Cerebral venous sinus thrombosis as the initial presentation of systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a hypercoagulable state due to a variety of mechanisms. Herein, we discuss the case of a 40-year-old gentleman who presented with cerebral venous sinus thrombosis (CVST) as the first manifestation of underlying SLE. On initial presentation, he did not endorse any other signs and symptoms to suggest the presence of an autoimmune condition. Work-up revealed an absence of antiphospholipid antibodies. Further evaluation uncovered the underlying etiology of the CVST as SLE-induced nephrotic syndrome. The existing literature on CVST suggests that there are only two other biopsy-proven cases of lupus nephritis leading to nephrotic range proteinuria as the etiology for CVST. Given the rarity of this presentation, there are no clearly delineated treatment strategies.

Protein transduction: identification, characterization and optimization.

Protein transduction domains (PTDs), both naturally occurring and synthetic, have been increasingly employed to deliver biologically active agents to a variety of cell types in vitro and in vivo. In addition to the previously characterized arginine-rich PTDs, including Tat (transactivator of transcription), Antp (Antennapedia) and PTD-5, we have demonstrated that lysine and ornithine, as well as arginine, homopolymers are able to mediate transduction of a wide variety of agents. To screen for optimal PTDs, we have used as a therapeutic cargo a peptide derived from IKK {IkappaB [inhibitor of NF-kappaB (nuclear factor kappaB)] kinase} beta, able to bind to the IKK regulatory subunit [NEMO (NF-kappaB essential modulator)], preventing formation of an active kinase complex. This peptide, termed NBD, is able to block activation of NF-kappaB, but not basal activity. We demonstrate that PTD-mediated delivery of NBD using certain PTDs, in particular 8K (octalysine), is therapeutic following systemic delivery in murine models of inflammatory bowel disease, diabetes and muscular dystrophy. In addition, we have developed a peptide phage display library screening method for novel transduction peptides able to facilitate tissue-specific internalization of marker protein complexes. Using this approach, we have identified transduction peptides that are able to facilitate internalization of large protein complexes into tumours, airway epithelia, synovial fibroblasts, cardiac tissue and HEK-293 (human embryonic kidney) cells in culture and/or in vivo.

Two patients with postpartum HELLP syndrome after a normotensive twin pregnancy.

Two patients with postpartum HELLP syndrome after a normotensive twin pregnancy are presented. As seen in one of the patients, morbidity can be significant. These cases illustrate that even after uneventful pregnancies one should be on the alert for symptoms of HELLP syndrome. If symptoms exist laboratory investigations should be carried out.