Plasminogen activators and plasminogen activator inhibitors in liver deficiencies caused by chronic alcoholism or infectious hepatitis

Plasma concentrations of tissue-type plasminogen activator (t-PA), urokinase (u-PA), plasminogen activator inhibitor 1 (PAI-1) and PAI-2 were studied in 53 patients with liver deficiency caused by chronic alcoholism (n = 40), viral hepatitis (n = 10) or malignant disease of the liver (n = 3) and compared to that of a control group (n = 20) of healthy subjects. u-PA and PAI-1 levels were significantly increased in all patients with chronic alcoholism, whereas high t-PA was only observed in combination with disturbed liver function tests or with liver cirrhosis (two and six-fold above control values, respectively). A good correlation was observed between t-PA and gamma glutamyl transferase (r = 0.615; p less than 0.001). In patients with infectious hepatitis or with malignant disease of the liver t-PA was normal whereas u-PA and PAI-1 were increased. PAI-2 levels were close to or below the detection limit (15 ng/ml) in the control group and in most patients. However, in two patients with alcohol induced cirrhosis PAI-2 levels were approximately 45 ng/ml and in one patient with hepatocarcinoma even 66 ng/ml. Thus, in liver disease, marked elevations of t-PA, u-PA and PAI-1 levels may occur, with increased PAI-1 as an early marker of liver defects and t-PA a marker of severe liver defects.

[Prospective study of the undesirable effects of allergic desensitization]

Untoward allergic reactions were monitored prospectively in 98 patients undergoing hyposensitization with depot type preparations of house dust mites (42 patients) or grass pollens administered before the pollen season (56 patients). 44% of the patients experienced at least one major local reaction, usually when injected with high doses of allergens. A mild systemic reaction (benign crisis of rhinitis or asthma within 12 hours after the injection) was reported at least once by 9% of the pollen-treated and 52% of the mite-treated patients. A severe systemic reaction, which improved rapidly with adrenaline, was noted in 3% of the pollen-treated and 5% of the mite-treated patients. These data indicate that untoward allergic reactions during hyposensitization are not uncommon, and this type of treatment therefore requires a strict indication.

Influence of palmitoyl-3-catechin and heptyl-3-catechin on the leucocyte migration inhibition test carried out in the presence of PPD and hepatitis B surface antigen (HBsAg)

It has been shown that (+)-cyanidanol-3 [+)-catechin) is able to stimulate in vitro the cell-mediated immune response specific for hepatitis B surface antigen (HBsAg), and might contribute to the elimination of hepatitis B virus (HBV) during HBV infection. In the present study, the possible action of two of its derivatives, palmitoyl-3-catechin and heptyl-3-catechin, on this type of immunity was investigated by adding the substances to leucocyte migration inhibition tests performed in presence of PPD and HBsAg, with leucocytes from individuals sensitized to these antigens. In normal individuals sensitized to PPD, the addition of palmitoyl-3-catechin and heptyl-3-catechin amplified the inhibition of migration by resp. 7.2% (p less than 0.05) and 13.5% (p less than 0.001). In patients previously infected by HBV and sensitized to HBsAg, the maximum amplification was resp. 12.7% (p less than 0.001) and 7.6% (p less than 0.05). This effect was dose-dependent. These substances did not modify the leucocyte migration measured in the absence of antigen. Palmitoyl-3-catechin and heptyl-3-catechin therefore seem capable of amplifying the cell-mediated immune response. The effect of the two derivatives, which were selected because of their liposolubility, was more pronounced than the effect of (+)-cyanidanol-3. It is thus possible that the two new catechin-derivatives, not yet in therapeutical use, will also stimulate cell-mediated immunity to HBsAg, and that a more marked clinical effect might be expected.

Absence of circulating HBsAg in acute hepatitis B

We are describing five of a group of 72 cases of acute hepatitis B in which HBsAg was not present when the disease was diagnosed, i.e. two to six days after the appearance of icterus. The role of HBV infection was assessed by demonstrating the absence of anti-HBs during the first few weeks and its appearance at the time of recovery, as well as the presence of anti-HBe, high anti-HBc titers and the IgM class of immunoglobulin. The high levels of transaminases observed in early sera returned to normal values within two to six weeks. Anti-HAV antibodies were absent in all serum samples tested. These case reports should remind us that the absence of HBsAg at the onset of acute viral hepatitis does not exclude the possibility of HBV infection. Therefore, if HBsAg and anti-HAV are not present at the beginning of acute viral hepatitis, serum should also be tested for anti-HBc IgM before the diagnosis of non-A, non-B hepatitis is considered.