HTLV-I and HTLV-II Infections in Spain

IgG present in the circulation of newborn infants is predominantly of maternal origin. In cases of severe Rh D alloimmunization, the maternal anti-D antibodies may lead to Rh D-haemolytic disease of the newborn. However, an impaired placental transport of maternal IgG could be associated with the protection of the fetus/newborn against haemolytic disease as shown in this case report.     

The epidemiology of diseases associated with HTLV-I and HTLV-II

Considerable progress is being made in the understanding of at least two diseases associated with HTLV-I, ATLL and TSP. While laboratory methodology has not yet permitted comparable advances in identifying diseases associated with HTLV-II, if any, it is likely that a greater understanding of this and other retroviruses will result from the increasing focus of attention in this area. As illustrated by a recent meeting on retroviruses in the nervous system, which included discussions on polymyositis and multiple sclerosis as well as TSP, ATLL, and AIDS, the number of diseases associated with retroviruses is likely to increase and, if the applications of research data to the control of malignancies associated with hepatitis B virus and Epstein-Barr virus are applicable, the future for improving control of HTLV-I-associated disease should be quite promising.     

Retroperitoneal fibrosis: evolving concepts

Retroperitoneal fibrosis (RPF) is a rare fibro-inflammatory condition that is idiopathic in most cases, but may be secondary to various causes. Although the cause and pathogenesis of the idiopathic form are unknown, immunogenetic factors and immunopathologic/autoimmune mechanisms are probably involved. Idiopathic RPF usually develops around the abdominal aorta and iliac arteries but in some cases may also involve the thoracic aorta and the origin of its major branches, with a pattern similar to that of other forms of large-vessel vasculitis. In addition, the disease is frequently associated with autoimmune conditions affecting other organs. Glucocorticoids alone or in combination with immunosuppressive agents are usually effective treatment options, but the disease frequently has a chronic relapsing course.     

Hormone therapy: evolving concepts

OBJECTIVE: To review the medical literature published in 2002 regarding menopausal hormone therapy and its impact on clinical practice. METHODS: A literature search was performed using MEDLINE with the keywords of menopause, sex steroids, and hormone replacement therapy. Randomized clinical trials were reviewed. An evidence-based review is presented. RESULTS: Menopausal hormone therapy has undergone radical change since the publication of the Women's Health Initiative randomized prospective trial of combined estrogen plus progestin therapy for disease prevention. After a mean of 5.2 years of follow-up, the E + P versus placebo trial of 16,608 women was stopped because the health risks of taking E + P exceeded the benefits. An increase in breast cancer risk, coupled with an adverse trend in overall risk-benefit ratio, reached the preset stopping boundaries. In addition, there was an increased risk of nonfatal myocardial infarction, stroke, and pulmonary embolism. The decreased risks seen for osteoporotic fracture and colorectal cancer were outweighed by the above risks. The FDA has required mandatory label changes for all hormone products based on these findings. The Women's Health Initiative found that treatment with estrogen plus progestin for up to 5 years is not beneficial overall. There is early harm for coronary heart disease, continuing harm for stroke and venous thromboembolism, and increasing harm for breast cancer. This risk-benefit profile is not consistent with a viable intervention for primary prevention of chronic diseases in postmenopausal women. Menopausal hormone therapy should be reserved for women with moderate to severe vasomotor symptoms. CONCLUSIONS: In the past 20 years, menopause has become a household word, with much better understanding of its consequences. The growing numbers of menopausal women and clinical trials have coincided to draw increasing attention to the perimenopausal and menopausal years. Better studies of older therapies and the expanded number of new choices today, with more in development and evaluation, have complicated provider and patient choices but greatly improved the potential for effective intervention.     

Psoriatic arthritis: evolving concepts

Articles included in this review reflect the recent advances made in basic research and the clinical management of psoriatic arthritis in 1999. Some of these advances are destined to modify the current approach to the disease. The problems related to nosology and epidemiology, the two still controversial aspects, are discussed first. Genetic susceptibility to psoriasis and psoriatic arthritis, and the inciting role played by some bacteria, are confirmed, and attention is focused on the role of T cells, cytokines, adhesion molecules, and angiogenetic factors in the skin and synovial membrane. New classification criteria are provided and a simplified spectrum of the disease seems to emerge from clinical studies. Modern imaging techniques enable early articular changes to be discovered, support innovative pathogenetic hypotheses, and allow new therapeutic approaches.     

A seroepidemiological survey of HTLV-I/HTLV-II in selected Belgian populations

A preliminary survey of the prevalence of HTLV-I antibody during 1987 and 1988 in Belgium revealed no positive results among selected blood donors who sided for some length of time in areas where HTLV-I/HTLV-II is endemic (n = 270), in development-aid workers (n = 145), or in missionaries (n = 35) serving in developing countries. Among foreign groups, African students (n = 212), and political refugees (n = 311), HTLV-I/HTLV-II antibodies were detected and confirmed in 3 cases. Limited data from 1987 and 1988 suggest that HTLV-I/HTLV-II poses no major public health problem in Belgium.     

Inflammasomes and rheumatic diseases: evolving concepts

The realisation that the production of inflammatory cytokines in inflammatory rheumatic diseases may be induced by non-infectious endogenous signals has encouraged researchers to explore mechanisms of innate immunity and their contribution to the pathogenesis of these diseases. The nucleotide-binding and oligomerisation domain (NOD)-like receptors (NLRs) sense pathogens, products of damaged cells or endogenous metabolites and could potentially be involved in the initiation, amplification and progression of the inflammatory response in rheumatic diseases. NLRs are involved in the regulation of innate immune responses with some of them promoting the activation of inflammatory caspases within multiprotein complexes, called inflammasomes. A typical inflammasome consists of a sensor, an NLR protein, an adaptor protein such as ASC (for apoptosis-associated speck-like protein containing a caspase recruitment domain (CARD)) and an effector protein that is a caspase that activates pro-inflammatory cytokines such as interleukin (IL)1beta and IL18. Recent data suggest a role of the inflammasome in the pathogenesis of autoinflammatory as well as inflammatory rheumatic diseases such as juvenile chronic arthritis, adult onset Still disease, rheumatoid arthritis and gout. Modulation of these pathways may be a potential therapeutic target for inflammatory rheumatic diseases.     

HTLV-I and HTLV-II infections in volunteer blood donors and high-risk groups in Lebanon

A serosurvey for Human T-cell Lymphotropic virus type 1 (HTLV-I)/HTLV-II was conducted in 1,900 blood donors, 120 pregnant women and 436 high-risk group patients in Beirut, Lebanon. One of the 1,900 blood donors was anti-HTLV-I/II-seroreactive on screening by enzyme immunoassay (EIA) but was indeterminate by Western blot and negative by polymerase chain reaction. None of the other 556 subjects studied was seroreactive by EIA. The credibility of the zero prevalence of HTLV-I/II infection among the Lebanese blood donors is supported by the absence of seroreactivity of antibodies in the multiply transfused patients. It seems therefore that the prevalence of HTLV-I/II appears to be less than 1 in 2,456 in the Lebanese population and hence, HTLV-I/II infection does not appear to require routine screening in Lebanon.     

Parathyroid hormone: evolving therapeutic concepts

PURPOSE OF REVIEW: Osteoporosis results from a loss of bone mass and structure such that bones break with very little trauma. To reduce bone loss and improve strength, antiresorptive agents have been instituted. Just more than a year ago, a 34-amino acid fragment of parathyroid hormone (recombinant human parathyroid hormone 1-34) was approved for the treatment of osteoporosis. The parathyroid hormone treatment works by stimulating bone formation on all bone surfaces and is referred to as an osteoanabolic agent. The purpose of this article is to review initial phase 2 and phase 3 studies that establish the effectiveness of this agent to treat osteoporosis. RECENT FINDINGS: In addition, studies that use parathyroid hormone in combination with antiresorptive agents and sequentially are reviewed. Last, unresolved issues related to the duration of use of parathyroid hormone are discussed. SUMMARY: In summary, parathyroid hormone compounds are a major advance in the treatment of osteoporosis. Additional research will enlighten clinicians on the most efficacious way to use them.     

Wegener's granulomatosis: evolving concepts in treatment

Wegener's granulomatosis (WG), the most common of the pulmonary granulomatous vasculitides, typically involves the upper respiratory tract, lower respiratory tract (bronchi and lung), and kidney, with varying degrees of disseminated vasculitis. Major histological features include a necrotizing vasculitis involving small vessels, extensive "geographic" necrosis, and granulomatous inflammation. Clinical manifestations of WG are protean; virtually any organ can be involved. Further, the spectrum and severity of the disease is heterogeneous, ranging from indolent disease involving only one site to fulminant, multiorgan vasculitis leading to death. The pathogenesis of WG has not been elucidated, but both cellular and humoral components are involved. Circulating antineutrophil cytoplasmic antibodies (cANCA) likely play a role in the pathogenesis and often correlate with activity of the disease. Treatment strategies are evolving. Cyclophosphamide (CYC) plus corticosteroids (CS) is the mainstay of therapy for generalized, multisystemic WG. Historically, the combination of CYC plus CS was used for a minimum of 12 months, but concern about late toxicities associated with CYC has led to novel treatment approaches. Currently, short-course (3-6 months) induction treatment with CYC plus CS, followed by maintenance therapy with less toxic agents (e.g., methotrexate, azathioprine) is recommended. Further, recent studies suggest that methotrexate combined with CS may be adequate for limited, non-life threatening WG. The role of other immunomodulatory agents (including trimethoprim-sulfamethoxazole) is also explored.