Anti-immunologic and anti-inflammatory effects of steroid therapy

Colon perforation in multiple myeloma patients - A complication of high-dose steroid treatment

Gastrointestinal complications of multiple myeloma (MM) treatment are common and include nausea, constipation, and diarrhea. However, acute gastrointestinal events like perforations are rare. We aimed to describe the characteristics and outcomes of patients with MM that had colonic perforations during their treatment. This is a retrospective study that included patients from all three Mayo Clinic sites who had MM and developed a colonic perforation. All patients were diagnosed with colonic perforations based on CT scans and were surgically treated. Patients diagnosed with AL amyloidosis, a perforated colon complicating neutropenic colitis during ASCT and those with perforation due to colonic cancer were excluded. A high dose of dexamethasone was defined as ≥40 mg dexamethasone once a week. Thirty patients met inclusion criteria. All patients received steroids at doses ≥10 mg once weekly prior to the perforation, while four (11%) were on high-dose dexamethasone without chemotherapy. Fourteen patients were given high doses of dexamethasone. Twenty-five patients required ostomies with all surviving surgery. Twenty-four perforations (80%) were associated with diverticulitis. Treatment with steroids was resumed in 23 patients with no further gastrointestinal complications. The median OS was 20 months following perforation (IQR 8-59). Within the same timeframe 5854 patients were treated at Mayo Clinic for MM, making the risk of bowel perforation 0.5%. Intestinal perforations in MM are rare and, in our series, always occurred with dexamethasone ≥10 mg per week. Urgent surgery is lifesaving and resumption of anti-myeloma treatment appears to be safe.

Soluble CD93 in allergic asthma

CD93 has been shown critical roles in inflammatory and immune diseases. However, in allergic asthma, the potential roles of soluble CD93 (sCD93) have not been well studied. We conducted house dust mite (HDM) stimulation with Der p 1 in BEAS-2B and U937 cells, followed by treatment with dexamethasone or small interfering RNA against CD93. A HDM-induced murine allergic asthma model was also established. We estimated the power of sCD93 to predict allergic asthma in a retrospective post-hoc analysis containing 96 human samples. HDM-stimulated BEAS-2B cells showed increased mRNA expression levels of IL-6, IL-8, IL-33, TSLP, and CD93. The CD93 level in culture supernatants steadily increased for 24 h after allergen stimulation, which was significantly suppressed by both dexamethasone and CD93 silencing. CD93 silencing increased IL-6 and TSLP, but not IL-33 levels in culture supernatants. HDM-induced asthma mice showed significant airway hyperresponsiveness and inflammation with Th2 cytokine activation, along with decreased CD93 expression in bronchial epithelial cells and lung homogenates but increased serum CD93 levels. The sCD93 level in asthma patients was significantly higher than that in healthy controls and could predict asthma diagnosis with moderate sensitivity (71.4%) and specificity (82.4%) (AUC = 0.787, P < 0.001). The level of sCD93 which has potential role to predict asthma significantly increased after HDM stimulation via IL-6 and TSLP in vitro and in vivo.

Antiproliferative and apoptotic potencies of glucocorticoids: nonconcordance with their antiinflammatory and immunossuppressive properties

Relative antiinflammatory and immunosuppressive potencies of glucocorticoids (GC) were previously well defined. Nonetheless, GC also regulate cell proliferation and programmed death (apoptosis). The aim of this study was to determine the relative potency of different GC on the modulation of cell survival. The GC-sensitive lymphoblast cell line CEM-c7/14 was submitted to 48h-exposure to GC (dose-response curve from 10-8 to 10-5M). Cell survival was analyzed employing the DimethylTiazol-Tetrazolium (MTT) test. For each GC at least 4 experiments were performed in quadruplicate. Responses to different GC at the same molarity were analyzed by ANOVA on Ranks. Cell responses to the same GC in different concentrations were tested by repeated measures ANOVA. The EC50 for each GC was calculated with the GraphPad Prism 3.0 software. The use of low concentrations (10-8 and 10-7M) of hydrocortisone and methylprednisolone determined a similar effects on cell survival, which was less prominent than that observed with betamethasone, budesonide or momethasone. Momethasone was the most potent GC, inducing the most intense dexamethasone reduction on cell survival at the lowest concentration (10-8M). Momethasone and methylprednisolone were the two GC with the strongest impact on cell survival. Our findings suggest that antiproliferative and apoptotic potencies of GC are different from those previously reported antiinflammatory and immunosuppressive actions.

Electron microscopic study on the effect of alternate-day hydrocortisone therapy on lymphocyte populations in rat spleen and lymph nodes

The ultrastructural effects of 400 mg/M2/day of hydrocortisone sc, given alternatively from day 7 through day 19, were studied on the lymphocyte populations in the white pulp of the spleen and in the cortex of the mesenteric lymph nodes of the immunologically immature rat. Results were consistent with both a direct lytic effect of hydrocortisone on small lymphocytes of the nodular cortex of the mesenteric lymph nodes and an indirect effect on small lymphocytes of the periarterial lymphatic sheath (PALS) of the spleen supplied via the thymus. In contrast, medium-sized lymphocytes in the PALS appeared to be unaffected by hydrocortisone, while medium-sized lymphocytes of the nodular cortex of the mesenteric lymph nodes exhibited a temporary depletion of cytoplasmic organelles. Hydrocortisone appeared to depress protein synthesis in these latter cells. The decrease in numbers of lymphoblasts and plasmablasts observed in the nodular cortex of the mesenteric lymph nodes and the white pulp of the spleen is consistent with hydrocortisone interference with proliferation and differentiation of activated B cells.

Effect of alternate-day hydrocortisone therapy on the immunologically immature rat. I: Effect on blood cell count, immunoglobulin concentrations, and body and organ weights

The effect of 400 mg/M2/day of hydrocortisone, given alternatively from day 7 to day 19, was studied in the immunologically immature rat, a steroid-sensitive species. Animals, sacrificed 2 days following the completion of treatment, suffered from an underweight thymus and spleen, leucocytosis, and peripheral lymphocytopenia, probably not due to redistribution of lymphocytes from blood to tissues. In addition, a significant decrease in serum IgM concentration, reflecting a deficit in primary immune response, was evidenced. Although the percentage of lymphocytes returned to normal in rats sacrificed 23 days after treatment, an overweight thymus and spleen and persistent leucocytosis may reflect a compensatory overactivity of the developing immune system. In contrast, serum IgM concentration increased, but to a value less than normal. An indirect effect of hydrocortisone on lymphocytes through its action on thymus, as well as a direct effect on B cells, is suggested. Unlike humans, alternate-day steroid therapy delayed the normal growth pattern of rat, with a defective rate of growth only during the treatment period.

Kinetics and requirements for activation of macrophages for fungicidal activity: effect of protein synthesis inhibitors and immunosuppressants on activation and fungicidal mechanism

Peritoneal-and pulmonary macrophages can be activated in vitro with lymphokines (LK) or IFN-gamma, without exogenous lipopolysaccharide, for fungicidal activity against several pathogenic fungi. However, neither the biochemical nor metabolic events of the activation process or of the effector phase have been defined. In the present work we sought to elucidate these events with time-course studies using inhibitors of protein synthesis as well as immunosuppressive agents. We found that protein synthesis inhibitors abrogated the activation process, because cycloheximide (CHX) (1-2 micrograms/ml) prevented activation of macrophages for fungicidal activity against Candida albicans, Blastomyces dermatitidis, and Paracoccidioides brasiliensis. Blocking of the activation process by CHX was not due to macrophage cytotoxicity, and CHX did not impair the ability of nonactivated macrophages to kill Candida parapsilosis. In kinetic studies we showed that activation of macrophages was induced in 4 hr of LK treatment and that CHX had no effect if added after this time. In contrast to CHX, therapeutic concentrations of hydrocortisone (HC), such as less than or equal to 5 micrograms/ml, or cyclosporin A (CsA), 5 micrograms/ml, did not significantly inhibit LK activation of macrophages for killing of fungi. In the effector phase, the fungicidal capacity of activated macrophages in short-term (less than or equal to 4 hr) killing assays could not be abrogated by CHX (5 micrograms/ml), HC (100 micrograms/ml), or CsA (10 micrograms/ml). These results demonstrate that the activation but not the effector mechanism of macrophages for fungicidal activity is blocked by inhibition of protein synthesis. In contrast, therapeutic concentrations of HC or CsA may not interfere with activation of macrophages or their killing mechanisms, thus providing a rationale for antifungal immunotherapy in certain clinical situations (e.g., infection in the immunosuppressed patient).

Prostatic malakoplakia associated with prostatic adenocarcinoma and multiple prostatic abscesses

Two cases of prostatic malakoplakia are presented. One case was associated with adenocarcinoma of the prostate and the second was noted with multiple prostatic abscesses. The literature on malakoplakia of the prostate is reviewed.

Immune responses in experimental allergic neuritis treated with corticosteroids

The preventive and suppressive effects of methylprednisolone (MP) were investigated in 22 rabbits immunized with peripheral nerve myelin. Cellular reactivity to bovine P2 protein (P2) and anti-P2 antibody were also examined serially in these animals, using the lymphocyte proliferation test or enzyme-linked immunosorbent assay. Seven animals (preventive group), given 15 mg/day of MP subcutaneously from Days 0-28, showed a significant reduction in maximal severity and a delay in onset in comparison with 8 control animals. The remaining 7 animals (suppressive group), given the same dose of MP from Days 11-28, also showed significantly milder clinical signs than those observed in the controls. However, cellular hypersensitivity to P2 were manifested at Day 14 (just after clinical onset) in the controls, as well as in the preventive or suppressive groups. Furthermore, anti-P2 antibody was detected in each group after Day 14. These results suggested that the interference of inflammatory processes of immune-mediated disease might respond to the preventive and suppressive effects of MP.

Perforation of the colon in renal homograft recipients. A report of 11 cases and a review of the literature

Colon perforation in renal transplant recipients is a potentially lethal condition that is amenable to appropriate medical and surgical treatment. The 11 cases seen at the Cleveland Clinic (incidence 1.1% of all renal transplant patients) and previous reports in the literature have been reviewed. The pathogenesis is related to a high incidence of diverticular disease in patients with polycystic kidneys and/or chronic renal failure, the effects of long-term immunosuppression, and the transplant procedure itself. The high mortality of this condition (61% overall) is related to the effects of immunosuppression on the response to sepsis and the surgical procedure used. Mortality has fallen from 88% (1970-1974) to 53% (1975-1979), and there are indications that it is continuing to fall. All four cases operated on here since 1980 have survived, giving a total operative mortality of 2/6, and all have maintained excellent allograft function. A high clinical index of suspicion, prompt exteriorization of the perforated colon, reduction of immunosuppression to minimal levels, and effective antibiotic coverage have all contributed to the declining mortality.

Malakoplakia of urinary bladder following cadaveric renal transplantation

Malakoplakia of the urinary bladder following cadaveric renal transplantation in a twenty-two-year-old woman is reported. Urinary tract infection with Escherichia coli persisted postoperatively. Three years later, gross hematuria and fever occurred. Yellow-tan mucosal plaques or nodules were observed cystoscopically, and histologic examination revealed malakoplakia of the urinary bladder with characteristic foamy histiocytes containing Michaelis-Gutmann bodies.

Effect of methylprednisolone on swelling after orthognathic surgery

The effectiveness of methylprednisolone for the reduction of postoperative facial edema was evaluated by the computed tomographic examination of 39 patients who underwent either a Lefort I osteotomy or a transoral vertical osteotomy. Results of the CT scans, which were performed preoperatively and at 24 and 72 hours postoperatively, showed that in the LeFort I osteotomy patients methylprednisolone reduced the degree of facial edema by 61% at 24 hours postoperatively and by 10% at 72 hours. In the transoral vertical osteotomy patients methylprednisolone reduced the degree of facial edema by 38% at 24 hours postoperatively and by 45% at 72 hours. It was concluded that methylprednisolone is effective for the control and management of postoperative facial edema following orthognathic surgery.

Corticosteroids in airway management

Adrenal corticosteroids exert a strong suppressive influence on the basic inflammatory response that leads to tissue swelling. The corticosteroid effect is nonspecific. In upper airway obstruction caused by edema from infection, allergy, or trauma, corticosteroids will exert some degree of suppressive effect. The steroid effect is local and directly proportional to the concentration of steroids in the inflamed tissue. In upper airway obstruction steroids should be delivered to the inflamed tissue in high concentration with the least delay. Dexamethasone and methylprednisolone produce high blood levels within 15 to 30 minutes of intramuscular injection. Recommended initial doses for acute airway obstruction are dexamethasone, 1.0 to 1.5 mg/kg, or methylprednisolone, 5 to 7 mg/kg. The risk of harm from steroid therapy of 24 hours or less is negligible.

Localized colonic perforation following renal transplantation

Well-contained abdominal abscesses developed in two renal transplant patients ten years and six months, respectively, after transplantation. Investigations including gastrointestinal series and CT scan demonstrated cystic collections within the abdominal cavity. Laparotomy in each case revealed an infected cystic mass arising from the sigmoid colon. In both patients deroofing the abscess and, in one patient, defunctioning colostomy were performed. Both patients did well in the postoperative period.

Glucocorticoid influence on growth of vascular wall cells in culture

Primary mass cultures and cloned strains of bovine aortic endothelial and smooth muscle cells were investigated with respect to their growth responses to glucocorticoid hormones. The growth of primary endothelial cells was not influenced by glucocorticoid treatment in the absence of fibroblast growth factor (FGF) but was inhibited by about 30% in the presence of FGF; with cloned endothelial cells, glucocorticoids were also growth inhibitory only in the presence of FGF. In contrast, smooth muscle cell growth was inhibited 30%-70% by glucocorticoid treatment in both primary cultures and in the cloned strains in the absence of FGF, and this inhibition was totally abolished by the addition of FGF for both cultures. The corticosteroid influences on cell growth were glucocorticoid specific, concentration dependent, and were observed to be independent of the serum concentration. The results indicate that glucocorticoid hormones have direct and pronounced growth inhibiting effects on aortic smooth muscle cells but only minimal effects on endothelial cells when these components of the vascular wall are analyzed under identical conditions in vitro.

"Nutritional insurance" supplementation and corticosteroid toxicity

Specialized "nutritional insurance" supplementation may reduce the risk of many important complications of long-term corticosteroid treatment. Supplementation with calcium, fluoride, activated vitamin D metabolites, and GTF, should help prevent osteoporosis. GTF, vitamin C, zinc and fluoride might help offset the inhibitory effect of corticosteroids on fibroblast and osteoblast function. Diabetic, hyperlipidemic and protein-losing effects might be compensated with supplementary GTF. Antioxidant nutrients could support humoral immunity and neutrophil function, while complementing the anti-inflammatory actions of corticosteroids. Supplementary magnesium could reduce the risk of nephrocalcinosis and nephrolithiasis.

Immunodeficiency models in characterization of immune responses to parasites--an overview

The use of selected immunosuppressant agents and genetically immunodeficient animals in studies designed to characterize the immune response to parasitic infections is reviewed. Immunosuppression induced by commonly used chemicals (corticosteroids and alkylating agents) and ionizing radiation is examined briefly. A greater emphasis is placed on congenitally immunodeficient animals and on immunosuppression induced by purified antisera directed against a variety of cellular specificities. The use of such immunodeficient animals has aided our understanding of the complex interrelationship between host and parasite. However, chemical immunosuppressants and the levels of irradiation used in adoptive cell transfer studies are usually indiscriminant in their toxic effects on a variety of tissues other than those targeted. These affected tissues may be crucial in establishment of the delicate physiological balance required for maintenance of equilibrium between host and parasite. Thus the effects of cytotoxic drugs or irradiation on parasite burdens may reflect alteration of not only immunity, but other essential factors leading to misinterpretation of results. Use of congenitally immunodeficient animals, which are readily repaired by introduction of specific cellular components, may be more useful in dissecting host responses to parasites. In addition, depletion of specific components of the immune system through use of anti-isotype antiserum, for example, is another useful probe. These approaches do not suffer from the generalized cytotoxic effects of chemicals and irradiation, and remove a potentially important and misleading variable from experimental designs. They also allow one to discriminate between non-specific inflammatory and specific immunological factors. The potential pitfalls of broadly used induced immunodeficiency states in studies on parasitisms may now be overcome at least partially by use of highly purified and specific cytotoxic reagents coupled with an ever-increasing array of genetically immunodeficient animal models.

Inhibition by glucocorticoids of endocytosis in a macrophage-like cell line

A macrophage-like cell line (P388D1) has been used to demonstrate that glucocorticoids inhibit the fluid-phase endocytosis of fluorescein-labeled dextran (FITC-dextran). Initial experiments demonstrated that the interaction of FITC-dextran with cells had all the features of fluid-phase uptake, ie, the amount taken up was proportional to the concentration in the medium, the uptake proceeded continuously with time and was blocked at 4 degrees C. Dexamethasone (10(-7) M) had no effect on endocytosis until 11 hours after addition of the steroid, when it inhibited the uptake of FITC-dextran by 35%. The amount of inhibition increased with longer exposure times to the hormone up to 50% after 22 hours. Although this effect on endocytosis was observed prior to any effect on growth of the cells, endocytosis as well as cell proliferation were inhibited in a dose dependent fashion. A preliminary survey of selected steroids has established that the inhibition of endocytosis was restricted to steroids of the glucocorticoid class. The key experiments were also performed using horseradish peroxidase instead of FITC-dextran with, essentially, identical results.

Acute perforation of sigmoid diverticula

Forty patients underwent operative therapy for acute perforation of colonic diverticula. The group I patients had some localization of infection, group II had generalized feculent-purulent contamination with free perforation, and group III had free perforation and were treated with chronic steroids for various medical disorders. The retrospective evaluation was directed at evaluating the effect on survival of methods to treat the hole in the colon and methods to treat peritoneal contamination. It is concluded that control of the perforation in the bowel and aggressive peritoneal irrigation may decrease the high morbidity and mortality rates.

Bowel perforation in steroid-treated patients

Gastrointestinal perforation in patients receiving glucocorticosteroid (GCS) therapy has been reported to have mortality rates as high as 100%. From 79 patients seen during a nine-year period, three groups were formed according to GCS dosage: group 1 (steroid perioperative coverage), group 2 (low-dose steroids, prednisone < 20 mg daily), and group 3 (high-dose steroids, prednisone greater than or equal to 20 mg daily). Of 11 clinical presentation factors, only abdominal tenderness was consistently present in group 3. The mean delay from onset of symptoms to treatment for group 3 was 8.3 days and was in marked contrast to that for group 1 or 2, 1.7 and 2.2 days, respectively (p < 0.005). Mortality increased from 11.8% in group 1 to 13.3% in group 2 to 85% in group 3. High-dose GCS therapy decreased the clinical expression of peritonitis to the point that recognition and, therefore, treatment of gastrointestinal perforation were markedly delayed. In a patient receiving high-dose GCS, a high degree of clinical suspicion must accompany any new abdominal discomfort, and aggressive diagnostic efforts should be made to establish the cause. If abdominal pain persists, surgical exploration should be considered.

Periodontal status of patients with reduced immunocapacity

The periodontal status of patients with reduced immunocapacity was assessed. Gingival inflammation, periodontal destruction, and plaque accumulation were compared in three groups--renal transplant patients, dialysis patients, and normal individuals. The levels of all parameters were similar in the three groups indicating that immunosuppression does not affect the clinical appearance of periodontal disease when measurements are made in a single examination. In the transplant group, however, there is a lack of correlation between P.I. and G.I. and between P.I. and P.D.I., indicating a dissociation between plaque accumulation and the tissue response. Long-term longitudinal studies of periodontal disease in such patients are needed in order to obtain more meaningful information on the role of the immune system in affecting the rate of periodontal destruction. This study suggests that nonimmune mechanisms such as the direct effect of bacterial products on supporting tissues can account for at least some of the clinical manifestations of periodontal disease.

Mechanisms of the immunosuppressive and anti-inflammatory effects of glucocorticosteroids

Corticosteroids have multifaceted effects on various phases of inflammatory and immunological activity. These include effects on vascular and tissue responses, effects on the movement or traffic of inflammatory or immunologically reactive cells, direct effects on functional capabilities of cells, and direct or indirect effects on various soluble factors mediating inflammation or immunologic activity. It is clear that there is a differential sensitivity of various populations and subpopulations of cells to the corticosteriod modulation of cellular kinetic patterns, cellular interactions, and functional capabilities. In general, corticosteroids have a much greater and more obvious effect on the traffic and kinetics than on the functional properties of cells involved in inflammation and immunologic activity. Hypotheses concerning the precise mechanisms of many of these effects have been proposed, but still await verification and possibly amplification.

Influence of hydrocortisone on granulocyte function and glucose metabolism

Examination has been made of the influence of hydrocortisone on the in vitro phagocytosis and intracellular killing of Staphylococcus aureus by human neutrophils and the production of lactate and CO2 during phagocytosis of latex particles. In high concentrations, 0.5-2 mg per ml, hydrocortisone caused a significant reduction in the phagocytosis and the production of lactate. Neither the bactericidal activity nor the production of 14CO2 from (U-14C) glucose in phagocytizing leukocytes was influenced by these hydrocortisone concentrations.

Diverse effects of triamicinolone on the ocular response to circulating endotoxin

The ocular response to circulating bacterial endotoxin (E coli 055:B5, 100 microgram/kg) can be either significantly reduced or made more servere by pretreatment with the synthetic glucocorticoid triamcinolone. A single injection (25 mg/kg) 3 hr prior to endotoxin sharply curtails the response. Daily injections for 3 days preceding endotoxin produces an enhanced response. With this regimen, an enhanced alteration in ocular vascular permeability is produced 4 hr following endotoxin if 5 mg of triamcinolone is injected daily; if larger quantities of steroid are employed (25 mg), there is a slight reduction in ocular vascular permeability, but an enhanced intravascular fibrin accumulation in ocular blood vessels as well as in capillaries of renal glomeruli (generalised Shwartzman reaction). Once the enhancement of the ocular response to endotoxin has been established by prior treatment with steroids, additional triamcinolone given 2--3 hr before endotoxin is no longer effective in protecting against ocular or renal changes. These divergent effects of steroid could be produced by either subcutaneous or intra-orbital injection, and the response was equal in both eyes following intra-orbital injection, suggesting that steroids probably do not exert their effects locally in this situation. Although different mechanisms of action of corticosteroids may be responsible for these diverse effects, it is suggested that a loss of responsiveness to steroids may be important in their ability to enhance the effects of endotoxinemia.

Malacoplakia of the prostate in an immunosuppressed patient

Malacoplakia predominantly affects the bladder but occasionally involves other sites. The third case of malacoplakia of the prostate, occurring in a renal transplant patient who was receiving prednisone for immunosuppression, is reported. Modification of phagocytosis and the normal inflammatory response to bacterial infection by the steroid may have been of major importance in the genesis of malacoplakia.

Double-blind study of prednisolone and papase as inhibitors of complications after oral surgery

Both prednisolone and papase are effective in reducing the oral surgical sequelae of trismus and pain, although prednisolone apparently is the more potent drug. The countervailing case for the routine use of prednisolone includes the relatively serious complications produced in some patients.

Acute perforation of the colon associated with chronic corticosteroid therapy

Perforation of the colon occurred in thirteen patients receiving corticosteroids for diseases unrelated to the bowel. Treatment averaged 3.5 years. The paucity of symptoms, signs, and laboratory indexes of visceral perforation led to frequent delays in treatment and to incorrect preoperative diagnoses in all but three patients. The perforations were often unusual in location (cecum, hepatic flexure, and multiple points in the transverse and descending colon) and often resulted from single punched-out ulcers in otherwise normal bowel. In seven patients the lesion could not be distinguished from perforated sigmoid diverticulitis, but in two of these patients the ulcerations were found in adjacent diverticula. The evidence strongly suggests that corticosteroids can be responsible for ulceration and perforation of the colon either by direct injury or by interference with normal mechanisms of bowel repair.

Influence of hydrocortisone on uptake and elimination of 32P-labelled E. coli by rat polymorphonuclear neutrophils (PMN) in vitro

Hydrocortisone was tested for inhibition of uptake and of elimination of E. coli by monolayers of rat peritoneal PMN. 32P was used as label of the bacteria and their degradation products eliminated from the phagocytes. The cellular uptake was reduced by hydrocortisone (1-2 mg per ml) both in the presence and absence of serum, while the elimination of bacterial label was reduced by 0.5 mg per ml and higher concentrations of the drug.

Reduction of phagocytosis and lysosomal enzyme release from human leukocytes by serum from patients with systemic lupus erythematosus

Serums from 22 of 30 (73.3%) patients with systemic lupus erythematosus (SLE) interfered significantly with particle (zymosan) uptake and subsequent release from normal human neutrophils of lysosomal enzymes. SLE serums with low as well as those with normal functional hemolytic complement activity (CH50) suppressed phagocytosis and enzyme release despite the presence of normal serum in cell suspensions. The defect did not appear to be caused by anticomplementary activity of serum. Serums from patients whose clinical activity of disease varied from none to severe and whose treatment varied from none to high doses of prednisone were capable of suppressing phagocytosis and enzyme release. The severity of clinical SLE activity did not affect the degree of suppression. Serums from patients treated with corticosteroids were more inhibitory than serums from patients not so treated. The nature of the inhibitor is unknown.

Effect of glucocorticosteroids on the phagocytosis and intracellular killing by peritoneal macrophages

The effect of hydrocortisone on the phagocytosis and intracellular killing by mouse peritoneal macrophages in vitro was studied by a method making it possible to measure these processes separately. The results showed that in vivo treatment with 15 mg of hydrocortisone acetate did not significantly decrease the phagocytosis of several bacterial species such as Staphylococcus albus, Staphylococcus aureus, Escherichia coli, Salmonella typhimurium, and Pseudomonas aeruginosa. The killing indexes of normal macrophages for the various microorganisms were found to be significantly different. This may indicate that the bactericidal mechanisms are not uniform for these bacteria. The effect of hydrocortisone on the intracellular killing was also variable. For Staphylococcus albus a normal killing index was found. For the other species of bacterial and for Candida albicans some decrease was found, but this was only significant for Salmonella typhimurium. It is concluded that a decrease host resistance due to glucocorticosterioid treatment is not caused by a direct effect of these drugs on the phagocytosis and intracellular killing by mononuclear phagocytes.

[Experimental Study On The Effect Of Cortisone In Mice Infected With Toxocara Canis: Histopathological Findings Of Granuloma In The Liver]

The present study was carried out to examine the effect of "Cortisone" on the worm burden migrated in the organs, and granulomatous change in the liver of mice infected with Toxocara canis eggs. Daily does of 0.5 mg "Cortisone" was administrated subcutaneously to Toxocara-infected mice with different schedule. The results are summarized as follows: 1. More number of Toxocara larvae migrated into the muscle tissue, especially into the carcass through the wall of the large intestine and higher distribution rate and longer persistence of worms were also recognized in the carcass of the experimental group than in the control. 2. Cortisone administration resulted the inhibition of granuloma formation, as well as the resolution of granuloma in the liver. However, the discontinuation of the administration induced the reccurence of heavier grade of inflammation. In non-cortisone treated group (control), cellular infiltration appeared around the worms in the liver on the 10th day of the infection, and typical granulomatosis was followed on the 20th day. As in above results, it is considered cortisone has remarkable anti-inflammatory and immunosuppressive effects in mice infected with T.canis, but histopathological changes on the granuloma formation might be related closely with the duration of Toxocara infection, dosage, duration and timing of cortisone administration.