Rush Hymenoptera venom immunotherapy: a safe and practical protocol for high-risk patients

BACKGROUND: Hymenoptera venom immunotherapy in allergic patients is a well-established treatment modality for the prevention of systemic anaphylactic reactions caused by insect stings. A variety of therapy regimens exists, from conventional to rush and ultrarush modalities that operate on continuous or intermittent schedules. OBJECTIVE: The aim of this study was to report the 8-year experience with our rush venom immunotherapy regimen in predominantly high-risk patients and to compare data on safety and convenience with the results of 26 studies published from 1978 to 2001. METHODS: One hundred one patients allergic to bee, yellow jacket, or hornet venom were treated with rush Hymenoptera venom immunotherapy. Diagnosis and selection of patients for venom immunotherapy were carried out according to the recommendations of the European Academy of Allergology and Clinical Immunology. We used a 4-day regimen, and the incidence and nature of systemic reactions (SRs) were documented. Fifty-two patients were treated with honeybee venom, and 49 were treated with yellow jacket venom. RESULTS: One hundred (99%) patients reached the maintenance dose. We observed 8 injection-related SRs (0.47% of all injections given) in 7 (6.9%) patients. The number of SRs was higher in patients treated with bee venom extract (12%) compared with in patients receiving yellow jacket venom extract (2%). There was no significant difference in the risk of SRs between female and male patients. The incidence of SRs was considerably lower than the average of 17.8% reported in the literature. CONCLUSION: With a rush immunotherapy regimen over a time period of 8 years in predominantly high-risk patients, the incidence of SRs was low, despite the high number of patients with bee venom allergy, who are more likely to have side effects. Epinephrine as rescue medication was never necessary, and the regimen proved to be safe and convenient for both the patients and the medical staff.     

Escherichia coli Nissle 1917 distinctively modulates T-cell cycling and expansion via toll-like receptor 2 signaling

Although the probiotic Escherichia coli strain Nissle 1917 has been proven to be efficacious for the treatment of inflammatory bowel diseases, the underlying mechanisms of action still remain elusive. The aim of the present study was to analyze the effects of E. coli Nissle 1917 on cell cycling and apoptosis of peripheral blood and lamina propria T cells (PBT and LPT, respectively). Anti-CD3-stimulated PBT and LPT were treated with E. coli Nissle 1917-conditioned medium (E. coli Nissle 1917-CM) or heat-inactivated E. coli Nissle 1917. Cyclin B1, DNA content, and caspase 3 expression were measured by flow cytometry to assess cell cycle kinetics and apoptosis. Protein levels of several cell cycle and apoptosis modulators were determined by immunoblotting, and cytokine profiles were determined by cytometric bead array. E. coli Nissle 1917-CM inhibits cell cycling and expansion of peripheral blood but not mucosal T cells. Bacterial lipoproteins mimicked the effect of E. coli Nissle 1917-CM; in contrast, heat-inactivated E. coli Nissle 1917, lipopolysaccharide, or CpG DNA did not alter PBT cell cycling. E. coli Nissle 1917-CM decreased cyclin D2, B1, and retinoblastoma protein expression, contributing to the reduction of T-cell proliferation. E. coli Nissle 1917 significantly inhibited the expression of interleukin-2 (IL-2), tumor necrosis factor alpha, and gamma interferon but increased IL-10 production in PBT. Using Toll-like receptor 2 (TLR-2) knockout mice, we further demonstrate that the inhibition of PBT proliferation by E. coli Nissle 1917-CM is TLR-2 dependent. The differential reaction of circulating and tissue-bound T cells towards E. coli Nissle 1917 may explain the beneficial effect of E. coli Nissle 1917 in intestinal inflammation. E. coli Nissle 1917 may downregulate the expansion of newly recruited T cells into the mucosa and limit intestinal inflammation, while already activated tissue-bound T cells may eliminate deleterious antigens in order to maintain immunological homeostasis.     

The use of luteinizing hormone releasing hormone agonists and antagonists in gynaecological cancers

The use of agonistic analogues of luteinizing hormone releasinghormone (LHRH) is an established therapy for hormone-dependentmetastatic pre-menopausal breast cancer. Their mechanism ofaction in this disease is the suppression of ovarian oestrogenproduction (medical castration). In the treatment of post-menopausalmetastatic breast cancer, LHRH agonists alsohave some effect,although minor, probably through a suppression of ovarian androgenproduction. Convincing evidence has been accumulated that LHRHanalogues can directly inhibit the proliferation of breast cancercells in vitro. The clinical impact of these findings, however,is still controversial. Experimental data and several pilotclinical trals suggest that in epithelial ovarian cancer andsex-cord-stromal tumours of the ovary, LHRH agonists might haveantitumour activity through the suppression of gonadotrophinsecretion (selective medical hypophysectomy). Phase III clinicaltrials, evaluating this hypothesis, are in progress. Directantiproliferative effects of LHRH analogues on epithelial ovariancancer cells have been demonstrated in vitro. In endometrialcnacer, experimental and early clinical results support theconcept of a direct antiproliferative activity of LHRH analogues.Recently, potent antagonistic analogues of LHRH, devoid of relevantside-effects have become available for clinical testing. Thesenew antagonists might be superior to agonistic LHRH analogueswith respect to the rapidity and efficacy of selective medicalhypophysectomy and medical castration. Modern LHRH antagonistsmight also permit a better exploitation of direct antitumoureffects. A further therapeutic improvement in gynaecologicaloncology might result from a combination of LHRH agonists orantagonists with other peptide hormone anlogues such as agonistsof somatostatin or antagonists of bombesin/gatrin releasingpeptide which have antitumour activity. Since 50% of breastcancers and 80% of epithelial ovarian cancers and endometrialcancers have high affinity binding sites for LHRH, cytotoxicLHRH analogues might provide a targeted chemotherapy, whichwould be more efficacious and less toxic than conventional regimens.     

Loss of membranous E-cadherin expression in pancreatic cancer: Correlation with lymph node metastasis,high grade,and advanced stage

Epithelial cadherin (E-cadherin) is a Ca²⁺-dependent cell-cell adhesion molecule that connects cells via homotypic interactions. Its function is critical in the induction and maintenance of cell polarity and differentiation, and its loss of downregulation is associated with an invasive and poorly differentiated phenotype in colon and other tumours. We have used an avidin-biotin immunoperoxidase technique to localize E-cadherin in microwave-treated, paraffin-embedded sections from 36 patients with pancreatic adenocarcinomas. E-cadherin was expressed by normal ductal and acinar cells with typical membranous staining at the intercellular junctions. Loss of normal surface E-cadherin expression was found in 19/36 (53 per cent) tumours compared to the adjacent normal ductal cells. Abnormal E-cadherin expression was found more frequently in poorly differentiated (grade III) (6/7, 86 per cent) than in well-differentiated tumours (grade I) (4/14, 28 per cent) (P=0·012). Membranous E-cadherin expression was also lost more frequently in primary tumours with lymph node (stage III) (14/23, 61 per cent) and distant metastasis (stage IV) (2/2, 100 per cent) compared with 3/11 (27 per cent) lymph node-negative tumours (stage I) (P=0·043). In conclusions, our data indicate that loss of membranous E-cadherin expression is associated with high grade and advanced stage in pancreatic cancer.     

Evidence of a diverse T cell receptor repertoire for acetylcholine receptor,the autoantigen of myasthenia gravis

We utilized two methods to look for T cell clonal expansions in myasthenia gravis (MG). We analyzed TCRBV CDR3 length polymorphism (spectratyping) to look for evidence of clonal expansion of CD4 or CD8 T cells directly from peripheral blood of MG patients. No statistically significant differences were found between the diversity of TCR repertoires in MG patients compared to normal control individuals when analyzed as groups. Rare oligoclonal expansions were detected in some individual MG patients but the significance of these findings is unclear. Next, we analyzed a panel of T cell hybridomas from acetylcholine receptor (AChR) immunized, MG-susceptible HLA-DR3 transgenic mice. The epitope specificity, TCRBV gene usage and CDR3 sequences of these hybridomas were highly diverse. We conclude there is only limited evidence for restricted TCR repertoire usage in human MG and suggest this may be due to the inability of HLA-DR molecules to select for restricted TCR recognition of AChR epitopes.     

Amygdala-prefrontal coupling depends on a genetic variation of the serotonin transporter

Major depression is conditionally linked to a polymorphism of the human serotonin transporter gene (SLC6A4). During the presentation of aversive, but not pleasant, pictures, healthy carriers of the SLC6A4 short (s) allele showed stronger activation of the amygdala on functional magnetic resonance imaging. s carriers also showed greater coupling between the amygdala and the ventromedial prefrontal cortex, which may contribute to the abnormally high activity in the amygdala and medial prefrontal cortex seen in major depression.     

A silencing pathway to induce H3-K9 and H4-K20 trimethylation at constitutive heterochromatin

Histone lysine methylation is a central modification to mark functionally distinct chromatin regions. In particular, H3-K9 trimethylation has emerged as a hallmark of pericentric heterochromatin in mammals. Here we show that H4-K20 trimethylation is also focally enriched at pericentric heterochromatin. Intriguingly, H3-K9 trimethylation by the Suv39h HMTases is required for the induction of H4-K20 trimethylation, although the H4 Lys 20 position is not an intrinsic substrate for these enzymes. By using a candidate approach, we identified Suv4-20h1 and Suv4-20h2 as two novel SET domain HMTases that localize to pericentric heterochromatin and specifically act as nucleosomal H4-K20 trimethylating enzymes. Interaction of the Suv4-20h enzymes with HP1 isoforms suggests a sequential mechanism to establish H3-K9 and H4-K20 trimethylation at pericentric heterochromatin. Heterochromatic H4-K20 trimethylation is evolutionarily conserved, and in Drosophila, the Suv4-20 homolog is a novel PEV modifier to regulate position-effect variegation. Together, our data indicate a function for H4-K20 trimethylation in gene silencing and further suggest H3-K9 and H4-K20 trimethylation as important components of a repressive pathway that can index pericentric heterochromatin.     

Differential pattern of DNA-aneuploidy in human malignancies

The differential pattern of DNA-aneuploidy, detected by flow cytometry (FCM) regarding its frequency, grade and multiclonality, was investigated and correlated to tumor type, malignancy grade, tumor stage and prognosis in a multi-institutional study at the University of Münster. High resolution measurements using admixed normal blood reference cells were undertaken in 2413 cases of 13 different malignant diseases and in 776 benign lesions or samples. The incidence of DNA-aneuploidy was highest in melanomas, carcinomas, testicular tumors, sarcomas (75%-95%) and myelomas (65%). Acute leukemias showed an intermediate DNA-aneuploidy rate of 40% with special subgroups represented by common ALL (44%), p less than 0.05) and myelomonocytic/monocytic AML (47%, p less than 0.01). The lowest DNA-aneuploidy-rate was found in basal cell skin carcinomas (19%) and congenital melanocytic nevi (9%). No case of DNA-aneuploidy was observed in the 776 benign lesions or samples.--DNA-indices giving the grade of DNA-aneuploidy with 1.0 for normal diploid G1/0 cells were found distributed predominantly between 1.0 and 2.0 in the solid tumors, except testicular tumors, clustering around a triploid maximum at 1.5. DNA-indices of myelomas and acute leukemias generally ranged below 1.25 with lower DNA-aneuploidy grades in AML than in ALL (p less than 0.01).--In melanomas the aneuploidy rate was higher (86%) in metastases than in the primary tumors (54%, p = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Detection of DNA damage after hyperbaric oxygen (HBO) therapy

Hyperbaric oxygen HBO therapy is successfully used for the treatmentof a variety of conditions. However, exposure to high concentrationsof oxygen is known to induce damage to cells, possibly due toan increased oxygen radical production. As reactive oxygen speciesalso cause DNA damage, we investigated the DNA-damaging effectof HBO with the alkaline version of the single cell gel testcomet assay. Oxidative DNA base modifications were determinedby converting oxidized DNA bases to strand breaks using bacterialformamidopyrimidine-DNA glycosylase FPG, a DNA repair enzyme,which specifically nicks DNA at sites of 8-oxo-guanines andformamidopyrimidines. HBO treatment under therapeutic conditionsclearly and reproducibly induced DNA damage in leukocytes ofall test subjects investigated. Increased DNA damage was foundimmediately at the end of the treatment, while 24 h later, noeffect was found. Using FPG protein we detected significantoxidative base damage after HBO treatment DNA damage was detectedonly after the first treatment and not after further treatmentsunder the same conditions, indicating an increase in antioxidantdefences. DNA damage did not occur when the HBO treatment wasstarted with a reduced treatment time which was then increasedstepwise. ³To whom correspondence should be addressed     

The urinary myeloma cast. Frequency of detection and clinical correlations in 30 patients with multiple myeloma

The authors examined urine specimens from 30 patients with multiple myeloma (MM) to determine the usefulness of cytodiagnostic urinalysis in evaluating such patients. Nine patients had clinical evidence of renal failure. In six of these nine patients (67%), or 20% of all patients, the urine sediment contained unique "MM-casts." These were characterized by a waxy to granular matrix surrounded by reactive, syncytial, giant cells with occasional renal cells embedded in the cast matrix. These casts were not observed in urine specimens from patients with normal renal function. Renal biopsy in two patients with MM-casts confirmed that cytologic diagnosis of "MM-kidney." The patient groups with or without MM-casts were comparable with respect to age, sex, and clinical stage of disease. In contrast, those with MM-casts were more likely to have clinical evidence of renal disease (100% vs. 13%), Bence Jones proteinuria (100% vs. 35%), hypercalcemia (50% vs. 8%), and hyperuricemia (50% vs. 4%). The two groups could not be distinguished reliably by urine physicochemical determinations. However, there were marked differences in the frequency of microscopic abnormalities. All patients with MM-cast formation excreted other pathologic casts as well and had evidence of tubular injury, while five of six had evidence of ischemic necrosis. This compared with 17%, 13%, and 21%, respectively, of those without MM-casts. Thus, cytodiagnostic urinalysis is of value in distinguishing MM-kidney from the numerous other causes of renal failure in patients with MM.