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The effect of costimulatory factors in the pathogenesis of chronic idiopathic thrombocytopenic purpura.

To investigate the effect of costimulatory factors in the pathogenesis of chronic idiopathic thrombocytopenic purpura (CITP), we examined the expression of CD80 on platelets and megakaryocytes in patients with CITP and the controls by FACS. By using CD80 monoclonal antibody (McAb) to inhibit interaction among cells which is mediated by costimulatory factors, we observed the effect of CD80 McAb on the growth and maturation of megakaryocytic progenitors of patients with CITP in vitro. The results showed the expression of CD80 on platelets and megakaryocytes in CITP group was significantly higher than that in controls (P<0.01). There was a significantly positive correlation between the expression of CD80 on platelets and serum PAIgG in CITP (r=0.86, P<0.05). The mean of various clone numbers (CFU-MK, BFU-MK and mCFU-MK) in CITP were all lower than those in controls (P<0.05). In megakaryocytes co-cultured with CD80 McAb, there was an increasing tendency of the number of CFU-MK and big CFU-MK (the number of megakaryocyte with GP IIIa positive was more than 20) and mediate CFU-MK (the number of megakaryocyte with GP IIIa positive was 11-20). When the concentration of CD80 McAb was 10 microg/L, there was a significant difference in the number of megakaryocytic colony formation (CFU-MK, BFU-MK and mCFU-MK) between the group with CD80 McAb and that without it (P<0.05). These showed the abnormality of costimulatory factors had important effect in the pathogenesis of CITP.

Adult↗

The role of neutrophil activation in pathogenesis of preeclampsia.

To investigate the effect of neutrophil activation on pathogenesis of pre-eclampsia, neutrophil activation was examined by using flow cytometry to assess the CD11b expression and the levels of plasma endothelin-1 (ET-1) and serum NO2- were also measured by using non-equilibrium radioimmunoassay and by Griess assay in 29 pregnant women with pre-eclampsia and 31 normal pregnant women at third trimester. The expression of neutrophil CD11b was significantly elevated in women with pre-eclampsia as compared with that of normal pregnant women at third trimester. The mean fluorescence index of CD11b was 438.38 +/- 179.91 and 326.97 +/- 170.14 respectively (P < 0.05). The plasma ET-1 level and serum NO2- concentration in pre-eclampsic women (63.69 +/- 48.33 pg/ml and 20.03 +/- 4.77 mumol/L, respectively) were both significantly increased as compared with those in the normal pregnancy women (29.98 +/- 20.25 pg/ml and 15.47 +/- 5.47 mumol/L, respectively, P < 0.01). The neutrophil CD11b expression was significantly elevated in pre-eclampsia. The increased neutrophil activation may cause the damage of vascular endothelium and result in NO release compensatory increase in endothelial cells, suggesting that the neutrophil activation may play a key role in pathogenesis of pre-eclampsia.

Adult↗

Isolated rat pancreatic acini as a model to study the potential role of lipase in the pathogenesis of acinar cell destruction.

We have recently reported that lipase may play a role in the pathogenesis of acute pancreatitis by its ability to release fatty acids from triglycerides. The aim of this study was to further investigate the effect of lipase and its various digestive products on the integrity of isolated pancreatic rat acini. Pancreatic acini were prepared by collagenase digestion and their newly synthesized proteins labeled with 35S-methionine. Acini were later incubated in buffer to which various factors were added: Products of lipolytic digestion, such as various fatty acids and monoglycerides, fat tissue, nonactivated or trypsin activated homogenized pancreatic tissue, and a specific lipase inhibitor (THL, tetrahydrolipstatin). Cellular destruction was quantified by the degree of radiolabeled proteins released. Short chain fatty acids and monoglycerides (up to C-12) caused cellular destruction, whereas long chain fatty acids and their respective monoglycerides were not harmful. With regard to unsaturated fatty acids, long chain fatty acids (C-18 to C-22) were also able to destroy cells. The degree of cellular necrosis correlated with incubation time and fatty acid concentration. The cellular damage caused by incubation of acini with either inactive or trypsin activated pancreatic homogenates together with triglycerides could be completely inhibited by the specific lipase inhibitor THL. Bile alone caused no damage. When bile was combined with activated-pancreatic homogenates, about 25% of newly synthesized proteins were released by acini within 30 min. Incubation with a combination out of bile activated pancreatic homogenates and triglycerides resulted in the most pronounced damage. This acinar destruction could only be partly inhibited by THL. These studies suggest that both lipase and phospholipase-A2 may play an important role in the pathogenesis of acinar cell destruction.

Animals↗

Pathogenesis of gangrene following intra-arterial injection of drugs: a new hypothesis.

We have demonstrated the toxicity of diazepam and the safety of ketamine hydrochloride following intra-arterial injection in an anaesthetized animal model. The pathogenesis of gangrene following intra-arterial injection of drugs is unclear. Clinical reports and this experiment suggest that it only follows injection of highly membrane-soluble drugs. Early swelling and disruption of capillary endothelial cells were demonstrated after intra-arterial injection of diazepam and thiopentone. We believe that a theory of pathogenesis based on this finding is consistent not only with our experimental findings, but with known in vitro effects of membrane soluble drugs on cell membranes and the clinical features following intra-arterial injections in both human subjects and in animals.

Animals↗

The therapy of myelofibrosis: targeting pathogenesis.

Myelofibrosis with myeloid metaplasia (MMM) encompasses the diagnoses of agnogenic myeloid metaplasia (idiopathic myelofibrosis), as well as the advanced phases of polycythemia vera and essential thrombocythemia (post polycythemic and post thrombocythemia myeloid metaplasia, respectively). MMM is a clonal, hematopoietic stem cell disorder in which neither the pathogenesis, nor a broadly applicable effective therapy have been described. Clinically, these patients experience progressive marrow replacement by fibrotic tissue, ineffective hematopoiesis, problematic cytopenia's, significant hepato-splenomegaly, extramedullary hematopoiesis, profound constitutional symptoms, and a risk of blastic transformation. Historically, therapies have been targeted at palliating symptoms (i.e. splenectomy, transfusions, hydroxyurea, erythropoietin, androgens, localized radiotherapy). Stem cell transplantation appears promising, but is often toxic and not broadly applicable due to co-morbidities and age of MMM patients. Non-myeloablative approaches to conditioning may broaden the applicability of stem cell transplantation in MMM, yet results to date are preliminary. Although a definitive molecular abnormality responsible for the pathogenesis of MMM has not been described, much has been learned about the aberrant expression of pro-fibrotic cytokines and the presence of increased angiogenesis in MMM. These pathogenetic insights have led to a series of pilot clinical trials with therapeutic agents targeting aberrantly expressed cytokines (and possibly angiogenesis) including Thalidomide (alone or in combination), Etanercept, and STI-571. Amongst these later agents Thalidomide has demonstrated the most promise (palliating disease associated cytopenia's), whereas the TNF-alpha inhibitor Etanercept has aided with MMM associated constitutional symptoms. Although these later trials have been helpful in a subset of patients, no agent to date has led to solid complete responses in MMM across the spectrum of disease manifestations. Further insights into the pathogenetic mechanisms responsible for myeloproliferation (aberrant cell signaling pathways, apoptotic resistance, other) are necessary to guide selection and testing of the expanding number of novel anti-neoplastic agents in chronic myeloid disorders and MMM.

Combined Modality Therapy↗

Methamphetamine modulates gene expression patterns in monocyte derived mature dendritic cells: implications for HIV-1 pathogenesis.

BACKGROUND: The US is currently experiencing a grave epidemic of methamphetamine use as a recreational drug, and the risk for HIV-1 infection attributable to methamphetamine use continues to increase. Recent studies show a high prevalence of HIV infection among methamphetamine users. Dendritic cells (DCs) are potent antigen presenting cells that are the initial line of defense against HIV-1 infection. In addition, DCs also serve as reservoirs for HIV-1 and function at the interface between the adaptive and the innate immune systems, which recognize and internalize pathogens and subsequently activate T cells. Exposure to methamphetamine results in modulation of immune functional parameters that are necessary for host defense. Chronic methamphetamine use can cause psychiatric co-morbidity, neurological complications, and can alter normal biological processes and immune functions. Limited information is available on the mechanisms by which methamphetamine may influence immune function. This study explores the effect of methamphetamine on a specific array of genes that may modulate immune function. We hypothesize that methamphetamine treatment results in the immunomodulation of DC functions, leading to dysregulation of the immune system of the infected host. This suggests that methamphetamine has a role as a cofactor in the pathogenesis of HIV-1. METHODS: We used the high-throughput technology of gene microarray analysis to understand the molecular mechanisms underlying the genomic changes that alter normal biological processes when DCs are treated with methamphetamine. Additionally, we validated the results obtained from microarray experiments using a combination of quantitative real-time PCR and Western blot analysis. RESULTS: These data are the first evidence that methamphetamine modulates DC expression of several genes. Methamphetamine treatment alters categories of genes that are associated with chemokine regulation, cytokinesis, signal transduction mechanisms, apoptosis, and cell cycle regulation. This report focuses on a selected group of genes that are significantly modulated by methamphetamine treatment and that have been associated with HIV-1 pathogenesis. DISCUSSION/CONCLUSION: The purpose of this study was to identify genes that are unique and/or specific to the complex immunomodulatory mechanisms that are altered as a result of methamphetamine abuse in HIV-1-infected patients. These studies will help to identify the molecular mechanisms that underlie methamphetamine toxicity, and several functionally important classes of genes have emerged as targets in methamphetamine-mediated immunopathogenesis of HIV-1. Identification of novel DC-specific and methamphetamine-responsive genes that modulate several biological, molecular, and signal transduction functions may serve as methamphetamine- and/or HIV-1-specific drug targets.

Adult↗

The role of nuclear factor kappa B in the pathogenesis of pulmonary diseases: implications for therapy.

The nuclear factor kappa B (NF-kappaB) transcription factor plays a key role in the induction of pro-inflammatory gene expression, leading to the synthesis of cytokines, adhesion molecules, chemokines, growth factors and enzymes. Results of studies in in vitro and in vivo models of inflammation and malignancy have also suggested central roles for NF-kappaB in programmed cell death, or apoptosis. NF-kappaB plays a central role in a variety of acute and chronic inflammatory diseases. In the common lung diseases associated with a significant inflammatory component such as severe sepsis, acute lung injury, acute respiratory distress syndrome, cystic fibrosis and asthma, the pathogenic roles of NF-kappaB have been extensively investigated. In COPD, activation of NF-kappaB has been implicated in disease pathogenesis but its exact role is less clearly demonstrable in this heterogeneous patient population. However, the principal risk factor for COPD, cigarette smoking, is strongly associated with NF-kappaB activation. Activation of NF-kappaB has been demonstrated in mineral dust diseases and probably plays a role in the pathogenesis of these chronic illnesses. NF-kB also plays a variety of roles in lung cancer including resistance to chemotherapy, inhibition of tumorigenesis and inducing expression of antiapoptotic genes. The complex NF-kappaB pathway offers a variety of potential molecular targets for chemotherapeutic intervention. A variety of agents aimed at modulating NF-kappaB activity are in various stages of investigation.

Anti-Inflammatory Agents↗

TSH receptor expression in orbital tissue and its role in the pathogenesis of Graves' ophthalmopathy.

The TSH receptor (TSHr) is the autoantigen responsible for the hyperthyroidism of Graves' disease. Recent studies suggest that this receptor may also be an autoimmune target in Graves' ophthalmopathy (GO) and pretibial dermopathy (PTD). Its involvement in the pathogenesis of these conditions would help to explain the close clinical associations between hyperthyroidism, GO and PTD. TSHr has been shown to be present in normal orbital and dermal tissues and evidence supports the conviction that expression may be increased in tissues involved in GO and PTD. In the setting of Graves' disease, the expression of this antigen in connective tissues throughout the body may lead to systemic, subclinical connective tissue inflammation. Given this background, local or environmental factors such as circulating or local cytokines, gravitational dependency, anatomic constraint of the bony orbit, or trauma, may augment clinical disease involvement within the orbit and pretibial skin. Alternately, locally enhanced expression of this protein at the sites of clinical disease may not be directly involved in pathogenesis, but could be secondary to the ongoing process, and nonetheless important in disease progression.

Adipocytes↗

The molecular pathogenesis of the Marfan syndrome.

The Marfan syndrome (MFS) is an autosomal dominant heritable disorder of connective tissue with highly variable clinical manifestations including aortic dilatation and dissection, ectopia lentis, and a range of skeletal anomalies. Mutations in the gene for fibrillin-1 (FBN1) cause MFS and other related disorders of connective tissue collectively termed type-1 fibrillinopathies. Fibrillin-1 is a main component of the 10- to 12-nm extracellular microfibrils that are important for elastogenesis, elasticity, and homeostasis of elastic fibers. Mutations in fibrillin-1 are hypothesized to exert their effects by dominant negative mechanisms, but recent work has also emphasized the potential role of proteases and disturbances in tissue homeostasis in the pathogenesis of the MFS. This article provides an overview of the clinical aspects of the MFS and current thinking on the pathogenesis of this disorder.

Animals↗

[Antiphospholipid syndrome. Pathogenesis, molecular basis and clinical aspects].

BACKGROUND: In 1983 the antiphospholipid syndrome was first described as an independent clinical entity by Graham Hughes and characterized by thrombosis, thrombocytopenia and recurrent fetal losses. In the following years evidence accumulated from various studies that the thrombotic events in the antiphospholipid syndrome correlate with elevated serum titers of antiphospholipid antibodies. These autoantibodies represent a very heterogeneous group as multiple specificities against various negatively charged phospholipids are found. Most commonly described are antibodies against cardiolipin, but also cross-reactivities between the different phospholipids are observed. Moreover, efficient binding of antiphospholipid antibodies against a phospholipid requires the presence of certain protein-cofactors which on the other hand can be antigens themselves. PATHOGENESIS: Although numerous animal models strongly indicate that antiphospholipid antibodies play a causal role in the pathogenesis of the disease, the exact pathogenetic mechanisms are still to be elucidated. There is accumulating evidence from in vitro studies with poly- and monoclonal antiphospholipid antibodies that these autoantibodies are able to interfere with all aspects of the hemostatic balance. Influences of antiphospholipid antibodies on plasmatic processes of the coagulation cascade as well as antithrombotic and fibrinolytic mechanisms are described. Furthermore, antiphospholipid antibodies are able to exert prothrombotic effects on cells participating in hemostasis, mainly platelets and endothelial cells. THERAPEUTIC APPROACHES: Therapeutic approaches to the antiphospholipid syndrome today are mainly restricted to the prevention of further thrombosis by permanent anticoagulation. Although 30-50% of all patients, according to the literature, with moderately to highly elevated antiphospholipid antibody titers develop the clinical symptoms of the syndrome, there are only few studies investigating the benefits of a prophylactic anticoagulation of the affected patients. There is an urgent need for prospective clinical studies to clarify this question. Therapy of nonthrombotic manifestations of the antiphospholipid syndrome are scarcely standardized. In obstetrics, treatment with aspirin, heparin and steroids is the main approach. Here also controlled studies are restricted to small numbers of patients and are therefore of limited validity.

Antibodies, Anticardiolipin↗

Diabetes incidence in children of different nationalities: an epidemiological approach to the pathogenesis of diabetes.

AIMS/HYPOTHESIS: Incidence studies of children with Type I (insulin-dependent) diabetes mellitus and different ethnic backgrounds are known to provide important insights into the pathogenesis of the disease. For this reason, we compared the incidence rate in Baden-Württemberg, Germany, of children who were not of German descent with that of German children as well as with the reported incidence rates pertaining to the countries of origin of the children who were not of German descent. METHODS: Our study was based on the Baden-Württemberg incidence register, part of the EURODIAB TIGER network, which includes 2,121 children aged 0-14 years, diagnosed as having Type I diabetes between 1987 and 1997. The study covered a population at risk of 1.8 million children, which represents 13.3% of the total number of children in Germany. RESULTS: The total incidence rate was found to be 12.5 per 100,000 per year (95 %-CI 12.0-13.0); for German children alone it was calculated as 13.5 (95%-CI 12.9-14.1) and for children who were not of German descent it was significantly lower at 6.9 per 100,000 per year (95%-CI 5.8-8.0). The percentage of children who were not of German descent with Type I diabetes (8.3 %) is smaller than that among the general population (15.2%). Children from former Yugoslavia, Italy and Greece had incidence rates closer to their countries of origin than to the incidence rate of German children. CONCLUSION/INTERPRETATION: Our findings indicate that genetic factors play a predominant role in the pathogenesis of Type I diabetes. However, the influence of certain aspects of life-style, which remain constant even after immigration, cannot be excluded.

Adolescent↗

Epinephrine, but not dexamethasone, induces apoptosis in retinal pigment epithelium cells in vitro: possible implications on the pathogenesis of central serous chorioretinopathy.

BACKGROUND: The pathogenesis of central serous chorioretinopathy is poorly understood. It is believed to be due to dysfunction of the retinal pigment epithelium and/or choroid and has been associated with elevated levels of epinephrine and administration of corticosteroids. Epinephrine and corticosteroids have previously been shown to induce apoptosis (programmed cell death) in various types of cells. The objective of this study was to investigate whether these agents can induce apoptosis in cultured retinal pigment epithelium cells. This may help elucidate the pathogenesis of central serous chorioretinopathy. METHODS: Third-passage porcine retinal pigment epithelium cells were grown to confluence and incubated for 1-7 days in culture medium containing epinephrine (10(2)-10(9) pg/ml) or a corticosteroid, dexamethasone (4-4x10(4) ng/ml). The cultures were evaluated for apoptosis by phase-contrast microscopy and in situ terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling. RESULTS: Epinephrine (7x10(7)-10(9) pg/ml) induced apoptosis in a dose- and time-dependent manner. Exposure to lower concentrations of epinephrine (10(2)-6x10(7) pg/ml) and all tested levels of dexamethasone did not result in apoptosis. CONCLUSION: Retinal pigment epithelium cells may undergo apoptosis following exposure to elevated levels of epinephrine. These findings suggest a possible pathophysiologic mechanism for the development of central serous chorioretinopathy.

Animals↗

The potential role of the Arthus and Shwartzman reactions in the pathogenesis of pneumonic pasteurellosis.

Pneumonic pasteurellosis (PP) is an economically important disease in cattle, sheep, and goats. Pasteurella haemolytica is commonly isolated from the severe fibrinopurulent pneumonia that characterize this respiratory syndrome. During infection, the bacteria produce leukotoxin (LKT) and lipopolysaccharide (LPS), both potent inducers of inflammation. Nonetheless, it has also been demonstrated that an exacerbated host's inflammatory response is responsible for the severe lung damage. Despite research in this field, the pathogenesis of PP is still incomplete. Two classical models of acute inflammatory response induced in laboratory animals, the Arthus and Shwartzman reactions, could explain the pathogenesis of the severe lung lesions that characterize PP.

Animals↗

Pathogen, host and environmental factors contributing to the pathogenesis of listeriosis.

Listeriosis is a severe human and animal disease caused by two species of pathogenic bacteria from the genus Listeria, L. monocytogenes and L. ivanovii. In humans, listeriosis is overwhelmingly a foodborne disease, yet much remains to be learned regarding the transmission dynamics of pathogenic Listeria from the environment, through food, to humans. Similarly, our understanding of the various host, pathogen and environmental factors that impact the pathogenesis of listeriosis at the cellular and molecular level is incomplete. This review will summarize what is currently known about animal and human listeriosis, detail the pathogen, host and environmental factors that contribute to pathogenesis and, finally, examine the interactions among those factors that influence the occurrence of human infection.

Animals↗

Unraveling the pathogenesis of Parkinson's disease--the contribution of monogenic forms.

The field of Parkinson's disease pathogenesis is rapidly evolving from the one of a monolithic and obscure entity into the one of a complex scenario with several known molecular players. The ongoing systematic exploration of the genome holds great promise for the identification of the genetic factors conferring susceptibility to the common non-Mendelian forms of this disease. However, most of the progress of the last 5 years has come from the successful mapping and cloning of genes responsible for rare Mendelian variants of Parkinson's disease. These discoveries are providing tremendous help in understanding the molecular mechanisms of this devastating disease. Here we review the genetics of the monogenic forms of Parkinson's disease. Moreover, we focus on the mechanisms of disease caused by alpha-synuclein and parkin mutations, and the implications of this growing body of knowledge for understanding the pathogenesis of the common forms of the disease.

Humans↗

Genetics and molecular pathogenesis of mitochondrial respiratory chain diseases.

Dysfunction of the mitochondrial respiratory chain has been recognised as a cause of human disease for over 30 years. Advances in the past 10 years have led to a better understanding of the genetics and molecular pathogenesis of many of these disorders. Over 100 primary defects in mitochondrial DNA (mtDNA) are now implicated in the pathogenesis of a group of disorders which are collectively known as the mitochondrial encephalomyopathies, and which most frequently involve skeletal muscle and/or the central nervous system. Although impaired oxidative phosphorylation is likely to be the final common pathway leading to the cellular dysfunction associated with such mtDNA mutations, the complex relationship between genotype and phenotype remains largely unexplained. Most of the genes which encode the respiratory chain reside in the nucleus, yet only five nuclear genes have been implicated in human respiratory chain diseases. There is evidence that respiratory chain dysfunction is present in common neurological diseases such as Parkinson's disease and Huntington's disease. The precise cause of this respiratory chain dysfunction and its relationship to the disease process are unclear. This review focuses upon respiratory chain disorders associated with primary defects in mtDNA.

Base Sequence↗

Molecular pathogenesis of apolipoprotein E-mediated amyloidosis in late-onset Alzheimer's disease.

Apolipoprotein E (apoE) epsilon4 allele is a genetic risk factor for late-onset familial and sporadic Alzheimer's disease (AD). In the central nervous system, apoE is secreted mainly by astrocytes as a constituent of high-density lipoproteins. A recent study using apoE knockout mice provided strong evidence that apoE promotes cerebral deposition of amyloid beta protein (Abeta). However, no clear explanation of the pathogenesis of apoE-induced AD has been provided. Here we discuss two possible mechanisms by which apoE might enhance Abeta deposition. One is the intracellular pathway in which apoE is internalized by neurons and induces lysosomal accumulation of Abeta and amyloidogenic APP (amyloid precursor protein) fragments, leading to neuronal death. The other is the extracellular pathway in which apoE-containing lipoproteins are trapped by Abeta1-42 deposits mobilizing soluble Abeta peptides and consequently enlarge amyloid plaques. These two mechanisms may operate at different stages of AD pathogenesis and suggest a chaperone-like function for the apoE molecule

Age of Onset↗

[Prevalence and pathogenesis of aortic valve calcifications].

BACKGROUND: Calcific aortic valve disease is present in more than 25% of patients > 65 years of age and is associated with a 50% increased risk of cardiovascular events. The clinical significance of aortic valve calcification detected incidentally by radiologic examinations, especially on CT scans of the chest, was unknown. Concerning the multifactorial pathogenesis of aortic valve calcification, recent data indicate that, besides other factors, also the regulators of calcification play a key role in the disease process. PURPOSE: This study aims to give an overview of the prevalence and clinical significance of incidentally detected aortic valve calcifications. Moreover, the role calcification inhibitors in the pathogenesis of aortic valve calcification is discussed.

Adult↗