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On the origin of self-incompatibility haplotypes: transition through self-compatible intermediates.

Self-incompatibility (SI) in flowering plants entails the inhibition of fertilization by pollen that express specificities in common with the pistil. In species of the Solanaceae, Rosaceae, and Scrophulariaceae, the inhibiting factor is an extracellular ribonuclease (S-RNase) secreted by stylar tissue. A distinct but as yet unknown gene (provisionally called pollen-S) appears to determine the specific S-RNase from which a pollen tube accepts inhibition. The S-RNase gene and pollen-S segregate with the classically defined S-locus. The origin of a new specificity appears to require, at minimum, mutations in both genes. We explore the conditions under which new specificities may arise from an intermediate state of loss of self-recognition. Our evolutionary analysis of mutations that affect either pistil or pollen specificity indicates that natural selection favors mutations in pollen-S that reduce the set of pistils from which the pollen accepts inhibition and disfavors mutations in the S-RNase gene that cause the nonreciprocal acceptance of pollen specificities. We describe the range of parameters (rate of receipt of self-pollen and relative viability of inbred offspring) that permits the generation of a succession of new specificities. This evolutionary pathway begins with the partial breakdown of SI upon the appearance of a mutation in pollen-S that frees pollen from inhibition by any S-RNase presently in the population and ends with the restoration of SI by a mutation in the S-RNase gene that enables pistils to reject the new pollen type.

Evolution, Molecular↗

The mutated S1-haplotype in sour cherry has an altered S-haplotype-specific F-box protein gene.

Gametophytic self-incompatibility (GSI) is an outcrossing mechanism in flowering plants that is genetically controlled by 2 separate genes located at the highly polymorphic S-locus, termed S-haplotype. This study characterizes a pollen part mutant of the S(1)-haplotype present in sour cherry (Rosaceae, Prunus cerasus L.) that contributes to the loss of GSI. Inheritance of S-haplotypes from reciprocal interspecific crosses between the self-compatible sour cherry cultivar Ujfehértói Fürtös carrying the mutated S(1)-haplotype (S(1)'S(4)S(d)S(null)) and the self-incompatible sweet cherry (Prunus avium L.) cultivars carrying the wild-type S(1)-haplotype revealed that the mutated S(1)-haplotype confers unilateral incompatibility with a functional pistil component and a nonfunctional pollen component. The altered sour cherry S(1)-haplotype pollen part mutant, termed S(1)', contains a 615-bp Ds-like element within the S(1)-haplotype-specific F-box protein gene (SFB(1)'). This insertion generates a premature in-frame stop codon that would result in a putative truncated SFB(1) containing only 75 of the 375 amino acids present in the wild-type SFB(1). S(1)' along with 2 other previously characterized Prunus S-haplotype mutants, S(f) and S(6m), illustrate that mobile element insertion is an evolutionary force contributing to the breakdown of GSI.

Alleles↗

Nectar sources and age structure in a population of Aedes provocans (Diptera: Culicidae).

Gonotrophic-age structure of a population of Aedes provocans (Walker) and nectar sources used by adults were studied for 2 yr at a field site near Belleville, Ontario, Canada. Females emerged during a short period, and aging of the population was highly synchronous. Complete parity of the population was achieved within about 17 d in 1978 and 27 d in 1979. Some females completed as many as four gonotrophic cycles. This synchronous pattern of population aging is compared with patterns in other species of snow-melt Aedes, which typically age much more gradually. The pattern of synchronous aging permitted estimation of daily mortality rates from an index of population size derived from human-bait catches; peaks in the biting index were related to each gonotrophic cycle in the population. Nectar sources for adults were ranked according to abundance and the extent to which they were used by Ae. provocans, permitting a coarse, semiquantitative estimate of preferences. Ae. provocans obtained nectar from the extrafloral nectaries of one species and the floral nectaries of 19 species of angiosperms. Shrubs and trees, especially of the Rosaceae (primarily species of Prunus), were particularly important as nectar sources and bloomed concurrently with the appearance of nulliparous females. Sharp declines in the population of Ae. provocans were associated with the cessation of blooming of these plant species. It is hypothesized that the highly synchronous pattern of gonotrophic aging in Ae. provocans was attributable, in part, to the ready availability of nectar sources and bloodmeal hosts near breeding sites.

Aedes↗

Serum beta-glucuronidase activity is inversely associated with plant-food intakes in humans.

Beta-glucuronidase hydrolyzes glucuronide moieties from steroids and xenobiotics, such that circulating glucuronyl conjugates can interact with target tissues. In animal models, dietary constituents can alter beta-glucuronidase activity. In humans, serum beta-glucuronidase activity reflects liver enzyme loss during cell turnover, and thus is a surrogate for hepatic beta-glucuronidase. We recruited 83 men and 120 women, who were nonsmokers, 20-40 y of age, with self-reported vegetable and fruit (V&F) intakes of < or = 2.5 or > or = 4.5 servings/d. Diet was assessed by 3-d food record and serum carotenoids were measured as biomarkers of V&F intake (e.g., servings V&F vs. alpha-carotene; r = 0.47, P = 0.0001). Serum beta-glucuronidase activity (Modified Sigma Units/L), determined in blood samples collected on two consecutive days from fasting subjects, was higher in men than women (mean +/- SEM: 20.4 x 10(3) +/- 1.0 x10(3) and 17.0 x 10(3) +/- 0.6 x 10(3), P = 0.002). beta-Glucuronidase activity (adjusted for sex) was inversely associated with intakes of plant protein, fruit, dietary fiber (r = -0.24 to -0.30; P < 0.001), botanical groupings Cucurbitaceae, Rosaceae, and Leguminosae (r = -0.16 to -0.19; P < 0.05), and serum alpha- and beta-carotene and beta-cryptoxanthin (r = -0.18 to -0.26; P < or = 0.01). Activity was not associated with overall vegetable intake. Although these associations are modest, the data suggest that plant foods, particularly constituents of fruits and fiber-containing foods, may influence human beta-glucuronidase activity in a potentially favorable direction.

Adult↗

Identification and partial amino acid sequences of seven S-RNases associated with self-incompatibility of Japanese pear, Pyrus pyrifolia Nakai.

S-allele-specific proteins (S-proteins) were separated and identified by two-dimensional (2D) gel electrophoresis from the style extract of 14 cultivars of Japanese pear, Pyrus pyrifolia Nakai, which exhibits gametophytic self-incompatibility. These S-proteins were 30-32 kDa basic proteins with putative pIs of 9.6-10.1 and were distinct from the other proteins, which were common for all cultivars examined. Each S-protein was assigned to a given S-genotype based on electrophoretic mobility and the partial amino acid sequence. For S1- to S7-proteins, five different N-terminal amino acid sequences sharing the YFQFTQQY sequence were determined. Since the same N-terminal amino acid sequences were found for both S1- and S7-proteins, and for S3- and S5-proteins, the two S-proteins of each pair were distinguished based on their electrophoretic behavior. The internal amino acid sequences of S2- and S4-proteins, determined for Achromobacter protease I (API) digests, revealed that these proteins are S2- and S4-RNases, respectively. In the cultivar Nijisseiki, these two RNases were expressed from the white bud to mature flower stages when the cultivar acquires and enforces self-incompatibility. Osa-nijisseiki, a self-compatible mutant of Nijisseiki, produced S2-RNase, but did not produce S4-RNase. The absence of S4-RNase was also observed in self-compatible offsprings derived from Osa-Nijisseiki. These results suggest that Japanese pear in the family Rosaceae possesses a gametophytic self-incompatibility system involving an S-RNase, and that a reduction or lack of expression of S4-RNase in the style is responsible for the self-compatibility of Osa-Nijisseiki.

Alleles↗

Molecular cloning and nucleotide sequences of cDNAs encoding S-allele specific stylar RNases in a self-incompatible cultivar and its self-compatible mutant of Japanese pear, Pyrus pyrifolia Nakai.

The genes encoding three RNases were cloned from the style of a self-incompatible cultivar, Nijisseiki (S2S4), and its self-compatible mutant, Osa-Nijisseiki (S2S4sm, sm means stylar part mutant), of Japanese pear. For Nijisseiki, cDNAs coding for two S-RNase (S2-RNase and S4-RNase) and an RNase unrelated to self-incompatibility (non-S-RNase) were cloned from the stylar cDNA library. The cDNAs coding for S2-RNase, S4-RNase, and non-S-RNase include 678-, 684-, and 681-bp open reading frames, respectively. Their deduced amino acid sequences were composed of signal peptides and mature RNases (201-203 residues) which were verified by partial amino acid sequencing. The primary structures of mature proteins revealed that these RNases are of the RNase T2 type; only the two S-RNases have several potential N-glycosylation sites and 60% of their amino acid residues are identical, compared with 25% sequence identity with the non-S-RNase. Such a distinct difference in the primary structures between S-RNases and non-S-RNase has not previously been reported and may be a feature typical of S-RNases in the family Rosaceae. Similar experiments were performed for Osa-Nijisseiki. The cDNAs coding for S2-RNase and non-S-RNase were similarly cloned from the stylar cDNA library. However, the cDNA coding for S4-RNase was neither amplified by PCR nor cloned from the library, suggesting that the mutation of self-incompatible Nijisseiki to self-compatible Osa-Nijisseiki is due to a failure of expression of S4-RNase. These results lead to the idea that Osa-Nijiisseiki is a variant of Nijisseiki in which the S4-allelic gene in the S-locus is exclusively mutated or deleted, causing severely impaired or suppressed expression of its gene product, S4-RNase, at the style.

Alleles↗

S-RNase-mediated gametophytic self-incompatibility is ancestral in eudicots.

The evolutionary relationship between self-incompatibility systems in different families of flowering plants has long been a topic of interest. Physiological differences in the mode of gene action and the enormous sequence differences between genes with different modes of action suggest that many instances of self-incompatibility have arisen independently. In contrast, previous analyses of the S-RNase associated with gametophytic self-incompatibility in the eudicot families (Solanaceae, Scrophulariaceae, and Rosaceae) have suggested that sequences within families form well-supported and distinct lineages. In this study we demonstrate that in fact, S-RNase-mediated gametophytic self-incompatibility evolved only once in the eudicots.

Magnoliopsida↗

Gene expression during cold acclimation in strawberry.

To elucidate the molecular basis of cold acclimation in strawberry (Fragaria x anannassa), we have begun studies to identify genes associated with low temperature (LT) acclimation. Differential screening of a cDNA library prepared from cold-acclimated strawberry plants allowed us to isolate several cDNAs showing differential expression at LT. Northern analysis showed that the transcript level of Fcor1 (Fragaria Cold-Regulated) peaked after 2 days of LT exposure while that of Fcor2 peaked after 2 weeks. On the other hand, the level of Fcor3 transcript decreased within 24 hours of LT exposure and remained low during the 8 weeks acclimation period. Fcor1 and Fcor2 are expressed in all tissues while Fcor3 is specific to leaves. The Fcor1-encoded protein has a compositional bias for leucine, isoleucine, glycine, proline and serine. This protein shares homology with the proteins encoded by blt101, a LT-responsive gene from barley, and ESI3, a gene induced by salt stress in Lophopyrum. The FCOR2 protein is rich in lysine, leucine, valine, alanine and arginine, and shows no homology with any known gene products. The partial Fcor3 cDNA clone encodes a polypeptide that shows a very high identity with the spinach PSI subunit V and with the PSI PsaG polypeptide from barley. The level of Fcor1 transcript accumulation is correlated with the freezing tolerance of the strawberry cultivars used in our study. This suggests that Fcor1 may be useful as a molecular marker to select for this trait in resulted species of the Rosaceae family.

Acclimatization↗

Sorbitol synthesis in transgenic tobacco with apple cDNA encoding NADP-dependent sorbitol-6-phosphate dehydrogenase.

The apple (Malus domestica) cDNA encoding NADP-dependent sorbitol-6-phosphate dehydrogenase (S6PDH) was stably integrated and expressed in transgenic tobacco (Nicotiana tabacum cv. SR1). Expression of the cDNA in either a sense or antisense orientation was accomplished using cauliflower mosaic virus regulatory sequences (CaMV35S). Sorbitol synthesis was confirmed by gas-chromatography-mass-spectroscopy (GC-MS). Sorbitol concentration in the leaves of the transgenic plants expressing the sense orientation varied from 186 to 446 nmol (g fr wt)-1. The concentration positively correlates with S6PDH activity in leaves. Neither sorbitol nor S6PDH activity was detected in the extracts of nontransformed tobacco or transgenic tobacco expressing the antisense orientation. These results provide key genetic evidence that S6PDH expression is sufficient for the synthesis of sorbitol in tobacco, implicating it as a key enzyme in the sorbitol biosynthetic pathway in apple and perhaps other members of the woody Rosaceae.

Base Sequence↗

Phylogenetic analyses of DNA and allozyme data suggest that Gonioctena leaf beetles (Coleoptera; Chrysomelidae) experienced convergent evolution in their history of host-plant family shifts.

A phylogenetic analysis of the genus Gonioctena (Coleoptera, Chrysomelidae) based on allozyme data (17 loci) and mitochondrial DNA sequence data (three gene fragments, 1,391 sites) was performed to study the evolutionary history of host-plant shifts among these leaf beetles. This chrysomelid genus is characteristically associated with a high number of different plant families. The diverse molecular data gathered in this study are to a large extent congruent, and the analyses provide a well-supported phylogenetic hypothesis to address questions about the evolution of host-plant shifts in the genus Gonioctena. The most-parsimonious reconstruction of the ancestral host-plant associations, based on the estimated phylogeny, suggests that the Fabaceae was the ancestral host-plant family of the genus. Although most of the host-plant shifts (between different host species) in Gonioctena have occurred within the same plant family or within the same plant genus, at least eight shifts have occurred between hosts belonging to distantly related and chemically dissimilar plant families. In these cases, host shifts may have been simply directed toward plant species available in the environment. Yet, given that two Gonioctena lineages have independently colonized the same three new plant families (Salicaceae, Betulaceae, Rosaceae), including four of the same new genera (Salix, Alnus, Prunus, Sorbus), some constraints are likely to have limited the different possibilities of interfamilial host-plant shifts.

Animals↗

Low temperature, but not photoperiod, controls growth cessation and dormancy induction and release in apple and pear.

In contrast to most temperate woody species, apple and pear and some other woody species of the Rosaceae family are insensitive to photoperiod, and no alternative environmental seasonal signal is known to control their dormancy. We studied growth and dormancy induction in micropropagated plants of four apple (Malus pumila Mill.) and one pear (Pyrus communis L.) commercial rootstock cultivars in controlled environments. The results confirm that growth cessation and dormancy induction in apple and pear are not influenced by photoperiod, and demonstrate that low temperature (< 12 degrees C) consistently induces both processes, regardless of photoperiodic conditions. Successive stages of the autumn syndrome (growth cessation, formation of bud scales and winter buds, leaf senescence and abscission, and dormancy induction) occurred in response to low temperature. Long days increased internode length at higher temperatures, but had no significant effect on leaf production in any of the cultivars. Chilling at 6 or 9 degrees C for at least 6 weeks (about 1000 h) was required for dormancy release and growth resumption, whereas treatment at 12 degrees C was marginally effective, even after 14 weeks of exposure. We are thus faced with the paradox that the same low temperature conditions that induce dormancy are also required for dormancy release in these species.

Cold Temperature↗

Scaling of angiosperm xylem structure with safety and efficiency.

We tested the hypothesis that greater cavitation resistance correlates with less total inter-vessel pit area per vessel (the pit area hypothesis) and evaluated a trade-off between cavitation safety and transport efficiency. Fourteen species of diverse growth form (vine, ring- and diffuse-porous tree, shrub) and family affinity were added to published data predominately from the Rosaceae (29 species total). Two types of vulnerability-to-cavitation curves were found. Ring-porous trees and vines showed an abrupt drop in hydraulic conductivity with increasing negative pressure, whereas hydraulic conductivity in diffuse-porous species generally decreased gradually. The ring-porous type curve was not an artifact of the centrifuge method because it was obtained also with the air-injection technique. A safety versus efficiency trade-off was evident when curves were compared across species: for a given pressure, there was a limited range of optimal vulnerability curves. The pit area hypothesis was supported by a strong relationship (r2 = 0.77) between increasing cavitation resistance and diminishing pit membrane area per vessel (A(P)). Small A(P) was associated with small vessel surface area and hence narrow vessel diameter (D) and short vessel length (L)--consistent with an increase in vessel flow resistance with cavitation resistance. This trade-off was amplified at the tissue level by an increase in xylem/vessel area ratio with cavitation resistance. Ring-porous species were more efficient than diffuse-porous species on a vessel basis but not on a xylem basis owing to higher xylem/vessel area ratios in ring-porous anatomy. Across four orders of magnitude, lumen and end-wall resistivities maintained a relatively tight proportionality with a near-optimal mean of 56% of the total vessel resistivity residing in the end-wall. This was consistent with an underlying scaling of L to D(3/2) across species. Pit flow resistance did not increase with cavitation safety, suggesting that cavitation pressure was not related to mean pit membrane porosity.

Biological Transport↗

Iatrogenic limbal stem cell deficiency.

PURPOSE: To describe a group of patients with limbal stem cell (SC) deficiency without prior diagnosis of a specific disease entity known to be causative of SC deficiency. METHODS: We performed a retrospective review of the records of all patients with ocular surface disease seen at the University of Minnesota between 1987 and 1996. Patients were categorized according to origin of limbal deficiency. Patients who did not have a specific diagnosis previously described as being causative of limbal deficiency were analyzed. Risk factors, clinical findings, and sequelae were evaluated. RESULTS: Fourteen eyes of 12 patients with SC deficiency not caused by a known diagnosis were described. All eyes had prior ocular surgery involving the corneoscleral limbus. Eleven eyes had been receiving long-term topical medications, and all eyes had concurrent external disease such as pterygium, keratoconjunctivitis sicca, rosacea, herpes simplex virus keratitis, or aphakic or pseudophakic corneal edema. All eyes had superior quadrants affected, corresponding to areas of prior limbal surgery. Sequelae of disease included corneal scarring and neovascularization, with seven eyes having visual acuity of 20/150 or worse. CONCLUSION: Because the epitheliopathy started peripherally and extended centrally in all patients, we believe it represents an SC deficiency. The fact that all patients were affected superiorly, at sites of a prior limbal surgical incision, points to surgical trauma to the SC as the likely major etiologic factor for the deficiency. The surgical trauma to the limbal SC probably made these cells more susceptible to damage from other external disease influences and toxicity from long-term topical medications. Because the SC deficiency is the result of prior ocular surgery and long-term topical medications, we propose the term "iatrogenic limbal stem cell deficiency."

Adult↗

Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation.

PURPOSE: To determine which subjective assessments and objective tests have clinical utility as diagnostic tools in ocular irritation associated with Sjögren's syndrome-related aqueous tear deficiency (ATD), non-Sjögren ATD, inflammatory meibomian gland disease (MGD) associated with rosacea, and atrophic MGD. METHODS: Forty adults with ocular irritation and 10 with normal ocular surfaces were enrolled in a nonrandomized, nonblinded clinical trial. Symptoms were evaluated. Tests included biomicroscopy; evaluation of tear-film integrity, production, and clearance; fluorescein and rose bengal staining; and serum autoantibody screening. RESULTS: Symptoms were similar among groups and most severe in the Sjögren's group. Fluorescein tear break-up time was significantly faster in the ATD and MGD groups than that in controls. Schirmer scores were significantly lower in the ATD group than those in MGD and control groups. Tear clearance was delayed in the ATD and atrophic MGD groups. Xeroscope grid distortion was noted only with ATD. The Sjögren's group had greater loss of naso-lacrimal reflex, slower fluorescein clearance, and greater ocular-surface fluorescein and rose bengal staining than did the others. More MGD subjects had meibomian gland orifice metaplasia and acinar dropout than did those with Sjögren-related ATD and controls. Schirmer scores correlated inversely with rose bengal staining, corneal fluorescein staining, and grid distortion. Rose bengal staining correlated with grid distortion and loss of nasal-lacrimal reflex, but not with MGD. CONCLUSION: Subjective assessments and objective diagnostic tests have clinical utility as diagnostic tools in tear-film disorders. ATD is correlated with ocular-surface disease. An algorithm summarizing the diagnostic utility of these tests is included.

Adolescent↗

Limbal stem cell deficiency following phototherapeutic keratectomy.

PURPOSE: To describe a case of limbal stem cell (LSC) deficiency following phototherapeutic keratectomy (PTK). METHODS: We analyzed the case of a 67-year-old man who developed LSC deficiency in his left eye following PTK for recurrent epithelial erosions. Predisposing factors included diabetes mellitus and rosacea. RESULTS: Surgical treatment consisted of debridement of the diseased corneal epithelium, followed by limbal autografting from the fellow eye. The cornea healed and remained transparent after 1 year. Histologic examination confirmed the diagnosis of LSC deficiency, showing the presence of goblet cells and inflammatory cells within the epithelium. CONCLUSION: The extensive corneal mechanical debridement and laser photoablation incurred during phototherapeutic keratectomy can cause clinical LSC deficiency in patients with predisposing external diseases.

Aged↗

Blepharoconjunctivitis.

Most patients with chronic blepharoconjunctivitis will fall into one of the four seborrheic groups or the primary meibomianitis group. With all of these, there appears to be a predisposition to develop an abnormality in sebaceous glands, as manifested by the fact that such patients have clinically diagnosable seborrheic dermatitis or acne rosacea. These patients tend to develop an abnormality of either the anterior portion of the eyelid with involvement of the gland of Zeis or the posterior portion of the eyelid with involvement of the meibomian glands. Patients in the staphylococcal group are typically younger, a higher percentage are female, and they have a history of symptoms for a relatively shorter period of time. It is only in this latter group that one can hope for a cure with therapy, whereas in the other groups one must aim for control of the disease process. The diagnosis of the various types of blepharoconjunctivitis is important not only because it directs therapy, but also because it gives both the physician and patient an idea about the prognosis. Laboratory evaluation in these patients appears to be of limited value; only in the staphylococcal and mixed seborrheic-staphylococcal group is a pathogen found in the form of S. aureus. The other organism that may contribute directly to disease is S. epidermidis. The antibiotic susceptibility patterns of these two organisms are fairly consistent, and so it is not necessary to culture them to determine antibiotic sensitivities: The majority are sensitive to both bacitracin and erythromycin ointments, as well as the aminoglycosides. Attempts to identify Demodex or to obtain conjunctival scrapings for cytology have not proved helpful. Therefore, the diagnosis is a clinical one and, from a practical standpoint, laboratory evaluation is not required for either diagnosis or management. Therapy for each case of chronic blepharoconjunctivitis must be tailored to the individual and based on the type and severity of blepharoconjunctivitis present. The mainstays in therapy are mechanical and hygienic (i.e., warm compresses and eyelid scrubs ). The use of topical antibiotics must be based on the sensitivities of the likely pathogens (i.e., S. aureus and S. epidermidis). Therefore, while sulfonamides would not appear to be appropriate therapy, bacitracin, erythromycin, or the aminoglycosides are effective antibiotics. The therapy is topical, with the exception of the rare and more severe case of seborrheic blepharoconjunctivitis with secondary meibomianitis and all cases of primary meibomianitis (meibomian keratoconjunctivitis).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

Helicobacter pylori infection is markedly increased in patients with autoimmune atrophic thyroiditis.

Infection by viral or bacterial pathogens has been suspected in playing a role in the development of autoimmune thyroid disease. Because Helicobacter pylori might be involved in the development of nongastrointestinal conditions such as rosacea, ischemic heart disease, and diabetes mellitus, we evaluated the prevalence of H. pylori infection in patients with autoimmune thyroid disease. Fifty-nine patients with autoimmune thyroid disease were included: autoimmune atrophic thyroiditis (n=21), Hashimoto's thyroiditis (n=18), and Graves' disease (n=20). Twenty patients with nontoxic multinodular goiter served as controls for nonautoimmune thyroid disease, and 11 patients with Addison's disease served as controls for nonthyroid endocrine autoimmune disease. The levels of anti-H. pylori immunoglobulin G (IgG) were determined, and a radiolabeled urea breath test were performed. The prevalence of H. pylori infection was markedly increased in the patients with autoimmune atrophic thyroiditis (85.7%), compared with the controls with nontoxic multinodular goiter (40%) and Addison's disease (45.4%). Infection by H. pylori resulted in increased levels of gastrin, pepsinogen I, and pepsinogen II in the H. pylori-positive groups, compared with the H. pylori-negative groups. A positive linear regression was found between the levels of microsomal autoantibodies and those of anti-H. pylori IgG in patients with autoimmune atrophic thyroiditis (n=21; r=0.79; p < 0.01). Finally, and although the overall prevalence of H. pylori infection was not increased, the anti-H. pylori IgG levels and the results from the breath test were higher in the patients with Graves' disease and Hashimoto's thyroiditis patients than in the controls. Clearly, the prevalence of H. pylori infection is increased in autoimmune atrophic thyroiditis and results in abnormalities of gastric secretory function. The strong relation between the levels of anti-H. pylori IgG and the levels of microsomal antibodies suggests that H. pylori antigens might be involved in the development of autoimmune atrophic thyroiditis or that autoimmune function in autoimmune atrophic thyroiditis may increase the likelihood of H. pylori infection.

Addison Disease↗

Mooren's ulcer.

BACKGROUND: Mooren's ulcer is a rapidly progressive, painful, ulcerative keratitis which initially affects the peripheral cornea and may spread circumferentially and then centrally. Mooren's ulcer can only be diagnosed in the absence of an infectious or systemic cause and must be differentiated from other corneal abnormalities, such as Terrien's degeneration. Although the etiology remains unknown, recent research has proposed an underlying immune process and a possible association with the hepatitis C virus. The response to medical and surgical intervention is typically poor, and the visual outcome can be devastating. CASE SERIES: Three patients presented to our clinic with inferior peripheral corneal defects characteristic of Mooren's ulceration. The first patient, a 67-year-old white male, presented with an area of progressive peripheral thinning of the left inferior cornea 1 week after a preoperative skin cleanser was inadvertently splashed in both eyes. This occurred during a surgical procedure to remove a basal cell carcinoma. The second patient, a 56-year-old white male, was treated for a recurrent left inferior corneal ulcer with impending risk of perforation. The third patient was a 68-year-old white male referred for a painful left inferior peripheral ulcer, which rapidly progressed into a bilateral corneal melt disorder. All patients were diagnosed with Mooren's ulcerative keratitis after they underwent extensive medical and laboratory testing to rule out an infectious or systemic cause of their corneal melt. The first patient was treated with oral steroids, as well as doxycycline, to control his acne rosacea. The second patient responded to aggressive treatment with topical steroid therapy. This patient also tested positive for hepatitis C. The third patient rapidly developed a perforated left cornea and was treated with a penetrating keratoplasty after a patch graft had failed. DISCUSSION: Mooren's ulcer is an idiopathic, painful, progressive ulceration of the peripheral cornea. These ulcers usually respond poorly to conventional therapy, as there is limited knowledge of the pathophysiology of the disease. Evidence of an autoimmune component advocates the use of steroids and immunosuppressive agents. With further research and understanding of Mooren's ulcer, better treatment options may be available in the future.

Aged↗