Impact of direct-acting antiviral treatment of hepatitis C on the quality of life of adults in Ukraine.

BACKGROUND: Direct-acting antivirals (DAAs) are highly effective in achieving sustained virologic response among those with chronic hepatitis C virus (HCV) infection. Quality of life (QOL) benefits for an HCV-infected population with high numbers of people who inject drugs and people living with HIV (PLHIV) in Eastern Europe have not been explored. We estimated such benefits for Ukraine. METHODS: Using data from a demonstration study of 12-week DAA conducted in Kyiv, we compared self-reported QOL as captured with the MOS-SF20 at study entry and 12 weeks after treatment completion (week 24). We calculated domain scores for health perception, physical, role and social functioning, mental health and pain to at entry and week 24, stratified by HIV status. RESULTS: Among the 857 patients included in the final analysis, health perception was the domain that showed the largest change, with an improvement of 85.7% between entry and week 24. The improvement was larger among those who were HIV negative (104.4%) than among those living with HIV (69.9%). Other domains that showed significant and meaningful improvements were physical functioning, which improved from 80.5 (95% CI 78.9-82.1) at study entry to 89.4 (88.1-90.7) at 24 weeks, role functioning (64.5 [62.3-66.8] to 86.5 [84.9-88.2]), social functioning (74.2 [72.1-76.2] to 84.8 [83.2-86.5]) and bodily pain (70.1 [68.2-72.0] to 89.8 [88.5-91.1]). Across all domains, QOL improvements among PLHIV were more modest than among HIV-negative participants. CONCLUSION: QOL improved substantially across all domains between study entry and week 24. Changes over the study period were smaller among PLHIV.

Tissue factor deficiency increases alveolar hemorrhage and death in influenza A virus-infected mice.

UNLABELLED: Essentials H1N1 Influenza A virus (IAV) infection is a hemostatic challenge for the lung. Tissue factor (TF) on lung epithelial cells maintains lung hemostasis after IAV infection. Reduced TF-dependent activation of coagulation leads to alveolar hemorrhage. Anticoagulation might increase the risk for hemorrhages into the lung during severe IAV infection. SUMMARY: Background Influenza A virus (IAV) infection is a common respiratory tract infection that causes considerable morbidity and mortality worldwide. Objective To investigate the effect of genetic deficiency of tissue factor (TF) in a mouse model of IAV infection. Methods Wild-type mice, low-TF (LTF) mice and mice with the TF gene deleted in different cell types were infected with a mouse-adapted A/Puerto Rico/8/34 H1N1 strain of IAV. TF expression was measured in the lungs, and bronchoalveolar lavage fluid (BALF) was collected to measure extracellular vesicle TF, activation of coagulation, alveolar hemorrhage, and inflammation. Results IAV infection of wild-type mice increased lung TF expression, activation of coagulation and inflammation in BALF, but also led to alveolar hemorrhage. LTF mice and mice with selective deficiency of TF in lung epithelial cells had low basal levels of TF and failed to increase TF expression after infection; these two strains of mice had more alveolar hemorrhage and death than controls. In contrast, deletion of TF in either myeloid cells or endothelial cells and hematopoietic cells did not increase alveolar hemorrhage or death after IAV infection. These results indicate that TF expression in the lung, particularly in epithelial cells, is required to maintain alveolar hemostasis after IAV infection. Conclusion Our study indicates that TF-dependent activation of coagulation is required to limit alveolar hemorrhage and death after IAV infection.

Alternatively spliced tissue factor and full-length tissue factor protect cardiomyocytes against TNF-α-induced apoptosis.

Tissue Factor (TF) is expressed in various cell types of the heart, such as cardiomyocytes. In addition to its role in the initiation of blood coagulation, the TF:FVIIa complex protects cells from apoptosis. There are two isoforms of Tissue Factor (TF): "full length" (fl)TF--an integral membrane protein, and alternatively spliced (as)TF--a protein that lacks a transmembrane domain and can thus be secreted in a soluble form. Whether asTF or flTF affects apoptosis of cardiomyocytes is unknown. In this study, we examined whether asTF or flTF protects murine cardiomyocytes from TNF-α-induced apoptosis. We used murine cardiomyocytic HL-1 cells and primary murine embryonic cardiomyocytes that overexpressed either murine asTF or murine flTF, and stimulated them with TNF-α to initiate cell death. Apoptosis was assessed by annexin-V assay, propidium iodide assay, as well as activation of caspase-3 and -9. In addition, signaling via integrins, Akt, NFκB and Erk1/2, and gene-expression of Bcl-2 family members were analyzed. We here report that overexpression of asTF reduced phosphatidylserine exposure upon TNF-α-stimulation. asTF overexpression led to an increased expression and phosphorylation of Akt, as well as up-regulation of the anti-apoptotic protein Bcl-x(L). The anti-apoptotic effects of asTF overexpression were mediated via α(V)ß(3)/Akt/NFκB signaling and were dependent on Bcl-x(L) expression in HL-1 cells. The anti-apoptotic activity of asTF was also observed using primary cardiomyocytes. Analogous yet less pronounced anti-apoptotic sequelae were observed due to overexpression of flTF. Importantly, cardiomyocytes deficient in TF exhibited increased apoptosis compared to wild type cells. We propose that asTF and flTF protect cardiomyocytes against TNF-α-induced apoptosis via activation of specific signaling pathways, and up-regulation of anti-apoptotic members of the Bcl-2 protein family.

Regulation of cardiomyocyte full-length tissue factor expression and microparticle release under inflammatory conditions in vitro.

SUMMARY BACKGROUND: Myocardial inflammation is associated with an increase in circulating microparticles (MPs) and procoagulability. OBJECTIVES: We determined whether acute inflammation was associated with altered full-length tissue factor (flTF) expression and increased procoagulability in cardiomyocytic cells. METHODS: This study examined the transcriptional regulation of flTF expression in murine cardiomyocytic (HL-1) cells. Also, the generation of MPs by HL-1 cells and their ability to diffuse through an artificial endothelium was evaluated. RESULTS: Constitutive and tumor necrosis factor-alpha (TNF-alpha)-induced flTF expression of HL-1 was reduced when c-Jun N-terminal kinase (JNK) was inhibited. Tissue factor (TF)-positive procoagulant MPs were released from HL-1 cells in response to TNF-alpha. JNK inhibition potentiated the release of MPs from HL-1 cells without affecting MP-associated TF activity. MP generation was dependent on RhoA activation and associated with a reorganization of the actin cytoskeleton. Increased diffusion of HL-1-derived MPs through an endothelial monolayer was found after TNF-alpha treatment. The increased diffusion was dependent not only on TNF-alpha but also on HL-1-released mediators. CONCLUSIONS: Full-length TF expression in HL-1 cells was regulated through JNK. The TNF-alpha-induced increase in procoagulability was mediated through RhoA-dependent release of flTF-bearing MPs. These MPs were able to diffuse through an endothelial barrier adjacent to HL-1 cells and increased the procoagulability of the extracellular endothelial space. Cardiomyocytes seem to be a likely source of flTF-bearing procoagulant MPs.

High molecular weight adiponectin correlates positively with myeloperoxidase in patients with type 2 diabetes mellitus.

Adiponectin (APN) is present in human plasma as a low molecular weight (LMW), a middle molecular weight (MMW) and a high molecular weight form (HMW). As a support to determine properties such as anti-atherogenic or atherogenic effects, recent clinical studies suppose to determine the ratio of each APN multimer to total APN but not the absolute plasma concentration of APN. In the present study, the correlation of APN and its multimers with myeloperoxidase (MPO), an enzyme with pro-inflammatory properties, was examined in patients with type 2 diabetes mellitus. MPO and APN serum levels were assessed in 49 patients with type 2 diabetes mellitus at the beginning and at the end of an anti-diabetic treatment. After treatment a significant increase in the ratio of HMW to total APN (from 0.43+/-0.16 to 0.59+/-0.14, p<0.05) was found. Before treatment, HMW-APN was correlated positively with MPO (r=0.314, p<0.05). Moreover, a positive correlation was observed between the increased HMW ratio and MPO during treatment (r=0.304, p<0.05). HMW-APN correlates positively with MPO in patients with type 2 diabetes. Therefore, HMW-APN may exert possible pro-inflammatory effects in type 2 diabetes.

[The clinico-epidemiological characteristics of HIV infection and AIDS in Ukraine]. / Kliniko-épidemiologicheskie osobennosti VICh-infektsii i SPIDa na Ukraine.

The summarized results of the observations of 449 hospitalized patients, aged mainly 18-37 years (40 patients with active AIDS, 43 patients with AIDS, other patients were HIV carriers and infected at the stage of lymphadenopathy). In most of the HIV-infected patients the infection process progressed in 3-5 years, which was manifested by associated candidiasis in 74.7% of cases. In AIDS patients opportunistic infections of viral etiology (herpes simplex, cytomegalovirus infection, etc.) prevailed. 14 patients were found to have tuberculosis. Clinico-epidemiological analysis made it possible to come to the conclusion that the specific features of HIV carriership and AIDS were greatly linked with different groups of risk to which the patients belonged. Thus, a shorter period of carriership, the prevalence of opportunistic viral infections were mostly characteristic of drug addicts.

[Pulmonary tuberculosis and acquired immunodeficiency syndrome in Ukraine (first communication)]. / Tuberkulez organov dykhaniia i sindrom priobretennogo immunodefitsita na Ukraine (pervoe soobshchenie).

The epidemiological HIV infection situation in the Ukraine in the past 4 years is analyzed. In patients with AIDS, the clinical manifestations of tuberculosis are atypical; prolonged intoxication, negative tuberculin tests, no bacterial isolation in half the cases. These patients should be treated with 4 - 5 antituberculous drugs, by taking into account the fact that only long-term continuous therapy may yield a positive effect.

PIP: In the Ukraine, the first case of HIV infection was reported in 1987 and, by the end of 1992, the number rose to 112 cases, 12 of which developed AIDS. By mid-1996, about 4500 HIV-positive cases were known to exist and there were 73 known AIDS patients, of which 40 died. Another cause for concern is the resurgence of tuberculosis (TB) and, in particular, TB in combination with HIV infection. There were 177.8 double infection cases/100,000 population in the country according to recent statistical data versus 38.7 TB cases/100,000 population in the general population. The first 8 cases of double infection were reported in 1991. TB is commonly treated with the following drugs: 5-10 mg/kg isoniazid; 10 mg/kg ethambutol or 25 mg/kg pyrazinamide; 15 mg/kg streptomycin or 15 mg/kg kanamycin. AIDS is treated with azidothymidine, dextransulfate, and by the implantation of lymphocytes for the restoration of immune function. The observation period of the 8 patients infected with TB and HIV lasted from 4-5 months to 2 years, during which time intensive therapy consisted of 4-5 preparations. Post-TB sequelae, such as fibrous inflammation in the lungs, should be treated with 5 mg/kg isoniazid for 3 months twice a year. The traditional diagnosis of TB relies on negative TB tests, atypical X-ray images, and the presence of Mycobacterium tuberculosis in more than 50% of the patients.

Metabolic deglucuronidation and demethylation of estrogen conjugates as a source of parent estrogens and catecholestrogen metabolites in Syrian hamster kidney, a target organ of estrogen-induced tumorigenesis.

Estrogen-induced tumors in kidneys of male Syrian hamsters have been postulated to arise from cells which are damaged by free radicals and other reactive species generated during metabolic redox cycling of catecholestrogens and which at the same time are exposed to excessive growth stimulation mediated by estrogen receptors. In this study, we have determined the rates of metabolic deconjugation of estrogen glucuronides and of catecholestrogen methyl ethers by cellular fractions from male hamster kidney and liver to evaluate the contribution of this process to renal pools of parent estrogens and of catecholestrogen metabolites. Lysosomes from male hamster kidney catalyzed the deconjugation of estradiol- and estrone-3 beta-D-glucuronides at rates of 51.7 and 64.6 pmol/mg protein/min, respectively, which were 65 and 34% higher than corresponding deconjugation rates by liver lysosomes. Treatment of hamsters with estradiol implants for 9 days increased lysosomal glucuronidase activities for these estrogen glucuronides by 15 to 25% in kidney and doubled the activities in liver, but it did not alter their corresponding Km values. Microsomal glucuronidase activities in kidney and liver were approximately 10 to 20% of lysosomal activities. Rates of demethylation of 2- and 4-methoxyestradiol by kidney microsomes were comparable (with Vmax values of 24 and 30 pmol/mg protein/min, respectively), whereas the rate of demethylation of 2-methoxyestradiol by liver microsomes was approximately fivefold higher than that of 4-methoxyestradiol. The rates of renal demethylation of methoxyestrogens were comparable with previously published rates of renal aromatic hydroxylation of estradiol, whereas rates of hepatic demethylation were about one-fifth of the corresponding hydroxylation rates. It is concluded that metabolic deconjugation is an important source of primary estrogens and of catecholestrogen metabolites in hamster kidney, a target of estrogen-induced tumorigenesis. The increased renal estrogen glucuronidase activity during prolonged estradiol treatment may also facilitate the development of estrogen-induced tumors in this target organ.

[The pseudotumorous course of viral hepatitis B]. / Psevdotumoroznoe techenie virusnogo gepatita B.

A rare case is described of viral B hepatitis in a woman of 60 years with prevailing clinical, ultrasonic and scintigraphic signs of mechanical jaundice due to a tumour in the hepatopancreatoduodenal zone. The diagnosis of viral hepatitis B was confirmed by 5-fold detection of HBsAg in the blood, positive clinical dynamics revealed after corticosteroid treatment with subsequent complete recovery of the patient.