Utility of QuantiFERON<Superscript>®</Superscript>-TB Gold test in diagnosis and management of suspected tubercular uveitis in India

The tuberculin skin test, used to detect latent systemic tuberculosis (TB), has its limitations. The utility of interferon-gamma assays, found useful in the diagnosis of latent TB, is still unestablished in tubercular uveitis. We present the results of QuantiFERON^®-TB Gold (QFT-G) test and its relevance in the diagnosis and management of suspected tubercular uveitis in India. All suspected tubercular uveitis patients seen at our uveitis clinic between October 2006 and June 2008 who underwent relevant blood investigations, chest X-rays, Mantoux tests and QFT-G tests were included. Clinical profile, systemic correlation and outcome with treatment were analysed. Fifty suspected tubercular uveitis patients underwent QFT-G testing. The age range of the patients was 6–55 years (mean 32.66 years). Seven patients presented with active and three with a past history of systemic TB. The QFT-G test was positive in 29 patients. Radiological findings of TB were seen in four patients with a positive QFT-G and one patient with a negative QFT-G test. In 11 patients both QFT-G and Mantoux tests were positive. Eighteen Mantoux-negative patients were QFT-G-positive. Significantly, no patient with a positive Mantoux had a negative QFT-G test. Of the 32 patients with posterior uveitis, 17 patients had serpiginous choroiditis, four patients had a choroidal granuloma, six patients had multifocal choroiditis, four patients had retinal vasculitis, and one patient had a subretinal abscess. All QFT-G-positive patients were treated with anti-tuberculosis therapy as well as systemic steroids with a favorable clinical outcome. Our study shows that the QFT-G test is very useful in the diagnosis and management of suspected ocular TB. It was found to be very sensitive in identifying latent TB patients who, upon treatment, had a significantly reduced frequency of recurrences. It was more sensitive than the Mantoux test and is not significantly affected by previous treatment with systemic steroids or immunosuppressives. A negative QFT-G test can also be used as an adjunct before initiation of systemic steroids or immunosuppressives in uveitic patients particularly in an endemic setting like India.     

INAUGURAL ARTICLE by a Recently Elected Academy Member:Protein mutated in paroxysmal dyskinesia interacts with the active zone protein RIM and suppresses synaptic vesicle exocytosis

Paroxysmal nonkinesigenic dyskinesia (PNKD) is an autosomal dominant episodic movement disorder precipitated by coffee, alcohol, and stress. We previously identified the causative gene but the function of the encoded protein remains unknown. We also generated a PNKD mouse model that revealed dysregulated dopamine signaling in vivo. Here, we show that PNKD interacts with synaptic active zone proteins Rab3-interacting molecule (RIM)1 and RIM2, localizes to synapses, and modulates neurotransmitter release. Overexpressed PNKD protein suppresses release, and mutant PNKD protein is less effective than wild-type at inhibiting exocytosis. In PNKD KO mice, RIM1/2 protein levels are reduced and synaptic strength is impaired. Thus, PNKD is a novel synaptic protein with a regulatory role in neurotransmitter release.Paroxysmal nonkinesigenic dyskinesia (PNKD)^* is a rare dominantly inherited episodic movement disorder. First reported in 1940 (1), PNKD is characterized by childhood onset with involuntary movements in the limbs, trunk, and face manifesting as dystonia, chorea, and athetosis (2). PNKD shows nearly complete penetrance and attacks are precipitated by fatigue, stress, hunger, and consumption of coffee or alcohol. Patients are completely normal between attacks.Hereditary forms of many episodic disorders are recognized and include movement disorders, muscle diseases, cardiac arrhythmias, epilepsy, and headache. A majority of the causative genes that have been identified encode ion channels (3). Studies in several spontaneous mouse mutants with a paroxysmal dyskinesia phenotype have provided intriguing insights into these otherwise complicated diseases (4–6). The tottering and lethargic mice display motor abnormalities mimicking paroxysmal dyskinesia and harbor mutations in the genes encoding the α1A and β4 subunits of the P/Q-type voltage-gated Ca²⁺-channel, respectively (7, 8). Like PNKD, the dyskinesia phenotype in tottering mice can also be triggered by caffeine and stress. PNKD is interesting in that the gene encodes a novel protein with homology to human glyoxalase II, an enzyme in a stress-response pathway. Although the normal role of PNKD is unknown, we previously identified the causative gene of PNKD (9) and a mouse model of the human mutations recapitulates the phenotype and shows dopamine signaling dysregulation (10).At synapses, vesicle priming, docking, and fusion at synaptic terminals are complex and coordinately regulated by proteins from the active zone, presynaptic membrane, and vesicles (11). Rab3-interacting molecules (RIMs) are a family of active zone proteins encoded by genes, Rims 1 to 4 (12). Through their interactions with vesicle proteins, active zone proteins, and presynaptic membrane proteins, RIMs are centrally involved in basic parameters of neurotransmitter release, and they contribute to both long-term and short-term synaptic plasticity (13–18).Given that PNKD is a novel protein whose function is unknown, we set out to identify proteins that interact with PNKD to provide clues to its normal function. Here, we show that PNKD is a novel synaptic protein that interacts with RIMs and can be found at presynaptic terminals. RIM1 and RIM2 are known to facilitate exocytosis and wild-type PNKD protein inhibits the RIM-dependent increase of neurotransmitter release. Mice deficient in Pnkd have decreased RIM levels, impaired synaptic facilitation and transmission, and abnormal motor behavior. Thus, PNKD is a novel synaptic protein regulating exocytosis in vitro and in vivo.     

“I am Not a Supporter of Simplistic Explanations...”, An Interview with Zhores Medvedev

Zhores Medvedev has been successful in two careers. Firstly as a gerontologist where he investigated the mechanisms of ageing using several biological systems. He also studied radiobiology, with special emphasis on the effects of radiation on lifespan. His second career as a political writer began as a result of his experience with the Soviet authorities after he wrote a book denouncing Lysenko for his anti-Mendelian policies on Soviet agriculture. Thus, he became a dissident. His passport was confiscated shortly after he came to Britain as a visiting scientist, where he and his family have subsequently lived. Since then he has written many books on Soviet politics and nuclear accidents in the USSR. After nearly 60 years studying ageing, in his retirement Zhores Medvedev continues to pursue this interest.This revised version was published online in September 2005 with corrections to the Cover Date.     

Prevalence of IgG varicella zoster virus antibodies in the Kuikuro and Kaiabi indigenous communities in Xingu National Park, Brazil, before varicella vaccination

The purpose of the study was to estimate the prevalence of IgG antibodies against varicella zoster virus (VZV) in the two most populated indigenous ethnic groups from Xingu Indigenous National Park, in Brazil, prior to the introduction of vaccination against the disease, and to determine the positive and the negative predictive values of a history of varicella infection. In 2001, 589 inhabitants of two Kuikuro villages and three Kaiabi villages were evaluated and provided information concerning previous varicella infection. An indirect immunosorbent assay (ELISA) to detect IgG anti-VZV antibodies was performed in 224 blood samples--volunteer selection had no interference of anamnesis. IgG prevalence was 80.8% (95% Confidence Interval: 76%-86%). The seroepidemiology of varicella in Xingu National Park prior to varicella vaccine introduction was comparable to the Brazilian national seroprevalence described in the literature, and so were the positive (98%) and the negative predictive value (41%) of the referred history.     

Pulse pressure and cardiovascular events in postmenopausal women with coronary heart disease

BACKGROUND: Pulse pressure (PP) has been shown to predict risk for cardiovascular events in men; however, this association has not been well established in women. Hormone replacement therapy may improve arterial compliance, but findings from cross-sectional and prospective studies report inconsistent results. We sought to examine the relationship between PP and risk for cardiovascular events, and to determine the effect of hormone therapy on PP in postmenopausal women with coronary heart disease (CHD). METHODS AND RESULTS: A total of 2,763 postmenopausal women (mean age, 66 +/- 7 years [+/- SD]) with CHD in the Heart and Estrogen/Progestin Replacement Study, a randomized, placebo-controlled, secondary CHD prevention trial of estrogen plus progestin, were followed up on average for 4.1 years. BP was measured at baseline and annually. Mean baseline PP was 62 +/- 16 mm Hg. There were 361 myocardial infarctions (MIs) or CHD deaths, 265 hospitalizations for congestive heart failure (CHF), and 215 strokes or transient ischemic attacks (TIAs). Women in the highest quartile of PP at baseline had a 47% increase in risk for MI or CHD death and more than a twofold increase in risk for stroke and TIA events or hospitalization for CHF (p < 0.01 for each outcome). After adjustment for other cardiovascular risk factors and mean arterial pressure, PP remained significantly associated with incident stroke or TIA events (odds ratio, 1.25; p = 0.02) and hospitalizations for CHF (odds ratio, 1.31; p < 0.01) but not with MI or CHD death. After adjustment for diastolic BP, systolic BP was similarly associated with stroke or TIA (odds ratio, 1.30; p < 0.01) and hospitalized CHF (odds ratio, 1.30; p < 0.01) and was also weakly associated with risk for MI and CHD death (odds ratio, 1.18; p = 0.02). Mean PP was 1- to 2-mm Hg higher in women randomized to hormone replacement therapy vs those receiving placebo (p < 0.01). CONCLUSIONS: PP had predictive value for CHF and stroke or TIA, but not MI or CHD death in this cohort of postmenopausal women with CHD. Use of hormone replacement therapy produced a small, statistically significant increase in PP. Further research is necessary to determine the clinical utility of PP as a potential therapeutic target.     

Chk2 regulates irradiation-induced,p53-mediated apoptosis in Drosophila

The tumor suppressor function of p53 has been attributed to its ability to regulate apoptosis and the cell cycle. In mammals, DNA damage, aberrant growth signals, chemotherapeutic agents, and UV irradiation activate p53, a process that is regulated by several posttranslational modifications. In Drosophila melanogaster, however, the regulation modes of p53 are still unknown. Overexpression of D. melanogaster p53 (Dmp53) in the eye induced apoptosis, resulting in a small eye phenotype. This phenotype was markedly enhanced by coexpression with D. melanogaster Chk2 (DmChk2) and was almost fully rescued by coexpression with a dominant-negative (DN), kinase-dead form of DmChk2. DN DmChk2 also inhibited Dmp53-mediated apoptosis in response to DNA damage, whereas overexpression of Grapes (Grp), the Drosophila Chk1-homolog, and its DN mutant had no effect on Dmp53-induced phenotypes. DmChk2 also activated the Dmp53 transactivation activity in cultured cells. Mutagenesis of Dmp53 amino terminal Ser residues revealed that Ser-4 is critical for its responsiveness toward DmChk2. DmChk2 activates the apoptotic activity of Dmp53 and Ser-4 is required for this effect. Contrary to results in mammals, Grapes, the Drosophila Chk1-homolog, is not involved in regulating Dmp53. Chk2 may be the ancestral regulator of p53 function.