The Hong Kong Society of Rheumatology consensus recommendations for the management of gout

Clinical Rheumatology - Gout is one of the most common noncommunicable diseases in Hong Kong. Although effective treatment options are readily available, the management of gout in Hong Kong remains...     

细粒棘球蚴重组抗原B的表达提取及其血清学检测初探

用基因工程技术制备出的细粒棘球绦虫重组抗原B（rAgB）表达载体,经诱导表达、亲和层析纯化获得具生物活性的重组蛋白质rAgB,用Western-Blot法检测病人血清。结果显示rAgB敏感性为91．6％（44／48）,特异性为93．8％（30／32）,其中10例泡球蚴（AE）病人及10例肿瘤病人血清均无交叉反应。说明rAgB具有较高的敏感性及特异性,可用于包虫病的常规血清学诊断,rAgB在宿主菌JM109内稳定表达,因此可在实验室内大量制备用于血清学诊断的rAgB。     

泡状棘球蚴病宿主淋巴细胞的变化及意义

目的　为探讨泡状棘球蚴病宿主体内淋巴细胞在免疫调节和发病中的作用。方法　对泡球蚴感染BALB/c小鼠观察至 2 5周 ,在不同时间取脾制备细胞悬液 ,检测CD+ 4 ,CD+ 8细胞数量。对 2 5例泡球蚴病患者和 18例健康人群 ,用FCM分析了CD+ 3 ,CD+ 4 ,CD+ 8,CD+ 19,CD+ 3 8,CD+ 56和HLA -DR+ 细胞的变化。结果　泡球蚴感染BALB/c小鼠后 ,1～ 8周以CD+ 4 细胞为主 ,随后CD+ 4 细胞减少 ,CD+ 8细胞增加 ,2 0周后改变显著 (P <0 0 5 ) ,CD+ 4 /CD+ 8比值迅速倒置。泡状棘球蚴病患者CD+ 3细胞未发生改变 ,CD+ 4 细胞较正常对照组下降 (P <0 0 5 ) ,CD+ 8细胞上升 (P <0 0 5 ) ,使CD+ 4 /CD+ 8比值降低 (P <0 0 5 )。CD+ 56细胞较正常对照组显著性降低 (P <0 0 1) ,CD+ 19,CD+ 3 8和HLA -DR+ 细胞未发生改变 (P >0 0 5 )。结论　泡球蚴感染小鼠前 8周 ,以CD+ 4 细胞反应为主 ,具有保护性免疫。感染后期逐渐以CD+ 8细胞为主 ,使机体呈免疫抑制状态 ,有利于泡球蚴生存。泡状棘球蚴病患者机体呈免疫抑制状态 ,有利于泡状棘球蚴在体内的生长     

OXIDATIVE STRESS AND DIABETIC NEUROPATHY: PATHOPHYSIOLOGICAL MECHANISMS AND TREATMENT PERSPECTIVES

Increased oxidative stress is a mechanism that probably plays a major role in the development of diabetic complications, including peripheral neuropathy. This review summarises recent data from in vitro and in vivo studies that have been performed both to understand this aspect of the pathophysiology of diabetic neuropathy and to develop therapeutic modalities for its prevention or treatment. Extensive animal studies have demonstrated that oxidative stress may be a final common pathway in the development of diabetic neuropathy, and that antioxidants can prevent or reverse hyperglycaemia-induced nerve dysfunction. Most probably, the effects of antioxidants are mediated by correction of nutritive blood flow, although direct effects on endoneurial oxidative state are not excluded. In a limited number of clinical studies, antioxidant drugs including alpha-lipoic acid and vitamin E were found to reduce neuropathic symptoms or to correct nerve conduction velocity. These data are promising, and additional larger studies with alpha-lipoic acid are currently being performed.     

Monoclonal antibody T101 in T cell malignancies: a clinical, pharmacokinetic, and immunologic correlation

Eight patients with cutaneous T cell lymphomas (CTCL) and five with various other T cell malignancies were treated with mouse monoclonal antibody (MoAb) T101. Doses of 1 to 500 mg were administered weekly over a two-hour period and resulted in one complete remission (convoluted T cell lymphoma) and one partial remission (CTCL). Remission duration was 6 weeks and 3 months, respectively. Frequent toxicities were pruritus, hives, flushing, and shortness of breath. Supraventricular arrhythmias and blood pressure instability were also observed. Complete targeting of peripheral blood T cells was achieved with 1 mg of MoAb in the nonleukemic patients (WBC less than 10,000/microL), and free, bioavailable antibody was present at the next (10-mg) dose level. Even higher doses resulted in substantial antibody excess that persisted for as long as 6 weeks. Serum concentrations of MoAb decreased with increasing number of peripheral blood T cells, and 25 to 35 mg of T101 were required for induction of antibody excess in leukemic patients. Excess antibody induced antigenic modulation, which was of consequence only if MoAb excess persisted to the next treatment. In the original treatment, the rapidly administered MoAb was able to target and remove peripheral blood T cells before the development of antigenic modulation. Antimouse antibodies developed in three patients. Their presence rendered further therapy ineffective and was associated with an anaphylactic reaction in one patient. Development of these antibodies could not be predicted by lymphoproliferative assays. In these assays, however, the T101 protein strongly stimulated the mononuclear cells of the patient who reached the only complete remission of this trial. Immunologic stimulation by the MoAb thus might have played a role in this patient's antitumor response. In summary, therapy with MoAb T101 was specific but only modestly efficacious. Rapid infusion of nonmodulating doses of antibody provided excellent targeting and removal of peripheral blood T cells and might be a valid approach in future trials with immunoconjugated T101.     

Differential expression levels of the heat shock protein 27 isoforms in pediatric normal, nonleukemic and common acute lymphoblastic leukemia B- cell precursors

Heat shock protein 27 (hsp27) may function as a regulator of microfilament dynamics and may participate in signal transduction pathways of different cell growth regulators, with the mitogen- activated protein kinase-activated protein (MAPKAP) kinase 2 being a major enzyme responsible for its phosphorylation. Using two-dimensional gel electrophoresis, we have compared the expression levels of two hsp27 isoelectric variants (hsp27 isoforms) M2 (molecular weight, 26 kD; isoelectric point, 6.02) and M3 (molecular weight, 26 kD; isoelectric point, 5.60) in pediatric bone marrow CD19+CD10+B-cell precursors (BCPs) purified from either common acute lymphoblastic leukemia (c-ALL) patients, normal donors, or non-c-ALL patients. Compared with normal BCPs, we found increased hsp27 expressions (M2 isoform) (by a factor 5 to 9 of mean level) in c-ALL as well as in non- c-ALL (nonleukemic) precursors. Though increased phosphorylation of hsp27 (M3 isoform) was observed in BCPs from c-ALL patients at relapse (by a factor 3 of mean level compared with normal BCPs and precursors from c-ALL at diagnosis), which might represent a differential enzymatic activity, this was not distinguishable from that of non-c-ALL patients. Therefore, our studies suggest constitutive differences of hsp27 isoforms between pediatric leukemic BCPs and their relatively low- expressing, immunophenotypically normal bone marrow counterparts. In light of the occasional and possibly transient increase of hsp27 expression during nonleukemic BCP differentiation and the possible role of hsp27 in signal transduction to microfilaments, these differences might be of considerable biologic interest and of importance in future studies of regulated normal or dysregulated leukemic hematopoietic cellular differentiation.