Clinical pathophysiology of human T-lymphotropic virus-type 1-associated myelopathy/tropical spastic paraparesis

Human T-lymphotropic virus type 1 (HTLV-1), a human retrovirus, is the causative agent of a progressive neurological disease termed HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). HAM/TSP is a chronic inflammatory disease of the central nervous system and is characterized by unremitting myelopathic symptoms such as spastic paraparesis, lower limb sensory disturbance, and bladder/bowel dysfunction. Approximately 0.25-3.8% of HTLV-1-infected individuals develop HAM/TSP, which is more common in women than in men. Since the discovery of HAM/TSP, significant advances have been made with respect to elucidating the virological, molecular, and immunopathological mechanisms underlying this disease. These findings suggest that spinal cord invasion by HTLV-1-infected T cells triggers a strong virus-specific immune response and increases proinflammatory cytokine and chemokine production, leading to chronic lymphocytic inflammation and tissue damage in spinal cord lesions. However, little progress has been made in the development of an optimal treatment for HAM/TSP, more specifically in the identification of biomarkers for predicting disease progression and of molecular targets for novel therapeutic strategies targeting the underlying pathological mechanisms. This review summarizes current clinical and pathophysiological knowledge on HAM/TSP and discusses future focus areas for research on this disease.

Increased prevalence of group A β-hemolytic streptococcus among an ethnic population in Kyrgyzstan detected by the rapid antigen detection test

The incidence of rheumatic fever (RF) has markedly increased in the last 10 years in Kyrgyzstan. Therefore, investigating the prevalence of group A β-hemolytic streptococcus (GABHS), which is the cause of RF, in the Kyrgyzstan population is crucial. We studied 189 subjects: 59 children [29 with RF and/or rheumatic heart disease (RHD)] and 130 adults (15 with RHD). The average age of the subjects was 41.0±10.0 years (range 8 months to 72 years). A general clinical examination and medical history including eating habits was carried out. The prevalence of GABHS was tested using the highly sensitive rapid antigen detection test (RADT) to detect the outcrop of streptococcus antigen in smears taken from the mucosal surface of the tonsils or the back of the throat. GABHS antigen was positive in 70 of a total 189 subjects [37.0%; 22/59 children (37.2%), 48/130 adults (36.9%)]. In patients with RF/RHD (n=44), GABHS was positive in 14 subjects [31.8%; 8/29 children (27.6%), 6/15 adults (40.0%)]. Thirty-two subjects with RF/RHD had frequent episodes of tonsillopharyngitis. In subjects without RF/RHD (n=145), GABHS was positive in 56 subjects [38.6%; 14/30 children (46.6%), 42/115 adults (36.5%)]. Thirty of these subjects had frequent episodes of tonsillopharyngitis. Of the 130 adults, the most-consumed dairy products included yoghurt (n=115; 88.4%), milk kasha (n=75; 57.7%) and milk (n=40; 30.7%). Of the 115 subjects in the yoghurt-consuming group, 44 (38.2%) had positive results for GABHS. In the non-yoghurt-consuming group, 4/15 subjects (26.6%) had positive results for GABHS. Using RADT for GABHS, a high prevalence of GABHS antigen was detected not only in patients with RF/RHD, but also in the healthy population (without RF/RHD). The low GABHS prevalence in children with RF/RHD (27.6%) was probably due to corresponding antibiotic therapy. In conclusion, the high prevalence of GABHS is one of the main reasons for the rapid increase in RF/RHD in Kyrgyzstan, and RADT would be an effective tool for its detection.

The Japanese version of the modified ACR preliminary diagnostic criteria for fibromyalgia and the fibromyalgia symptom scale: reliability and validity

PURPOSE

The aim of this study is to investigate the reliability and validity of the Japanese version of the modified American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia (mACR 2010-J) and the Fibromyalgia Symptom Scale (mFS-J).

METHODS

According to the ACR 1990 classification criteria, patients with chronic pain were divided into the fibromyalgia group and nonfibromyalgia group (rheumatoid arthritis and osteoarthritis). Patients in both groups were assessed using mACR 2010-J and mFS-J.

RESULTS

294 of 462 (64 %) patients in the fibromyalgia group met mACR 2010-J, whereas 4 % (9/231) of the nonfibromyalgia group did, with sensitivity of 64 %, specificity of 96 %, positive predictive value of 97 %, negative predictive value of 56 %, and positive likelihood ratio of 16.3. Mean total scores on mFS-J significantly differentiated the fibromyalgia from the nonfibromyalgia group. According to the value of the Youden index, the best cutoff score for the mFS-J was 9/10.

CONCLUSION

Our findings indicate that mACR 2010-J as a positive test and mFS-J as a quantification scale might be suitable for assessing fibromyalgia among Japanese chronic pain populations.

RING-finger type E3 ubiquitin ligase inhibitors as novel candidates for the treatment of rheumatoid arthritis

Rheumatoid arthritis (RA) significantly affects quality of life. We recently cloned synoviolin, a RING-type E3 ubiquitin ligase implicated in the endoplasmic reticulum-associated degradation (ERAD) pathway. Synoviolin is highly expressed in rheumatoid synovial cells and may be involved in the pathogenesis of RA. Inhibition of synoviolin activity is a potentially useful therapeutic approach for the treatment of RA. We conducted a high-throughput screen of small molecules to find inhibitors of synoviolin autoubiquitination activity. We identified two classes of small molecules, named LS-101 and LS-102, which inhibited synoviolin activity. LS-102 selectively inhibited synoviolin enzymatic activity, while LS-101 inhibited a broad array of RING-type E3 ligases. Moreover, these inhibitors suppressed the proliferation of rheumatoid synovial cells, and significantly reduced the severity of disease in a mouse model of RA. Our results suggest that inhibition of synoviolin is a potentially useful approach in the treatment of RA.

Abstract 4803: Quantitative proteome profiling of CD4+CD25+CCR4+ T-cells to identify potential therapeutic targets for adult T-cell leukemia (ATL) and Human T-lymphotropic virus type-1 associated myelopathy (HAM)

Human T-cell leukemia virus type 1 (HTLV-1) is a retro-viruse known as the one of the causative factors of adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), both of which are developed after a long latency period over 30 years. ATL is developed in HTLV-1-infected individuals at the prevalence of 5% with poor prognosis. Meanwhile, HAM/TSP has a prevalence of approximately 0.25% of HTLV-1-infected individuals and is characterized by its neurological symptoms, such as sensory disturbance of lower extremities. Regardless of the importance of early diagnosis and appropriate therapeutic intervention for the patients, the diagnostic markers or the effective molecular treatment targets have not been discovered yet. The objective of the present study is to identify determinants responsible for the development of ATL or HAM/TSP, which could be useful as the potential therapeutic targets or prognostic biomarkers. Here we performed a quantitative proteomic profiling of CD4+CD25+CCR4+ T-cells, which are known as the predominant viral reservoir, by means of label-free quantification analysis on the Expressionist proteome server. CD4+CD25+CCR4+ T cells were isolated from the peripheral blood mononuclear cells derived from 6 uninfected volunteers, 5 asymptomatic carriers, 9 HAM/TSP patients, and 9 ATL patients. The isolated T cells from 29 individuals were lysed, digested, and subjected to LC/MS/MS analyses. Subsequently, we integrated the 29 LC/MS/MS data on the Expressionist proteome server and conducted label-free quantification analysis, obtaining 14,064 non-redundant peptides. Kruskal-Wallis test and leave-one-out cross validation test finally extracted 20 peptides derived from 17 distinct proteins, which allowed statistical classification of four pathological groups. The 17 candidates included a couple of proteins which are well known as an apoptotic enzyme-substrate pair; Calpain-2 (CAN2) and Spectrin alpha chain (SPTA2). Our mass spectrometric quantification data demonstrated that CAN2 expression was significantly down-regulated in CD4+CD25+CCR4+ cells from ATL patients, while SPTA2 was abnormally accumulated. Indeed, exogenous overexpression of CAN2 remarkably induced apoptosis to ATL cell line SO-4 (expressing high level of SPTA2) but not in KOB cells (SPTA2 negative). These observations indicate that CAN2 and SPTA2 coordinately regulate the apoptosis and the suppression of CAN2 in HTLV-1 infected T-cells would be one of the plausible causes of ATL onset. Our label-free quantification-based proteome profiling of CD4+CD25+CCR4+ T cells enabled us to identify 17 pathological determinants for HAM/TSP and ATL, which could contribute to developing new strategies for treatment and diagnosis in the future.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4803. doi:1538-7445.AM2012-4803

[The current and future approaches to the treatment of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP)]

Human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus that is the causative agent of a progressive neurological disease termed HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). HAM/TSP is a chronic neuroinflammatory disease characterized by spastic paraparesis, lower limb sensory disturbance and bladder/bowel dysfunction. Over the twenty-five years since the discovery of this disease, significant advancements have been made in the pathogenic mechanisms associated with HAM/TSP, however, little progress has been made in the treatment of this disorder. This review highlights the natural history of HAM/TSP, informative results of clinical trials, and discusses the current and future approaches to the treatment of HAM/TSP within the context of our understanding of the underlying pathogenic mechanisms.

Vacuum insulation of the high energy negative ion source for fusion application

Vacuum insulation on a large size negative ion accelerator with multiple extraction apertures and acceleration grids for fusion application was experimentally examined and designed. In the experiment, vacuum insulation characteristics were investigated in the JT-60 negative ion source with >1000 apertures on the grid with the surface area of ∼2 m(2). The sustainable voltages varied with a square root of the gap lengths between the grids, and decreased with number of the apertures and with the surface area of the grids. Based on the obtained results, the JT-60SA (super advanced) negative ion source is designed to produce 22 A, 500 keV D(-) ion beams for 100 s.

Overexpression of SPACIA1/SAAL1, a newly identified gene that is involved in synoviocyte proliferation, accelerates the progression of synovitis in mice and humans

OBJECTIVE

To identify novel genes associated with dysregulated proliferation of activated synovial fibroblasts, which are involved in arthritic joint destruction.

METHODS

We performed transcriptome analysis to identify genes that were up-regulated in the foot joints of mice with collagen-induced arthritis (CIA). The effect of candidate genes on proliferation of synovial fibroblasts was screened using antisense oligodeoxynucleotides and small interfering RNAs (siRNAs). We characterized the expression and function of a novel gene, synoviocyte proliferation-associated in collagen-induced arthritis 1 (SPACIA1)/serum amyloid A-like 1 (SAAL1) using antibodies and siRNA and established transgenic mice to examine the effect of SPACIA1/SAAL1 overexpression in CIA.

RESULTS

Human and mouse SPACIA1/SAAL1 encoded 474 amino acid proteins that shared 80% homology. SPACIA1/SAAL1 was primarily expressed in the nucleus of rheumatoid arthritis (RA) synovial fibroblasts and was highly expressed in the hyperplastic lining of inflamed synovium. In addition, its expression level in RA- or osteoarthritis (OA)-affected synovial tissue was positively correlated with the thickness of the synovial lining. Furthermore, SPACIA1/SAAL1 siRNA inhibited the proliferation of synovial fibroblasts, especially tumor necrosis factor α-induced synovial fibroblasts, by blocking entry into the S phase without inducing apoptosis. Finally, transgenic mice overexpressing SPACIA1/SAAL1 exhibited early onset and rapid progression of CIA.

CONCLUSION

These results suggest that SPACIA1/SAAL1 is necessary for abnormal proliferation of synovial fibroblasts and its overexpression is associated with the progression of synovitis in mice and humans. Thus, therapy targeting SPACIA1/SAAL1 might have potential as an inhibitor of synovial proliferation in RA and/or OA.

Functional impairment of Tax-specific but not cytomegalovirus-specific CD8+ T lymphocytes in a minor population of asymptomatic human T-cell leukemia virus type 1-carriers

Background

Human T-cell leukemia virus type 1 (HTLV-1) causes adult T-cell leukemia (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in a small percentage of infected individuals. ATL is often associated with general immune suppression and an impaired HTLV-1-specific T-cell response, an important host defense system. We previously found that a small fraction of asymptomatic HTLV-1-carriers (AC) already showed impaired T-cell responses against the major target antigen, Tax. However, it is unclear whether the impaired HTLV-1 Tax-specific T-cell response in these individuals is an HTLV-1-specific phenomenon, or merely reflects general immune suppression. In this study, in order to characterize the impaired HTLV-1-specific T-cell response, we investigated the function of Tax-specific CD8⁺ T-cells in various clinical status of HTLV-1 infection.

Results

By using tetramers consisting of HLA-A*0201, -A*2402, or -A*1101, and corresponding Tax epitope peptides, we detected Tax-specific CD8⁺ T-cells in the peripheral blood from 87.0% of ACs (n = 20/23) and 100% of HAM/TSP patients (n = 18/18) tested. We also detected Tax-specific CD8⁺ T-cells in 38.1% of chronic type ATL (cATL) patients (n = 8/21), although its frequencies in peripheral blood CD8⁺ T cells were significantly lower than those of ACs or HAM/TSP patients. Tax-specific CD8⁺ T-cells detected in HAM/TSP patients proliferated well in culture and produced IFN-γ when stimulated with Tax peptides. However, such functions were severely impaired in the Tax-specific CD8⁺ T-cells detected in cATL patients. In ACs, the responses of Tax-specific CD8⁺ T-cells were retained in most cases. However, we found one AC sample whose Tax-specific CD8⁺ T-cells hardly produced IFN-γ, and failed to proliferate and express activation (CD69) and degranulation (CD107a) markers in response to Tax peptide. Importantly, the same AC sample contained cytomegalovirus (CMV) pp65-specific CD8⁺ T-cells that possessed functions upon CMV pp65 peptide stimulation. We further examined additional samples of two smoldering type ATL patients and found that they also showed dysfunctions of Tax-specific but not CMV-specific CD8⁺ T-cells.

Conclusions

These findings indicated that Tax-specific CD8⁺ T-cells were scarce and dysfunctional not only in ATL patients but also in a limited AC population, and that the dysfunction was selective for HTLV-1-specifc CD8⁺ T-cells in early stages.

Human T-lymphotropic virus type 1 (HTLV-1) and regulatory T cells in HTLV-1-associated neuroinflammatory disease

Human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus that is the causative agent of adult T cell leukemia/lymphoma (ATL) and associated with multiorgan inflammatory disorders, including HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and uveitis. HTLV-1-infected T cells have been hypothesized to contribute to the development of these disorders, although the precise mechanisms are not well understood. HTLV-1 primarily infects CD4(+) T helper (Th) cells that play a central role in adaptive immune responses. Based on their functions, patterns of cytokine secretion, and expression of specific transcription factors and chemokine receptors, Th cells that are differentiated from naïve CD4(+) T cells are classified into four major lineages: Th1, Th2, Th17, and T regulatory (Treg) cells. The CD4(+)CD25(+)CCR4(+) T cell population, which consists primarily of suppressive T cell subsets, such as the Treg and Th2 subsets in healthy individuals, is the predominant viral reservoir of HTLV-1 in both ATL and HAM/TSP patients. Interestingly, CD4(+)CD25(+)CCR4(+) T cells become Th1-like cells in HAM/TSP patients, as evidenced by their overproduction of IFN-γ, suggesting that HTLV-1 may intracellularly induce T cell plasticity from Treg to IFN-γ(+) T cells. This review examines the recent research into the association between HTLV-1 and Treg cells that has greatly enhanced understanding of the pathogenic mechanisms underlying immune dysregulation in HTLV-1-associated neuroinflammatory disease.

Fucoidan therapy decreases the proviral load in patients with human T-lymphotropic virus type-1-associated neurological disease

BACKGROUND

Human T-lymphotropic virus type-1 (HTLV-1) is a human retrovirus that causes HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukaemia (ATL). A higher viral load in individuals with HTLV-1 infection increases their risk of developing HAM/TSP and ATL. Moreover, the high proviral load is associated with the clinical progression of HAM/TSP. Reduction of the number of HTLV-1-infected cells is therefore crucial for preventing and treating HTLV-1-associated diseases. Recently, fucoidan, a complex sulphated polysaccharide derived from marine seaweed, has been demonstrated to exert inhibitory effects on HTLV-1 infection in vitro. In this study, we examined the in vivo effects of fucoidan on HTLV-1 infection.

METHODS

In this single-centre open-label trial, 13 patients with HAM/TSP were treated with 6 g fucoidan daily for 6-13 months. The HTLV-1 proviral DNA load and frequencies of HTLV-1-specific CD8(+) T-cells, natural killer cells, invariant natural killer T-cells and dendritic cells in the peripheral blood were analysed. Furthermore, the in vitro inhibitory effect of fucoidan on cell-to-cell HTLV-1 infection was examined by using luciferase reporter cell assays.

RESULTS

Fucoidan inhibited the cell-to-cell transmission of HTLV-1 in vitro. Furthermore, fucoidan therapy resulted in a 42.4% decrease in the HTLV-1 proviral load without affecting the host immune cells. During the treatment, no exacerbation was observed. Four patients with HAM/TSP developed diarrhoea, which improved immediately after stopping fucoidan administration.

CONCLUSIONS

Fucoidan is a new potential therapeutic agent for the prevention and treatment of HTLV-1-associated diseases.

The Japanese version of the 2010 American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and the Fibromyalgia Symptom Scale: reliability and validity

The aim of this study was to investigate the reliability and the validity of the Japanese version of the 2010 American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia (ACR 2010-J), and its quantification scale, the Fibromyalgia Symptom Scale (FS-J). In this study, we divided patients with chronic pain without psychiatric disorders other than depression into two groups according to the 1990 ACR Diagnostic Criteria for Fibromyalgia, a fibromyalgia group and a non-fibromyalgia group (rheumatoid arthritis, osteoarthritis, and gout). Patients in both groups were assessed using the ACR 2010-J and FS-J. Seventy-seven of 94 (82%) patients in the fibromyalgia group met the ACR 2010-J, whereas 9% (4/43) of the non-fibromyalgia group did so, with a sensitivity of 82%, specificity of 91%, positive predictive value of 95%, negative predictive value of 70%, and positive likelihood ratio of 8.8. Mean total scores on the FS-J significantly differentiated the fibromyalgia from the non-fibromyalgia group. The scale had high inter-rater reliability and high internal consistency. With a cutoff score of 10, the positive likelihood ratio was 10.1. Our findings indicate that the ACR 2010-J and FS-J have high reliability and validity, and are useful for assessing fibromyalgia in Japanese populations with chronic pain. As regards the positive likelihood ratio, that of the FS-J might be suitable as a positive test.

Prostaglandin EP2 receptor signalling inhibits the expression of matrix metalloproteinase 13 in human osteoarthritic chondrocytes

OBJECTIVES

Matrix metalloproteinase (MMP) 13 is a pathogenic collagenase that causes cartilage destruction and plays a leading role in causing osteoarthritis. This study focused on 114 genes that are differentially expressed between intact and damaged osteoarthritis cartilage, in order to determine which molecules are involved in suppressing MMP-13 expression.

METHODS

MMP-13 concentrations were measured in the supernatant of human osteoarthritis chondrocyte cultures transfected with small interfering RNA (siRNA) against the 114 genes. MMP-13 levels changed most dramatically in response to siRNA against prostaglandin EP2 receptor. The authors performed further measurements of MMP-13 production in osteoarthritis chondrocytes stimulated by the EP2 agonist butaprost in the presence or absence of interleukin-1β (IL-1β) and/or cyclooxygenase-2 (COX-2) inhibitor. They also assessed the effect of butaprost on chondrocyte viability, and investigated the involvement of the cAMP-protein kinase A (PKA) pathway on EP2 signalling using inhibitors. Cartilage-related gene expression was examined in chondrocytes treated with butaprost. The authors also investigated which E series of prostaglandin (EP) receptors are expressed in osteoarthritis cartilage.

RESULTS

MMP-13 messenger RNA expression was significantly affected by two molecules, EP2 receptor and SLC14A1, a urea transporter. In IL-1β-treated osteoarthritis chondrocytes, butaprost suppressed MMP-13 production, which was further decreased by COX-2 inhibitor. EP2 signalling downregulated MMP-13 mRNA expression via the cAMP-PKA pathway without affecting cell viability. Although EP2 signalling enhanced IL-6 expression, the expressions of several catabolic factors (MMP-1, MMP-3, MMP-13, ADAMTS5, IL-1β and tumour necrosis factor alpha) were inhibited. EP2 receptor was the major EP receptor in osteoarthritis cartilage.

CONCLUSION

The results suggest that EP2 signalling has 'anti-catabolic' effects in osteoarthritis chondrocytes.

Intra- and inter-laboratory variability in human T-cell leukemia virus type-1 proviral load quantification using real-time polymerase chain reaction assays: a multi-center study

Human T-cell leukemia virus type-1 (HTLV-1) proviral load (VL) is an important determinant of viral pathogenesis and malignant evolution. Although VL has been quantified by in-house real-time quantifiable polymerase chain reaction (qPCR) technology, little is known about the harmonization among different VL assay systems. We evaluated intra- and inter-laboratory variability of VL measured at six laboratories using the same DNA samples seropositive for HTLV-1 in a two-step manner. The first study measured 60 samples by original in-house assays, finding that the median intra- and inter-laboratory coefficient of variation (CV) was 44.9% (range, 25.4-71.8%) and 59.9% (34.2-93.4%), respectively. The inter-laboratory correlation coefficients ranged from 0.760 to 0.875, indicating that VL were measured with good precision in each laboratory, but inter-laboratory regression slopes differed from 0.399 to 2.206, indicating that VL were measured with a wide variation between laboratories. To examine the effect of standardization of reference materials (RM) on the VL variability, we performed a second study using only 20 samples by substituting RM for plasmid including the HTLV-1 pX region. The median inter-laboratory CV for raw pX copy number was reduced significantly from 66.9% to 35.7%, whereas the median CV for the internal control remained almost unchanged, resulting in no improvement in inter-laboratory CV for VL. This indicates that each in-house assay system worked well with good precision, but standardizing RM alone was insufficient for harmonization. The relevant choice of not only RM, but also internal control genes for data normalization is expected to be realistic to standardize HTLV-1 VL measurement.

E3 ubiquitin ligase synoviolin is involved in liver fibrogenesis

BACKGROUND AND AIM

Chronic hepatic damage leads to liver fibrosis, which is characterized by the accumulation of collagen-rich extracellular matrix. However, the mechanism by which E3 ubiquitin ligase is involved in collagen synthesis in liver fibrosis is incompletely understood. This study aimed to explore the involvement of the E3 ubiquitin ligase synoviolin (Syno) in liver fibrosis.

METHODS

The expression and localization of synoviolin in the liver were analyzed in CCl(4)-induced hepatic injury models and human cirrhosis tissues. The degree of liver fibrosis and the number of activated hepatic stellate cells (HSCs) was compared between wild type (wt) and Syno(+/-) mice in the chronic hepatic injury model. We compared the ratio of apoptosis in activated HSCs between wt and Syno(+/-) mice. We also analyzed the effect of synoviolin on collagen synthesis in the cell line from HSCs (LX-2) using siRNA-synoviolin and a mutant synoviolin in which E3 ligase activity was abolished. Furthermore, we compared collagen synthesis between wt and Syno(-/-) mice embryonic fibroblasts (MEF) using quantitative RT-PCR, western blotting, and collagen assay; then, we immunohistochemically analyzed the localization of collagen in Syno(-/-) MEF cells.

RESULTS

In the hepatic injury model as well as in cirrhosis, synoviolin was upregulated in the activated HSCs, while Syno(+/-) mice developed significantly less liver fibrosis than in wt mice. The number of activated HSCs was decreased in Syno(+/-) mice, and some of these cells showed apoptosis. Furthermore, collagen expression in LX-2 cells was upregulated by synoviolin overexpression, while synoviolin knockdown led to reduced collagen expression. Moreover, in Syno(-/-) MEF cells, the amounts of intracellular and secreted mature collagen were significantly decreased, and procollagen was abnormally accumulated in the endoplasmic reticulum.

CONCLUSION

Our findings demonstrate the importance of the E3 ubiquitin ligase synoviolin in liver fibrosis.

Prevalence of Group A b-Hemolytic Streptococcus Among Children with Tonsillopharyngitis in Kyrgyzstan: The Difficulty of Diagnostics and Therapy

OBJECTIVE

Rheumatic fever (RF) is well known disease as a result of frequent complication of the group A b-hemolytic streptococcal (GABHS) tonsillopharyngitis, have noticeably grown for the last 15 years among young generation in the Kyrgyz Republic. It is important to hold a study about the prevalence of RF and GABHS and their susceptibility to antibiotics in the Kyrgyz Republic.

MATERIALS AND METHODS

We have studied 200 children with chronic tonsillopharyngitis at the National Center of Pediatrics and Child Surgery in Bishkek (the Kyrgyz Republic) from August till September 2008. 188 (48 out of them are with RF) out of total 200 children are Kyrgyz and 12 are Russian (2 out of them are with RF). 111 out of total are female (34 out of them are with RF) and 89 are male (17 out of them are with RF). The average age of the subjects is 10.9±6.0 (from 3 to 17 years old). The presence of GABHS was assessed using two ways: by the rapid antigen detection test (RADT) for outcrop of streptococcus antigen in smear from mucosal surface of tonsils, and by bacterial culture analysis (BA). RADT was used to determine its specificity and sensitivity in order to recommend practitioners its further wide use. Furthermore, the discovered culture of GABHS have been investigated on susceptibility to antibiotics by disc-diffusion method. RESEARCH RESULTS: GABHS antigen was positive in 72 (36.0 %) subjects from RADT and in 80 (40.0%) subjects from BA out of 200 total subjects. In the patients with RF (n=51), GABHS was positive in 18 (35.2%) subjects by RADT and in 24 (47.0%) subjects by BA. In the subjects without RF (n=149), GABHS was positive in 54 (36.2%) subjects by RADT and in 56 (37.5%) by BA. Among 80 GABHS positive results sensitive to antibiotics were: to penicillin only 10 (12.5%), to ampicillin-29 (36.2%), to amoxicillin-36 (45.0%), to ceftriaxon - 31 (38.7%), to roxithromycin - 21 (26.2%), to erythromycin- 19 (23.7%). It is noted that 21 (26.2%) GABHS positive results were absolutely resistant for all these tested antibiotics. RADT showed that its specificity is 85% as well as its sensitivity is equal to 67.5%.

CONCLUSION

In this study the sensitivity of RADT was low; therefore, the negative results of RADT don't exclude presence of GABHS. High prevalence of GABHS antigen demonstrates not only in patients with RF, but also among healthy children (without RF) of the Kyrgyz Republic. The high prevalence of GABHS at children with RF (47.0%), probably, presents a low sensitivity to antibiotics and irregular secondary prophylaxis. Significant presence of GABHS among healthy children (37.5%) requires improvement of primary prevention to prevent further spread of RF and Rheumatic Heart Disease (RHD) in the country.

[Development of anti-inflammatory drugs targeted against prostaglandin-related molecules]

Prostaglandin E2 (PGE2) is a proinflammatory mediator that is synthesized by cyclooxygenases (COX-1 and COX-2) and prostaglandin E synthases (cPGES-1 and mPGES-1); PGE2 exerts its biological effects by binding to specific receptors. Although non-steroidal anti-inflammatory drugs(NSAIDs), which are non-selective COX inhibitors, have been very often used as painkillers, their side effects such as gastrointestinal hemorrhage remain a serious problem. Therefore, the selective COX-2 inhibitors were developed; the use of these inhibitors exerted anti-inflammatory effects without the increased risk of gastrointestinal events. Unfortunately, however, several clinical studies demonstrated that the inhibition of COX-2 was associated with the increased risk of cardiovascular events. Consequently, mPGES-1 and PGE2 receptors are currently expected to be attractive targets for anti-inflammatory drug development in order to reduce the side effects.