PUVA and cancer risk: the Swedish follow-up study.

There is concern about the long-term carcinogenic effects of psoralen and ultraviolet A radiation (PUVA) for treatment of skin disorders. Many authors have found an increased risk for cutaneous squamous cell carcinoma (SCC). Except in anecdotal reports, malignant melanoma had not been observed in patients treated with PUVA until recently. In the U.S.A., a 16-centre prospective study of 1380 patients showed for the first time that there might also be an increased risk for malignant melanoma in patients treated with high cumulative dosages of PUVA. We have therefore followed up the Swedish PUVA cohort until 1994. This cohort had previously been followed up until 1985. Information from 4799 Swedish patients (2343 men, 2456 women) who had received PUVA between 1974 and 1985 was linked to the compulsory Swedish Cancer Registry in order to identify individuals with cancer. The average follow-up period was 15.9 years for men and 16.2 for women. We did not find any increased risk for malignant melanoma in our total cohort of 4799 patients treated with PUVA or in a subcohort comprising 1867 patients followed for 15-21 years. For cutaneous SCC there was an increase in the risk: the relative risk was 5.6 (95% confidence interval, CI 4. 4-7.1) for men and 3.6 (95% CI 2.1-5.8) for women. Significant (P < 0.05) increases were also found in the incidence of respiratory cancer in men and women and of kidney cancer in women. In conclusion, we did not find any increased risk for malignant melanoma in our patients treated with high doses of PUVA and followed up for a long time. We confirm previous reports of an increase in the incidence of cutaneous SCC in patients treated with PUVA, and recommend that patients should be carefully selected for PUVA and rigorously followed up.

Formation of active IL-1 beta from pro-IL-1 beta catalyzed by stratum corneum chymotryptic enzyme in vitro.

Interleukin 1 beta (IL-1 beta) is produced as a biologically inactive 31 kD precursor, which is converted to the active 18 kD form by proteolytic processing. Keratinocytes express IL-1 beta but not the active form of the specific IL-1 beta converting enzyme (ICE). We have recently presented evidence that IL-1 beta activation in human epidermis occurs via an alternative mechanism involving hitherto unknown proteases. We asked whether stratum corneum chymotryptic enzyme (SCCE), which is a serine protease specifically expressed in keratinizing squamous epithelia, can act as an IL-1 beta activator in vitro. Recombinant human pro-IL-1 beta was incubated with recombinant SCCE, and the reaction products were characterized as regards molecular size and ability to induce expression of E-Selectin in human umbilical cord endothelial cells. SCCE caused degradation of pro-IL-1 beta and the accumulation of a component with electrophoretic mobility slightly lower than recombination mature IL-1 beta. Whereas incubation mixtures with pro-IL-1 beta which had been incubated in the absence of SCCE, or with SCCE, which had been incubated in the absence of pro-Il-1 beta, did not induce expression above baseline levels of E-Selectin, pro-Il1 beta which had been incubated with SCCE induced a significant increase in E-Selectin expression. This effect could be abolished by neutralizing antibodies to IL-1 beta, but not by antibodies to IL-1 alpha. In addition to IL-1 beta activation, SCCE also prepared to be able to catalyze a further degradation of IL-1 beta, leading to a loss of biological activity. We conclude that SCCE is a potential candidate for being responsible for IL-1 beta activation in human epidermis.

Vulvar vestibulitis in the north of Sweden. An epidemiologic case-control study.

OBJECTIVE: To determine the epidemiologic characteristics of patients with vulvar vestibulitis. STUDY DESIGN: During the years 1992-1994, 32 women with vulvar vestibulitis were referred to the Vulva Clinic, University Hospital, Umeå, Sweden. They were asked questions regarding age, age at first intercourse, pregnancies, number of lifetime partners, use of oral contraceptives and past gynecologic history, including infections and previous treatments. The cases were compared to 17 healthy controls. For statistical evaluation, the two-tailed Wilcoxon rank sum test was used. RESULTS: There were no differences between the groups regarding age, age at first intercourse, pregnancies, number of lifetime partners or history of genital infections, with the exception of human papillomavirus. The cases had been treated significantly more often for suspected papillomavirus infection and had also used oral contraceptives for a significantly longer period. CONCLUSION: This study provided support for the hypothesis of a steroidal etiology of the syndrome.

IL-1 beta activation in human epidermis.

IL-1 beta is produced as an inactive 31-kDa precursor processed to active 18-kDa IL-1 beta by proteolytic cleavage, catalyzed by the highly specific IL-1-converting enzyme (ICE). In vitro activation of IL-1 beta can also be obtained by other proteases. Human keratinocytes express IL-1 beta, but not active ICE. The role played by IL-1 beta produced by keratinocytes has therefore been unclear. We asked whether normal human plantar stratum corneum contains biologically active IL-1 beta and, if so, by which mechanism this IL-1 beta is activated. Crude extracts and partially purified preparations from which IL-1 alpha had been removed were used. Biologic IL-1 activity was measured as the ability to induce expression of E-selectin in HUVEC. The crude extract contained IL-1-like activity that could be partially abolished with Abs to IL-1 alpha or IL-1 beta and totally inhibited with a mixture of the two Abs. IL-1 activity in the partially purified preparation was totally inhibited by Abs to IL-1 beta. The specific IL-1 beta activity in the two preparations was 60 to 85% of the sp. act. of recombinant human IL-1 beta. IL-1 beta from plantar stratum corneum had a slightly higher molecular mass than recombinant mature IL-1 beta. Its isoelectric point was approximately 6.1 compared with 6.9 for rIL-1 beta. We conclude that human plantar stratum corneum contains biologically active IL-1 beta that has been activated by an alternative mechanism that does not involve ICE. This is, to our knowledge, the first report of an alternative mechanism of IL-1 beta activation occurring in vivo.

Binding of tissue plasminogen activator to human endothelial cells. Importance of the B-chain as a ligand.

The aim of the present study was to investigate the binding of tissue plasminogen activator (tPA) to cultured endothelial cells and to characterize binding structures present in the cultures. Studies on the binding of 125I-tPA to cultured endothelial cells from human umbilical-cord veins (HUVEC) indicated that the number of sites for specific binding of tPA is 8 x 10(5) per cell. Treatment with an excess of antibodies against plasminogen-activator inhibitor type 1 (PAI-1) caused an 80% decrease in the binding, leaving about 1.6 x 10(5) unoccupied binding sites per cell, which appeared to be different from PAI-1. About 1.9 x 10(5) binding sites/cell for tPA were found on the surface of HUVEC that had been detached from the matrix. This indicates that only minor amounts of PAI-1 occur on the surface of the cells. In addition, immunocytochemical analysis showed that PAI-1 antigen is present almost exclusively in the cytoplasm but was not observed on the surface of the cells, whereas tPA antigen is abundant on the plasma membrane of tPA-treated cells as well as intracellularly. Competition studies using unlabelled compounds showed that native tPA and tPA B-chain (the proteinase domain), as well as the inactive derivatives, B-chain inactivated with D-Phe-Pro-Arg-chloromethane and tPA-PAI-1 complex, caused a considerable quenching of the binding of 125I-tPA to HUVEC, whereas the isolated A-chain had no demonstrable effect. Two components (apparent molecular masses 38 kDa and 56 kDa) reacting with tPA but lacking PAI-1 antigen determinants were identified. Thus the data suggest that tPA binds to HUVEC by two principally different mechanisms. One is mediated by PAI-1, which binds and inactivates tPA with a functional active site. The other binding is achieved by components which react with sites on the activator molecule other than structures of the A-chain or the active site.

Prevalence of anti-endothelial cell antibodies in patients with autoimmune diseases.

The prevalence of anti-endothelial cell antibodies (AECA) of IgA, IgG and IgM classes was studied by means of enzyme-linked immunosorbent assays (ELISA) in 466 patients with autoimmune/inflammatory disorders. The reference limits in the ELISAs for the AECA were determined from a random population sample of 249 subjects. The frequency of AECA was highest in patients with SLE (n = 42), 14.6% mainly of IgG class, and the presence of AECA correlated with disease activity in these patients. In the RA patient group (n = 200), 9.5% had AECA, mostly of IgA type. We found no association between the presence of AECA and extra-articular manifestations of RA or survival rate. In patients with undefined connective tissue disease (n = 57), ankylosing spondylitis (n = 109), and psoriatic arthritis (n = 58), the frequency of AECA corresponded to that of the random population sample. In a cohort of samples sent to the laboratory for determination of anti-nuclear antibodies (ANA) there was a correlation between the presence of ANA and AECA. Our findings indicate that RA patients are characterized by IgA class AECA, whereas SLE patients have IgG class AECA also correlating to disease activity.