Targeted therapies for uveitis in spondyloarthritis: A narrative review

Spondyloarthritis (SpA) encompasses a group of chronic inflammatory disorders of the joints frequently associated with uveitis in almost a quarter of cases. SpA-related uveitis typically affects the eye anterior chamber with sudden onset, causing pain, redness, photophobia, and blurred vision. Ophthalmologists will describe an acute anterior unilateral uveitis. Most patients present with episodic acute anterior non-granulomatous uveitis and retain excellent visual acuity. However, systemic treatments are recommended in the event of frequent relapses (2-3/year) or in rare cases of sight-threatening with ocular complications. The improved understanding of the pathogenesis of SpA has led to the management of this disease by biologics. Here, we review the main data regarding the opportunity to target specific components in inflammatory pathways for the treatment of SpA-related uveitis. These therapies are recommended for long-term control when uveitis relapses occur too frequently despite conventional systemic treatments. Significant benefits have been obtained with the tumor necrosis factor-α inhibitors (TNFis), particularly infliximab and adalimumab. Paradoxically, a high number of uveitis occurrences have been shown on etanercept. Mixed results have been demonstrated with interleukin-17 antagonists (secukinumab) and interleukin-12/interleukin-23 antagonists (ustekinumab) in cases of failure of TNFis. JAK inhibitors seem to be a valuable class of medications for these patients in the future. Although SpA-related uveitis is typically managed with conventional local and/or systemic treatments, these biological/targeted therapies may provide avenues to control both the underlying SpA and uveitis manifestations. Thus, a close collaboration between patients, rheumatologists, internists, and ophthalmologists is needed to optimally manage ocular inflammation in SpA.

Etiological Diagnosis of Uveitis: Contribution of the of the Extra-Ophthalmological Clinical Examination

PURPOSE

Determining uveitis etiology is a challenge. It is based primarily on demographic data and the characteristics of eye examination. It is not clear to what extent extraocular physical signs contribute to elucidating the etiology. This study aimed to establish the contribution of the clinical extra-ophthalmological features for the assessment of the underlying etiology of uveitis.

METHODS

We retrospectively reviewed 1307 patients with uveitis referred to our tertiary center between 2003 and 2021. Uveitis was classified according to the Standardization of Uveitis Nomenclature. Clinical features were collected at diagnosis by internists before the etiological diagnosis was made. The main outcome description was the contribution of clinical features.

RESULTS

Clinical extra-ophthalmological features contributed to the assessment of the underlying etiology of uveitis in 363 (27.8%) patients. The joint and the skin examinations were the most useful for etiological investigations, respectively in 12.3% and 11.8% of patients. Five etiologies of uveitis accounted for 80% of the cases: sarcoidosis, HLA-B27-related uveitis, Behçet's disease, multiple sclerosis, and Vogt-Koyanagi-Harada disease. Clinical extra-ophthalmological features were particularly important in the etiological diagnosis of acute bilateral anterior uveitis and panuveitis.

CONCLUSION

This study suggests that clinical extra-ophthalmological features are essential for the etiological diagnosis of uveitis in more than a quarter of patients. It demonstrates once again the value of collaboration between ophthalmologists and other specialists experienced in performing extra-ophthalmological clinical examinations, particularly in patients with acute bilateral anterior uveitis and panuveitis.

H syndrome treated with Tocilizumab: two case reports and literature review

H syndrome is a rare autosomal recessive genetic disorder characterized by the following clinical features: cutaneous hyperpigmentation, hypertrichosis, hepatosplenomegaly, heart anomalies, hearing loss, hypogonadism, short stature, hallux valgus, hyperglycemia, fixed flexion contractures of the toe joints, and the proximal interphalangeal joints. In rare cases, autoinflammatory and lymphoproliferative manifestations have also been reported. This disorder is due to loss-of-function mutations in SLC29A3 gene, which encode the equilibrative nucleoside transporter ENT3. This deficiency leads to abnormal function and proliferation of histiocytes. H syndrome is part of the R-group of histiocytosis. We report two different cases, one was diagnosed in adulthood and the other in childhood. The first case reported is a 37-year-old woman suffering from H syndrome with an autoinflammatory systemic disease that begins in adulthood (fever and diffuse organ's infiltration) and with cutaneous, articular, auditory, and endocrinological manifestations since childhood. The second case reported is a 2-year-old girl with autoinflammatory, endocrine, and cutaneous symptoms (fever, lymphadenopathy, organomegaly, growth delay, and cutaneous hyperpigmentation). Homozygous mutations in SLC29A3 confirmed the diagnosis of H syndrome in both cases. Each patient was treated with Tocilizumab with a significant improvement for lymphoproliferative, autoinflammatory, and cutaneous manifestations. Both cases were reported to show the multiple characteristics of this rare syndrome, which can be diagnosed either in childhood or in adulthood. In addition, an overview of the literature suggested Tocilizumab efficiency.

Diagnosis, Classification, and Assessment of the Underlying Etiology of Uveitis by Artificial Intelligence: A Systematic Review

Recent years have seen the emergence and application of artificial intelligence (AI) in diagnostic decision support systems. There are approximately 80 etiologies that can underly uveitis, some very rare, and AI may lend itself to their detection. This synthesis of the literature selected articles that focused on the use of AI in determining the diagnosis, classification, and underlying etiology of uveitis. The AI-based systems demonstrated relatively good performance, with a classification accuracy of 93-99% and a sensitivity of at least 80% for identifying the two most probable etiologies underlying uveitis. However, there were limitations to the evidence. Firstly, most data were collected retrospectively with missing data. Secondly, ophthalmic, demographic, clinical, and ancillary tests were not reliably integrated into the algorithms' dataset. Thirdly, patient numbers were small, which is problematic when aiming to discriminate rare and complex diagnoses. In conclusion, the data indicate that AI has potential as a diagnostic decision support system, but clinical applicability is not yet established. Future studies and technologies need to incorporate more comprehensive clinical data and larger patient populations. In time, these should improve AI-based diagnostic tools and help clinicians diagnose, classify, and manage patients with uveitis.

Sarcoidosis-Related Uveitis: A Review

Sarcoidosis is an inflammatory disease that involves the eyes in 10-55% of cases, sometimes without systemic involvement. All eye structures can be affected, but uveitis is the most common ocular manifestation and causes vision loss. The typical ophthalmological appearance of these uveitis is granulomatous (in cases with anterior involvement), which are usually bilateral and with synechiae. Posterior involvement includes vitritis, vasculitis and choroidal lesions. Tuberculosis is a classic differential diagnosis to be wary of, especially in people who have spent time in endemic areas. The diagnosis is based on histology with the presence of non-caseating epithelioid granulomas. However, due to the technical difficulty and yield of biopsies, the diagnosis of ocular sarcoidosis is often based on clinico-radiological features. The international criteria for the diagnosis of ocular sarcoidosis have recently been revised. Corticosteroids remain the first-line treatment for sarcoidosis, but up to 30% of patients require high doses, justifying the use of corticosteroid-sparing treatments. In these cases, immunosuppressive treatments such as methotrexate may be introduced. More recent biotherapies such as anti-TNF are also very effective (as they are in other non-infectious uveitis etiologies).

[Sarcoid uveitis: Ophthalmologist's and internist's viewpoints]

Sarcoidosis is one of the leading causes of inflammatory eye disease. All ocular structures can be affected, but uveitis is the main manifestation responsible for vision loss in ocular sarcoidosis. Typical sarcoid anterior uveitis presents with mutton-fat keratic precipitates, iris nodules, and posterior synechiae. Posterior involvement includes vitritis, vasculitis, and choroidal lesions. Cystoid macular edema is the most important and sight-threatening consequence of sarcoid uveitis. Patients with clinically isolated uveitis at diagnosis rarely develop other organ involvement. Even though, ocular sarcoidosis can have a severe impact on visual prognosis, early diagnosis and a wider range of available therapies (including intravitreal implants) have lessened the functional impact of the disease, particularly in the last decade. Corticosteroids are the cornerstone of treatment for sarcoidosis, but up to 30% of patients achieve remission with requiring high-dose systemic steroids. In these cases, the use of steroid-sparing immunosuppressive therapy (such as methotrexate) is unavoidable. Among these immunosuppressive treatments, anti TNF-α drugs have been a revolution in the management of non-infectious uveitis.

[Parvovirus B19 infections in adults]

Acute Parvovirus B19 (PVB19) infection is responsible for erythema infectiosum in children and non-specific polyarthralgias in immunocompetent adults associated with skin lesions and rarer manifestations (hepatic, neurological, cardiac or nephrological). In immunocompromised patients, cytopenias are more frequent and in some cases, viremia persists and is responsible for PVB19 chronic infection. PVB19 is responsible for pure red cell aplasia during chronic hemolytic diseases. Acute PVB19 infection is a differential diagnosis of some autoimmune diseases and has been suspected to be a trigger for some autoimmune diseases because of its ability to promote the emergence of autoimmune markers. Mechanisms of molecular mimicry, induction of apoptosis and activation of enzymes have been demonstrated, explaining in part the production of autoantibodies during infection. However, the demonstration of a causal relationship in the triggering of autoimmune disease remains to be done. This review provides a synthesis of the PVB19 infection clinical data in adults with a particular focus on these links with autoimmunity.

Murine typhus complicated by sHLH mimicking adult-onset Still's disease

INTRODUCTION

Adult-onset Still's disease (AOSD) is a rare multisystemic disorder and a diagnostic challenge for physicians because of the wide range of differential diagnoses. Common features of AOSD and secondary hemophagocytic lymphohistiocytosis (sHLH) could favour diagnostic uncertainty, in particular in case of infection-related sHLH.

OBSERVATION

A 61-year-old man was admitted to our internal medicine department for suspected AOSD. He reported a 2-week history of sudden onset fever, headaches, myalgia, sore throat, diarrhoea, and an erythematous macular rash of the trunk as well as petechial purpuric lesions on both legs on return from Reunion Island. Laboratory tests found cytopenia, hepatic cytolysis, hypertriglyceridaemia, and hyperferritinaemia. Hemophagocytosis was diagnosed on bone marrow aspiration in favour of the diagnosis of secondary hemophagocytic lymphohistiocytosis (sHLH). Subcutaneous anakinra (100mg) was initiated to treat sHLH with favourable course. Oral doxycycline was added 3days later because of atypical features for AOSD diagnosis such as diarrhoea, hypergammaglobulinaemia, and doubtful serologies for Rickettsia and Coxiella. Three weeks later, Rickettsia typhi serology was checked again and revealed an increase in IgG titer>4 times that confirmed the diagnosis of murine typhus. A diagnosis of murine typhus complicated by sHLH was retained, successfully treated by anakinra and doxycycline.

CONCLUSION

Our observation shows that AOSD diagnosis has to be stringent due to the many differential diagnoses, particularly infection complicated by sHLH, which may be rare. It is important to consider murine typhus in patients returning from endemic areas, such as La Reunion or other tropical areas, when they present fever of unknown origin with non-specific clinical features. Moreover, this case illustrates the effectiveness of IL-1 blockers as a treatment for symptomatic sHLH without severity criteria, regardless of the aetiology.

Glucose uptake by rat erythroid cells: the effects of erythropoietin and dexamethasone

Erythropoietin (Ep) stimulated glucose uptake by erythroid progenitor cells in the liver of fetal rats, as measured by [3H]2-deoxy-D-glucose uptake. This dose-dependent stimulation was maximal at 0.2 U/ml Ep and decreased during cell differentiation. Dexamethasone (DEX) inhibited glucose uptake by erythroid progenitors; this dose-dependent effect was maximal at 10(-7) M DEX. Ep partly counteracted the inhibitory effect of DEX. This antagonism may contribute to the overall antagonism between Ep and glucocorticoids in the development of erythroid tissue in vivo and in vitro.

Induction of erythropoietin receptors during aclacinomycin-mediated erythroid differentiation of K562 leukemia cells

Human K562 leukemia cells have been induced to differentiate along the erythroid lineage by aclacinomycin (ACM), an anthracyclic antitumor drug. During differentiation over 3 days in culture, the expression and the nature of erythropoietin (EPO) receptors have been analyzed using 125I-labeled bioactive recombinant human EPO. Aclacinomycin at 20 nM, the concentration inducing optimum differentiation, progressively increased EPO-specific binding. On day 3, EPO binding was nine-fold higher than that of the controls (1031 +/- 101 cpm/5 x 10(6) cells versus 112 +/- 15 cpm); with various concentrations of ACM, the increase in EPO binding appeared to parallel the recruitment of hemoglobin-producing cells. However, at 95% of growth inhibition, EPO binding remained constant while the percentage of differentiated cells decreased. Specific binding was reversible, saturable, and proportional to cell number; bound EPO was displaced by unlabeled EPO. Scatchard analysis of the equilibrium binding data suggested the existence of a single class of EPO receptors with an apparent Kd of 867 +/- 458 pM, corresponding to 400 +/- 142 receptors per cell. Affinity cross-linking of 125I-EPO using disuccinimidyl suberate followed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis under reducing conditions demonstrated that EPO was preferentially cross-linked to a protein of approximately 116 kD. Taken together, these results demonstrate that, in addition to cytostatic properties, antitumor drugs such as ACM can modulate the expression of differentiation factor receptors on the surface of leukemic cells.

Differentiating activity of adriamycin in human erythroleukemic cells: effect on globin and heme synthesis

The human leukemic cell line K 562 can be induced to differentiate along the erythroid lineage by various chemical compounds and particularly by the anthracyclic antitumor drug, adriamycin (ADR). In this study, we show that, in the presence of a subtoxic concentration of ADR (30 nM), the appearance of hemoglobin-producing K 562 cells is associated with a specific increase in globin mRNA accumulation corresponding to epsilon-, zeta-, gamma-, alpha-globin chains. At the translational level, bulk protein synthesis is strongly decreased following ADR treatment, whereas globin chain synthesis is specifically enhanced. Globin chains represent about 20% of total proteins in ADR-treated cells, versus about 3.5% in controls on day 3. Similarly, on day 3, heme synthesis (55Fe incorporation) is about 10-times higher in ADR-treated cells than in control cells (20,888 dpm/10(5) cells versus 1693 dpm/10(5) cells) which confirms the increase in heme content (420 pM/10(6) treated cells versus 100 pM/10(6) control cells). In the presence of succinylacetone, a heme synthesis inhibitor which prevented the differentiating effects of ADR, the globin mRNA accumulation was not affected. This suggests that heme did not play a regulatory role in globin mRNA transcription, a result at variance with observations published by others. Such results strongly support the notion that in addition to cytostatic properties, ADR stimulates specifically globin and heme synthesis.

In vivo effects of glucocorticoid excess on the contents of the rat fetal liver in erythroid progenitors

Following a laparotomy of the pregnant rat at 12 days of gestation, erythroid cell suspensions prepared from the fetal livers at 14 days contained an increased proportion of progenitor cells forming colonies after 2 or 7 days of culture. When laparotomy was performed at 14 days and the fetal livers were sampled at 16 days, the opposite effects were observed. Injection of 0.25 mg/kg dexamethasone to the 12 days pregnant rat increased the proportion of erythroid progenitors in suspensions from 14 days fetal livers; injection of 10 mg/kg (a long-acting dose) produced the opposite effects. Both the composition of the erythroid cell line and its environment change between 12 and 14 days, and these modifications might explain the inversion of glucocorticoid effects between these two stages.

The erythropoietin receptor of rat erythroid progenitor lens. Characterization and affinity cross-linkage

Commercially available 125I-labeled erythropoietin, obtained by genetic engineering from a human gene, was used to characterize receptors for this hormone on the cell surface of rat erythroid progenitor cells. A low number of high affinity binding sites (487 +/- 32 sites/cell, Kd = 167 +/- 14 pm) were found. Nonerythroid cells and erythrocytes did not exhibit specific binding. The high affinity binding was reversible and displaced by unlabeled erythropoietin, but not by other hormones and growth factors. After incubation at 37 degrees C, nearly 35% of the specifically bound erythropoietin seemed to be internalized, as judged by resistance to acidic buffer treatment. Thus, binding showed characteristics of a hormone-receptor association. 125I-Erythropoietin-labeled cells were treated with the bifunctional reagent dissucinimidyl suberate. Analysis of the cellular extracts by polyacrylamide gel electrophoresis under denaturing and reducing conditions revealed that erythropoietin can be cross-linked to two molecules of 94 and 78 kDa, respectively. Both labeled bands disappeared when the cells were labeled in the presence of an excess of unlabeled erythropoietin. Under nonreducing conditions, a cross-linked band of 230-255 kDa was observed. The relationships between these bands are discussed.

Murine erythroleukaemia cells (Friend cells) possess high-affinity binding sites for erythropoietin

Murine erythroleukaemia cells represent erythroid precursors blocked near the CFU-E or proerythroblast stage. In contrast to their non-leukaemic equivalents, neither their proliferation nor their differentiation seems to be affected by erythropoietin. However, we show in this paper that both uncommitted and committed, benzidine-positive, cells bind iodinated erythropoietin. The binding is of high affinity (Kd = 490 +/- 160 pM) and reversible with a half-life of the complex of 77 +/- 19 min. The number of binding sites is low (300-600 per cell). In contrast the haematopoietic non-erythroid cell lines HL 60 and L 1210 and the myeloid-erythroid human cell line K 562 do not exhibit specific binding. If these binding sites represent true hormone receptors, their presence on a permanent cell line should facilitate erythropoietin receptor purification.

Induction by hemin of proliferation and of differentiation of progenitor erythroid cells responsible for erythropoietin

Erythroid progenitor cells were obtained from rat fetal liver by immunolysis of the whole erythroid population with an antiserum directed against adult rat erythrocytes, followed by separation on a density gradient. Immediately after their isolation, these cells contained only minute amounts of globin mRNAs and their heme synthesis was negligible. In the absence of erythropoietin (Epo), they did not proliferate or differentiate. In the presence of Epo, they proliferated, synthetized heme and globins actively, accumulated large amounts of globin mRNAs, and developed hemoglobinized colonies in methylcellulose. Hemin, in concentrations of 5-100 microM, induced, in the absence of Epo, the proliferation and differentiation of these cells (e.g., accumulation of globin mRNAs, synthesis of heme and globins, and increased density of membrane antigens characteristic of the erythrocyte). Nevertheless, Epo and hemin actions were not superimposable: in methylcellulose, Epo induced the appearance of large (greater than or equal to 32 cells) hemoglobinized colonies in 48 h, whereas hemin induced smaller and fewer colonies in only 24 h. Succinylacetone (SA, inhibitor of heme synthesis) mostly prevented the effects of Epo on cell proliferation and differentiation; SA inhibition was relieved by hemin. Thus, hemin seems to intervene in erythroid differentiation as a factor of both proliferation and maturation.

Mode of action of erythropoietin and glucocorticoids on the hepatic erythroid precursor cells: role of prostaglandins

The hypothesis that prostaglandins, and especially PGE2, are the second messengers of erythropoietin (Ep) and that glucocorticoids inhibit Ep action by inhibiting PG synthesis was tested on the erythroid cell line from fetal rat liver. The optimal (10(-9) M) stimulatory concentration of PGE2 did not reproduce, by far, the maximal effect of Ep on the growth of CFUE erythroid colonies. Ep did not increase PGE2 release in liquid culture media of cell suspensions made of the whole erythroid line or enriched (over 85%) in precursor cells. Ep did not modify the turnover rate of arachidonate. Nevertheless, indomethacin partially inhibited Ep effect on CFUE development, and this inhibition was abolished by PGE2. These results suggest that PGE2 potentiates Ep action but is not its second messenger. Spontaneous PGE2 release in liquid culture media brought about concentrations of the order of 10(-9) M, and 10(-7) M dexamethasone completely inhibited this release. Part of (but not all) the anti-Ep effects of glucocorticoids might thus be mediated this way. Dexamethasone effects required previous protein synthesis.

Effect of the antiglucocorticoid agent RU 38486 on the dexamethasone inhibition of Friend cell differentiation

Glucocorticoid hormones are known to inhibit the erythroid differentiation of Friend cells. The mechanism of action of these hormones has been questioned, and results suggesting an action not involving the nuclear binding of the receptors have been published. We have used the antiglucocorticoid RU 38486 to block the inhibitory effect of dexamethasone on the induced differentiation of Friend cells. Our results strongly suggest a glucocorticoid action involving the binding of classical receptors to the cell nucleus.

Effect of thyroid hormones on postnatal fibrinogen levels in the rat

From normal adult values of about 2.4 g/l at birth, rat plasma fibrinogen levels decrease to a minimum between 10 and 30 days of age and increase again at the end of weaning. The values of fibrinogenemia measured with different methods (heat precipitation at 56 degrees C versus clotting time) disagree. These results are discussed in connection with the development of the hypothalamic-pituitary-thyroid axis.

Kinetics of dexamethasone binding to the glucocorticoid receptor of intact erythroid cells from rat fetal liver

The erythroid cells from the rat fetal liver have been shown to possess a receptor for glucocorticoids. In the present work, the characteristics of [3H]dexamethasone binding have been studied on intact cells, in order to minimize receptor degradation, and at 4 degrees C, in order to prevent the activation of the hormone-receptor complex. Dissociation kinetics were those of a first-order reaction and the value of the rate constant of dissociation was similar to the values available in the literature. When studied at low concentrations of the ligand and using short-term incubations, association kinetics were apparently those of a simple bimolecular reaction. But at high ligand concentrations and/or using long-term incubations, association kinetics indicated a more complex reaction. Our results were compatible with the model proposed by Pratt W.B., Kaine J.L. and Pratt V.D. (J. Biol. Chem. 250 (1975) 4584-4591) for cytosolic preparations. This model implies the rapid formation of a transient unstable form of the complex, further converted into a stable form with slower kinetics. Equilibrium dissociation constant of the first (rapid) reaction was 80 microM and the rate constant of 'stabilization' was of the order of 70 X 10(-3) min-1. These values agree with the results of Pratt et al. relative to a cytosolic preparation from rat thymocytes.

Evidence for glucocorticosteroid receptors in the erythroid cell line of fetal rat liver

A role for glucocorticosteroids in the evolution of the rat fetal liver erythropoiesis in vivo has been proposed; accordingly suppressible binding of [3H]dexamethasone by intact liver erythroid cells at 4 °C has been described. The nature of this binding was further investigated in the present paper. Suspensions of cells of the erythroid line were prepared from liver erythropoietic tissue obtained from fetuses aged 15 or 16 days. Suppressible binding of [3H]dexamethasone was studied on these suspensions. After incubation at 4 °C, approximately 89 per cent of this binding was located in the cytosol (100 000 g supernatant fraction), was excluded from Sephadex G-50 columns and was not adsorbed on activated charcoal; 11·3 ± 2·6 (s.d.) per cent (n = 4) of the suppressible binding was present in the nucleus. When cells prelabelled with [3H]dexamethasone at 4 °C were warmed to 37 °C, 52 ± 10 per cent (n = 5) of the suppressible binding was rapidly transferred to the nucleus. The suppressible radioactivity present in the cytosols at 4 °C was eluted from diethylaminoethyl (DEAE)–cellulose columns, in the presence of molybdate, as a single peak (peak II) at phosphate concentrations between 200 and 250 mmol/l. When these cytosols were warmed at 25 °C before chromatography, the radioactivity was eluted from DEAE-cellulose as a major peak (peak I) at phosphate concentrations between 50 and 70 mmol/l, and as a smaller peak corresponding to peak II. The presence of molybdate during the incubation at 25 °C prevented the formation of peak I. The suppressible binding present in the cytosols of cells incubated at 37 °C was eluted from DEAE–cellulose columns in two equivalent peaks corresponding to peaks I and II. It was concluded that [3H]dexamethasone was bound to a macromolecular component sharing the properties generally ascribed to the receptor of glucocorticosteroids.

Early erythropoiesis in foetal rat bone marrow: evidence for a liver-to-bone marrow relay

Erythropoietic activity of foetal rat femoral marrow was examined during the last four days of intra-uterine life. Insignificant at day 18, it develops slowly thereafter until birth. In the non-suckled neonate (not older than two hours), it appears notably enhanced. In order to test the potential of the foetal marrow to develop precocious or increased erythropoiesis, the activity of the erythropoietic organ predominant at this time, the liver, was altered by modifying the level of circulating corticosteroids, which govern its function. Maturation and involution of the hepatic erythron wee prevented by corticosteroid deprivation of the foetus (maternal adrenalectomy and foetal hypophysectomy). Precocious maturation and exhaustion of the hepatic erythron was induced by submitting foetuses to corticosteroids excess from day 14. Both corticosteroid deprivation and excess increase the erythropoietic activity of the femoral marrow. This activity can reach and even exceed by day 20 of intrauterine life that in neonatal marrow. Foetal hepatic erythron misfunction can therefore initiate and stimulate bone marrow erythropoiesis. The study of circulating red blood cells demonstrates that : (1) anaemia initiates medullary erythropoietic activity; (2) this anaemia is largely corrected by the bone marrow. The regulatory mechanism is presumably erythropoietin mediated.

Early erythropoiesis in foetal rat bone marrow: evidence for a liver-to-bone marrow relay

Erythropoietic activity of foetal rat femoral marrow was examined during the last four days of intra-uterine life. Insignificant at day 18, it develops slowly thereafter until birth. In the non-suckled neonate (not older than two hours), it appears notably enhanced. In order to test the potential of the foetal marrow to develop precocious or increased erythropoiesis, the activity of the erythropoietic organ predominant at this time, the liver, was altered by modifying the level of circulating corticosteroids which govern its function. Maturation and involution of the hepatic erythron were prevented by corticosteroid deprivation of the foetus (maternal adrenalectomy and foetal hypophysectomy). Precocious maturation and exhaustion of the hepatic erythron was induced by submitting foetuses to corticosteroids excess from day 14. Both corticosteroid deprivation and excess increase the erythropoietic activity of the femoral marrow. This activity can reach and even exceed by day 20 of intrauterine life that in neonatal marrow. Foetal hepatic erythron misfunction can therefore initiate and stimulate bone marrow erythropoiesis. The study of circulating red blood cells demonstrates that: (1) anaemia initiates medullary erythropoietic activity; (2) this anaemia is largely corrected by the bone marrow. The regulatory mechanism is presumably erythropoietin mediated.

Binding of glucocorticosteroids to hepatic erythropoietic cells of the rat fetus

A role for glucocorticosteroids in the evolution of the fetal liver erythron in vivo has been proposed. If direct, such an intervention implies the presence of receptor sites in the cells of the erythroid cell lines. To test this hypothesis cell suspensions were prepared from liver haematopoietic tissue obtained from rat fetuses aged 13, 14, 17 and 20 days. Their composition was determined by light microscopy. The populations consisted essentially of cells of the erythroid line: juvenile cell types (progenitor and basophilic cells) predominated in tissue collected at 13 and 14 days of gestation, more mature types (polychromatic and acidophilic cells) became more abundant at 17 and 20 days of gestation. Suppressible binding of glucocorticosteroid at 4 degrees C was studied on these suspensions, using [3H]dexamethasone. Binding sites were found at all stages of gestation studied. The mean number per cell (for the entire erythroid population) was roughly 3600, 3500, 2300 and 1700 at 13, 14, 17 and 20 days of gestation respectively, without any change in the apparent equilibrium dissociation constant (Kd:5.5 X 10(-9) to 6.5 X 10(-9) mol/l). Suspensions containing essentially progenitor cells were prepared from erythropoietic cells from livers obtained at 14 and 16 days of gestation, using a rabbit immune serum against rat erythrocytes in the presence of an excess of complement. These cells had 1800 and 1600 receptor sites per cell respectively (same Kd as above). No receptors were found on circulating adult or fetal erythrocytes. The results strongly suggest that there is an uneven distribution of the number of the glucocorticosteroid binding sites per cell amongst the different cell types of the erythroid line. These sites were present in progenitors, increased in number in the basophilic cells and then progressively disappeared as the cells matured.

Evolution of fibrinogen levels in rat fetal and maternal blood during gestation

Plasma fibrinogen levels increase during the last third of gestation in the pregnant rat. In the fetus, they are barely measurable at 18 days, increase rapidly thereafter and reach adult values just before birth, in a matter of 3 days.

Glucocorticoids and evolution of haemopoietic tissue in the liver of the rat foetus

The number of haematopoietic cells per unit of volume decreases after day 18 and falls rapidly until day 21. On day 21 it is reduced by three quarters as compared to the day 17 value. Maternal laparotomy causes, in the 24 h period following the operation, an anticipated and accelerated decrease. This effect is prevented by previous adrenalectomy. After maternal adrenalectomy, rat foetuses submitted to decapitation in utero, and therefore completely deprived of corticosteroids, do not present in their liver the involution of the haematopoietic tissue normally observed in their intact littermates. Cortisol administration restores the normal involution. These results show the importance of the role played by corticosteroids in the regulation of foetal liver hematopoietic function. The evolutions of proportions and frequencies of the different cellular types composing the haematopoietic tissue studied during normal pregnancy and after either overload or deprivation of corticosteroids, suggest that corticosteroids exert their action essentially at two levels of the maturation process. They decrease the ability of self-maintenance of the precursor cell pool and accelerate the maturation of the polychromatophilic cells, resulting in a progressive exhaustion of the haematopoietic tissue.

[Immuno-reactive insulin-like substances in the rat]

Chromatography on G50 or G100 sephadex column of rat plasma or serum divides up the insulin-like immunoreactive material into three peaks: monomere insulin, proinsulin and a fraction of molecular weight between 50 and 100,000. This fraction is virtually absent (less than 1%) from immunoreactive material extracted from the pancreas. Comparison of the results obtained by methods using double or simple antibodies (charcoal dextran) and study of fixation in vitro of labelled insulin, taken up by various plasma proteins, suggest that the high molecular weight material includes insulin more or less broken down and linked to proteins. Furthermore, when one uses a double antibody method, the alpha globulins and albumin in the rat present also an insulin-like reactivity. This disadvantage does not occur with the charcoal dextran method which is more specific.