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Biomedical subjects

A H Mulder

Publications and source records attributed to A H Mulder.

At least 55 records · Page 3Linked to original sources

Hepatitis in a patient with SLE: is it autoimmune hepatitis?

In a patient with systemic lupus erythematosus (SLE), we considered the diagnosis of autoimmune hepatitis (AIH) in view of raised serum aminotransferases, hypergammaglobulinaemia, antinuclear antibodies (titre 1:10,240), seronegativity of markers for viral hepatitis and absence of recent hepatotoxic drug usage. The diagnosis of AIH was supported by using the scoring system, recently developed by the International Autoimmune Hepatitis Group and the excellent response to treatment with prednisone. Liver histology, however, showed no characteristic features of AIH. The relevance of liver histology and scoring for AIH in SLE with hepatic involvement is discussed.

Adult↗

Vertebral bone destruction in sickle cell disease: infection, infarction or both.

Infectious and vaso-occlusive vertebral bone and joint destruction in two patients with sickle cell disease (SCD) are featured by H-shaped vertebrae, kyphotic angulation, osteolysis of endplates and collapse of intervertebral discs as shown by X-ray films and magnetic resonance imaging. Staphylococcal serology supported the diagnosis of staphylococcal osteomyelitis/spondylo-discitis in both SCD patients. The difficulties of establishing the causes and treatment of the osteoarthropathy in these particular cases are discussed in the light of the literature.

Adult↗

Cytogenetic analysis of Barrett's mucosa and adenocarcinoma of the distal esophagus and cardia.

We performed flow cytometry and cytogenetic analysis of 37 adenocarcinomas of the distal esophagus and cardia, of which 22 arose in Barrett's mucosa. Two of eight analyzed specimens of Barrett's mucosa had clonal chromosomal abnormalities. In 19 cases clonal chromosomal abnormalities were found in tumor tissue. The complex pattern of cytogenetic changes did not differ among the adenocarcinomas arisen in Barrett's esophagus, and those in the distal esophagus without Barrett's mucosa or cardia. Abnormal karyotypes with multiple and complex rearrangements were seen in 11 cases and with single or a few numeric changes in eight. Losses of chromosomes 4, 18, 21, and Y were the most frequent numeric changes. Loss of the Y chromosome was observed in eight of 26 tumors of males (31%). Gains of chromosomes 14 and 20 were also frequent numeric changes. Structural abnormalities were observed in 13 of the abnormal karyotypes (68%). The chromosome arms most frequently rearranged were 1p, 3q, 11p and 22p. The chromosome arm most frequently contributing to losses was 1p, with the shortest region of overlap being 1p22-33. The chromosome arms most often involved in gains were 11p and 22p, and i(3q) was the isochromosome that was most frequently identified.

Adenocarcinoma↗

Chronic rejection of concordant aortic xenografts in the hamster-to-rat model.

Several groups have demonstrated that it is possible to obtain long-term graft survival of concordant xenografts. One of the important questions that remains is whether xenografts are susceptible to chronic rejection. To answer this question we used the aorta transplantation model. One centimetre of hamster aorta was interposed in the abdominal aorta of Lewis rat recipients. The recipients were either untreated (group 1), or treated with 10 mg/kg cyclosporine (CsA), given intramuscularly three times a week (group 2). Rats were sacrificed at day 7, 14, 21, 28, 56 and 84 and the thickness of the intima, the media and the adventitia was measured. Furthermore, the cellularity of the media and the adventitia was assessed by counting the number of nuclei per 0.05 mm2 and immunohistochemistry of the aortic grafts was performed. Graft arteriosclerosis developed in aortic xenografts of both group 1 and group 2. In group 1, intimal lesions were already present from day 21 onwards in all rats, whereas in group 2 they were present only in 33% (2/6) of the rats. At day 84 all the grafts in group 1 were totally occluded, while those in group 2 were still open. The thickness of the media was slightly increased in both groups during the whole observation period, mainly due to edema. Although a few infiltrating macrophages could be seen, the number of nuclei per 0.05 mm2 of the media remained constant during the first 21 days, but declined sharply from day 21 onwards, as a consequence of disappearing myocytes. Thickness of the adventitia in both groups increased after transplantation due to infiltrating macrophages and T cells, reaching a peak at day 14. After day 14 the adventitial thickness in group 1 decreased rapidly to reach values comparable to group 2 from day 28 onwards. In conclusion, graft arteriosclerosis, as a sign of chronic rejection, occurs in concordant aortic xenografts. The lesions in the xenografts develop extremely rapidly, and compared to data from the literature, faster than in aortic allografts. The process of chronic rejection in aortic xenografts can be reduced by CsA.

Animals↗

Intermittent morphine treatment causes long-term desensitization of functional dopamine D2 receptors in rat striatum.

3 weeks following cessation of intermittent morphine administration (10 mg/kg, s.c., once daily for 14 days), [3H]dopamine and [14C]acetylcholine release induced by 10 microM N-methyl-D-aspartate (NMDA) from superfused rat striatal slices appeared to be significantly higher than the release from striatal slices from saline-treated rats. A similar adaptive increase of the NMDA-evoked release of these neurotransmitters was observed in slices of the nucleus accumbens, whereas that of [3H]noradrenaline from hippocampal slices remained unchanged. Blockade of dopamine D2 receptors by 10 microM (--)-sulpiride enhanced NMDA-induced [3H]dopamine and [14C]acetylcholine release from striatal slices from saline-treated animals, but was found to be ineffective in this respect following intermittent morphine treatment. Moreover, morphine administration appeared to cause a profound decrease in the apparent affinity of the full dopamine D2 receptor agonist LY171555 (quinpirole) for these release-inhibitory dopamine D2 receptors, indicating the occurrence of dopamine D2 receptor desensitization. It is suggested that such a desensitization of dopamine D2 receptors on dopaminergic nerve terminals as well as on cholinergic interneurons may play a pivotal role in the long-lasting nature of behavioural sensitization upon cessation of treatment with morphine and possibly other drugs of abuse.

Acetylcholine↗

Intermittent morphine treatment causes a protracted increase in cholinergic striatal neurotransmission measured ex vivo.

Considering the long-lasting neuroadaptations that occur in the brain after exposure to drugs of abuse, we found that the facilitatory effect of an EC50 concentration (0.1 microM) of the acetylcholinesterase inhibitor physostigmine, unlike that of the muscarinic receptor agonist oxotremorine, on K(+)-induced [3H]dopamine release from rat striatal slices was enhanced about 2-fold 1 month after cessation of intermittent morphine treatment. Similarly, the inhibitory effect of physostigmine on K(+)-induced [14C]acetylcholine release from the slices was enhanced subsequent to morphine treatment, whereas that of oxotremorine appeared to be unchanged. Therefore, intermittent morphine administration may cause a very long-lasting increase of muscarinic receptor activation by released endogenous acetylcholine in rat striatum, which may play a pivotal role in the enduring character of stimulus hyperresponsiveness after exposure to drugs of abuse.

Acetylcholine↗

Intermittent and chronic morphine treatment induces long-lasting changes in delta-opioid receptor-regulated acetylcholine release in rat striatum and nucleus accumbens.

Intermittent treatment of rats with morphine (10 mg/kg s.c., once daily) caused an increase (of about 30%) of the electrically evoked release of [14C]acetylcholine from cholinergic interneurons of superfused striatal slices 1-21 days after morphine withdrawal. Similarly, chronic treatment with escalating doses of morphine (5-50 mg/kg s.c., 3 times daily), causing physical dependence (unlike intermittent treatment), resulted in an enduring enhanced response of these neurons towards depolarization. Following chronic morphine treatment this adaptive increase of acetylcholine release was associated with a slight but long-lasting decrease of the (delta-opioid receptor-mediated) maximal inhibitory effect of [Met5]enkephalin, whereas upon intermittent drug treatment delta-opioid receptor desensitization was observed 1 day after opiate withdrawal only. Also in slices of the nucleus accumbens both intermittent as well as chronic morphine administration caused a long-lasting increase of the electrically evoked [14C]acetylcholine release. Therefore, we hypothesize that an enhanced (re)activity of striatal and accumbal cholinergic neurons, which are regulated by dopaminergic neurons of the ventral mesencephalon, may represent a long-lasting neuroadaptive effect of morphine (and possibly other drugs of abuse) playing a crucial role in behavioral sensitization associated with enhanced vulnerability to drugs of abuse.

Acetylcholine↗

A double-blind, placebo-controlled study of monoclonal anti-interleukin-2 receptor antibody (BT563) administration to prevent acute rejection after kidney transplantation.

In a double-blind, randomized, placebo-controlled trial, BT563, a murine IgG1 anti-IL-2R antibody, was given as a rejection prophylaxis after kidney transplantation. Drug-related side effects were not observed. During the 10-day course of BT563, no rejections (0/27) were found, whereas a rejection episode occurred in 7 patients (7/29) (P = 0.01) during placebo treatment. Within the first 4 postoperative weeks, freedom from rejection in the BT563 group and in the placebo group was 96% vs. 76% (P = 0.05). Due to rejection in the placebo group, 2 grafts were lost. At 3 months, an overall rejection incidence in the BT563 and placebo group was found of 3/27 (11%) vs. 8/29 (28%) patients (P = 0.18). Infectious complications were distributed equally between the 2 groups. CMV disease, found in 3 placebo-treated patients, occurred after rejection treatment (2/3). Within the BT563 group, 1 patient lost his graft due to renal artery thrombosis, 2 grafts were lost as a result of technical failure, and 2 patients had a squamous cell carcinoma that could be treated curatively. We conclude that the use of the anti-IL-2R mAb BT563 effectively prevents rejection after kidney transplantation without increasing infectious complications.

Acute Disease↗

Accumulation of genetic abnormalities during neoplastic progression in Barrett's esophagus.

Sex chromosome status, ploidy, and proliferation rate were evaluated in archival material of 73 Barrett's esophagus patients (48 males and 25 females). Diagnosis in esophageal mucosa samples ranged from intestinal metaplasia with no dysplasia to invasive esophageal adenocarcinoma; also, four lymph node metastases were studied. Chromosomal and ploidy aberrations were determined by in situ hybridization with repetitive DNA probes specific for chromosomes Y, X, and 1. Proliferation index (Ki-67 protein expression) was assessed by immunohistochemistry. Proliferation rate was elevated in all stages of dysplasia and in the adenocarcinomas. Aneuploidy (hyperdiploidy) and loss of the Y chromosome correlated with the advancing stages toward neoplasia (P < 0.001) and reached high prevalences (70-100%) in high-grade dysplasia and adenocarcinoma. Abnormalities of the X chromosome were not seen. These data suggest that in Barrett's esophagus, genetic perturbations may be generated in relation to a high proliferation rate.

Adenocarcinoma↗

Accumulation of p53 protein in normal, dysplastic, and neoplastic Barrett's oesophagus.

Accumulation of p53 protein was determined by immunohistochemistry in archival material of biopsy specimens from 102 patients with Barrett's oesophagus with different grades of dysplasia, in 24 oesophageal adenocarcinomas associated with Barrett's oesophagus, and in 23 cases of metaplastic epithelium adjacent to these carcinomas. Immunostaining for the p53 protein was found in 23/102 (23 per cent) cases of the Barrett's oesophagus biopsies and in 12/23 (52 per cent) cases of Barrett's oesophagus adjacent to adenocarcinoma. Significant correlations were found between the grade of dysplasia and p53 immunoreactivity in both Barrett's biopsies without adenocarcinoma (P < 0.001) and Barrett's oesophagus adjacent to adenocarcinoma (P < 0.05). In the adenocarcinomas, intense nuclear immunohistochemical staining for p53 was diffusely or focally present in 20/24 (83 per cent) of the specimens. In Barrett's oesophagus, p53 is a progression marker with high expression in high-grade dysplasia (89 per cent) and adenocarcinoma (83 per cent).

Adenocarcinoma↗

Activation of granulocytes by anti-neutrophil cytoplasmic antibodies (ANCA) in Wegener's granulomatosis: a predominant role for the IgG3 subclass of ANCA.

To study ANCA-induced granulocyte activation in relation to disease activity in Wegener's granulomatosis (WG), serum samples taken from patients with WG at the time of active (n = 17) and inactive (n = 17) disease were analysed for their capacity to activate primed normal donor granulocytes. Compared with control sera (n = 6), the capacity of IgG fractions from patients with WG to induce the respiratory burst was significantly higher (P < 0.0001). Furthermore, the capacity to induce the respiratory burst significantly correlated with ANCA titre (r = 0.499, P = 0.003). IgG fractions from patients with active extensive disease induced the respiratory burst significantly more strongly than IgG fractions from patients with limited disease (n = 7) (P < 0.01) or patients during disease remission (n = 17) (P < 0.001). As ANCA-induced neutrophil activation is Fc-dependent and different IgG subclasses are involved in the interaction with various Fc receptors from neutrophils, we assessed changes in ANCA titre, total IgG and IgG subclass distribution of ANCA during active disease and remission in relation to the neutrophil-activating capacity of ANCA. Changes in capacity to activate granulocytes were related neither to changes in titre nor to changes in levels of total IgG, IgG1, IgG3, or IgG4 subclass of ANCA. However, changes in capacity to induce the respiratory burst were significantly related to changes in the relative amount of the IgG3 subclass of ANCA (P < 0.001), and not to changes in the relative amount of IgG1 or IgG4 subclass of ANCA. These data suggest that the increase in neutrophil-activating capacity of ANCA from inactive to active disease is, at least in part, based on the relative increase of the IgG3 subclass of ANCA that occurs during active disease.

Adult↗

Heterotopic ossification induced by hypoxia in a retrosternal gastric tube following transhiatal oesophagectomy.

A 71 year old man underwent retrosternal gastric tube reconstruction following transhiatal oesophagectomy for squamous cell carcinoma. On the second post-operative day, the patient developed a cardiac arythmia with secondary hypotension followed by hypoxaemia necessitating artificial ventilation. Two weeks after surgery, endoscopy revealed massive necrosis of the proximal segment of the gastric tube extending from the anastomosis in the neck to the watershed area. Three weeks later, the patient died and a necropsy was performed. Macroscopic evaluation of the gastric tube revealed a sharply demarcated and fully ossificated proximal segment. Heterotopic ossification was present on histological examination. This condition has only been described in conjunction with primary or metastatic gastric adenocarcinoma. The location of the ossification and the presence of temporary systemic hypoxia suggest that the latter was the main factor responsible for the ossificative response.

Aged↗

Glucocorticoid receptor activation potentiates the morphine-induced adaptive increase in dopamine D-1 receptor efficacy in gamma-aminobutyric acid neurons of rat striatum/nucleus accumbens.

The present study was designed to evaluate the hypothesis that enhanced corticosterone levels may facilitate the enduring neuroadaptive effects in the brain caused by drugs of abuse. Treatment of primary neuronal cultures of the rat striatal complex (striatum/nucleus accumbens, consisting for more than 90% of gamma-aminobutyric acid neurons) with 10 microM morphine for 2 hr to 3 days, enhanced the maximal stimulatory effect of the dopamine D-1 receptor agonist SKF38393 on adenylyl cyclase activity. This adaptive increase in D-1 receptor efficacy upon long-term mu-opioid receptor activation was about doubled after simultaneous or previous exposure of the neurons to the glucocorticoid receptor agonist dexamethasone (EC50 about 2 nM). A similar facilitation of the effect of morphine was observed upon exposure of the neurons to relatively high (nanomolar) concentrations of corticosterone, whereas the mineralocorticoid receptor agonist aldosterone appeared to be ineffective in this respect, indicating the involvement of glucocorticoid receptors. Interestingly, whereas morphine exposure also enhanced isoprenaline-stimulated adenylyl cyclase activity, this increase of beta adrenoceptor efficacy was not at all affected by dexamethasone. In both morphine-treated and untreated neurons, low concentrations (< .3 nM) of corticosterone or aldosterone, but not dexamethasone, caused a slight (about 20%) reduction of dopamine D-1 receptor-stimulated adenylyl cyclase activity, indicating the involvement of mineralocorticoid receptors. These data show that the morphine-induced adaptive increase of postsynaptic dopamine D-1 receptor efficacy (also observed in striatal slices of rats weeks after repeated treatment with morphine or cocaine) is strongly enhanced after previous or simultaneous glucocorticoid receptor activation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenylyl Cyclases↗

Glucocorticoid and mineralocorticoid receptors differentially modulate cultured dopaminergic neurons of rat ventral mesencephalon.

Activation of kappa-opioid receptors by U69,593 in a concentration of 1 microM maximally inhibited dopamine release. Withdrawal from chronic (4 days) treatment with U69,593 (1 microM) induced a long-lasting (at least 7 days) increase (30-50%) in [3H]dopamine release induced by 25 mM K+ from cultured rat mesencephalic neurons without causing functional kappa-opioid receptor desensitization. Incubation of these cultured neurons with the glucocorticoid agonist, dexamethasone (3 nM), had no effect on basal or 25 mM K(+)-induced dopamine release, whereas the steroid completely blocked the development of opiate-induced neuronal supersensitivity to depolarization. This blockade was found to be concentration-dependent, with an EC50 of about 0.3 nM and was not associated with changes in corticotropin-releasing factor (CRF) receptor, dopamine D2 autoreceptor or kappa-opioid receptor functioning. Therefore, opioid and glucocorticoid receptors appear to be co-localized in dopaminergic neurons of rat ventral mesencephalon and interact in a functionally antagonistic manner. Interestingly, the mineralocorticoid agonist, aldosterone (5 nM), itself increased K(+)-stimulated [3H]dopamine release by about 25%, consistent with the putative role of mineralocorticoid receptors in maintaining neuronal excitability. Moreover, whereas 1 nM corticosterone appeared to mimic the dopamine release-facilitating effect of aldosterone, 30 nM corticosterone displayed a modulatory effect similar to that of dexamethasone. Thus, whereas mineralocorticoid receptors that are already activated at low plasma corticosterone levels may uphold neuronal sensitivity to depolarizing stimuli, activation of glucocorticoid receptors by higher plasma corticosterone levels may prevent the development of neuronal supersensitivity, e.g. following chronic activation of kappa-opioid receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex Hormones↗

Adaptive changes in rat striatal preproenkephalin expression and dopamine-opioid interactions upon chronic haloperidol treatment during different developmental stages.

This study was designed to evaluate the effects of a chronic treatment with the classical neuroleptic drug haloperidol on the preproenkephalin (ppEnk) mRNA synthesis and its consequences for opioid and dopamine (DA) receptor-regulated adenylate cyclase in the developing and adult rat striatum. Prenatal exposure to haloperidol (2 mg/kg, 14 days) caused a 40% reduction of striatal ppEnk mRNA levels, but had no consequences for DA-stimulated or Met-enkephalin-inhibited adenylate cyclase activity in striatal slices from embryonic day 21 (E21) foetal brain. Postnatal treatment of rat pups from day 10 (P10) until P23 and adult rats resulted in significant increases of mRNA levels of 8 and 41%, respectively, a clear reduction of D1 DA receptor-stimulated cAMP production and a profound desensitization of delta-opioid receptors inhibitory coupled to adenylate cyclase. Since striatal D2 receptor-mediated inhibition of adenylate cyclase activity, in contrast to its activation through D1 receptors, is not present in the prenatal period, this study indicates that the tonic inhibitory effect of DA on striatal ppEnk mRNA synthesis is dependent on the presence of adenylate cyclase-coupled D2 receptors which gradually develops postnatally and further supports the idea that striatal D1 and D2 DA receptors have bidirectional effects on enkephalin synthesis in this brain area. The adaptive changes in D1 DA and delta receptor-regulated adenylate cyclase activity are discussed in relation to the well-known increase in the locomotor and reinforcing effects of mu-opioid receptor agonists upon chronic neuroleptic treatment.

Aging↗