Mesothelioma Risk Among Maritime Workers According to Job Title: Data From the Italian Mesothelioma Register (ReNaM)

The study describes the 466 cases of malignant mesotheliomas (MM) collected by the National Mesothelioma Register (ReNaM) in Italy in the period 1993-2018 relating to subjects with exclusive asbestos exposure in merchant or military navy. The cases among maritime workers represent 1.8% of the total cases with defined exposure registred in the ReNaM, of which 212 cases (45.4%) among merchant maritime workers and 254 cases (54.5%) among navy. The distribution by site of mesothelioma showed 453 (97.2%) MM cases of the pleura, 11 (2.3%) of the peritoneum and 2 (0.4%) of the tunica vaginalis of the testis. With regard to occupational exposure, it was classified as certain in 318 (68.2%) cases, probable in 69 (14.8%) cases and possible in 79 (16.9%) cases. Among the 23 classified jobs, the highest percentages of certain exposures are among naval engineers, motor mechanics, machine captains and sailors. Machine crew accounted for 49.3% of the cases, deck crew for 27.6%. All cases began exposure on board between 1926 and 1988. Seamen were exposed to asbestos while at sea by virtue of living onboard ships and from continual release of asbestos fibers due to the motion of a vessel. Epidemiological surveillance through the ReNaM has allowed us to verify among cases in the maritime, navy and merchant marine sectors, that in the past, subjects were exposed regardless of the ship's department where have provided service therefore all these cases must be considered as occupational diseases.

Mesothelioma Risk among Construction Workers According to Job Title: Data from the Italian Mesothelioma Register

BACKGROUND

An increased risk of mesothelioma has been reported in various countries for construction workers. The Italian National Mesothelioma Registry, from 1993 to 2018, reported exposure exclusively in the construction sector in 2310 cases. We describe the characteristics of these cases according to job title.

METHODS

We converted into 18 groups the original jobs (N=338) as reported by ISTAT codes ('ATECO 91'). The exposure level was attributed at certain, probable and possible in accordance with the qualitative classification of exposure as reported in the Registry guidelines. Descriptive analysis by jobs highlights the total number of subjects for each single job and certain exposure, in descending order, insulator, plumbing, carpenter, mechanic, bricklayer, electrician, machine operator, plasterer, building contractor, painter and labourer.

RESULTS

The cases grow for plumbing in the incidence periods 1993-2018, while, as expected, it decreases for insulator. Within each period considered the most numerous cases are always among bricklayers and labourers, these data confirm the prevalence of non-specialised "interchangeable" jobs in Italian construction sector in the past.

CONCLUSIONS

Despite the 1992 ban, the construction sector still presents an occupational health prevention challenge, circumstances of exposure to asbestos may still occur due to incomplete compliance with prevention and protection measures.

Night shift work and lymphoma: results from an Italian multicentre case-control study

BACKGROUND

Night shift work can disrupt circadian rhythm and cause chronic sleep deprivation, which might increase the risk of lymphoma through immunosuppression and oxidative stress.

MATERIAL AND METHODS

We investigated the association between night shift work and risk of lymphoma subtypes in 867 incident cases and 774 controls, who participated in a multicentre Italian study between 2011 and 2017. Based on questionnaire information, occupational experts assessed the lifetime probability of night shift work, the total number of night shifts and years of night shift work among study participants. OR and 95% CI for lymphoma and its major subtypes associated with night shift work was calculated with logistic regression, adjusting by age, gender, education, study area, marital status and family history of haemolymphatic cancer.

RESULTS

Ever working night shifts was associated with an increase in the risk of chronic lymphocytic leukaemia (CLL) (OR 1.9, 95% CI 1.14 to 3.32), which was highest after a 15-34 years latency. However, there was not a linear increase in risk by probability of exposure, years of night shift work, nor lifetime number of night shifts whether under rotating or permanent work schedules. Risk of lymphoma overall, B cell lymphoma (BCL), its major subtypes other than CLL, and other less prevalent BCL subtypes combined did not show an association.

CONCLUSIONS

We found conflicting evidence of an association between night shift work and the risk of CLL. We did not observe an association with other lymphoma subtypes.

Occupational exposure to glyphosate and risk of lymphoma:results of an Italian multicenter case-control study

BACKGROUND

The International Agency for Research on Cancer (IARC) recently classified glyphosate, the most used herbicide worldwide, as a probable human carcinogen. We inquired into the association between occupational exposure to glyphosate and risk of lymphoma subtypes in a multicenter case-control study conducted in Italy.

METHODS

The Italian Gene-Environment Interactions in Lymphoma Etiology (ItGxE) study took place in 2011-17 in six Italian centres. Overall, 867 incident lymphoma cases and 774 controls participated in the study. Based on detailed questionnaire information, occupational experts classified duration, confidence, frequency, and intensity of exposure to glyphosate for each study subject. Using unconditional regression analysis, we modelled risk of major lymphoma subtypes associated with exposure to glyphosate adjusted by age, gender, education, and study centre.

RESULTS

Very few study subjects (2.2%) were classified as ever exposed to glyphosate. Risk of follicular lymphoma (FL) was elevated 7-fold in subjects classified as ever exposed to glyphosate with medium-high confidence, 4.5-fold in association with medium-high cumulative exposure level, 12-fold with medium-high exposure intensity, and 6-fold with exposure for 10 days or more per year. Significant upward trends were detected with all the exposure metrics, but duration. The overall p-value for an upward trend with four independent metrics was 1.88 × 10- 4. There was no association with risk of lymphoma (any subtype), Non Hodgkin Lymphoma, B-cell lymphoma, or the major lymphoma subtypes other than FL.

CONCLUSIONS

Our findings provide limited support to the IARC decision to classify glyphosate as Group 2A human carcinogen.

[Experimental measurement of the real reduction (PAR) of seven ear plugs]

The study aimed to evaluate, through the use of the EA-RfitTM Validation System, the real reduction (PAR) for the right ear (AuD), for the left ear (AuS) and biaural reduction related to each of the seven earplugs currently produced by 3M. In addition, we wanted to verify any difference between the aforementioned PARs in consideration of the tendency to predominantly use the right hand (right-handed) or the left hand (left-handed) and in relation to gender. Finally, for each insert and for each subject, an audiometric examination was conducted with the insert worn, to compare the average PAR value obtained by the EA-RfitTM system for each of the seven inserts and for all selected subjects, with the determined abatement curve through the audiometric measurement of the hearing threshold with the insert worn. The use of the E-ARfitTM system for the choice of the ear insert leads to important advantages in the protection of all workers. Moldable acoustic PPE generally proved to be more efficient than non-moldable, so much so that the higher SNRs (provided by the manufacturer), especially when referring to non-moldable inserts, were found to be misleading as to the real personal abatement capacity of the inserts. The average audiometric curves, obtained with the different inserts worn, confirmed that all of them guarantee a higher reduction for high frequencies than for "social" ones.

Biological Monitoring of Exposure to Benzene in Port Workers

Port workers are exposed to a wide range of occupational hazards that can cause injuries and occupational diseases. Among these, exposure to benzene is one of the most important but least studied. The highest occupational exposures for port workers occur during the filling and loading of gasoline, and cleaning of tanks and receptacles. The aim of the study was to evaluate occupational exposure to low levels of benzene by measuring trans,trans-muconic acid (t,t-MA) in urine samples from workers operating at fuelling stations in a tourist port of Southern Italy. The overall sample was composed of 43 port workers of a tourist port in Southern Italy. In 2018, each participant provided two (morning and evening) urine samples for the determination of urinary t,t-MA. Urinary excretion of t,t-MA was always higher at the end of the work shift than at the beginning with significant difference (p = 0.002). In smokers, median t,t-MA urinary excretion is higher than non-smokers both at the beginning (90.5 μg/g creatinine vs. 61.45 μg/g creatinine) and at the end of the work shift (128.2 μg/g creatinine vs. 89.5 μg/g creatinine). Urinary excretion of t,t-MA is higher at the end of the work shift than at the beginning in both smokers and non-smokers, but the difference is significantly higher in non-smokers (p = 0.003) than in smokers (p = 0.05). In conclusion, our results showed that the role of inhaled benzene at fuelling stations in a tourist port can be relevant. On the basis of these results and the known adverse effects of benzene on human health, we encourage the use of personal protective equipment in the fuelling area of ports in order to minimize exposure to benzene to workers.

Nanoparticles: An Experimental Study of Zinc Nanoparticles Toxicity on Marine Crustaceans. General Overview on the Health Implications in Humans

The presence of products containing nanoparticles or nanofibers is rapidly growing. Nanotechnology involves a wide spectrum of industrial fields. There is a lack of information regarding the toxicity of these nanoparticles in aqueous media. The potential acute toxicity of ZnO NPs using two marine crustacean species: the copepod Tigriopus fulvus and the amphypod Corophium insidiosum was evaluated. Acute tests were conducted on adults of T. Fulvus nauplii and C. insidiosum. Both test species were exposed for 96 h to 5 increasing concentrations of ZnO NPs and ZnSO4H2O, and the endpoint was mortality. Statistical analysis revealed that the mean LC50 values of both ZnO NPs and ZnSO4H2O (ZnO NPs: F = 59.42; P < 0.0015; ZnSO4H2O: F = 25.57; P < 0.0015) were significantly lower for Tigriopus fulvus than for Corophium insidiosum. This result confirms that the toxic effect could be mainly attributed to the Zn ions, confirming that the dissolution processes play a crucial role in the toxicity of the ZnO NPs.

Asbestos Air Pollution: Description of a Mesothelioma Cluster Due to Residential Exposure from an Asbestos Cement Factory

The study describes a cluster of 71 malignant mesothelioma cases among Bari residents without asbestos exposure other than residential exposure. This small cohort, as expected, was composed of a majority of females (56.34%) with a M/F ratio of 0.8, ages ≤ 65 years old (52.11%) and the epithelioid morphological type (78.87%). Sixty-four subjects (90.14%) lived between 10 m and 1000 m from the asbestos cement factory (Fibronit), and the latency length was longer than 55 years for 25 subjects (35.21%). The adjusted risk (adjusted OR) of observing the epithelial form of mesothelioma among subjects living at small distances from Fibronit was high (OR = 1.870 (0.353-9.905)) for people living 550-1000 m from the site and for those living less than 550 m from the site (OR = 1.470 (0.262-8.248)). Additionally, the subjects with a high length of exposure showed a relevant risk of epithelioid mesothelioma both for 21-40 years of exposure (OR = 2.027 (0.521-7.890)) and more than 40 years of exposure (OR = 2.879 (0.651-12.736)). All of the estimates were high but not significant because this transitional study has a typically low power. The adjustment for latency showed the same trend. Using detailed information collected by the regional mesothelioma registry, this study provided evidence of a continuing health impact of the Fibronit asbestos cement factory in Bari on the resident population.

Environmental Monitoring of PAHs Exposure, Biomarkers and Vital Status in Coke Oven Workers

A follow-up study of a cohort of workers from a coke plant compared with a control group from the same industrial area was conducted in 2019. The recruitment and environmental and biomarker measurements were performed during 1993/1994. The environmental concentrations of polycyclic aromatic hydrocarbons (PAH), B(a)P, pyrene and nitro-PAH were measured. Personal data were collected via an individual semi-structured questionnaire by a trained physician. All biomarkers were measured after a specific blood drawing for every test. Significant risks (ORs) were observed for nitro-PAH (≥0.12 µg/m³) [OR = 7.96 (1.01–62.82)], urinary 1-hydroxypyrene (1-OHpy) (≥0.99 µmoles/moles of creatinine) [OR = 11.71 (1.47–92.90)], PAH DNA adducts (P³²) (≥2.69 adducts/10⁸ nucleotides) [OR = 5.46 (1.17–25.58)], total nitro-PAH hemoglobin adducts (≥161.68 fg/µg of Hb) [OR = 5.92 (1.26–27.86)], sister chromatid exchange (SCE) with TCR (≥377.84 SCE/cell chromosomes) [OR = 13.06 (3.95–93.10)], sister chromatid exchange with T (≥394.72 total SCE) [OR = 13.06 (3.95–93.10)], and sister chromatid exchange with X (≥8.19 mean SCE) [OR = 13.06 (3.95–93.10)]. Significant risk of death for all causes and chromosomal aberrations (48 h) (OR = 7.19 [1.19–43.44]) or micronuclei in culture at 48 h (OR = 3.86 [1.04–14.38]) were also found.

Healthy Diet and Reduction of Chronic Disease Risks of Night Shift Workers

BACKGROUND

The large increase in epidemiological studies on night shift work is due to the important effects of night shift work on workers' health and psychophysical wellbeing. The short-term effects-insomnia, difficulties in managing work and private life, lower work performance, and more work and extra-work accidents-are easily studied. However, there are several long-term effects that are difficult to study because of the need for detailed exposure assessment and the long latency periods of these diseases.

OBJECTIVE

The aim was to collect epidemiologic evidence of diseases in night shift workers, describing their biological pathways and a set of dietary guidelines.

METHODS

This is a review on diet and health effects in night shift workers.

RESULTS

Significant increases in the rate ratios and hazard ratios of different diseases were associated with modified eating behaviours and poor eating habits among night shift workers. Night shift work is a risk factor for disruption of the circadian rhythms and for some genetic deregulation because it produces the inversion of the sleep/wake cycle and modifies the alternation between activity and rest.

CONCLUSION

A healthy diet and improved dietary practices, together with other factors, can reduce shift workers' chronic disease risk. The literature showed the importance of eating behaviour in order to prevent diseases in these workers; therefore, educational programmes are necessary to encourage several important lifestyle changes. The target of our future research will be the role of food components in some dietetic habits for the prevention of disease in night shift workers.

Malignant mesothelioma in construction workers: the Apulia regional mesothelioma register, Southern Italy

Objective

Asbestos was widely used in construction in both a friable and a compact form until the 1990s, before its use was banned. Today, many of these materials are still in situ and represent a source of risk for construction workers. The objective of the study was to analyse the cases of mesothelioma arising among construction workers registered in the Apulia regional register of mesothelioma.

Results

For the period 1993–2018, there were 178 male cases, and 10.2% of the cases were present in the regional register. The average age at diagnosis was 64.7 years. The site was pleural in 96.06% of cases, with a diagnosis of certainty in 86.5% of the total cases and 61.8% of cases with epithelial histology. The average latency is 43.9 years. In 75.2% of cases, the exposure began between 1941 and 1970, with an average duration of 24.3 years. The age at the start of exposure in 68.5% of cases is between 8 and 20 years. The ORs were 2.5 (C.I. 95% 1.01–6.17) for the epithelioid histotype and the high duration of exposure. The data underline the need for prevention and information on all activities involving construction workers in which asbestos-containing materials are still used.

Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register

BACKGROUND

Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is a rare disease with a poor prognosis. The diagnosis and management of these lesions are often difficult for pathologists, surgeons, oncologists and occupational physicians. A preoperative diagnosis of malignancy is rarely made, and there is no established effective therapy except orchidectomy.

METHODS

A systematic literature review was conducted among the articles published in the English literature on primary MMTVT. Moreover four cases from the Apulia mesothelioma register are reported here.

RESULTS

Two hundred eighty-nine cases of MMTVT have been reported from 1943 to 2018. Overall asbestos exposure has been investigated only for 58% of all cases reported in this review, while in 41.8% this data are not available. Noteworthy is the fact that in many reports there is not an anamnestic reconstruction of any asbestos exposure. A history of direct occupational, environmental or familial asbestos exposure is found in 27.6% of the cases. The four cases from the Apulia mesothelioma register are all with ascertained occupational exposure to asbestos.

CONCLUSIONS

The true incidence of asbestos exposure in MMTVT is underestimated because of insufficient information reported in older literature. To establish a broad consensus on the causal relationship between asbestos and MMTVT in the scientific community its necessary to analyze the same variables in the epidemiological studies. In general it should be recommended that a positive history of exposure to asbestos or to asbestos-containing materials are at risk for the development of a MMTVT and should be monitored.

Estimates of the Lung Cancer Cases Attributable to Radon in Municipalities of Two Apulia Provinces (Italy) and Assessment of Main Exposure Determinants

Indoor radon exposure is responsible for increased incidence of lung cancer in communities. Building construction characteristics, materials, and environmental determinants are associated with increased radon concentration at specific sites. In this study, routine data related to radon measurements available from the Apulia (Italy) Regional Environmental Protection Agency (ARPA) were combined with building and ground characteristics data. An algorithm was created based on the experience of miners and it was able to produce estimates of lung cancer cases attributable to radon in different municipalities with the combined data. In the province of Lecce, the sites with a higher risk of lung cancer are Campi Salentina and Minervino, with 1.18 WLM (working level months) and 1.38 WLM, respectively, corresponding to lung cancer incidence rates of 3.34 and 3.89 per 10 × 10³ inhabitants. The sites in the province of Bari with higher risks of lung cancer are Gravina di Puglia and Locorotondo, measuring 1.89 WLM and 1.22 WLM, respectively, which correspond to an incidence rate of lung cancer of 5.36 and 3.44 per 10 × 10³ inhabitants. The main determinants of radon exposure are whether the buildings were built between 1999 and 2001, were one-room buildings with porous masonry, and were built on soil consisting of pelvis, clayey sand, gravel and conglomerates, calcarenites, and permeable lithotypes.

Environmental asbestos exposure and mesothelioma cases in Bari, Apulia region, southern Italy: a national interest site for land reclamation

Asbestos is an environmental carcinogen, and asbestos-related diseases are a global-scale public health issue. We report three cases (one male and two females) of pleural malignant mesothelioma (PMM) caused by environmental asbestos exposure reported by the Apulia Regional Operating Centre (COR) to the National Mesothelioma Registry (ReNaM). The patients revealed no history of asbestos exposure even after detailed assessment. The environmental (neighborhood) asbestos exposure for each of the three cases was due to both the residential history of the subjects and their workplace, close to a military barracks, at a distance of between 45 and 100 m. Moreover, in addition to this new source of pollution, an asbestos cement factory was located in the urban area of Bari municipality, in the Apulia region, southern Italy. Environmental-residential/neighborhood asbestos exposure in the city of Bari, a contaminated area classified as a site of national concern for land reclamation, is discussed also with reference to the military barracks.

Radon Levels in Indoor Environments of the University Hospital in Bari-Apulia Region Southern Italy

Since 1988, the International Agency for Research on Cancer (IARC) has classified radon among the compounds for which there is scientific evidence of carcinogenicity for humans (group 1). The World Health Organization (WHO) recommends a reference radon level between 100 and 300 Bq/m³ for homes. The objective of this study is to measure the radon concentrations in 401 workplaces, different from the patient rooms, in 28 different buildings of the university hospital in Bari (Apulia region, Southern Italy) to evaluate the exposure of health care workers. Radon environmental sampling is performed over two consecutive six-month periods via the use of passive dosimeters of the CR-39 type. We find an average annual radon concentration expressed as median value of 48.0 Bq/m³ (range 6.5–388.0 Bq/m³) with a significant difference between the two six-month periods (median value: February/July 41.0 Bq/m³ vs. August/January 55.0 Bq/m³). An average concentration of radon lower than the WHO reference level (100 Bq/m³) is detected in 76.1% of monitored environments, while higher than 300 Bq/m³ only in the 0.9%. Most workplaces report radon concentrations within the WHO reference level, therefore, the risk to workers’ health deriving from occupational exposure to radon can be considered to be low. Nevertheless, the goal is to achieve near-zero exposures to protect workers’ health.

Risk of lymphoma subtypes by occupational exposure in Southern Italy

Background

Occupational exposure is known to play a role in the aetiology of lymphomas. The aim of the present work was to explore the occupational risk of the major B-cell lymphoma subtypes using a case–control study design.

Methods

From 2009 to 2014, we recruited 158 lymphoma cases and 76 controls in the provinces of Bari and Taranto (Apulia, Southern Italy). A retrospective assessment of occupational exposure based on complete work histories and the Carcinogen Exposure (CAREX) job-exposure matrix was performed.

Results

After adjusting for major confounding factors, farmers showed an increased risk of diffuse large B-cell lymphoma (DLBCL) [odds ratio (OR) = 10.9 (2.3–51.6)] and multiple myeloma (MM) [OR = 16.5 (1.4–195.7)]; exposure to the fungicide Captafol was significantly associated with risk of non-Hodgkin lymphoma (NHL) [OR = 2.6 (1.1–8.2)], particularly with the risk of DLBCL [OR = 5.3 (1.6–17.3)].

Conclusions

Agricultural activity seems to be a risk factor for developing lymphoma subtypes, particularly DLBCL, in the provinces of Bari and Taranto (Apulia Region, Southern Italy). Exposure to the pesticides Captafol, Paraquat and Radon might be implicated.

Trial registration

Protocol number UNIBA 2207WEJLZB_004 registered 22/09/2008.

Activation of the aryl hydrocarbon receptor and risk of lymphoma subtypes

The aryl hydrocarbon receptor (AhR) is a transcription factor implicated in several pathways known to be relevant in lymphomagenesis. Aim of our study was to explore the link between AhR activation and risk of lymphoma subtypes. We used a Dual-Luciferase Assay® and a luminometer to detect the activation of the luciferase gene, in HepG2 cells transfected with a specific reporter systems, by a 50 ml serum aliquot of cases of diffuse large B cell lymphoma (N = 108), follicular lymphoma (N = 85), chronic lymphocytic leukemia (N = 72), multiple myeloma (N = 80), and Hodgkin lymphoma (N = 94) and 357 controls who participated in the multicentre Italian study on gene-environment interactions in lymphoma etiology (ItGxE). Risk of each lymphoma subtype associated with AhR activation was calculated with polytomous logistic regression adjusting by age, gender, and study centre. The overall prevalence of AhR activation ranged 13.9-23.6% by subtype, and it varied by study area (8-39%). Risk associated with AhR activation was moderately elevated for follicular lymphoma (OR = 1.56, 95% CI 0.86, 2.80) and chronic lymphocytic leukemia (OR = 1.56, 95% CI 0.83, 2.96). Despite our inconclusive findings about the association with risk of lymphoma subtypes, we showed that the Dual-Luciferase Assay can be reliably and easily applied in population-based studies to detect AhR activation.

Assessment of environmental and occupational exposure to heavy metals in Taranto and other provinces of Southern Italy by means of scalp hair analysis

The monitoring of heavy metals in industrialized areas to study their association with different occupational and environmental factors is carried out in different ways. In this study, scalp hair analysis was used for the assessment of exposure to these metals in the industrial city of Taranto, characterized by a severe environmental pollution. The highest median values were observed for aluminum, barium, cadmium, lead, mercury, and uranium. Moreover, in the industrial area of Taranto, high levels of barium, cadmium, lead, mercury, nickel, and silver were observed in comparison with other Apulia areas. The risk odds ratios (ORs) for observing values above the 50th percentile were elevated for mercury and fish consumption, uranium and milk consumption, lead and female sex, and aluminum and mineral water consumption. No significant increased risk was observed for occupational activities. In a dendrogram of a cluster analysis, three clusters were observed for the different areas of Taranto (Borgo, San Vito, and Statte). A scree plot and score variables plot underline the presence of two principal components: the first regarding antimony, lead, tin, aluminum and silver; the second regarding mercury and uranium. The observed clusters (Borgo, San Vito, and Statte) showed that lead, antimony, tin, aluminum, and silver were the main component. The highest values above the 50th percentile of these minerals, especially lead, were observed in the Borgo area. The observed metal concentration in the Borgo area is compatible with the presence in Taranto of a military dockyard and a reported increase of lung cancer risk among residents of that area.

Urine chemokines: biomarkers of human lupus nephritis?

Lupus nephritis is characterized by intrarenal inflammation. Leukocytes trafficking from peripheral blood into affected tissues spaces represent an important factor in the development of many renal diseases. During the past few years has been attributed the crucial role of a family of chemotactic cytokines--the chemokines--in this process. In the course of renal diseases, the infiltration of monocytes/macrophages and T cells into kidneys represent an important role in progressive interstitial fibrosis and the progression of chronic renal failure. In this review, we summarize the in vitro and in vivo data on chemokines and chemokine receptors in kidney diseases, with a special focus on urine chemokine measurement as possible biomarker of human lupus nephritis.

Anti-lactoferrin antibodies in systemic lupus erythematosus: isotypes and clinical correlates

Lactoferrin (LF) is a multifunctional iron-binding protein present in several mucosal secretions as well as in secondary granules of polymorphonuclear leukocytes (PMN). Anti-LF antibodies, which belong to antineutrophil cytoplasmic antibodies (ANCA), have been described in several immunomediated diseases, including systemic lupus erythematosus (SLE), with conflicting results regarding either their prevalence or clinical associations. We studied the prevalence and isotype distribution of anti-LF and their association with clinical manifestations, disease activity, and other autoantibodies in 97 patients (83 women) affected by SLE. Anti-LF were detected by enzyme-linked immunosorbent assay. Disease activity was assessed using the Systemic Lupus Activity Measure (SLAM). Cutoff for antibody positivity was set at three standard deviations (SD) above the mean optical density obtained in sera from 34 healthy subjects. Positive sera were arbitrarily subdivided into low (from >3 to 5 SD), medium (from >5 to 10 SD), and high (>10 SD) positive. IgG, IgM, and IgA anti-LF were detected in 53, 18, and 14 patients, respectively. IgG1, IgG2, IgG3, and IgG4 anti-LF were demonstrated in 34, 10, 31, and 35 patients, respectively. IgG anti-LF at the medium/high level were found in 33 patients, correlated with disease activity (p = 0.017), anti-dsDNA (0.04), and anticardiolipin antibodies (p = 0.02) and were associated with Raynaud's phenomenon (p = 0.028), renal involvement (p = 0.007), serositis (p = 0.026), and history of thrombosis (p = 0.006). Anti-LF of IgM, IgA, or IgG subclass isotypes showed no correlation with clinical and serological findings. Our results demonstrate that anti-LF are frequently present in patients affected by SLE. IgG anti-LF at the medium/high level are associated with some clinical manifestations and other autoantibodies. However, it remains to be established whether anti-LF play a specific pathogenic role.

Neuropsychiatric lupus syndromes: relationship with antiphospholipid antibodies

The authors assessed the prevalence of neuropsychiatric manifestations occurring in patients with systemic lupus erythematosus (NPSLE), according to the American College of Rheumatology standardized definitions for NPSLE, and evaluated the relationship between NPSLE and antiphospholipid antibodies. Sixty-one consecutive SLE patients were studied. Neuropsychiatric manifestations consistent with the diagnosis of NPSLE occurred in 44 (72%). Patients with NPSLE showed significantly higher levels of anticardiolipin antibodies.

[Exposure to PAHs, urinary 1-pyrenol and DNA adducts in samples from a population living at different distances from a steel plant]

This study aims at measuring association between environmental exposure to PAHs and internal or biologically effective dose biomarkers among 212 individuals living at different distance from the industrial area of Taranto, Italy. Environmental PAH exposure was determined by area monitoring. PAH levels was measured by HPLC UV/FL. Urinary 1-hydroxypyrene levels were measured by HPLC/Fluorescence. The levels of DNA adducts were determined by 32P. post-labelling. A questionnaire was administered to gather personal data, residence, occupational history, alcohol, tobacco smoke, and diet, to control for other sources of exposure to PAH. Blood and urinary samples, drawn from the subjects studied were collected and analysed. A multivariate regression model was used to investigate the influence of several confounding factors. Housing was placed within 1 km from smokestacks in Taranto and Statte, whereas they were more far away in Locorotondo and in Alberobello. The prevalence of current smokers was 31.6%.

[Molecular epidemiology in occupational medicine: methodological features and impact of individual genetic susceptibility]

A review of main methodological questions regarding biomarkers is reported focusing on validation, laboratory variability, study design and statistical analysis. The indicated perspective is the setup of protocols finalized at the study of multiple panels of genotoxicity biomarkers taking into account the influence of gene-environment interaction at low doses, of the modulation of the biomarkers associated to the genetic polymorphism. An overview on the influence of metabolic and DNA repair polymorphisms on biological indicators of genotoxic risk in occupational, environmental or life-style exposure is also presented. Genetic polymorphisms that influence human genotoxic risk are those of glutathione s-transferase and cytochrome P450 in exposure to polycyclic aromatic hydrocarbons (PAHs), those of N-acetyltransferase in both occupational and environmental exposures to aromatic amines (AAs) and similar compounds. Lastly recent and important studies, on the effect of the newly discovered polymorphisms affecting DNA repair enzymes on the modulation of genotoxic risk linked to life style (i.e., aflatoxin and PAHs from diet) and smoking behaviour and to environmental genotoxic exposure, are reported. To date biomarkers represent a new tool for epidemiological research in occupational medicine and they could represent a valid instrument for group evaluation but they are not useful for the risk assessment on individual basis. To achieve this objective it is necessary to demonstrate a stronger association with the endpoint that perhaps the future development of genetic and molecular epidemiology will make possible.

Expression of lactoferrin on neutrophil granulocytes from synovial fluid and peripheral blood of patients with rheumatoid arthritis

OBJECTIVE

To analyze lactoferrin expression on synovial fluid (SF) and peripheral blood neutrophils of patients with rheumatoid arthritis (RA) and to compare it with the lactoferrin expression on neutrophils from patients with osteoarthritis (OA).

METHODS

Paired samples of peripheral blood and SF were obtained from 14 patients with RA and 9 patients with OA. Lactoferrin expression was evaluated on cell surfaces by cytofluorimetric analysis utilizing both polyclonal antibodies and the monoclonal anti-lactoferrin antibody AGM 2.29. Data are presented as mean fluorescence intensity.

RESULTS

In patients with RA, the expression of membrane lactoferrin was significantly increased on SF neutrophils in comparison with those in peripheral blood. This increase was found using both polyclonal antibodies and AGM 2.29 (p = 0.0001, p = 0.0017, respectively). In patients with OA, the difference was not significant. In addition, lactoferrin expression on SF neutrophils of patients with RA was significantly increased compared with that found on SF neutrophils of patients with OA (polyclonal antibodies, p = 0.0015; AGM 2.29, p = 0.005). In patients with RA, no correlation was found between lactoferrin expression and disease activity.

CONCLUSION

Our results provide evidence for an activation of neutrophil granulocytes at site of inflammation in RA and indicate that lactoferrin surface expression represents a reliable neutrophil activation marker.

Anti-neutrophil cytoplasmic antibodies in echinococcus granulosus hydatid disease

The authors studied the presence of ANCA, evaluated by indirect immunofluorescence (IIF) and ELISA for anti-lactoferrin (LF), and anti-myeloperoxidase antibodies (anti-MPO), in sera of 69 patients with cystic echinococcosis (CE). According to Caremani's classification, 27 patients were considered to have active cysts and 42 patients were considered to have inactive cysts. ANCA were detected in 9 out of 27 patients (33.3%) with active cysts and in 3 out of 42 patients (7.1%) with inactive cysts. Differences between the two groups were statistically significant (P < 0.05). Anti-LF antibodies were found in seven patients (10.14%) and anti-MPO antibodies in ten patients (14.5%).

Assessment of echocardiographic abnormalities in patients with systemic lupus erythematosus: correlation with levels of antiphospholipid antibodies

BACKGROUND

The aim of this study was to evaluate the incidence of morphologic and functional cardiac abnormalities in patients with systemic lupus erythematosus and correlate the data with antiphospholipid antibody (aPL) levels.

METHODS

Ninety-one patients with systemic lupus erythematosus were enrolled and divided into two groups according to the presence (Group 1, n = 45) or absence of aPL (Group 2, n = 46). All patients underwent standard two-dimensional and Doppler echocardiographic examination. aPL were detected by a standardized and validated ELISA test. Five patients with regional ventricular dysfunction also underwent coronary angiography. The chi2 test was used for the statistical analysis of the data. For smaller groups of samples the Fisher's exact test was employed.

RESULTS

Pericardial effusion was detected in 19 patients without any statistical difference between the two groups. A valvular involvement was present in 39 patients: a moderate-severe degree was more frequent in Group 1 (p = 0.02). Regional wall motion abnormalities were observed in 8 patients: only 1 in Group 2 and 7 in Group 1 (p = 0.03). Coronary angiography showed normal arteries in all patients of Group 1.

CONCLUSIONS

aPL play a role in the pathogenesis of the severity of valvular lesions as well as in regional myocardial dysfunction, suggesting a small vessel disease.

The influence of cytochrome P450 1A1 and glutathione S-transferase M1 genotypes on biomarker levels in coke-oven workers

The present study has the aim of evaluating gene-environment interaction on the levels of different biomarkers in coke-oven workers exposed to PAH. In order to assess whether the levels of some biomarkers (PAH-DNA adducts, nitro-PAH adducts to Hb and MN frequency) could be modulated by the genetic metabolic polymorphisms for CYP1A1 and GSTM1, we analysed in 76 coke-oven workers and 18 controls the CYP1A1 (MspI and Ile/Val sites) and the GSTM1 genotypes by a PCR assay. In individuals with shared setup of CYP1A1 or GSTM1 genotypes, we analysed how the specified biomarkers correlated with total PAH exposure (urinary levels of 1-hydroxypyrene) both by a stratified analysis and logistic regression modelling. Statistically significant (P = 0.03 and P = 0.01) higher percentages of the more susceptible GSTM1- subjects compared to the GSTM1+ subjects and of the more susceptible CYP1A1 Ile/Val individuals compared to the CYP1A1 Ile/Ile individuals were detected for high levels of PAH-DNA adducts in the high exposure group (namely high levels of 1-OHP). A statistically significant association was observed between increased PAH-DNA adduct levels and the more susceptible GSTM1- genotype (P.O.R. = 4.18, P = 0.03) in a logistic regression modelling and a significant interaction between PAH exposure and GSTM1-genotype was found for PAH-DNA adducts. No effect of these metabolic genotypes was observed for MN frequency and nitro-PAH adducts to Hb. In conclusion, a gene-environment interaction between PAH exposure and two metabolic genotypes involved in activation (CYP1A1) and detoxification (GSTM1) of PAHs, respectively, has been identified.

Neurological involvement in antiphospholipid antibodies syndrome (APS)

Antiphospholipid antibodies (aPL) have been most strongly associated with a syndrome (APS) characterized by venous and/or arterial thrombosis, thrombocytopenia, recurrent fetal losses and a variety of non-thrombotic and thrombotic neurological disorders. Cerebral ischemia associated with aPL is the most common arterial thrombotic manifestation. Other neurological syndromes, such as cognitive dysfunction, dementia, psychosis, depression, seizures, chorea and transverse myelopathy, have all been associated with antiphospholipid antibodies.

Increased levels of lactoferrin in synovial fluid but not in serum from patients with rheumatoid arthritis

Lactoferrin is a multifunctional immunoregulatory protein, stored in specific granules of neutrophil granulocytes, from which it is released following cell activation. As activated neutrophils play a crucial role in the destruction of synovial joints in rheumatoid arthritis, we evaluated lactoferrin concentration in synovial fluid and sera from 21 patients with rheumatoid arthritis and 11 patients with osteoarthritis. We also measured lactoferrin levels in sera from 12 healthy controls. Lactoferrin was measured by a solid-phase inhibition immunoassay. Median lactoferrin levels were significantly higher in synovial fluid from rheumatoid arthritis than from osteoarthritis patients (P = 0.0002). In contrast, no significant difference was found between serum lactoferrin from patients with rheumatoid arthritis or osteoarthritis compared with normal controls. In patients with rheumatoid arthritis, lactoferrin concentrations were higher in synovial fluid than in sera (P = 0.036). In both rheumatoid arthritis and osteoarthritis no correlation was found between serum and synovial fluid lactoferrin (P = 0.51 and P = 0.5, respectively). In synovial fluid from patients with rheumatoid arthritis, lactoferrin concentrations correlated with neutrophil granulocyte count (P < 0.0001), but neither serum nor synovial lactoferrin levels correlated with disease activity (P = 0.32 and P = 0.25, respectively). In conclusion, lactoferrin is a reliable marker of neutrophil activation at sites of inflammation in rheumatoid synovitis, but does not represent a marker of disease activity.

Pathophysiology, clinical features and management of hepatorenal syndrome

Hepatorenal syndrome (HRS) is a form of functional renal failure occurring in patients with advanced liver disease. Hypoperfusion of the kidney, due to renal vasoconstriction, is the main feature of HRS. Conversely, the extrarenal circulation is characterized by low systemic resistance, especially occurring in splanchnic vessels, and arterial hypotension. It has been postulated that renal vasoconstriction is induced either by a hepatorenal reflex related to the diseased liver or by arterial vasodilation and the subsequent baroreceptor-mediator activation of systemic vasoconstrictor factors. The diagnosis of HRS requires the exclusion of other causes of renal failure in patients with liver disease. On the basis of clinical and prognostic differences, two types of HRS have been defined. The prognosis of HRS is poor and, to date, the only effective treatment is the liver transplantation.

Methimazole treatment in Graves' disease: behaviour of CD5+B lymphocytes and regulatory T cell subsets

In the present study we analyzed some circulating lymphocyte subsets in eleven patients affected by Graves' disease before and after three and six months of methimazole treatment. Peripheral blood mononuclear cells were studied by a panel of monoclonal antibodies with single and double fluorescence cytometric analysis. Our results demonstrated an increased percentage of CD5+B cells and HLADR+T lymphocytes at the beginning of the disease in comparison to the normal controls (p < 0.001), and a significant decrease after six months of treatment (p < 0.01 and p < 0.05, respectively). The CD4+ CD45RA+ subset was significantly reduced in untreated Graves' patients in comparison to the normal group (p < 0.01), and increased towards normalization after six months of treatment. The significant modifications of lymphocyte subsets, as well as the reduction of thyroid autoantibodies, support a direct or mediated effect of methimazole on the immune system.

Coexpression of CD69 and HLADR activation markers on synovial fluid T lymphocytes of patients affected by rheumatoid arthritis: a three-colour cytometric analysis

The aim of the present study was to evaluate the coexpression of very early (CD69), early (CD25) and late (HLADR) antigens and to analyse the mean fluorescence intensity (MFI) of such activation markers on synovial fluid (SF) and peripheral blood (PB) lymphocytes of patients affected by rheumatoid arthritis (RA) and other types of chronic synovitis (OCS). A three colour cytometric analysis was performed using a peridinin chlorophyll protein conjugated anti-CD3 antibody in combination with fluorescein isothiocyanate or phycoerythrin labelled anti-CD69, anti-HLADR, anti-CD25 monoclonal antibodies (mAbs). A T cell gating method was utilized, so that three sets of bivariant dot plot quadrant displays were obtained (CD69/HLADR, CD69/CD25, CD25/HLADR). A large percentage of SF T lymphocytes in RA showed the coexpression of very early and late activation antigens (CD3 + CD69 + HLADR +), whereas CD3 + CD69 + CD25 + bearing cells and CD3 + CD25 + HLADR + lymphocytes were only a small percentage. Similar results were obtained in patients with OCS, although to a lesser extent. No statistically significant differences in MFI of CD69 and HLADR positive SF T cells between RA and OCS were observed. The CD69 + CD25-HLADR + T cell subset is the most commonly represented in the synovial environment, among those we have evaluated; this phenotype may be characteristic of chronic inflammatory arthritis.

Expression of lactoferrin on human granulocytes: analysis with polyclonal and monoclonal antibodies

Lactoferrin (LF), an iron-binding protein present in specific granules of neutrophils, is expressed on membrane after granulocyte activation. It may represent a target for anti-neutrophil cytoplasmic antibodies (ANCA) in patients affected by some immunomediated diseases. We recently produced two MoAbs, AGM 2.29 and AGM 10.14, that recognize two spatially distant epitopes of human LF. In this study we perform a cytometric analysis in order to evaluate the expression of LF on the surface of granulocytes obtained from freshly drawn blood or after purification, in both the presence and absence of stimuli. Our results demonstrate that LF is not constitutively expressed on membrane of circulating neutrophils. After priming with phorbol myristate acetate (PMA) or tumour necrosis factor-alpha (TNF-alpha), an increased mean fluorescence intensity (MFI) was obtained on neutrophils stained with polyclonal anti-LF antibodies and with AGM 2.29. The kinetics of LF expression during activation demonstrated a progressive increase in MFI within 45 min. No increase in MFI was documented when primed granulocytes were stained with MoAb AGM 10.14, thus indicating that the epitope recognized by AGM 10.14 is not exposed at the cell surface. Following membrane permeabilization, performed in order to analyse the binding of anti-LF MoAbs to cytoplasmic LF, a marked increase in MFI was obtained by staining granulocytes with both anti-LF MoAbs. Indirect immunofluorescence (IIF) analysis confirmed that AGM 2.29 and AGM 10.14 reacted with human granulocytes, showing a cytoplasmic pattern on formalin-acetone-fixed neutrophils and a perinuclear one on ethanol-fixed cells.

Anti-TNF-alpha antibodies are not associated with Helicobacter pylori induced gastritis

Over the past few years, it has been suggested that increased gastric production of some cytokines, including tumor factor-alpha (TNF-alpha), play a crucial role in the pathogenesis of H. pylori associated gastroduodenal diseases. On the other hand, it has been postulated that the presence of autoantibodies directed against several cytokines could represent or a down-regulatory response of the host to limit the damage associated with chronic bacterial infection or a specific cytokine inhibitor. The aim of this study was to evaluate whether serum anti-TNF-alpha antibodies are produced in response to H. pylori infection. The anti-TNF-alpha antibody titer among H. pylori positive and H. pylori negative patients showed no statistically significant difference. Interestingly, after eradication of H. pylori, no significant modification in anti-TNF-alpha antibody levels was found. In H. pylori positive patients, no correlations (either positive or negative) was demonstrated between anti-TNF-alpha antibody and activity of gastritis, nor between these antibodies levels and presence of duodenal ulcer. The lack of correlation between anti-TNF-alpha antibody levels and activity of gastritis indicates that these autoantibodies do not affect the clinical course of the H. pylori associated gastroduodenal diseases. Therefore, the biological and clinical relevance (if any) of anti-TNF-alpha antibodies in H. pylori associated gastritis remains to be better elucidated.

CD5 B cells in autoimmune and non immune-mediated thyroid dysfunctions

In a previous study we demonstrated a significant increase of CD5+ B subset in patients with Graves' disease (GD) compared with normal controls. The aim of this study was to compare the percentage of CD5+ B and CD5- B cells in GD with that in different forms of autoimmune and non immune-mediated thyroid diseases. Seventy-two patients were studied: 28 patients with GD, 20 with silent thyroiditis (ST), 12 with Hashimoto's disease (HD), and 12 subjects affected by hyperthyroidism due to toxic adenoma (TA). Eleven out of 28 patients with GD were also evaluated after six months of methimazole treatment. The study was performed by cytometric analysis. In GD the percentage and the absolute number of CD5+ B cells were significantly increased compared with normal controls (42.5 +/- 18.2% versus 19 +/- 6.3%, p < 0.0001; 142 +/- 153.3/cmm versus 46.9 +/- 22/cmm, p < 0.003, respectively. CD5+ B cells tended to normalise after six months of treatment. In ST the percentage of CD5+ B cells was increased (28.6 +/- 10.2%); conversely the absolute number was in the normal range. Patients affected by HD did not show any significant modification in B cells and their subsets in comparison with controls. In TA, CD5+ B were 7.6 /- 4.4% and 14.3 /- 10.9/cmm. Our results demonstrated a marked increase in both percentage and absolute number of CD5+ cells, only in active GD. The expansion of CD5+ B cells could play a role in the immune imbalance present in this disease.

Long-term treatment of systemic lupus erythematosus with cyclosporin A

OBJECTIVE

To evaluate the efficacy of long-term treatment with cyclosporin A (CSA) in systemic lupus erythematosus (SLE).

METHODS

Thirty patients with SLE whose condition was either poorly responsive or unresponsive to treatment with steroids and/or cytotoxic drugs were enrolled in a prospective, nonrandomized study of CSA. Patients with hypertension or hypercreatinemia were excluded. Disease activity was evaluated according to the systemic lupus activity measure. Assessments were made prior to study entry and after 6, 12, 18, and 24 months.

RESULTS

Twenty-seven patients completed at least 24 months of treatment with CSA. The mean disease activity score significantly decreased after 6 months of therapy (P < 0.01); this result was maintained throughout the study. A conspicuous steroid-sparing effect was observed following administration of CSA (P < 0.01). Side effects included hypertrichosis (63% of patients), paresthesias (23%), gastrointestinal symptoms (20%), gingival hyperplasia (17%), hypertension (10%), tremors (7%), and nephrotoxicity (13%). No significant changes in serum creatinine levels were observed.

CONCLUSION

CSA represents a helpful second-choice treatment for patients with active SLE. Administration of CSA necessitates expert and careful followup of patients.

Two spatially distant epitopes of human lactoferrin

Lactoferrin (LF) is an iron binding protein, which may represent a target for antineutrophil cytoplasmic antibodies (ANCA) in patients affected by rheumatoid arthritis, ulcerative colitis, and primary sclerosing cholangitis. Here we describe the production and characterization of two new monoclonal antibodies (MAbs) against human LF. These MAbs (AGM 10.14, an IgG1, and AGM 2.29, an IgG2b) recognize spatially distant epitopes of LF as assessed by cross-blocking experiments. We also demonstrated by indirect immunofluorescence that both MAbs react with ethanol-fixed neutrophil granulocytes showing a perinuclear staining pattern. AGM 2.29 and AGM 10.14 have been utilized as capture and labeled tracer antibody, respectively, in a double determinant immunoassay (DDIA) to measure soluble LF. The results obtained show that this DDIA allows us to quantify even low concentrations of LF, the maximal range of the assay sensitivity being between 12 and 780 ng/ml. Therefore, AGM 10.14 and AGM 2.29 may represent useful reagents for studying the role of autoantibodies to LF as well as for measuring soluble LF, which is a reliable secretory marker of neutrophil activation.

Hypertension and menopausal syndrome: effects of hormone replacement therapy and antihypertensive drugs

Arterial hypertension is a common finding in climacteric women even though the role of reduced estrogen levels in promoting this condition remains unclear. The purpose of the present survey was to evaluate the effects of hormone replacement therapy in hypertensive postmenopausal women. 180 patients were studied; they had been postmenopausal for 12-18 months and afflicted with mild or moderate essential arterial hypertension for less than 2 years. Patients were randomly divided into two groups and treated with progestin-estrogen therapy (group I, 96 patients) or with antihypertensive drugs (group II, 84 patients). Fourty-one cases in group I (42.7%) responded adequately to hormone therapy with persistent normalization of blood pressure levels; antihypertensive drugs were effective in 61 patients in group II (72.5%). The 23 unresponsive patients in group II were subsequently treated with progestin-estrogen therapy and a normalization of pressure values was achieved in 10 of these (43.5%). These results suggest that hormonal treatment determines, in at least one third of the cases, a significant reduction in blood pressure values. Moreover, hormone replacement may be effective even in patients that have not responded to antihypertensive drugs.

Hypertension and CHD: evidence of glucose and lipid metabolism involvement

Three hundred and seventy subjects (217 women and 153 men) affected by essential hypertension of moderate or severe degree were studied. Their age ranged from 28 to 57 years, with a mean of 47 years. 251 patients had a normal electrocardiogram (ECG) and 119 patients an abnormal ECG: 78 with T wave abnormalities, 4 with Q-S segment abnormalities, 9 with left bundle branch block and 28 with left ventricular hypertrophy. Control group was composed by 45 non hypertensive subjects matched for age and sex. Glucose and insulin concentrations, before and after the oral glucose intake, were higher in patients with essential hypertension than in control group. The hypertensive patients with abnormal ECG were found to have higher plasma insulin response, high triglyceride plasma levels, total cholesterol and LDL cholesterol concentrations, associated with a significant increase in the total cholesterol/HDL cholesterol ratio.

[Increased plasma levels of endothelin in patints with essential arterial hypertension]

Endothelin-1 (ET-1) is an endothelium-derived vasoconstrictive peptide. In this study the Authors measured in 25 subjects (15 with essential hypertension and 10 normal) plasma levels of endothelin-1. Patients with hypertension had significantly higher plasma ET-1 concentration than normal subjects (2.18 +/- 1.07 vs. 1.36 +/- 0.40 pg/ml, p < 0.02). Plasma arginine vasopressin, renin activity and aldosterone concentration did not show significant differences between hypertensive and normotensive subjects. These data suggest that ET-1 may be involved in the development or maintenance of hypertension.

Antineutrophil cytoplasmic antibodies in synovial fluid and in serum of patients with rheumatoid arthritis and other types of synovitis

OBJECTIVE

Antineutrophil cytoplasmic antibodies (ANCA) are present in several vasculitides and in other immunomediated diseases. The reported prevalence of ANCA in rheumatoid arthritis (RA) is variable. In addition, the presence of such autoantibodies has been poorly investigated in synovial fluid (SF). The objectives of this study were (1) to investigate the presence of ANCA both in the serum and in SF from patients with RA and other forms of synovitis (OS); (2) to analyze the reactivity of ANCA against isolated antigens proteinase 3 (PR3), myeloperoxidase (MPO) and lactoferrin (LF); and (3) to evaluate the clinical relevance of these autoantibodies.

METHODS

Twenty-eight patients with RA, 13 with OS, and 17 with osteoarthritis (OA) of the knee joint were studied. No patient had clinical manifestations of vasculitis. SF and serum samples were investigated for the presence of ANCA by indirect immunofluorescence (IIF); the reactivity against PR3, MPO and LF was assessed by ELISA.

RESULTS

ANCA were detected by IIF in SF of 39.3% patients with RA, 38.5% with OS, and 5.9% with OA. With 2 exceptions, patients who had ANCA in SF showed positivity also in serum. The presence of both anti-MPO and anti-LF antibodies was found in 3 patients with RA and 1 with OA; a patient with RA showed antibodies only against LF and another one with RA only against MPO. No reactivity was found against PR3. In patients with RA ANCA were not associated with disease activity.

CONCLUSION

We found an increased incidence of ANCA both in SF and serum from patients with RA and OS. The pathogenic role and the clinical relevance of such autoantibodies in these diseases remain to be established.

[Immunopathogenic mechanisms in glomerulonephritis]

In this note the involvement of the immune system in glomerular injury is discussed: humoral and cell-mediated immune response, and soluble mediators of inflammation play an important role in the development of tissue injury. Clinical and experimental studies are in progress to better define the different pathogenic mechanisms involved in glomerular diseases and to give us new therapeutic approaches.

[Tumors of the hemolymphopoietic tract and employment in agriculture: a case-control study carried out in an epidemiologic area in southern Italy]

To evaluate the role of agricultural exposures in the development of lymphatic and haemopoietic tumors a population-based case-referent study has been carried out in three health districts of Southern Italy. All incident cases of leukemia, lymphoma and myeloma from 1 July 1987 to 30 June 1989, aged 14 years or more, have been identified (71 subjects). The control group is formed by subjects with other neoplasms. A Job Exposure Matrix, specific to 10 areas, to 6 major crops and to 4 calendar periods, was built for assessing pesticide exposure. To date 100 interviews (to the index subject or to proxies) have been carried out (26 cases and 74 referents). The odds ratio (OR) of hematologic malignancies for agricultural workers was 1.63 [95% Confidence Intervals (95% CI): 0.69-4.34] in the whole sample and 6.00 (95% CI: 1.21-25.52) in the female group. Significative increased risks have been observed for exposure to DDT and creolin (OR = 4.11; 95% CI: 1.16-14.55) and, for leukemia, for cattle breeders (OR = 6.38; 95% CI: 1.46-27.83).

[Concentration of asbestos fibers in urothelial tumors and in the neoplasm-free bladder wall]

The aim of our study was to search the eventual presence of asbestos fibers in the neoplastic tissue of 13 cases of bladder carcinoma and in the normal vesical tissue of 12 control cases without neoplasia and operated upon for other urologic pathologies. To all patients a standardised questionnaire has been administered in order to ascertain the entity of the eventual exposition to asbestos. The organic component of the tissues has been oxidated at low temperature in atomic oxygen plasma and the residual inorganic component has been analysed by transmission electronic microscopy and energy dispersion spectrometry. We have found asbestos fibers only in two over the 25 examined samples; in both cases they belonged to patients affected by the neoplasia and in one of them also by pulmonary asbestos. The procedures that we used in this study, in respect to our other experiences, allowed us to reduce the risk of contamination of the tissues by asbestos, as it is shown by the lower number of cases with positive finding of fibers and by lower concentration of fibers in the positive cases.

Anti-idiotypes against antiphospholipid antibodies are present in normal polyspecific immunoglobulins for therapeutic use

In the present study we found that antiphospholipid activity in sera from patients with anticardiolipin antibodies was inhibited in vitro by therapeutic polyspecific normal immunoglobulins (IVIg). In fact, F(ab')2 fragments from IVIg (IVIg-F(ab')2) inhibited the binding of anticardiolipin antibodies to the corresponding antigen in a dose-dependent fashion, thus suggesting that the interaction between IVIg-F(ab')2 and anticardiolipin antibodies occurred within or near the antigen combining site. The maximal inhibition ranged from 35.25 +/- 5.56 to 64 +/- 5.48%. In addition, patients' IgG containing antiphospholipid activity specifically bound insolubilized IVIg-F(ab')2, as assessed by enzyme-linked immunosorbent assay (ELISA). These results indicate that IVIg obtained from a large pool of normal donors contain anti-idiotypic antibodies directed against idiotypes located on antiphospholipid antibodies. Moreover, our observations suggest that the reported favourable effect of high dose infusion of IVIg in patients with recurrent abortions due to antiphospholipid antibodies may depend, at least in part on inhibition of the binding of such autoantibodies to the corresponding antigens (s) and/or inactivation of idiotype bearing B cell clones.