Ethanol metabolism and aging: the role of "first pass metabolism" and gastric alcohol dehydrogenase activity

To investigate the effect of age and gender on ethanol metabolism, first-pass metabolism (FPM) and gastric alcohol-dehydrogenase (ADH) activity were compared in 32 elderly and 30 young adult nonalcoholic subjects. The FPM was obtained from the difference between the area under the curve of ethanol blood concentration after intravenous or oral administration of ethanol 0.3 g/Kg b.w. The ADH activity was determined in samples of gastric mucosa obtained during diagnostic endoscopy. In the young adult group the FPM was higher in men than in women (3.3 +/- 2.3 vs 1.2 +/- 0.9 mmol/l/h, respectively, p < .01). In aged subjects FPM was found to be very low for men (1.1 +/- 0.8 mmol/l/h, p < .001); conversely, FPM was not significantly reduced in women (1.7 +/- 0.8 mmol/l/h, p = n.s.). The gastric ADH activity was significantly (p < .01) higher in young adult men than women, whereas in aged subjects the activities were low (p < .0001) in both sexes. Thus, gender-related FPM differences equalize in the elderly or are even reversed, most likely because of gastric mucosal atrophy, which occurs more in men than women.

Interferon therapy in chronic hepatitis C virus: evidence of different outcome with respect to different viral strains

The aim of the study was to assess the role of different viral strains of hepatitis C virus (HCV) in determining the outcome of the alpha-interferon (IFN) therapy. Fifty-seven patients (34 from Italy and 23 from Japan) with HCV-positive liver disease were enrolled in the study. The NS4 region of HCV was amplified in sera by "nested" polymerase chain reaction (PCR) using a primer pair synthesized according to the sequence of JK-1. The NS4 region was positive in 14 (41%) Italian and in 13 (56%) Japanese patients. In positive patients the sequence of the NS4 region was also obtained. Subsequently, HCV genotype was determined in all patients by PCR amplification of the core region. All patients received recombinant alpha 2a-interferon (IFN), 6 million units 3 times a week for 1 month followed by 3 million units 3 times a week for 5 months. The patients were followed for 1 year after the end of treatment. At the end of the follow-up, 17 (30%) had sustained normal levels of serum alanine aminotransferase (ALT). The outcome of treatment was not correlated with race, age, sex, histology, and pretreatment ALT level, but was significantly (P < 0.00001) associated with the presence of both the NS4-JK-1 region and HCV type II. Among the 27 NS4-positive patients, only 1 patient (3.7%) achieved a complete response, whereas the remaining 26 patients (95.3%) either were non-responders or relapsed after IFN was discontinued.(ABSTRACT TRUNCATED AT 250 WORDS)

Initiation and duration of breast-feeding in women receiving antiepileptics

OBJECTIVE

Our purpose was to characterize breast-feeding initiation and the duration of breast-feeding in women receiving antiepileptics.

STUDY DESIGN

A cohort study was performed on 34 pregnant epileptic women receiving antiepileptics and 34 pregnant age-matched controls.

RESULTS

Fifty percent of the group receiving antiepileptics chose breast-feeding as the initial feeding method, which was significantly less than the controls (85%, p = 0.004). The decision to choose initial feeding methods was closely associated with advice from physicians and other sources. The 17 women in the antiepileptics group who chose breast-feeding initially terminated breast-feeding significantly earlier than did the control group (4.7 +/- 2.6 vs 9.3 +/- 5.7 months post partum, p < 0.005).

CONCLUSIONS

Mothers receiving antiepileptics tend to choose formula feeding. Even when they choose breast-feeding initially, its duration is shorter than usual. Consensus and guidelines on this matter among experts remain to be reflected on and effectively implemented in current medical practice.

Expression of alpha-bungarotoxin receptor subtypes in chick central nervous system during development

Chick central nervous system (CNS) expresses alpha-bungarotoxin (alpha Bgtx) receptors. We have recently reported the purification and characterization of two alpha Bgtx receptor subtypes, alpha 7 and alpha 7-alpha 8 from chick optic lobe (COL). In order to study whether other alpha Bgtx receptor subtypes are present in other areas of the chick CNS, as well as their developmental expression, we used anti-alpha 7 and anti-alpha 8 subunit-specific antibodies to study alpha Bgtx receptors at different developmental stages in COL, brain and retina. We found that only the alpha 7 and alpha 7-alpha 8 subtypes are present at all developmental stages in chick COL and brain, where they represent 90% of all the alpha Bgtx receptors at embryonic day 19 and 1 day post hatching (D1). In chick retina, an alpha 8 subtype representing 50% of all alpha Bgtx receptors at D1 is present in addition to the alpha 7 and alpha 7-alpha 8 subtypes, and the expression of this alpha 8 subtype increases during neurodevelopment.

Hepatic glutathione determination after ethanol administration in rat: evidence of the first-pass metabolism of ethanol

As a fraction of ingested ethanol is metabolized by gastric mucosa, different amounts of alcohol should reach the liver when the same dose is administered by oral or intravenous route. Therefore, we investigated the time-course of hepatic reduced glutathione (GSH) concentrations after intra-peritoneal or intra-gastric load of the same amount of ethanol in the rat. The test was also performed in fasted and Cimetidine-treated rats. The oral ethanol administration was followed by a less pronounced decrease and by a quicker recovery of hepatic content of GSH than after intraperitoneal route. In the fasted rat, basal hepatic GSH significantly decreased; after alcohol administration the decrease of hepatic GSH was more severe and prolonged than in the fed rat. Cimetidine was shown to be a potent inhibitor of gastric ADH. Pre-treatment with Cimetidine did not change the basal levels of hepatic GSH, but after oral ethanol load, the decrease of the hepatic GSH content was significantly (p < 0.005) more pronounced than in controls. This study demonstrates the beneficial effects of gastric ethanol metabolism on the liver. The reduced gastric ethanol metabolism, induced by fasting or by Cimetidine resulted in a decreased content and delayed recovery of liver GSH content.

Low-grade malignant lymphoma, hepatitis C virus infection, and mixed cryoglobulinemia

Because a close relationship has been established between mixed cryoglobulinemia and hepatitis C virus (HCV) infection, the clinical, histologic, and virologic findings of 31 patients affected by mixed cryoglobulinemia have been determined. HCV infection was investigated by the presence of anti-HCV antibodies and by polymerase chain reaction (PCR) amplification of the 5' untranslated region (5'UTR), and the genotype of HCV was also determined according to Okamoto et al (J Gen Virol 73:673, 1992). A bone marrow (BM) biopsy was performed in all patients, and liver and kidney biopsies were performed when indicated. The prevalence of anti-HCV antibodies was high (83.9%); polymerase chain reaction amplification of the 5' untranslated region was positive in 26 subjects (83.9%), and Core region amplification in 26 of 27 subjects (96.2%). A high prevalence of genotype II was found (76.6%). Chronic liver disease was present in 15 (48%) patients. BM biopsy specimens showed the presence of low-grade non-Hodgkin's lymphomas in 12 cases (38.7%), whereas, in 11 patients (35.5%), the BM infiltration was not monoclonal (reactive). Mixed cryoglobulinemia is closely associated with HCV infection. Apparently, only 1 patient was not infected by the virus. Several HCV genotypes are involved in the pathogenesis of mixed cryoglobulinemia. The disease is associated with a high prevalence of low-grade non-Hodgkin's lymphomas.

[Semeiotic flowmetry in complex varicocele]

The Authors report on their specific experience on the funicular Doppler veocimetry, regarding the varicocele. In particular we enhance the semeiological spects of the C.W. Doppler velocimetry in the sub-clinical varicocele, in the bilateral one and in the characterization of the spermatic and cremasteric refluxes, and of the external pudenda vein. The Authors stress the utility of the definition of the amount of the reflux, so achieving an integration with the existing classification by degrees, that as it is now days expressed, it seems, to regard the elapsed time and the quantity of reflux caused by the Valsalva manoeuvre. In the practical velocimetry those elements have not been proved to have a parallel increment. Lastly, we report on some cases of veno-spermatic refluxes, uniquely observed in the clynostatism, along with a missing orthostatism. Moreover the Authors believe that some of these hemodynamical consideration could be revisited.

Studies of migration of potentially genotoxic compounds into water stored in pet bottles

Coloured polyethylene terephthalate (PET) bottles for carbonated beverages were studied for potential migration of genotoxic compounds. A combined approach, using physicochemical methods and a bacterial short-term mutagenicity test (Ames test) was followed. Standard EEC and US FDA tests for total migration of non-volatile migrant compounds into distilled water were performed, together with modified tests, where freeze-drying instead of evaporation of water was used, in order to measure both volatile and non-volatile chemicals. Gas chromatography-mass spectrometry (GC-MS) analysis was performed on these residues. PET bottles filled with naturally carbonated mineral water were also used for long-term total organic carbon (TOC) and mutagenicity migration studies (up to 6 months' storage). Total migration results for PET bottles were within the EEC and US FDA limits. The use of freeze-drying for the elimination of water enabled much higher total migration data (higher than the limits) to be revealed. Some potentially genotoxic compounds (acetaldehyde, dimethyl terephthalate, terephthalic acid) were identified in these migrant compounds by GC-MS analysis. The tests for TOC migration gave a maximum value after 2 wk storage and the mutagenicity tests on non-volatile migrant compounds gave always negative results.

Pharmacology and biophysical properties of alpha 7 and alpha 7-alpha 8 alpha-bungarotoxin receptor subtypes immunopurified from the chick optic lobe

Two chick optic lobe alpha-bungarotoxin receptor subtypes (alpha 7 and alpha 7-alpha 8) were immunopurified using polyclonal antibodies raised against synthetic peptides of chick alpha 7 and alpha 8 alpha-bungarotoxin receptor subunits. The alpha 7 subtype contained the M(r) 57,000 alpha 7 subunit, and represented 60-70% of the alpha-bungarotoxin receptors; the alpha 7-alpha 8 subtype contained the M(r) 57,000 alpha 7 and alpha 8 subunits, and represented only 20-25% of the receptors. Both subtypes also had an additional M(r) 52,000 subunit. The affinity of these subtypes for alpha-bungarotoxin as well as antagonists was similar. However, the alpha 7-alpha 8 subtype displayed consistently higher affinities for agonists. When reconstituted in planar lipid bilayers, the alpha 7-alpha 8 subtype displayed several conductance states of 10-50 pS; the alpha 7 subtype had only one conductance state of 45 pS. The alpha 7-alpha 8 subtype was activated by lower agonist concentrations than the alpha 7 subtype. When expressed in Xenopus oocytes, the alpha 8 subunit formed functional homomeric receptors that desensitized rapidly. These channels were blocked by alpha-bungarotoxin and displayed a higher affinity for agonists than the alpha 7 homomeric receptor. Taken together, these data indicate that at least two alpha-bungarotoxin subtypes are present in the chick optic lobe. They operate as ligand-gated channels and display different agonist sensitivities and kinetics/conductance properties.

Sequelae of acute hypoglycaemia on 24 hour blood pressure and metabolic parameters in normal and type 1 (insulin-dependent) diabetic individuals

This study was performed to assess possible delayed after-effects of acute hypoglycaemia on blood pressure (BP) and heart rate (HR) over a 24-h period. Eleven insulin-dependent diabetic patients and 11 sex, age, and body mass index matched non-diabetic subjects were studied. Blood pressure was measured using a non-invasive ambulatory blood pressure monitor following acutely induced hypoglycaemia in the morning. No significant differences were observed in 24-h systolic and diastolic BP and HR in either groups, between the day when hypoglycaemia was induced and the day when plasma glucose was kept normal. In diabetic patients, hypoglycaemia induced a temporary but significant fall in mean BP (-7 +/- 1 mmHg vs -2 +/- 2; p < 0.05). Plasma glucose levels were significantly higher in insulin-dependent diabetic patients following hypoglycaemia than in those observed during the reference test. This study demonstrates that acute hypoglycaemia in insulin-dependent diabetic subjects does not cause significant alterations in 24-h BP in either diabetic or normal subjects.

Long-term effects of alpha-interferon therapy for type II mixed cryoglobulinemia

BACKGROUND

Several reports showed that mixed cryoglobulinemia (MC) is closely associated with hepatitis C virus (HCV) infection. Since several authors reported the efficacy of alpha-interferon in the treatment of MC, we investigated the long-term effects of this drug on clinical, hematological and virological parameters in a group of 18 patients (13 women and 5 men, mean age 56 +/- 11 years) affected by MC.

METHODS

A bone marrow biopsy was performed in all patients, and a liver biopsy was obtained in those with biochemical signs of chronic liver disease. The presence of HCV-RNA in serum was assessed by detection of anti-HCV antibodies and by PCR amplification of the 5' untranslated region of HCV. All patients followed the same treatment schedule: three million units of recombinant interferon alpha-2b s.c., three times a week for 1 year.

RESULTS

In 5 cases bone marrow histology showed the presence of a monoclonal lymphocytic infiltrate. Liver biopsies were performed in 13 (72%) of the patients and a chronic liver disease was found in all 13. Anti-HCV antibodies were present in 17 (95%) subjects. HCV-RNA was detected in all cases (100%) before therapy. Five (28%) patients achieved a complete response and 9 (50%) a partial response, while the others (4 cases, 22%) showed minor responses. Four patients cleared the virus and obtained a complete remission of the MC.

CONCLUSIONS

HCV may be a cause of MC. The disease is associated with a high incidence of monoclonal lymphocytic infiltrate of the bone marrow. Alpha-interferon seems to be an effective agent for the treatment of MC.

Different genotypes of hepatitis C virus are associated with different severity of chronic liver disease

The presence of the "Japanese type" NS4 region was investigated in two series of patients (53 from Italy and 58 from Japan) with hepatitis C virus (HCV)-related chronic liver disease. The two populations were homogeneous as regard to age, male/female ratio, histological diagnosis, and serum aminotransferase activities. Genomic amplification was carried out by "nested" polymerase chain reaction (PCR) with a pair of primers synthesized according to the sequence of JK-1 isolated in Japan. The presence of viral replication was confirmed further by PCR amplification of the 5'NC region. The NS4 region of the Japanese strain was detected in 24 sera (45%) from Italy and in 44 (71%) from Japan. NS4-positive patients were significantly older and showed an ALT serum level significantly lower (P < 0.01) than NS4 negative cases in each group. Cirrhosis was significantly (P < 0.0007) more common in NS4-positive than in NS4-negative patients. The HCV genotype was subsequently obtained according to Okamoto. All the NS4-positive patients were infected by Type II, whereas in NS4-negative patients all four genotypes were present though Type II still constituted the majority. Cirrhosis was associated exclusively with Type II both in NS4-positive and -negative subjects. These data indicate that, although the positivity for NS4 "Japanese" region seems to be associated with a more aggressive liver disease, the most prevalent Type II predicts more specifically those who are likely to develop cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of alpha-interferon and steroids on CD23 expression and release in B-cell chronic lymphocytic leukemia

BACKGROUND

Since high CD23 expression and release have been reported in B-chronic lymphocytic leukemia (B-CLL), we investigated whether alpha-interferon or corticosteroids were able to modulate the expression and/or the release of this factor.

METHODS

CD23 expression was determined with FITC-labelled anti-CD23 monoclonal antibody, and sCD23 release with a sandwich enzyme immunoassay. Twenty-one patients affected by B-CLL (stage A or B) were studied before and after three different treatment regimens (alpha-interferon, corticosteroids, alpha-interferon+corticosteroids).

RESULTS

CD23 was highly expressed in the B-cells of all patients, and expression was not modified by any of the therapies, sCD23 release from leukemic cells was significantly greater (p < 0.00001) in untreated subjects than controls, and in vitro treatment with phorbol myristate acetate (PMA) led to a 10-fold increase (p < 0.0001) in sCD23 secretion. On the contrary, PMA did not increase sCD23 release in normal B cells. Treatment with corticosteroids (either alone or associated with alpha-interferon) reduced sCD23 secretion from leukemic cells, whereas alpha-interferon alone was not able to modify sCD23 release.

CONCLUSIONS

Our data support the hypothesis that CD23 plays a role in the maintenance and progression of B-CLL and that the pharmacological modulation of this receptor/lymphokine could be useful in the therapy of B-CLL.

Effects of MR889, a cyclic thiolic neutrophil elastase inhibitor, on rheologic properties of mucus

MR889 is a synthetic inhibitor of human neutrophil elastase with potential in clinical conditions characterized by a high load of this proteolytic enzyme, mainly chronic obstructive pulmonary disease. On the basis of its mechanism of inhibition, it has been suggested that MR889, upon reaction with elastase, would generate new free thiol groups. The aim of this study was to investigate whether MR889, upon reaction with elastase, may modify rheologic properties, i.e. apparent viscosity and elasticity, of both human sputum and porcine stomach mucus, in ex-vivo and in vitro experiments. MR889 10(-4) M alone had no effect on rheologic properties of samples, whereas an agent with free thiol group, n-acetylcysteine 10(-4) M reduced both viscosity and elasticity. MR889 10(-4) M upon reaction with elastase 0.03 nMol (giving 83% of elastase inhibition) had no effect on rheologic properties of samples, whereas upon reaction with elastase 0.15 nMol (49% inhibition) yielded a marked decrease in viscosity. This result would suggest that MR889, in the presence of a high load of elastase, may acquire direct mucus modifying capacity, likely because of its greater utilization upon reaction with the enzyme.