Nitrite determination in human plasma and synovial fluid using reactions of nitric oxide with 3, 5-dibromo-4-nitrosobenzenesulphonate (DBNBS).

DBNBS (3,5-dibromo-4-nitrosobenzenesulphonate) reacts with nitric oxide (NO) produced from nitrite ions in acid solution to give a radical with a characteristic electron spin resonance spectrum, attributable to a 'DBNBS-NO' product, and comprising a triplet with alphaN=0.96 mT. This is identical with the spectrum obtained when NO, introduced from the gas phase, reacts with DBNBS. Under certain conditions, an additional signal is observed, attributable to oxidation of DBNBS to the radical cation, DBNBS*+ (a triplet with alphaN=1.32 mT). Conditions are described for the determination of nitrite, which avoid this DBNBS oxidation. The height of the low-field signal from the DBNBS-NO product is directly proportional to the nitrite concentration up to about 0.08 mM nitrite. The method has been applied to the measurement of nitrite concentrations in whole blood, plasma and synovial fluid taken from rheumatoid arthritis patients. In order to avoid the oxidation of DBNBS when analysing biological samples of this type, it is necessary to treat the specimen by ultrafiltration as soon as possible after collection and before addition of DBNBS.

Detection and investigation of the molecular nature of low-molecular-mass copper ions in isolated rheumatoid knee-joint synovial fluid.

Low-molecular-mass copper(II) species have been detected and quantified in ultrafiltrates (n = 7) of rheumatoid synovial fluid (SF) by a highly-sensitive HPLC-based assay system with the ability to determine Cu(II) concentrations of < 10(-7) mol.dm-3. High field 1H NMR spectroscopy demonstrated that addition of Cu(II)(aq.) to isolated samples of RA SF ultrafiltrates resulted in complexation by histidine > alanine > formate > threonine > lactate > tyrosine > phenylalanine, their effectiveness in this context being in the given order. CD spectra of Cu(II)-treated samples of intact SF exhibited absorption bands typical of copper(II)-albumin complexes, in addition to a band attributable to a low-molecular-mass histidinate complex (lambda min 610 nm). Since both albumin and histidine are potent radical scavengers, these results indicate that any .OH radical generated from bound copper ions will be 'site-specifically' scavenged. Hence, low-molecular-mass copper complexes with the ability to promote the generation of .OH radical which can then escape from the metal ion co-ordination sphere (and in turn, cause damage to critical biomolecules) appear to be absent from inflammatory SF.

Electron spin resonance spectroscopic demonstration of the generation of reactive oxygen species by diseased human synovial tissue following ex vivo hypoxia-reoxygenation.

OBJECTIVE: To apply an electron spin resonance (ESR) spectroscopic technique as a means of determining the oxidising capacity of reactive oxygen species produced during hypoxia and reoxygenation of diseased human synovial tissue. METHODS: Twenty four specimens of fresh synovial tissue were obtained from patients undergoing primary total knee joint replacement and graded according to the degree of inflammation present. Tissue samples were subjected to an ex vivo hypoxia-reoxygenation cycle in the presence of the nitroso based spin trap, 3,5-dibromo-4-nitrosobenzene sulphonate. The degree of oxidation of the spin trap to a stable free radical was determined and followed with time. Control samples were subjected to hypoxia only. RESULTS: The results indicate that the oxidising capacity of reactive oxygen species produced by human synovial tissue varies with the degree of inflammation present. Only the more inflamed specimens, from both rheumatoid arthritis and osteoarthritis patients, demonstrated increased production of reactive oxygen species when subjected to a hypoxia-reoxygenation cycle. This change was reduced by both competitive and non-competitive inhibitors of the endothelial based enzyme xanthine oxidase. The relative concentration of reactive oxygen species generated by the synovial tissue samples correlated with the mean capillary density of the specimens. CONCLUSION: This study supports the hypothesis of movement induced hypoxicreperfusion injury of the chronically inflamed joint by demonstrating the generation of reactive oxygen species within inflamed human synovium following an ex vivo hypoxia-reoxygenation cycle. Evidence is presented that the microvascular endothelial based enzyme xanthine oxidase is the predominant source of ESR detectable oxidising species in inflamed synovial specimens exposed to hypoxia-reoxygenation.

Relationship between alpha 1-antitrypsin inactivation and tumor necrosis factor alpha concentration in the synovial fluid of patients with rheumatoid arthritis.

OBJECTIVE: To examine the relationship between alpha 1-antitrypsin (alpha 1AT) specific activity and tumor necrosis factor alpha (TNF alpha) concentration in synovial fluid from 48 patients with rheumatoid arthritis. METHODS: The specific activity of alpha 1AT was calculated from the measurement of alpha 1AT concentration (by rocket immunoelectrophoresis) and elastase inhibitory capacity. TNF alpha was detected by enzyme-linked immunosorbent assay. RESULTS: TNF alpha concentrations correlated with the extent of alpha 1AT inactivation. CONCLUSION: Our findings are consistent with a role of elastase in TNF alpha release within the inflamed joint.

Nurses' attitudes to visiting in coronary care units.

In many coronary care areas there are still restricted visiting times (Shaw 1989). This investigative study describes some relevant research in this area, and documents a small study of 14 nurses in two coronary care units (CCUs). A semi-structured interview was used to obtain information regarding nurses' attitudes to visiting. The results showed that the majority of these nurses are flexible when it comes to visiting, and expressed a relaxed attitude to it. Although in the area investigated visiting times are specified, some nurses consider and act on the concept of individualised patient care. However, there are still some nurses who insist on doing everything for the patient in the morning and only allow relatives access in the afternoon. These nurses also believe visiting times are precious to the patients and relatives and will not intrude on them, which may limit communication.

Intercellular adhesion molecules in normal synovium.

The vasculature of normal synovium and skin has been examined for the presence of molecules believed to be involved in intercellular adhesion and whose expression on endothelial cells in vitro is known to be upregulated by cytokines. Synovium was obtained from clinically and histologically normal joints removed during amputations for proximal sarcomata. Skin was obtained from healthy volunteers. Cryostat sections of tissues were assessed by immunohistochemistry and microdensitometry for the presence of E-selectin using monoclonal antibody 1.2B6, intercellular adhesion molecule-1 (ICAM-1) using monoclonal antibody 6.5B5 and vascular cell adhesion molecule (VCAM-1) using monoclonal antibody 1.4C3. Both E-selectin and ICAM-1 were present on a proportion of normal synovial venules but at a level comparable to or lower than that found on dermal vessels. (Staining intensities given as mean absorption indices: superficial synovium 1.2B6: 9.9 +/- 11.4, 6.5B5: 10.2 +/- 12.0, deep synovium 1.2B6: 6.6 +/- 9.9, 6.5B5: 24.6 +/- 15.7, skin 1.2B6: 13.1 +/- 16.6, 6.5B5: 36.4 +/- 12.9.) E-selectin expression was most prominent on small superficial venules in synovium and ICAM-1 most strongly expressed on larger, deep venules. VCAM-1 was found at low levels on cells associated with vessel walls but no significant endothelial staining was seen in either type of tissue. VCAM-1 was also present on cells of the synovial lining layer. Some of the findings in synovium could have been attributable to tumour related cytokine release, but the consistency of findings and comparability to skin suggest that this is relatively unlikely.(ABSTRACT TRUNCATED AT 250 WORDS)

Alpha-tocopherol, lipids and lipoproteins in knee-joint synovial fluid and serum from patients with inflammatory joint disease.

1. We have determined the antioxidant status of synovial fluid and serum of patients with inflammatory joint disease in terms of the biologically active lipid-soluble antioxidant, alpha-tocopherol. Synovial fluid concentrations of alpha-tocopherol were significantly lower relative to those of paired serum samples (P < 0.001). Serum levels of alpha-tocopherol in these patients did not differ significantly from those in control serum. 2. Lower concentrations of cholesterol, triacylglycerol and low-density lipoprotein were also observed in patients' synovial fluid compared with matched serum samples. However, multiple regression analysis of the data indicated that there remained a significant depletion of alpha-tocopherol, which was largely independent of these co-variables, in inflammatory synovial fluid. These findings are consistent with the consumption of alpha-tocopherol within the inflamed joint via its role in terminating the process of lipid peroxidation. 3. Nuclear magnetic resonance spectroscopic analysis of matched inflammatory synovial fluid and serum confirmed lower concentrations of triacylglycerol in synovial fluid together with evidence of a shortened mean triacylglycerol chain length. The latter metabolic difference suggests an increased utilization of triacylglycerols for energy within the inflamed joint.

Autoantibodies to mitochondrial and centromere antigens in primary biliary cirrhosis and systemic sclerosis.

High levels of IgG antibodies to the multi-enzyme complex bovine pyruvate dehydrogenase (PDHC) were detected by a sensitive ELISA in all patients with histologically proven primary biliary cirrhosis (PBC), in a minority of patients with systemic sclerosis without overt PBC or with chronic liver diseases of another cause and in no rheumatoid arthritis or normal controls. Most (15/21) but not all of these positive patients recognized a 70-kD (E2) component of PDHC on immunoblotting. Additional recognition of a centromere-associated 140-kD polypeptide was associated with the presence of scleroderma-like features (Raynaud's phenomenon and sclerodactyly) in PBC, further emphasizing the serological and clinical overlap between these two conditions.