Thrombotic microangiopathy with skin localization secondary to cytarabine-daunorubicin association: report of a case.

The thrombotic microangiopathy is a syndrome characterized by the combination of mechanical hemolytic anemia, peripheral thrombocytopenia, and organ failure of variable severity. In addition to the idiopathic form, several cases are identified as secondary to pregnancy, infections, disease systems, organ transplants, and cancer. Other forms are secondary to drugs including antimitotics. We report the case of a patient followed for acute myelogenous leukemia. She received induction chemotherapy combining daunorubicin and cytarabine, complicated by thrombotic thrombocytopenic purpura.

Tenascin and strictures in inflammatory bowel disease: an immunohistochemical study.

Tenascin is an extracellular matrix protein involved in morphogenesis of muscle tissue and in wound healing. In the present study we examined its distribution in tissue from patients with inflammatory bowel disease. Intestinal biopsies from 10 normal controls, 15 patients with Crohn's disease, and 6 with ulcerative colitis were studied. Samples were obtained both from uninvolved and involved areas. Mucosal tenascin is increased in ulcerative colitis and Crohn's disease, especially in areas of ulceration. In Crohn's disease, tenascin is also strongly expressed in the submucosa and in smooth muscle cells of the muscularis mucosae and propria, especially in areas of stricture. We conclude that tenascin is involved in stricture formation in Crohn's disease and that it is a marker of phenotypic change in smooth muscle cells.

Mast cells mediate the severity of experimental cystitis in mice.

PURPOSE: We hypothesized that experimental cystitis induced by substance P (SP) or E. coli lipopolysaccharide (LPS) would be less severe in mice rendered mast cell deficient by genetic manipulation. MATERIALS AND METHODS: Two strains of mast-cell deficient mice (WBB6F1- kitW/kitW-v or kitW/kitW-v and WCB6F1-Sl/Sld or Sl/Sld) and their congenic, normal (+/+) counterparts were used. Cystitis was induced in female mice by intravenous injection of SP (0.1 ml.; 10(-6) M) or E. coli LPS (0.1 ml.; 2 mg./ml.), and inflammation was assessed by Evans blue dye extravasation. In a separate group of kitW/kitW-v and congenic normal mice, cystitis was induced by intravesical infusion of SP (0.05 ml.; 10(-5) M) or E. coli LPS (0.05 ml.; 100 microg./ml.) and compared with intravesical pyrogen-free saline (0.05 ml.; 0.9%). Severity of cystitis was determined by histological evaluation of the bladder wall 24 hours after intravesical infusions. RESULTS: Intravenous SP or LPS stimulated increased plasma extravasation in congenic normal mice but not in mast cell-deficient mice. Intravesical SP or LPS resulted in increased edema, leukocytic infiltration, and hemorrhage within the bladder wall in congenic normal mice, but the only histological evidence of inflammation in the bladders of kitW/kitW-v mice was increased hemorrhage in response to LPS. CONCLUSIONS: This study indicates that mast cells modulate the inflammatory response of the bladder to SP and LPS in mice. Although clinical trials of the use of antihistamines to treat or prevent cystitis have not been successful, these results suggest that therapies directed toward preventing mast cell activation may yet prove effective in treating cystitis.

In vitro passive sensitization of the ureter as a basis for the study of noninfectious ureteral inflammation.

PURPOSE: To develop an in vitro model of passive sensitization for the ureter for the study of noninfectious ureteral inflammation. MATERIALS AND METHODS: Human ureteral tissues were obtained from excess segments of ureters from patients undergoing donor nephrectomy. Following excision, ureters were placed in physiologic salt solution (PSS) and passively sensitized by incubating with ragweed serum from allergic donor (1 ml. serum: 4 ml. PSS) for 20 hours at room temperature. Ureteral segments were incubated with PSS only and served as non-sensitized controls (n = 4). After sensitization, excess serum was removed by serial washing with PSS without serum. Ureteral strips were then suspended in vitro for determination of tissue contraction. Contractile responses and histamine release were measured. Tissues were then exposed to antigen. To investigate the role of inflammatory mediators in tissue contraction, 4 groups of 8 sensitized ureteral segments were incubated for 1 hour with the following substances: a H1 histamine receptor antagonist (pyrilamine), an inhibitor of prostaglandin synthesis (indomethacin), an inhibitor of leukotriene synthesis (A-64077), and a control substance (DMSO). Following incubation, the tissues were exposed to antigen, and contraction and histamine release were determined. RESULTS: Sensitized ureteral segments (n = 8) responded to antigen with contraction (30% BaCl maximum; p <0.01) and histamine release (205/ng./gm. tissue) within the first 5 minutes of superfusion. Non-sensitized control segments (n = 4) did not respond. Both indomethacin and pyrilamine reduced (7-10% of BaCl maximum; p <0.05) the contractile response of sensitized ureter to antigen, whereas A-64077 did not. Analysis of the superfusate for histamine indicates that indomethacin reduced histamine release (150 ng./gm.) whereas A-64077 and pyrilamine did not (p <0.05). CONCLUSION: We have demonstrated that ureteral segments can be passively sensitized and that subsequent antigen challenge stimulates contraction and histamine release. Our findings suggest that contraction of ureteral tissue and histamine release may be utilized as an inherent bioassay indicating the activity of inflammatory mediators. In addition, these results suggest that both prostaglandins and histamine, but apparently not leukotrienes, participate in the early inflammatory response to antigen challenge of the sensitized ureter.

Human anti-IgE monoclonal antibody blocks passive sensitization of human and rhesus monkey bladder.

IgE antibodies may play an important role in noninfectious urinary inflammation, including interstitial cystitis (IC). In this study, urinary bladder strips were passively sensitized for 20 hours with serum from a ragweed-sensitive patient in the absence or presence of an anti-human IgE monoclonal antibody (MaE11) at 0, 1-, or 5-fold IgE concentration. The urinary bladder strips then were suspended in a superfusion apparatus for measurement of contraction and histamine release in response to antigen E (AgE) challenge. Non-sensitized tissues did not react to AgE challenge, whereas AgE challenge of passively-sensitized tissues resulted in time-dependent bladder contraction and histamine release. MaE11 abolished AgE-induced contraction and histamine release in a concentration-dependent manner. The safety of MaE11 was confirmed by its failure to contract or release histamine from passively-sensitized bladder tissues. The results of this study suggest that MaE11 may have immunotherapeutic benefit for amelioration of IgE-mediated diseases of the urinary system.

Human FcERI-IgG and humanized anti-IgE monoclonal antibody MaE11 block passive sensitization of human and rhesus monkey lung.

IgE antibodies are thought to play an important role in the induction of allergic inflammation of the bronchi. In this study we assessed the capacity of two inhibitors, FcERI-IgG, an immunoadhesin made up of the alpha chain of the high-affinity IgE receptor joined to a truncated IgG heavy chain, and MaE11, a humanized murine anti-human IgE antibody, to prevent allergen sensitization. Lung parenchyma strips from rhesus monkeys and human beings were passively sensitized for 20 hours with serum from a ragweed-sensitive patient in the presence of 0, 1-, 5-, or 10-fold concentrations of the inhibitors relative to IgE. The parenchymal strips were then suspended in a superfusion apparatus for measurement of isometric tone and collection of superfusate for histamine analysis in response to challenge with antigen E (AgE). Nonsensitized tissues did not react to AgE challenge, whereas AgE challenge of passively sensitized tissues resulted in a time-dependent parenchymal contraction and histamine release. Both FcERI-IgG and MaE11 completely abolished the AgE-induced contraction and histamine release in a dose-dependent manner. In addition, passively sensitized lung tissues failed to respond to direct challenge with either FcERI-IgG or MaE11. The results of this study suggest that FcERI-IgG and MaE11 may have important immunotherapeutic benefit for the amelioration of IgE-mediated diseases.

In vitro passive sensitization of guinea pig, rhesus monkey and human bladders as a model of noninfectious cystitis.

Studies of human bladder inflammation have been limited to examination of urine, bladder biopsy, or examination of autopsy material. We have developed an in vitro bladder passive sensitization technique which can measure type I responses of isolated human bladder tissue. We have compared these results using human tissue to those obtained with bladder tissue from guinea pigs and Rhesus monkeys. In our studies, bladder tissue was passively sensitized in vitro for 20 hours with immunoglobulin-containing serum. Subsequent antigen challenge of the passively sensitized tissue resulted in a time-dependent contraction that was accompanied by tissue histamine release. Contractions of guinea pig, monkey and human bladder tissue reached 79%, 100% and 78% of the maximal contraction induced by potassium chloride. In contrast, adjacent strips of unsensitized tissue had no detectable response to antigen challenge. The responses were reduced in the presence of histamine H1 receptor blockade with pyrilamine and abolished in the presence of a concomitant blockade of leukotriene synthesis with nordihydroguaiaretic acid (NDGA). Blockade of cyclooxygenase activity with indomethacin increased the contraction of the sensitized guinea pig bladder in response to antigen challenge. These findings demonstrate that in vitro passive sensitization of human bladder tissue can be used to investigate basic mechanisms of noninfectious bladder inflammation in humans.