Exposure to physical and psychological stressors elevates plasma interleukin 6: relationship to the activation of hypothalamic-pituitary-adrenal axis.

Interleukin 6 (IL-6) is a pleiotropic cytokine produced by the cells of immune and nonimmune origin. Increased production of IL-6 is associated with disturbances of homeostasis, such as trauma, sepsis, or inflammatory diseases. Endotoxemia, tissue injury, or immune inflammatory reactions as well as physical or psychological stress are known to cause increased production of IL-6. We have confirmed this by showing that rats exposed to electric footshock, physical restraint, or a conditioned aversive stimulus have increased levels of plasma IL-6. Interestingly, the kinetics of the increase in plasma IL-6 resembled that of increase in plasma corticosterone. As no detectable endotoxin was found in the plasma samples from stressed and nonstressed rats and there is no evidence of tissue damage and inflammation in situations of restraint or conditioned aversive stimulus, a nonimmune origin of IL-6 is possible. Thus, the releasing of IL-6 into plasma may be under the regulation of neural and endocrine responses to stress. This hypothesis is supported by the decreased production of IL-6 in cultures of splenic cells and peripheral blood mononuclear cells from stressed animals. Furthermore, substantial attenuation of increased plasma IL-6 was achieved by adrenalectomy but not by pretreatment with the beta-receptor antagonist propranolol. The important role of the adrenal gland in the IL-6 response to stress suggests that increased plasma IL-6 may be part of the hormonal responses to stress. As IL-6 induces acute-phase proteins along with glucocorticoids from the adrenal, and regulates the secretion of various hormones from neuroendocrine and endocrine tissues, it is possible that stress-induced increase in plasma IL-6 contributes to the maintenance of homeostasis.

Age-related alterations in inflammatory response during experimental autoimmune prostatitis.

Experimental autoimmune prostatitis (EAP) is an experimental model of autoimmune disease, developed in Wistar rats against prostatic components. The 12-and 18-month-old rats with EAP show a higher cellular autoimmune response and lower humoral autoimmune response compared to 3-month-old rats. The analysis of NO(.) and O(2)(-) production by peritoneal exudate cells (PECs) resulted in a higher NO(.) and O(2)(-) production in EAP rats at all ages, compared to control animals. PECs from 12- and 18-month-old rats produced more NO(.) and less O(2)(-) than PECs from 3-month-old rats. However, lipopolysacharide (LPS) did not stimulate PECs from aged rats for NO(.) production as much as in 3-month-old rats and thus, turning out in a lower index of LPS-stimulation of PECs from aged rats, compared to 3-month-old rats. Furthermore, the mast cells number in prostates of EAP rats, especially the number of degranulated cells, was higher than in control animals, but no significant differences were found between 3- and 12-month-old control rats. In conclusion, these results show that aging affects differentially the inflammation mediators during EAP.

DNA antibodies detected by microhemagglutination test in the diagnosis of systemic lupus erythematosus.

A method of tanned erythrocyte agglutination of wide applicability is described for the study of DNA antibodies. The practical aspects of the method have been explored in estimation of antibodies to DNA in human cases of systemic lupus erythematosus, discoid lupus erythematosus, rheumatoid arthritis, other collagenoses and not related diseases. This method was found to be of high sensitivity and specificity, detecting DNA antibodies only in sera of systemic lupus erythematosus. Results were compared with those obtained by immunofluorescence test using rat liver hepatocytes as source of nuclei.

Experimental autoimmune prostatitis (EAP): enhanced release of reactive oxygen intermediates (ROI) in peritoneal macrophages.

The metabolic state of peritoneal macrophages is defined quantitatively for spontaneous ROI release and compared with those produced after cell contact with phorbol myristate acetate (PMA) or zymosan (OZ) particles. Peritoneal exudate cells (PEC) from EAP animals spontaneously released significantly more ROI than cells from controls rats, indicating that mononuclear phagocytes from autoimmune rats were more activated than populations cells arising from rats injected with BSA, with CFA or non-injected. These findings could indicate an in vivo activation state in PEC from autoimmune rats different from that obtained with heterologous antigens or CFA immunization procedures. The release of ROI induced after in vitro stimulus was, in general, higher in cells from autoimmune than in BSA or CFA treated rats. This differential responsiveness between the MAG, BSA and CFA injected macrophage populations could indicate that during the autoimmune process the autoantigen/s could amplify the inflammatory response triggered by them. Although release of oxygen metabolites represents only one of many potential mechanisms of tissue injury, this together with the lesions observed in the prostate gland indicate that oxygen radicals could be involved in this autoimmune disease.

Activation of cytotoxic cells by syngeneic prostate antigens in experimental autoimmune vesiculo-prostatitis.

In our experimental model of autoimmune vesiculo-prostatitis, obtained by immunization with syngeneic male accessory glands (MAG) and complete Freund's adjuvant, the presence of specific autoreactive cells with cytotoxic activity against prostate antigens was studied. The specific cytotoxicity generated in MAG immunized rats was tested using 51Cr labelled syngeneic prostate cells or labelled chicken erythrocytes coated with specific antigens (MAG homogenate or chromatographic fractions from prostate homogenate) which were used as target cells in a medium free of complement. The addition of spleen sensitized cells to prostate cells suspension produced a significant release of 51Cr in regard to normal effector cells (11.87 +/- SE 1.12 versus 1.5 +/- 0.75). Similar results were obtained when MAG-coated erythrocytes were used as target cells (10.87 +/- SE 0.62 versus 1.50 +/- 0.25). Depletion of T but no B or adherent-cells was shown to abolish the lytic effect indicating that MAG immunization provides determinants which are recognized by sensitized T-cells on cells of the prostate gland where the most severe tissue alterations were previously observed. Erythrocytes coated with chromatographic fractions obtained from prostate homogenate were used to identify the antigens triggering the lytic effect. It was demonstrated that two fractions (FI and FII) functioned as in vivo sensitizing antigens as well as in vitro activating antigens for themselves. The restimulation in vitro of sensitized cells with purified prostate fractions induces an additional lytic effect suggesting that an expansion of effector cells may take place after contacting the antigens at the prostate site.(ABSTRACT TRUNCATED AT 250 WORDS)

Tear and serum soluble leukocyte activation markers in conjunctival allergic diseases.

PURPOSE: To measure markers of leukocyte activation in patients with an exclusively ocular inflammatory or bacterial disease. METHODS: Neutrophil myeloperoxidase, eosinophil cationic protein, eosinophil neurotoxin, and soluble interleukin-2 receptor were measured in serum and tears of 17 patients with allergic vernal keratoconjunctivitis, seven with atopic keratoconjunctivitis, 11 with seasonal allergic conjunctivitis, seven with giant papillary conjunctivitis, 13 with rosacea blepharokeratoconjunctivitis, seven with bacterial conjunctivitis, and 13 normal subjects as controls. RESULTS: In serum of patients with vernal and atopic keratoconjunctivitis, levels of eosinophil cationic protein, eosinophil neurotoxin, and interleukin-2 receptor were significantly increased compared with control subjects but were not correlated with the severity of ocular symptoms. In tears of patients with vernal and atopic keratoconjunctivitis and seasonal allergic conjunctivitis, as well as in the nonallergic diseases, rosacea blepharokeratoconjunctivitis and bacterial conjunctivitis, levels of eosinophil cationic protein, neurotoxin, and interleukin-2 receptor were significantly increased compared with control subjects. The highest values of these markers were found in vernal keratoconjunctivitis samples. Neutrophil myeloperoxidase was significantly increased in vernal and atopic keratoconjunctivitis, rosacea blepharokeratoconjunctivitis, and bacterial conjunctivitis. In vernal keratoconjunctivitis, tear markers were correlated to the clinical score of the disease, but not with cytology. CONCLUSIONS: Tear histamine was measured in 10 allergic patients after allergen challenge. Although none of the above markers can be considered specific to a single disease, their measurement may still be useful for the quantification of local cell activation in ocular inflammatory diseases.

Experimental autoimmunity to rat male accessory glands (MAG): circulating antibodies, immunoglobulins bound to target glands, and immunoglobulins-secreting cells.

A correlation between spleen B-cell antibody production against MAG antigens and the presence of different antibodies in circulation or antibodies bound to target glands was attempted. The number of 7S and 19S Ig-secreting cells (ISC) found in the spleen and the number of ISC generated after in vitro stimulation of the cells with MAG antigens were evaluated by using the hemolytic plaque assay. Low numbers of 7S and 19S ISC--less than 0.01% of spleen cells--were generated in response to MAG immunization, and no significative increase was observed after in vitro culture of spleen cells with MAG antigens, suggesting that secretory activity of the B-cells can not be improved when liberated from humoral homeostatic mechanisms. The humoral response of MAG-immunized rats, investigated by complement fixation and immunodiffusion assays, has proved negative, and in only two out of 17 rats a weak haemagglutinating activity was observed. Attempts to detect antibodies bound to cellular MAG antigens by immunofluorescence have shown a weak fluorescence in the epithelial cells of the prostate gland in only two rats. In both cases a concomitant tissue damage was observed, but in nine out of 11 cases with histological alterations no fluorescence was observed in the target glands. The medium value of rosette-forming cells (RFC) found in the spleen of MAG-immunized rats did not significantly differ from the value of the HSA-treated control group, although both groups differ in their specific humoral response.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic variable stress facilitates tumoral growth: reversal by imipramine administration.

The present study was conducted to examine whether a chronic variable stress procedure (CVS)--an animal model of depression--facilitates tumor growth, and whether this effect can be modified by concurrent administration of the antidepressant imipramine (IMI). Unstressed rats, with or without previous administration of the immunosuppressive agent cyclosporine (CS), were inoculated with 5 x 10(6) cells of a sarcoma. Another group of rats was inoculated with tumoral cells and later exposed to the CVS procedure with or without concurrent administration of IMI (10 mg/kg, i.p.). An additional group of animals was treated with CS and later given daily injections of IMI (10 mg/kg, i.p.) without stress manipulation. A lack of tumoral development was observed in unstressed animals without previous injections of CS, whereas, prior injections of this immunosuppressive agent increased tumoral growth in unstressed animals. Exposure to the CVS procedure facilitated tumoral growth even in animals without CS injections. This effect was clearly attenuated when chronically stressed rats were concurrently given IMI. These findings support the notion that the development of a tumoral process is facilitated when a state of experimental depression is induced and that the reversal of such a state by antidepressant treatment results in the inhibition of tumor development.

Chronic restraint attenuates the immunosuppressive response induced by novel aversive stimuli.

The exposure to a novel aversive event, such as foot shock, induced a decrease in the percentage of T lymphocytes and a clear reduction in the delayed-type hypersensitivity reaction (DTH). This immunosuppressive response to an acute stressor was absent in rats that were previously exposed to a chronic immobilization stress regime (2 h daily during 7 consecutive days), but was still present in animals with prior exposure to only one or three restraint sessions. No stress effect was observed in other immunologic parameters, such as the percentage of B lymphocytes or the hemagglutinin titer, in any of the experimental treatments. The possible involvement of central adaptive mechanisms in the attenuation of the immunosuppressive response induced by an acute stress is discussed.

Seven-day variable-stress regime alters cortical beta-adrenoceptor binding and immunologic responses: reversal by imipramine.

Rats were submitted daily to a variable stressor for 1 week with or without concurrent imipramine (IMI) administration. One day after the last injection or stressful event, binding of cortical beta-adrenoceptors was determined in all experimental groups. Another group of chronically stressed animals with or without concurrent IMI administration were sacrificed 24 h following the last stress or injection treatment, and several immunologic parameters were evaluated. Chronically stressed rats showed an enhanced number of cortical beta-adrenergic sites without changes in their affinity. This effect was not present following concurrent administration with the antidepressant. In addition, a decreased percentage of T lymphocytes and a reduced delayed-type hypersensitivity reaction was also observed in stressed animals. Both responses were no longer evident when stressed rats were previously administered IMI. A possible link between behavioral, neurochemical, and immunologic alterations due to the stress regime is discussed.

Production of reactive nitrogen intermediates (RNI) by peritoneal macrophages from rats with experimental autoimmune prostatitis (EAP).

Peritoneal macrophages from experimental autoimmune prostatitis (EAP) rats were examined for their capacity to secrete reactive nitrogen intermediates (RNI), measured by the release of nitrite (NO2-). Under basal conditions, there was a significant increase of NO2- secretion by cells from autoimmune rats in relation to resident cells. After stimulation in vitro with lipopolysaccharide (LPS), the NO2- production was higher in cells from autoimmune rats compared to treated and nontreated controls. The NO2- production was dependent upon the presence of L-arginine in the culture medium. The addition of L-NG-monomethyl arginine, an inhibitor of nitric oxide synthesis, to the medium reduced the amount of measurable NO2-. Kinetic studies in cells from EAP rats showed that in basal conditions there was an significant release of NO2- at day 7 of immunization that was maintained during the whole period studied. After LPS stimulation, there was a similar behavior and maximum values were reached at day 28 of immunization. These results, together with the lesion observed in the prostate gland, suggest that RNI may be of pathogenic importance in the development of early tissue inflammation and autoimmune disease of the prostate.

Prostate cancer induction in autoimmune rats and modulation of T cell apoptosis.

In this study we present an experimental model of prostate gland cancer induced by long term hormonal treatment with testosterone in combination with a chemical carcinogenic agent in male Wistar rats with autoimmune prostatitis (AIP). This system is particularly attractive in order to study the factors involved in the transition from a non-invasive to an invasive carcinoma, decisive in the risk of human cancer. At first, autoimmune prostatitis was induced by immunization in 3 months-old male Wistar rats with autologous accessory glands. Then, rats were treated with continuous intradermal implants of testosterone propionate (TP) and with single doses of the chemical carcinogen 7, 12 dimethylbenz (alpha) anthracene (DMBA) by intraperitoneal injection. Histopathological studies of the prostate gland revealed the presence of pre-malignant lesions, particularly the so-called prostatic intraepithelial neoplasm (PIN) in 50% of animals. Moreover, we observed the development of carcinomas in 50% of treated-animals, which could be histologically discriminated in adenocarcinomas, carcinoma of epidermal origin and undifferentiated carcinoma. In autoimmune rats which did not receive any other treatment, exposure to autoantigens gave rise to an atypical hyperplasia of the prostatic gland which could be attributed to the hyperactive state of the gland. Control groups constituted by autoimmune rats treated with TP or DMBA, and normal rats which were exposed to TP and/or DMBA evidenced the presence of PINs at different degrees, but did not develop carcinomas. Moreover, serum acid phosphatase significantly increased as treatment was accomplished, reaching its maximum levels in animals with carcinoma, in which DNA content, determined by image cytometry, showed to be aneuploid. Finally, we provided biochemical and cytofluorometrical evidence of the induction of apoptosis of spleen T cells in carcinoma-bearing hosts, and to a lesser extent in animals with PIN, but not in autoimmune or normal controls, which could represent an alternative molecular mechanism for explaining host immunosuppression triggered by tumors.

[Continuous sinusoid systemic Fudr infusion in advanced colorectal carcinoma. Preliminary experience]. / Infusione sistemica continua sinusoidale di Fudr nel carcinoma colorettale avanzato. Esperienza preliminare.

Sinusoidal circadian continuous infusion with a maximal flow rate in the afternoon (3-9 pm) reduces Fudr toxicity. In order to estimate if the reported lower toxicity is merely due to the quasi-intermittence of the daily dose or to the circadian rhythm of infusion. Ten patients with widespread cancer (9 colorectal and 1 renal) underwent sinusoidal continuous iv Fudr infusion with the peak level in antiphase (ie 68% of the dose from 3 to 9 am) as compared with the Römeling shape. An initial dose of 0.15 mg/kg/d for 14 days monthly has been given, escalating it every cycle by 0.025 mg/kg/d increments until toxicity. Mean (+/- SD) number of cycles has been 4.1 +/- 2.1 (range 2-8), maximal dose given has been 0.2 mg/kg/die in 5 patient and mean dose intensity of 0.570 +/- 0.04. Gastrointestinal toxicity consisted of nausea/vomiting WHO grade 1 in one patient and diarrhoea grade 1 in two, grade 2 and 3 in one and one case. Toxicity and dose intensity of both sinusoidal infusion seem to be similar and allow higher dose of Fudr than continuous constant infusion. Some other studies have to be done to include pharmacokinetics evaluation in order to estimate chronobiologic implication in continuous Fudr infusion.

[Hyperthermic-antiblastic isolation perfusion for advanced melanoma of the limbs. The technic, immediate results and a review of the literature]. / La perfusione isolata ipertermico-antiblastica per il melanoma avanzato degli arti. Tecnica, risultati immediati e revisione della letteratura.

Hyperthermic antiblastic isolated perfusion is a method largely used for the treatment of locally advanced limb melanoma. The method requires vascular isolation and hyperthermic perfusion of the limb using an extracorporeal circuit and administering the melphalan as antiblastic drug. Twenty-six patients with primary or recurrent melanoma of the limbs have undergone this treatment at our Institute. There were no cases of operative mortality and systemic toxicity was negligible. The local complications were transitory and no patient showed symptoms of nervous toxicity or permanent functional damage. Two cases of deep thrombophlebitis and two of lymphocele were documented a few months after treatment. Four clinically complete responses, 3 partial and 2 cases of stable disease were observed in the 9 patients treated with unexcised lesions. Our data like the totality of the present experience points to the safety of this method in the therapy of locally advanced limb melanoma. Nevertheless further controlled studies are required to define its role in order to improve survival.

Comparison of tanned cell hemagglutination and counter immunoelectrophoresis test in the detection of antibodies to extractable nuclear antigens (ENA) and to DNA in the systemic lupus erythematosus.

A comparative study of tanned cell hemagglutination (TCH) and counterimmunoelectrophoresis (CIE), two easy and reliable methodes for the routine detection of antibodies against nuclear antigens was performed. Antibodies against ENA, RNA-ase sensitive ENA and DNA antigens were searched in patients affected by systemic lupus erythematosus (SLE). Analysis of the results obtained for a particular antibody using TCH and CIE techniques suggests that both methods should be used for the detection of antibodies to nuclear antigens since in several cases antibodies were detected by one method and not for the other. Besides, the frequency of antibodies to ENA, RNA-ase sensitive ENA and DNA revealed by both techniques is similar to the results reported by others employing laborious tests. TCH and CIE serve as a screen to determine the presence of an antibody system and seems to provide the sensitivity enough as to be used in the smaller routine laboratories that wish to provide services for antibodies to nuclear antigens. When tanned cell hemagglutination was used looking for antibodies to DNA or ENA in the sera of patients affected by SLE it proved to be useful since in samples where antibodies to DNA were absent or at very low titres, antibodies to ENA were present in titres ranging from 1:9 to 1:6 561. The authors think this is of considerable importance since the variety of clinical features seen in different subjects with SLE is often accompanied by different specificities or types and amounts of autoantibodies and that certain combinations of these antibodies coincide with specific clinicopathological abnormalities.

[Nail pigmentation caused by azidothymidine]. / Pigmentazione ungueale indotta da azidotimidina.

Azidothymidine is a new antiviral drug that acts by competitive inhibition of reverse transcriptase of retroviruses. Azidothymidine is now widely used in treatment of patients with AIDS or ARC; the most important side effects of this drug are anaemia and neutropenia. Recently pigmentary changes of the nails (diffuse pigmentation and longitudinal or transverse bands) provoked by azidothymidine-treatment have also been reported. We describe a such case.

Application of breast tomosynthesis in screening: incremental effect on mammography acquisition and reading time.

OBJECTIVE: The aim of this study was to supplement the paucity of information available on logistical aspects of the application of three-dimensional (3D) mammography in breast screening. METHODS: We prospectively examined the effect on radiographers' and radiologists' workload of implementing 3D mammography in screening by comparing image acquisition time and screen-reading time for two-dimensional (2D) mammography with that of combined 2D+3D mammography. Radiologists' accuracy was also calculated. RESULTS: Average acquisition time (measured from start of first-view breast positioning to compression release at completion of last view) for seven radiographers, based on 20 screening examinations, was longer for 2D+3D (4 min 3 s; range 3 min 53 s-4 min 18 s) than 2D mammography (3 min 13 s; range 3 min 0 s-3 min 26 s; p<0.01). Average radiologists' reading time per screening examination (three radiologists reading case-mix of 100 screens: 10 cancers, 90 controls) was longer for 2D+3D (77 s; range 60-90 s) than for 2D mammography (33 s; range 25-46 s; p<0.01). 2D+3D screen-reading was associated with detection of more cancers and with substantially fewer recalls than 2D mammography alone. CONCLUSION: Relative to standard 2D mammography, combined 2D+3D mammography prolongs image acquisition time and screen-reading time (at initial implementation), and appears to be associated with improved screening accuracy. ADVANCES IN KNOWLEDGE: These findings provide relevant information to guide larger trials of integrated 3D mammography (2D+3D) and its potential implementation into screening practice.