Percutaneous coronary intervention triggers a systemic inflammatory response in patients treated for in-stent restenosis -- comparison with stable and unstable angina.

OBJECTIVE AND DESIGN: It is believed that the magnitude of the systemic inflammatory response induced by percutaneous coronary intervention (PCI) impacts on the long-term outcomes in patients with stable angina (SA) and unstable angina (UA). We aimed to determine whether an inflammatory response appears in in-stent restenosis (ISR) patients undergoing balloon angioplasty and to assess its pattern and magnitude in relation to SA and UA subjects. SUBJECTS: 80 patients (59 with SA, 10 with UA, 11 with ISR) were enrolled into the prospective study. TREATMENT: SA and UA patients undergoing single vessel coronary balloon angioplasty followed by stenting versus ISR subjects in whom only balloon angioplasty was performed. METHODS: C-reactive protein (CRP), serum amyloid A (SAA), tumor necrosis factor alpha (TNF-alpha) and interleukin 10 (IL-10) were measured in blood samples collected before and 6, 24 h and 1 month after the procedure. RESULTS: A comparable pattern of inflammatory response in terms of CRP and SAA concentrations in subjects undergoing PCI due to ISR and SA was discovered while in unstable patients its magnitude was substantially higher. CRP and SAA levels increased significantly in each group with the peak value at 24 h and the baseline levels remarkably correlated with the highest markers' concentrations. In contrast, preprocedural TNF-alpha concentrations were higher in ISR group when compared with SA and UA patients. Additionally, in ISR group a twofold increase in their values of borderline significance at 6 h was noted. SA and UA subjects were found to have significantly lower TNF-alpha levels at 6 and 24 h after the intervention though the marker concentrations markedly increased with peak values at 1 month. The levels of IL-10 did not differ at any time point between the groups. CONCLUSIONS: We suggest that PCI triggers a systemic inflammatory response in patients with ISR and considerable differences in its pattern when compared with SA and UA patients were demonstrated. Moreover, a high preprocedural TNF-alpha level and its increase provoked by PCI in the ISR group warrant the need for further investigation of its possible involvement in the restenosis process.

Evaluating the profile of selected cytokines in patients with food allergy and chronic gastritis.

INTRODUCTION: Evaluating the profile of selected cytokines in patients with food allergy and chronic gastritis. Cytokines are produced by many cells and they play a role of mediators in the development of local and systemic inflammatory reaction. The aim of the study was to determine serum concentrations of IL-4, IL-5, IL-8, TNF alpha in patients with chronic gastritis and food allergy, who had been infected with H. pylori. MATERIAL AND METHODS: The study was conducted on patients with atopic diathesis, who were allergic to certain foods. The study group consisted of 71 patients, including 42 females aged 16-54 years (mean age 35.5 years) and 29 males aged 18-60 years (mean age 36.2 years). One control group was formed of 40 non-atopic patients aged 18-56 years (mean age 34.8 years), suffering from chronic gastritis. The other control group consisted of 30 subjects with the diagnosis of functional dyspepsia. Serum levels of selected cytokines were determined with the kits manufactured by ENDOGEN (Cambridge MA, USA) using enzyme immunoassay ELISA. The concentrations of parameters were determined in two tests and they were given as mean value. RESULTS: Mean serum Il-4 level in atopic patients was 27.85 pg/ml, while it was 13.26 pg/ml in non-atopic subjects with chronic gastritis and 4.3 pg/ml in patients with functional dyspepsia. The concentration of IL-5 ranged between 0 and 111.3 pg/ml (mean value: 7.43 pg/ml) in subjects with food allergy. Comparative analysis of IL-4 and IL-5 concentrations in atopic patients and in control subjects showed the presence of statistically significant differences (p < 0.001). The remaining cytokines, i.e. IL-8 and TNF alpha showed a significant increase in serum levels in patients chronic gastritis when compared to the subjects with functional dyspepsia, without inflammatory changes. CONCLUSIONS: Chronic exposure of the patients with food allergy to a given food allergen makes the levels of IL-4 and IL-5 rise. In atopic subjects with chronic gastritis and H. pylori infection, the increase in IL-4, IL-5, IL-8 and TNF alpha levels suggests that both infectious and allergic factors play an important role in the pathogenesis of inflammation.

Anaphylactic histamine release from human gastric and duodenal mast cells.

Mast cells from human gastric and duodenal walls were isolated using a collagenase dispersion technique. The reactivity of both mast cell populations with anti-human IgE antibodies and specific antigens was tested in an in vitro model of anaphylactic reaction. Mast cell populations were sensitive to the action of anti-IgE, and histamine release was 17.4-27.4% (duodenal) and 19.3-29.3% (gastric mast cells). No significant differences between both mast cell populations of the same individuals were observed. Gastric and duodenal mast cells obtained from patients with peptic ulcer and positive intradermal test with allergens (grass pollen, tomato, cocoa) released histamine after challenge with adequate antigens. The reaction was dose-dependent. Gastric mast cells were more reactive than duodenal cells to challenge with antigen.

Allergy to cockroach antigens in patients with peptic ulcers and chronic gastritis.

Cockroach allergy was investigated in 10 patients with the endoscopic diagnosis of peptic ulcers and chronic gastritis, all with positive skin reactions to Blatella germanica extract. In all the cases examined, the total serum IgE level was raised, specific serum IgE detectable and both the increased number of eosinophils and IgE-bearing cells found in biopsy specimens of gastric and/or duodenal tissues. The direct provocation test of the gastric mucosa, done under fiberoscopic control, was positive in all patients, in which the immediate oedematous and haemorrhagic reaction was observed after allergen challenge. Seven patients reacted also a few minutes later with abdominal pains and/or nasal and conjunctival manifestations. The provocation with the same cockroach extracts was negative in 4 control patients with peptic ulcers but without symptoms of allergy. In the authors' opinion, cockroach antigens, like other food and inhalant allergens, may be partly responsible for the chronic inflammatory processes as well as ulcerations of gastroduodenal tissues in predisposed persons.

The immunologic response to tobacco antigens in smokers. VI. Phagocytosis of tobacco antigens by peripheral blood polymorphonuclear leucocytes studied by immunofluorescence.

Polymorphonuclear leucocytes (PMNL) isolated from the defibrinated blood of 44 healthy volunteers (20 no smoking subjects and 22 smokers) were examined for the presence of tobacco antigens using specific rabbit antiserum conjugated with FITC. In 11 persons from the smokers group PMNL were examined by the direct immunofluorescence technique, using appropriate antisera, as well as for the presence of IgG, IgM and C3. It was stated that the number of PMNL with fluorescent tobacco antigens rose significantly after exposure to tobacco smoke. The above cells were detected both in non-smokers and smokers venous blood, while their percentage was more important in the latter. IgG, IgM and C3 were found in PMNL of all 11 examined smoking subjects. In the authors opinion, tobacco antigens are phagocytized after penetration into the organism, either alone or in the shape of immune complexes formed with specific serum antibodies. The possibility of vascular injuries caused by the above complexes as well as the question of a presumed affinity of tobacco and solanaceae antigens are discussed.

Allergy to cockroach antigens in asthmatic patients.

Cockroach allergy was investigated in a group of 56 patients with atopic bronchial asthma (37 men and 19 women with ages ranging from 16 to 65) all allergic to house dust antigen. In all patients, both intracutaneous tests and bronchial provocation tests were performed with cockroach antigen prepared from the species most common in Poland, Blattella germanica and Blatta orientalis. Positive skin reactions to cockroach antigen were found in 17 patients while an immediate bronchoconstrictive response was noted in 11. In the authors opinion, cockroach antigens may be partly responsible for the antigenic properties of house dust and may play a causative role in some cases of atopic asthma.

The immunologic response to tobacco antigens in smokers. IV. Effect of heparin, aspirin, promethazine and prednisone.

The effects of heparin, aspirin, promethazine and prednisone on late skin reactions, provoked by tobacco extracts were studied in four groups of 17 patients with coronary artery disease. In all patients, intracutaneous tests were made with four different tobacco preparations, both on the first day of their hospitalisation and after 14 days of therapy. It was found that strongly positive late skin reactions with tobacco extracts were decreased or suppressed in patients taking heparin and in patients taking prednisone, but not in those who were treated with promethazine or with aspirin. This seems to confirm the hypothesis that these reactions are really provoked by a local type III allergy to tobacco antigens.