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Biomedical subjects

A S Russell

Publications and source records attributed to A S Russell.

At least 19 recordsLinked to original sources

Pregnancy impairs resistance of C57BL/6 mice to Leishmania major infection and causes decreased antigen-specific IFN-gamma response and increased production of T helper 2 cytokines.

Resolution of cutaneous leishmaniasis in infected mice is associated with a polarized Th1 immune response by the host, whereas maternal immune responses during pregnancy appear to be biased toward humoral (Th2) and away from cell-mediated (Th1) responses. The objective of this study was to evaluate whether the putative Th2 bias in pregnant C57BL/6 mice would impair their normal ability to mount a curative Th1 response against Leishmania major infection. Pregnant C57BL/6 mice developed larger cutaneous lesions that showed no signs of resolution up to 70 days after infection. The infection appeared to be contained but not cured, as the footpad lesion remained stable, neither decreasing (as in normal C57BL/6 mice) nor showing uncontrolled expansion leading to death (as in susceptible mouse strains such as BALB/c). The number of parasites harvested from the footpads of pregnant mice was markedly higher than controls throughout the course of infection. The increased severity of infection in pregnant mice was accompanied by reduced IFN-gamma and increased IL-4, IL-5, and IL-10 production by spleen and popliteal lymph node cells stimulated in vitro with Leishmania Ags. Furthermore, IgG1 was elevated in the serum of pregnant mice as opposed to an increase of IgG2a in infected but nonpregnant controls. These observations support the existence of a bias toward Th2 cytokine expression during pregnancy and suggest that these cytokines effectively down-regulate the course of a normal Th1 response against a parasite infection in the periphery.

Animals

Incidence of myopathy in patients treated with antimalarials. A report of three cases and a review of the literature.

A retrospective review of 4405 patients' charts identified 214 patients who initiated antimalarial therapy between January 1987 and April 1993 for different rheumatic disorders (mean duration of therapy of 17 months). From these, three patients with myopathy were found for a total of 303 patient-years of therapy, for an incidence of 1 in 100 patient-years (95%, confidence interval 0.2-3). All three patients had rheumatoid arthritis and had received chloroquine for between 12 and 18 months with a maximum dose of 250 mg/daily. All had a muscle biopsy, but only one showed the classical rimmed vacuoles. All patients improved within 2 months after the drug was stopped. A review of the literature was carried out with special reference to the significance of clinical myopathy with a negative biopsy. We found that positive biopsies are usual only if the duration of symptoms have been allowed to persist for more than 6 months.

Adult

Allelic variation at the TAP 1 locus influences disease phenotype in HLA-B27 positive individuals with ankylosing spondylitis.

The objective was to determine the role of the TAP 1 gene in influencing the phenotype of disease in adult patients with ankylosing spondylitis (AS). The distribution of TAP 1 gene alleles was determined using the PCR RFLP method and restriction enzymes Bcl I and Acc I. The study population included 115 HLA-B27 positive patients with well-documented AS and 41 HLA-B27 positive normal controls. No significant difference in distribution of TAP 1 alleles was noted in comparisons of all AS patients with normal controls. However, AS patients with extraspinal disease were noted to have a significantly increased prevalence of the TAP 1B allele (17.0%) as compared to AS patients without extraspinal disease (2.9%) (P = 0.005) or normal controls (1.9%) (P = 0.005). Polymorphism at the TAP 1 locus may influence disease outcome in patients with AS.

ATP Binding Cassette Transporter, Subfamily B, Mem

Matching prevalence of peripheral arthritis and acute anterior uveitis in individuals with ankylosing spondylitis.

OBJECTIVE: To study the association between the occurrence of peripheral arthritis and of acute anterior uveitis during the course of ankylosing spondylitis (AS). METHODS: Retrospective clinical follow up by both chart review and direct patient interview was performed on 271 individuals comprised of 222 local white and 49 Taiwanese individuals with AS. RESULTS: Of 89 white patients with acute anterior uveitis, 36 (40.4%) also had peripheral arthritis, compared with only 33 (24.8%) having peripheral arthritis among the 133 who did not have acute anterior uveitis (p < 0.02). Thirty seven (78.7%) of 49 Taiwanese individuals with AS had peripheral arthritis and these included all 10 patients with acute anterior uveitis from the entire disease cohort (p < 0.05). CONCLUSIONS: This cross-sectional survey of AS patients supports the view that patients who develop peripheral arthritis are also more likely to develop acute anterior uveitis.

Acute Disease

Polymorphism in the LMP2 gene influences susceptibility to extraspinal disease in HLA-B27 positive individuals with ankylosing spondylitis.

OBJECTIVE: To investigate the potential influence of the HLA-linked LMP2 gene on disease susceptibility in HLA-B27 individuals with ankylosing spondylitis (AS). METHODS: A polymorphic CfoI restriction enzyme site in the coding region of the LMP2 gene was evaluated in genomic DNA samples from 193 white and 49 Chinese B27 individuals with well documented AS, 97 of whom had had acute anterior uveitis (AAU) and 97 peripheral arthritis; 42 samples from normal, white, B27 positive blood donors in whom AS was excluded were also evaluated. RESULTS: Analysis of B27 white AS individuals with AAU, peripheral arthritis, or both, revealed significant differences in genotypic distribution of this bi-allelic locus compared with B27 AS patients without extraspinal manifestations (p < 0.005) or B27 controls (p < 0.01). Furthermore, homozygosity for one LMP2 gene allele was significantly more prevalent in AS patients with AAU (71.3%) (p < 0.01) or peripheral arthritis (68.3%) (p < 0.02) than in B27 controls (45.2%). A similar genotypic distribution was noted in B27 Chinese AS individuals with extraspinal manifestations compared with those with axial disease alone. CONCLUSIONS: These findings support the involvement of the HLA linked LMP2 gene in the expression of disease in B27 individuals and represent a novel finding in rheumatic disease.

Adult

Clinical evaluation of various selected ELISA kits for the detection of anti-DNA antibodies.

Fifty four coded sera, 38 from eight patients with systemic lupus erythematosus (SLE), four from one patient with systemic vasculitis, one from one patient with polyarthritis and 11 normal controls were tested for anti-dsDNA antibodies using seven commercial enzyme linked immunosorbent assays (ELISA) and the radioimmunoassay method (RIA) routinely used in our unit. Sensitivity, specificity and predictive values were tested for both SLE diagnosis and disease activity. Using anti-dsDNA antibodies as a diagnostic test for SLE there were differences in sensitivity (from 66% to 95%), specificity (from 75% to 100%), predictive positive values (from 89% to 100%) and predictive negative values (from 50% to 87%) among ELISA kits. The RIA method was either more specific or equal to ELISA kits. Using 'equivocal' values as positive values an increase in sensitivity was observed but at the expense of specificity. Similar differences and trends were observed when the results were used as a measure for disease activity. This suggests that there are differences in sensitivity, specificity and predictive values among ELISA kits both in the diagnosis of SLE as well as in the determination of disease activity.

Adolescent

Polymorphism in the LMP2 gene influences the relative risk for acute anterior uveitis in unselected patients with ankylosing spondylitis.

Although human leukocyte antigen (HLA) B27 has been directly implicated in the pathogenesis of ankylosing spondylitis (AS), additional evidence favours the involvement of an additional genetic factor(s). In a previous population analysis of AS patients selected for a history of acute anterior uveitis (AAU), we had demonstrated a phenotypic association between polymorphism in an HLA-linked proteasome subunit gene, LMP2, and the development of AAU and peripheral arthritis. In the present study, we have assessed the relative risk of homozygosity for the LMP2 arginine variant, the disease-associated genotype, for these complications in an unselected group of 86 patients with AS seen sequentially in 1 centre by 1 rheumatologist over a 2-y period. LMP2 genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) using the CfoI restriction enzyme. Homozygosity for the LMP2 arginine variants was observed in 68.4% of AS patients who had had AAU as compared to 41.7% without AAU (relative risk 3.0; chi 2 = 6.1, p < 0.02). The proportion of AS patients with peripheral arthritis homozygous for the arginine residue was 55.2% as compared to 52.6% without this complication (relative risk 1.1; p > 0.05). Our data suggest a primary association with the development of AAU and provide evidence for genetic heterogeneity in distinct clinical subgroups of patients with AS as a basis for phenotypic variation.

Adult

An open study of pentoxifylline in the treatment of severe refractory rheumatoid arthritis.

OBJECTIVE: Recent data implicates the cytokine, tumor necrosis factor alpha (TNF-alpha), in the pathophysiology of rheumatoid arthritis (RA). In vitro data suggest that pentoxifylline may possess anti-TNF-alpha properties. We have therefore carried out a prospective 3-month open evaluation of pentoxifylline in a group of adult patients with RA refractory to conventional disease remittive therapies. METHODS: Nineteen patients with RA were included and clinical assessments were performed according to the World Health Organization/International League of Associations for Rheumatology (WHO/ILAR) criteria at baseline, and one and 3 months after the initiation of therapy. Laboratory assessments included a complete blood count, erythrocyte sedimentation rate (ESR), and whole blood assays of TNF-alpha production. TNF-alpha was assayed using ELISA and semiquantitative polymerase chain reaction methodologies. RESULTS: A significant diminution in number of tender and swollen joints as well as the ESR was noted after 3 months (p < 0.05) although no consistent effects on TNF-alpha production were observed. Furthermore, whole blood assays of TNF-alpha production shortly after initiation of pentoxifylline therapy were not predictive of the clinical response to this agent. CONCLUSION: Although pentoxifylline may possess therapeutic properties in RA, any beneficial effects appear to be unrelated to changes in TNF-alpha generation in whole blood assays.

Adult

Small bowel permeability--a variable effect of NSAIDS.

The baseline permeability of small bowel in 57 healthy volunteers was assessed by measuring the mannitol and chromium-EDTA recovery in a 5-hour urine collection after ingestion of a drink containing a mixture of 1 g of mannitol and 3.7 MBq of 51Cr-EDTA. Subjects were treated with medication for 1 week followed by permeability studies as described above. The regimens used were diclofenac sodium (Voltaren) 50 mg po tid (21 subjects), Voltaren SR 75 mg bid for 1 week (34 subjects), indomethacin 50 mg tid (10 subjects), and tenoxicam (Mobiflex) 20 mg daily (13 subjects). There was no significant difference between the mannitol recoveries at baseline or after any of the drugs. The permeability was clearly increased by indomethacin and by Voltaren SR. Conventional-release Voltaren increased permeability, but the results were not significantly above baseline. Mobiflex had no influence on the measured permeability. Our results suggest that the SR preparation of diclofenac has a more pronounced effect than regular diclofenac sodium; thus different NSAIDs and different preparations of the same NSAID may have different effects on small bowel permeability.

Adult

Use of second line drugs for the treatment of rheumatoid arthritis in Edmonton, Alberta. Patterns of prescription and longterm effectiveness.

OBJECTIVE: Our purpose was to compare the patterns of prescription of 2nd line drugs for the treatment of rheumatoid arthritis (RA) among rheumatologists in Edmonton, Alberta, and to examine the longterm effectiveness of these drugs. METHODS: A 1985 inception cohort of 128 patients with RA was assessed between 1991 and 1992, using measures of disease activity, radiological scores and physical functional status. Use of different therapies was retrieved from the medical charts. RESULTS: All patients had seen a rheumatologist at any time between January, 1985 and December, 1991, 88% within the first 3 years of disease. Most (85%) had received at least one 2nd line drug, the majority within the first 2 years. Overall, gold salts were the most frequently prescribed drugs. Patterns of prescription varied among different rheumatologists; some drugs were never prescribed by some and very often by others (e.g., auranofin). Terminations because of toxicity and lack of efficacy were high. Methotrexate (MTX) had the lowest termination rate and sulfasalazine the highest, mostly due to lack of efficacy. CONCLUSION: In this cohort, patients were treated early in the course of RA. Patterns of prescription of 2nd line drugs varied among rheumatologists. Termination rates were highest for sulfasalazine and lowest for MTX.

Adrenal Cortex Hormones

HLA-DR1, DR4, and DRB1 disease related subtypes in rheumatoid arthritis. Association with susceptibility but not severity in a city wide community based study.

OBJECTIVE: To determine the relationship of DR1, DR4, and DR4 subtypes with disease severity in patients with rheumatoid arthritis (RA). METHODS: We studied a cohort of 103 Caucasian patients with an onset of disease in 1985, and 6 to 7 years of disease at the time of the study. All rheumatologists in Edmonton participated in the city wide study which included hospital and community based patients with mild and severe disease. HLA status was determined using polymerase chain reaction amplification and amplified fragment length polymorphism typing. Outcome measures included joint counts, radiological scores, and physical functional status. RESULTS: Fifty-six patients (54%) were DR4 positive, (OR = 2.3, 95% CI 1.4-3.6, compared to controls). This association was only statistically significant for seropositive patients (OR = 2.8 in seropositive patients and OR = 1.5 in seronegative patients). A higher risk was observed for DR1/DR4 heterozygotes (OR = 6.8 in seropositive patients and OR = 1.7 in seronegative patients). No significant differences were observed in disease activity, joint counts, radiological scores, or functional status among patients carrying 1, 2 or no disease related alleles, although the prevalence of rheumatoid factor (RF) showed a linear association with allele dose (0, 1, or 2). CONCLUSION: DR4 and in particular DR1/DR4 heterozygosity were related to susceptibility to RA only in seropositive patients. RF was a better predictor of severity than disease related HLA subtypes. These findings suggest that the effect of these alleles on severity may be related to seropositivity, or that perhaps, seropositive and seronegative RA are genetically distinct entities. The results of our study suggest that in community based settings, which include patients with milder disease, DR1 and DR4 disease related alleles increase susceptibility for RA, but are not clinically useful as predictors of longer term outcome.

Alleles

Hematologic disposition of hydroxychloroquine enantiomers.

Hydroxychloroquine (HCQ) is a racemic antiarthritic agent that has a long half-life (t1/2) in plasma and accumulates in blood cells. To study the relationships between HCQ concentrations in plasma, serum, and whole blood and to determine the optimal blood fraction to use for therapeutic drug monitoring of the drug, we studied the relative distribution of the HCQ enantiomers in various fractions of human blood under in vivo and in vitro conditions. Substantially greater concentrations of both enantiomers were found in serum as compared with plasma because of release via platelet activation. After in vitro incubations of the separated blood cells with HCQ, high concentrations of both enantiomers were found in leukocytes, and low concentrations in erythrocytes and platelets; the R:S ratio in vitro was near unity in all of the cells examined. Unlike the in vitro cellular uptake, the concentrations of HCQ in vivo were significantly lower and stereoselective (R:S ratio = 2). There was almost no drug in the polymorphonuclear cells (PMN) in vivo, despite a substantial uptake in vitro after incubation of separated cells. The enantiomeric (R:S) ratio in the urinary excretion of the enantiomers was significantly correlated with that in plasma. The plasma-protein binding of the enantiomers was stereoselective and complimented the cellular uptake findings; the unbound fraction was dependent on the plasma concentrations of alpha 1-acid glycoprotein, but not albumin. Although concentrations in whole blood correlated well with those in lymphocytes and monocytes (the proposed site of HCQ action), stronger correlations were found between concentrations in serum and in the mononuclear cells.

Adult

HLA in ankylosing spondylitis: is HLA-B27 the only MHC gene involved in disease pathogenesis?

Linkage analysis of HLA haplotypes, HLA-B27 subtypes, and a 9.2-kb PvuII B7 restriction fragment length polymorphism (RFLP) (shown previously to be associated with peripheral arthritis in ankylosing spondylitis [AS]) in 115 relatives from 12 multiplex spondyloarthropathy (SNSA) and 2 B27-positive control families showed AS to be linked to HLA-B27 haplotypes. The RFLP segregated with HLA-A3- and HLA-A9-bearing haplotypes (lod score, 10.98; odds in favor of linkage, 9.2 x 10(10):1), although its linkage to AS or other SNSA per se was not seen. The association of HLA-A3/A9 with the RFLP was also seen in 52 AS patients and 92 controls, although no HLA-A, -B, -C, or -DR allele (other than HLA-B27) was significantly increased in frequency. The HLA-B27 subtype seen on all but one of the haplotypes studied was B*2705, the sole exception being HLA-B*2702. Although not ruling out a second HLA-A-linked gene influencing the clinical expression of AS, these data fail to support the role of a second MHC-associated gene in the pathogenesis of AS per se.

Alleles