Combining skin and olfactory α-synuclein seed amplification assays (SAA)-towards biomarker-driven phenotyping in synucleinopathies.

Seed amplification assays (SAA) are becoming commonly used in synucleinopathies to detect α-synuclein aggregates. Studies in Parkinson's disease (PD) and isolated REM-sleep behavior disorder (iRBD) have shown a considerably lower sensitivity in the olfactory epithelium than in CSF or skin. To get an insight into α-synuclein (α-syn) distribution within the nervous system and reasons for low sensitivity, we compared SAA assessment of nasal brushings and skin biopsies in PD (n = 27) and iRBD patients (n = 18) and unaffected controls (n = 30). α-syn misfolding was overall found less commonly in the olfactory epithelium than in the skin, which could be partially explained by the nasal brushing matrix exerting an inhibitory effect on aggregation. Importantly, the α-syn distribution was not uniform: there was a higher deposition of misfolded α-syn across all sampled tissues in the iRBD cohort compared to PD (supporting the notion of RBD as a marker of a more malignant subtype of synucleinopathy) and in a subgroup of PD patients, misfolded α-syn was detectable only in the olfactory epithelium, suggestive of the recently proposed brain-first PD subtype. Assaying α-syn of diverse origins, such as olfactory (part of the central nervous system) and skin (peripheral nervous system), could increase diagnostic accuracy and allow better stratification of patients.

Neutropenia and anaemia due to carbimazole-dependent antibodies.

Carbimazole-dependent antibodies to erythrocytes were detected in the sera of three anaemic patients who had been treated with carbimazole for hyperthyroidism. By the use of Rhnull-typed erythrocytes, we could show that some of these were directed against the proteins of the Rh complex. Carbimazole-dependent antibodies eluted from erythrocytes showed no binding to other blood cells. One patient also presented with neutropenia and mild thrombocytopenia. Additional carbimazole-dependent antibodies against the neutrophil-specific Fcgamma receptor IIIb (FcgammaRIIIb, CD16b) and the broadly expressed platelet endothelial cell adhesion molecule 1 (PECAM-1; CD31) were detected in this patient's serum. Surprisingly, the PECAM-1-reactive drug-dependent antibodies were also detectable in the sera of the other two patients with normal leucocyte and platelet counts. We assume that carbimazole can induce cell lineage-specific drug-dependent antibodies that cause cytopenia and also drug-dependent antibodies against the broadly expressed PECAM-1 molecule that may cause mild but not severe cytopenia.

[Prevention of pneumonia by endotracheal micronebulization of tobramycin]. / Pneumonieprophylaxe durch endotracheale Tobramycin-Mikroverneblung.

In 69 artificially ventilated patients the clinical, bacteriological and pharmacological effects of endotracheally administered tobramycin were studied in comparison to a control group. In the therapy group, 52% of all specimens were sterile, in the control group only 25%. During the first 4 days these changes were significant (p < 0.05). In the therapy group the endotracheal colonisation with ps. aeruginosa was significantly lower between the 4th and 14th day (p < 0.05). The incidence of secondary pneumonia was reduced from 42% to 17.5% (not significant). Systemic administration of antibiotics, e.g. of aminoglycosides, was significantly more often necessary in the control group. No increasing of growth of fungi in the upper respiratory tract was observed, but these was a non-significantly higher incidence mainly of staph. epidermidis. The application of 80 mg tobramycin four times a day as an aerosol was well tolerated by the patients. Under there conditions, tobramycin could not be measured in the serum. No allergic reactions, increased respiratory pressures or bronchoconstrictions were observed.

Continuous hydrolysis of tallow with immobilized lipase in a microporous membrane.

Thermostable lipase from Thermomyces lanuginosus was immobilized in untreated microporous membranes. Melted tallow pumped through the membrane did not wash the enzyme out. From 0.4 to 0.9% of the soluble activity remained after immobilization with half-lives of 1-2 months or more at 50 degrees C. Membranes can be acid/base washed and reloaded with enzyme with no adverse effects. Buffer was required for a long half-life, and recycling the buffer improved the mass transfer of glycerol out of the immobilized lipase reactor. Immobilized activity was unaffected when the pH of the aqueous product changed from 5.5 to 6.5.