人类风湿性关节炎滑膜-软骨-NOD．scid小鼠嵌合体模型的建立

目的:建立能反应自身免疫特点的类风湿性关节炎动物模型,为进一步研究该病发病机制奠定基础。方法:实验于2006-03/12在南方医科大学实验动物中心完成。①实验材料:SPF级2～4个月龄NOD.scid小鼠20只,体质量17～22g,雌雄各半;人类风湿性关节炎滑膜组织(佛山市第一人民医院风湿科提供,患者知情同意);骨关节炎滑膜及正常软骨(南方医院创伤骨科提供,患者及供者知情同意)。②实验分组:将小鼠随机分为2组,类风湿性关节炎滑膜组和骨关节炎滑膜组,雌雄不限,每组10只。③实验过程:每组小鼠背部皮下植入的正常软骨组织,随后将类风湿性关节炎滑膜和骨关节炎滑膜植入软骨之上。④造模10周后麻醉下处死小鼠,用放射免疫法检测血清中肿瘤坏死因子α含量,移植物进行组织病理学观察,并进行组织学积分。结果:①模型鼠一般情况:实验期间NOD.scid小鼠无手摸皮骨感、活动度差、毛稀疏等典型移植物抗宿主疾病表现,模型鼠在SPF环境下10周存活率100%。②肿瘤坏死因子α含量:类风湿性关节炎滑膜组鼠血清中肿瘤坏死因子α放射含量类风湿性关节炎组明显高于骨关节炎组[(0.80±0.06),(0.70±0.03)μg/L,t=4.466,P<0.001]。③组织病理学观察:苏木精-伊红染色,骨关节炎滑膜组只见少量的滑膜细胞增生和炎症细胞,移植的滑膜组织主要被纤维组织形成的条索状物代替,无明显地软骨被侵蚀破坏发生;类风湿性关节炎滑膜组可明显见到大量的滑膜细胞增生和生化中心形成,病变部位的组织结构间质变为疏松,变为境界不清晰的颗粒状或块状无结构强嗜酸性红染物质;软骨边缘被滑膜组织侵蚀破坏明显;类风湿性关节炎滑膜组滑膜增生、软骨侵蚀和软骨降解积分均高于骨关节炎滑膜组(P<0.04)。结论:在NOD.scid体内可成功建立类风湿性关节炎动物模型。     

Temporal sequence of mammary intraductal proliferations, ductal carcinomas in situ and adenocarcinomas induced by 1-methyl-1- nitrosourea in rats

An experimental model for mammary carcinogenesis has been described in which intraductal proliferations, ductal carcinomas in situ and adenocarcinomas can be readily detected and the frequency of their occurrence quantified. The objective of the experiment reported in this study was to determine the latency period between carcinogen administration and the occurrence of each of these types of lesion. A total of 150 female Sprague-Dawley rats were injected i.p. with 50 mg 1- methyl-1-nitrosourea (MNU)/kg body wt at 21 days of age. Groups of 30 rats each were killed at 7, 14, 21, 28 and 35 days post-carcinogen. Mammary intraductal proliferations were the first detected lesions and were observed in 20% of the animals at 14 days following carcinogen administration. At 21 days post-carcinogen ductal carcinomas in situ and adenocarcinomas were observed. The number of each type of lesion increased with time post-carcinogen, but the temporal pattern of occurrence was different among lesion types. The pattern of lesion occurrence was consistent with intraductal proliferations being a precursor lesion for ductal carcinomas in situ and adenocarcinomas. Furthermore, the data imply that ductal carcinomas in situ represent one pathway of morphological progression by which intraductal proliferations evolve into invasive carcinomas, but that this lesion type, as currently defined histologically, may not be an obligatory intermediate in morphologic progression. These findings are consistent with emerging evidence of multiple but distinct pathogenetic pathways leading to mammary carcinomas that display different morphological patterns and biological activities.      

Wilms' tumor and gonadal dysgenesis in a child with the 2q37.1 deletion syndrome

Here we report Wilms' tumor, gonadal dysgenesis and a bifid uterus in an 18-month-old female with a terminal deletion of the long arm of chromosome 2 [46, XX, del(2)(q37.1)]. Since Wilms' tumor has been previously reported in the 2q37 deletion syndrome, the present observation raises the question of whether a tumor susceptibility gene maps to chromosome 2q37 and suggests giving consideration to the possible occurrence of Wilms' tumor in the course of disease.     

Stromal growth factor production in irradiated lectin exposed long-term murine bone marrow cultures

Hematopoietic regulatory factors produced by adherent (stromal) cells in long-term murine bone marrow cultures have been investigated. Using an in situ double layer agar overlay system, we demonstrated that exposure of the stromal cells to 1,100-rad irradiation increased their activities in stimulating colony formation of FDC-P1, an interleukin 3 (IL 3)-responsive cell line. The colony-stimulating activities (CSAs) of the irradiated stroma also stimulated normal marrow cells to form granulocyte-macrophage, megakaryocyte, and mixed lineage colonies. Addition of the lectin pokeweed mitogen to the irradiated stroma increased the level of CSAs. The FDC-P1 CSA of the irradiated stroma was inhibited by antibodies directed against murine granulocyte- macrophage colony stimulating factor (GM-CSF) but not by those against murine IL 3. Stromal-derived CSA for marrow cells was also partially blocked by anti-GM-CSF antibodies, probably reflecting the presence of other CSAs such as CSF-1. This latter growth factor has been found to be present in conditioned media from Dexter stroma, but levels are not increased after irradiation or lectin exposure. Partially purified GM- CSF, like IL 3, stimulated FDC-P1 proliferation and granulocyte, macrophage, and megakaryocyte colony formation. These results indicate that the major terminal differentiating hormone elicited by irradiation or lectin exposure of murine marrow stromal cells is GM-CSF. This growth factor, along with CSF-1, can account for the differentiated progeny produced in this system: macrophages, granulocytes, and megakaryocytes.     

Purified interleukin-3 and erythropoietin support the terminal differentiation of hemopoietic progenitors in serum-free culture

We studied the effect of purified interleukin-3 (IL-3) and erythropoietin on colony formation by hemopoietic progenitors in serum- free cultures of spleen cells from 5-fluorouracil (5-FU)-treated mice. In the presence of IL-3 alone, most of the multilineage (three or more lineages) colonies did not contain erythroid cells. However, in the presence of IL-3 and erythropoietin, most of the multilineage colonies contained various numbers of erythroid cells. Replating experiments suggest that IL-3 maintains the growth of the progenitor cells, which could differentiate into erythroid cells. Erythropoietin facilitated the terminal differentiation and amplification of erythroid cells, although it did not sustain the growth of multipotential stem cells. Single-cell transfer experiments demonstrate that IL-3 supported the late stages of differentiation of neutrophils, macrophages, eosinophils, and megakaryocytes in the absence of lineage-specific factors. Therefore, IL-3 supports the differentiation of multilineage hemopoietic progenitors, and the terminal differentiation of most hemopoietic lineages, with the exception of the erythroid lineage.     

Managing drugs for rare genetic diseases: trends and insights

Managed care organizations generally pay for expensive drugs that treat rare genetic diseases because few patients have these conditions, the conditions are often life threatening, and the benefit design mandates coverage. In most cases, the cost-control measures and management restrictions applied to many other specialty pharmaceuticals do not make sense for the orphan drugs used to treat extremely rare genetic conditions because treatment alternatives usually are lacking for rare conditions (e.g., Gaucher's disease) and because the per member per month costs for truly rare conditions are low. The increasing number of biologic and injectable therapies for more common conditions, however, is prompting managed care decision makers to manage these new therapies more actively. There is a potential that treatments for rare disorders will be swept up in this broad-based response. This article provides definitions, background, and stakeholder perspectives on this topic and describes recent trends and challenges in health system management of exceedingly rare genetic diseases. The author suggests that current protocols are appropriate for managing rare and ultra-rare diseases, and that applying more active management practices to less rare diseases is neither efficient nor productive; in fact, it may be counter-productive.