INSECT PHYLOGENOMICS. Response to Comment on "Phylogenomics resolves the timing and pattern of insect evolution".

Tong et al. comment on the accuracy of the dating analysis presented in our work on the phylogeny of insects and provide a reanalysis of our data. They replace log-normal priors with uniform priors and add a "roachoid" fossil as a calibration point. Although the reanalysis provides an interesting alternative viewpoint, we maintain that our choices were appropriate.

Effect of long-term colchicine therapy on jejunal mucosa.

Colchicine is recommended as daily prophylactic therapy in patients with familial Mediterranean fever (FMF) to prevent febrile paroxysms. The drug is known to be a potent inhibitor of mitotic activity and might therefore be expected to have a significant adverse effect on tissues that undergo rapid turnover. We studied small bowel biopsies from nine patients with FMF who were receiving daily low-dose oral colchicine therapy. In each patient the lengths of 20 crypts and villi were measured and the number of mitotic figures in 20 crypts were counted. The data were compared with similar measurements from histologically normal-appearing biopsies obtained from 14 patients with a variety of mild gastrointestinal complaints. The mean crypt length was found to be significantly greater (0.197 mm vs 0.186 mm, P < 0.0001) and the mean villous length significantly smaller (0.369 mm vs. 0.442 mm, P < 0.0001) in the FMF patients than in the control population. In addition, the mean number of mitotic figures per crypt was significantly higher in the FMF patients (2.58 vs 1.00, P < 0.001). The data reveal a pattern of mucosal injury in the colchicine-treated FMF patients characterized by a hyperplastic crypt-villous atrophy pattern with increased mitotic rate, which is indicative of an increase in cell turnover and opposite to what we anticipated based on colchicine's known effect on mitotic activity.

Angiodysplasia of the colon. A review of 17 cases.

From October 1977 through December 1982, 24 patients with lower gastrointestinal tract hemorrhage were diagnosed by visceral angiography as having angiodysplasia of the colon. Seventeen of them underwent surgery for definitive treatment of their hemorrhage. Five patients had lesions on both sides of the colon, and five had coagulation disorders. Three of the 17 patients with lesions isolated to the cecum underwent right hemicolectomy. The rest underwent subtotal colectomy with ileoproctostomy. No patient had recurrent or persistent bleeding. There were three deaths in the subtotal colectomy group (21%); coagulation disorders contributed to two of them. Subtotal colectomy was universally successful in controlling bleeding but had a significant mortality in these elderly patients. Coagulopathy, especially platelet disorders, was a significant risk factor with this diagnosis. A coagulation panel, including platelet function, should be part of the preoperative assessment.

Colchicine use for familial Mediterranean fever. Observations associated with long-term treatment.

Of 85 patients with familial Mediterranean fever receiving continuous prophylactic colchicine therapy, 62 (73 percent) have had a significant reduction in the severity and frequency of their attacks. All 62 have been observed for three years or more, for a total of 4,680 patient-months and a mean duration of 75.5 months. Of the 85 patients, 23 (27 percent) did not complete three years of treatment for a variety of reasons. Diarrhea was the most common side effect, necessitating reduction of colchicine dosage in 12 patients, but discontinuation of treatment in only one. No other significant side effects were observed. Continuous, prophylactic colchicine therapy is effective in preventing the recurrent febrile paroxysms of familial Mediterranean fever and is indicated in those patients who are incapacitated by frequent attacks or who are at risk for amyloidosis developing.

Microtubules in PMNs from patients with familial Mediterranean fever.

Polymorphonuclear (PMN) cells derived from patients with Familial Mediterranean Fever (FMF) were evaluated in vitro for the function and concentration of their microtubules. Using the time-decay colchicine binding assay to determine the tubulin concentration in PMN cells, no difference was found in PMN cells derived from FMF patients in comparison with those from normal healthy subjects. Colchicine treatment had no effect on the detectable tubulin concentration in the cells. The mobility of fluorescent con A(F-con A)-receptor complexes on PMN membranes was used to test the function of the microtubules. PMNs from untreated FMF patients showed the same pattern of con A cap formation as seen in normal cells. PMNs derived from colchicine treated patients, however, showed 22-32% spontaneous cap formation. These cells also showed 10-30% more capping in comparison with normal or untreated FMF cells, for any given in vitro colchicine concentration, suggesting that at therapeutic doses, the colchicine does accumulate in the PMNs in vivo. We were unable to demonstrate a microtubule defect in the neutrophils from FMF patients in these studies.

A neutrophil lysozyme leak in patients with familial Mediterranean fever.

Polymorphonuclear cells derived from the peripheral blood of patients with Familial Mediterranean Fever release more lysozyme in response to high temperature (42 degrees, 46 degrees C) than do control cells. No differences between the FMF and control cells were observed in the release of acid phosphatase, beta-glucuronidase, or lactoferrin. Colchicine treatment had no effect on the measurable release of the enzyme from PMNs derived from FMF patients. The increased release of lysozyme in response to high temperatures appears to be specific to FMF neutrophils, and was not found in PMNs from non-FMF patients with febrile or inflammatory diseases, nor was it seen in monocytes derived from the FMF patients. It is suggested that the increased release of lysozyme from the neutrophils may be of importance in the pathogenesis of FMF.

Long-term colchicine therapy of familial Mediterranean fever.

Familial Mediterranean fever is a disorder characterized by recurrent fever and polyserositis. Continuous prophylactic colchicine therapy has been effective in suppressing attacks in affected adults. From 30 children with FMF, 14 were selected for colchicine therapy. Eight children continued prophylactic colchicine therapy for 29 months (mean) and experienced a marked decrease in the frequency of attacks. Six other children did not comply with the treatment regimen. Although no deleterious side effects were noted, the safety of long-term colchicine administration in childhood is unknown.

HLA-B27-negative sacroiliitis: a manifestation of familial Mediterranean fever in childhood.

Familial Mediterranean fever is a polysystemic disease seen most frequently in persons of Mediterranean ancestry. Arthritis is one of the common manifestations. Both symptomatic and asymptomatic sacroiliitis have been reported in adults. We report on two children with familial Mediterranean fever with radiographic abnormalities similar to those described in adults. Although sacroiliitis is strongly correlated with the presence of HLA-B27 in most arthropathies, these children were HLA-B27-negative. The diagnosis of familial Mediterranean fever was delayed in both patients because the association of sacroiliitis with familial Mediterranean fever in childhood was not recognized.

Leukocyte function in familial Mediterranean fever.

Neutrophilic leukocytes of patients with familial Mediterranean fever and of normal control subjects were studied in vitro. FMF neutrophils were found to be morphologically normal by light and electron microscopy and to have normal quantities of the lysosomal enzyme lysozyme. FMF cells demonstrated a slight decrease in their ability to migrate randomly in capillary tubes, this was primarily seen in Armenian patients and in those experiencing an acute attack. The leukocytes of these patients functioned normally in regard to their chemotactic and Candida-killing activity.