New mechanism of oral immunity to mucosal candidiasis in hyper-IgE syndrome.

Oropharyngeal candidiasis (OPC, thrush) is an opportunistic infection caused by the commensal fungus Candida albicans. An understanding of immunity to Candida has recently begun to unfold with the identification of fungal pattern-recognition receptors such as C-type lectin receptors, which trigger protective T-helper (Th)17 responses in the mucosa. Hyper-IgE syndrome (HIES/Job's syndrome) is a rare congenital immunodeficiency characterized by dominant-negative mutations in signal transducer and activator of transcription 3, which is downstream of the Th17-inductive cytokines interleukin (IL)-6 and IL-23, and hence patients with HIES exhibit dramatic Th17 deficits. HIES patients develop oral and mucocutaneous candidiasis, supporting a protective role for Th17 cells in immunity to OPC. However, the Th17-dependent mechanisms of antifungal immunity in OPC are still poorly defined. An often unappreciated aspect of oral immunity is saliva, which is rich in antimicrobial proteins (AMPs) and exerts direct antifungal activity. In this study, we show that HIES patients show significant impairment in salivary AMPs, including ß-defensin 2 and Histatins. This tightly correlates with reduced candidacidal activity of saliva and concomitantly elevated colonization with Candida. Moreover, IL-17 induces histatins in cultured salivary gland cells. This is the first demonstration that HIES is associated with defective salivary activity, and provides a mechanism for the severe susceptibility of these patients to OPC.

[Somatosensory evoked potentials in a population with chronic lead poisoning]. / Potenciales evocados somatosensitivos en una población crónicamente intoxicada con plomo.

Eleven patients with chronic lead intoxication were submitted to somatosensory evoked potential (SEP) studies. All patients demonstrated increased lead blood levels and reduced ALA D activity in red blood cells. Three patients showed delayed spinal arrival (N13 wave), four delayed cortical arrival (N20 wave), and three prolonged central conduction time (time elapsing between N13 and N20 waves) (see table 1). No relationship was found between the abnormal findings and the levels of lead or ALA D. Time of intoxication was not related to the altered electrophysiological features either. The findings reported suggest that, beside the well known peripheral involvement in chronic lead intoxication, some patients may develop central nervous system impairment perhaps related to myelin involvement as suggested by the prolonged SEP central conduction time.

[Electrophysiological study of neuromuscular function in a population poisoned by lead]. / Estudio electrofisiológico de la función neuromuscular en una población intoxicada con plomo.

A comprehensive electrophysiological examination of the peripheral nervous system was carried out in 12 patients who proved to be toxicated with lead (high lead blood levels, and diminished activity of the delta-aminolevulinate dehydratase, ALA D, in erythrocytes). Maximal motor nerve conduction velocities and terminal latencies were investigated in the median, radial and deep peroneal nerves. Also the amplitude of the evoked muscle response (M wave) was measured in thenar, extensor longus and extensor digitorium brevis muscles. Sensory conduction velocity and amplitude of the nerve compound action potential were measured at the median nerve. Tibialis anterior muscle responses to deep peroneal nerve repetitive stimulation were also explored. Conventional needle electromyogram was performed in the deltoid and tibialis anterior muscles. Slight diminished motor and sensory conduction velocities were found as well as a reduction of the amplitude of the evoked muscle response of the compound sensory action potential. Four out of the 12 patients tested showed either decremental or incremental amplitude of the muscle response with nerve repetitive stimulation. A electromyographical diminished interference pattern was found in all patients tested. Most of the remaining motor unit potentials were fragmented or polyphasic. Just one patient disclosed potentials of enhanced duration and amplitude. No relationship was found between blood lead levels or ALA D erythrocytes concentration and the different electrophysiological tests performed, except between reduced ALA D concentration and diminished amplitudes of the M wave and of the sensory compound action potential, and also between ALA D and diminished radial motor conduction velocity.(ABSTRACT TRUNCATED AT 250 WORDS)

S-adenosyl-L-methionine and lead intoxication: its therapeutic effect varying the route of administration.

A comparative study on the effect of oral and subcutaneous (sc) or intravenous (iv) administration of S-adenosyl-L-methionine (SAM) in lead poisoning was carried out. SAM was given daily sc (20 mg/kg) and orally (80 mg/kg) to acute lead-intoxicated mice for 20 days. Chronic lead-poisoned patients received SAM, administered intravenously at a daily dose of 12 mg/kg or orally at a dose of 25-30 mg/kg. Independent of the method of administration in either animals or patients, GSH concentration in reduced lead intoxication was increased after SAM dosing. Corresponding blood lead content rapidly decreased and a significant recovery of hepatic and erythrocytic delta-aminolevulinate dehydratase (ALA-D), initially reduced, was clearly produced in the groups receiving SAM, although the response was slightly slower when SAM was given orally. It was found that the bulk of body lead burden was excreted in the feces, showing a peak within the first 24-48 hr and being much greater in animals treated with SAM. In these cases, urinary lead excretion was very low. Lead ALA-D inhibition was also evidenced by elevated urinary excretion of delta-aminolevulinic acid (ALA), porphobilinogen (PBG), and porphyrins. During treatment, precursors and porphyrins elimination declined, reaching normal levels soon after therapy ended. A good correlation between the recovery of both GSH levels and ALA-D activity and decreased lead content was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Beneficial effect of S-adenosyl-L-methionine in lead intoxication. Another approach to clinical therapy.

Five patients with chronic lead intoxication were treated with S-adenosyl-L-methionine (12 mg/kg body weight, daily), given intravenously, over a period of 22 days. A significant recovery of erythrocytic ALA-D was observed in all cases, after therapy. Blood lead content significantly pathologic at the beginning of SAM administration, rapidly decreased within 24-48 h of initiating treatment, reaching nearly control values at the end of the trial. A good correlation between recovery of ALA-D activity and decreased concentration of lead in RBC was found. GSH content in blood was diminished in lead poisoned patients, increasing to normal levels after SAM administration. Other biochemical parameters such as Deaminase activity in RBC, ALA, PBG, porphyrins and lead in urine and serum gamma-GT were measured, showing no important deviations from control values before, during or after treatment. Both biochemical and clinical improvement was observed, indicating that SAM therapy is beneficial in the treatment of lead intoxication. No untoward signs were observed. The mechanism of action of SAM is not yet clear; however, a chelating effect could be excluded, and very likely its action can be attributed to glutathione availability.

Enzyme replacement therapy in porphyrias--IV. First successful human clinical trial of delta-aminolevulinate dehydratase-loaded erythrocyte ghosts.

A patient with chronic lead intoxication was treated with only one course of highly purified human blood aminolaevulinate dehydratase entrapped in autologous erythrocyte ghosts given intravenously. No untoward effects were observed during or after infusion. An immediate increase in the patient's erythrocyte dehydratase activity was detected 1 hr after enzyme administration, reaching its maximum and nearly normal level 2 days later, values remained unchanged for a week, to slowly diminish after 2 weeks of initiated the treatment, and finally recovered activity was kept practically leveled off for weeks. This novel therapeutic trial produced complete improvement both clinical and biochemical, showing that enzyme infusion has been beneficial and can be safely and successfully used in the treatment of human lead intoxication.