Freedom from disease in psoriasis: a Delphi consensus definition by patients, nurses and physicians.

BACKGROUND: Physician-reported clinical outcome and quality of life (QoL) measures are currently used to assess outcomes and direct treatment of plaque psoriasis. However, people with psoriasis may have different criteria for judging treatment success. OBJECTIVES: To build a unified consensus on the definition of 'freedom from disease' from a European stakeholder group, including people with psoriasis, dermatologists and nurses. METHODS: The modified Delphi consensus methodology was used to define 'freedom from disease', with a consensus group consisting of people with psoriasis, nurses and dermatologists. This methodology involved people with psoriasis during the entire process and consisted of a 15-member Facilitating Consensus Panel to drive the programme content and a larger Voting Consensus Panel to vote on defining 'freedom from disease'. The Facilitating Panel agreed on disease domains, and aspects of each domain were put forward to the Voting Consensus Panel to establish relative importance. Following two voting rounds, a meeting was held to agree on a final consensus statement. RESULTS: The Facilitating Panel consisted of six patient advocacy group representatives, three specialist nurses and six dermatologists. Voting rounds 1 and 2 were completed by 166 and 130 respondents from the Voting Consensus Panel, respectively. The outputs from both rounds of voting were similar, focusing on normality of living, symptom control, and a relationship of mutual respect and trust between the individual with psoriasis and their healthcare professional. The consensus statement emphasizes that 'freedom from disease' is multifaceted and includes the following domains 'management of clinical symptoms', 'psychosocial elements', 'QoL and well-being', 'treatment' and 'healthcare team support'. 'Freedom from disease' means all aspects are addressed. CONCLUSIONS: Freedom from disease in psoriasis is a multicomponent concept including five main domains. This diverse and multifaceted patient perspective will help us to improve understanding of the outcomes of treatment interventions in people with psoriasis.

Swelling enhanced remanent magnetization of hydrogels cross-linked with magnetic nanoparticles.

Hydrogels that are pH-sensitive and partially cross-linked by cobalt ferrite nanoparticles exhibit remarkable remanent magnetization behavior. The magnetic fields measured outside our thin disks of ferrogel are weak, but in the steady state, the field dependence on the magnetic content of the gels and the measurement geometry is as expected from theory. In contrast, the time-dependent behavior is surprisingly complicated. During swelling, the remanent field first rapidly increases and then slowly decreases. We ascribe the swelling-induced field enhancement to a change in the average orientation of magnetic dipolar structures, while the subsequent field drop is due to the decreasing concentration of nanoparticles. During shrinking, the field exhibits a much weaker time dependence that does not mirror the values found during swelling. These observations provide original new evidence for the markedly different spatial profiles of the pH during swelling and shrinking of hydrogels.

Interaction with colon cancer cells hyperactivates TGF-ß signaling in cancer-associated fibroblasts.

The interaction between epithelial cancer cells and cancer-associated fibroblasts (CAFs) has a major role in cancer progression and eventually in metastasis. In colorectal cancer (CRC), CAFs are present in high abundance, but their origin and functional interaction with epithelial tumor cells has not been elucidated. In this study we observed strong activation of the transforming growth factor-ß (TGF-ß)/Smad signaling pathway in CRC CAFs, accompanied by decreased signaling in epithelial tumor cells. We evaluated the TGF-ß1 response and the expression of target genes including matrix metalloproteinases (MMPs) and plasminogen activator inhibitor (PAI)-1 of various epithelial CRC cell lines and primary CAFs in vitro. TGF-ß1 stimulation caused high upregulation of MMPs, PAI-1 and TGF-ß1 itself. Next we showed that incubation of CAFs with conditioned medium (CM) from epithelial cancer cells led to hyperactivation of the TGF-ß signaling pathway, enhanced expression of target genes like PAI-1, and the expression of α-smooth muscle actin (α-SMA). We propose that the interaction of tumor cells with resident fibroblasts results in hyperactivated TGF-ß1 signaling and subsequent transdifferentiation of the fibroblasts into α-SMA-positive CAFs. In turn this leads to cumulative production of TGF-ß and proteinases within the tumor microenvironment, creating a cancer-promoting feedback loop.

Rapid integrated biosensor for multiplexed immunoassays based on actuated magnetic nanoparticles.

The realization of biomolecular detection assays for diagnostic purposes is technologically very challenging because such tests demand full integration for ease of use and need to deliver a high analytical performance with cost-effective use of materials. In this article an optomagnetic immunoassay technology is described based on nanoparticles that are magnetically actuated and optically detected in a stationary sample fluid. The dynamic control of nanoparticles by magnetic fields impacts the key immunoassay process steps, giving unprecedented speed, assay control and seamless integration of the total test. The optical detection yields sensitive and multiplexed assays in a low-cost disposable cartridge. We demonstrate that the optomagnetic technology enables high-sensitivity one-step assays in blood serum/plasma and whole saliva. Drugs of abuse are detected at sub-nanogram per millilitre levels in a total assay time of 1 min, and the cardiac marker troponin I is detected at sub-picomole per litre concentrations in a few minutes. The optomagnetic technology is fundamentally suited for high-performance integrated testing and is expected to open a new paradigm in biosensing.

Tissue level, activation and cellular localisation of TGF-beta1 and association with survival in gastric cancer patients.

Transforming growth factor-beta1 (TGF-beta1), a tumour suppressing as well as tumour-promoting cytokine, is stored as an extracellular matrix-bound latent complex. We examined TGF-beta1 activation and localisation of TGF-beta1 activity in gastric cancer. Gastric tumours showed increased stromal and epithelial total TGF-beta1 staining by immunohistochemistry. Active TGF-beta1 was present in malignant epithelial cells, but most strongly in smooth muscle actin expressing fibroblasts. Normal gastric mucosa from the same patient showed some staining for total, and little for active TGF-beta1. Active TGF-beta1 levels were determined by ELISA on tissue homogenates, confirming a strong increase in active TGF-beta1 in tumours compared to corresponding normal mucosa. Moreover, high tumour TGF-beta1 activity levels were significantly associated with clinical parameters, including worse survival of the patients. Total and active TGF-beta1 levels were not correlated, suggesting a specific activation process. Of the different proteases tested, active TGF-beta1 levels were only correlated with urokinase activity levels. The correlation with urokinase activity suggests a role for plasmin in TGF-beta1 activation in the tumour microenvironment, resulting in transformation of resident fibroblasts to tumour promoting myofibroblasts. In conclusion we have shown localisation and clinical relevance of TGF-beta1 activity levels in gastric cancer.

Hydrogen-bonded network in biphenyl-4,4'-diphosphonic acid.

The crystal structure of the title compound, C(12)H(12)O(6)P(2), displays two different regions alternating along the a axis: a hydrogen-bonded region encompassing the end-positioned phosphonic acid groups and a hydrophobic region formed by the aromatic spacers. The asymmetric unit contains only half of the biphenyl-4,4'-diphosphonic acid (4,4'-bpdp) molecule, which is symmetric with an inversion centre imposed at the mid-point between the two aromatic rings. The periodic organization of the molecules is controlled by two strong O-H...O interactions between the phosphonic acid sites. Weak C-H...pi interactions are established in the aromatic regions.

Velocity distributions in dilute granular systems.

We investigate the idea that velocity distributions in granular gases are determined mainly by eta, the coefficient of restitution and q, which measures the relative importance of heating (or energy input) to collisions. To this end, we study by numerical simulation the properties of inelastic gases as functions of eta, concentration phi, and particle number N with various heating mechanisms. For a wide range of parameters, we find Gaussian velocity distributions for uniform heating and non-Gaussian velocity distributions for boundary heating. Comparison between these results and velocity distributions obtained by other heating mechanisms and for a simple model of a granular gas without spatial degrees of freedom, shows that uniform and boundary heating can be understood as different limits of q, with q>>1 and q < or approximately 1 respectively. We review the literature for evidence of the role of q in the recent experiments.

Crucial role of sidewalls in velocity distributions in quasi-two-dimensional granular gases.

Our experiments and three-dimensional molecular dynamics simulations of particles confined to a vertical monolayer by closely spaced frictional walls (sidewalls) yield velocity distributions with non-Gaussian tails and a peak near zero velocity. Simulations with frictionless sidewalls are not peaked. Thus interactions between particles and their containers are an important determinant of the shape of the distribution and should be considered when evaluating experiments on a constrained monolayer of particles.

Velocity distributions in dissipative granular gases.

Motivated by recent experiments reporting non-Gaussian velocity distributions in driven dilute granular materials, we study by numerical simulation the properties of 2D inelastic gases. We find theoretically that the form of the observed velocity distribution is governed primarily by the coefficient of restitution eta and q=N(H)/N(C), the ratio between the average number of heatings and the average number of collisions in the gas. The differences in distributions we find between uniform and boundary heating can then be understood as different limits of q, for q>>1 and q less, similar 1, respectively.

Phenylalanine ammonia-lyase: the use of its broad substrate specificity for mechanistic investigations and biocatalysis--synthesis of L-arylalanines.

Several fluoro- and chlorophenylalanines were found to be good substrates of phenylalanine ammonia-lyase (PAL/EC 4.3.1.5) from parsley. The enantiomerically pure L-amino acids were obtained in good yields by reaction of the corresponding cinnamic acids with 5M ammonia solution (buffered to pH 10) in the presence of PAL. The kinetic constants for nine different fluoro- and chlorophenylalanines do not provide a rigorous proof for but are consistent with the previously proposed mechanism comprising an electrophilic attack of the methylidene-imidazolone cofactor of PAL at the aromatic nucleus as a first chemical step. In the resulting Friedel-Crafts-type sigma complex the beta-protons are activated for abstraction and consequently the pro-S is abstracted by an enzymic base. Results from semi-empirical calculations combined with a proposed partial active site model showed a correlation between the experimental kinetic constants and the change in polarization of the pro-S Cbeta-H bond and heat of formation of the sigma complexes, thus making the electrophilic attack at the neutral aromatic ring plausible. Furthermore, while 5-pyrimidinylalanine was found to be a moderately good substrate of PAL, 2-pyrimidinylalanine was an inhibitor.

Tritium secondary kinetic isotope effect on phenylalanine ammonia-lyase-catalyzed reaction.

The mechanism by which phenylalanine ammonia-lyase (PAL, EC 4.3.1.5) catalyzes the reversible elimination of ammonia from phenylalanine yielding (E)-cinnamic acid has gained much attention in the recent years. Dehydroalanine is essential for the catalysis. It was assumed that this prostetic group acts as the electrophile, leading to a covalently bonded enzyme-intermediate complex with quarternary nitrogen of phenylalanine. Recently, an alternative mechanism has been suggested in which the enzyme-intermediate complex is formed in a Friedel-Crafts reaction between dehydroalanine and orthocarbon of the aromatic ring. Using semiempirical calculations we have shown that these two alternative mechanisms can be distinguished on the basis of the hydrogen secondary kinetic isotope effect when tritium label is placed in the orthopositions. Our calculations indicated also that the kinetic isotope effect measured using ring-labeled d(5)-phenylalanine could not be used to differentiate these alternative mechanisms. Measured secondary tritium kinetic isotope effect shows strong dependence on the reaction progress, starting at the inverse value of k(H)/k(T) = 0.85 for 5% conversion and reaching the normal value of about 1.15 as the conversion increases to 20%. This dependence has been interpreted in terms of a complex mechanism with initial formation of the Friedel-Crafts type intermediate.

Molecular genotyping of Staphylococcus aureus strains: comparison of repetitive element sequence-based PCR with various typing methods and isolation of a novel epidemicity marker.

Repetitive sequence-based (Rep)-PCR genotyping as described here is based on the presence of homologues of Mycoplasma pneumoniae repeat-like elements in Staphylococcus. In this study we comparatively evaluated the usefulness of rep-PCR typing with two sets of well-defined collections of Staphylococcus aureus strains. Rep-PCR analysis of the first collection of S. aureus strains (n = 59) and one Staphylococcus intermedius strain showed 14 different rep-PCR patterns, with each pattern harboring 6 to 15 DNA fragments. The discriminatory power of rep-PCR typing compared well to those of arbitrarily primed PCR (average of 20 types) and pulsed-field gel electrophoresis (11 types). S. aureus strain collection I comprised four outbreak-related groups of isolates. The isolates in only one group were found to have identical rep-PCR profiles. However, in an analysis of isolates from three additional independent local outbreaks (n for outbreaks 1 and 2 = 5, n for outbreak 3 = 12), identical rep-PCR types were found among strains isolated during each outbreak. Therefore, we conclude that rep-PCR genotyping may be an easy and fast method for monitoring of the epidemiology of nosocomial Staphylococcus infections. Rep-PCR analysis of strain collection II, which consisted of epidemic and nonepidemic methicillin-resistant S. aureus (MRSA) strains, revealed that a cluster of similar rep-PCR profiles was found among MRSA isolates which were more frequently isolated and which were most often associated with outbreaks.

Suppression of intestinal mucosal natural killer cells by corticosteroids.

BACKGROUND: Corticosteroid therapy of patients with inflammatory bowel disease can give rise to systemic side-effects. Budesonide is a topically acting corticosteroid with low systemic bioavailability and is efficacious in the treatment of inflammatory bowel disease. Natural killer cells were previously found to be altered, both systemically and locally, in patients with inflammatory bowel disease. Modulatory effects of budesonide, prednisolone, dexamethasone, and cortisol on peripheral blood NK cells have already been described, but have never been assessed on mucosal NK cells from the intestine. METHODS: The effect of the synthetic corticosteroids prednisolone and budesonide, the endogenous corticosteroid cortisol, and adrenocorticotropic hormone was analysed on NK cells isolated from the lamina propria of human intestinal resection specimens. RESULTS: The three corticosteroids suppressed intestinal NK cell activity, not only during the cytotoxicity assay, but also after pre-incubation of the lamina propria mononuclear cells. ACTH, however, did not affect the activity of intestinal NK cells. We previously showed that corticosteroid-suppressed peripheral blood NK cell activity could be restored in vivo, but not in vitro, by the administration of ACTH. In the present study, the in vitro incubation of budesonide- or prednisolone-suppressed mucosal NK cells with cortisol, alone or combined with ACTH, did not revert the suppressed NK cell activity. These findings are similar to our previous observations with peripheral blood NK cells. CONCLUSIONS: Intestinal mucosal NK cells can be suppressed by systemically as well as locally acting corticosteroids. This suppression in NK cell activity is not reversed by incubation with cortisol and/or ACTH.

Large discrepancy between prostate-specific antigen results from different assays during longitudinal follow-up of a prostate cancer patient.

A case is presented of a patient with stage D prostatic carcinoma, from whom a serum sample proved to be an outlier in a correlation study performed with a 2nd-generation prostate-specific antigen (PSA) assay on the Immulite system (6.4 micrograms/L) and IMx (101 micrograms/L). Clearly, the PSA result reported by Immulite was falsely low. For nine longitudinal samples, Immulite results were approximately 20-fold lower than the IMx value (range of IMx results 5-275 micrograms/L). A selection of the samples was analyzed with the ACS:180, ES-600, and IMx (all > 180 micrograms/L); Immulite, DPC Coat-A-Count IRMA, Immuno 1, AIA-pack, and Tandem-R (all <70 micrograms/L); and Immulite free PSA assay (41 micrograms/L). Gel filtration demonstrated that apart from the alpha1-antichymotrypsin (ACT) complex, no other complexes were found. However, the sample consisted of 53% free PSA (IMx). Possibly, a change of conformation of the PSA molecule resulted in a decreased binding to ACT and a reduced affinity of the antibodies used in the affected assays.

1-amino-2-imidazol-4'-ylethylphosphonic acid is a potent reversible inhibitor of Pseudomonas putida histidine ammonia-lyase.

A phosphonic acid analogue of L-histidine, 1-amino-2-imidazol-4'-ylethylphosphonic acid (HisP), was identified as a reversible competitive inhibitor of histidine ammonia-lyase (histidase). The affinity of histidase for HisP was pH dependent, with Ki values of 0.28 microM and 10.4 microM compared to substrate Km values of 1 and 5 mM at pH 7 and 9, respectively. HisP did not appear to be a substrate for histidase. A twenty-fold molar excess of HisP over enzyme completely protected the active site of histidase from inactivation by 10 mM bisulfite. Neither isohistidine nor two other phosphonic acid compounds were inhibitory towards histidase when tested at 1 mM concentration.

In vitro cellular cytotoxicity in Crohn's disease and ulcerative colitis: relation with disease activity and treatment, and the effect of recombinant gamma-interferon.

In a previous study using total mononuclear cells and lymphocytes, enriched by elutriation centrifugation, of patients with Crohn's disease and ulcerative colitis were found to have a decreased NK cell activity. In the present study the relation with disease activity and treatment, and the effect of recombinant gamma-interferon (gamma-IFN) on NK cell and monocyte cytotoxicity has been studied in 19 patients with Crohn's disease, 11 with ulcerative colitis, two with indeterminate colitis and 12 healthy controls. Patients with active Crohn's disease and active ulcerative colitis were shown to have an impaired NK cell activity compared to the control group. However, no difference was found in the percentage of CD16 (Leu 11+) cells, as determined by fluorocytometry, between patients with active or inactive disease. Moreover, the NK cell impairment was not related to corticosteroid treatment. Recombinant gamma-interferon (gamma-IFN) stimulated significantly the cytotoxic activity of the total mononuclear cells and the monocyte-enriched fraction against all target cell lines, both in patients and controls. No relation was found between the increase in cytotoxicity by gamma-IFN and disease activity in the patients. Stimulation with gamma-IFN demonstrated that the monocyte cytotoxic response of inflammatory bowel disease patients is normal. The present study reveals that the impairment in NK cell activity in patients with inflammatory bowel disease is related to disease activity and therefore suggests to be secondary to the inflammatory process.

Natural, lectin- and phorbol ester-induced cellular cytotoxicity in Crohn's disease and ulcerative colitis.

Cellular cytotoxicity of peripheral blood cells was studied in patients with Crohn's disease or ulcerative colitis and healthy controls. The spontaneous cytotoxicity or natural killer (NK) cell activity, evaluated against the erythroleukemia K-562 and the colon cancer CaCo-2 and HT-29 cell lines, of total mononuclear cells and enriched lymphocytes was depressed in Crohn's disease and ulcerative colitis patients compared to the controls. Phytohaemagglutinin (PHA) increased the cytotoxicity in the patients, to a similar maximal level as the stimulated controls. In contrast, the phorbol ester, phorbol-myristate-acetate (PMA), enhanced the cytotoxicity in patients and in controls, but in the patients not to the levels of the controls. No cytotoxicity was observed in the monocyte-enriched fraction both in patients and controls using the same assay system. A similar small but significant stimulation of monocyte cytotoxicity was obtained by PHA and PMA in patients and in controls. In conclusion, inflammatory bowel disease is associated with a depressed NK cell activity in peripheral blood which is not target specific. PHA but not PMA could restore the deficient NK cell activity. Monocytes seem not to be involved in the decreased NK cell activity in patients with inflammatory bowel disease.

The living cell as a plasma physical system.

The question of whether plasma physical phenomena are compatible with biological structures is discussed using as examples the electrons in mitochondria and the electrolytes in cytoplasm interstices. The criteria for the occurrence of the plasma state are fulfilled only if the static dielectric constant epsilon r of the medium through which the electrons in mitochondria move is > > 31.55 and if epsilon r of the medium between ions in cytoplasm is > > 90.97 of > > 421.56. Suggestions are made for experiments testing whether plasma physical phenomena might actually exist in the living cell.

Physical plasma in biological solids: a possible mechanism for resonant interactions between low intensity microwaves and biological systems.

Observed semiconductor properties of biological material in vitro indicate possible involvement of semiconduction in biological processes. Since in inorganic semiconductors solid-state plasma occurs, it is hypothesized that in organic semiconductors solid-state plasma similarly occurs. Some results of experimental investigation of resonant effects of microwaves in biological systems are considered in the light of that hypothesis. The conditions necessary for the existence of physical plasma in biological solid structures are discussed, and certain parameters of physical plasma in these structures are evaluated. Its is proposed that microwave radiation may support or damp plasma oscillations, thereby stimulating or suppressing biological functions.