The interleukin-5 messenger RNA expression in a patient with idiopathic hypereosinophilic syndrome

Interleukin-5 has a specific role in various eosinophilic activities. It is the predominant cytokine produces by activated T-lymphocytes isolated from patients with idiopathic hypereosinophilic syndrome. We studied a young patient suffering from idiopathic hypereosinophilic syndrome who presented with Horner's syndrome, peripheral neuropathy and skin ulcers. The IL-5 gene expression by CD4⁺ T-lymphocytes and the peripheral eosinophil count were raised. The skin ulcers continued to deteriorate despite a swift reduction of the IL-5 gene expression and peripheral eosinophil count following systemic corticosteroid treatment. We suggest that peripheral eosinophilia may not be responsible for the damage in skin lesions and more aggressive treatment may be required.     

Heterogeneity of FeNO response to inhaled steroid in asthmatic children

Background Nitric oxide in exhaled air is regarded as an inflammation marker, and may be used to monitor the anti‐inflammatory control from inhaled corticosteroids (ICSs). However, this response to ICSs exhibits a heterogeneous pattern. Objective The study aimed to describe the independent variables associated with the heterogeneity in the response of exhaled nitric oxide to ICSs. Methods Exhaled nitric oxide (FeNO), lung function, bronchial hyper‐responsiveness (BHR), specific IgE to common inhalant allergens, blood eosinophils, other atopic manifestations and variants in nitric oxide synthethase 1 (NOS1) gene were studied in a double‐blind, placebo‐controlled crossover comparison of budesonide (BUD) Turbohaler 1600 mcg daily vs. placebo in asthmatic schoolchildren. Results Forty children were included in the study from a screening of 184 asthmatic children with moderately persistent asthma, well controlled on regular BUD 400 mcg daily: 20 children with normal FeNO and 20 with raised FeNO. FeNO, BHR and forced expiratory volume in 1 s improved significantly after BUD 1600 mcg (BUD1600). However, FeNO after ICS treatment exhibited a Gaussian distribution and FeNO was significantly raised in 15 children. Allergy and BHR, but none of the other independent variables under study were significantly related to FeNO after BUD1600. Conclusion Exhaled nitric oxide exhibited a heterogeneous response to ICS in asthmatic schoolchildren. Allergy and BHR were driving FeNO level independently of high‐dose steroid treatment. This should be considered when using FeNO for steroid dose titration and monitoring of ICS anti‐inflammatory control in asthmatic children.     

Renal metabolism of corticosteroid hormones

Summary IK and STF from male and female rats have been used to study in vitro the renal metabolism of B. in male rat tissue four lipid soluble metabolites (I–IV) have been found, I+II being more polar and III+IV being less polar than B. I and II have been identified as 11-dehydro-20-hydroxy-B and 20-hydroxy-B. The structure of III and IV remains to be determined. Renal tissue from female rats produced predominantly III indicating sexual variations of steroid metabolism in kidneys. — The literature has been reviewed which documents that the kidneys in addition to B metabolize A, cortisol, progesterone and other corticosteroids.

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Abbreviations A Aldosterone - B Corticosterone - Alb Albumin - CS Corticosteroids - MCS/GCS Mineralo-/gluco-CS - IK Isolated (perfused) kidney - STF Suspended tubular fragments Supported by Deutsche Forschungsgemeinschaft Hi 97/16     

Expert opinion on the management and follow-up of uveitis patients during SARS-CoV-2 outbreak

ABSTRACT

Introduction

Routine medical and ophthalmic care is being drastically curtailed in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Uveitis patients require particular attention because of their theoretical risk of viral infection, in the context of therapeutic immunosuppression.     

Corticosteroid enhances TNF‐α‐mediated leukocyte adhesion to pulmonary microvascular endothelial cells

Background: Some severe asthma patients are characterized by elevated levels of tumor necrosis factor alpha (TNF‐α) and neutrophilic inflammation in the airways. Although such phenotypic changes in asthma might contribute to corticosteroid refractoriness, the role of TNF‐α in the process remains unclear. TNF‐α exerts its biological effects mainly by acting on the vascular endothelium, and thereby upregulates leukocyte recruitment into inflamed tissues. The aim of this study was to investigate the effects of dexamethasone (DEX) on the TNF‐α‐mediated responses of human microvascular endothelial cells from lung blood vessels (HMVEC‐LBl) in vitro. Methods: HMVEC‐LBl were cultured with TNF‐α in the presence and absence of DEX. The effects of DEX on various TNF‐α‐mediated responses, such as the expressions of chemokines and cellular adhesion molecules, leukocyte adhesion were determined. Results: TNF‐α significantly induced growth‐related oncogene alpha (GRO‐α), interleukin 8 (IL‐8), regulated on activation, normal T‐cell expressed and secreted (RANTES) and interferon‐inducible protein 10 (IP‐10) productions and cell surface expressions of intracellular adhesion molecule 1 (ICAM‐1) and vascular cell adhesion molecule 1 (VCAM‐1) on HMVEC‐LBl. TNF‐α‐induced GRO‐α and IL‐8 were slightly attenuated by DEX treatment (reaches to 89% and 79%, respectively), whereas expressions of IP‐10, ICAM‐1 and VCAM‐1 were significantly enhanced by the same treatment (up to 172%, 152% and 139%, respectively). Correspondingly, in vitro adhesion of eosinophils and neutrophils to TNF‐α‐treated HMVEC‐LBl were significantly enhanced by DEX. Conclusions: Some proinflammatory effects of DEX, a corticosteroid, were found in TNF‐α‐mediated in vitro reactions of pulmonary microvascular endothelial cells, i.e. chemokine productions and leukocyte adhesion. These in vitro results may explain, at least in part, the corticosteroid refractoriness accompanied by a marked increase in TNF‐α production that is seen in severe asthmatic patients.     

The SCMC test: a reliable monitor for antispermatozoal antibodies

Seventeen couples (13%) were selected from a group of 129 infertilepatients according to the following criteria: (i) unexplainedinfertility for 3 years and (ii) <50% shaking spermatozoaduring SCMC testing. The couples were tested for sperm antibodiesafter a complete diagnostic work-up schedule. Post-coital testswere performed during the first menstrual cycle of the wife,followed by SCMC and sperm antibody titre testing. Ten malesand seven females were thus treated with 96 mg methylprednisolone.Nine (52%) of the 17 with sperm antibodies achieved a pregnancy.The results of the SCMC test were in all the cases indicativeof the actual sperm antibody titre. Reduction of the antibodytitre and a decrease in the percentage of shaking spermatozoaas detected by the SCMC test correlated well with the pregnancyrate amongst the patients.     

Efficacy and safety of mometasone furoate nasal spray in nasal polyposis

BACKGROUND: Studies have suggested that topical corticosteroids are effective in the treatment of nasal polyps; however, this has yet to be confirmed in a large, robust clinical trial. OBJECTIVE: To evaluate the efficacy and safety of mometasone furoate nasal spray (MFNS) for nasal polyposis. METHODS: A total of 354 subjects with bilateral nasal polyps and clinically significant congestion/obstruction participated in this multinational, randomized, double-blind, placebo-controlled study. Subjects received MFNS 200 microg once or twice daily or placebo for 4 months. Coprimary endpoints were (1) change from baseline to last assessment in physician-evaluated bilateral polyp grade score and (2) change from baseline averaged over month 1 in subject-assessed nasal congestion/obstruction. ANOVA was used for all efficacy endpoints, except for change in bilateral polyp grade score, for which baseline polyp grade was added as a covariate. RESULTS: Compared with placebo, MFNS 200 microg administered once or twice daily produced significantly greater reductions in bilateral polyp grade score (P < .001, P = .010, respectively) and congestion/obstruction (P = .001, P < .001), as well as improvement in loss of smell (P < .001, P = .036), anterior rhinorrhea (P < .001 for both), and postnasal drip (P < .001, P = .001) over month 1. MFNS 200 microg twice daily was superior to MFNS 200 microg once daily in reducing congestion/obstruction (P = .039), and there were more improvers in the MFNS 200 microg twice daily group (P = .035). MFNS was well tolerated in both groups. CONCLUSION: MFNS 200 mug, once or twice daily, was safe and significantly superior to placebo in reducing polyp grade (size and extent) and improving congestion/obstruction and return of sense of smell. MFNS is an effective medical treatment for nasal polyposis and may reduce or delay the need for surgery.     

微量皮质类固醇联合抗病毒药物治疗单纯疱疹病毒性角膜炎

目的观察微量皮质类固醇与抗病毒药物合用对单纯疱疹病毒性角膜炎（ＨＳＫ）的疗效。方法将１６０例ＨＳＫ患者随机分为治疗组和对照组,治疗组用５ｇ·Ｌ－１可的松、１ｇ·Ｌ－１无环鸟苷（ＡＣＶ）和２５ｇ·Ｌ－１三氮唑核苷（ＲＢＶ）３种眼液,对照组用１ｇ·Ｌ－１ＡＣＶ和２５ｇ·Ｌ－１ＲＢＶ２种眼液交替滴眼治疗。结果治疗组治愈率、有效率明显高于对照组（Ｐ＜０．０１）,治愈时间明显短于对照组（Ｐ＜０．０１）,随访１４～２４ｍｏ复发率明显低于对照组（Ｐ＜０．０１）。结论在临床上用微量皮质类固醇联合足量有效的抗病毒药物,对上皮型和实质层型ＨＳＫ都能促进其痊愈过程,并可降低复发率。