[Statins: hepatotoxicity and monitoring]. / Statines : quelle hépatotoxicité et quelle surveillance?

Statins are among the most widely prescribed drugs throughout the industrialized world. Their benefits in primary and secondary prevention of cardiovascular events are undeniable. An asymptomatic increase in aminotransferase levels, generally less than 3 times the upper limit of normal range, is often observed in patients receiving statins. It is dose-dependent and often regresses even though treatment continues. A significant increase in aminotransferase levels is very rare in patients receiving statins Cases of hepatocellular, cholestatic, and mixed pattern liver injuries have been described, but severe hepatitis is rare. Cases mimicking autoimmune hepatitis have been described. There is usually no cross hepatotoxicity between the different statins. When indicated, statins may be used in patients with nonalcoholic fatty liver, chronic viral hepatitis or compensated cirrhosis. Statins should not be used in patients with decompensated cirrhosis.

Candida albicans is an immunogen for anti-Saccharomyces cerevisiae antibody markers of Crohn's disease.

BACKGROUND AND AIMS: Antibodies directed against oligomannose sequences alpha-1,3 Man (alpha-1,2 Man alpha-1,2 Man)(n) (n = 1 or 2), termed anti-Saccharomyces cerevisiae antibodies (ASCAs) are markers of Crohn's disease (CD). S. cerevisiae mannan, which expresses these haptens, is used to detect ASCA, but the exact immunogen for ASCA is unknown. Structural and genetic studies have shown that Candida albicans produces mannosyltransferase enzymes that can synthesize S cerevisiae oligomannose sequences depending on growth conditions. This study investigated whether C. albicans could act as an immunogen for ASCA. METHODS: Sequential sera were collected from patients with CD, systemic candidiasis, and rabbits infected with C. albicans. Antibodies were purified by using chemically synthesized (Sigma) ASCA major epitopes. These affinity-purified antibodies and lectins were then used to analyze the expression of ASCA epitopes on molecular extracts and cell walls of C. albicans and S cerevisiae grown in various conditions. RESULTS: In humans and rabbits, generation of ASCA was shown to be associated with the generation of anti-C. albicans antibodies resulting specifically from infection. By using affinity-purified antibodies, C. albicans was shown to express ASCA epitopes on mannoproteins similar to those of S. cerevisiae. By changing the growth conditions, C. albicans mannan was also able to mimic S. cerevisiae mannan in its ability to detect ASCA associated with CD. This overexpression of ASCA epitopes was achieved when C. albicans grew in human tissues. CONCLUSIONS: C. albicans is one of several immunogens for ASCA and may be at the origin of an aberrant immune response in CD.

Pneumocystis jiroveci (carinii) pneumonia following initiation of infliximab and azathioprine therapy in a patient with Crohn's disease.

Anti-TNFalpha therapy is an effective treatment of Crohn's disease. There is an increased risk of infection, including atypical infection associated in infliximab treated patients. We report a case of a young man who developed Pneumocystisjiroveci pneumonia shortly after starting therapy with infliximab. Thus, although rare, prophylaxis against Pneumocystis jiroveci pneumonia might be considered when starting a treatment with infliximab, especially in patients receiving concomitant immunosuppressive agents.