. However, there was no correlation between levels of 5-hydroxyindoleacetic acid in patients with chronic or acute pain, nor between groups of patients with chronic pain whose pain mechanisms were of psychogenic, sympathetic, somatic, or central origin, based on their responses to differential spinal block; there was also no correlation between levels of depression, as evaluated by the Zung scale, in patients with different types of chronic pain, even though all of these patients were depressed. The elevated levels of 5-hydroxyindoleacetic acid in the depressed patients with chronic pain are not consistent with previous studies on the etiology and types of chronic pain. As recent research indicates that the perception of pain may be modulated by endogenous analgesic systems involving enkephalin and serotonin (5-HT), this study was undertaken to clarify the association between 5-HT activity and nociception. Our findings did show a link between acute noxious stimulation and central increases in serotonergic activity. However, we could not differentiate between pain mechanisms and degree of depression. Our studies did indicate that, because of both the persistence of pain complaints and the increased levels of brain 5-HT activity, the endogenous analgesic systems are not totally effective as natural inhibitors of pain. Furthermore, the increased depression and continued pain in the presence of elevated 5-HT activity in patients with chronic pain may represent a tolerance or decreased responsiveness to 5-HT.

The pharmacologic approach in differential diagnosis of chronic pain

Chronic pain of unknown cause below waist level was evaluated in 100 patients by using the Differential Spinal Block (DSB) in a multidisciplinary pain clinic setting. The classic DSB approach, refined for better control of psychologic variables, was found to be a safe and effective means of differentiating various pain mechanisms. We found that, of all patients tested, 55% had pain of central or psychogenic origin and 30% had sympathetically mediated pain, as compared with 15% who had somatic pain. A long-term follow-up of these patients confirmed this impression. These results substantiated the importance of psychologic variables, in dicating the necessity for use of behavioral-based therapies in conjunction with the routine use of the refined diagnostic DSB procedure in patients with chronic pain.

Towards an understanding of chronic pain mechanisms: the use of psychologic tests and a refined differential spinal block

Forty patients with chronic pain below the waist level were evaluated in a multidisciplinary pain clinic using a refined differential spinal block (DSB) technique. The refinements consisted of verbal instructions to prevent biasing the patients, coupled with a thorough evaluation of verbal and physiologic responses to the block. When demographic and psychologic data were assessed according to pain mechanisms, a pattern of patient groups emerged along a chronic pain continuum. Stress, anxiety, depression, and hysteria, as well as the neurophysiologic and demographic factors, modified the responses to the block. Long-term follow-up of these patients, including repeat DSB procedures and confirmatory anatomic blocks of sympathetic and somatic nerves, validated these impressions. The findings indicate a link between pain mechanisms and psychosocial factors that may directly influence responses to DSB.

An unsuccessful attempt to treat hypertension with acupuncture

The effectiveness of 5 sets of acupuncture loci in decreasing systemic blood pressure was compared with chlorthalidone and propranolol in patients with essential hypertension. No statistically significant acute or long-term changes in plasma catecholamines, renin activity, or blood pressure and pulse rate were observed as a result of acupuncture treatment. The decrease in blood pressure was significantly less than that observed with propranolol, but not significantly less than that produced by chlorthalidone. Because of the poor patient acceptance of acupuncture and in the absence of a beneficial response, we feel acupuncture as employed in this study is of limited value in the management of patients with essential hypertension.