Tacrolimus is an effective treatment for lupus nephritis in pregnancy.

Lupus nephritis during pregnancy increases morbidity and mortality for mother and baby. Flares are difficult to treat as many therapeutic options are teratogenic or fetotoxic. Steroids alone may be unable to control disease activity and are associated with higher rates of preterm delivery, sepsis and gestational diabetes. Reports of using tacrolimus to treat lupus nephritis in pregnancy are limited. We describe the pregnancies of nine women in whom tacrolimus was successfully used to treat lupus nephritis flare (six patients) or maintain stable disease (three patients). Introduction or dose escalation of oral steroids was avoided in five of the patients who developed active disease and steroid dose was rapidly reduced in the sixth patient. All women with disease flare attained partial or complete remission after starting tacrolimus. None of the women on maintenance treatment developed active disease. We propose tacrolimus as an effective adjuvant or alternative therapy to steroids for treating lupus nephritis flare or maintaining stable disease during pregnancy.

Paediatric pulmonary hypertension and sildenafil: current practice and controversies.

In recent times, paediatric pulmonary arterial hypertension management has been transformed to focus on disease modifying strategies that improve both quality of life and survival, rather than just symptom palliation. Sildenafil, a phosphodiesterase-V inhibitor, has been at the centre of this. Despite controversial beginnings, its success in treating pulmonary arterial hypertension has led to its consideration for related pathologies such as persistent pulmonary hypertension of the newborn and bronchopulmonary dysplasia, as well as the development of a range of alternative formulations. However, this has caused its own controversy and confusion regarding the use of sildenafil in younger patients. In addition, recent data regarding long-term mortality and the repeal of US drugs approval have complicated the issue. Despite such setbacks, sildenafil continues to be a major component of the contemporary care of paediatric pulmonary hypertension in a variety of contexts, and this does not seem likely to change in the foreseeable future.

Erosion and perforation of the biliary tree by plastic biliary endoprostheses.

Biliary endoprostheses are increasingly used in the treatment of both benign and malignant pancreaticobiliary disorders. Common bile duct stones are a common clinical problem for which there now exist a range of treatment modalities. Official guidelines in the UK advocate the use of plastic biliary endoprostheses in the treatment of common bile duct stones only as a short-term measure prior to definitive endoscopic or surgical clearance. Long-term use of such stents is associated with several complications related to stent insertion, occlusion, and migration. Organ perforation resulting from plastic biliary stents is very rare and can occur either as an early complication at stent insertion or as a late complication resulting from stent migration and pressure necrosis. Although duodenal, small-bowel, and colonic perforations have been described, we have found no reports of extra-hepatic bile duct perforation occurring as a complication of plastic biliary stents. We present three cases of biliary tree erosion and perforation by plastic stents placed in patients with common bile duct stones cleared endoscopically prior to laparoscopic cholecystectomy and discuss the possible implications of this previously unreported phenomenon.

Analysis of the postulated interaction between the angiotensin II sub-type 1 receptor gene A1166C polymorphism and the insertion/deletion polymorphism of the angiotensin converting enzyme gene on risk of myocardial infarction.

A synergistic interaction between the insertion/deletion (I/D) polymorphism within the angiotensin-converting enzyme (ACE) gene and an A/C transversion at nucleotide position 1166 within the angiotensin II sub-type 1 receptor (AT1R) gene on risk of myocardial infarction has been reported. The risk associated with the ACE DD genotype increased with the number of AT1R C alleles present. To investigate this further, ACE I/D and AT1R A1166C genotypes were determined in 541 cases recruited at the time of infarction and 507 population-based controls. There was no difference in either the genotype distribution or allele frequencies between cases and controls for either the ACE polymorphism (P=0.48 and 0.35 respectively) or the AT1R polymorphism (P=0.35 and 0.21 respectively). Odds ratios for risk of MI associated with the ACE DD and AT1R CC genotypes were 1.09 (95% CI, 0.82-1.45) and 1.06 (0.67-1.68) respectively. 3.1% of cases versus 3.6% of controls were homozygous for both the D and C alleles (P=0.71). There was no increase in risk associated with the DD genotype in the presence of either one or two AT1R C alleles in the whole cohorts (OR 0.99, 95% CI 0.65-1.51 and 0.76, 95% CI 0.30-1.88, respectively) nor in sub-groups defined by specific risk factors. In conclusion, no evidence was found to support any interaction between the ACE gene I/D polymorphism and the ATIR gene A1166C transversion in determining the risk of myocardial infarction in the population studied.

Glutathione S-transferase class Kappa: characterization by the cloning of rat mitochondrial GST and identification of a human homologue.

We have isolated a cDNA clone that encodes rat glutahione S-transferase (GST) subunit 13, a GST originally isolated from rat liver mitochondrial matrix by Harris, Meyer, Coles and Ketterer [(1991) Biochem. J. 278, 137-141]. The 896 bp cDNA contains an open reading frame of 678 bp encoding a deduced protein sequence of which the first 33 residues (excluding the initiation methionine residue) correspond to the N-terminal sequence reported by Harris et al. Hence like many other nuclear-encoded, mitochondrially located proteins, there is no cleavable mitochondrial presequence at the N-terminus. GST subunit 13 was originally placed into the Theta class of GSTs on the basis of sequence identity at the N-terminus; however, this is the only identity with the Theta class and in fact GST subunit 13 shows little sequence similarity to any of the known GST classes. Most importantly it lacks the SNAIL/TRAIL motif that has so far been a characteristic of soluble GSTs, although it does possess a second motif (FGXXXXVXXVDGXXXXXF) reported for GST-related proteins (Koonin, Mushegian, Tatusov, Altschul, Bryant, Bork and Valencia [(1994) Protein Sci. 3, 2045-2054]. Southern and Northern blot analyses of rat DNA and mRNA are consistent with GST subunit 13's being the product of a single hybridizing gene locus. Searches of EST databases identified numerous similar human DNA sequences and a single pig sequence. We have derived a human cDNA sequence from these EST sequences which shows a high nucleotide similarity (77%) to rat GST subunit 13. The largest open reading frame is identical in length with subunit 13 and yields a deduced protein sequence identity of 70%. Most unusually the 3' non-coding nucleotide sequence identity is also 77%. We conclude that these cDNAs belong to a novel GST class hereby designated Kappa, with the rat GST subunit 13 gene designated rGSTK1 and the human gene being called hGSTK1.

Volatile compounds released by disturbed and calm adults of the tarnished plant bug, Lygus lineolaris.

Volatile compounds released by disturbed and calm female and male Lygus lineolaris were collected and analyzed. Six major compounds were present in samples from disturbed bugs and from calm females: (E)-2-hexenal, 1-hexanol, (E)-2-hexenol, hexyl butyrate, (E)-2-hexenyl butyrate, and (E)-2,4-oxohexenal. (E)-2-hexenal was lacking in volatiles collected from calm males. Hexyl butyrate accounted for approximately 68% and 66% of volatiles released by agitated and calm females, and 87% and 88% of volatiles released by agitated and calm males, respectively. Blends released by disturbed insects differed quantitatively from blends released by calm insects, with amounts of compounds increasing 75-350 times in samples from disturbed insects. In static air bioassays, both females and males were repelled by natural volatiles collected from females and by five-component [(E)-2,4-oxohexenal excluded] and six-component synthetic blends at doses of 1 and 10 bug-hours, indicating that these volatiles may serve an alarm or epideictic function, as well as a possible role as defensive allomones. Adults also avoided hexyl butyrate, (E)-2-hexenyl butyrate, (E)-2-hexenol, and (E)-2,4-oxohexenal, but not 1-hexanol and (E)-2-hexenal when compounds were assayed individually in static air bioassays at doses equal to 1 bug-hour. When tested over 1 day in two-choice cage trials, adults did not prefer untreated bean plants over bean plants surrounded by vials releasing up to 8.1 mg/hr (= 234 bug-hours) of the five-component synthetic blend. Therefore, the volatiles produced by disturbed adults would not be useful as a repellent for L. lineolaris.

The isolation and mapping of 19 tetranucleotide microsatellite markers in the chicken.

Microsatellites consisting of tetranucleotide repeats are more easily, and consequently efficiently, scored than loci consisting of dinucleotides. However, they are much less frequent in the genome. A hybridisation selection protocol was therefore employed to generate a chicken genomic library enriched for inserts containing the tetranucleotide repeat motif (TTTC)n. Forty-five new microsatellite sequences were isolated that mainly consisted of perfect repeats of the tetranucleotide (TTTC) motif. Nineteen markers were mapped in one or both of the East Lansing and Compton international chicken reference populations.

Chicken microsatellite markers isolated from libraries enriched for simple tandem repeats.

The total number of microsatellite loci is considered to be at least 10-fold lower in avian species than in mammalian species. Therefore, efficient large-scale cloning of chicken microsatellites, as required for the construction of a high-resolution linkage map, is facilitated by the construction of libraries using an enrichment strategy. In this study, a plasmid library enriched for tandem repeats was constructed from chicken genomic DNA by hybridization selection. Using this technique the proportion of recombinant clones that cross-hybridized to probes containing simple tandem repeats was raised to 16%, compared with < 0.1% in a non-enriched library. Primers were designed from 121 different sequences. Polymerase chain reaction (PCR) analysis of two chicken reference pedigrees enabled 72 loci to be localized within the collaborative chicken genetic map, and at least 30 of the remaining loci have been shown to be informative in these or other crosses.