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1.
Int J Colorectal Dis ; 26(8): 989-98, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21455745

RESUMO

PURPOSE: There is increasing evidence that a defect of the gastrointestinal mucosal barrier is important for the development of inflammatory bowel diseases (IBD). The hydrophobicity of the colonic mucosal surface is a measure of its resistance to luminal antigens, e.g. of bacterial origin. Therefore, the purpose of this study was to determine this parameter in patients suffering from IBD. METHODS: Nineteen patients with ulcerative colitis (UC), ten patients with Crohn's disease (CD) and 20 controls were examined. All underwent colonic surgery at the University Hospital Heidelberg. Clinical disease activity was determined. From every subject, colonic tissue specimens were obtained, and hydrophobicity of the mucosal surface was determined with a goniometer by multiple plateau contact angle measurements. Histological evaluation of disease activity was performed in directly adjacent tissue specimens. RESULTS: Hydrophobicity of the colonic mucosal surface, expressed as plateau contact angles, was significantly reduced in patients with UC (mean ± SEM, 47.8° ± 3.4°) compared to those with CD (72.0° ± 5.2°) and controls (72.5° ± 5.6°; over-all P = 0.0004; UC versus controls, P < 0.001; UC versus CD, P < 0.05; CD versus controls, P > 0.05). Between mucosal hydrophobicity and clinical disease activity, as well as mucosal hydrophobicity and histological disease activity, no significant correlation was found. CONCLUSIONS: The results suggest a defective physicochemical barrier as an essential factor in the pathogenesis of UC, but not CD. The fact that no correlation was found between mucosal hydrophobicity and disease activity may indicate that the loss of mucosal hydrophobicity in UC is not exclusively a secondary effect due to inflammation.


Assuntos
Colite Ulcerativa/patologia , Colo/patologia , Interações Hidrofóbicas e Hidrofílicas , Mucosa Intestinal/patologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Doença de Crohn/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Propriedades de Superfície , Adulto Jovem
2.
Hum Mol Genet ; 17(19): 2967-77, 2008 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-18614545

RESUMO

Diarrhea predominant irritable bowel syndrome (IBS-D) is a complex disorder related to dysfunctions in the serotonergic system. As cis-regulatory variants can play a role in the etiology of complex conditions, we investigated the untranslated regions (UTRs) of the serotonin receptor type 3 subunit genes HTR3A and HTR3E. Mutation analysis was carried out in a pilot sample of 200 IBS patients and 100 healthy controls from the UK. The novel HTR3E 3'-UTR variant c.*76G>A (rs62625044) was associated with female IBS-D (P = 0.033, OR = 8.53). This association was confirmed in a replication study, including 119 IBS-D patients and 195 controls from Germany (P = 0.0046, OR = 4.92). Pooled analysis resulted in a highly significant association of c.*76G>A with female IBS-D (P = 0.0002, OR = 5.39). In a reporter assay, c.*76G>A affected binding of miR-510 to the HTR3E 3'-UTR and caused elevated luciferase expression. HTR3E and miR-510 co-localize in enterocytes of the gut epithelium as shown by in situ hybridization and RT-PCR. This is the first example indicating micro RNA-related expression regulation of a serotonin receptor gene with a cis-regulatory variant affecting this regulation and appearing to be associated with female IBS-D.


Assuntos
Diarreia/genética , Síndrome do Intestino Irritável/genética , MicroRNAs/genética , Receptores de Serotonina/genética , Regiões 3' não Traduzidas/genética , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Linhagem Celular , Estudos de Coortes , Diarreia/metabolismo , Feminino , Expressão Gênica , Alemanha , Humanos , Mucosa Intestinal , Síndrome do Intestino Irritável/metabolismo , Masculino , Pessoa de Meia-Idade , Mutação , Receptores de Serotonina/metabolismo , Receptores 5-HT3 de Serotonina , Especificidade da Espécie , Reino Unido
3.
Eur J Immunol ; 39(3): 833-42, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19189310

RESUMO

Deleted in malignant brain tumors 1 (DMBT1) is a secreted glycoprotein displaying a broad bacterial-binding spectrum. Recent functional and genetic studies linked DMBT1 to the suppression of LPS-induced TLR4-mediated NF-kappaB activation and to the pathogenesis of Crohn's disease. Here, we aimed at unraveling the molecular basis of its function in mucosal protection and of its broad pathogen-binding specificity. We report that DMBT1 directly interacts with dextran sulfate sodium (DSS) and carrageenan, a structurally similar sulfated polysaccharide, which is used as a texturizer and thickener in human dietary products. However, binding of DMBT1 does not reduce the cytotoxic effects of these agents to intestinal epithelial cells in vitro. DSS and carrageenan compete for DMBT1-mediated bacterial aggregation via interaction with its bacterial-recognition motif. Competition and ELISA studies identify poly-sulfated and poly-phosphorylated structures as ligands for this recognition motif, such as heparansulfate, LPS, and lipoteichoic acid. Dose-response studies in Dmbt1(-/-) and Dmbt1(+/+) mice utilizing the DSS-induced colitis model demonstrate a differential response only to low but not to high DSS doses. We propose that DMBT1 functions as pattern-recognition molecule for poly-sulfated and poly-phosphorylated ligands providing a molecular basis for its broad bacterial-binding specificity and its inhibitory effects on LPS-induced TLR4-mediated NF-kappaB activation.


Assuntos
Carragenina/imunologia , Sulfato de Dextrana/imunologia , Receptores de Superfície Celular/imunologia , Bactérias/imunologia , Bactérias/metabolismo , Proteínas de Ligação ao Cálcio , Carragenina/farmacologia , Carragenina/toxicidade , Linhagem Celular , Proteínas de Ligação a DNA , Sulfato de Dextrana/farmacologia , Sulfato de Dextrana/toxicidade , Células Epiteliais/imunologia , Células Epiteliais/metabolismo , Células Epiteliais/microbiologia , Humanos , Mucosa Intestinal/metabolismo , Intestinos/imunologia , Intestinos/microbiologia , Ligantes , Fosfatos/imunologia , Fosfatos/metabolismo , Receptores de Superfície Celular/antagonistas & inibidores , Receptores de Superfície Celular/genética , Receptores de Superfície Celular/metabolismo , Proteínas Supressoras de Tumor
4.
J Clin Gastroenterol ; 44(5): e101-7, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20048683

RESUMO

BACKGROUND: In 2 preceding studies, delayed release phosphatidylcholine (rPC) was found to (a) improve disease activity and (b) withdraw steroids in patients with chronic-active ulcerative colitis. GOAL: Objective of the study was to determine the most effective rPC dose with least adverse events. STUDY: A randomized, dose-controlled, double-blinded study. Four groups of 10 patients each with nonsteroid-treated, chronic-active ulcerative pancolitis with a clinical activity index (CAI) and endoscopic activity index (EAI) >or=7. Patients were treated with oral rPC at doses of 0.5, 1, 3, and 4 g daily over 12 weeks. RESULTS: The CAI changes from baseline to the end of the study were 2.5 (0.5 g), 7.0 (1 g), 5.5 (3 g), and 6.0 (4 g dose arm). Significant improvement of the CAI was registered between the lowest rPC dose of 0.5 g (control group) and all higher doses of 1.0, 3.0, and 4.0-g rPC (Por=50% CAI improvement) were 70% in all of the effective dose groups (1 to 4 g, P=0.003). This was paralleled by the EAI improvement and by the rates of mucosal healing. Median time to clinical response was 5 (IQR 2 to 8) weeks. Bloating was registered in 40% of the patients irrespective of the treatment dose. Three of the 10 patients in the 4 g dose group reported nausea. CONCLUSION: We found a saturable dose response of rPC in the treatment of chronic-active ulcerative colitis with effective doses >or=1 g per day; doses of 3 and 4 g seem to be superior in achieving remission.


Assuntos
Colite Ulcerativa/tratamento farmacológico , Fosfatidilcolinas/uso terapêutico , Adulto , Doença Crônica , Colite Ulcerativa/fisiopatologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Fosfatidilcolinas/administração & dosagem , Fosfatidilcolinas/efeitos adversos , Indução de Remissão/métodos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
5.
Clin Cancer Res ; 15(2): 650-9, 2009 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-19147771

RESUMO

PURPOSE: The death ligand tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and its receptors (TRAIL-R) are involved in immune surveillance and tumor development. Here, we studied a possible association between the expression of TRAIL/TRAIL-Rs and the prognosis in patients with renal cell carcinomas (RCC). EXPERIMENTAL DESIGN: A tissue microarray containing RCC tumor tissue samples and corresponding normal tissue samples from 838 patients was generated. Expression of TRAIL and TRAIL-Rs was examined by immunohistochemistry and the effect of TRAIL and TRAIL-R expression on disease-specific survival was assessed. RESULTS: High TRAIL-R2 expression levels were associated with high-grade RCCs (P < 0.001) and correlated negatively with disease-specific survival (P = 0.01). Similarly, high TRAIL expression was associated with a shorter disease-specific survival (P = 0.01). In contrast, low TRAIL-R4 expression was associated with high-stage RCCs (P < 0.001) as well as with the incidence of distant metastasis (P = 0.03) and correlated negatively with disease-specific survival (P = 0.02). In patients without distant metastasis, multivariate Cox regression analyses revealed that TRAIL-R2 and TRAIL are independent prognostic factors for cancer-specific survival (in addition to tumor extent, regional lymph node metastasis, grade of malignancy, and type of surgery). CONCLUSION: High TRAIL-R2, high TRAIL, and low TRAIL-R4 expression levels are associated with a worse disease-specific survival in patients with RCCs. Therefore, the assessment of TRAIL/TRAIL-R expression offers valuable prognostic information that could be used to select patients for adjuvant therapy studies. Moreover, our findings are of relevance for a potential experimental therapeutic administration of TRAIL-R agonists in patients with RCCs.


Assuntos
Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/metabolismo , Regulação Neoplásica da Expressão Gênica , Neoplasias Renais/diagnóstico , Neoplasias Renais/metabolismo , Receptores do Ligante Indutor de Apoptose Relacionado a TNF/metabolismo , Ligante Indutor de Apoptose Relacionado a TNF/metabolismo , Idoso , Feminino , Perfilação da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Sequência com Séries de Oligonucleotídeos , Prognóstico , Modelos de Riscos Proporcionais , Resultado do Tratamento
6.
Circulation ; 117(25): 3216-26, 2008 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-18574060

RESUMO

BACKGROUND: High-mobility group box-1 (HMGB1) is a nuclear factor released by necrotic cells and by activated immune cells. HMGB1 signals via members of the toll-like receptor family and the receptor for advanced glycation end products (RAGE). Although HMGB1 has been implicated in ischemia/reperfusion (I/R) injury of the liver and lung, its role in I/R injury of the heart remains unclear. METHODS AND RESULTS: Here, we demonstrate that HMGB1 acts as an early mediator of inflammation and organ damage in I/R injury of the heart. HMGB1 levels were already elevated 30 minutes after hypoxia in vitro and in ischemic injury of the heart in vivo. Treatment of mice with recombinant HMGB1 worsened I/R injury, whereas treatment with HMGB1 box A significantly reduced infarct size and markers of tissue damage. In addition, HMGB1 inhibition with recombinant HMGB1 box A suggested an involvement of the mitogen-activated protein kinases jun N-terminal kinase and extracellular signal-regulated kinase 1/2, as well as the nuclear transcription factor nuclear factor-kappaB in I/R injury. Interestingly, infarct size and markers of tissue damage were not affected by administration of recombinant HMGB1 or HMGB1 antagonists in RAGE(-/-) mice, which demonstrated significantly reduced damage in reperfused hearts compared with wild-type mice. Coincubation studies using recombinant HMGB1 in vitro induced an inflammatory response in isolated macrophages from wild-type mice but not in macrophages from RAGE(-/-) mice. CONCLUSIONS: HMGB1 plays a major role in the early event of I/R injury by binding to RAGE, resulting in the activation of proinflammatory pathways and enhanced myocardial injury. Therefore, blockage of HMGB1 might represent a novel therapeutic strategy in I/R injury.


Assuntos
Proteína HMGB1/metabolismo , Isquemia Miocárdica/metabolismo , Traumatismo por Reperfusão/prevenção & controle , Animais , Células Cultivadas , Ecocardiografia , Proteína HMGB1/antagonistas & inibidores , Proteína HMGB1/farmacologia , Imuno-Histoquímica , Macrófagos/efeitos dos fármacos , Macrófagos/imunologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Isquemia Miocárdica/tratamento farmacológico , Isquemia Miocárdica/patologia , Ligação Proteica , Receptor para Produtos Finais de Glicação Avançada , Receptores Imunológicos/genética , Receptores Imunológicos/metabolismo , Proteínas Recombinantes/farmacologia , Traumatismo por Reperfusão/imunologia , Traumatismo por Reperfusão/patologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Transdução de Sinais/imunologia , Regulação para Cima/efeitos dos fármacos
7.
Gastroenterology ; 134(1): 179-91, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18061179

RESUMO

BACKGROUND & AIMS: T-cell receptor reactivity of intestinal lamina propria T cells (LP-T) critically depends on the capacity of local accessory cells to secrete cysteine. For T cells, cysteine is the limiting precursor for glutathione synthesis, a prerequisite for antigen-dependent proliferation. We aimed to determine the role of the redoxactive microenvironment for hyporeactivity of LP-T in normal human gut vs hyperreactivity of LP-T in inflammatory bowel disease. METHODS: Parameters relevant to cysteine production, determined as acid-soluble thiol, by intestinal lamina propria macrophages (LP-MO) vs peripheral blood monocytes were investigated (L-[(35)S]cystine uptake via system x(c)(-), messenger RNA, and protein expression of the cystine transporter subunit xCT). Glutathione levels in LP-T and peripheral blood T cells were analyzed both spectrophotometrically and by immunofluorescent staining in situ and in vitro. RESULTS: LP-MO from normal gut, unlike peripheral blood monocytes, are unable to take up cystine, which is due to a deficient expression of the transporter xCT in situ and in vitro. As a consequence, LP-MO do not secrete cysteine. The glutathione content in LP-T from normal gut is <50% of that in autologous peripheral blood T cells. In contrast, in inflammatory bowel disease, CD14(+)CD68(+) LP-MO express xCT and secrete substantial amounts of cysteine upon stimulation, which results in high glutathione levels and full T-cell receptor reactivity in LP-T. CONCLUSIONS: The antioxidative microenvironment of LP-T in inflammatory bowel disease and the prooxidative microenvironment in normal gut explain the differential T-cell receptor reactivities.


Assuntos
Cisteína/metabolismo , Cistina/metabolismo , Imunidade nas Mucosas/fisiologia , Doenças Inflamatórias Intestinais/imunologia , Doenças Inflamatórias Intestinais/metabolismo , Mucosa Intestinal/metabolismo , Estudos de Casos e Controles , Técnicas de Cultura de Células , Cisteína/genética , Cistina/genética , Glutationa/metabolismo , Humanos , Doenças Inflamatórias Intestinais/patologia , Mucosa Intestinal/imunologia , Mucosa Intestinal/patologia , RNA Mensageiro/metabolismo , Linfócitos T/fisiologia
9.
Gastroenterology ; 133(5): 1499-509, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17983803

RESUMO

BACKGROUND & AIMS: Impaired mucosal defense plays an important role in the pathogenesis of Crohn's disease (CD), one of the main subtypes of inflammatory bowel disease (IBD). Deleted in malignant brain tumors 1 (DMBT1) is a secreted scavenger receptor cysteine-rich protein with predominant expression in the intestine and has been proposed to exert possible functions in regenerative processes and pathogen defense. Here, we aimed at analyzing the role of DMBT1 in IBD. METHODS: We studied DMBT1 expression in IBD and normal tissues by quantitative reverse transcription-polymerase chain reaction, immunohistochemistry, and mRNA in situ hybridization. Genetic polymorphisms within DMBT1 were analyzed in an Italian IBD case-control sample. Dmbt1(-/-) mice were generated, characterized, and analyzed for their susceptibility to dextran sulfate sodium-induced colitis. RESULTS: DMBT1 levels correlate with disease activity in inflamed IBD tissues. A highly significant fraction of the patients with IBD displayed up-regulation of DMBT1 specifically in the intestinal epithelial surface cells and Paneth cells. A deletion allele of DMBT1 with a reduced number of scavenger receptor cysteine-rich domain coding exons is associated with an increased risk of CD (P = .00056; odds ratio, 1.75) but not for ulcerative colitis. Dmbt1(-/-) mice display enhanced susceptibility to dextran sulfate sodium-induced colitis and elevated Tnf, Il6, and Nod2 expression levels during inflammation. CONCLUSIONS: DMBT1 may play a role in intestinal mucosal protection and prevention of inflammation. Impaired DMBT1 function may contribute to the pathogenesis of CD.


Assuntos
Doença de Crohn/genética , Doença de Crohn/fisiopatologia , Deleção de Genes , Mucosa Intestinal/fisiopatologia , Receptores de Superfície Celular/genética , Receptores de Superfície Celular/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Proteínas de Ligação ao Cálcio , Estudos de Casos e Controles , Criança , Doença de Crohn/induzido quimicamente , Proteínas de Ligação a DNA , Sulfato de Dextrana , Suscetibilidade a Doenças , Éxons/genética , Feminino , Humanos , Interleucina-6/metabolismo , Mucosa Intestinal/metabolismo , Mucosa Intestinal/patologia , Masculino , Camundongos , Camundongos Transgênicos , Pessoa de Meia-Idade , Mucinas/genética , Mucinas/fisiologia , Proteína Adaptadora de Sinalização NOD2/metabolismo , RNA Mensageiro/metabolismo , Fatores de Risco , Fator de Necrose Tumoral alfa/metabolismo , Proteínas Supressoras de Tumor , Regulação para Cima/genética
10.
BJU Int ; 102(11): 1700-6, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18990137

RESUMO

OBJECTIVES: To assess the protein expression of Livin, an apoptosis inhibitor, in renal cell carcinoma (RCC) and to determine its prognostic relevance. PATIENTS AND METHODS: Immunohistochemical staining for Livin was performed in tissue microarrays (TMAs), including tumour tissue cores, from patients with RCC who had undergone renal surgery. In 682 TMAs cytoplasmatic staining intensity and nuclear staining quantity were evaluated, and the association of Livin expression with progression-free survival (PFS) and cancer-specific survival (CSS) was analysed with a multivariate Cox regression model. RESULTS: Over a median (range) follow-up of 5.2 (0-16.1) years, 204 patients (28%) had died from their disease. The CSS rates at 1 and 5 years for the entire cohort was 88% and 71%. Cytoplasmatic Livin staining was absent in 516 (76%) specimens; staining was positive in 166 (24%) specimens. Weak nuclear Livin staining (25%) nuclear Livin expression was a favourable independent predictor of PFS and CSS even after adjusting for tumour stage, Fuhrman grade, age, sex and Karnofsky severity rating. Cytoplasmatic Livin expression did not offer additional prognostic information. CONCLUSION: High nuclear Livin expression is a favourable independent predictor of PFS and CSS in patients with RCC.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Biomarcadores Tumorais/metabolismo , Carcinoma de Células Renais/patologia , Proteínas Inibidoras de Apoptose/metabolismo , Neoplasias Renais/patologia , Proteínas de Neoplasias/metabolismo , Nefrectomia/métodos , Idoso , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/cirurgia , Estudos de Coortes , Feminino , Humanos , Neoplasias Renais/mortalidade , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Prospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
11.
Horm Res ; 70(4): 249-53, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18772599

RESUMO

AIM: We describe the clinical features of a 6-year-old boy with sexual precocity caused by a somatic activating mutation of the luteinizing hormone (LH) receptor gene preceding gonadotropin-releasing hormone (GnRH)-dependent sexual precocity. STUDY DESIGN: Genomic DNA was extracted from the right testis and from the peripheral leukocytes followed by DNA amplification and sequencing of the LH receptor gene. We described the clinical characteristics including anthropometric parameters, bone age, and endocrine evaluation when the boy presented with sexual precocity. These data were compared with the clinical and hormonal evaluation after orchiectomy preceding GnRH-dependent sexual precocity and after subsequent treatment with GnRH agonist. RESULTS: No mutation was found in the sequence of the LH receptor gene extracted from peripheral leukocytes. Interestingly, sequencing of the tumor LH receptor gene revealed a heterozygous mutation in exon 11 encoding a replacement of Asp(578)His. Despite normalization of plasma testosterone, true precocious puberty was triggered within a year. CONCLUSIONS: Inmales with GnRH-independent sexual precocity the presence of small testicular Leydig cell tumorous lesions harboring a somatic mutation of the LH receptor gene should be considered. A close follow-up of affected patients should be instigated in order to monitor recurrence or subsequent true precocity.


Assuntos
Tumor de Células de Leydig/genética , Mutação de Sentido Incorreto , Proteínas de Neoplasias/genética , Puberdade Precoce/genética , Receptores do LH/genética , Neoplasias Testiculares/genética , Substituição de Aminoácidos , Criança , Éxons/genética , Hormônio Liberador de Gonadotropina/sangue , Heterozigoto , Humanos , Tumor de Células de Leydig/sangue , Tumor de Células de Leydig/fisiopatologia , Masculino , Proteínas de Neoplasias/metabolismo , Puberdade Precoce/sangue , Puberdade Precoce/fisiopatologia , Receptores do LH/metabolismo , Neoplasias Testiculares/sangue , Neoplasias Testiculares/fisiopatologia
12.
Ann Intern Med ; 147(9): 603-10, 2007 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-17975182

RESUMO

BACKGROUND: Although long-term steroid treatment is discouraged in ulcerative colitis, alternatives are lacking when therapy with immunosuppressant drugs fails. An insufficient level of phosphatidylcholine in colonic mucus is a possible pathogenetic factor for ulcerative colitis. OBJECTIVE: To see whether steroid withdrawal is easier with retarded-release phosphatidylcholine or placebo in adults with chronic steroid-refractory ulcerative colitis. DESIGN: Randomized, double-blind, placebo-controlled trial conducted from March 2003 to January 2006. SETTING: University Hospital Heidelberg, a referral center for inflammatory bowel disease. PATIENTS: 60 patients with chronic steroid-refractory ulcerative colitis and high clinical and endoscopic disease activity indexes (score > or =5). INTERVENTION: Phosphatidylcholine or cellulose placebo was ingested 4 times daily for 12 weeks for a total dosage of 2 g/d. The follow-up rate was 97%. MEASUREMENTS: The number of patients achieving complete steroid withdrawal and either a low clinical activity index (< or =3) or improvement in the clinical activity index of 50% or more. RESULTS: The primary end point was achieved in 15 of 30 (50%) phosphatidylcholine recipients and in 3 of 30 (10%) placebo recipients (difference, 40% [95% CI, 19% to 61%]; P = 0.002). Twenty-four phosphatidylcholine recipients (80%) and 3 (10%) placebo recipients discontinued steroid therapy without disease exacerbation (difference, 70% [CI, 52% to 88%]; P <0.001). Mild bloating was a common adverse event. LIMITATIONS: The sample size was small, and the study was of short duration. CONCLUSION: Phosphatidylcholine reduced corticosteroid dependence more than placebo in patients with chronic steroid-refractory ulcerative colitis. The next step is long-term trials to evaluate the sustainability of steroid withdrawal in these patients. ClinicalTrials.gov registration number: NCT00259545.


Assuntos
Corticosteroides/administração & dosagem , Colite Ulcerativa/tratamento farmacológico , Fosfatidilcolinas/administração & dosagem , Corticosteroides/efeitos adversos , Adulto , Colite Ulcerativa/metabolismo , Colite Ulcerativa/patologia , Preparações de Ação Retardada , Método Duplo-Cego , Endoscopia Gastrointestinal , Feminino , Seguimentos , Humanos , Mucosa Intestinal/metabolismo , Masculino , Muco/metabolismo , Fosfatidilcolinas/efeitos adversos , Fosfatidilcolinas/farmacocinética , Qualidade de Vida , Tamanho da Amostra , Resultado do Tratamento
13.
Virchows Arch ; 450(6): 713-7, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17487505

RESUMO

The vascular type of Ehlers-Danlos syndrome (type IV) is an infrequent disease caused by heterozygous germline mutations in the procollagen 3A gene (COL3A1). Clinical signs include characteristic facial features, easy bruising, and a translucent skin. These signs are less obvious than the hyperflexibility of skin and joints seen in other types of Ehlers-Danlos syndrome. Therefore, diagnosis of Ehlers-Danlos syndrome type IV is usually not considered until complications have occurred. Complications include spontaneous ruptures of vessels and hollow organs, particularly the colon. We, herein, report pathologic findings in colon specimens from related Ehlers-Danlos syndrome type IV patients. Thorough examination revealed abnormalities of the large bowel architecture including abrupt changes in the caliber of the lamina muscularis, secondary diverticula formation, and strongly reduced expression of abnormal collagen 3. These findings are not seen in other diseases of the colon and should prompt the pathologist to include Ehlers-Danlos syndrome type IV in the differential diagnosis of spontaneous bowel perforation in younger patients.


Assuntos
Colo/patologia , Síndrome de Ehlers-Danlos/classificação , Síndrome de Ehlers-Danlos/patologia , Adulto , Colágeno Tipo III/metabolismo , Colo/metabolismo , Doenças do Colo/etiologia , Doenças do Colo/patologia , Diagnóstico Diferencial , Divertículo/etiologia , Divertículo/patologia , Síndrome de Ehlers-Danlos/complicações , Síndrome de Ehlers-Danlos/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Perfuração Intestinal/diagnóstico , Masculino , Microscopia Eletrônica
14.
Eur J Gastroenterol Hepatol ; 19(5): 399-400, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17413291

RESUMO

This leading article refers to the paper by Meier-Ruge WA, Muller-Lobeck H, Stoss F, Bruder E. The pathogenesis of idiopathic megacolon. Eur J Gastroenterol Hepatol 2006; 18:1209-1215. We apologise to all concerned for the dissociation between the two papers, which was due to an administrative error. The pathogenesis of idiopathic megacolon is still unclear. Besides abnormalities of the enteric nervous system, alterations in the function of intestinal smooth muscle cells and connective tissue elements might play an important role. A permanent extension of the bowel diameter without concrete hints to its aetiology is termed idiopathic megacolon. Evidence exists that idiopathic megacolon comprises a heterogeneous group of conditions characterized by alterations of the enteric nervous system, smooth muscle cells and/or connective tissue. Innovative molecular techniques are needed to get further insights into the pathogenesis of these intestinal motility disorders.


Assuntos
Megacolo/fisiopatologia , Tecido Conjuntivo/fisiopatologia , Sistema Nervoso Entérico/fisiopatologia , Motilidade Gastrointestinal , Humanos , Intestinos/fisiopatologia , Megacolo/etiologia , Músculo Liso/fisiopatologia
15.
World J Gastroenterol ; 13(11): 1687-95, 2007 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-17461471

RESUMO

AIM: To study susceptibility genes which may play a potential role in the pathogenesis and etiology of inflammatory bowel disease (IBD). METHODS: To identify potential susceptibility genes we performed global gene expression profiling in patients with IBD and control specimens. For determination of an intrinsic gene expression profile in ulcerative colitis (UC) and Crohn's disease (CD) compared to normal subjects, mucosal biopsies of non-inflamed regions of the colon and the terminal ileum were subjected to DNA microarray analysis. Real-time RT-PCR and immunohistochemistry were used for verification of selected regulated candidate genes and a genetic analysis was performed. RESULTS: We could show that aquaporin-8 (AQP8) mRNA and protein levels were significantly increased in the colon of UC patients compared to controls. Genetic analysis of the six exons and the promoter region of AQP8, however, revealed no mutations or polymorphisms in IBD patients. CONCLUSION: Our results suggest that upregulation of AQP8 in the colon of UC patients represents a secondary phenomenon which may, due to altered water exchange of the distal intestinal mucosa, disturb the physiologic colonic mucus barrier and thus lead to chronic inflammation and ulceration.


Assuntos
Aquaporinas/metabolismo , Colite Ulcerativa/metabolismo , Colo/metabolismo , Íleo/metabolismo , Adulto , Aquaporinas/genética , Biópsia , Estudos de Casos e Controles , Colite Ulcerativa/etiologia , Colo/patologia , Suscetibilidade a Doenças/metabolismo , Suscetibilidade a Doenças/patologia , Feminino , Regulação da Expressão Gênica , Humanos , Íleo/patologia , Mucosa Intestinal/metabolismo , Mucosa Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Análise de Sequência com Séries de Oligonucleotídeos , RNA Mensageiro/genética , RNA Mensageiro/metabolismo
16.
Langenbecks Arch Surg ; 392(5): 567-71, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17636321

RESUMO

BACKGROUND AND AIMS: Low anterior resection and abdominoperineal resection with total mesorectal excision are the standard treatment in patients with low rectal cancer. Rectal resection remains a surgical intervention with considerable morbidity and long-term impairment of quality of life. Local excision of low rectal cancer is regarded as an alternative to radical surgery; however, occurrence of lymph node metastasis even in patients with highly differentiated early-stage rectal cancer may be underestimated. PATIENTS AND RESULTS: In two patients with T1 rectal cancer, minimal-invasive partial excision of the mesorectum was performed after transanal excision of the tumor. The postoperative course was uneventful in both patients. Patients left the hospital on the fourth and fifth postoperative day without any complaints. In one patient, histo-pathological workup revealed a lymph node metastasis in the specimen. DISCUSSION: The technique of "Endoscopic posterior mesorectal resection" represents an interesting option in the surgical treatment of rectal cancer, as it allows for the first time an organ preserving resection of local lymph nodes in the small pelvis. It may evolve as an efficient new staging procedure to identify patients with metastatic disease who may benefit from multimodal treatment or extended surgery.


Assuntos
Adenocarcinoma/cirurgia , Endoscopia , Excisão de Linfonodo , Procedimentos Cirúrgicos Minimamente Invasivos , Proctoscopia , Neoplasias Retais/cirurgia , Adenocarcinoma/patologia , Idoso , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias Retais/patologia , Reto/patologia , Reto/cirurgia , Reoperação
17.
Hepatogastroenterology ; 54(74): 643-8, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17523341

RESUMO

BACKGROUND/AIMS: Severe gastric inflammation or ulcer disease can alter gastric motility and influence sufficient glycemic control in patients with type 2 diabetes mellitus. However, visceral neuropathy may reduce the perception of typical gastrointestinal symptoms in these patients. The aim of the present study was to evaluate the prevalence of silent severe acute gastritis, gastric ulcers or erosions in asymptomatic patients with diabetes mellitus and to determine potential predictive parameters. METHODOLOGY: Seventy-two patients with type 2 diabetes mellitus and little or no dyspeptic symptoms were investigated by endoscopy of the upper gastrointestinal tract under screening conditions. Before endoscopy the presence of gastrointestinal symptoms and standard laboratory parameters were determined. In addition, the presence of Helicobacter pylori infection was investigated by rapid urease test and histology. RESULTS: Highly active gastric inflammation was found in 34 patients (gastric ulcers in 10, gastric erosions in 21, and histologically acute, grade two or three gastritis in 3 patients). Episodic heartburn was significantly associated with highly active gastric inflammation (odds ratio 2.96 (1.05-8.32), p = 0.036). Elevated levels of C-reactive-protein and blood leukocyte counts proved to be of positive predictive value for highly active gastric inflammation in patients without other causes of acute inflammatory diseases (odds ratio 3.52 (p = 0.026) and 7.64 (p = 0.007) respectively). No significant association was found for gender, age, duration of disease, BMI, considerably raised HbA1c (>8.5%), complications of diabetic disease, general gastrointestinal symptoms, Helicobacter pylori infections and therapy with acetylsalicylic acid on 100 mg/d. CONCLUSIONS: The results of this study indicate that severe acute gastric inflammation or ulcer disease can occur with high prevalence in patients with diabetes mellitus with little or no dyspeptic symptoms. Additional endoscopic investigations might be of particular diagnostic value in patients with inexplicable raised levels of inflammatory parameters like C-reactive-protein or blood leukocyte counts.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Gastrite/epidemiologia , Úlcera Gástrica/epidemiologia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Testes Respiratórios , Proteína C-Reativa/metabolismo , Comorbidade , Estudos Transversais , Neuropatias Diabéticas/epidemiologia , Endoscopia do Sistema Digestório , Feminino , Alemanha , Azia/epidemiologia , Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Humanos , Contagem de Leucócitos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estudos Prospectivos , Estatística como Assunto
18.
J Histochem Cytochem ; 54(2): 161-9, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16087702

RESUMO

Gata-3 has been shown to specifically alter its expression patterns in different types of cancers. Recent evidence suggests that an interference of Gata-3 exists in the TGF-beta signaling pathway. To determine the role of Gata-3 in pancreatic cancer, pancreatic cancer samples were analyzed in comparison to normal pancreatic tissues. Furthermore, four different pancreatic cancer cell lines with different alterations of the TGF-beta pathway were studied. To evaluate if a potential relationship with TGF-beta signaling pathway exists, we correlated mRNA expression levels with the expression of TGF-betas, TGF-beta receptors, and Smad-3. Finally, we analyzed the influence of TGF-beta on Gata-3 expression in vitro. All pancreatic cancer samples demonstrated a marked overexpression of Gata-3 mRNA and protein. Immunohistochemical staining revealed strong and persistent cytoplasmic Gata-3 immunoreactivity in cancer cells. In an electrophoretic mobility shift assay, a disturbed nuclear translocation was confirmed. The expression of Gata-3 showed a significant correlation with the expression of TGF-betas, TGF-beta receptors, and Smad-3. TGF-beta responsive cell lines showed a downregulation of Gata-3 mRNA upon TGF-beta exposure, whereas in TGF-beta-unresponsive cell lines, Gata-3 mRNA expression persisted at high levels. Furthermore, strong specific upregulation of Gata-3 impaired nuclear translocation and its cooperative action with the TGF-beta pathway, suggesting that Gata-3 plays a central role in human pancreatic cancer.


Assuntos
Fator de Transcrição GATA3/biossíntese , Neoplasias Pancreáticas/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Linhagem Celular Tumoral , Núcleo Celular/metabolismo , Citoplasma/metabolismo , Ensaio de Desvio de Mobilidade Eletroforética , Feminino , Fator de Transcrição GATA3/genética , Humanos , Imuno-Histoquímica , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pâncreas/metabolismo , Transporte Proteico , RNA Mensageiro/biossíntese , Transdução de Sinais , Fator de Crescimento Transformador beta/farmacologia , Fator de Crescimento Transformador beta/fisiologia , Regulação para Cima
19.
Inflamm Bowel Dis ; 12(6): 437-46, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16775487

RESUMO

BACKGROUND: CD4+CD25+ regulatory T cells have been shown to prevent immune-mediated colitis in mice; however, it is unclear whether the absence of CD4+CD25+ in the normal CD4+ T cell pool is responsible for the development of chronic colitis. Using the T cell-deficient Tgepsilon26 mouse model, we show that CD4+CD25- cells but not CD4+CD25+ cells induce a severe intestinal inflammation. Transfer of CD4+CD25+ cells, together with CD4+CD25- cells, ameliorated intestinal inflammation, and reconstitution with the whole mesenteric lymph node cell pool did not induce colitis in recipients. Transferred CD4+CD25- cells were found mainly in the mesenteric lymph nodes, where they showed an activated TH1-like phenotype. In the absence of regulatory CD4+CD25+ T cells, recipient CD4 cells secreted IFN-gamma in response to stimulation with intestinal bacterial antigen that was prevented in vivo and in vitro by regulatory CD4+CD25+ cells. These studies suggest that CD4+CD25- cells have a strong colitogenic effect in the Tgepsilon26 colitis model and that CD4+CD25+ cells may be the main regulators that prevent or downregulate the proinflammatory effect of colitogenic T cells in the Tgepsilon26 mouse model.


Assuntos
Linfócitos T CD4-Positivos/imunologia , Colite/imunologia , Tolerância Imunológica , Intestinos/imunologia , Receptores de Interleucina-2/análise , Subpopulações de Linfócitos T/imunologia , Animais , Linfócitos T CD4-Positivos/patologia , Doença Crônica , Colite/microbiologia , Colite/patologia , Modelos Animais de Doenças , Hospedeiro Imunocomprometido , Intestinos/microbiologia , Intestinos/patologia , Linfonodos/imunologia , Linfonodos/patologia , Depleção Linfocítica , Mesentério/imunologia , Mesentério/patologia , Camundongos , Baço/imunologia , Baço/patologia , Subpopulações de Linfócitos T/patologia
20.
Virchows Arch ; 448(5): 630-8, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16211391

RESUMO

Independent of the severity, phenotypes and clinical outcomes of myocardial infarction may vary considerably in patients, suggesting a strong genetic influence on healing and adaptive processes. Since little is known about these genetic determinants, we examined the tissue response to myocardial injury in seven inbred mouse strains, including those employed for gene targeting or transgenic overexpression. Myocardial necrosis was produced by non-ischemic, trans-diaphragmal freeze-thaw injury in strains C57BL/6, C3H/He, DBA/2, BALB/c, 129S1, FVB/n and A/J. Two days after injury, necrotic cardiomyocytes calcified in C3H/He, DBA/2, BALB/c and 129S1, a phenotype known as dystrophic cardiac calcinosis (DCC). The susceptibility to DCC of 129S1 was determined by Dyscalc1, a locus on chromosome 7, which was identified previously in C3H/He and DBA/2. DCC was also observed in C3H/He following ischemic injury by permanent coronary artery ligation, indicating that DCC was independent of the mode of injury. In contrast, strains C57BL/6, FVB and A/J were resistant to DCC, showing formation of a fibrous scar without calcification. The development of DCC was studied in detail in C3H/He and C57BL/6. In both strains, no calcium deposition and only little structural disintegration were noted in necrotic myocardium 24 h after injury upon calcium-sensitive fluorescence staining. Ultrastructural examination revealed calcified mitochondria in C3H/He that may have served later as a nidus for rapid intracellular calcification of cardiomyocytes. We concluded that the susceptibility to calcification of myocardial necrosis may be common among inbred strains and should be recognised as a strong genetic modifier of experimental myocardial injury.


Assuntos
Calcinose/genética , Calcinose/patologia , Traumatismos Cardíacos/genética , Camundongos/genética , Miocárdio/patologia , Animais , Feminino , Traumatismos Cardíacos/patologia , Microscopia Eletrônica de Transmissão , Necrose , Reação em Cadeia da Polimerase
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