Biomedical subjects
Publications and source records attributed to R Knobler.
With the introduction of the antispasticity agent, tizanidine hydrochloride (Zanaflex), physicians have requested information about the optimal way to switch appropriate patients from baclofen to tizanidine. A group of neurologists and rehabilitation specialists with a particular interest in spasticity was therefore asked to draw up a suitable approach to changing treatment.
Transgenic mice harboring the early genome from the human neurotropic JC virus, JCV, develop massive abdominal tumors of neural crest origin during 6-8 months after birth and succumb to death a few weeks later. The viral early protein, T-antigen, which possesses the ability to transform cells of neural origin, is highly expressed in the tumor cells. Immunoblot analysis of protein extract from tumor tissue shows high level expression of the tumor suppressor protein, p53, in complex with T-antigen. Expression of p21, a downstream target for p53, which controls cell cycle progression by regulating the activity of cyclins and their associated kinases during the G1 phase, is extremely low in the tumor cells. Whereas the level of expression and activity of cyclin D1 and its associated kinase, cdk6, was modest in tumor cells, both cyclin A and E, and their kinase partners, cdk2 and cdk4, were highly expressed and exhibited significant kinase activity. The retinoblastoma gene product, pRb, which upon phosphorylation by cyclins:cdk induces rapid cell proliferation, was found in the phosphorylated state in tumor cell extracts, and was detected in association with JCV T-antigen. The transcription factor, E2F-1, which dissociates from the pRb-E2F-1 complex and stimulates S phase-specific genes upon phosphorylation of pRb and/or complexation of pRb with the viral transforming protein, was highly expressed in tumor cells. Accordingly, high level expression of the E2F-1-responsive gene, proliferating cell nuclear antigen (PCNA), was detected in the tumor cells. These observations suggest a potential regulating pathway that, upon expression of JCV T-antigen, induces formation and progression of tumors of neural origin in a whole animal system.
Primary cutaneous lymphomas represent a heterogeneous group of T- and B-cell lymphomas that show considerable variation in histology, phenotype, and prognosis. Recently, the European Organization for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Project Group has reached consensus on a new classification for this group of diseases. The EORTC classification for primary cutaneous lymphomas is based on a combination of clinical, histologic, and immunophenotypic criteria, and thus contains well-defined disease entities rather than histologic subgroups. In addition, this new classification contains a number of provisional entities, which may display characteristic histologic features, but are not yet well defined clinically. These provisional entities account for less than 5% of all primary cutaneous lymphomas. In this report the basic principles of this new classification, as well as the characteristic features of the different disease entities, are described. In addition, survival data of 626 patients with primary cutaneous lymphomas derived from the registry of the Dutch Cutaneous Lymphoma Working Group, illustrating the clinical validity of this new classification, are presented.
A 45-year-old female patient with CML underwent allogeneic BMT and developed two episodes of acute GVHD. The first episode of acute cutaneous GVHD grade II (day +17) responded well to systemic CsA and steroids. During the second episode (around day +60) the patient developed erythroderma (grade III), and subsequently signs of lichen-planus-like GVHD. The patient did not respond to increased dosages of prednisolone and CsA. On day +89 extracorporeal photochemotherapy (ECP) was initiated. After four cycles, a significant improvement of erythroderma and lichen-planus-like lesions was documented, and after 12 cycles, a lasting complete remission was achieved. To our knowledge this is the first report of successful treatment of early-onset, lichen-planus-like GVHD after allogeneic BMT with ECP.
We investigated the effects of photopheresis in systemic sclerosis by analysing its influence on lymphocytes with regard to apoptosis and expression of bcl-2 and fas. Peripheral blood lymphocytes isolated immediately before and 24 h after photopheresis were investigated for apoptosis, bcl-2 and fas expression by fluorocytometry, and compared to controls. In addition, leucocytes from systemic sclerosis patients taken directly from the photopheresis system were tested for apoptosis after 24 h in culture. fas expression was similar in controls and patients with systemic sclerosis just before photopheresis, but increased 24 h after photopheresis, mainly due to an increase of CD4+CD95+ cells. bcl-2 was overexpressed in scleroderma peripheral lymphocytes, but not influenced by photopheresis. As compared to healthy controls, the percentage of apoptotic cells 24 h after photopheresis was high in cultured lymphocytes, but not ex vivo. The significant increase in fas on peripheral lymphocytes observed in this study may be a major operative mechanism of photopheresis in addition to (and possibly related to) the induction of apoptosis.
Detection of the intravascular placement of epidural catheters is an important but difficult task. In this study, we evaluated maternal and fetal hemodynamic responses to intravenous (i.v.) and epidural injection of isoproterenol (ISO), a proposed chronotropic test dose, in gravid ewes. Near-term, chronically instrumented, gravid ewes with single fetuses were studied at least 48 h after surgery. We continuously recorded maternal heart rate (MHR), systemic and pulmonary blood pressures, uterine blood flow (UBF), and fetal blood pressure and heart rate. Maternal cardiac output was measured by thermodilution. In random sequence, each ewe (n = 11) received i.v. injections of saline, epinephrine (EPI) 15 microg; ISO 4, 16, and 80 microg; or epidural (n = 9 ewes) injections of saline, ISO 4 microg and ISO 40 microg. All variables returned to baseline between experiments. Sections of lumber spinal cord were harvested from five animals for later histopathological study. I.v. ISO caused a dose-related increase in MHR. Cardiac output also increased transiently after all doses of ISO but not after EPI. Maternal diastolic blood pressure decreased after ISO 16 and 80 microg. UBF decreased significantly for 120 s after EPI 15 microg. Epidural ISO did not significantly change maternal systemic or pulmonary blood pressure, cardiac output, or UBF. The 40-microg dose increased MHR significantly. No histopathological changes were seen in three ISO-exposed and two control spinal cords. I.v. ISO reliably induces maternal tachycardia in nonstressed gravid ewes. Unlike EPI, I.v. ISO lacks a statistically significant effect on UBF. However, ISO seems to be rapidly absorbed from the epidural space. Identifying the source of maternal tachycardia after epidural injection of a large dose of ISO could be difficult. If the absence of histopathological change is confirmed, ISO represents an alternative to EPI as a chronotropic test dose.
Since pentoxifylline (PTX) was recently recognized as a substance with antiinflammatory capacities, we studied the in vivo and in vitro effect of PTX on the expression of the intercellular adhesion molecule-1 (ICAM-1) on human monocytes. For this purpose four healthy volunteers were treated with PTX (5 x 400 mg/day) for 2 days. Monocytes were isolated before and after PTX treatment and ICAM-1 expression was investigated. As shown by fluorescence-activated cell sorter (FACS) analysis, cultured monocytes isolated after oral application of PTX expressed significantly decreased amounts of ICAM-1 when compared with monocytes collected prior to oral PTX application. Northern blot analysis revealed reduced amounts of ICAM-1 mRNA in monocytes derived from volunteers after oral PTX treatment in comparison with monocytes isolated before oral PTX administration. Similarly, in monocytes treated with PTX (200 micrograms/ml) in vitro ICAM-1 was found decreased both at the protein and mRNA level in comparison with untreated cells. The inhibitory effect of PTX on ICAM-1 expression in monocytes could be reversed by the addition of exogenous tumour necrosis factor-alpha (TNF-alpha; 200 U/ml) suggesting that ICAM-1 down-regulation is mediated secondary to TNF-alpha suppression by PTX. The specific role of TNF-alpha in mediating ICAM-1 expression in cultured monocytes could be confirmed by the finding that a neutralizing anti-TNF-alpha antibody partially down-regulated ICAM-1 expression. The observed suppressive in vivo and in vitro effects of PTX on ICAM-1 expression in monocytes may contribute to the recently described antiinflammatory effects of PTX, e.g. in sepsis or allergic contact dermatitis.
The soluble tumour necrosis factor receptor I (sTNFRI, p55) is produced at similar levels by both immortalized (A431, HaCaT, KB) and primary normal human keratinocytes (HNK), whereas the soluble TNFR II (sTNFR II, p75) appears to be specifically released only by immortalized human keratinocytes. The purpose of this study was to investigate whether the increase in p75 secretion by immortalized human keratinocytes is due to an increased shedding of the receptor from the cell membrane, or is related to increased steady-state levels of p75 mRNA. FACS analysis showed that levels of membranous p75 decreased in a time-dependent manner in immortalized cells cultured for 1, 3, 6, 12 and 24 h, while remaining unchanged in HNK throughout. Northern blot analysis showed that after 12 h of culture, when p75 expression was decreased on the cell membrane of all immortalized cells, there was no significant difference in steady state levels of p75 mRNA between immortalized keratinocytes and HNK. Supernatants of immortalized cells, cultured for 24 h contained distinct levels of p75, while levels of p75 in supernatants of HNK were under the detection limit, confirming that the p75 decrease on the cell membrane results from increased p75 shedding from the cell membrane of immortalized cells. In contrast to p75, p55 was continuously expressed on the cell membrane of normal and immortalized keratinocytes without significant variation throughout the entire 24-h culture period and was similarly shed by both cell types. These results suggest that immortalized keratinocytes are specifically activated for shedding of p75 from the cell membrane. Since p75 has a high affinity for TNF, the release of this receptor may imply a direct role in the escape of malignant/transformed keratinocytes from the TNF-mediated immune response.
We describe a multiplex polymerase chain reaction (PCR) method suitable for the detection of all T-cell receptor (TCR) gamma-chain gene rearrangements in patients with lymphoproliferative diseases. 40 patients with various lymphoproliferative disorders and 40 healthy individuals were tested. Clonal TCR gamma rearrangements were identified in all patients with malignant disorders, and in one of 10 cases with established reactive lymphocytosis but not in normal controls. In all individuals testing positive, the patient's specific V and J segment involved in the rearrangement could be determined by simply splitting the multiplex primer mix. Our data show that the multiplex PCR technique enables rapid, simple and sensitive screening for clonal TCR gamma chain gene rearrangements.
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BACKGROUND: The receptor for the murine coronavirus mouse hepatitis virus (MHV)-A59, called MHVR or Bgp1a, is a glycoprotein in the carcinoembryonic antigen family of the Ig superfamily. Biliary glycoprotein (Bgp) isoforms play a role in cell adhesion, bile acid transport, and ecto-ATPase activity. MHV-resistant SJL/J mice express a different allele of Bgp1 called Bgp1b. Analysis of the tissue and cellular distribution of Bgp1 proteins can therefore provide new insight on both cellular functions and MHV-A59--induced pathogenesis. EXPERIMENTAL DESIGN: Bgp1 expression was analyzed in the digestive, respiratory, endocrine, urinary, and central nervous systems of adult BALB/c and SJL/J mice by immunocytochemistry and immunoelectron microscopy using a monoclonal Ab specific for the N-terminal domain of the Bgp1a proteins and polyclonal rabbit anti-Bgp1, which recognizes both the Bgp1a and Bgp1b proteins. The function of Bgp1 proteins as viral receptors was tested on tissue sections by a virus binding assay. MHV-A59 replication was analyzed by immunocytochemistry. RESULTS: Bgp1 expression was observed on membranes of epithelial cells (including hepatocytes, intestinal, endocrine, and respiratory epithelial cells), kidney proximal tubules, and endothelial cells in many tissues. It was usually localized at the apical pole of the cells and, when present, on the brush borders and the cilia. A new direct virus binding assay showed that MHV attachment onto cells correlates with Bgp1 expression. Viral infection was detected in hepatocytes, lymphoid tissue, and the exocrine pancreas but not in endocrine cells, enterocytes, kidney, or respiratory cells. In the central nervous system, no immunolabeling of neurons or glial cells was found with anti-Bgp1 Ab. CONCLUSIONS: Bgp1 proteins are present on BALB/c and SJL/J epithelia and endothelia. These glycoproteins might be involved in cell-to-cell contacts, for example between hepatocytes. On BALB/c mice, Bgp1a expression is consistent with the tropism of MHV-A59 for the liver. However, Bgp1a was also expressed on cells that were not infected by MHV-A59.
Most tumor cells produce both tumor necrosis factor (TNF) receptors, the M(r) 55,000 TNFRI and the M(r) 75,000 TNFRII, but they are mostly resistant to TNF-alpha-induced cytotoxicity. To gain further insight into the escape mechanisms of tumor cells from the harmful effect of TNF-alpha, we investigated the production of TNF-binding proteins (TNF-BPI, TNF-BPII, both M(r) 30,000) by malignant and normal epidermal cells and studied their functional role in TNF-alpha-induced cytotoxicity. Malignant human keratinocytes (A431, KB, HaCaT) and malignant human melanoma cells (KRFM) produced significant levels of both TNF-BPI and TNF-BPII on stimulation with phorbol myristate acetate. In contrast, normal human keratinocytes (HNK) and normal human melanocytes (HNM) released TNF-BPI but not TNF-BPII. The specific production of TNF-BPII in concert with TNF-BPI by the malignant cell lines revealed an inhibitory effect of supernatants on recombinant human TNF-alpha-mediated cytotoxicity of the TNF-dependent murine cell line L929, while supernatants of normal epidermal cells had no effect. Preincubation of supernatants with anti-TNF-BPI monoclonal antibody htr-9 or anti-TNF-BPII monoclonal antibody utr-1 reversed this inhibitory effect additively, indicating that the production of both TNF-BPs is necessary to protect cells from TNF-alpha-mediated cytotoxicity. A TNF-alpha scavanging effect of TNF-BPs resulting in subsequent inhibition of TNF-alpha binding to L929 cells could be demonstrated by ligand blotting and fluorescence-activated cell sorting analysis. Thus the production of TNF-BPII by epidermal tumor cells in concert with TNF-BPI appears to demonstrate a specific mechanism by which malignant epithelial cells escape from TNF-alpha-mediated cytotoxicity.
Psoralen plus UV-A (PUVA) is an effective therapy for psoriasis but also for other inflammatory dermatoses. The precise mechanisms of action, however, are not absolutely clear. Therefore, the effect of PUVA on the release of the proinflammatory cytokines interleukin (IL)-1, IL-6, IL-8 and tumor necrosis factor alpha (TNF alpha) was studied. Peripheral blood mononuclear cells (PBMC) obtained from humans were incubated with 8-methoxypsoralen (8-MOP) and exposed to UV-A (20 kJ/m2). This treatment resulted in a significant reduction of IL-6 and IL-8 amounts in the supernatants. In addition, an inhibition of IL-1 beta and TNF alpha production by lipopolysaccharide (LPS)-stimulated PBMC was observed upon PUVA treatment. Accordingly, northern blot analysis showed decreased levels of mRNA encoding for IL-1 beta, IL-6, IL-8 and TNF alpha in PUVA-treated PBMC. Finally PBMC were obtained from psoriatics undergoing oral photochemotherapy before the beginning and after completion of treatment. The PBMC collected after PUVA spontaneously produced significantly less IL-6 and IL-8 in comparison to the respective samples obtained before therapy. A similar suppression of IL-1 beta and TNF alpha by in vivo PUVA was found in LPS-stimulated PBMC. The present data demonstrate that PUVA both in vitro and in vivo suppresses the production of the proinflammatory cytokines IL-1 beta, IL-6, IL-8 and TNF alpha by PBMC. Because these cytokines are important in the mediation of inflammatory reactions, one may speculate that the inhibitory effects could contribute to the antiinflammatory activity of PUVA.
BACKGROUND AND DESIGN: Immunohistochemical analysis using four monoclonal antibodies specific for endothelium was performed to evaluate the possible role the endothelium may play in the pathogenesis of port-wine stains. In 11 patients with port-wine stains, biopsy specimens were obtained from involved and normal skin. On frozen tissue sections, we studied and compared the distribution and staining pattern of PAL-E, anti-intercellular adhesion molecule-1 (ICAM-1), anti-endothelial leukocyte adhesion molecule-1 (ELAM-1), and anti-factor VIIIrAg (FVIIIrAg), all recognizing specific epitopes of vascular endothelial cells. RESULTS: The PAL-E, anti-FVIIIrAg, and anti-ICAM-1 antibodies showed a similar distribution and staining pattern. The intensity of staining was equally strong with PAL-E and FVIIIrAg, while the expression of ICAM-1 was moderate. The ELAM-1 antibody exhibited only a weak expression in about 70% of evaluated specimens. No substantial differences in the intensity and distribution pattern of expression of these proteins could be demonstrated between normal skin and port-wine stains. CONCLUSION: Our findings suggest that the abnormal vessel pathologic findings in port-wine stains are not due to defects associated with the endothelium. According to PAL-E antibody staining properties, port-wine stain vessels could be classified as capillaries and/or postcapillary venules and small veins.
Pentoxifylline (PTX) is a methylxanthine compound known to inhibit the production of tumour necrosis factor-alpha (TNF-alpha), which is an important inflammatory mediator. There is also recent evidence that PTX may influence other inflammatory cytokines, such as interleukin-1 (IL-1) and IL-6. Due to the therapeutic implications, the present study addressed the in vivo effects of PTX on the release of TNF-alpha, IL-1 beta, IL-6 and IL-8 by human peripheral blood mononuclear cells (PBMC). When PBMC were obtained from healthy volunteers ingesting 5 x 400 mg PTX orally for 2 days, the ability of PBMC cultured for 24 hr to release TNF-alpha was significantly reduced, while secretion of IL-1 beta, IL-6 and IL-8 was not affected. However, when PBMC were obtained from the same individuals 5 days after PTX had been stopped, the release of all four cytokines was significantly suppressed. This effect appeared to be exerted at the transcriptional level, since Northern blot analysis revealed reduced cytokine transcripts. In order to gain more insight into the effect of PTX on cytokine release, PBMC were obtained from normal volunteers, either stimulated with lipopolysaccharide (LPS) or left unstimulated, and subsequently incubated in vitro with PTX for 48 hr. Under these conditions, only TNF-alpha was found to be reduced by PTX, while IL-1 beta and IL-8 were not affected, IL-6 was even enhanced. However, when PBMC were incubated with PTX for 24 hr, PTX removed thereafter by medium change and cells further cultured, the production not only of TNF-alpha but also of IL-1 beta, IL-6 and IL-8 was reduced, demonstrating that PTX exerts diverse (inhibitory) effects on cytokine release by PBMC.
The unique aspects of this therapy are presented in this article to provide background information critical to understanding the clinical results, which are then presented. The laboratory models discussed in the later parts of this article demonstrate the dependence of this response on the photoinactivation of lymphocytes by 8-methoxypsoralen in the presence of ultraviolet-A light.
50 year old patient with advanced stage Sézary syndrome was treated with extracorporeal photochemotherapy. During extracorporeal photochemotherapy the photoactivable agent 8-methoxypsoralen was administered orally. After 2 h a leucocyte enriched blood fraction was irradiated with UVA extracorporeally and reinfused to the patient. Besides the extracorporeal photochemotherapy Prednisolone and Leukeran were administered. Slow but permanent improvement was observed, the erythroderma, pruritus disappeared, lymph nodes, liver, spleen enlargement reduced, the number of CD4 positive lymphocytes decreased, that of CD8 positive lymphocytes increased.