Type III collagen aminopropeptide and laminin P1 levels in serum of patients with silicosis-associated and idiopathic systemic scleroderma

A group of 191 patients with systemic scleroderma and 12 patients with silicosis-associated scleroderma were investigated for connective tissue turnover. The serum levels of type III collagen aminopropeptide (P-III-P), the laminin PI (Lam PI) fragment and the acid lysosomal beta-galactosidase (beta-Gal) were determined by specific radioimmunoassays and spectrofluorometry, respectively. Increased levels of type III collagen aminopropeptide strongly correlated with enhanced activity of beta-galactosidase. Both parameters correlated with the clinical course in idiopathic systemic scleroderma and in silicosis-associated scleroderma. Serum levels of Lam PI were also found to be elevated in both groups, although there was no correlation with the severity of the disease. Autoantibodies directed against the DNA topoisomerase Scl-70 and against centromeric proteins were found in a similar range in patients with idiopathic systemic and silicosis-associated scleroderma. These results suggest that P-III-P, Lam PI and beta-Gal are useful serological markers of fibrotic activity and demonstrate similarities between idiopathic systemic scleroderma and scleroderma associated with silica-dust exposure.

[Pharmacokinetic comparison of 3 8-methoxypsoralen preparations and clinical aspects]

In order to register the inter- and intraindividual variability of serum levels of 8-methoxypsoralen (MOP) (Oxsoralen, n = 12; Geroxalen, n = 46; Mopsoralen, n = 30), we investigated a total of 1,276 serum samples obtained at 11 patient appointments over 8 h in 88 patients and compared the individual serum concentrations - time curves with the pharmacokinetic parameters Cmax (maximal serum concentration) on the time tmax, as well as the AUC value (area under the curve) as a parameter of bioavailability. The individual serum concentration value showed a high interindividual variability (Oxsoralen Cmax: 47-473 ng.ml-1; Geroxalen Cmax: 37-416 ng.ml-1 and Mopsoralen Cmax: 44-300 ng.ml-1) and preparation specific differences (Oxsoralen Cmax: 188 +/- 125 ng.ml-1; tmax: 2.0 +/- 0.6 h; AUC: 461 +/- 322 ng.ml-1.h; Geroxalen Cmax: 193 +/- 87 ng.ml-1; tmax: 0.9 +/- 0.4 h; AUC: 290 +/- 198 ng.ml-1.h; Mopsoralen Cmax: 164 +/- 71 ng.ml-1; tmax: 1.7 +/- 0.5 h; AUC: 389 +/- 221 ng.ml-1.h). On repeated administration of Geroxalen (n = 16) and Mopsoralen (n = 12), minimal intraindividual distributions were noted, so the mean serum concentration curves did not show a significant difference. The importance of 8-MOP serum level determinations for better puva therapy, particularly in therapeutic failure in problem cases, is discussed.

Interleukin-2 receptor expression and interleukin-2 production in bullous pemphigoid

Expression of interleukin-2 (IL2) receptors was studied on peripheral blood lymphocytes (PBLs) in 25 patients with bullous pemphigoid. Analysis was carried out by flow cytometry. Without immunosuppressive therapy expression of IL2 receptors only on T cells (CD5) was significantly increased as shown by double staining (11.9% +/- 7.8% vs 2.1% +/- 1% in controls). After 2-3 weeks under immunosuppressive treatment with prednisolone and azathioprine, however, BP lymphocytes did not exhibit any IL2 receptors. PBLs of 18 BP patients showed an increase in IL2 production (1027.4 +/- 670.5 U/ml vs 270 +/- 100 U/ml in controls) during the acute stage of the disease after stimulation with phytohaemagglutinin (PHA)/phorbol myristate acetate (PMA). On the contrary, IL2 production of the same cells in five patients was only in the lowest range of control values after PHA stimulation without PMA (12.5 +/- 29.6 U/ml vs 40 +/- 20 U/ml in controls). Under treatment with immunosuppressants the IL2 production normalized after PHA/PMA stimulation and slightly decreased following PHA stimulation. From these results we conclude that a T-cell activation via activation antigens, as IL2 receptors, and the production of the specific ligand, IL2, may play a role in the pathogenesis of bullous pemphigoid, especially in the earliest stages, and serve as a marker of disease activity.

Silica-induced scleroderma

In a survey done in East Germany between 1981 and 1988, we found that 93 of 120 male scleroderma patients had long-term exposure to silica dust. We describe our findings in 12 patients with scleroderma and silicosis. The exposure time to silica dust was between 3 and 34 years; the interval between the beginning of exposure and the onset of scleroderma averaged 27.3 years (range 9 to 40 years). Antinuclear antibodies in titers between 80 and 10,240 with nucleolar and/or speckled patterns were found in 10 patients, antibodies against double-stranded DNA in three, Scl-70 (topoisomerase I) in three, and anticentromere antibodies in five. The following markers of collagen metabolism were increased in serum: beta-galactosidase in 12 patients, laminin peptide-P1 in 10 patients, N-terminal procollagen type III peptide in 10, and urinary sialic acid excretion in 7. We propose that crystalline particles of silica less than 5 microns may be phagocytosed by macrophages and release lymphokines and monokines, which activate fibroblasts and enhance their collagen and glycosaminoglycan synthesis. In addition, silica may act as an adjuvant to increase immune reactivity.

[Phagocytic activity of granulocytes after UV-irradiation]

The effect of UV-irradiation on three functions of human isolated granulocytes (viability, phagocyte activity and capacity to reduce nitrotetrazolium blue) was investigated. The phagocytosis appeared to be the most sensitive function. The number of phagocytic cells was decreased under UV-doses as low as 0.63 kJ.m-2. Cell lethality was increased under UV-doses 4.32 kJ.m-2 and higher. The capacity to reduce nitrotetrazolium blue was uneffected even at the dose as high as 10.17 kJ.m-2.

[Expression of leukocyte antigens in human sperm]

The expression of leukocyte antigens on human ejaculated spermatozoa and lymphocytes was compared by means of the immunofluorescence technique and monoclonal antibodies against anti-HLA class I (pan-HLA-A,B,C) and class II (DR, DR/DP). Lymphocytes showed specific fluorescence phenomena after incubation with the antibodies. However, in the case of spermatozoa no immunofluorescent labeling was detected. Modifications of the method of sperm preparation (Ficoll centrifugation, swim-up technique, addition of azide, fetal calf serum or benzamidinchloride) did not lead to different results. We were not able to find HLA-antigen expression on fresh human spermatozoa using immunofluorescence.

[The behavior of membrane receptors of peripheral blood lymphocytes in bullous pemphigoid]

In 35 patients with bullous pemphigoid (BP) various parameters of the cellular immune system were studied. It was shown that the average 29% decrease in the number rosette-forming lymphocytes in sheep red blood cells is converted by the immune complexes and by a second serum factor in the acute stage of BP that has not yet been characterized precisely. These changes were reversible in patients who were placed on immunosuppressants. Obviously, this mechanism is partly due to the binding of immune complexes via Fc receptors on T-lymphocytes and is consequently due to the steral blocking of sheep erythrocyte receptors. No decrease in the number of T-cells was found by means of monoclonal antibodies (CD2, CD3), and the number of suppressor cells was also normal (CD8). On the other hand, the number of T-helper cells increased by an average of 15% (CD4). In addition, in the acute stage, there is a significant increase in the number of activation antigen Tac (CD25) and DR-bearing lymphocytes: 29% and 37% respectively (the normal values are 2% and 11%, respectively). Double staining permitted the phenotype of activated lymphocytes to be detected within the T-cells and the T-helper cell subpopulation, respectively. The number of activated T-helper cells correlates with the disease activity, and from that point it seems to be useful as a marker of activity in follow-up studies.

[Treatment of chronic recurrent erysipelas with streptococcal vaccine]

One hundred patients suffering from relapsing erysipelas were treated with streptococcal vaccine consisting of a phenol- und heat-inactivated mixture of 12 different types of streptococci. Simultaneously the entry point was cured and general disposition and local terrain factors were treated. In the majority of cases further relapses were avoided or their frequency reduced. The results of the treatment with streptococcal vaccine were compared with those of long-term benzathine-penicillin therapy in 47 patients. The vaccine has proved to be equivalent to the penicillin therapy and can be recommended as a real alternative to it for prevention of further infections and late sequelae, especially those of chronic lymphedema. The beneficial therapeutic effect of the vaccine is probably attributable to a non-specific immune stimulation. A partial cellular immune defect involving the protective M-antigen together with simultaneous partial abnormalities of immune reactivity is discussed as a cause of relapsing erysipelas.

Lymphocytotoxic autoantibodies in progressive systemic sclerosis

In 53 patients with progressive systemic sclerosis (PSS) the lymphocytotoxic activity of their serum was measured in a microlymphocytotoxicity assay. In 21 of the 53 patients the test reacted distinctly positively in the heterologous system, and in 9 of these 21 also in the autologous system. After preparation of the immunoglobulins from these positive sera, whole cytotoxic activity was detected only in the IgM fraction but not in the IgG fraction. When using prepared T lymphocytes as target cells in the microlymphocytotoxicity test, the cytotoxic activity of the positive PSS sera showed itself to be directed against this lymphocyte population. Further analysis using the Western-blot technique showed that the IgM autoantibody in PSS sera reacted with the cell surface of CD4+ lymphocytes. The cross reactivity with extractable nuclear antigens was rather improbable. These results suggest that lymphocytotoxic autoantibodies may play a role in immunological disturbances in PSS.

Localized nonscarring bullous pemphigoid of the vagina

Here we report on a 60-year-old female patient suffering from multiple erosive inflammatory lesions of the vagina for 2 years. Subepidermal blister in the histological examination, deposits of IgG and C3 in the direct immunofluorescence studies and the basement membrane zone antibody titers between 80 and 320 have confirmed the diagnosis of bullous pemphigoid. The lesions responded to treatment with prednisolone and azathioprine fairly well. There have been no signs of scarring till now.

[Quartz--its relevance for dermatology]

Next to oxygen silicium is the most common substance of our environment. It occurs mostly in form of quartz (SiO2). In the past silica was usually mentioned in connection with foreign body granulomas in dermatological papers. Recently relations between occupational silica exposure and several diseases were reported. Silica exposure was related to the development of scleroderma, lupus erythematodes and sarcoidosis. Pathogenetic connections may be due to a stimulating effect on fibroblasts and due to immunmodulating properties of silica.

The equatorial fibronectin band (EFB) on human spermatozoa--a diagnostic help for male fertility?

Spermatozoa were prepared by swim up technique in the same way as for in vitro fertilization of human eggs and incubated with antihuman fibronectin antibodies in the immunofluorescence technique. Fibronectin mediates adhesive interactions between cells. 69 p.c. of spermatozoa with a normal shape and only 17 p.c. of them exhibiting a pathological shape showed a positive fibronectin-fluorescent band on the equatorial segment, called equatorial fibronectin band (EFB). The cryopreservation of semen did not influence the EFB. The significance of EFB for the sperm-oocyte-binding is discussed in connection with the sperm morphology and epididymal function.

Origin of the enhanced activity of lysosomal beta-galactosidase in serum and skin in progressive systemic sclerosis

In 14 patients with progressive systemic sclerosis (PSS) the activities of acid lysosomal glycosidases (alpha-, beta-galactosidase, beta-glucosidase, beta-glucuronidase, and beta-N-acetyl-glucosaminidase) were determined fluorometrically in serum, leukocytes, and skin tissue. The beta-galactosidase was the only enzyme which exhibited a significantly elevated activity in PSS serum and skin but not leukocytes, as compared to the control. The activity patterns of the studied glycosidases in serum were similar to those found in skin, but differ from the distribution of glycosidase activities in leukocytes. In cultured dermal fibroblasts derived from PSS patients, an elevated intracellular activity of beta-galactosidase was detected. These results suggest that the increased beta-galactosidase activity in the serum originates from the skin fibroblasts.

[Bone changes in long-term therapy with etretinate (Tigason)]

We report on a 10-year-old girl with ichthyosis vulgaris, suffering from pains in her left arm and wrist after 1 1/2 years' treatment with etretinate (Tigason) The activity of the alkaline phosphatase was increased. Scintigraphy with technetium showed increased accumulation of activity as well as beginning transformation processes of the left ulna, which recovered after the reduction of the maintenance dose and are no longer detectable after a total of 3 1/2 years' treatment. The potential bone toxicity must be taken into consideration in long-term treatment with retinoids. Its manifestation should be prevented by thorough follow-up.

4,5-Dimethylangelicin effects on lymphocytes with and without UV-radiation

Compared to the linear derivative 8-methoxypsoralen (8-MOP) the angular structured furocoumarin 4,5'-dimethylangelicin (4,5'-DMA) causes smaller photosensitization effects (loss of viability, inhibition of phytohemagglutinin (PHA)-induced transformation rate and E-rosette formation of T-cells, respectively) on cultured human lymphocytes. When 4,5'-DMA or 8-MOP are added to the cultures without additional UV-irradiation, increased or decreased PHA-stimulation rates are observed, respectively. In addition, 4,5'-DMA is able to reduce the binding of sheep erythrocytes to lymphocytes in a higher degree than 8-MOP. These findings suggest different action mechanisms on cytoplasma membranes and intracellular structures of lymphocytes by different furocoumarins.