ANCA: serology in Wegener's granulomatosis.

BACKGROUND AND OBJECTIVES: Wegener's granulomatosis (WG) is being increasingly diagnosed in India, which exists in two forms, the 'limited Wegener's granulomatosis' (LWG) having upper respiratory tract (URT) and lower respiratory tract (LRT) involvement and the 'classical Wegener's granulomatosis' (CWG), with the triad of URT, LRT involvement along with kidney involvement. Cytoplasmic ANCA (C-ANCA) or anti-Proteinase3 (anti-PR3), which is highly diagnostic for WG, rarely perinuclear ANCA (P-ANCA) may exist. AIMS: To detect anti-neutrophil cytoplasmic antibodies (ANCA) and correlate it with serological, hematological parameters, and the Birmingham Vasculitis Activity Score (BVAS). SETTINGS AND DESIGN: Twenty-three clinically and histopathologically proven WG (16 CWG, 7 LWG) were studied. MATERIAL AND METHODS: C-ANCA and P-ANCA patterns were identified by immunofluorescence and specificities were confirmed by 'alpha granule' enzyme linked immunosorbent assay (ELISA), anti-PR3, anti-MPO (myeloperoxidase) and anti-Lactoferrin (anti-LF) by ELISA. RESULTS: LRT involvement was seen in 91.3%, URT in 78.3%, and renal manifestations in 69.6% cases. The BVAS in CWG was significantly higher than BVAS in the LWG. Decreased hemoglobin, increased WBC counts, ESR, CRP and Creatinine were seen in CWG as compared to LWG. The C-ANCA was present in 65.2% patients and P-ANCA in 13% cases. Anti-PR3 was seen in 69.6% patients and anti-LF in 17.4% cases. Severity of disease and ANCA was higher in CWG than in LWG. CONCLUSIONS: Vasculitis syndromes are known to overlap and many go undetected; therefore ANCA testing, along with the clinical and histopathological observations may be helpful in early detection and management of WG cases.

Effect of acute inflammatory response to maximal and submaximal exercise on iron-related indices

Twenty male subjects were studied to evaluate the effect of inflammatory response on iron status after maximal and submaximal exercises aiming to identify the appropriate intensity with minimal effect on iron status. The resting levels of the iron related indices were within normal range, whereas, after submaximal and maximal exercises, a fall in serum iron [-28.23%+15.31, - 27.4%+10.14], percent transferrin saturation [-25.71% +/- 12.5, - 33.77% +/- 13.65] and serum ferritin [-2.46% +/- 6.32, - 3.66% +/- 5.63] and a rise in the white cell count [59.5% +/- 13.31, 74.59%+10.12] with release of lactoferrin [73.47% +/- 27.28, 88.6+27.94] were noted. These changes were attributed to the known actions of interleukin-1 [IL-1] being one of the mediators of acute inflammatory reaction as evidenced by the positive correlations found between interleukin-1 and lactoferrin levels both after submaximal and maximal exercises. Moreover, positive correlation was observed between minute oxygen consumption [VO[2]] and [IL-1] level after both types of exercises denoting that the more the subject is fit the more he withstands the tissue hypoxia. The percent changes in serum lactoferrin, white blood cells and interleukin-1 due to maximum exercise were significantly higher when compared with the corresponding values after submaximal exercise. We conclude that although both maximal and submaximal exercises stimulate the acute phase response, yet the submaximal exercise exerts a less harmful effect on iron indices