Oral probiotic treatment of Lactobacillus rhamnosus Lcr35® prevents visceral hypersensitivity to a colonic inflammation and an acute psychological stress

AIMS

This study evaluated the efficacy of a repeated oral treatment with two active pharmaceutical ingredients (Lcr Lenio^® and Lcr Restituo^® ) derivated from the probiotic bacterial strain Lactobacillus rhamnosus Lcr35^® in two animal models mimicking different features of irritable bowel syndrome (IBS). IBS is characterized by visceral pain associated with alteration of bowel transit. IBS patients present visceral hypersensitivity with peripheral and central origins.

METHODS AND RESULTS

The injection of 2,4,6-trinitrobenzenesulfonic acid (TNBS) into the proximal colon as well as an acute partial restraint stress (PRS) produces colonic hypersensitivity measured in conscious rats by a decrease in pain threshold in response to distal colonic distension. Visceral hypersensitivity was produced by injection of TNBS 7 days before colonic distension or by acute PRS on testing day. Treatments were performed once a day during eight consecutive days.

CONCLUSIONS

This study indicates that an 8-day probiotic treatment (Lcr Lenio and Lcr Restituo) produces an antihypersensitivity activity in both TNBS and PRS visceral pain models. As this probiotic strain attenuates peripherally and centrally induced visceral hypersensitivity in rats, it may be active in treatment of IBS symptoms. An immunomodulatory effect of the probiotics was highlighted in the TNBS model on the IL-23 secretion, suggesting a mechanism of action involving a regulation of the local IL-23/Th17 immune activation.

SIGNIFICANCE AND IMPACT OF THE STUDY

Two formulas of Lcr35^® probiotic strain show very encouraging results for the treatment of IBS patients. Further studies are needed to better understand the role and mechanisms of probiotics on the pathogenesis of IBS.

Binding Potency of Heparin Immobilized on Activated Charcoal for DNA Antibodies

In vitro experiments showed that heparin adsorbed on activated charcoal can bind antibodies raised against native and single-stranded DNA in a diluted sera pool with a high level of these DNA. Thus, heparin used as anticoagulant during hemosorption procedure can demonstrate supplementary therapeutic activity resulting from its interaction with various agents involved in acute and chronic inflammatory reactions such as DNA- and RNA-binding substances, proinflammatory cytokines, complement components, growth factors, etc. Research and development of heparin-containing carbonic adsorbents for the therapy of numerous inflammatory and autoimmune diseases seems to be a promising avenue in hematology.

Airborne pollen levels and drug consumption for seasonal allergic rhinoconjunctivitis: a 10-year study in France

BACKGROUND

Few time-series studies, and none lasting longer than 4 years, have investigated the etiology of treated seasonal allergic rhinoconjunctivitis (SAR) on the basis of anti-allergic medication prescriptions. The aim of this article was to study the short-term relationship between pollen exposure and drug-treated SAR over 10 years in an urban area in central France.

METHODS

A SAR case was defined as the association between an oral antihistamine and a local anti-allergic drug on the same prescription. The relationship between daily changes in pollen concentrations and daily changes in the number of treated SAR cases was analysed using generalized additive models, taking into account confounding factors such as air pollution, weather and days of the week.

RESULTS

Between 2003 and 2012, the total yearly number of treated SAR cases rose from 7265 to 11 315. The relative risk of treated SAR associated with an interquartile increase in pollen concentration increased significantly for Fraxinus, Betula, Carpinus, Platanus, Poaceae and Urticaceae for the whole pollen season, and for Urticaceae in the first semester.

CONCLUSIONS

The prevalence of treated SAR cases rose by about 55% in 10 years. The study not only confirmed the highly allergenic role of Fraxinus, Betula and Poaceae pollens but also showed a relatively unknown association between treated SAR and Carpinus and Platanus pollens, despite their pollen counts being <1% of overall pollen concentration. It also showed robust correlations with Urticaceae pollens, especially during the first semester, suggesting a potential allergenic role of Parietaria pollination in this non-Mediterranean area.

[Crozet protocol: does a lipid-rich meal interfere with cryoglobulinemia assay?]

Cryoglobulins are serum immunoglobulins that precipitate reversibly at low temperature. It is important to determine their presence, because they can be responsible for severe complications. They can also reveal underlying conditions, in particular hepatitis C and haematological diseases. Laboratory investigations of cryoglobulins are problematic and require adherence to strict preanalytical conditions. We decided to determine wether a patient really needs to be in a fasting state when a blood sample is taken. In practice, this requirement is difficult for us to meet, because of our large patient population (consultations in a teaching Hospital). We therefore devised a protocol, called the Crozet protocol based on the assay of cryoglobulinemia in healthy volunteers, before and after a meal rich in lipids. Ten patients were tested. Cryoglobulinemia assays were performed according to the technique of Hartree. Lipid profiles were measured on Modular P (Roche Diagnostics). Cryoglobulinemia assay does not seem to be unduly affected by a meal rich in lipids, in particular in triglycerides. Hence the patient does not necessarily have to be on an empty stomach at blood sampling. This study allowed us to modify our threshold of significance (from 15 to 30 microg/mL), which confirmed our view of the physiological character of a low cryoglobulinemia level. Studies involving a greater number of healthy subjects are needed to accurately establish a new threshold and to confirm our findings.

Increase in complement component C3 is an early response to experimental magnesium deficiency in rats

The importance of the inflammatory process in the pathology of experimental Mg-deficiency has been reconsidered but the sequence of events leading to inflammatory response remains unclear. In this study, the effect of Mg-deficiency on complement system by measuring total C3 concentration, mRNA abundance for rat pre-pro complement C3 in liver by RT-PCR, complement haemolytic activity and C3 activation by Western Blot was studied. Weaning male Wistar rats were fed either Mg-deficient or control experimental diets for 2 or 8 days. At 8 days, a characteristic inflammatory response of Mg-deficiency including hyperaemia, leukocytosis and enlarged spleen was accompanied by an increase in the total C3 quantity in plasma. Moreover, at 8 days, RT-PCR analysis indicated higher level of mRNA rat pre-pro complement C3 in liver from Mg-deficient rats compared to control rats. Even if the inflammatory syndrome was not observed in rats after 2 days, total plasma C3 was shown to be significantly increased as compared to total plasma C3 level in control rats. Because of the high variability of complement haemolytic activity values in Wistar rats, weaning male Sprague-Dawley rats were used in a second experiment. At 8 days, the inflammatory response of Sprague-Dawley rats was accompanied by an increase in total C3 quantity and by a higher haemolytic activity. The Western Blot technique failed to display distinct bands resulting from C3 cleavage in plasma from Mg-deficient rats. Since, the complement C3 is a positive acute phase reactant, the elevation of C3 indicates that the modification of inflammatory response is an early event of Mg-deficiency. However, complement activation does not appear to be involved in the acute phase of the deficiency.

[Analysis of eosinophilia and ECP levels in blood and nasal secretions of 119 nasal polyposis patients]

OBJECTIVE

The aim of this prospective study was to determine eosinophilia and ECP (Eosinophilic Cationic Protein) levels in blood and in nasal secretions of patients with nasal polyposis (NP).

PATIENTS

119 patients with NP were prospectively studied. The control group included 25 patients.

METHODS

They included: questionnaire about asthma and intolerance to aspirin; nasal endosopic grading; nasal symptoms scoring; allergy testing; measurements of serum and nasal values of eosinophilia expressed as a percentage; measurements of serum and nasal values of ECP expressed in ng/ml; the Spearman correlation test, the T series and Khideux tests were used in the statistical analysis.

RESULTS

In NP group, 66 were asthmatic (As) and 53 non asthmatics (NAs), 40 were atopic (ATo), and 79 were non atopic (NAto). Values of nasal eosinophilia and nasal ECP in NP patients were significantly higher (respectively 40.7+/-35.6% and 22.8+/-48.0 ng/ml) than the control group (respectively 3.0+/-14% and 2.1+/-3.6 ng/ml). Nasal and serum eosinophilia values in asthmatic patients (As) (respectively 47+/-36% and 7.6+/-6.3%) were significantly higher (p<0.05) than in non asthmatic patients (NAs) (respectively 32.6+/-33.8% and 4.6+/-3.1%). No difference was found in nasal and serum ECP values between asthmatic and non asthmatic patients. Nasal eosinophilia values were significantly correlated (p=0.02) with nasal scoring in NP patients. No correlation was found between nasal ECP and serum ECP values and clinical scoring.

CONCLUSION

Nasal eosinophilia and nasal ECP values are significantly increased in NP. Nasal eosinophilia seems to be a relevant biological marker of clinical severity (association with asthma and a high clinical score) in NP patients. By contrast, nasal ECP cannot be consider as a marker of clinical severity.

High magnesium concentration in vitro decreases human leukocyte activation

In view of experimental data suggesting that pharmacological magnesium (Mg) therapy could be expected to temper hypersensitivity, the aim of the present study was to assess the effect of in vitro high Mg concentration (8 mmol/l vs. 0.8 mmol/l) on human leukocyte activation. The first experiment in nine healthy volunteers was performed on total leukocyte suspension containing 82 +/- 4 per cent of neutrophils. The results demonstrate the inhibitory effect of high Mg concentration as shown by the significant reduction of superoxide anion production following phorbol myristate acetate (PMA) or formyl-methionyl-leucyl-phenylalanine (fMLP) activation. Moreover, neutrophils activated with fMLP showed an increased respiratory burst when incubated in low Mg concentration (0.2 mmol/l) as compared to normal Mg concentration (0.8 mmol/l). Similarly, high concentration of Mg resulted in a significant reduction in superoxide anion production by eosinophils in response to PMA in five eosinophilic patients. In patients showing Hymenoptera venom hypersensitivity, high Mg concentration resulted in a significant reduction of sulphidoleukotrienes production by leukocytes in response to venom allergen (six patients) or in response to zymosan activated particules (fourteen patients). Taken together, the results suggests that Mg acts via a non specific mechanism and appears to be non specific to a particular cell type. As Mg counteracts calcium in many physiological and pathological processes, it is reasonable to hypothesise that extracellular Mg can diminish leukocyte activation by its calcium antagonism.

[Ophthalmologic manifestations of systemic vasculitis: report of six cases and review of the literature]

PURPOSE

Study of characteristics of ocular involvement in systemic vasculitis.

METHODS

We describe six cases of systemic vasculitis with ocular involvement observed between 1992 and 2000. These cases are compared with those reported in the literature.

RESULTS

Our patients suffered from Wegener's granulomatosis (four cases), periarteritis nodosa and Churg-Strauss syndrome. Ocular manifestations were conjunctivitis, scleritis, orbital pseudotumor, optic neuritis and extraocular muscle palsy. These manifestations are similar to those reported in the literature. Their treatment requires steroids and immunosuppressive drugs. In one of our cases, intravenous immunoglobulins were effective in controlling an optic neuritis.

CONCLUSION

Ocular involvement in systemic vasculitis may concern any orbital structure. It usually occurs during the course of vasculitis but may be one of its first manifestations. It requires an appropriate treatment to prevent ophthalmic complications and especially blindness.

Specific and nonspecific immune responses to fasting and refeeding differ in healthy young adult and elderly persons

BACKGROUND

Undernutrition is a main cause of immunodeficiency. Many confounding factors limit the interpretation of immune function in hospitalized elderly patients.

OBJECTIVE

We compared the effects of short-term fasting and refeeding on lymphocyte subset distribution and neutrophil function in healthy subjects.

DESIGN

Seven young adult (x +/- SE age: 24 +/- 2 y) and 8 elderly (71 +/- 3 y) subjects were fed standardized diets (1.6 x predicted resting energy expenditure; 16% protein) for 7 d. They then fasted for 36 h and were refed for 4 h (42 kJ/kg). Lymphocyte subsets were quantified by using fluorochrome-conjugated monoclonal antibodies. Neutrophil chemotactic migration was evaluated by using a 2-compartment chamber. Neutrophil reactive oxygen species production was measured by using a luminol-amplified chemiluminescence assay and oxidation of 2'7'-dichlorofluorescein diacetate.

RESULTS

Baseline total and cytotoxic T lymphocyte subpopulations were lower in elderly than in adult subjects (P < 0.01). Nutritional state had a significant effect (P < 0.05) on total, helper, and cytotoxic T and B lymphocyte counts in all subjects, and the response of lymphocyte subpopulations to nutritional fluctuations was significantly affected by age. The chemotactic index was lowered by fasting in both groups (P < 0.05 compared with basal values). After refeeding, neutrophil migration was restored in adult but not elderly subjects. The superoxide anion production rate increased with fasting and reverted to prefasting values with refeeding in both groups (P < 0.05). Fasting induced a significant decrease in hydrogen peroxide production in stimulated neutrophils that was reversed by refeeding in adult but not elderly subjects.

CONCLUSION

The lack of response of lymphocyte subpopulation counts and neutrophil function to nutritional changes may help to explain the proneness of elderly persons to infection.

[Chronic urticaria and Hashimoto-Hashimoto's thyroiditis: report of 6 cases]

PURPOSE

Chronic urticaria is a common skin disorder. The cause is rarely determined. Autoimmune diseases, particularly autoimmune thyroiditis, have been implicated in the occurrence of chronic urticaria.

METHODS

We reviewed clinical records of patients with Hashimoto's disease and chronic urticaria.

RESULTS

In our department, six patients had presented chronic urticaria associated with Hashimoto's thyroiditis: four patients, of which three treated with L-thyroxine were euthyroid, the other two were hypothyroid. Hashimoto's thyroiditis had been diagnosed for three patients during the investigation of chronic urticaria. Three patients developed chronic urticaria though they were treated with thyroid suppression for Hashimoto's disease. Two of them had a dramatic improvement with opotherapy. One patient who was euthyroid without treatment improved with hormonal therapy. The fourth patient had a partial remission with thyroid hormones and was cured with corticotherapy.

CONCLUSION

The mechanism by which thyroid autoimmunity is associated with urticaria is poorly understood. A cross-linking of IgE receptors of mastocytes induced by antithyroid antibodies may be a cause of histamine release. Hormonal therapy may be a potent event for the clinical improvement by the suppression of chronic thyroid stimulation. Assay of thyroid hormone and antithyroid antibodies should be performed in patients with chronic urticaria. Discovery of Hashimoto's thyroiditis with chronic urticaria requires thyroid hormone replacement not only in hypothyroid but also euthyroid patients.

Leptin: a potential regulator of polymorphonuclear neutrophil bactericidal action?

It is well known that leptin, the ob gene product, is involved in the regulation of food intake and thermogenesis. Recent studies also demonstrate that leptin may be able to modulate functions of cells involved in nonspecific immune response such as phagocytosis and secretion of cytokines by macrophages. This and the prominent implication of polymorphonuclear neutrophils (PMNs) in infectious response suggested a possible role of leptin as a modulator of PMN functions. We detected a leptin receptor on the PMN membrane by immunocytochemistry with an anti-leptin receptor. Using chemiluminescence we then demonstrated that leptin enhances oxidative species production by stimulated PMNs. These results show for the first time that a functional leptin receptor is present on PMNs and that leptin may be able to influence their oxidative capacity.

Acquired angioedema with C1 inhibitor deficiency: is the distinction between type I and type II still relevant?

BACKGROUND

Acquired angioedemas are divided into type I associated with lymphoproliferation and type II caused by anti-C1-inhibitor antibodies. Recent reports have suggested that this distinction is not so clear-cut, mainly because of the presence of antibodies against the C1 inhibitor in some cases belonging to the type I group. We report herein 2 additional cases of acquired angioedema with anti-C1-inhibitor antibody.

MATERIAL AND METHODS

One man and 1 woman had had acquired angioedema for several years. In the man, a monoclonal component had been detected several years before the present study. In the second patient, a monoclonal component was detected during the study. The following data were studied on successive blood samples collected during angioedema manifestations: complement component levels, functional activity of the classical pathway, functional and antigenic C1 inhibitor doses, ELISA test to detect autoantibodies to C1 inhibitor and Western blot analysis of the C1 inhibitor.

RESULTS

In both patients, CH50 and C4 activities were decreased, and an autoantibody to C1 inhibitor was detected. In 1 case, the antibody appeared after the monoclonal component; in the second case, it appeared before and belonged to a different immunoglobulin class.

CONCLUSION

Our data suggest that the distinction between type I and type II acquired angioedema is no longer valid because of overlapping in some cases.

Atopy parameters in asthmatic infants

We evaluated various atopy parameters in 44 asthmatic infants aged 1-3 years: nonspecific parameters (total IgE and eosinophilia), and specific parameters relative to 21 allergens (specific IgE and skin tests), together with tests of leukotriene release by blood leukocytes (cellular allergen stimulation test; CAST) in the presence of a mixture of 21 allergens. Thus far 17 infants have displayed no sign of atopy, but 27 met at least one criterion. Eight met nonspecific criteria, and the others single or multiple criteria. Of the 21 allergens, 20 gave rise to at least one sensitization in this population. The specific IgE was more frequently positive than the skin tests. Dissociations between the two types of specific tests were practically systematic. Different phenotypes based on the chosen parameters were individualized, demonstrating heterogeneity in the expression of atopy in these young infants. The polyvalent CAST was positive only when other criteria of atopy were also positive (specific IgE and/or skin tests), and the range of intensity of the responses obtained supports reactivity rather than sensitization.

Electrophoretic analyses in a case of monoclonal gamma chain disease

Abnormal low molecular weight immunoglobulin heavy chain can be detected in serum samples from patients with heavy chain disease. In this paper, we report the characterization of a gamma heavy chain in a patient suffering from a lymphoplasmocytic disorder, using immunofixation analysis and two-dimensional polyacrylamide gel electrophoresis. We demonstrate that the combination of serum protein agarose electrophoresis and two-dimensional electrophoresis (three-dimensional electrophoresis) can be used to further characterize abnormal protein bands detected by immunofixation.

[Mixed cryoglobulins and autoimmunity in hepatitis C]

We explored and studied cryoglobulins and autoantibodies in 149 patients with hepatitis C. 49% of untreated patients have cryoglobuliemia (36% polyclonal cryoglobulins) and 76% of ineffectively treated patients since more than 6 months (50% polyclonal cryoglobulins). Other observed cryoglobulins are half of type II and half oligoclonal. In 22 cryoglobulinemic patients before treatment, a good clinical response to IFN is induced only among patients for which cryoglobulins are negative at the end of treatment. Cryoglobulins could be indicators of viremia. The prevalence of autoantibodies is low and without clinical significance (they are more frequently detected in cryoglobulinemic patients, except anti-thyroid autoantibodies). Nevertheless, autoantibodies induced by IFN in our study (anti-thyroid autoantibodies, ANCA) are associated with clinical symptoms.

[Cold agglutinins and cryoglobulinemia in a patient with hepatitis C]

OBJECTIVES

Cold agglutinins and cryoglobulins are uncommon in the same patient as observed in our case.

CASE REPORT

A 74-year-old patient suffered repeated episodes of hemolytic anemia for one year and had hepatitis C anti-virus antibodies. Mixed cryoglobulinemia was found at levels which increased during episodes of acute hemolysis in addition to anti-I cold agglutinins. Two-dimensional electrophoresis revealed identical oligoclonal cold agglutinins and cryoglobulins.

DISCUSSION

Unlike mixed cryoglobulinemia, cold agglutinins are not known to occur subsequent to hepatitis C infection. The identical immunoglobulins observed in our patient suggest a common origin. Chronic anti-I cold oligoclonal agglutinins are rarely observed and could be an intermediary step towards monoclonal lymphopathy as has been described in prolonged hepatitis C infection.

[Multiple complications of monoclonal IgM]

A 64 year old woman with monoclonal IgM Kappa cryoglobulinemia had developed neurologic, vascular and bone involvements. If each features were previously reported, their association appears to be rare. The polyneuropathy was consistent with an IgM anti MAG neuropathy rather than a cryoglobulinemic neuropathy. The vascular occlusion is well known in dysglobulinemia. The diffuse osteosclerosis without medullary fibrosis or myeloproliferative disorder was as like as a Schnitzler's syndrome (chronic urticaria, osteosclerosis, monoclonal IgM Kappa gammopathy.

Treatment of homozygous familial hypercholesterolemia by plasma exchange and LDL-apheresis

Two girls with familial hypercholesterolemia were treated for 7 years by plasma exchanges (PE) or LDL-apheresis (LA). We compared different methods of treatment; PE with or without reuse of the plasma separator, LA of varying frequency, and LA with or without oral administration of simvastatin. We assessed the long-term results by measuring the blood levels of the biochemical parameters before sessions, and determined the effectiveness of each session by the percentage of decrease in the blood levels between the beginning and the end of the sessions. LA led to a more selective treatment (lowering of LDL cholesterol and maintenance of HDL cholesterol), but the blood levels of total cholesterol before sessions were the same as those obtained by PE. IgG and haemoglobin levels decreased little with LA. The rhythm of one session a week gave better results in LA. Although reuse of the plasma separator represents a financial saving it produced poorer results. The oral administration of simvastatin improved the results of LA.

[Detection and analysis of cryoglobulins: comparative study of a population of patients and one of healthy controls]

During an 11-month period, 270 cryoglobulins were identified in 735 sera from patients versus 34 in 82 sera from apparently healthy blood donors. Western-blot analysis of the cryoglobulins was performed and cryoglobulin protein content was determined using a colorimetric assay. Comparison of findings in the two groups suggested that a substantial proportion of cryoglobulins identified in the sera of patients are quantitatively and qualitatively indistinguishable from cryoglobulins identified in healthy controls.

Complement activation during low-density lipoprotein apheresis

Complement system activation was investigated in two girls with familial homozygous hypercholesterolemia undergoing two monthly sessions on LA15 or LA40 (Kaneka liposorber). We determined blood levels of C3c and C3a, leukocyte counts, and plasma levels of C3c and C3a in the extracorporeal circulation device at the start of the sessions and 15 and either 60 or 120 min into them. Sequential eluates were collected from LA40 at the end of the sessions (0.5M NaCl, 1M hydroxylamine). Anaphylatoxin C3a increased throughout, especially with LA40. As previously reported, C3a was trapped in the dextran column but was noticeably present in efferent plasma. Besides many proteins, nonnative complement fragments bearing C3a and C3d antigens were detected in almost all the eluates, suggesting possible in situ complement activation. Practically, complement activation induced by the first filter is a risk; long-term side effects may arise from this extracorporeal circulation device.

[Mixed cryoglobulins and heterogeneity restriction]

Cryoglobulins from 143 patients were analyzed using an immunoblot technique with a nitrocellulose membrane. Fifty-four p. cent of cases were classified as type III, with polyclonal IgG, IgA, and IgM being the most common components. Type II was found in 24% of cases, with a monoclonal IgM in most instances. Lastly, classification was impossible in 22% of cases, usually because of the presence of oligoclonal IgM bands. Use of this highly sensitive technique to analyse cryoglobulins raises the problem of identification of patterns that are difficult to include in types II and III.

Analysis of proteins eluted from hemodialysis membranes

To further investigate the types of interactions occurring between blood and hemodialysis membranes, proteins were sequentially eluted from used dialysers. Four different membranes (cuprophan, hemophan, cellulose acetate and polyacrylonitrile) were successively treated with a hydrogen bond cleaving agent (10 M urea), an ionic detergent destabilizing the hydrophobic interactions between apolar groups (SDS solution), and a hydroxylamine solution at alkaline pH to release postulated covalently bound C3 fragments. The eluted proteins were analyzed by SDS-PAGE and immunological techniques. Total protein determinations demonstrate different behaviour of the membranes as regards the 'protein cake'. Electrophoretic analysis suggests that qualitative and quantitative differences in the binding of the blood proteins are related to the membrane material. Complement fragment studies indicate that the complement activating potential of the dialysis membrane may not be determined by the availability of potential binding sites for activated C3b. An attempt is made to correlate these results with the biocompatibility concept.

Leukotriene B4 in hemodialysis

Leukotrienes are eicosanoids arising from arachidonic acid via 5 lipooxygenase, an enzyme essentially present in leukocyte cells. Leukotriene B4 might be an indicator of neutropolymorphonuclear leukocyte activation when there is contact with artificial membranes. The level of plasmatic leukotriene B4 was measured at three different times during the hemodialysis treatment in several patients undergoing dialysis on three different membranes (one cellulosic and two synthetics). A moderate increase of leukotriene B4 was observed early (at 15 min), comparable among the three membranes, but levels returned to baseline at 180 min. Leukotriene B4 production proved leukocyte activation and was probably related to a direct interaction with dialysis membrane. Nevertheless, complement intervention could not be excluded. Leukotriene B4 is one molecule more among the group of inflammatory mediators produced during hemodialysis treatment.