Direct immunofluorescence staining patterns compared between oral and cutaneous lichen planus.

This retrospective study performed to investigate direct immunofluorescence (DIF) findings in oral and cutaneous lichen planus (LP), and to identify any differences between them. There were 147 patients with a definite diagnosis of LP by clinical and histological criteria, with 87 (59.2%) oral and 60 (40.8%) cutaneous specimens. Of these, 125 (85%) had positive DIF findings, with positive yields being significantly lower in oral (79.3%) than in cutaneous (93.3%) LP. Deposition of immunoreactants at the dermoepidermal junction (DEJ) was significantly greater in oral than in cutaneous LP, and fibrin deposition with shaggy pattern at the DEJ was also significantly greater in oral than in cutaneous LP. Deposition of immunoreactants at colloid bodies (CBs) with or without DEJ was significantly greater in cutaneous than in oral LP. IgM deposition at CBs was commonly detected in both groups. We propose that fibrin deposition with shaggy pattern at the DEJ is the best diagnostic indicator of oral LP.

The measurement of drug-induced interferon γ-releasing cells and lymphocyte proliferation in severe cutaneous adverse reactions.

BACKGROUND: The lymphocyte transformation test (LTT) is a standard laboratory method to identify culprit drugs in patients with a history of drug-induced non-immediate hypersensitivity and is mainly performed during the recovery phase. The measurement of drug-specific interferon γ (IFN-γ)-releasing cells has been introduced to confirm culprit drugs, even during the acute phase of drug allergy. OBJECTIVES: This study aimed to evaluate the capability of the enzyme-linked immunospot assay (ELISpot) to detect drug-specific IFN-γ-releasing cells during the acute phase and the capability of LTT to identify culprit drugs during the recovery phase in patients presenting with severe cutaneous adverse reactions (SCARs). METHODS: Peripheral blood mononuclear cells (PBMCs) from 23 SCAR patients were collected during the acute and recovery phases and assayed for drug-specific IFN-γ-releasing cells and lymphocyte proliferation, respectively. RESULTS: Drug-specific IFN-γ-releasing cells were detectable in 73.9% of SCAR subjects (55.6% and 85.7% in patients who were and were not taking systemic steroids, respectively), whereas LTT results were positive in 52.2% of SCAR subjects. The frequencies of drug-specific IFN-γ-releasing cells were significantly higher in patients with positive LTT than in those with negative LTT (260.1 ± 110.0 and 46.6 ± 20.7 cells/106 PBMCs, P = 0.01). A significant correlation between the results of the IFN-γ ELISpot assay and LTT was demonstrated (r = 0.65, P value <0.01). CONCLUSION: The IFN-γ ELISpot assay could be a useful tool to identify culprit drugs in SCAR patients when culprit drug identification is urgently needed during the acute phase of drug allergy.

A case of hypersensitivity to progesterone presenting as an eczematous eruption.

Hypersensitivity to progesterone is a rare condition, and it represents a hypersensitivity reaction to endogenous progesterone. Here we report a case of a woman who presented to our attention for evaluation of a rash for a few years on her posterior elbows, forearms, and right lateral lower extremity. We report this case because it describes a rare clinical entity, with an atypical clinical presentation pemphigoid-like, that is rarely described in literature.

In vitro test to confirm diagnosis of allopurinol-induced severe cutaneous adverse reactions.

BACKGROUND: Allopurinol is a frequent cause of severe cutaneous adverse reactions (SCARs), such as drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The reactions can potentially be fatal. As drug rechallenge in patients with a history of drug-induced SCARs is contraindicated, in vitro testing may have a diagnostic role as a confirmation test. OBJECTIVES: To study the diagnostic value of interferon (IFN)-γ enzyme-linked immunospot (ELISpot) assay as a confirmatory test in patients with a history of allopurinol-induced SCARs. METHODS: Peripheral blood mononuclear cells (PBMCs) from 24 patients with a history of allopurinol-induced SCAR (13 DRESS, 11 SJS/TEN) and 21 control subjects were incubated with allopurinol or oxypurinol in the presence or absence of antiprogrammed death ligand 1 antibody (anti-PD-L1). The numbers of IFN-γ-releasing cells after stimulation in each group were subsequently measured with ELISpot. RESULTS: The numbers of IFN-γ-releasing cells in allopurinol-allergic subjects were significantly higher than in control subjects when stimulating PBMCs with oxypurinol 100 µg mL-1 , especially when adding anti-PD-L1 supplementation. According to the receiver operating characteristic curve results, the optimal discriminatory power of IFN-γ ELISpot in confirming diagnosis of allopurinol-induced SCARs can be obtained using 16 spot-forming cells per 106 PBMCs as a cut-off value upon oxypurinol/anti-PD-L1 stimulation (79·2% sensitivity and 95·2% specificity). CONCLUSIONS: The measurement of oxypurinol/anti-PD-L1-inducing IFN-γ-releasing cells yields a high diagnostic value in distinguishing between allopurinol-allergic and control subjects. This technique is beneficial in confirming diagnosis of allopurinol-induced SCARs in patients whose reaction develops while taking multiple drugs.

Contact allergic dermatitis to gold in a tattoo: a case report.

The art of tattooing has increasing in recent decades. Allergic sensitivity to one of the pigments is the most frequent cause of dermatological reactions at the site of the tattoo. Gold is a new pigment used in tattooing, because of its bright yellow color and luster. Allergy to this metal is uncommon. To our knowledge, this is the first reported case of allergic contact dermatitis to gold in a tattoo.

Langerhans cells in allergic contact dermatitis.

Allergic contact dermatitis (ACD) is a common skin disease that has significant socio-economic impact. ACD is mediated by a T-cell mediated inflammatory reaction. Langerhans cells (LCs) are an epidermal DCs subset specialized in antigen presentation. After hapten exposure, LCs play a major role as in induction adaptive immune response against allergens. LCs recognize, take up and process haptens and migrate to the local draining lymph nodes. However, LCs specific functions and the LCs migration to local draining lymph nodes are not yet clearly defined. Recent advance in the knowledge of LCs function has increased in the past decades including the evidence for a tolerogenic function of LCs. The present review will focus on the role for LCs response to contact allergens.

2-substituted furans from Polyalthia suberosa.

Two new 2-substituted furans, 1-(2-furyl)pentacosa-16,18-diyne and 23-(2-furyl)tricosa-5,7-diynoic acid, have been isolated from stems of Polyalthia suberosa. The structures were assigned by spectroscopic methods. The two compounds together with the previously reported kalasinamide, N-trans-feruloyltyramine and N-trans-coumaroyltyramine showed anti-HIV activities.

General practice residency training program in Thailand: past, present, and future.

The General Practice was approved by the Thai Medical Council as a specialty in 1969. The residency training programs were revised in 1992. The first three - year rotating postgraduate residency training program was started in 1973 with a total of 9 programs by the late 1980s. Seven were in Bangkok, and the other 2 were in the North. The programs contained curricula objectives, clinical rotation in various disciplines including a general practice block in provincial or community hospitals. The weakness of the programs was the lack of a general practice department, a general practice trainer or preceptor and a general practice course organizer. Finally, the General Practitioners Association played a little role in the postgraduate general practice residency. After the revision, the general practice residency was changed to family medicine residency training in 1999. The College of Family Physicians of Thailand was established to take a central role in postgraduate education.

An azaanthracene alkaloid from Polyalthia suberosa.

An azaanthracene alkaloid, 1-aza-9,10-dimethoxy-4-methyl-2-oxo-1,2-dihydroanthracene (kalasinamide) has been isolated from the stems of Polyalthia suberosa. In addition, the known N-trans-feruloyltyramine and N-trans-coumaroyltyramine are also reported from the same source. The structures were elucidated by spectroscopic methods.

Evaluation of the mutagenic, cytotoxic, and antitumor potential of triptolide, a highly oxygenated diterpene isolated from Tripterygium wilfordii.

Triptolide, a highly oxygenated diterpene isolated from Tripterygium wilfordii Hook f. (Celastraceae), has been shown to demonstrate potent antileukemic activity in rodent models at remarkably low treatment doses. A variety of other physiological responses are known to be mediated by this compound, including immunosuppressive and antifertility effects. We currently report that triptolide was not mutagenic toward Salmonella typhimurium strain TM677, either in the presence or absence of a metabolic activating system. Relatively potent but non-specific cytotoxicity was observed with a panel of cultured mammalian cell lines, and modest antitumor activity was observed when an i.p. dose of 25 microg was administered three times weekly to athymic mice carrying human breast tumors. Treatment regimens involving higher doses of triptolide (e.g. 50 microg/mouse three times weekly) were lethal.

Topical antiinflammatory activity of the major lipophilic constituents of the rhizome of Zingiber cassumunar. Part II: Hexane extractives.

A hexane extract of the rhizome of Zingiber cassumunar was found to exhibit topical antiinflammatory activity, when tested in the model of 12-O-tetradecanoylphorbol-13-acetate-induced ear edema in rats (ID(50) = 854 µg/ear). Bioassay-guided fractionation (by MPLC on silica gel) of the hexane extract led to the isolation and identification of (E)-4-(3',4'-dimethoxyphenyl)but-3-enyl acetate (1), cis-3-(3',4'-dimethoxyphenyl)-4-[(E)-3,‴,4‴- dimethoxystyryl]cyclohex-l-ene (2), cis-3-(3',4'-dimethoxyphenyl)-4-[(E)-2‴,4‴,5‴- trimethoxystyryl]cyclohex-1-ene (3), cis-3-(2',4',5'-trimethoxyphenyl)-4-[(E)-2‴,4‴,5‴- trimethoxystyryl]cyclohex-l-ene (4) and (E)-4-(3'-4'-dime-thoxyphenyl)but-3-en-l-ol (5). Compounds 1-5 exerted potent topical antiinflammatory activities with ID(50)-values of 62, 21, 20, 2 and 47µg/ear, respectively. The ID(50) of the reference drug diclofenac was determined to be 61 µg/ear.

Three non-phenolic diarylheptanoids with anti-inflammatory activity from Curcuma xanthorrhiza.

Bioassay-guided fractionation of a hexane extract of the rhizomes of Curcuma xanthorrhiza Roxb. (Zingiberaceae) led to the isolation of three non-phenolic diarylheptanoids, identified mainly by high-field 1H-NMR as trans-trans-1,7-diphenyl-1,3-heptadien-4-one (alnustone), trans-1,7-diphenyl-1-hepten-5-ol, and trans,trans-1,7-diphenyl-1,3-heptadien-5-ol. The latter is reported for the first time as a plant constituent. Germacrone, curzerenone, and cinnamaldehyde were also isolated and identified. The three diarylheptanoids all exerted significant anti-inflammatory activity in the assay of carrageenin-induced hind paw edema in rats.

Cytotoxic activity of cardenolides from Beaumontia brevituba stems.

Five known cardenolides, digitoxigenin (1), oleandrigenin (2), digitoxigenin alpha-L-cymaroside (3), digitoxigenin beta-gentiobiosyl-alpha-L-cymaroside (4), and delta 16-digitoxigenin beta-D-glucosyl-alpha-L-cymaroside (5), were isolated from the stems of Beaumontia brevituba Oliver by cytotoxicity-directed fractionation monitored by a cultured human lung cancer cell line. The cytotoxic activity of these compounds was evaluated with a panel of twelve human and murine cancer cell lines. The lignan glycoside, syringaresinol beta-D-glucoside, was obtained for the first time in the form of its levo-enantiomer.

Plant anticancer agents, L. cytotoxic triterpenes from Sandoricum koetjape stems.

A new ring-A secotriterpene, koetjapic acid [1], and five known compounds, 3-oxo-olean-12-en-29-oic acid [2] (a novel natural product), katonic acid [3], (-)-alloaromadendrene, (-)-caryophyllene oxide, and (+)-spathulenol, have been isolated and characterized from a cytotoxic Et2O-soluble extract of Sandoricum koetjape stems. Of these compounds, 2 and 3 demonstrated significant cytotoxic activity against cultured P-388 cells (ED50 values of 0.61 and 0.11 microgram/ml, respectively). Significant, albeit less intense, cytotoxicity was also observed with a variety of cultured human cancer cells. The 13C-nmr chemical shifts of these triterpenes were assigned unambiguously using selective INEPT nmr experiments. Aside from compounds 2 and 3, these substances were not toxic with cultured cells.

Plant anticancer agents, XLVIII. New cytotoxic flavonoids from Muntingia calabura roots.

From a cytotoxic Et2O-soluble extract of Muntingia calabura roots, twelve new flavonoids were isolated, constituting seven flavans 1-7, three flavones 8, 10, and 12, and two biflavans 9 and 11. The structures of compounds 1-12 were established by the interpretation of spectral data, with the nmr assignments of these constituents being based on 1H-1H COSY, 1H-13C HETCOR, and selective INEPT experiments. This is the first report of the occurrence of 7,8-di-O-substituted flavans, biflavans, and flavones. Most of the isolates demonstrated cytotoxic activity when tested against cultured P-388 cells, with the flavans being more active than the flavones. Furthermore, certain of these structurally related flavonoids exhibited somewhat selective activities when evaluated with a number of human cancer cell lines.