A new chapter opens in anti-inflammatory treatments: the antidepressant bupropion lowers production of tumor necrosis factor-alpha and interferon-gamma in mice.

In a wide range of human diseases of inflammatory nature like Crohn's disease, pathology is mediated in part by pro-inflammatory cytokines like tumor necrosis factor-alpha (TNF) or interferon-gamma. We show here that a commonly used generic antidepressant bupropion, in wide use worldwide to treat depression in humans for a decade now, profoundly lowers levels of TNF, interferon-gamma, and interleukin-1 beta in vivo, in a mouse lipopolysaccharide (LPS) induced inflammation model. Mice challenged with an otherwise lethal dose of LPS were protected by bupropion and levels of the anti-inflammatory cytokine interleukin-10 were increased. Previous data in rodents and humans indicate antidepressant effects of bupropion are mediated by its weak reuptake inhibition of norepinephrine and dopamine. Concordant with this, TNF suppression by bupropion in our mouse LPS model was largely abrogated by beta-adrenergic or dopamine D1 receptor antagonists but not by a D2 antagonist. TNF synthesis is controlled by an inverse relationship with intracellular cyclic adenosine monophosphate (cAMP) and stimulation of either beta-adrenoreceptors or D1 dopaminergic receptors result in increased cAMP but stimulation of D2 receptors lowers cAMP. We conclude that bupropion may suppress TNF synthesis by mediating increased signaling at beta-adrenoreceptors and D1 receptors, resulting in increased cAMP that inhibits TNF synthesis. Bupropion is well tolerated also in non-psychiatric populations and has less risk with long term use than current anti-inflammatory, immunosuppressive or TNF suppressive treatments such as prednisone, azathioprine, infliximab, or methotrexate. New anti-inflammatory treatments are needed. We believe a new chapter in antiinflammatory, TNF lowering treatment of disease has been opened. Bupropion's use for this in humans should be explored.

Monoamine oxidase inhibitors for IgA nephropathy.

IgA nephropathy (IgAN), characterized by renal mesangial deposits of antibodies (of the IgA subtype), is the most common glomerulonephritis worldwide. The cause of IgAN is not known. IgAN can often lead to end stage renal disease (ESRD), and there is no known treatment proven to prevent ESRD in IgAN. Long term use of steroids or other immunosuppressant drugs carry severe toxicities and other risks. IgAN patients have high serum levels of tumor necrosis factor-alpha (TNF). Increased monoamine levels, via increased cellular cyclic AMP, can decrease TNF elaboration. Monoamine oxidase inhibitors (MAO-Is) have been found effective in case studies for a number of diseases, e.g. rheumatoid arthritis and Crohn's disease, characterized by high TNF levels. Here I suggest that MAO-Is might be of utility in IgAN by decreasing TNF levels.

Cleidocranial dysostosis and the unity of the Homeric epics: an essay.

Numerous years ago, in this journal, Beasley diagnosed the character Thersites from Homer's Iliad with cleidocranial dysostosis. Additional evidence from the text is presented to support a diagnosis of cleidocranial dysostosis, and it is pointed out that this diagnosis may have implications in studying the question whether the two Homeric epics (the Iliad and the Odyssey) were composed by the same author.

Viral inoculation for prophylaxis of polyoma virus associated diseases.

A number of human diseases - colon cancer (JC virus), medulloblastoma (JC virus), and neuroblastoma (BK virus) have recently been associated with human polyoma viruses. If such viral links can be proven, I suggest viral inoculation as prophylaxis against these diseases, especially colon cancer, in seropositive immunocompetent individuals.

Consideration of mycophenolate mofetil for idiopathic pulmonary fibrosis.

Idiopathic pulmonary fibrosis (IPF) is an inflammatory disorder of the lungs of unknown etiology, with no effective treatment. Besides the recent finding of utility of mycophenolate mofetil (MMF) in a case of refractory interstitial lung disease associated with ulcerative colitis, I suggest that there are at least three other reasons to consider MMF for IPF. Previously, MMF has been found to be effective as salvage therapy in a number of diseases. MMF might work for IPF not only by white cell suppression, but also in vivo against proliferation of primary human pulmonary fibroblasts. There is one group of patients for whom, logically, MMF should be most strongly considered--those with a high likelihood of receiving a lung transplant. As MMF is often part of the post-transplant immunosuppressive regimen in these patients, logic would seem to dictate MMF should be considered for use before subjecting the patient to major surgery.

Is JC polyoma virus the cause of ulcerative colitis and multiple sclerosis?

JC polyoma virus (JCV) is known to be the cause of the degenerative central nervous system white matter disease progressive multifocal leucoencephalopathy. Recently, JCV DNA has unexpectedly been found in significant quantity in normal colon mucosa and in tissue from colonic carcinomas, with increased quantities in the cancerous tissues. The yield of JCV DNA was increased by use of topoisomerase I, possibly because the JCV DNA was negatively supercoiled. The causes of ulcerative colitis (in which colon cancer is common) and multiple sclerosis are not known. Here I suggest that JCV may play a role in the pathogenesis of these diseases, and discuss methods for testing this hypothesis.