The Occurrence of Atopy in Patients with Isolated Spontaneous Mast Cell (or Nonallergic) Angioedema

BACKGROUND

Isolated mast cell angioedema (MC-AE) can be divided into allergic and nonallergic (spontaneous) forms. The former is often associated with food, Hymenoptera venoms or drug allergies. This study aimed to evaluate the relationship between the occurrence of atopic diseases and the risk of angioedema.

METHODS

A retrospective study analyzed 304 patients with confirmed MC-AE and 1066 controls. All were analyzed for allergic asthma (AA), atopic dermatitis (AD) and allergic rhinitis (AR) based on ICD-10 codes. In addition, total IgE and peripheral eosinophilia were calculated.

RESULTS

The analyzed atopic diseases were more frequent in the group of patients diagnosed with MC-AE than in the controls: 78 (25.7%) vs. 173 (16.2%) for p < 0.01. Patients diagnosed with AD had a higher risk of MC-AE (hazard ratio (HR) = 1.48,) similar to those diagnosed with AR (HR = 1.51). However, in patients with two or three atopic comorbidities, the risk increased significantly to HR = 2.45 or HR = 4.1, respectively. There was a positive correlation between the serum total IgE concentration or eosinophilia and the risk of angioedema (p < 0.01).

CONCLUSION

Patients with MC-AE had a more frequent occurrence of atopic diseases associated with inhalant allergies. This risk increased in patients with IgE-mediated polymorphic disease.

Acquired Angioedema in Selected Neoplastic Diseases

Background and Objectives. Acquired angioedema is a relatively common revelation accompanying some diseases such as autoimmune or cancer. The study aimed to assess the incidence of one subtype of angioedema-C1-INH-AAE (acquired angioedema with C1 inhibitor deficiency). Material and methods. The study was retrospective and based on 1 312 patients with a final diagnosis of breast cancer, colorectal cancer, or lung cancer: 723 women and 589 men with a mean age of 58.2 ± 13.5 years. The cancer diagnosis according to the ICD (International Classification of Diseases)-10 code, medical history including TNM (Tumour, Node, Metastasis) staging, histopathology, and assessment of the occurrence of C1-INH-AAE angioedema were analysed. Results. C1-INH-AAE occurred more often in patients with cancer than in the control group, as follows: 327 (29%) vs. 53 (6%) for p < 0.05. C1-INH-AAEs were observed most often in the group of patients diagnosed with breast cancer compared to colorectal and lung groups: 197 (37%) vs. 108 (26%) vs. 22 (16%) (p < 0.05). A higher incidence of C1-INH-AAE was observed in the early stages of breast cancer. However, there was no relationship between the occurrence of C1-INH-AAE and the BRCA1 (Breast Cancer gene 1)/BRCA2 (Breast Cancer gene 2) mutation or histopathological types of breast cancer. Conclusion. Angioedema type C1-INH-AAE occurs more often in patients with selected neoplastic diseases, especially in the early stages of breast cancer.

Post-COVID-19 complications in hospitalized and non-hospitalized patients: the Silesian complications of the COVID-19 (SILCOV-19) database

INTRODUCTION

Due to the extent of the pandemic, a high prevalence and severity of complications in the early post-recovery period are expected.

OBJECTIVES

This study aimed to compare the scope of early complications after COVID-19 in patients who had the disease with and without hospitalization.

PATIENTS AND METHODS

This study was designed as a prospective observational registry-based cohort study at the tertiary cardiovascular hospital in Silesia, Poland. The interdisciplinary diagnostics during the study visit, including cardiovascular, pneumatological, neurological, and psychiatric tests, were performed. All patients completed the study. Two-hundred unselected adult Caucasian men and women who had symptoms of COVID-19 in the acute phase were included, of which 86 patients had the disease without the need for hospitalization.

RESULTS

The median (IQR) time from symptom onset to the study visit was 107 (87-117) and 105 (79-127) days in non-hospitalized and hospitalized patients, respectively. Lung lesions in high-resolution computed tomography were found in 10 (8.8%) and 33 (39.3%) non-hospitalized and hospitalized patients (P <0.01), respectively; no lesions were visualized on chest X-ray images. Elevated platelet distribution width was found in more than 70% of patients in both groups. More than half of the patients had insomnia, regardless of the hospitalization status.

CONCLUSIONS

The abnormal platelet parameters, NT-proBNP levels, functional and radiological findings in the lungs, and insomnia were the most frequent short-term COVID-19 complications in hospitalized and non-hospitalized patients. Considering the number of patients who have had COVID-19 worldwide, the high burden of the post-COVID-19 complications might be expected.

Allergen immunotherapy against house dust mites in patients with local allergic rhinitis and asthma

METHODS

The study was a prospective, double-blind, placebo-controlled trial with patients diagnosed with LAR to HDMs and with concomitant asthma who underwent a 12-month treatment course of SLIT for HDM allergies. Seventeen patients were randomized to SLIT with the use of allergen extracts of D. pteronyssinus and D. farinae (50/50%) in SQ-HDM SLIT tablets and 15 patients were randomized to the placebo group. The total rhinitis score (TRSS), total asthma symptom score (TASS), combined total symptom score (TSS), total medication score (TMS), and FEV1 were analyzed.Results: In the final analysis, 16 patients who received SLIT and 14 who received placebo who completed the study protocol were included. Significant reductions in TRSS, TASS, TSS, and TMS after 12 months of treatment were observed in patients after SLIT (p < 0.05). A significant increase in the mean FEV1 between baseline and after 12 months of therapy was observed in the study, with p = 0.03 in the study group. Conclusion: SLIT can improve nasal and bronchial symptoms and reduce symptomatic treatment in patients with LAR and asthma and with hyperresponsiveness to HDMs.

Impact of influenza vaccination on the risk of SARS-CoV-2 infection in a middle-aged group of people

Aims: An observational study of a retrospective cohort was performed to assess the impact of influenza vaccination (IV) on the risk of SARS-CoV-2 infection in a population of middle-aged people for 8 weeks after IV and compared with an unvaccinated group.

Patients and methods: Data from 1098 middle-aged patients (53.7 ± 4.7 years) after IV and 1205 unvaccinated patients (50.1 ± 6.8 years) were analyzed based on medical documentation. The inclusion criteria were age between 40 − 60 years and IV in the period from 1−30 September 2020. The incidence of infection with SARS-CoV-2 was confirmed by PCR and the classification of ICD-10 (U07.1).

Results and conclusions: After IV, patients had significantly fewer SARS-CoV–2 infections than the unvaccinated patients (P = .017). The hazard ratio was 0.74 (95% CI: 0.54−0.89). IV may partially reduce the risk of SARS-CoV-2 infection.

Elevated circulating heat shock protein 70 and its antibody concentrations in chronic spontaneous urticaria

Heat shock proteins (Hsp) play a complex role in cytoprotection, inflammation, and function of the immune system. They may be involved in pathogenesis of various diseases. Our aim was to determine circulating Hsp70 and anti-Hsp70 antibodies concentrations in patients with chronic spontaneous urticaria (CSU). Concentrations of Hsp70 in plasma and anti-Hsp70 antibodies in serum as well as serum C-reactive protein (CRP) were measured in CSU patients and in the controls. Plasma Hsp70 concentrations were significantly higher in CSU (all) and mild CSU patients as compared with the controls. Moderate–severe CSU patients tended to show higher Hsp70 concentration as compared with the controls, but not with mild activity of the disease. There were no significant differences in Hsp70 concentration between moderate–severe and mild CSU patients. Serum anti-Hsp70 antibodies concentrations were significantly higher in CSU (all) and mild CSU in comparison to the controls. Association was observed between anti-Hsp70 antibodies and increased CRP concentration; however, no correlation between anti-Hsp70 and Hsp70 concentrations was seen in the patients. It seems that up-regulation of Hsp70 in CSU may induce marked increase in anti-Hsp70 antibodies production, which are accompanied by parallel changes in CRP concentration. We suggest that Hsp may be released in CSU in response to stressful stimuli, such as inflammation.

Elevated plasma il-8 concentration is related to severity of systemic inflammation in chronic spontaneous urticaria

Chronic spontaneous urticaria (CSU) is associated with activation of acute phase response. Questions arise regarding its association with other inflammatory mediators. To determine plasma IL-8 concentration in CSU patients and its association with C-reactive protein (CRP) concentration, a nonspecific inflammatory marker of the disease activity, concentrations of plasma IL-8 and serum CRP were measured in CSU patients and compared with healthy controls. IL-8 and CRP concentrations were significantly higher in CSU patients as compared with the healthy subjects. In addition, there were significant differences in IL-8 and CRP concentrations between CSU patients with moderate-severe symptoms and the healthy subjects. Plasma IL-8 and serum CRP concentrations showed a significant correlation with urticaria activity score (UAS). Additionally, a significant positive correlation was observed between IL-8 and CRP concentrations. Up-regulations of IL-8 and its association with the marker of clinical and inflammatory activity suggest a role of this cytokine in the pathogenesis of CSU.

The relationship between circulating concentrations of interleukin 17 and C reactive protein in chronic spontaneous urticaria

Background

Up-regulation of interleukin 17 (IL-17) family cytokines and acute phase response have been observed in patients with chronic spontaneous urticaria (CSU). It has been demonstrated that IL-17 stimulates C-reactive protein (CRP) expression.

Aim

To determine relationship between circulating concentrations of IL-17 and CRP in CSU.

Methods

Concentrations of IL-17 in plasma and CRP in serum were measured in patients with CSU of varying severity and in the healthy subjects.

Results

IL-17 and CRP concentrations were significantly higher in CSU patients as compared to the healthy subjects. In addition, there were significant differences in IL-17 and CRP concentrations between CSU patients with mild, moderate-severe symptoms and the healthy subjects. CRP did not correlate significantly with IL-17.

Conclusions

Increased circulating IL-17 concentration may represent an independent index of systemic inflammatory response in CSU, which is not related to increased CRP concentration.

Decreased plasma kallikrein 5 concentrations in patients with chronic spontaneous urticaria

Little is known about the role of the kallikrein-kinin system in chronic spontaneous urticaria (CSU). Kallikrein 5 (KLK5), a trypsin-like enzyme, is the most abundant in the skin and plays a role in itching and inflammatory reaction. In this study, we determined plasma KLK5 concentration, and its associations with acute phase response in CSU patients. Concentrations of KLK5 in plasma and CRP in serum were measured in patients with CSU of varying severity and in the healthy subjects. Plasma KLK5 concentrations were significantly lower in CSU (all) and moderate-severe CSU patients, as compared with the controls. There were no significant differences in KLK5 concentration in mild CSU patients as compared with the healthy subjects and moderate-severe CSU patients. No correlation was observed between KLK5 and CRP concentrations in the patients. It may be considered that circulating kallikrein 5 is down-regulated in CSU patients, however its potential role and the possible underlying mechanism are unknown.

Effective treatment of different phenotypes of chronic urticaria with omalizumab: Case reports and review of literature

Despite the excellent efficacy and safety profile of omalizumab in chronic spontaneous urticaria (CSU), there are scarce data concerning its role in the treatment of refractory cases with different phenotypes of urticaria. We describe our experience with the therapy of nine patients with CSU co-existing with delayed pressure urticaria (DPU) or angioedema or both and refractory to treatment with high-dose antihistamines. The first patient, with severe CSU and recurrent angioedema, did not respond well to cyclosporine A or corticosteroids and suffered from numerous side effects of long-term corticosteroid therapy. The second patient presented with severe symptoms of DPU, which first of all prevented any daily activities of the professional routines. Both patients showed a complete remission of urticaria after the first injection of omalizumab. The third patient with CSU and severe DPU had been ineffectively treated for more than 20 years with various medications. Following the administration of omalizumab, the symptoms of CSU subsided but those of DPU intensified, and the drug was withdrawn after two cycles. In another four patients with refractory CSU and angioedema, the symptoms subsided after the first administration of omalizumab, and the patients have been in remission for about 5 weeks. In the remaining two patients, the symptoms did not resolve despite four 300 mg doses of omalizumab. It is important to establish a therapeutic regimen with omalizumab (150-300 mg; every 4-8 weeks) tailored to individual patient's needs and dependent on the type of urticaria; this may minimize unnecessary the medication exposure, adverse drug effects, and healthcare costs.

Evaluation of circulating vascular endothelial growth factor and its soluble receptors in patients suffering from persistent allergic rhinitis

Background

Overexpression and enhanced release of vascular endothelial growth factor (VEGF) have been detected in various types of allergic inflammation, including asthma.

Aim

To further evaluate the pattern of systemic release of VEGF in atopic allergy, free circulating VEGF was measured in patients with persistent allergic rhinitis (PAR).

Methods

The concentrations of VEGF and its soluble receptors (sVEGF-R1 and VEGF-R2) in plasma were measured in patients with PAR sensitized to house dust mites and the healthy subjects.

Results

No significant differences were found between PAR patients and healthy subjects with respect to plasma levels of VEGF and its receptors.

Conclusions

It seems that free circulating VEGF may not be elevated in PAR patients. Moreover, on the basis of the present study as well as the earlier ones, it appears likely that systemic release of VEGF varies among patients with distinct clinical manifestation of atopy; may depend on severity/activity and the extent of inflammatory response.

Hypersensitivity lo local anesthetics

Using local anaesthetics in daily practice, particularly by anaesthetists and dentists, is connected with the risk of side effects. Therefore, the observation of side effects, carrying out detailed research (according to the chart proposed in this study) and conducting specialist examinations is of the highest importance. There is a variety of side effects that could occur during local anaesthesia procedures, with the intensity ranging from clinically unimportant to life threatening. Clinicians' major concerns are the appearance of various hypersensitivity reactions, including anaphylaxis. Healthcare providers responsible for the administration of local anaesthetics should be able to detect hypersensitivity reactions to implement appropriate treatment and then choose highly selected diagnostic procedures. The final diagnosis should be based on specific medical history; documentation, including a description of the case and measurement of tryptase activity; skin tests; and provocation trials. Screening tests are not recommended in populations without hypersensitivity to local anaesthestics in their medical history.

IL-6 Transsignaling in Patients with Chronic Spontaneous Urticaria

Background

IL-6 trans-signaling is critically involved in the initiation and promotion of inflammatory and autoimmune diseases. Therefore, we investigated the clinical relevance of soluble members of IL-6 trans-signaling system in chronic spontaneous urticaria (CSU).

Methods

IL-6, interleukin 6 soluble receptor (IL-6 sR) and soluble gp130 (sgp130) were measured by ELISA method in plasma from CSU patients and the healthy subjects. The data were related to activation of the acute phase response as indicated by serum C-reactive protein (CRP) concentration and compared between patients stratified by the disease activity.

Results

Concentrations of IL-6, IL-6 sR, sgp130 in plasma and CRP in serum were significantly elevated in CSU patients compared with the healthy controls. CRP correlated significantly with IL-6 and sgp130, similarly IL-6 correlated significantly with sgp130. By contrast, CRP and IL-6 did not correlate significantly with IL-6 sR. However, significant correlation was noted between IL-6 sR and sgp130.

Conclusions

Concentrations of IL-6 and its soluble receptors were significantly elevated in patients with CSU, suggesting upregulation of the IL-6 trans-signaling in the disease. In addition, our results support the concept that the system may be involved in pathogenesis of the systemic inflammatory activation in CSU patients.

Refractory chronic spontaneous urticaria and permanent atrial fibrillation associated with dental infection: Mere coincidence or something more to it?

Controversy surrounds the role of dental infection/inflammation in the oral cavity in chronic spontaneous urticaria (CSU) and atrial fibrillation (AF), which is mainly due to scarce literature in this area. Therefore, this case report and review of literature illustrate a possible association between the acute-phase response (APR) and clinical conditions, such as CSU and dental infection/inflammation of oral cavity and AF.We describe a 36-year-old man with an 8-year history of difficult-to-treat, uncontrolled CSU, co-existent with dental infection/inflammatory processes of oral cavity and permanent atrial fibrillation (AF). In the presented case, the most likely triggering or aggravating/maintaining factor of the symptoms was the inflammation/dental infection of the oral cavity because of rapid reduction of the urticarial symptoms, drug doses, and serum CRP levels after the dental therapy. Dental treatment may have a beneficial effect on the systemic inflammatory response, reducing/normalizing the circulating levels of APR markers. APR activation appears to worsen CSU course, early identification and treatment of infectious/inflammatory foci in the oral cavity would form the mainstay of supportive therapy for CU probably through reduction of the systemic inflammatory burden. APR associated with infectious/inflammatory foci in the oral cavity could be taken into account as a predisposing agents to AF.

Frequency of IgE-dependent hypersensitivity to moulds in patients with chronic rhinosinusitis with polyps

INTRODUCTION

The complicated etiology of chronic sinusitis with polyps and frequent allergy to mould is established.

AIM

We aimed to investigate the frequency of the IgE-dependent hypersensitivity in this group of patients and prove the need of surgery in allergic chronic rhinosinusitis patients.

MATERIAL AND METHODS

Forty-two patients (19 females, 23 males) aged 34-73 years (55 ±12.6 years), with chronic sinusitis with polyps were included into the study. Functional endoscopic sinus surgery, laryngological examination, sinus computed tomography scans, and smear from maxillary sinus for microbiological examination were done in all patients. Skin prick tests with common perennial and seasonal inhalant allergens, tIgE and sIgE against moulds were required.

RESULTS

Thirty-two of 42 patients (71.4%) were allergic to at least one inhalant allergen. A mean concentration of total IgE was 241.2 ±186.3 kU/l (35.0-708.0 kU/l) and was lower in patients with fungal culture found in sinus mucin than in patients without fungal presence 75.1 ±54.6 kU/l vs. 284.3 ±204.1 kU/l. We found no difference in the number of positive skin prick tests in a group with and without fungal culture. None of patients with fungal culture found in sinuses presented a detectable level of mold sIgE. All patients with fungal vegetation in sinuses required at least two polypectomy procedures.

CONCLUSIONS

The total IgE concentration was significantly lower in patients with fungal presence in sinuses. Nasal polyps occurred more frequently in patients with fungal presence in sinuses.

Relationship between vitamin D status and the inflammatory state in patients with chronic spontaneous urticaria

Background

Chronic spontaneous urticaria (CSU) is an immune-inflammatory disease, characterized by acute phase response (APR) and immune activation. There has been increasing evidence showing that vitamin D deficiency/insufficiency is associated with increased incidence and/or severity of immune-inflammatory disorders.

Aim

To assess relationship between vitamin D status and C-reactive protein (CRP), a nonspecific inflammatory marker of CSU activity.

Methods

Concentrations of CRP and 25-hydroxyvitamin D [25(OH)D], a biomarker of vitamin D status were measured in serum of CSU patients and compared with the healthy controls.

Results

Serum 25(OH)D concentration was significantly lower in CSU group as compared with the normal subjects. The prevalence of vitamin D deficiency (< 20 ng/ml) was significantly higher in patients with CSU than among normal population. There were no significant differences in prevalence of 25(OH)D insufficiency between the groups. Serum CRP concentrations were significantly higher in CSU patients as compared with the healthy subjects. There were no significant correlations between CRP and 25(OH)D concentrations in CSU patients.

Conclusions

CSU is associated with lower serum 25(OH)D concentration and higher prevalence of its deficiency. The results failed to show any effect of vitamin D status on circulating CRP concentrations in CSU. A potential role of vitamin D in pathogenesis and/or additive therapy of CSU needs to be examined in other cohorts of CSU patients as well as in larger studies.

How to isolate urothelial cells? Comparison of four different methods and literature review

The aim of this study is to present the comparison of four different methods for urothelial cell isolation and culture and compare them to methods cited in the literature. Four different techniques were examined for urothelium isolation from rat bladders. Isolation effectiveness was calculated using trypan blue assay. Confirmation of isolated cell phenotype and comparison with native bladder tissue was confirmed using immunohistochemical (IHC), immunocytochemical (ICC) and immunofluorescence (IF) analysis. The method with bladder inversion and collagenase P digestion resulted in the highest number of isolated cells. These cells showed positive expression of cytokeratin 7, 8, 18, α6-integrin and p63. Our results and the literature review showed that the best method for urothelium bladder isolation is dissection of the epithelium layer from other bladder parts and digestion of mechanically prepared tissue in a collagenase solution.

Increased serum complement C3 and C4 concentrations and their relation to severity of chronic spontaneous urticaria and CRP concentration

Chronic spontaneous urticaria (CU) is associated with activation of the acute phase response (APR). Nevertheless, APR-associated proteins have not been well characterized as potential biomarkers of the disease severity. To assess the pattern of complement proteins C3 and C4 – the acute phase reactants in patients with CU. C3, C4 and CRP concentrations were measured in serum of 70 patients showing different degrees of urticarial severity as well as in 33 healthy subjects. Serum C3 and C4 concentrations were significantly increased in CU patients as compared with the healthy subjects and exceed the normal lab range by about 5% and 10%, respectively. Significant differences were found between patients with mild and increased CU severity. In addition, significant correlations were observed between C3, C4 and CRP concentrations. More severe CU is characterized by higher production of C3 and C4 complements accompanied by parallel changes in CRP concentration.

Analysis of procalcitonin and CRP concentrations in serum of patients with chronic spontaneous urticaria

Background

Our previous findings showed the importance of analysing the peripheral markers of acute phase response (APR) activation, C-reactive protein (CRP) and IL-6 in the context of urticaria activity and severity. However, these biomarkers do not reliably differentiate between APR to infectious and the disease severity.

Aim

In order to investigate a possible association between the immune-inflammatory activation markers CRP and procalcitonin (PCT).

Methods

Serum PCT and CRP concentrations were measured in patients with CU of varying severity as well as in healthy subjects.

Results

Serum PCT and CRP concentrations were significantly increased in more severe CU patients when compared to healthy controls and mild CU, and within the CU population there was a significant correlation between concentrations of PCT and CRP. Serum PCT concentrations remained within normal ranges in most CU patients and were only slightly elevated in some severe CU cases.

Conclusions

PCT serum concentration may be only slightly elevated in some cases of severe CU. Upregulation of PCT synthesis accompanied by parallel changes in CRP concentration reflects a low-grade systemic inflammatory response in CU. PCT should be considered as a better marker than CRP to distinguish between APR to infection and an active non-specific urticarial inflammation.

[The quality of voice in coal-miners after burn/inhalation injury due to methane explosion]

The job as a coal-miner exposes to the greatest risk. One of the most dangerous health hazard is a burn/inhalation injury during the methane explosion. The victims undergo physical trauma, effect of high temperature and inhalation of toxic gases and products of incomplete combustion, As a result of inhalation injury both, upper and lower airways are affected. The aim of the study was to analyse the relationship between burn/inhalation injury and quality of voice in affected coal-miners. A group of 23 patients (men) in age from 28 to 59 (mean 38.5) 3 years after burn/inhalation injury participated in this study. The voice evaluation based on ENT examination, videlaryngostroboscopy, acoustic analysis, MPT parameter and GRBAS analysis was performed. The special control group of coal-miners served as a control. On the basis of the subjective evaluation and the objective acoustic analysis, aerodynamic parameter and videlaryngostroboscopy the worse quality of voice in the group of injured coalminers was shown in comparison to the control group. No substantial correlation between the acoustic parameters, MPT parameter and ventilating rates was found.

Acute phase inflammatory markers in patients with non-steroidal anti-inflammatory drugs (NSAIDs)-induced acute urticaria/angioedema and after aspirin challenge

BACKGROUND

Active chronic urticaria, identified as a mast cell- and basophil-dependent inflammatory disorder of the skin is able to elicit acute phase response (APR). However, systemic inflammatory response in different types of urticaria is poorly characterized.

AIM

To determine APR pattern in a clearly defined group of patients with acute urticaria and/or angioedema - induced by NSAIDs.

METHODS

Plasma IL-6 and serum C-reactive protein (CRP) concentrations were studied in 17 patients with NSAIDs-induced acute urticaria/angioedema (NSAIDsAU) and in 20 healthy controls. Eleven patients who used NSAIDs were presented at the emergency room with acute urticaria/angioedema while the remaining six manifested the symptoms during the aspirin challenge test. Patients were examined in a dynamic manner: during the acute phase, and next, after subsidence of the symptoms.

RESULTS

CRP and IL-6 concentrations increased significantly in patients with NSAIDsAU as compared with their asymptomatic period and the healthy subjects. In addition, NSAIDsAU patients showed elevated concentration of the biomarkers following aspirin provocation with the baseline values recovered in the asymptomatic period.

CONCLUSION

These results indicate that an acute systemic inflammatory response is activated in patients with NSAIDs-induced urticaria and/or angioedema. The study supports the evidence proving that up-regulation of CRP and IL-6 in urticaria/angioedema does not necessarily reflect any concomitant infection or other inflammatory processes, but may be due to the disease itself.

The Blood Urokinase System in Patients with Seasonal Allergic Rhinitis and Concomitant Seasonal Asthma during Pollen Season

It is well known that the fibrinolytic system actively participates in inflammatory processes. To investigate the role of the urokinase system in atopic allergy, we assessed circulating levels of urokinase-type plasminogen activator (uPA) and its soluble receptor (suPAR) in patients with pollen allergy suffering from allergic rhinitis and asthma during a period of natural pollens exposure. Plasma concentrations of uPA and suPAR were measured in 19 patients sensitized to grass and rye pollens (12 men and 7 women, 18 to 30 years old) who had seasonal allergic rhinitis and concomitant seasonal asthma symptoms, and 23 age- and sex-matched healthy controls, using THE enzyme-linked immunosorbent assay (ELISA) method. There were no significant differences in plasma concentrations of uPA and suPAR between patients and the control subjects. Seasonal allergic airway inflammation is not associated with enhanced release of uPA and suPAR into the systemic circulation.

Adverse effects of local anaesthetics - allergy, toxic reactions or hypersensitivity

BACKGROUND

There are several kinds of adverse reactions to the administration of local anaesthetics (LAs): hypersensitivity, which causes reproducible symptoms or signs, initiated by exposure to a defined stimulus at a dose tolerated by normal subjects; toxic reactions - caused by overdose or inappropriate administration; and allergy - when an immunologic mechanism can be shown to be important.The most serious adverse reaction is anaphylaxis, which can be of allergic or non-allergic (anaphylactoid) origin. We analysed clinical adverse reactions to local anaesthetic agents that occurred in the Silesian region.

METHODS

Thirty-two patients, aged 22-56 years, in whom significant reactions had occurred after administration of an LA, were investigated in our institution. The investigation was based on skin prick, intradermal injections and patch testing. In every patient, the concentration of latex IgE antibodies was measured.

RESULTS

True allergic reactions were confirmed in three patients. The allergens were: lidocaine in all three cases, additionally: nickel - in one person and preservative (paraben) - in one patient. No latex allergy was diagnosed.

DISCUSSION

The results showed that real allergic reactions to LA agents are rare and that most of the reported reactions were caused by hypersensitivity. Nevertheless, in each case of adverse reaction, careful review of the history, and testing of immediate and late allergic reactions not only to LA but also to latex and preservatives, should be mandatory.

Molecular mechanisms of glucocorticoids action: implications for treatment of rhinosinusitis and nasal polyposis

Intra-nasal glucocorticoids are the most effective drugs available for rhinosinusitis and nasal polyposis treatment. Their effectiveness depends on many factors and not all of them have been well recognized so far. The authors present the basic information on molecular mechanisms of glucocorticoid action, direct and indirect effects of glucocorticoids on transcription of genes encoding inflammatory mediators. They focus on recently proved nongenomic mechanisms which appear quickly, from several seconds to minutes after glucocorticoid administration and discuss clinical implications resulting from this knowledge. Discovery of nongenomic glucocorticoid actions allows for better use of these drugs in clinical practice.

HLA status in patients with chronic spontaneous urticaria

Chronic spontaneous urticaria (CSU) is the most common form of chronic urticaria. A considerable amount of data supports an immunological basis for CSU. Some research has focused on the association between chronic urticaria and specific human leukocyte antigen (HLA) alleles. The aim of this study was to investigate the HLA status of Polish patients diagnosed with CSU.

METHODS

The standard complement-dependent microlymphocytotoxicity assay and PCR amplification with sequence-specific primers were used to analyze HLA alleles in 115 patients diagnosed with CSU, and the results were compared to those from 162 healthy, genetically unrelated individuals.

RESULTS

Among the HLA-A alleles, A-33 occurred significantly more often in the control group (p < 0.01). Analysis of the HLA-B allele frequencies revealed the prevalence of the B44 antigen in the study group (p < 0.0001). Frequencies of HLA-C alleles and HLA-DQ did not differ significantly between the groups. Among the HLA class II alleles, DRB1*04 was observed significantly more often in the study population (p < 0.001), mainly in the autoimmunological subtype of urticaria.

CONCLUSION

HLA alleles may be involved in CSU development or play a protective role in CSU.

[Difficulties in determining of the equivalent doses of inhaled glucocorticoids]

Inhaled glucocorticoids are the most effective anti-inflammatory medicines used to treat asthma. Determination of equivalent dose is important, because different preparations vary in potency and bioavailability. Despite the large knowledge about the effect of inhaled glucocorticoids the data of their dosing are not consistent and continue to be verified in clinical studies. The authors discuss some of the indicators of pharmacodynamic and pharmacokinetic properties that may help determine the effectiveness, safety and equivalence of different doses of inhaled corticosteroids.

Immunoelectron microscopy in mycosis fungoides and benign dermatoses. Expression of CD3, CD4 and CD7 receptors

Mycosis fungoides is an epidermotropic cutaneous T-cell lymphoma (CTCL).Specimens for presented study were taken from sixteen patients with MF confirmed by immunohistochemical methods and PCR and from nine patients with benign dermatoses. To demonstrate CD3, CD4 and CD7 antigens immunogold method was used. We saw morphological differences between lymphocytes from MF and benign dermatoses. In MF, CD3 and CD4 were present rather in form of clusters placed on the surface of cell. On the contrary -CD3 to CD7 distribution analysis showed that these antigens were present rather individually, however there were seen clusters as well. In MF tumor stage labelling decreased in following order: CD7, CD3 and CD4. We also found internalisation of studied antigens via the coated structures of the cell membrane -especially in tumor stage. In benign dermatoses the majority of all receptors was present on the cell membrane. Our work showed differences in localization of studied antigens, between MF stages, what can suggest their possible translocation in cells. We also found loss of CD3 and CD7 antigens in tumor stage what might be use as adiagnosis tool for this disease.

KEYWORDS

mycosis fungoides, benign dermatoses, CD3, CD4 and CD7 receptors, immumogold labelling.

Nongenomic Effects of Glucocorticoids, an Important Mechanism of Inhaled Glucocorticoids Action in Asthma

Authors describe the clinical implications of nongenomic effects of glucocorticoids, important also for the inhaled drugs. Data suggest that these rapid actions of glucocorticoids are important in the pharmacotherapy of asthma, particularly for prevention and treatment of acute exacerbations. Their influence on remodeling is also considered.

Niegenomowy mechanizm działania glikokortykosteroidów

W pracy przedstawiono aktualną wiedzę dotyczącą mechanizmów działania glikokortykosteroidów (GK). Zgodnie z klasycznym modelem działania, określanym jako genomowy, GK wpływają (bezpośrednio lub pośrednio) na transkrypcję i translację genów kodujących mediatory procesu zapalnego. Aktualne badania podkreślają jednak znaczenie nietranskrypcyjnych oddziaływań GK, które ujawniają się szybko—od kilkunastu sekund do kilkunastu minut. W niegenomowym mechanizmie działania GK zasadniczą rolę odgrywają interakcje z receptorami GK zlokalizowanymi w cytoplazmie, ale przede wszystkim w błonie komórkowej, które aktywują wiele szlaków sygnałowych kinaz (MAPK, Src, PI3K) i kanałów jonowych, a także szlaki sygnałowe związane z receptorami sprzężonymi z białkiem G. Udowodniono także przekaz sygnału bez udziału receptora dla GK. Odkrycie niegenomowego mechanizmu GK pozwala lepiej zrozumieć ich przeciwzapalne i immunosupresyjne działanie.

[Nongenomic effects of glucocorticoids, an important mechanism of inhaled glucocorticoids action in asthma]

Authors describe the clinical implications of nongenomic effects of glucocorticoids, important also for the inhaled drugs. Data suggest that these rapid actions of glucocorticoids are important in the pharmacotherapy of asthma, particularly for prevention and treatment of acute exacerbations. Their influence on remodeling is also considered.

[Nongenomic effects of glucocorticoids]

The review describes current advances in the knowledge on the mechanisms of glucocorticoid (GC) action. According to the classic genomic model, GCs bind to intracellular receptors and subsequently regulate (directly or indirectly) gene transcription and synthesis of proteins responsible for inflammatory processes. The nongenomic effects of GCs, occur rapidly within seconds or minutes of drug administration, are mediated via a cytosolic but first of all by membrane GC receptors and lead to activation of multiple signal transduction pathways of protein kinases (MAPK, Src, PI3K), cation channels or G protein- -coupled receptors. Nongenomic effects may also occur without receptor involvement. The elucidation of nongenomic actions provides new insights for the understanding of their anti-inflammatory and immunosuppressive GC effects.

Hyperthermia-induced reorganization of microtubules and microfilaments and cell killing in CHO AA8 cell line

The aim of this study was to elucidate the effects of hyperthermic treatment on cell morphology and the cytoskeleton in CHO AA8 cell line. The effects of exposure to elevated temperature were analyzed in CHO AA8 cell line by fluorescence microscopy and flow cytometry. The 30 min, at 44.5 degrees C heat shock treatment resulted in the collapse of microtubules (MTs) and microfilaments (MFs) around the nucleus followed by their recovery 24 h after heating. The initial collapse of these cytoskeletal systems, observed 15 min after treatment, was accompanied by the appearance of cells with reduction of volume, shrunken cytoplasm and condensed chromatin. 24 h afterwards, there was the increase in the number of cells with restored and extended MT and MF cytoskeletons. Most of them were larger in size compared to the control cells and had multiple nuclei. 48 h after heat shock the highest number of the giant cells with alternation in nuclear morphology was seen. Flow cytometry analysis revealed the increase in the number of cells with externalized phosphatidylserine 24 h and 48 h after hyperthermic treatment. These results suggest that following heat shock, CHO AA8 cells undergo mitotic catastrophe that presumably represents one of the events resulting in apoptosis.

Expression of cyclin A in intestinal biopsies from children with celiac disease

The aim of this study was to determine the expression of cyclin A and describe its distribution in biopsy samples taken from children with suspected and confirmed celiac disease as well as in control samples. Investigated material consisted of 37 intestinal biopsies: 19 taken from patients with confirmed celiac disease, 9 from patients with its suspicion and 9 from healthy patients, who served as control. Immunohistochemical and immunogold methods were used to estimate cyclin A expression. In celiac disease samples morphological changes in epithelial cells, typical for disease, were shown. We observed weaker cyclin A expression, however there were also some cells with strong labeling in cytoplasm, near the nucleus. In control and suspected celiac disease groups cyclin A was present in the brush border, nucleus and whole cytoplasm, especially in proximity to the nucleus. In conclusion, these studies enabled us visualized pattern of distribution of cyclin A but let us also to presume that observed decrease of expression and its distribution might function as additional factor which could be taken under consideration to establish terminal diagnosis. We are aware of the fact that these are very first observations and that this subject needs to be further investigated with the use of additional methods and samples.

Reorganization of actin in K-562 and HL-60 cells treated with taxol

Influence of taxol, microtubular poison, has been studied on distribution of actin. K-562 and HL-60 cells were treated with taxol in a range of concentrations 0.02-10 microM for 72 hours. The reorganization of F-actin was dependent on its dose. Phalloidin conjugated to TRITC was used to evaluate actin distribution by classical fluorescence and confocal microscopy. Actin was visualized at ultrastructural level by using a postembedding streptavidin-gold method. The treatment of K-562 and HL-60 cells with 2-10 microM of taxol resulted in an increase of F- actin in the cytoplasm, with intense labeling as a ring close to surface of the cell. In HL-60 cells a concentration of F- actin at the site of apoptotic bodies was often observed. Immunogold labeling of actin was localized in the nuclei and cytoplasm in control cells and cells treated with all doses of taxol. At higher doses, compaction of chromatin in the nucleus with strong actin labeling was observed. These observations at the ultrastructural level suggest actin involvement in chromatin reorganization during the process of apoptosis. The present study demonstrated a dose dependent reorganization of actin after treatment with taxol.

Ultraviolet radiation (UV) induces reorganization of actin cytoskeleton in CHOAA8 cells

Effect of UV radiation on actin cytoskeleton was studied in CHOAA8 cells by fluorescence and electron microscopy. UV irradiated cells showed impaired adherence, disruption of the actin filaments and stronger F-actin labeling in the center of the cell. Attached cells, especially enlarged ones showed rather weak labeling of stress fibers and bundles of F-actin in the cytoplasm, but some cells with intensive labeling of these structures were also observed. Detached cells were rounded, showed strong F-actin labeling and often had buds. At the ultrastructural level UV-irradiated cells showed segmented nuclei, bodies resembling micronuclei, dilatation of endoplasmic reticulum, swollen and disturb mitochondria. Immunogold labeling of actin at the ultrastructural level was observed in non-radiated and UV irradiated cells. Actin labeling was seen in nuclei and cytoplasm. In nuclei gold particles were localized in the area of condense chromatin. Labeling for actin was not found after control incubation. Our observations show that UV radiation promotes changes in the distribution of actin in CHOAA8 cells. The results also suggest that not only reorganization of actin but changes in organelles are involved in the process of apoptosis initiated by UV radiation.

Immunogold detection of CD3 and CD4 antigens in patients with Mycosis fungoides

In this study, we analyzed the distribution of CD3 and CD4 antigens at the ultrastructural level in tissue samples from mycosis fungoides patients using double-immunogold labeling. We observed clusters composed of CD3 and CD4 antigens on the plasma membrane and intracellular. There were also clusters only of one type of the antigen and we could observe more often CD4 than CD3. Labeling of CD3 and CD4 was not found in control cells incubated with non-immune serum. In conclusion, our ultrastructural studies not only visualized pattern distribution and relationship between CD3 and CD4 antigens but might also suggest that the type and form of distribution provides new clues to their possible translocation in mycosis fungoides cells.

Bilateral nasal allergen provocation monitored with acoustic rhinometry. Assessment of both nasal passages and the side reacting with greater congestion: relation to the nasal cycle

BACKGROUND

The effect of bilateral nasal provocation on nasal mucosa measured with the use of acoustic rhinometry (AR) can be assessed for both nasal passages or for the side responding with greater congestion. Assessment of changes in nasal congestion during the nasal provocation test (NPT) can be affected by the nasal cycle (NC). The aim of this study was to find out the most accurate method to evaluate changes observed during bilateral nasal provocation.

METHODS

Cross-sectional areas (CSA) at the level of inferior nasal turbinate (CSA-2) were recorded by AR in 26 volunteers with allergic rhinitis during the NC for 5-7 h and subsequently during NPT. The risk of spontaneous total and unilateral CSA-2 decrease was established. Sensitivity of the NPT assessment for the total CSA-2 and for the side responding with greater congestion was evaluated at chosen thresholds. These thresholds were selected in a way that the risk levels of spontaneous decrease of unilateral and total CSA-2 were equal.

RESULTS

The assessment of the total CSA-2 was found to be more sensitive than the assessment of the side responding with greater congestion. The highest sensitivity and specificity of the test was achieved by using a combination of both assessments. Optimum thresholds of the CSA-2 decrease for assessment at 15 min after provocation, with this method, were 27% and 40% for the side responding with greater congestion and for the total CSA-2, respectively.

CONCLUSIONS

Recognition of the risk of spontaneous unilateral and total CSA-2 decreases enables introduction of combined assessment of bilateral NPT. This assessment seems to be the most accurate method for evaluation of the test results.

The effect of doxorubicin on the expression of cyclin A in K-562 leukemia cell line

Two opposite processes such as apoptosis and cell division cycle play an important role in cancer biology. During apoptosis cells die by degrading proteins and genome, whereas in the cell cycle cells divide and the genome is duplicated. There are very few studies on the role of cell cycle proteins in apoptosis although their role is distinctly different from that in the cell cycle. The significance of expression of cyclin A and other cyclin cell proteins (eg. Cdk2) in apoptosis remains to be investigated. The aim of this study was to characterize the distribution pattern of cyclin A by using the stereptavidin - biotin - peroxidase technique in K-562 cells treated with doxorubicin. The analysis of cell cycle phases using cytophotometric methods to estimate the cellular response to doxorubicin was also used. Studied cells were treated with doxorubicin in the range 0.5; 5.0 and 10 microM. Expression of cyclin A in K-562 was 32.2; 41.8; 69.9%, respectively, according to doses of doxorubicin. The number of apoptotic cells was increasing together with the increase of doxorubicin doses as well as positive labeling for cyclin A. After doxorubicin treatment decrease of G1/G0 phase and the growth of cell percentage with dose dependent manner at G2/M phase, compared to control was observed. The results allow to suggest that expression of cyclin A may have pro-apoptotic role however more studies are required to clarify whether and what role cyclin A plays in apoptosis.

Estimation of taxol influence on changes in tubulin and vimentin systems in K-562 and HL-60 cell lines by immunofluorescence microscopy

The cytoskeletal system may be considered as an additional pathway involved in process of apoptosis and can be promising target for development of new chemotherapies. The study describes alterations in the distribution of vimentin and tubulin in taxol treated K-562 and HL-60 cells in relation to apoptotic changes. K-562 and HL-60 cells were treated with taxol in a range of concentrations (0.02-10 microM) for 72 hours. Significant changes in distribution of studied proteins occurred in the range 2-10 microM of taxol. K-562 cells showed thin network of vimentin distributed throughout cells or collapsed on nucleus. There were also cells with bright aggregates remembering apoptotic bodies. HL-60 cells showed strong labeling of vimentin in the cytoplasm as well as at the site of apoptotic bodies. Vimentin collapsed on the nucleus, labeling at poles and along the major axis of the cell were also seen. K-562 and HL- 60 cells showed radial labeling of tubulin from the centre, aggregates at the surface and bundled microtubules. These findings indicate that alterations in expression of studied cytoskeletal proteins after treatment with taxol were dose-dependent and related with characteristic features of apoptosis.

Effect of doxorubicin on actin reorganization in Chinese hamster ovary cells

Exposure of Chinese hamster ovary (CHO AA8) cells to doxorubicin in doses of 75 microM resulted in reorganization of F-actin filaments and characteristic feature of apoptosis. Even increase in size of CHOAA8 cells was observed. Attached cells become more flattered and elongated than control ones. Intense labeling of F-actin around the nucleus and disrupted filaments in cytoplasm as well as stress fibres and bundles of F-actin were seen. Cells detached were rather rounded and there were not stress fibres present. In these cells the network of F-actin was weak and rather disrupted and cells with buds labelled for F-actin were observed. In section from confocal microscopy labeling of F-actin in nucleus was confirmed. Electron microscopy showed cells with multisegmented nuclei. Cells with intracellular area with small and large vacuoles and containing also electron-dense material were seen. Other cellular organelles were rather well preserve. There were margination and condensation of chromatin in nucleus. Immunogold labelling of actin was observed in cells whether or not treated with doxorubicin. Positivity for actin was localized in the nuclei and cytoplasm. In the nucleus gold particles were localized predominantly in the area of condense chromatin. Positive labeling for actin was not found after control incubation. These findings show that doxorubicin promotes changes in the distribution of actin in CHOAA8 cells and that reorganization of actin in these cells is involved in process of apoptosis.

[Lung function and exercise tolerance after treatment with salmeterol or ipratropium bromide in chronic obstructive pulmonary disease]

The aim of this study was to compare the effects of 6 months therapy with salmeterol or ipratropium bromide on lung function (resting and dynamic parameters), exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). In open, randomised study patients at visit 1 were included into trial, at visit 2 and, after 6 months therapy, at visit 3 lung function measured by a pressure body plethysmography, exercise tolerance was investigated by 6 minute walking test and dyspnoea was analysed by the means of Borg scale. We studied 24 patients (18 males, 6 females, range age 45-76 yrs, mean: 60.2+/-10.46) with stable COPD. 13 subjects (mean FEV1 = 63.61% predicted, SD = 15.66%) received salmeterol (2 x 50 microg/day) and 11 subjects (mean FEV1 = 62.52% predicted, SD = 12.39%) received ipratropium bromide (4 x 40 microg/day). There were no significant changes in lung function parameters (FEV1, VC, Rtot, TLC, RV and RV%TLC) after 6 months therapy with both drugs, but the treatment with salmeterol significantly improves exercise tolerance in 6 minute walking test (p=0.048) and Borg dyspnea ratings (p=0.008).

[Anesthesia for axillofemoral bypass surgery in the patient with multivessel coronary heart disease]

The paper presents a combination of two methods of regional anesthesia for axillofemoral bypass surgery. In the patient with coronary arthery disease and a high risk of anesthesia, brachial plexus block and thoracic epidural anesthesia was performed.

[Beta2-agonists--what does their chemical structure determine?]

The paper presents the structure and functional relationship of beta2-agonists and the beta2-adrenoceptor. The human beta2-adrenoceptor is a member of the 7-transmembrane family of receptors. Most of the actions of the beta2-receptor are mediated through the Gs protein and the cAMP-dependent PKA system. Alternative cAMP-independent pathways affected following beta2-receptor activation have also been described. Beta2-agonists have been used as bronchodilator agents in the treatment of asthma since the development of inhaled isoprenaline preparations in 1961. Over the years, these agents have been markedly improved through the development of short-acting beta2 selective agents followed by long-acting beta2 selective agents with prolonged duration of action. Efforts directed towards improving the pharmacodynamic and pharmacokinetic properties, including the long-acting and selective beta2-adrenoceptor agonists, included two major pathways of modifying the basic structure of the catecholamines, which are described in this paper. The pharmacological activity usually resides in the (R)-enantiomer. The kinetics of beta2-agonist-stimulated bronchodilation in asthma is determined by the differences in the molecular mechanism of beta2-agonists action. Regulation of the beta2-receptor is influenced by its desensitization following exposure to high concentrations of or repeated challenges with agonists, and up-regulation which can be induced by glucocorticoids and thyroid hormones.