沉默结缔组织生长因子对鼠转化生长因子β/Smads信号的影响

目的 研究小干扰RNA(siRNA)沉默结缔组织生长因子(CTGF)对大鼠转化生长因子(TGF)β/Smads信号通路的影响.方法 将化学合成CTGF siRNA转染肝星状细胞(HSC)T6和经门静脉注入CCl4诱导6周的肝纤维化大鼠,设空白及随机siRNA对照,抽提HSC T6及大鼠肝组织总RNA和蛋白质,应用Western blot和RT-PCR检测HSC T6及肝组织CTGF及TGF β1,Smad2、3、7蛋白质和基因表达. 结果与空白对照组相比,siRNA能显著下调HSC T6 CTGF蛋白表达,以48 h最明显,CTGF蛋白表达下调94%±4%(t=46.196,P<0.01),而TGF β1、Smad2,3,7 mRNA表达差异无统计学意义;模型组及对照siRNA组,CCl4诱导的大鼠肝组织CTGF和TGF β1蛋白表达明显上调,与模型组相比,CTGF siRNA组大鼠肝组织CTGF及TGF β1蛋白表达分别下调95%±2%(F=21.234,P<0.01)和74%±8%(F=13.464,P<0.05),但Smad2和Smad7蛋白表达无明显改变. 结论沉默CTGF基因表达对大鼠肝TGF β/Smads信号具有阻抑作用.     

沉默结缔组织生长因子对大鼠肝纤维化的影响

目的 研究结缔组织生长因子(CTGF)小干扰RNA(siRNA)在CCl4诱导的大鼠肝纤维化模型中的抗肝纤维化作用及其对肝星状细胞(HSC)激活的影响.方法 雄性SD大鼠24只,随机分成4组.模型组:皮下注射CCl4及经门静脉注射等渗盐水,每3 d 1次,连续6周(给药频率与时间,下同);CTGF siRNA干预组:皮下注射CCl4及经门静脉注射CTGF siRNA ;对照siRNA干预组:皮下注射CCl4及经门静脉注射对照siRNA;正常对照组:经门静脉注射等渗盐水.用HE染色和Sirius red染色评估大鼠肝组织学变化,Western blot检测肝组织CTGF及α平滑肌肌动蛋白(α-SMA)的表达,免疫组织化学染色评估肝组织α-SMA阳性细胞数量.对实验数据用单因素方差分析或Kruskal-Wallis检验分析.结果 模型组及对照siRNA组大鼠肝组织CTGF及α-SMA蛋白表达显著上调,α-SMA染色阳性细胞数量明显增加.与模型组相比,CTGF siRNA组CTGF及α-SMA蛋白表达分别下调95%±2%和86%±11%(F值分别为21.234和12.473,P值均＜0.01);肝组织α-SMA染色阳性细胞数减少76%±9%(F=9.179,P＜0.01);组织学检查显示肝纤维化程度明显减轻.结论 siRNA沉默CTGF基因能显著减轻大鼠实验性肝纤维化,减少活化HSC数量可能是其改善肝纤维化的主要机制之一.     

抗结缔组织生长因子小干扰RNA对肝星状细胞合成分泌细胞外基质的影响

目的 研究化学合成抗结缔组织生长因子(CTGF)小干扰RNA(siRNA)对肝星状细胞(HSC)CTGF基因表达及合成分泌细胞外基质(ECM)的影响。 方法 将化学合成抗CTGF siRNA以Oligofectamine包裹,转染HSC T6细胞,设空白对照,抽提孵育24、48、72 h细胞总RNA及蛋白质,并收集培养上清液,应用western blot和(或)逆转录聚合酶链反直检测HSC T6细胞CTGF及Ⅰ、Ⅲ型胶原基因表达,应用放射免疫法检测培养上清液中透明质酸及Ⅲ型前胶原含量。 结果 与空白对照相比,转染siRNA的HSC T6细胞CTGF及Ⅰ、Ⅲ型胶原基因表达水平显著下调,培养上清液中透明质酸及Ⅲ型前胶原含量24、48、72h分别降低46％±7％,52％±7％,53％±7％(F=157.45,P=0.0001)和29％±18％,29％±7％,27％±5％(F=10.77,P=0.0079)。 结论 化学合成抗CTGF siRNA能高效抑制HSC CTGF基因表达,显著减少HSC Ⅰ、Ⅲ型胶原及透明质酸等ECM的合成与分泌,抑制效应可持续72 h,提示化学合成CTGF siRNA具有预防及治疗肝纤维化的潜力并具有极好的开发前景。     

抗结缔组织生长因子小干扰RNA对鼠原代肝易状细胞增殖的影响

细胞外基质(ECM)积聚与活化肝星状细胞(HSC)数量密切相关,增殖是活化HSC的重要生物学特性之一,也是调控活化 HSC数量的一种重要方式。结缔组织生长因子(CTGF)主要由活化HSC产生,是HSC增殖的一个重要刺激因子。因此, 下调CTGF表达,将有望通过抑制HSC增殖,减少活化HSC 数量及ECM积聚防治肝纤维化发生与发展。小分子干扰RNA (siRNA)是一种转录后基因沉默的强大工具。研究旨在探讨是否抗CTGF siRNA能下调原代HSC CTGF基因表达及抑制 HSC增殖。一、材料与方法 1．材料：SD大鼠购自中国科学院上海实验动物中心,大鼠CTGF siRNA(序列483～503)由中国科学院上海生命研究院生物化学与细胞研究所合成,Oligofectamine及Opti-MEM1 为美国Invitrogen公司产品；Ⅳ型胶原酶、Nycodenz及小鼠     

整合素连接激酶在重组结缔组织生长因子诱导大鼠肝星状细胞表型转化中的作用

目的研究整合素连接激酶(ILK)在重组结缔组织生长因子(rCTGF)诱导大鼠原代肝星状细胞(HSC)表型转化中的作用。方法应用胶原酶原位灌注+密度梯度离心法分离SD大鼠原代HSC,细胞贴壁培养24 h后以rCTGF处理,24 h后转染ILK小干扰RNA(siRNA)或对照siRNA,设rCTGF对照及空白对照。应用RT-PCR及Western Blot检测转染siRNA 24、48及72 h时HSCα平滑肌肌动蛋白(αSMA)、ILK及I型胶原基因表达水平变化。计量资料采用t检验。结果与空白对照相比,rCTGF处理可显著上调大鼠HSCαSMA、ILK蛋白及I型胶原mRNA表达。转染ILK siRNA可特异性抑制rCTGF诱导的ILK表达上调,与rCTGF对照相比,转染ILK siRNA 24、48及72 h时,HSC ILK蛋白表达分别下调72%±6%(t=21.39,P0.01)、87%±9%(t=68.25,P0.01)及47%±3%(t=18.25,P=0.003);αSMA蛋白及I型胶原mRNA表达分别下调5%±1%(t=2.52,P0.05)及6%±3%(t=1.63,P0.05)、31%±7%(t=34.77,P0.01)及20±5%(t=6.71,P0.05)和67%±8%(t=58.82,P0.01)及43%±6%(t=15.21,P0.01);转染对照siRNA时,HSC ILK、αSMA及I型胶原mRNA表达在相同时点无显著变化。结论 ILK可能部分介导了rCTGF诱导的大鼠HSC表型转化。     

四氯化碳诱导的大鼠肝纤维化肝组织中SHP2表达与在体肝星状细胞活化及增殖的关系

目的 探讨四氯化碳诱导的大鼠肝纤维化肝组织及在体肝星状细胞(HSC)的含SH2结构域的蛋白酪氨酸磷酸酶2(SHP2)表达变化与在体HSC活化及增殖的关系。方法 随机将50只健康雄性SD大鼠分为对照组(10只)、模型组(40只),采用腹腔注射四氯化碳法构建大鼠肝纤维化模型，Masson三色及HE染色检测大鼠肝组织的病理组织学变化，免疫组织化学染色检测大鼠肝组织的α-平滑肌肌动蛋白(α-SMA)及SHP2表达，SHP2与α-SMA免疫荧光双标记检测大鼠肝组织中活化HSC的SHP2表达。结果 与对照组大鼠肝组织的α-SMA阳性表达积分光密度值(IOD)(0.09±0.01)相比，造模不同时间(2周、4周、6周、8周)大鼠纤维化肝组织的α-SMA阳性表达IOD (0.13±0.01、0.18±0.01、0.24±0.02、0.28±0.02)显著增加(P<0.05),并随着造模时间延长逐渐升高(P<0.05),即在体HSC的活化及增殖逐渐加快(α-SMA是HSC的活化标志)。造模不同时间(2周、4周、6周、8周)大鼠纤维化肝组织的SHP2阳性表达IOD (0.23±0.01、0.2...     

纤溶酶原激活物抑制剂-1 小干扰RNA对肝星状细胞生物学特性的影响

目的研究化学合成纤溶酶原激活物抑制剂-1（PAI-1）小干扰RNA（siRNA）对肝星状细胞（HSC）PAI-1基因表达及生物学特性的影响。方法将化学合成抗PAI-1 siRNA以Lipofectamine包裹，转染HSC—T6细胞，设阴性对照和空白对照，抽提细胞总RNA及蛋白质，收集培养上清液，应用逆转录-聚合酶链反应和免疫细胞荧光法检测细胞PAI—1表达。应用MTT法和流式细胞仪检测细胞增殖和细胞周期变化，应用酶联免疫吸附法检测培养上清液中Ⅰ、Ⅲ型胶原含量。结果转染siRNA的HSC—T6细胞PAI-1基因表达水平明显下调，HSC—T6细胞增殖抑制明显，48h和72h时培养上清液中Ⅰ型胶原表达水平显著减少，分别比阴性对照下降（20．71±8．40）％和（37．97±6．40）％（F=42．69。P=0．0001），Ⅲ型胶原含量于72h时降低（35．98±4．60）％（F=105．52，P=0．0001）。结论化学合成抗PAI-1 siRNA能高效抑制HSC—T6PAI-1表达，抑制HSC—T6细胞增殖，显著减少Ⅰ、Ⅲ型胶原的合成和分泌，具有预防及治疗肝纤维化的潜力。     

C/EBPα基因在大鼠肝星状细胞内的表达及意义

目的 初步探讨CCAAT增强子结合蛋白α(C／EBPα)在肝星状细胞(HSC)激活过程中的作用。方法 采用免疫细胞化学、western blot及RT-PCR检测原代培养不同时间段HSC内C／EBPd蛋白和mRNA的表达，以及α平滑肌肌动蛋白(α SMA)、结蛋白、基质金属蛋白酶-2(MMP2)mRNA、Ⅰ型前胶原(α1)mRNA的表达；Lipofect AMINE2000介导的瞬时转染方法将pcDNA3．1(-)-C／EBPα真核表达质粒转染入激活的HSC内，采用免疫细胞化学方法鉴定转染成功及转染后HSC内增殖细胞核抗原(PCNA)的表达；在相差显做镜下观察HSC在原代培养过程中形态的改变。结果 原代正常HSC中可以检测到C／FBPα mRNA和蛋白的表达，蛋白位于细胞质和细胞核内，但主要位于细胞质内，且除新鲜分离(0d)组以外，随着HSC培养至2、4、7、10d，C／EBPα蛋白和mRNA的表达呈逐步下降的趋势，而α-SMA、MMP2和Ⅰ型前胶原(α1)的表达则逐步增强；转染后24h，目的基因转染组HSC内C／EBPα的表达明显强于空载体对照组，而PCNA的阳性细胞数较空载体对照组明显减少；转染后36h，目的基因转染组细胞几乎全部死亡，残存的细胞形态变细，体积缩小，而空载体对照组细胞仍存括。结论 C／EBPα基因可能参与HSC的激活调控机制，且C／EBPα过表达对HSC的增殖存在抑制作用。     

转化生长因子β1对不同活化状态肝星状细胞增殖与Ⅰ型胶原表达的影响

目的 观察不同活化状态肝星状细胞(HSC)对外源性转化生长因子-β_1(TGF-β_1)旁分泌刺激的生物学效应作用。方法 原代分离培养大鼠HSC,无包被塑料培养皿上分别培养1、4、7d,细胞处于静止、中间活化与完全活化状态,继以10～500 pmol/L TGF-β_1温育细胞24h,~3H—TdR掺入法测定细胞增殖,western blot法检测细胞α-平滑肌肌动蛋白(α-SMA)与Ⅰ型胶原蛋白表达沉积,~3H-脯氨酸掺入与胶原酶消化法测定细胞总胶原的分泌量。100pmol/L TGF-β_1温育细胞15～90min,northern blot法检测细胞Ⅰ型前胶原mRNA的表达水平。结果 TGF-β_1浓度依赖性抑制培养1d HSC的细胞增殖,10～500 pmol/L TGF-β_1浓度组细胞内~3H—TdR掺入率分别为对照组的52.8％～16.8％,与对照组比较,q值为5.44～10.37,P<0.01。但TGF-β_1对培养4d与7d的细胞增殖无影响。随细胞活化,HSC基础性α-SMA、Ⅰ型胶原蛋白与mRNA水平明显增加,而TGF-β_1刺激各培养时间HSC以上蛋白与基因的表达。培养1、4、7d HSC基础水平与TGF-β_1刺激的总胶原分泌量分别为(804±274)dpm/孔与(1 200±708)dpm/孔;(2 966±1 701)dpm/孔与(6 160±1 123)dpm/孔;(2 580±767)dpm/孔与(4 583±1 467)dpm/孔,后2组组内比较,t值分别为3.84与2.96,P<0.01或P<0.05。以培养4d HSC     

氧化苯砷体外对大鼠原代肝星状细胞活化的阻抑作用研究

目的探讨氧化苯砷(PAO)对肝星状细胞(HSC)活化的影响。方法采用密度梯度离心法提取SD大鼠原代HSC,在倒置显微镜下观察HSC形态的改变;以25、50、100、150和200 nmol/L浓度PAO处理活化的HSC-T6细胞,以四甲基偶氮唑盐(MTT)法评估PAO的细胞毒性;分别以25、50、100 nmol/L浓度的PAO处理离体培养4 d的HSC 72 h,并设对照组,采用Western blot和Real-time PCR法检测各组细胞α-SMA和I型胶原m RNA和蛋白表达。结果原代HSC离体培养过程中α-SMA表达量逐渐升高,与培养1 d时(0.762±0.062)比,培养4 d时其α-SMA蛋白表达【(1.51±0.045),P0.05】显著升高;PAO在25~100 nmo/L浓度范围内对活化的HSC无明显的细胞毒性,但能浓度依赖性抑制活化的HSCα-SMA和I型胶原m RNA水平和蛋白表达。结论离体培养4 d时,HSC呈初始活化状态。PAO在25~100 nmol/L范围可浓度依赖性地阻抑离体培养的HSC的自发激活,提示PAO有潜力成为一类新型的抗肝纤维化药物。     

International Hemoglobin Information Center Policies - Ihic

Abstract

The levels of the inactive hemoglobin (Hb) pigments [such as methemoglobin (metHb), carboxyhemoglobin (HbCO) and sulfohemoglobin (SHb)] and the active Hb [in the oxyhemoglobin (oxyHb) form] as well as the blood Hb concentration in healthy non pregnant female volunteers were determined using a newly developed multi-component spectrophotometric method. The results of this method revealed values of SHb% in the range (0.0727–0.370%), metHb% (0.43–1.0%), HbCO% (0.4–1.52%) and oxyHb% (97.06–98.62%). Furthermore, the results of this method revealed values of blood Hb concentration in the range (12.608–15.777?g/dL). The method is highly sensitive, accurate and reproducible.     

慢型、潜在型克山病患者的血管内皮功能观察

目的观察山东省慢型、潜在型克山病患者的临床特点和血管内皮功能,探讨机体内皮功能失调与克山病发生发展的关系。方法选择慢型、潜在型克山病患者57人、病区健康人34人,分别采集清晨空腹血检测ET、NO、NOS、iNOS及cNOS含量及活性。结果(1)克山病患者ET水平明显高于病区健康人(P<0.01);心功能越差,ET升高越明显(P<0.01);(2)NO和NOS含量,潜在型、慢型克山病均明显高于病区健康人(P<0.01);慢型高于潜在型(P<0.01);iN-OS含量克山病患者也高于病区健康人(P<0.05);慢型克山病高于潜在型克山病(P<0.05)。结论ET、NO水平的变化可能作为一种中间环节参与了克山病的发病机制;心功能不同,血浆ET、NO升高的程度也不同;ET、NO可作为克山病病情严重程度的预测指标。     

The Mitochondrial Permeability Transition: Role in Ischemia/Reperfusion Injury

The mitochondrial permeability transition (MPT) occurs when a non-specific pore opens in the inner mitochondrial membrane and converts the mitochondrion from an organelle whose ATP production sustains the normal function of the cell to an instrument of death. Conditions favouring the MPT including high [Ca2+], oxidative stress and adenine nucleotide depletion, all of which occur when a tissue is reperfused following a period of ischemia. Cyclosporin A (CsA) and low pH (<7.0) are potent inhibitors of the MPT. Methods have been devised to demonstrate directly that the MPT pores open upon reperfusion but not during ischemia. The mechanism of the MPT appears to involve binding of mitochondrial cyclophilin (CyP) to the adenine nucleotide translocase (ANT) followed by a calcium-mediated conformational change that converts the ANT into a non-specific pore. Understanding the molecular mechanism has assisted in devising strategies that can be used to protect tissues from damage caused by reperfusion injury. These might also be of benefit in the prevention of multiple organ failure for which reperfusion injury of the gut is thought to be the initial trigger. Protective regimes include the pretreatment of tissues prior to ischemia/reperfusion with CsA (binds to CyP), free radical scavengers that reduce oxidative stress (e.g., pyruvate and propofol) and agents that decrease pHi (e.g., pyruvate or amelioride derivatives). Reperfusion injury can produce both immediate cell death by necrosis or delayed apoptotic cell death and it appears that the mitochondria determine which route is taken. Prolonged opening leads to rapid cell death by necrosis, whilst transient opening leads to cytochrome c release and subsequent apoptosis hours or days later.     

Usefulness of procalcitonin for diagnosis of infective endocarditis

The aim of this study was to evaluate the accuracy of procalcitonin (PCT) in predicting infective endocarditis (IE). 23 adult patients with IE, 30 patients with sepsis and 30 with tick-borne encephalitis were included in this prospective study. The PCT serum level, C-reactive protein (CRP), total leukocyte, and immature polymorphonuclear (PMN) cell counts were determined on admission, prior to the institution of antibiotic therapy, and compared according to the diagnosis. The median PCT level in patients with IE endocarditis was 0.81 ng/ml, in patients with sepsis it was 43.74 ng/ml, and in the group with viral infection it was 0.25 ng/ml (P < 0.001). The highest PCT level was found in patients with Staphylococcus aureus endocarditis. The area under the receiver operating characteristic curve that used PCT to predict IE was 0.722 (95% CI 0.572–0.873), compared with 0.909 (95% CI 0.829–0.989) for CRP, 0.699 (95% CI 0.551–0.846) for immature PMN cell count, and 0.619 (95% CI 0.468–0.770) for leukocyte count. Our study fails to demonstrate superiority of PCT as a diagnostic laboratorial parameter in predicting IE compared to CRP.     

Linear affine transformations between 3-lead (Frank XYZ leads) vectorcardiogram and 12-lead electrocardiogram signals

Background

Recent advances in computer graphics and wireless technologies have renewed interest in vectorcardiogram (VCG) signals that use fewer leads than the conventional 12-lead electrocardiogram (ECG) signals for medical diagnostic applications. However, most cardiologists are accustomed to the 12-lead ECG even though some of the leads are either nearly aligned with or derived from the others and consequently contain redundant information. The ability to transform from orthogonal 3-lead VCG to 12-lead ECG enables the use of fewer leads for signal analysis, computer visualization, and wireless transmission of signals. This can also improve mobility, albeit limited, to the patients.

Materials and Methods

We present a statistical approach to transform 3-lead Frank VCG to 12-lead ECG signals and vice versa, based on Dower's pioneering work on lead tranformation. This approach enables compensation of baseline shifts and other constant biases present in long ECG data streams, so that the resulting statistical transforms can be more consistent and accurate. We compare the performance of the affine transform with that of Dower transform (from 3 to 12 and from 12 to 3) using the data from the PhysioNet PTB database.

Results

The results show that for both myocardial infarction (MI) and healthy control (HC) subjects, the statistical affine transform presented here maps 3-lead VCG to12-lead ECG more accurately than Dower or other lead transformation matrices of the ECG recordings.

Discussion

This investigation also shows the limitations associated with single dipole assumption that underlies Dower's geometric transformation. The results also indicate that lead transformation accuracy can be improved using separate customized transforms to, for example, age or pathologic conditions (here, MI vs HC) than a single statistical or geometric transform. Pertinently, we find that the affine transform coefficients can serve as discriminating features for classification/discrimination of MI patients from HC subjects.     

Expression of membrane-type matrix metalloproteinases in synovial tissue from patients with rheumatoid arthritis or osteoarthritis

We investigated the expression of membrane-type matrix metalloproteinase (MT-MMP) and matrix metalloproteinase (MMP) mRNAs in synovial tissue from patients with rheumatoid arthritis (RA, n = 5) or osteoarthritis (OA, n = 5) by Northern blot analysis. Northern analysis demonstrated strong expression of MT1-MMP, MT3-MMP, MMP-1, and MMP-3 and weak expression of MT2-MMP and MMP-8 in synovial tissue from patients with RA or OA. MT4-MMP was not detected. No significant difference was shown in the expression of MT-MMP mRNAs between RA and OA. Synovial tissue of RA or OA patients expressed MT-MMPs as well as MMPs. These results indicate that, in addition to MMPs, MT1-MMP, MT3-MMP, and probably MT2-MMP may play a role in the degradation of bone and cartilage matrix in RA and OA. Such information may provide a clue to the development of a novel therapeutic approach targeted on the prevention of joint destruction. Received: April 30, 2000 / Accepted: September 19, 2000     

Efficacy of combination treatment with cyclosporin A and corticosteroids for acute interstitial pneumonitis associated with dermatomyositis

Interstitial pneumonitis (IP) associated with polymyositis and dermatomyositis (PM/DM) is a serious complication that affects prognosis. We therefore undertook a retrospective multicenter study to examine the efficacy of a combination treatment with cyclosporin A (CsA) and corticosteroids. Fifty-three IP patients with PM/DM (9 PM, 44 DM) were analyzed. Thirty-two patients treated with CsA plus corticosteroids (9 PM, 23 DM) were included in the study. Four parameters, i.e., subjective symptoms, ausculatory sound, chest radiographs, and respiratory index, were serially evaluated. A general evaluation was performed 4 weeks after the start of the combination treatment. All patients with PM and chronic IP with DM, and 52% of those with acute IP with DM were graded as better than partially effective in the general evaluation. In contrast, all patients graded as progressive in the general evaluation had acute IP with DM. It is of note that in acute IP with DM, the survival rate of the group primarily treated with CsA and corticosteroids from the early stage of their disease was significantly higher than that of the group initially treated with corticosteroids alone (P = 0.049). In conclusion, a combination treatment of CsA and corticosteroids from the early stage of disease may be advantageous for patients with IP with PM/DM, especially acute IP with DM.     

Relevance of Endocavitary Structures in Ablation Procedures for Ventricular Tachycardia

Endocavitary Structures and Ventricular Tachycardia Ablation. Background: Radiofrequency (RF) ablation for ventricular tachycardia (VT) has high failure rates. Whether endocavitary structures (ECS) such as the papillary muscles (PMs), moderator bands (MBs), or false tendons (FTs) impact VT ablation is unknown. Methods and Results: We retrospectively reviewed records of 190 consecutive patients presenting for VT ablation and identified 46 (24%) where ECS affected ablation. In 31 of 46 patients (67%), the ECS created difficulty with catheter manipulation (n = 20), interpretation of pace map data (n = 7), or with accurately defining a scar (n = 4). In 15 of 46 (33%), specific mapping and RF energy delivery targeting the ECS itself was necessary to eliminate the arrhythmia. Detailed electroanatomic mapping was performed in 11 of 15 (73%), noncontact mapping in 3 of 15 (20%), multielectrode catheter mapping in 1 of 15 (7%), and intracardiac ultrasound in 14 of 15 (93%) patients. The ablated ECS was a PM in 5 of 15, the MB in 7 of 15, and an FT in 3 of 15. The arrhythmogenic substrate on the ECS was a focus of automatic tachycardia in 9 of 15 and the slow zone responsible for reentrant arrhythmia in the remaining 6 of 15. Successful elimination of tachycardia without recurrence was obtained in all 15 cases. There was no evidence of valvular damage or disruption of the valvular apparatus. Conclusion: During VT ablation procedures, ECS should be considered for specific mapping and targeted ablation. Once recognized, these structures can be successfully targeted for ablation without valve damage. (J Cardiovasc Electrophysiol, Vol. 21, pp. 245–254, March 2010)     

Efficacy of combination treatment with cyclosporin A and corticosteroids for acute interstitial pneumonitis associated with dermatomyositis

Abstract

Interstitial pneumonitis (IP) associated with polymyositis and dermatomyositis (PM/DM) is a serious complication that affects prognosis. We therefore undertook a retrospective multicenter study to examine the efficacy of a combination treatment with cyclosporin A (CsA) and corticosteroids. Fifty-three IP patients with PM/DM (9 PM, 44 DM) were analyzed. Thirty-two patients treated with CsA plus corticosteroids (9 PM, 23 DM) were included in the study. Four parameters, i.e., subjective symptoms, ausculatory sound, chest radiographs, and respiratory index, were serially evaluated. A general evaluation was performed 4 weeks after the start of the combination treatment. All patients with PM and chronic IP with DM, and 52% of those with acute IP with DM were graded as better than “partially effective” in the general evaluation. In contrast, all patients graded as “progressive” in the general evaluation had acute IP with DM. It is of note that in acute IP with DM, the survival rate of the group primarily treated with CsA and corticosteroids from the early stage of their disease was significantly higher than that of the group initially treated with corticosteroids alone (P = 0.049). In conclusion, a combination treatment of CsA and corticosteroids from the early stage of disease may be advantageous for patients with IP with PM/DM, especially acute IP with DM.     

Efficacy and safety of bucillamine, a d-penicillamine analogue, in patients with active rheumatoid arthritis

Japanese rheumatologists consider bucillamine (Buc) to be a useful disease-modifying antirheumatic drug (DMARD) and often give Buc to patients with rheumatoid arthritis (RA) prior to administering methotrexate (MTX). However, no large studies on the efficacy and safety of Buc in RA patients have been published in English to date. We therefore investigated the clinical course of RA patients treated with Buc and compared the results with those for patients treated with MTX to evaluate and confirm the place of Buc in therapeutic strategies for RA in Japan. Our results suggested that Buc should be given to patients with moderately active RA either before or after the administration of MTX because its efficacy can be judged within 3 months and because serious adverse events are rare. Issues like the ability of Buc to prevent joint destruction and its efficacy and safety when combined with agents like etanercept require future study.