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I Hauser

Publications and source records attributed to I Hauser.

31 records · Page 2Linked to original sources

Apoptotic cell death in activated monocytes following incorporation of clodronate-liposomes.

The present study was performed to elucidate whether sterically stabilized liposomes laden with clodronate, which lead to depletion of macrophages (Mphis) and amelioration of experimental autoimmune arthritis in vivo, selectively affect cells of the mphi lineage in vitro. The rates of incorporation of drug-free, fluorescent liposomes and the rates of cell death following exposure to clodronate-liposomes were assessed in human peripheral blood monocytes, as well as in polymorphonuclear leukocytes (PMNs), T cells, endothelial cells, and fibroblasts, both at rest and following activation. Gel electrophoresis of nuclear extracts and ultrastructural analyses were performed to identify the modality of cell death. Monocytes, particularly upon activation, were more efficient in incorporating sterically stabilized liposomes than all other cells except PMNs. Twenty percent of resting monocytes and up to 65% of activated monocytes died within 24 h of exposure to clodronate-liposomes, whereas the other cell types, including PMNs, remained unaffected. Activated monocytes exposed to clodronate-liposomes, but not resting or activated monocytes exposed to drug-free liposomes, showed clear signs of apoptotic cell death. In most of the assays, sterically stabilized liposomes were more efficient than conventional phosphatidylcholine-liposomes. Sterically stabilized clodronate-liposomes preferentially affect cells of the mphi lineage, particularly if activated. Selective elimination of activated Mphis by apoptosis may explain both therapeutic efficacy and safety of clodronate-liposomes in experimental models of autoimmunity.

Analgesics, Non-Narcotic↗

Clinical pharmacokinetics of tacrolimus in rescue therapy after renal transplantation.

Tacrolimus, a potent new immunosuppressive drug, was introduced for rescue therapy in 25 renal transplant recipients with ongoing rejection (n = 24) or severe cyclosporine toxicity (n = 1). A highly significant (p < 0.001) rise in serum creatinine from 138 +/- 14 (3 months before conversion) to 295 +/- 26 mumol/l preceded conversion to tacrolimus. Tacrolimus rescue therapy started 73 +/- 9 months after transplantation, the follow-up was 8 +/- 1 months. Outcome, pharmacokinetics, and side-effects were analyzed. Patient survival was 100% on tacrolimus therapy. Graft survival was 88% after 3 months, and 70% after 8 months. Serum creatinine remained stable during the observation period (Crea after 8 months: 271 +/- 26 mumol/l). Starting with an initial dose of 9.6 +/- 0.3 mg/day (0.14 +/- 0.01 mg/kg/day) we could reduce tacrolimus dose to 6.0 +/- 0.9 mg/day (0.09 +/- 0.02 mg/kg/day; p < 0.001) after 1 month. Tacrolimus trough levels were adjusted to a therapeutic window of 5-8 ng/ml. We had to perform 3.4 +/- 0.5 dose adjustments per patient mainly within the first month after conversion (70%). A high variability in interindividual tacrolimus dose was noted. Last cyclosporine dose was a good predictor of required tacrolimus dose after 1 month (r = 0.88; p < 0.001). Overall, 82 adverse events were noted, of which 29 (35%) were associated with high trough levels (> 10 ng/ml). In contrast, 3 patients with trough levels < 4 ng/ml had ongoing rejection. Blood pressure and routine laboratory data remained unchanged. Steroid dose could be tapered from 12 +/- 2 to 5 +/- 0.3 mg/day (p < 0.02). Gingival hyperplasia and hirsutism improved after conversion. We conclude: Tacrolimus conversion for rescue therapy after renal transplantation is efficient and safe with target trough levels between 5 -8 ng/ml. Frequent drug monitoring is necessary, especially within the first month after conversion. Previous cyclosporine dose can be used as a guideline for starting dose.

Adult↗

Post-partum factor VIII inhibitors. A review of the literature with special reference to the value of steroid and immunosuppressive treatment.

In a retrospective study 51 published cases of post-partum factor VIII inhibitors were analyzed with regard to the outcome according to treatment. The overall outcome was favorable with 97% survival at two years. The probability of complete remission (CR, absence of the inhibitor and normalization of factor VIII activity) was almost 100% at 30 months. Steroid treatment appears to be not superior to no treatment, but patients treated with immunosuppressive drugs (cyclophosphamide, azathioprine, 6-mercaptopurine) had a significantly shorter time to CR. In the absence of a randomized trial this analysis may be helpful for decision-making in women with factor VIII post-partum inhibitors. Because of the retrospective study design, conclusions have to be regarded with caution.

Adolescent↗

[Therapy of Hodgkin's disease].

Hodgkin's disease has become the prototype of a curable neoplastic condition. In localized disease (stages I and II) cure can be achieved with radiotherapy alone unless B-symptoms are present. In case of B-symptoms or generalized disease (stages III and IV) the administration of polychemotherapy is mandatory. In advanced stages combinations of the non-cross-resistant regimens MOPP and ABVD seem to be the most effective. In patients relapsing from the MOPP/ABVD or MOPP/ABV regimen salvage chemotherapy offers a chance of remission but not cure. Such patients, in particular those with a short first remission, are candidates for autologous stem cell transplantation which can still induce durable remissions in a subset of patients. Considering the long term complications such as infertility and the development of secondary neoplasms one has to carefully balance the benefits against the potential risks of the initial treatment approach.

Combined Modality Therapy↗

Postpartum factor VIII inhibitors. Report of two cases with special reference to the efficacy of various treatments.

Two cases of postpartum inhibitors to F VIII are described. One patient had a severe bleeding tendency (iliopsoas bleeding, forearm bleeding). The maximum inhibitor titer was 800 BU/ml in case 1 and 120 BU/ml in case 2. Bleeding was controlled by treatment with human and porcine factor VIII concentrate and with activated prothrombin complex concentrate (FEIBA, Immuno AG, Vienna, Austria) in case 1, while no replacement therapy was given in case 2. Prednisone (given in both cases) and high-dose immunoglobulin (given in case 2) was without effect. Cyclophosphamide (100 mg per day), combined with small doses of prednisone led to complete disappearance of the inhibitor and normalization of factor VIII in case 1. In the other patient who refused treatment with cyclophosphamide the inhibitor titer remained high over a period of 13 months.

Adult↗

Immunocytochemical analysis of the regeneration of myofibrils in long-term cultures of adult cardiomyocytes of the rat.

Dissociated adult rat ventricular cardiomyocytes obtained from hearts by retrograde perfusion with collagenase were investigated in long-term cultures. Myofibril regeneration, isoprotein transition of alpha- and beta-myosin heavy chain (MHC), and M-band localization of M-creatine kinase in the reconstituting heart cells were studied. Myofibril formation was demonstrated by the use of antibodies against either cardiac C-protein or myomesin as early differentiation markers. Four days after plating, small myofibrils could be identified in attached cells in a perinuclear fashion; later in culture the cells displayed various shapes and myofibril distribution. Frequently a patchy distribution of myofibrils within the extending peripheral processes could be observed. Colocalization of sarcomeres and phalloidin-stained F-actin filament bundles was demonstrated by double fluorescence staining and by the use of high intensifying video microscopy and computerized image processing. The immunofluorescence distribution of alpha- and beta-MHC isoproteins in newly isolated and cultured cardiomyocytes changed from 100% alpha-MHC and 70% beta-MHC in rod-shaped cells to about 100% beta-MHC and 70% alpha-MHC in spread out cultured cells. This shift was corroborated by a relative gradual decline in alpha-MHC at the expense of increasing amounts of beta-MHC with time in culture as assessed by sodium dodecyl sulfate gel electrophoresis of total cell homogenates. In addition, whereas rod-shaped newly isolated cardiomyocytes showed a clear M-band association of M-creatine kinase as found in adult heart tissue, adult cultivated spread out cells did not show a cross-striated pattern after incubation with antibody. Taken together, these observations suggest that adult cardiomyocytes not only undergo extensive morphological transitions in long-term cultures, but also generate new myofibrillar structures lacking M-creatine kinase and containing the beta-MHC, thus fitting the characteristics of fetal myofibrils. These results indicate a change from the adult terminally differentiated to a less differentiated state of the cardiac cells in culture.

Animals↗

Myofibril formation in longterm-cultures of adult rat heart cells.

Immunocytochemistry using antibodies against myofibrillar proteins such as heart-C-protein and myomesin but also the fluorescence of rhodamine conjugated phalloidin as marker for F-actin structures was employed to study the redifferentiation of cultured adult rat cardiomyocytes. It was demonstrated that freshly isolated rod shaped cells in culture round up before they attach to the substratum, while myofibrillar structures of the cells degenerate. As soon as they attached to the substratum and gradually flattened out, small cross-striated myofibrils reappeared in the central part of the cells. F-actin, in freshly isolated cells present only in the I-band of the myofibrils, extended throughout the cells into the processes in the form of filament cables. In later stages the myofibrillar distribution varied. Smaller myocytes were frequently filled with myofibrils whereas in larger cells with many processes the myofibrils were found either arranged in perinuclear regions or showed a mosaic distribution. Myofibrils appear to be directly aligned with bundles of actin stress fibers, thus further supporting the suggestion that the actin filaments might serve as a scaffold for myofibril formation.

Actins↗

Atypical inflammatory myopathy associated with Crohn's disease.

INTRODUCTION: We report on a 37-year-old woman with quiescent Crohn's disease who developed steroid responsive myositis. Although there are some case reports about inflammatory myopathy in Crohn's disease, the myopathological characteristics have still to be detailed. MATERIAL AND METHODS: Open muscle biopsy was performed on the left medial gastrocnemius muscle. For light-microscopical investigation conventional and immunohistochemical detection procedures were employed. RESULTS: Focal necrotic changes together with peri- and endomysial inflammatory infiltrates were found predominantly consisting of CD67- and CD68-positive cells accompanied by CD8-and CD4-positive ones. Especially at sites of otherwise normal muscle area CD8-positive cells were seen, 100. Furthermore, severe inflammatory infiltration of connective tissue septa and the occurrence of granulocytes are striking features of the inflammatory myopathy in this condition. CONCLUSION: We report a probably T cell-mediated inflammatory myopathy associated with preceding Crohn's disease. The myositis is characterized by features which are unknown in disorders constituting the polymyositis and dermatomyositis syndromes. Thus, Crohn's disease associated "focal necrotizing neutrophilic myositis" probably has to be regarded as a specific myositis entity.

Adult↗