The effect of selective low-density lipoprotein apheresis on plasma lipoperoxides and antioxidant vitamins in familial hypercholesterolemic patients.

Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder characterized by a lifelong elevation in the concentration of low-density lipoprotein (LDL) bound cholesterol in blood by cholesterol deposits and by early coronary artery disease. The LDL apheresis technique has been introduced with the goal of reducing LDL cholesterol levels, thereby preventing the development of atherosclerosis. The literature on LDL apheresis reports 2 different facets, the therapeutic aspect associated with the lessening of LDL concentration and the initiation of a peroxidation process associated with the biocompatibility of the artificial membrane. Lipid and protein peroxidation gives rise to toxic and atherogenic hydroperoxide, mostly lipid hydroperoxides, and derivative compounds, which may offset the benefit of the procedure. In this paper, plasma hydroperoxide levels are determined along with the elevation of the serum and LDL antioxidant status in hypercholesterolemic patients before and following repeated LDL apheresis sessions. Hydroperoxide concentration has been expressed both in terms of plasma volume and LDL concentration. A highly significant increase in LDL lipid hydroperoxides is demonstrated when expressed in terms of LDL concentration and is associated with the LDL apheresis procedure. The usefulness of antioxidant supplementation in LDL apheresis is discussed.

Aedes albopictus (Diptera:Culicidae) is incompetent as a vector of hepatitis C virus.

In laboratory experiments, Aedes albopictus females were fed hepatitis C virus (HCV)-infected human blood with a unit-feeding apparatus. Pools of engorged females were tested at various time intervals after their blood meal for the presence of HCV RNA using two methods in parallel: reverse transcription-nested polymerase chain reaction (PCR) and PCR with the Amplicor HCV system. Comparable results were obtained with both methods. Mosquitoes were found to be positive only immediately and 24 h after feeding. Moreover, female progeny produced negative results. Our results indicate that the Ae.albopictus strain used is incompetent as a vector of HCV.

Low molecular weight IgM in primary Sjögren's syndrome.

Low molecular weight IgM (LMW IgM), the monomeric subunit of pentameric IgM, was measured in the serum of 27 patients with primary Sjögren's syndrome. LMW IgM was also measured in a control group consisting of 24 patients with psoriatic arthritis (PA) and 8 patients with active rheumatoid arthritis (RA). LMW IgM was found in the majority of patients with primary SS (63%) and those patients had a longer disease duration than those without SS (80.7 +/- 43.9 months vs 37 +/- 18.3, p = 0.01). Although the differences were not significant, SS patients with LMW IgM showed higher rates of: seropositive disease (71% vs 50%), anti-Ro (59% vs 30%) and anti-La antibodies (12% vs 0%), extraglandular involvement (76% vs 60%) and raised gammaglobulins levels (47% vs 30%) compared to those without LMW IgM. Our only two patients with active RA and vasculitis had LMW IgM. None of the patients with PA showed LMW IgM, regardless of their Kammer subgroup classification, disease activity or radiological evidence of erosions. The presence of LMW IgM in a high percentage of patients with primary SS appears to be the expression of a dysregulation of B cell state that may predispose these patients to developing malignant lymphoproliferation.

Fibrin glue from single-donation autologous plasmapheresis.

A method is described for preparing fibrin glue from fibrinogen obtained by double cryoprecipitation of plasma collected by plasmapheresis. Plasma (average volume, 528.8 +/- 86 mL), collected from 12 plasmapheresis donors was cryoprecipitated twice. When the cryoprecipitated pellet was resuspended in 0.5 to 2 mL of saline (total volume of saline-resuspended fibrinogen: 5 mL), the average yield of fibrinogen was 78.4 +/- 18.3 mg per mL. This is comparable to commercial preparations, is suitable for clinical use, and offers greater safety at a reduced cost.

Recombinant human erythropoietin therapy in patients with rheumatoid arthritis with the anemia of chronic disease.

We treated 5 patients with rheumatoid arthritis (RA) with anemia of chronic disease with recombinant human erythropoietin (rHuEPO) for 11 weeks. An increase in hematocrit (Hct) greater than 5 was seen in 4 patients after 4 weeks of therapy. The 5th patient had a significant rise in Hct when the dosage of rHuEPO was increased to 150 units/kg from the 4th to 7th week. The subcutaneous administration of rHuEPO dose, reduced by one third with respect to initial dose, maintained an effective Hct value in all the 5 patients during the last 4 weeks of therapy. There was no change in disease activity. In one patient Hct normalization completely resolved symptoms of angina pectoris and permitted hip replacement surgery in another. No side effects occurred during rHuEPO therapy. We conclude that HuEPO is an effective, safe and well tolerated therapy for RA patients with severe anemia of chronic disease.

The role of interleukin 1, erythropoietin and red cell bound immunoglobulins in the anaemia of rheumatoid arthritis.

Since interleukin 1 (IL-1) and erythropoietin (Epo) are believed to play a role in the pathogenesis of rheumatoid arthritis (RA) anaemia we measured IL-1 alpha and Epo concentrations in 10 RA patients with chronic disease anaemia (CDA) and in 14 RA patients without anaemia. Anaemic RA patients had significantly higher IL-1 alpha concentrations than patients without anaemia. IL-1 alpha correlated negatively with haemoglobin and correlated positively with ESR. The results of a multivariate analysis showed that the best predictors of the presence and absence of anaemia were IL-1 alpha and ESR. No clinical parameters permitted a distinction between these two groups of patients. Epo levels were not different in anaemic and non-anaemic RA patients. No correlation was found between Hb and Epo, indicating the presence of an impaired Epo response in RA patients with CDA. We completed our study with the determination of the mean red cell lifespan and with the quantification of IgG and IgM bound to the surfaces of red blood cells (RBC-IgG and RBC-IgM) using a sensitive ELISA method. We observed a modest reduction in red cell survival in anaemic RA patients compared to normal controls. We did not find any correlation between Hb and red cell lifespan and between Hb and RBC-IgG. RBC-IgG and RBC-IgM were not found to be more elevated in anaemic RA than in non-anaemic patients.

[Not the beta-thalassemia syndrome but hemoglobinopathy H. Studies of 3 clinical cases]. / Non sindrome beta-talassemica ma emoglobinopatia H. Osservazioni su tre casi clinici

Clinical and laboratory data for three patients are presented. Electrophoretic separation of the freshly obtained haemolysate showed a fast beta-chain fraction on each occasion. This is typical of Hb H disease. The test for erythrocyte inclusion bodies was also positive. The main clinical and haematological features of the disease are illustrated.

[Anatomo-clinical studies and therapeutic results in 2 cases of essential mixed cryoglobulinemia with renal insufficiency]. / Osservazioni anatomo-cliniche e risultati terapeutici in due casi di crioglobulinemia mista essenziale decorrenti con insufficienza renale

Two cases of essential mixed cryoglobulinaemia selected from a personal series on account of their clinical features (hyperviscosity syndrome in one case and frank renal involvement in the other) are presented. Extensive seroimmunological examinations were carried out, along with histopathological studies designed to reveal significant changes in organs and tissues, particularly the skin and kidneys. Reference is briefly made to the debate pathogenesis of the immunological phenomenon that probably lies at the root of the disease. A short account is also given of attempts at treatment with corticosteroids, immunosuppressors and plasmapheresis.