Arterial stiffness indexes and serum cytokine levels in seronegative spondyloarthritis: relationships between stiffness markers and metabolic and immunoinflammatory variables.

OBJECTIVE: The aim of this study was to investigate the relationship between immunoinflammatory markers and indexes of arterial stiffness in patients with seronegative spondyloarthritis (SpA). METHOD: We enrolled consecutive patients with inflammatory seronegative SpA referred to a rheumatology outpatient clinic. Control subjects were patients admitted in the same period for any cause other than chronic inflammatory disease or acute cardiovascular and cerebrovascular events. Carotid-femoral pulse wave velocity (PWV) was measured and the aortic pressure waveform was used to calculate the augmentation index (Aix). We also evaluated plasma levels of C-reactive protein (CRP), interleukin (IL)-1ß, tumour necrosis factor (TNF)-α, and interleukin (IL)-6 as markers of immunoinflammatory activation. RESULTS: This study enrolled 53 patients with SpA and 55 control subjects. After adjustment for blood glucose, cholesterol, and triglyceride levels, and systolic (SBP) and diastolic blood pressure (DBP), patients with seronegative SpA showed higher mean PWV and Aix compared to controls. Moreover, in patients with seronegative SpA, we observed higher mean plasma levels of IL-6, IL-1ß, and TNF-α in subjects with mean PWV > 8 m/s in comparison with those with PWV < 8 m/s. Multivariate analysis revealed a significant association between PWV > 8 m/s and male gender, age, diabetes, hypertension, low density lipoprotein cholesterol (LDL-C) > 120 mg/dL, total cholesterol (TC) > 200 mg/dL, coronary artery disease (CAD), microalbuminuria, carotid plaque, and plasma levels of IL-6, IL-1ß, and TNF-α. CONCLUSIONS: These findings emphasize the role of inflammatory variables and metabolic factors in indexes of high arterial stiffness. Thus, an inflammatory-metabolic background may influence the pathogenesis of increased arterial stiffness in seronegative inflammatory arthritis.

The in vitro addition of methotrexate and/or methylprednisolone determines peripheral reduction in Th17 and expansion of conventional Treg and of IL-10 producing Th17 lymphocytes in patients with early rheumatoid arthritis.

The aim of our study was to evaluate methotrexate (MTX) and methylprednisolone (MP) effect on peripheral Th17 and Treg subsets in patients with rheumatoid arthritis (RA). We enrolled 15 patients (10 early RA and 5 long-standing disease) with active RA and 10 age-matched healthy donors as controls. Frequencies of Th17 and Treg were quantified using flow cytometry before and after in vitro addition of MTX, MP or both drugs. Our results showed a reduction in the overall Th17 population followed by an increase in Th17 IL-10(+) and Treg, after in vitro treatment of PBMCs with the drugs in patients with early RA. Long-standing disease patients showed a less evident increase in Treg cells and less enhancement of IL-10 Th17 cells. We suggest that the treatment with MTX and MP could ameliorate RA disease activity by normalizing the distribution/imbalance of Th17/Treg and indicate a new regulatory role of IL-17(+) cells in RA patients.

Giant cell arteritis associated with chronic active Epstein-Barr virus infection.

Giant cell arteritis is an inflammatory vasculopathy that preferentially affects medium-sized and large arteries. A viral cause has been suspected but not confirmed in polymyalgia rheumatica and giant-cell arteritis. We report the case of a 81-year-old female who suffered from chronic active Epstein-Barr virus infection and developed giant cell temporal arteritis.

Tryptophan catabolism via kynurenine production in Streptomyces coelicolor: identification of three genes coding for the enzymes of tryptophan to anthranilate pathway.

Most enzymes involved in tryptophan catabolism via kynurenine formation are highly conserved in Prokaryotes and Eukaryotes. In humans, alterations of this pathway have been related to different pathologies mainly involving the central nervous system. In Bacteria, tryptophan and some of its derivates are important antibiotic precursors. Tryptophan degradation via kynurenine formation involves two different pathways: the eukaryotic kynurenine pathway, also recently found in some bacteria, and the tryptophan-to-anthranilate pathway, which is widespread in microorganisms. The latter produces anthranilate using three enzymes also involved in the kynurenine pathway: tryptophan 2,3-dioxygenase (TDO), kynureninase (KYN), and kynurenine formamidase (KFA). In Streptomyces coelicolor, where it had not been demonstrated which genes code for these enzymes, tryptophan seems to be important for the calcium- dependent antibiotic (CDA) production. In this study, we describe three adjacent genes of S. coelicolor (SCO3644, SCO3645, and SCO3646), demonstrating their involvement in the tryptophan-to-anthranilate pathway: SCO3644 codes for a KFA, SCO3645 for a KYN and SCO3646 for a TDO. Therefore, these genes can be considered as homologous respectively to kynB, kynU, and kynA of other microorganisms and belong to a constitutive catabolic pathway in S. coelicolor, which expression increases during the stationary phase of a culture grown in the presence of tryptophan. Moreover, the S. coelicolor ΔkynU strain, in which SCO3645 gene is deleted, produces higher amounts of CDA compared to the wild-type strain. Overall, these results describe a pathway, which is used by S. coelicolor to catabolize tryptophan and that could be inactivated to increase antibiotic production.

Long-term anti-tumour necrosis factor therapy reverses the progression of carotid intima-media thickness in female patients with active rheumatoid arthritis.

The objective of the study is to evaluate the effect of TNF inhibition on carotid thickness over a 2-year period. 144 women with RA diagnosed according to ACR criteria, without clinical evidence of cardiac and/or vascular disease were enrolled and compared with 78 matched controls. All patients received methotrexate (15­20 mg weekly) for 3 months. Responders (n = 79) continued to be treated with methotrexate, non-responders (n = 40) moved to methotrexate plus a TNF alpha antagonist. Echosonographic studies of carotids were obtained before and after 2-year follow-up. A significant decrease of ca-IMT was observed in anti-TNF-treated patients (P < 0.001); on the other hand, no significant variation of ca-IMT was observed after 2 years in MTX-treated patients. Our study indicates that anti-TNF blocking agents, but not methotrexate, are capable of reducing IMT of carotid arteries in female RA patients in a 2-year follow-up.

Blocking TNF in vitro with infliximab determines the inhibition of expansion and interferon gamma production of Vgamma9/Vdelta2 T lymphocytes from patients with active rheumatoid arthritis. A role in the susceptibility to tuberculosis?

BACKGROUND: Side effects of TNF neutralisation - mostly infectious complications - were recognized, the most important being pulmonary tuberculosis infections. gamma/ d T cells contribute to protective immune response against mycobacterium tuberculosis. OBJECTIVES: The aim of the present study was to assess the expansion capacity of Vgamma9/Vdelta2 T cells from (tuberculin purified protein derivative (PPD) positive and PPD negative) patients with active rheumatoid arthritis (RA), and to examine the in vitro effect of infliximab on this lymphocyte subset. METHODS: 28 PPD negative RA patients were studied and compared with 14 PPD positive RA patients, 45 PPD-negative and 110 PPD-positive healthy volunteers. Cell separation, expansion in vitro of Vgamma9/Vdelta2 T lymphocytes (EF) and the expression of tumor necrosis factor receptor II and IFN-gamma content by Vgamma9/Vdelta2 T lymphocytes were studied before and after infliximab in vitro addiction. RESULTS: The EF from PPD positive subjects was higher than that from PPD negatives. Patients with RA have the highest levels. The addition of infliximab to the cultures from PPD-positive patients determined a significant inhibition of cell expansion and TNF RII expression and a significant decrease of IFN gamma content. CONCLUSION: In this study we have documented that gamma/ delta T lymphocytes from patients with PPD positive rheumatoid arthritis have a high capacity to respond in vitro to phosphoantingens with expansion TNF-RII expression and IFN gamma production that is inhibited by the exposure to infliximab. These results might be of relevance in view of the effect of TNF blocking on the pulmonary tuberculosis infection.

Pentoxifylline inhibits Vgamma9/Vdelta2 T lymphocyte activation of patients with active Behçets disease in vitro.

The aim of this study is to evaluate the in vitro effect of pentoxifylline (PTX) on T Vgamma9/Vdelta2 lymphocyte function in Behçets disease (BD). We investigated the effect of PTX on Vgamma9/Vdelta2 T cell expansion and expression of TNFRII receptor and perforin content before and after PTX addition by means of FACS analysis lymphocyte cultures from patients with active and inactive BD and healthy subjects. The addition of PTX at a concentration of 1 mg/ml determined a significant inhibition of cell expansion, a down regulation of TNF receptor expression and inhibited the PMA-induced degranulation of perforin. Taken together these data indicate that PTX is capable of interfering with Vgamma9/Vdelta2 T cell function in BD, and although cell culture models cannot reliably predict all of the potential effects of the drug in vivo, our results encourage the possibility that this drug may find use in a range of immunological disorder characterized by dysregulated cell-mediated immunity.

Noninvasive testing for coronary artery disease in women.

Coronary artery disease is a major cause of morbidity and mortality for women in North America and Europe. Given the significance of coronary disease as a public health problem among women, accurate diagnosis of this condition is of great importance. Several noninvasive testing modalities are available for the diagnosis of coronary heart disease. An understanding of gender-based differences related to noninvasive cardiac testing is useful in order to optimally utilize these tests and improve detection and clinical outcomes in women.

Identification of SCP2165, a new SCP2-derived plasmid of Streptomyces coelicolor A3(2).

AIMS: Characterization of SCP2165, a plasmid identified in the Gram-positive bacterium Streptomyces coelicolor A3(2). METHODS AND RESULTS: Pulsed-field gel electrophoresis (PFGE) of mycelia of a S. coelicolor strain embedded in low melting agarose revealed the presence of a plasmid. Restriction enzyme mapping and sequence analysis of a 2.1 kb fragment revealed that this plasmid could be SCP2. SCP2 and its spontaneous derivative SCP2* are self-transmissible plasmids and have chromosome mobilizing ability (c.m.a.). SCP2* has a c. 1000-fold increased c.m.a. compared with SCP2. Interestingly the plasmid, named SCP2165, shows a c.m.a. from 5x10(-2) to 1x10(-1) which is 50-100-fold higher than that described for crosses involving SCP2*. CONCLUSIONS: SCP2165 is a SCP2 derivative plasmid with the highest c.m.a. so far described for SCP2 derivative plasmids. PFGE, under conditions we used, seems to be a fast way to identify large circular plasmids in Streptomyces strains. SIGNIFICANCE AND IMPACT OF THE STUDY: Further knowledge of the SCP2 family may allow the construction of improved SCP2-derived cloning vectors. SCP2165 could be a potential tool for conjugational transfer of gene clusters between different Streptomyces species.

The level of soluble Granzyme A is elevated in the plasma and in the Vgamma9/Vdelta2 T cell culture supernatants of patients with active Behçet's disease.

OBJECTIVE: Gramzyme A (GrA) is a serine proteinase with trypsin-like activity that is released extracellularly during the degranulation of cytotoxic cells. Among the cytotoxic cells, gamma/delta T cells participate in the early phases of the immune response and are known to express perforin and granzymes constitutively in agreement with their cytolytic pontential. METHODS: GrA activity was detected using the synthetic substrate N-alpha-benzyloxycarbonyl-L-lysine thiobenzyl ester in the plasma and supernatants of peripheral blood mononuclear cell cultured in the presence of Dimethylallyl pyrophosphate to obtain Vgamma9/Vdelta2 T cell expansion. RESULTS: Significantly high levels of GrA were found in the serum and supernatants of lymphocytes from patients with active Behçet's disease cultured in the presence of DMAPP. Levels were found to be significantly lower after remission. A positive correlation was observed between GrA levels in the supernatants and the Vgamma9/Vdelta2 T cell expansion factor. CONCLUSION: These results strongly suggest that Vgamma9/Vdelta2 T cells are active participants in the pathogenesis of the disease through their degranulation and granzyme release.

Shuttle walking test and 6-minute walking test induce a similar cardiorespiratory performance in patients recovering from an acute exacerbation of chronic obstructive pulmonary disease.

BACKGROUND: The incremental shuttle walking test (SWT) has recently been proposed as a more valid and reproducible alternative to the conventional 6-min walking test (6MWT) in the evaluation of exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE: To compare the cardiorespiratory performance obtained during two sessions of SWT with that obtained during two sessions of 6MWT. METHODS: We examined 18 patients (forced expiratory volume in 1 s: 48 +/- 14%) recovering from an acute exacerbation of COPD that had required hospitalization. In the same afternoon, each patient performed two SWT and two 6MWT, with an interval of at least 30 min between each test; the sequence of the tests was randomized. RESULTS: Mean walking distance was greater in the second SWT test than in the first SWT. The changes from baseline in systolic blood pressure, heart rate, respiratory rate, oxygen saturation and dyspnea Borg index at the end of the test were similar between the two 6MWT and the two SWT. There was a highly significant correlation between walking distances measured during SWT and during 6MWT (rho: 0.85, p < 0.0005). Neither SWT nor 6MWT correlated with functional data of COPD. CONCLUSIONS: SWT, though being considered to be closer to a submaximal exercise test than 6MWT, does not induce a greater cardiorespiratory performance than 6MWT in patients recovering from acute exacerbation of COPD.

Reduced bactericidal activity against Staphylococcus aureus and Pseudomonas aeruginosa of blood neutrophils from patients with early adult respiratory distress syndrome.

This study investigated the bactericidal capability of circulating neutrophils from blunt trauma patients admitted to an Intensive Care Unit against Staphylococcus aureus and Pseudomonas aeruginosa. Among those patients, two groups were considered and compared: patients who developed adult respiratory distress syndrome (ARDS) and patients who developed only pneumonia. Peripheral blood samples were drawn as soon as a diagnosis of pneumonia or ARDS was made, followed by the isolation of neutrophil cells and assessment of bacteria phagocytosis and killing. The results demonstrated that in patients with ARDS, phagocytosis and killing efficiency were significantly impaired in comparison with patients with pneumonia and healthy controls. A possible dysregulation of reactive oxygen species production involving the release of humoral mediators in early ARDS may be involved.

Acyclic stereoselection in the reaction of nucleophilic reagents with chiral N-acyliminium ions generated from N-

Optically active N-[1-(phenylsulfonyl)alkyl]imidazolidin-2-ones react at low temperature in the presence of tin tetrachloride to give acyclic N-acyliminium ions. These electrophilic substrates give addition products upon reaction with pi-nucleophiles. Allyltrimethylsilane affords the corresponding allylated products in good yields and high diastereoselectivity. The stereochemical outcome of this process can be rationalized by taking into account the preference of the intermediate N-acyliminium ion for an E configuration that favors the attack of the nucleophile from the si-si face. Disappointing results are obtained using silyl ketene acetals; conversely trimethylsilyl enol ether of acetophenone gives the corresponding adducts in high diastereoselectivity. The utilization of trimethylsilyl enol ether of 2-acetylfuran is particularly interesting since the corresponding adducts are obtained with good diastereoselectivity and the furan ring could be amenable of further synthetic transformations.

General anesthesia mode does not influence endocrine or immunologic profile after open or laparoscopic cholecystectomy.

To verify the impact on stress response and the influence of anesthesia on endocrine/immunologic changes, we have investigated the plasma level of norepinephrine, cortisol, TNFalpha, and IL-6 in 46 patients scheduled for laparotomy and laparoscopic cholecystectomy at 2, 6, 12, and 24 h after the operation. Among subjects who underwent open approach, 9 received fentanyl anesthesia and 13 received isoflurane anesthesia. In the laparoscopy group, 14 patients were given fentanyl anesthesia and 10 were given isoflurane anesthesia. The results obtained confirmed that laparoscopic cholecystectomy is associated with a lesser immunoendocrine response, and the two anesthesia models do not interfere with plasma changes of the assessed hormones and cytokines.

[L-arginine and immunity. Study of pediatric subjects]. / L-arginina e immunità. Studio in soggetti pediatrici.

BACKGROUND: Nitric oxide (NO) play a pivotal role in many biological processes, as in the vessel tone control, the atherogenesis, the platelets aggregation and the immune system modulation. The physiologic precursor of NO is the L-arginine. Evidence exists that the L-arginine administration can stimulate immune system in children with recurrent infections. This clinical trial was designed to evaluate the effects of oral administration of L-arginine on the number of infective events and on the lymphocytes subsets in children suffering from airways recurrent infections. METHODS: Forty outpatients, 21 male and 19 female, aging from 2 to 13 yrs. Two balanced groups, treated for 60 days with L-arginine or a placebo. Evaluation criteria: number of septic episodes; number of circulating white blood cells, % of the lymphocytes; lymphocytes subsets. STATISTICAL ANALYSIS: Descriptive analysis; inference tests: chi 2; "t" test; variance analysis. Statistical significance: p = 0.05. RESULTS: Fifteen patients treated with L-arginine and five treated with placebo (p < 0.01) were free from infections. The percentage of CD3 and CD4 subsets significantly (p < 0.05) increased in the L-arginine group than in the placebo group, while the CD8 subset significantly decreased. The CD4/CD8 ratio raised from 1.05 +/- 0.29 to 1.51 +/- 0.46 (p < 0.01) in the L-arginine group, from 1.12 +/- 0.16 to 1.27 +/- 0.24 in the placebo group. There were no side effects in both groups. CONCLUSIONS: L-arginine seems able to increase the immune system defences and to protect against the airway infections.

[HIV infection: results of 4 years of observation (May 1984-May 1988)- of the admitting department of the V. Cervello Hospital in Palermo]. / L'infezione da HIV: risultati di quattro anni di osservazioni (maggio 1984-maggio 1988) presso il centro operativo dell'Ospedale "V. Cervello" di Palermo.

During a period of four consecutive years (1984-1988) more than one thousand of serum samples were obtained from different "at risk" categories of patients with the aim to investigate on the prevalence of anti-HIV antibodies in these populations. Also HIV antigen and HBV markers were investigated in the same people. Some of them were followed up to monitor the various HIV markers and to cultivate biological material from symptomatic cases. All serological investigations were carried out by means of ELISA methods and the Western Blot technique, to confirm positive results. Data obtained from this study showed that: 1. in our area anti-HIV positive people prevail among intravenous drug addicts (IVDA) (42-48%) in contrast to 3.3% of homosexuals, and in 14-16% of subjects or patients declaring themselves "at risk" without stating what of risk it is. 2. HIV antigen was demonstrated in 5% of symptomatic IVDA patients but only in two cases of anti-HIV negative people. 3. HBV markers were found in all categories examined, prevailing in IVDA subjects (72%). 4. Five percent only of anti-HIV negative people followed up through 2-36 mo. seroconverted while only 39.7% of anti-HIV positive people showed an HIV markers variation (increase, decrease or disappearance) in different periods of time (1-8 mo.). 5. Opportunistic infections were observed in 50% of symptomatic patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Microbiological investigations on genital infections: a nosocomial experience in Palermo.

The new methods for in vitro fertilization and GIFT induced the authors to carry out a retrospective survey on microbiological investigations done on 820 patients (641 women and 179 men) affected with genital infections and 62 newborns hospitalized during the period 1980-1986 to the aim of studying the prevalence of the various microorganisms responsible for sexually transmitted diseases in our area. The biological material obtained from men gave positive results less frequently than that obtained from women (p less than 0.001) although the prevalence of "significant" microorganisms isolated from the same material was overlapping for both sexes (p greater than 0.5). Chlamydia trachomatis positive samples were rare in men (6.1%) as well as in women (4.2%); in one case C. trachomatis was contemporaneously observed in the auricular swab of a newborn and from the cervical swab of the mother. Herpes Simplex virus positive samples were observed in 4 (11.8%) out of 36 women only. This study confirms the usefulness of the microbiological investigation before undertaking attempts for in vitro fertilization.