Profile of soluble cytokine receptors in Crohn's disease

INTRODUCTION

Soluble cytokine receptors (sCRs) modulate the in vivo activity of cytokines. Deficient sCR production could participate in the pathogenesis and course of Crohn's disease (CD). The aim of the study was to examine the profile of sCRs in CD patients and their modulation by infliximab and corticosteroids.

METHODS

We prospectively examined active CD patients (aCD) treated with either infliximab (n = 21) or corticosteroids (n = 9), CD patients in clinical remission (rCD, n = 20), ulcerative colitis patients (UC, n = 24), and healthy subjects (HS, n = 15). Cultures of colonic biopsies were also examined from CD inflamed (n = 8), CD non-inflamed (n = 7), and healthy mucosa (n = 8). Levels of tumour necrosis factor alpha (TNF-alpha), soluble TNF receptor I (sTNFRI), soluble TNF receptor II (sTNFRII), interleukin 1beta (IL-1beta), soluble IL-1 receptor I (sIL-1RI), soluble IL-1 receptor II (sIL-1RII), IL-6, soluble IL-6 receptor (sIL-6R), and sgp130 were measured using ELISA.

RESULTS

Higher levels of sTNFRI (p<0.05, p<0.01), sTNFRII (p<0.01, p<0.01), sIL-1RI (p<0.05, NS), IL-6 (p<0.01, p<0.01), and sIL-6R (p<0.05, NS) were observed in aCD compared with rCD and HS. Interestingly, sIL-1RII (p<0.05, p<0.01) and sgp130 (p<0.01, p<0.01) were profoundly decreased in aCD compared with rCD and HS, and were negatively correlated with CRP. Deficient production of sIL-1RII was specific to CD (not observed in ulcerative colitis), and was further confirmed at the mucosal level. Infliximab decreased sTNFRII at one and four weeks (p<0.05) and enhanced sIL-6R levels at one week (p<0.05). Corticosteroids increased sIL-1RII levels at one week (p<0.05).

CONCLUSION

CD is associated with dysregulated production of sCRs. Deficiency in sIL-1RII and sgp130 may be essential to CD pathogenesis. Their replacement through the use of fusion proteins could represent future alternative therapeutic strategies for CD.

[Apprenticeship in radiology at the University Hospital Center in Grenoble: research on the most effective methods]

From analyses of strengths and weaknesses of the apprenticeship of radiology in France, of existing pedagogic methods, of time constraints within clinical settings and of scientific theories of teaching and learning, the authors define objectives that teaching should target and propose a new method of instruction problem and practise-based. The method appears applicable in French radiology departments. It should forster early acquisition by residents of professional attitudes and way of thinking, and make them active self-directed learners.

Tumour necrosis factor (TNF) gene polymorphism influences TNF-alpha production in lipopolysaccharide (LPS)-stimulated whole blood cell culture in healthy humans

TNF-alpha is involved in infectious and immuno-inflammatory diseases. Different individuals may have different capacities for TNF-alpha production. This might determine a predisposition to develop some complications or phenotypes of these diseases. The aims of our study were to assess the inter-individual variability of TNF-alpha production and to correlate this variability to a single base pair polymorphism located at position -308 in TNF gene. We studied 62 healthy individuals. TNF-alpha production after LPS stimulation was evaluated using a whole blood cell culture model. The TNF gene polymorphism was studied by an allele-specific polymerase chain reaction. Other cytokines produced in the culture, soluble CD14 concentrations and expression of CD14 on blood cells were also measured. Among the 62 individuals, 57 were successfully genotyped. There were 41 TNF1 homozygotes and 16 TNF1/TNF2 heterozygotes. TNF-alpha production after LPS stimulation of whole blood cell culture was higher among TNF2 carriers than among TNFI homozygotes (929pg/ml (480-1473pg/ml) versus 521 pg/ ml (178-1307 pg/ml); P<0.05). This difference was even more significant after correction of TNF-alpha production for CD14 expression on blood cells. In conclusion, the single base pair polymorphism at position -308 in the TNF gene may influence TNF-alpha production in healthy individuals.

[Clinical case of the month. Hepatoportal sclerosis in a patient treated with azathioprine]

We report a case of hepatoportal sclerosis in a renal transplant patient treated with azathioprine. The initial symptom was ascites. On the biochemical level, there were cholestasis without cytolysis or hepatocellular insufficiency. A presinusoidal portal hypertension was found on haemodynamic studies, without portal thrombosis at CT-scan. A diagnosis of hepatoportal sclerosis was evoked on histology and attributed to azathioprine. This case gives an illustration of a classical albeit rare complication of azathioprine. The indolent pattern of the disease and the risk of variceal bleeding point out the need for a hepatic follow-up during the treatment.

Scintigraphic cerebral spinal fluid leak study in a child with recurrent meningitis after resection of a frontal meningocele

An In-111 DTPA cerebrospinal fluid (CSF) leak study was performed on a 3-year-old boy admitted with recurrent meningitis. He was born with a congenital encephalocele that was surgically resected at 7 days-of-age. A residual skull floor defect with a recurrent tumor of the nasal radix was clinically suspected. Computed tomography and MRI scans could not confirm or rule out the presence of a CSF leak. The scintigraphic study clearly demonstrated a leak into the left naris. A large leptomeningeal cyst extending down into the left nares was resected and a defect in the left frontal calvarium, identified as the source of the CSF leak, was repaired at surgery.

Lack of effect of peroral acyclovir for the treatment of acute infectious mononucleosis

Perorally administered acyclovir was evaluated in the therapy of acute infectious mononucleosis in a multicentered, randomized, double-blind, placebo-controlled trial. A total of 120 patients received 600 mg of acyclovir or placebo five times daily for 10 days. All patients were entered into the study within 7 days of symptom onset and had a positive Monospot test. Analysis of mean values and time to resolution of fever, lymphadenopathy, weight change, hepatomegaly, splenomegaly, liver function tests, atypical lymphocytes, hours of bed rest, sense of well-being, and return to normal activities revealed no significant differences. There was a trend toward suppression of Epstein-Barr virus excretion in the oropharynx in acyclovir recipients. No toxicity was detected in patients treated with acyclovir. Under the conditions of the study, there was no evidence that treatment with perorally administered acyclovir affected the course of infectious mononucleosis.

Cutaneous lupus treated with topical tretinoin: a case report

We present a case of hypertrophic lupus erythematosus treated with topical tretinoin. To date, we believe this is the first description of such treatment of this disease.

Chronic suppression for six months compared with intermittent lesional therapy of recurrent genital herpes using oral acyclovir: effects on lesions and nonlesional prodromes

Forty-seven patients with frequently recurrent genital herpes were treated with 200 mg of acyclovir or placebo capsules taken orally three times daily for six months; the drug was then withdrawn. Active lesional events were treated with open-labeled 200-mg acyclovir capsules five times daily for five days during the six months of suppression and for six months thereafter if the patient returned to the clinic for culture and treatment. During the six months of treatment, seven of 24 acyclovir recipients and none of 23 placebo recipients reported no lesions (P less than 0.01), while 17 of 24 acyclovir and none of 23 placebo recipients failed to return for lesion assessment (P less than 0.0001). The median time to first recurrence was 72 days in the acyclovir recipients vs. 14 days in placebo recipients (P less than 0.0001). Home-recorded prodromes without lesion development were common in both groups but occurred more often in the acyclovir-treated group (P less than 0.05). During follow-up all patients experienced lesional episodes, and no differences could be detected between the acyclovir- and the placebo-treated groups. Resistance to acyclovir was not encountered either before, during, or after suppression by this drug. Adverse events were not significantly different between the groups. We conclude that suppression by oral acyclovir of frequently recurrent genital herpes remains effective for at least six months. Nonlesional prodromes have undetermined significance but are more common during acyclovir suppression.

Dihydrofolate reductase: thymidylate synthase, a bifunctional polypeptide from Crithidia fasciculata

The molecular weight of dihydrofolate reductase (5,6,7,8-tetrahydrofolate:NADP+ oxidoreductase, EC 1.5.1.3) from protozoa has been reported to be 5- to 10-fold larger than the isofunctional enzyme of most other organisms studied, based on gel filtration. This enzyme from the protozoal flagellate Crithidia fasciculata has been purified to homogeneity and found to be a bifunctional protein with thymidylate synthase (5,10-methylene tetrahydrofolate:dUMP C-methyltransferase, EC 2.1.1.45) activity. The purified protein, eluted from methotrexate-Sepharose columns by dihydrofolate, migrated as a single band on both nondenaturing and denaturing polyacrylamide gel electrophoresis. The monomer Mr is 56,700 +/- 200. The native Mr was calculated to be 107,000 from a sedimentation coefficient of 5.9 and Stokes radius of 4.4 nm. Dihydrofolate reductase and thymidylate synthase activities of the rodent malaria organism Plasmodium berghei also copurified on Sephadex G-200 and methotexate-Sepharose columns, suggesting that this unique bifunctional protein might occur throughout the Protozoa.