Endogenous IL-33 Accelerates Metacestode Growth during Late-Stage Alveolar Echinococcosis

During the course of the infectious disease alveolar echinococcosis (AE), the larval stage of Echinococcus multilocularis develops in the liver, where an initial Th1/Th17 immune response may allow its elimination in resistant individuals. In patients susceptible to infection and disease, the Th2 response initiates later, inducing tolerance to the parasite. The role of interleukin 33 (IL-33), an alarmin released during necrosis and known to drive a Th2 immune response, has not yet been described during AE. Wild-type (WT) and IL-33-/- C57BL/6J mice were infected by peritoneal inoculation with E. multilocularis metacestodes and euthanized 4 months later, and their immune response were analyzed. Immunofluorescence staining and IL-33 enzyme-linked immunosorbent assay (ELISA) were also performed on liver samples from human patients with AE. Overall, metacestode lesions were smaller in IL-33-/- mice than in WT mice. IL-33 was detected in periparasitic tissues, but not in mouse or human serum. In infected mice, endogenous IL-33 modified peritoneal macrophage polarization and cytokine profiles. Th2 cytokine concentrations were positively correlated with parasite mass in WT mice, but not in IL-33-/- mice. In human AE patients, IL-33 concentrations were higher in parasitic tissues than in distant liver parenchyma. The main sources of IL-33 were CD31+ endothelial cells of the neovasculature, present within lymphoid periparasitic infiltrates together with FOXP3+ Tregs. In the murine model, periparasitic IL-33 correlated with accelerated parasite growth putatively through the polarization of M2-like macrophages and release of immunosuppressive cytokines IL-10 and transforming growth factor β1 (TGF-β1). We concluded that IL-33 is a key alarmin in AE that contributes to the tolerogenic effect of systemic Th2 cytokines. IMPORTANCE Infection with the metacestode stage of Echinococcus multilocularis, known as alveolar echinococcosis, is the most severe cestodosis worldwide. However, less than 1% of exposed individuals, in which the immune system is unable to control the parasite, develop the disease. The factors responsible for this interindividual variability are not fully understood. In this in vivo study comparing wild-type and IL-33-/- infected mice, together with data from human clinical samples, we determined that IL-33, an alarmin released following tissue injury and involved in the pathogenesis of cancer and asthma, accelerates the progression of the disease by modulating the periparasitic microenvironment. This suggests that targeting IL-33 could be of interest for the management of patients with AE, and that IL-33 polymorphisms could be responsible for increased susceptibility to AE.

Childhood trauma and mental disorders: Exploring the relationship between trauma, immunity and psychosis

Introduction

A relationship between childhood trauma, psychotic experiences, and psychosis is well established, although causality is not yet ascertained. There are several hypotheses linking trauma and psychosis, regarding genetic vulnerability and/or other environmental factors, possibly also mediated by psychological mechanisms. Long-term modifications to the transcriptome are likely mediated by epigenetic mechanisms. There is also growing evidence supporting an association between childhood trauma and adulthood dysregulation of the immune system, which could help clarify the relationship between trauma and mental disorders, namely psychosis.

Objectives

Review evidence regarding the relationship of childhood trauma, immune system and psychosis.

Methods

Literature review using Medline database.

Results

The prevalence and severity of childhood trauma is characterized by both biological alterations and increased risk of experiencing symptoms of psychosis. Childhood trauma, namely through its effects on IL6 levels, may be a risk factor for schizophrenia in general. Some studies point to a direct relationship between childhood trauma, immunity and psychosis when examined along a continuum from non-clinical controls to psychotic disorders such as schizophrenia.

Conclusions

For better understanding this association, these findings must be replicated in larger cohorts. If the impact of childhood trauma on immune function in adulthood does indeed contribute to psychopathology, an improved understanding of this relationship may lead to new and possibly more specific treatment options. Other clinical implications of these findings include increased emphasis in establishing more comprehensive screening of early trauma in patients with psychotic symptoms, as well as the importance of screen and follow children who report traumatic events for emergence of psychotic symptoms.

IL-33/ST2 axis is involved in disease progression in the spleen during Leishmania donovani infection

Background

During infection with Leishmania donovani, parasite control is linked to the systemic Th1 immune response, but in infected organs (liver, spleen and bone marrow), the response differs according to the micro-environment. The pleiomorphic cytokine interleukin-33 (IL-33) exerts various roles during infection, either protective or detrimental. In this study, we explored the role of IL-33 in the outcome of Leishmania infection in the spleen.

Methods

We used several mouse models, on BALB/c and C57BL/6 (B6) backgrounds, infected with L. donovani and sacrificed at 15, 30 or 60 days after infection and characterized mRNA expression of immune markers, immune cell populations, histological response, and parasite loads.

Results

During infection IL-33 and ST2 mRNA increased in parallel in the spleen of wild type (wt) animals and paralleled the immunodetection of ST2+ and IL-33+ cells; their expression was twice as high in BALB/c, compared to B6 mice. Mice treated with twice-weekly injections of rIL-33 had higher splenic parasite burdens on D15 (BALB/c) or on D60 (B6). In BALB/c, IL-33 treatment led to immune exhaustion with abolition of Th1 cytokine expression (IFN-γ and IL-12) in the spleen and higher serum levels of Th2 cytokines (IL-4, IL-5 and IL-13). In B6, IL-33 treatment induced the Treg cell pathway with a dramatic increase of FoxP3 mRNA induction and expression on tissue sections. IL-33-KO mice had lower parasite loads and a higher Th1 response than their wt counterparts.

Conclusions

IL-33 appears as a factor of aggravation of the disease in the spleen tissue of mice infected with L. donovani.

In vitro and in vivo immunomodulatory properties of octyl-β-D-galactofuranoside during Leishmania donovani infection

BACKGROUND

The chemotherapeutic arsenal available to treat visceral leishmaniasis is currently limited, in view of many drawbacks such as high cost, toxicity or emerging resistance. New therapeutic strategies are particularly needed to improve the management and the outcome in immunosuppressed patients. The combination of an immunomodulatory drug to a conventional anti-Leishmania treatment is an emerging concept to reverse the immune bias from Th2 to Th1 response to boost healing and prevent relapses.

METHODS

Here, immunostimulating and leishmanicidal properties of octyl-β-D-galactofuranose (Galf) were assessed in human monocyte-derived macrophages (HM) and in a murine model, after challenge with Leishmania donovani promastigotes. We recorded parasite loads and expression of various cytokines and immune effectors in HM and mouse organs (liver, spleen, bone marrow), following treatment with free (Galf) and liposomal (L-Galf) formulations.

RESULTS

Both treatments significantly reduced parasite proliferation in HM, as well as liver parasite burden in vivo (Galf, P < 0.05). Consistent with in vitro results, we showed that Galf- and L-Galf-treated mice displayed an enhanced Th1 immune response, particularly in the spleen where pro-inflammatory cytokines TNF-α, IL-1β and IL-12 were significantly overexpressed compared to control group. The hepatic recruitment of myeloid cells was also favored by L-Galf treatment as evidenced by the five-fold increase of myeloperoxidase (MPO) induction, which was associated with a higher number of MPO-positive cells within granulomas. By contrast, the systemic level of various cytokines such as IL-1β, IL-6, IL-17A or IL-27 was drastically reduced at the end of treatment.

CONCLUSIONS

Overall, these results suggest that Galf could be tested as an adjuvant in combination with current anti-parasitic drugs, to restore an efficient immune response against infection in a model of immunosuppressed mice.

[Patentability of living material: public health concerns (1/2)]

A TOPICAL SUBJECT: The patentability of living material provokes debate in the scientific and medical world, but also concerns the political and legal circles. REGARDING PATENTS: Laws govern intellectual property rights and patients. There are contradictory arguments advanced by those who are in favour or who are opposed to patents, and particular problems related to the patenting of living organisms, particularly since the progress made in genomic research. ESSENTIAL PUBLIC HEALTH REQUIREMENTS: It is important to underline the limits imposed by the protection of intellectual property, regarding the access by all to any progress issued from research. The provisions must be widened in order to bypass the patents, when the health and nutrition of populations are at stake. It is essential to come to the universal accessibility, particularly in developing countries, to all innovations and that all knowledge be shared.

[Mandatory disclosure and infectious disease. From "pestilential" disease to "emerging" diseases]

Due to the recent overhaul of the procedure on mandatory disclosure of infectious diseases (law relating to the reinforcement of sanitation quality control established in July 1998, and the May 1999 and May 2001 decrees on the application of this law), wishing to take advantage of this opportunity, the authors propose a chronological review retracing the history of these legal declarations. For over a century, they have represented the main instrument used for intervention and surveillance allowing for the fight against infectious diseases. The health options kept have varied over the years, as well as the precautions taken to respect secrecy (nominative or anonymous disclosure, modalities of transmission...). Procedures adopted to reconcile the principle of confidentiality along with the necessity to protect public health in the case where it would require an immediate and urgent intervention are examined throughout the chronology (determining the source of contamination, prevention of contagion).

[Mandatory notification of HIV infection. Epidemiologic justifications and ethical questioning]

Since the appearance in May 1999 of the two decrees on the application of the law relative to the reinforcement of sanitation quality control established in July 1998, the disclosure of HIV infection "irregardless of the stage" has become mandatory. This is the first time that it is imposed that one must declare a serologic diagnosis, that is to say an infection in the asymptomatic stage. The sensitive nature of all of the information available on AIDS provides an explanation for the numerous contradictory reactions linked to this decision. We attempt to organise the arguments brought forth according to two approaches: 1) the epidemiological arguments that justify the compilation of the precise data thought to be necessary for the follow-up of the disease and for the implementation of well-targeted prevention actions; and 2) the ethical reservations concerning such an imposed measurement, as well as the questions related to anonymity and confidentiality.

Transport theory for a two-flavor color superconductor

QCD with two light-quark flavors at high baryonic density is a color superconductor. The diquark condensate breaks the SU(3) gauge symmetry down to an SU(2) subgroup. We study thermal fluctuations of the superconductor for temperatures below the gap. These are described by a simple transport equation. In the collisionless limit and close to equilibrium, it gives rise to the "hard superconducting loop" effective theory for the SU(2) gauge fields. This theory describes Debye screening and Landau damping of the gauge fields in the presence of the diquark condensate. We explain how our effective theory follows to one-loop order from quantum field theory. Our approach provides a convenient starting point for the computation of transport coefficients of the two-flavor color superconductor.

[The drama of blood contamination in France. An approach to public health]

The tragic HIV contamination of hemophilics and transfusion recipients between 1980 and 1985 in France led to low court proceeding the same events. In addition, last June a state minister was arraigned for not recalling transfused patients before 1985. This involves later events and announces other court actions. France is the only country where these dramatic events have take on the dimension of a major political scandal. Based on the scientific elements (reactions and articles in the international medical literature) and an analysis of the decisions made by France, a chronological examination of the disease and the risks for hemophiliacs and transfusion recipients offers helpful insight into possible options for reducing these risks. The interval between these the court proceeding allows time for further thought focusing on a serious deviation of public health in France.

[Multidrug resistant bacteria in a psychiatric milieu]

Isolation rates of multiple-drug resistant (MDR) bacteria were evaluated retrospectively in a psychiatric care facility. Over the six-year study period, 66 MDR bacterial strains were found. Methicillin-resistant Staphylococcus aureus contributed half of all MDR strains and 31% of all S. aureus strains. Among Pseudomonas aeruginosa strains, 22% were resistant to ticarcillin or imipenem, and among Enterobacteriaceae, 4.1% were MDR strains (production of a derepressed cephalosporinase or of an extended-spectrum beta-lactamase). Although most MDR strains were probably acquired during hospitalizations in short-term care facilities outside our institution, patient-to-patient transmission, either direct or via other individuals, cannot be ruled out. These data indicate that psychiatric care facilities should adopt the MDR strain monitoring strategies already used in other hospitals.

[Anti-hepatitis B vaccination: after the health authorities' decision]

In 1991, the WHO proposed that the antihepatitis B vaccine be included in national vaccination programs. In France, it was decided in 1994 to move on from a selective immunization scheme aimed at high-risk subjects to a general vaccination policy aimed first at adolescents in school and secondly infants. During this period, several cases of demyelinizing diseases after vaccination led to court actions and were magnified in the popular press, interfering with this new vaccination policy. On October 1, 1988, the French Secretary of Health decided to interrupt the school vaccination programs. This decision, taken as a precautionary measure, had some unexpected consequences. As had been feared by the WHO, there was an overall drop in the public's confidence in the vaccine. Health care professionals highly criticized the spectacular nature of the decision and the absence of scientific argumentation. These events lead us to raise a certain number of questions concerning the use of the public press in the management of health information, the notion of medical responsibility, and the rationality of political decisions in public health.

[Research using the human embryo. A timely question]

There has been a considerable amount of debate in Europe on the use of the human embryo in research, a key point in the ongoing examination of bioethics laws. The French Academy of Medicine, the National Consultative Committee on Ethics, the State Council and the Parliamentary Office for the evaluation of scientific and technologic decisions have all made formal statements. An examination of these opinions discloses that there is a critical agreement concerning the Laws of July 1994 and on the requirement for a better text regulating research on the human embryo. It is becoming very clear that an international harmonization will probably not be possible on this point. In this context, where research on the human embryo is authorized in the United States, it is reasonable to expect fundamental discoveries which will be of fundamental importance for all scientific disciplines, emphasizing the need for further thought on our protectionist legal position.

Is the legislation of European states in keeping with the recent convention on human rights and biomedicine?

Abstract

The Convention on Human Rights and Biomedicine, the first legally binding international instrument in the field of bioethics, was adopted in November 1996. In the present paper, following a brief overview of some of the Convention's provisions likely to conflict with national enactments already in effect, we shall attempt, on the basis of the materials available in the International Digest of Health Legislation, to analyse the positions adopted by the different states involved and to identify foreseeable conflicts, focusing on the following four issues: human genome; protection of the embryo; scientific research; and protection of live organ donors.

AIDS talks for adolescents

The authors discuss how to conduct information sessions on AIDS prevention for adolescents on the basis of experience gained in Marseilles secondary schools. Precautionary messages have to be conveyed without encouraging irrational fear and intolerance.

[Mass screening programs for breast cancer in France. Comparative evaluation]

OBJECTIVE

The purpose of this work was to comparatively assess the results of mass screening programs for breast cancer implemented in six French departments in 1986, within the scope of the National Fund for Health Prevention, Education and Information of the National Health Insurance Office of Salaried Workers.

MATERIAL AND METHODS

The data collected by the screening centres were analyzed by ten assessment teams that were independent from the program promotion staff, all using the same evaluation form. A complementary population study performed in eight French districts then, allowed assessing the frequency of self-referred screening (mammography performed out of program).

RESULTS

The rate of participation in screening programs, in relation to the invited population, ranged from 21 to 48%, according to the district (36% in average). This low participation was probably related to the extent of self-referred screening. In fact, 19 to 40% of women, according to the district, had previously had a screening mammographic coverage: rate was around 68% in women aged 50 to 69 years. Positive findings with mammography ranged from 4.5 to 15.8% (10.1% in average), while intervention rates ranged from 0.7 to 1.6% and detection rates from 3.8 to 6.2%. The ratio between benign tumors and cancers ranged from 0.7 to 2.1 according to the district. In order to enlighten the judgement on French results, we propose a comparison with the international standards in force.

CONCLUSION

The various experiences with breast cancer screening in France show that this screening is technically feasible on the basis of existing medical structures. However, some criteria are still below the expected values, especially if compared with international standards. This result is probably accounted for by the high rate self-referred screening before age 40 in France. In these conditions, the question is whether extending breast cancer screening programs in France is an appropriate course of action.

[Risk factors for postmenopausal osteoporosis. Review of the literature 1990-1995]

The steady increase in the prevalence of post-menopausal osteoporosis and the associated rise in mortality make this disease a serious threat to public health. Further research and a consequently greater understanding of the risk factors of this disease should make it possible for preventative strategies to be put into operation. Although the literature relating to these risk factors is particularly abundant, the conclusions are often inconsistent if not contradictory. The present survey aims to review all the data published on the subject over the past five years. When the main classically suspected risk factors are examined separately--age, weight, ethnic factors, family antecedents, physical activity, nutritional factors (e.g. calcium, vitamin D), tobacco smoking, consumption of alcohol or coffee--the results are generally inconclusive and inconsistent from one study to another. Several major multi-risk studies have been attempted to investigate in greater depth the factors associated with fractures, to identify the most important among them and to determine whether their effects are cumulative. Certain authors have examined the predictive value of the detection of these risk factors and the possible use of such signs for the prevention of osteoporosis, since this is the ultimate objective.

Mass screening programs for breast cancer in France--average values of assessment criteria

Breast cancer is the most common cancer in women worldwide. Many studies have been performed worldwide to assess the effectiveness of screening in terms of reduced mortality due to breast cancer. Since the end of 1989, 10 breast cancer mass screening programs using mammography have been carried out in France under the sponsorship of the National Fund for Health Prevention, Education, and Information (FNPEIS) from the National Health Insurance of Salaried Workers (CNAMTS). These 10 campaigns, which are on a district scale, are organized according to variable methods and are assessed using a common procedure. Four groups of criteria are measured in this procedure, which investigates the impact, quality, effectiveness, and costs of screening programs. The average and extreme values of each criterion as calculated from the campaigns are presented in this paper. In order to enlighten the judgment on the French results, a comparison with the international standards in force and with the results of foreign screening programs is proposed.

[Digestive amines of bacterial origin and behavior disorders. Apropos of a case]

Implication of amines in central nervous system diseases such as migraine, Parkinson disease, epilepsy and depressive illness, is well established. On an other hand, intestinal flora is responsible for the production of specific metabolites such as amines, particularly histamine, tyramine, putrescine and cadaverine. These amines can be absorbed in situ and, through unknown mechanisms, may affect the host's behavior. Most of the data about the pathological activities of bacterial amines concern animals. The concentrations of histamine, tyramine, putrescine and cadaverine in the feces of the studied "controls" appeared steady over time. For the patient presenting clastic crisis without any starting factor, variations appear to overcome the "controls" values, with a great variability. At least tyramine, putrescine and cadaverine concentrations variations are striking by superposed and seem associated to the arising hyper agressivity crisis.

Vertical transmission of HIV--a rediscussion of testing

It is worthwhile reconsidering the debate on mandatory or voluntary testing for HIV antibody among women of childbearing age, in the light of recent virological and therapeutic discoveries that have altered the parameters of the issue. The therapeutic possibilities of reducing the risk of transmission for women confirmed as seropositive are an incontestable benefit for anyone who is aware of her serological status; the fact of being able to detect real infection at birth could mean that causing unnecessary distress to the antibody positive but uninfected newborn infant is avoided. Medical professionals now have convincing arguments to persuade women at risk to accept the test when it is offered. But, in any case, the voluntary nature of the decision for testing must be respected.

Cadaver kidney transplantation: ethics and consent

Organ transplantation began to develop soon after the Second World War. The constant progress made in organ transplantation has resulted in an increase in the number of operations carried out. The laws governing transplantation are often drawn up to deal with the de facto situation in a particular country. The study focuses on Guideline 1 adopted by 44th World Health Assembly (resolution WHA 44-25) concerning consent in cadaver kidney transplantation. The discussion of the question of consent is based on a comparative study of the laws regarding kidney transplantation in the countries of what is known as Greater Europe. The points of discussion presented are not offered with a view to advocating a system where soliciting the consent of the family would be considered as ethically necessary. Given the current legal constraints, the presumed consent procedure, with consultation of the family would appear to be more appropriate.

[Phenotypes of resistance to antibiotics of the most frequently isolated strains in five specialized hospital centers. Multicenter study]

Antibiotic susceptibility of 948 bacterial strains isolated from varied samples essentially proceeding from urinary infections in five Paris psychiatric Hospitals was determined by disk diffusion method. E. coli, P. mirabilis, Klebsiella spp., P. aeruginosa et S. aureus are the predominant bacteria. 40% of S. aureus are methicilline resistant. Enterobacteriaceae are progressively becoming resistant to aminopenicillines, but remain sensitive to third generation cephalosporines. They are still susceptible to first generation quinolones. At least, if no resistance of P. aeruginosa to imipeneme has been reported, 30% of strains are resistant to ciprofloxacine. Resistance phenotypes to antibiotics of the strains isolated in patients from psychiatric Hospitals are located between those observed in out patients and in patients from general Hospitals. However, we noticed a worrying evolution of resistance to those encontered in psychiatric Hospitals. Therefore, a multiresistant strains emergence monitoring must be carried out regulary.

Oxidative stress in patients with unstable angina

The aim of this study was to determine whether oxidative stress occurs in unstable angina. Thirty patients with unstable angina class B (Braunwald classification) were prospectively studied. Control groups consisted of 23 patients presenting with stable angina and of 21 age-matched healthy volunteers. Upon admission and every 8 h for 24 h, blood samples were drawn for the determination of plasma malondialdehyde (MDA) levels, Se-glutathione peroxidase (GPX) activity, erythrocyte reduced glutathione (GSH) concentrations, erythrocyte GPX and superoxide dismutase (SOD) activities. Coronary angiograms were performed within 4 days of admission in 26 out of the 30 patients included in the study. Nine of these 30 patients were subsequently identified as presenting a non-Q wave myocardial infarction and were separately examined. On admission, only plasma MDA levels and erythrocyte GSH concentrations differed among groups. Plasma MDA levels of patients presenting with unstable angina (P < 0.01) and acute myocardial infarction (P < 0.05) were higher than those of patients with stable angina and of normal volunteers, whereas there was no difference in these parameters between unstable angina and non-Q wave myocardial infarction groups. Erythrocyte GSH concentration was lower in all patient groups as compared to normal subjects. ANOVA for repeated measures showed no difference between admission and subsequent levels for all parameters. Finally, no difference was observed for any of the parameters when anti-ischaemic or anti-aggregant treatment before admission, or the number of affected vessels on coronary angiograms, were considered. We conclude that an oxidative stress can be evidenced in patients with unstable angina or acute myocardial infarction.

Ethical problems raised by anti-HIV vaccination

At present questions are being asked world-wide about the risk of the AIDS epidemic. The discovery of an anti-HIV vaccine has become an urgent priority, but it also raises a number of sensitive questions. Ethical problems in this field are particularly delicate, since the perspectives of individual health and public health do not seem to coincide. Our research team conducted a review of more than 400 articles on the ethical problems raised by AIDS. We concentrated particularly on the ethical and legal issues raised by research on anti-HIV vaccine. These problems fall into three main categories: therapeutic assays, which must be controlled by a strict agreement defined by international norms; manufacture of the future vaccine, raising legal difficulties which must be faced and solved now; distribution of the vaccine to the population, which should be conducted on a general basis, i.e. it should be offered to all individuals and not only to risk groups.

AIDS, a social dilemma: detection of seropositives

At present, we can observe an evolution in ideas about the detection of HIV seropositivity through a qualitative analysis of specialised literature on the ethical aspects of AIDS. In the case of this disease, systematic screening of the population does not correspond to epidemiological criteria: it is wasteful, troublesome and costly. Whether it is voluntary, and therefore biased, or compulsory, and therefore controversial, systematic screening seems an unlikely option. This situation has prompted many versions of target-group screening, which correspond to two options: systematic screening of known risk-groups, discriminatory, confidential and anonymous; target-group screening linked to particular circumstances: recognised as necessary by blood-donors and well-accepted by pregnant mothers. This method can be institutionalised and applied in the armed forces and in prisons,.... Lastly, we consider measures taken by different countries and organisations.

The ethical approach to AIDS: a bibliographical review

This bibliographical study involved first the exploitation of four data-banks: Medline, CNRS, Bioethics and AIDS, with the following key words (in conjunction with AIDS): ethics, human rights, confidentiality, legislation, jurisprudence. A total of 412 references were listed between 1983 and the end of 1987. Examination of the quantitative increase of articles over these years shows that, while references to AIDS and/or HIV infection--referred to as 'AIDS' for brevity--increased by about one third per year, the number of papers treating ethical problems linked to AIDS doubled each year. This increase makes it clear that these problems are important and pressing, that they are evolving rapidly and can be given no easy solution. After reading and analysis of accessible articles in readily comprehensible languages, the different themes can be classified in two categories: 1: Measures intended to protect society (starting with the most coercive); quarantine and isolation; discriminatory measures concerning specific groups; non-respect of the confidential nature of medical information; application of the penal code; screening; obligatory declaration and registration; testing of blood given by donors; vaccination and medical innovations, therapeutic assays; information, education. 2. Measures intended to protect the individual: fundamental rights of the patient: his/her right to confidentiality, to information and to treatment; civil rights: civil liberty, right to education, right to work, etc...; rights of the healthy individual: right of those in contact with the patients, safety of hospital staff, of those receiving blood-transfusions, etc... The legislation adopted in the various countries and the main opinions to be found in these articles are listed and analysed, and for each particular theme it is possible to refer to a list of the 232 most important articles. While the debate seems to concentrate on the conflict between the right of society to protect itself against the spread of infection and the 'civil' rights of the infected minorities, our conclusion tends to reduce this antagonism, showing that, particularly as far as the confidential nature of medical information is concerned, measures intended to protect the individual also protect society.

No effect of roxithromycin on pharmacokinetic or pharmacodynamic properties of warfarin and its enantiomers

The macrolide antibiotics are metabolized by cytochrome P-450 enzymes in the liver and interactions with similarly metabolized compounds have been described. Simultaneous treatment with erythromycin and warfarin is known to decrease warfarin clearance and prolong prothrombin time. Roxithromycin (RU 28965), a new erythromycin derivative with improved pharmacokinetic properties, might then, because of structure similarity, be expected to interact with warfarin. In 21 healthy volunteers, the effect of orally administered roxithromycin (150 mg b.i.d.) on warfarin steady-state kinetics, and the effects of warfarin on roxithromycin kinetics, were investigated in a double-blind, randomized study versus placebo. Since the warfarin enantiomers, R- and S-warfarin have both different potency and different metabolism, the ratio between the enantiomers with and without roxithromycin, was also determined. In this study, mean AUC for warfarin increased slightly from day 14 of warfarin treatment to day 28, but no difference was found between the roxithromycin group and the placebo group, and no change appeared in the ratio between the warfarin enantiomers. A moderate increase in dosage was needed to maintain hypocoagulability during warfarin medication, but there was no difference between the roxithromycin group and the placebo groups, respectively. In addition, roxithromycin kinetics appeared to be unaffected by warfarin treatment.

Pulmonary disposition of roxithromycin (RU 28965), a new macrolide antibiotic

The penetration of roxithromycin (RU 28965), an ether oxime derivative of erythromycin, into the cells and fluid lining the epithelial surface of the lower respiratory tract was studied by performing fiber-optic bronchoscopy with bronchoalveolar lavage on eight patients who had received roxithromycin at 300 mg perorally every 12 h for 5 days. The apparent volume of epithelial lining fluid recovered by bronchoalveolar lavage was determined by using urea as an endogenous marker. There was a significant relationship (r = 0.75; P less than 0.02) between roxithromycin levels in plasma and epithelial lining fluid, with a correlation whose slope suggested that the level of drug penetration into the lining fluid was 0.2. Concentrations of the antibiotic in cells recovered by bronchoalveolar lavage (21 +/- 10 micrograms/ml) were 2 and 10 times higher than in plasma (11.4 +/- 5.7 micrograms/ml) and epithelial lining fluid (2.0 +/- 1.7 micrograms/ml), respectively. Thus, when administered perorally in humans, roxithromycin is markedly accumulated by resident alveolar macrophages in concentrations largely exceeding the MBCs of the drug for most facultative intracellular pathogens including Legionella pneumophila, despite low concentrations in the epithelial lining fluid.