Occurrence of the polyomavirus among kidney transplant recipients: a single-center study.

Polyoma virus-associated nephropathy is an increasingly recognized cause of graft dysfunction among kidney transplant recipients and could be the result of use of potent immunosuppression following transplantation. Because there is no safe and effective anti-viral therapy available presently, screening-based prevention and pre-emptive strategy are recommended. This study, which was conducted at the Nephrology Unit, Internal Medicine Department, Alexandria University, consisted of two phases: Phase 1 was a cross-sectional study and phase 2 was a 6-month follow-up study only for polyoma virus-positive cases. Phase 1 included 75 renal allograft recipients from living donors. Urine cytology for decoy cells and quantitative real-time blood polymerase chain reaction (PCR) for the BK virus (BKV) were performed on all the study patients. Renal biopsy was performed only in patients with deteriorating renal function associated with positive urine cytology. Patients who showed positive urine cytology for decoy cells and/or positive quantitative BKV PCR assay were followed-up for six months. During follow-up, the serum creatinine level, with or without urine cytology for decoy cells, and BKV PCR viral load assay were performed. Among the 75 kidney transplant recipients studied, eight were positive for decoy cells (11%), three showed viremia by quantitative PCR for BKV (4.1%), while two others showed nephropathy (2.7%) in the form of tubulointerstitial nephritis with intra-nuclear inclusions in the tubular cells. Cases with stable renal function and positive decoy cells or viremia cleared the virus spontaneously during follow-up without any intervention. Only one case with biopsyproven nephropathy and deteriorating graft function, with undetectable BKV in blood, lost the graft while another case with viremia died during follow-up due to septicemia. Our study suggests that polyoma virus should be considered as a cause of nephropathy in renal transplant recipients. Further research is required to understand this entity better.

Relation of middle molecules levels and oxidative stress to erythropoietin requirements in high-flux versus low-flux hemodialysis.

The objective of this study is to investigate the serum beta-2-microglobulin (B2MG) and advanced oxidation protein products (AOPP) as middle molecule uremic toxins and protein carbonyl (PCO) as oxidative stress marker in uremic patients undergoing high-flux versus low-flux hemodialysis (HD) and to correlate their levels to the erythropoietin requirements for those patients. Twenty patients on chronic low-flux HD were recruited in the study. At the start of the study, all patients underwent high-flux HD for eight weeks, followed by low-flux HD for two weeks as a washout period. The patients were then subjected to another eight weeks of low-flux HD. Blood samples were obtained at the beginning and at the end of the high-flux period and the low-flux period. The mean erythropoietin dose for patients using high-flux HD was significantly lower than that for low-flux HD (P = 0.0062). Post-high flux, the B2MG and PCO levels were significantly lower than the pre-high-flux levels (P = 0.026 and 0.0005, respectively), but no significant change was observed in AOPP (P = 0.68). Post-low flux, the B2MG, AOPP and PCO were significantly higher than the pre-low-flux levels (P = 0.0002, 0.021 and <0.0001, respectively). Post-low flux, the B2MG and PCO were significantly higher than the post-high-flux levels (P <0.0001), but no significant difference was observed in AOPP (P = 0.11). High-flux HD results in reduction of some of the middle molecule toxins and PCO levels better than low-flux HD, and is associated with a better response to erythropoietin.

Fasting the month of Ramadan by Muslims: could it be injurious to their kidneys?

Ramadan is the ninth lunar month of the Islamic calendar. During Ramadan, Muslims abstain from food and drink from dawn to sunset (fasting) to express their gratitude to God; eating and drinking is permitted only at night. Muslims typically consume two meals each day, one after sunset, and the other just before dawn. The effect of fasting during the month of Ramadan on patients with renal impairment is still a matter of controversy. This is a prospective study performed on 15 predialysis chronic kidney disease (CKD) patients and six healthy volunteers as control. They were studied during two phases: when the subjects were drinking and eating freely before the start of Ramadan, and a second phase toward the end of Ramadan. We estimated glomerular filtration rate (GFR) using DTPA dynamic renal scan, and tubular cell damage by measuring the level of N-acetyl-B-D- glucosaminidase (NAG). The change in glomerular filtration rate was -6.56 +/- 31.10 in the CKD group compared to 9.58 +/- 30.10 in the control group with no significant difference between them (p= 0.43). However, the urinary NAG percentage change was found to be significantly higher in the CKD patients compared to the control group (236 +/- 332, -49.1 +/- 60.1 respectively p= 0.03). There was a significantly positive correlation between the NAG values and the change in the blood glucose level (p=0.001), hence diabetic CKD patients should be meticulously followed during Ramadan fasting. In conclusion, fasting Ramadan may have injurious effect on the renal tubules in CKD patients. Larger studies are recommended to determine the extent of tubular injury and renal function in CKD patients during Ramadan fasting.

Application of adult worm and lung-stage antigens to immunize against Schistosoma mansoni using cytokines as adjuvants.

Different Schistosoma mansoni antigens; adult worm antigen (SWAP) and lung-stage antigen (SLAP) together with different cytokine adjuvants (Interferon-gamma and Interleukin-4) were used to immunize mice against. S. mansoni. Immunization program was directed towards the production of an intense immune response together with balanced T-helper1 and T-helper2 immune responses. The goal of immunization was not only to protect from infection but also to modulate the pathology inflicted by the parasite. Parameters like adult load, egg counts, anti-Schistosoma antibody titers and liver pathology were used to evaluate the different immunization scheme. SLAP antigen has proven to be a better antigen not only in protection but also in pathology modulation. SLAP plus IFN-gamma as an adjuvant was the best immunization regimen with almost 50% protection and a remarkable resolving of parasite pathology. Unexpectedly, IL-4 had a weak but observed adjuvant protective effect. The results is a step in the path for a Schistosoma vaccine that guides the immune system towards a balanced response targeting the pathology induced by the parasite rather than the parasite itself.

Molecular characterization of Egyptian Giardia lamblia isolates.

Six Giardia lamblia strains (4 from Egypt, one from the USA and one from Sudan) were used to study the phenotypic and genotypic variation in some Egyptian G. lamblia strains compared to other G. lamblia strains, which may be responsible for the difference in their behavioral characteristics. By using SDS-PAGE for antigenic study, E1 strain appeared different from the rest of the strains with two bands; one at 121 Kda and the other at 34 Kda which were not present in other strains, while bands at 130 and 43 Kda were present in all strains but absent in E1 strain. Another difference between E1 strain and the rest of the strains was obtained by CAE, using PGM enzyme where E1 strain gave a different zymodeme than the other strains. Based on the computerized RAPD- PCR analysis, 4 rapdemes were identified; rapdeme 1 contained E1 strain, rapdeme 2 contained E2, E3 and E4 isolates, rapdeme 3 contained Sudan strain and rapdeme 4 contained USA strain. In conclusion this study revealed diversity between G. lamblia strains especially E1 strain which showed unique characters.

Immunoblot analysis of Trichomonas vaginalis antigens recognized by rabbit hyperimmune serum raised against exoantignes.

The SDS-PAGE and immunoblot were used to identify Trichomonas vaginalis antigenic epitopes present in purified somatic and exo-antigens. The presence of common immunogenic proteins corresponding to molecular weights of 76, 60 and 23 kDa was revealed. Distinctive immunogenic bands of 92, 72, 55 and 40 kDa for the exo-antigens, and of 110, 80, 78 and 50 kDa for the somatic antigens, appeared when the antigens were probed by the homologous immune rabbit serum.

Characterization of three types of Schistosoma mansoni soluble egg antigen and determination of their immunodiagnostic potential by western blot immunoassay.

On the search of highly sensitive and specific antigenic components for use in serological tests, the serologic activities of the various protein fractions of three types of Schistosoma mansoni soluble egg antigen (SEA) were compared in an immunoblot analysis for their ability to detect schistosomiasis mansoni infections . Three types of soluble egg antigen (SEA) were prepared from three suspensions of Schistosoma mansoni eggs; namely living SEA (L-SEA), dead SEA (D-SEA) and mixed SEA (M-SEA). The three antigens were resolved by sodium dodecyl sulphate polyacrylamide gel electrophoresis. A total of 80 Egyptian individuals were enrolled in the present study. After being screened by clinical examination, urine and stool analysis, sigmoidoscopy rectal snip examination, abdominal ultrasonography and indirect haemagglutination test (IHAT), the study population were grouped into an active intestinal schistosomiasis group (group I, n=20), a schistosomiasis seropositive group by IHA test (group II, n=20), a parasite control group including 10 patients with hydatidosis & 10 patients with fascioliasis (group III, n = 20) and a normal control group (group IV, n=20). Sera of all subjects were studied by immunoblotting for the presence of IgG antibodies against the various protein fractions of the three prepared types of SEA. Several protein bands from the 3 types of SEA reacted with the schistosomiasis patients' sera in a heterogenous manner. However, a 31-32 kilo daltons (kDa) protein fraction of L-SEA reacted with 80% (16/20) of group I sera, 40% (8/20) of group II sera, one hydatidosis serum, but no reaction occurred with normal sera. Also, in the active intestinal schistosomiasis group, the 31-32 kDa fraction of L-SEA was more recognized by patients with early active intestinal schistosomiasis without organomegaly (100%, 12/12) than in those with organomegaly (50%, 4/8) (P < 0.05). On the other hand, a 80-82 kDa band of M-SEA was recognized by 70% (14/20) of group 1, 30% (6/20) of group II & sera from 3 hydatidosis and 2 fascioliasis cases, but not by normal human sera. So, it can be concluded that the 31-32 kDa protein fraction of L-SEA is highly immunogenic, with the least cross reaction with other parasitic infections, and may be a useful serologic marker for diagnosing and differentiating between early and chronic schistosomiasis mansoni infection.

A preliminary study on the relationship between Trichomonas vaginalis and cervical cancer in Egyptian women.

The relationship between Trichomonas vaginalis and cancer cervix was investigated by detection of T. vaginalis antibodies, in the sera of 48 invasive cervical cancer patients and 100 random age matched female control, using western immunoblot technique. It was found that antibodies to T. vaginalis were detected in sera of 18.75% (9/48) of cervical cancer patients compared with 5% (5/100) of controls. The increase was evident in age group, 40-49 years (21.05% vs 5%) and of those with squamous cell carcinoma (6/9) and mainly with grade II & III. All the reactive sera of invasive cancer patients reacted strongly with T. vaginalis surface antigen of about (109.9, 86.1, 56.2, 48.2 and 30 Kda). So, there may be an association between T. vaginalis and the risk of cervical cancer, as there was more than 3 fold increase in the prevalence of T. vaginalis antibodies in patients with invasive cervical cancer compared to age matched female controls. This study highlights the importance of clinically detection of T. vaginalis infection, which is one of the group of factors involved in the genesis and progression of cervical cancer. In addition, its treatment would aid in restricting the rising incidence of this dreaded disease.

Effect of schistosoma mansoni egg deposition on multiple low doses streptozotocin induced insulin dependent diabetes.

To explore the role of Schistosoma mansoni infection in the prevention of autoimmune mediated insulin dependant diabetes mellitus, we examined the effects of multiple low doses of the pancreatic islets beta cell toxin, streptozotocin (STZ) 40mg/kg body weight i.p., given 8 weeks post infection, period of S. mansoni egg deposition, on S. mansoni infected C57BL/6J mice, in comparison to non-infected STZ given group. Mice treated with STZ (G III) became gradually hyperglycemic reaching highest level on days 17 post STZ with mean blood glucose level of 334.9 +/- 14.9 vs 130.3 +/- 9.2 mg/dl in control group (G IV). S. mansoni infection (G II) significantly reduced the elevation in blood glucose levels from days 7 post STZ onwards reaching 224mg/dl +/- 12.7 on days 17 (P < .0.001). Morphologic examination of pancreas on day 21 post STZ, revealed that the non-infected STZ (G III) given mice had significantly smaller mean islets area (5,060.51 mu2 +/- 1,567.28) and significantly fewer mean number of beta cells/islets (76.23 +/- 19.18) than the infected STZ given group (G II) which had mean islets area (9,305. 3l mu2 +/- 3,277.59) and 116.75 +/- 27.27 beta-cells/islets. Pancreatic tissue revealed also focal degeneration in the cells of islets of Langrhans in the non-infected STZ given mice (G III), in comparison, to the infected STZ given group (G II). which had much less evident cells degeneration. These findings revealed that S. mansoni egg deposition which leads to a shift from Th1 (IFN-gamma mainly) to Th2 (IL4, IL5, IL10 and TGF-beta cytokine profiles causes down-regulation of the Th1 cell mediated autoimmune insulin dependant diabetes mellitus (IDDM). On the other hand, S. mansoni eggs excretions were significantly lower in the infected STZ given group (G II) than the infected group (G I). This finding may be the result of impaired maturation of egg in diabetic mice. It is concluded that the modulation of immune response in S. mansoni infected mice with S. mansoni egg deposition, can suppress the autoimmune type 1 insulin dependant diabetes mellitus induced by multiple low doses streptozotocin.