Comparison of Efficacy and Safety of Ciclosporin to Prednisolone in the Treatment of Erythema Nodosum Leprosum: Two Randomised,Double Blind,Controlled Pilot Studies in Ethiopia

Background

Erythema Nodosum Leprosum (ENL) is a serious complication of leprosy. It is normally treated with high dose steroids, but its recurrent nature leads to prolonged steroid usage and associated side effects. There is little evidence on the efficacy of alternative treatments for ENL, especially for patients who have become steroid resistant or have steroid side effects. These two pilot studies compare the efficacy and side effect profile of ciclosporin plus prednisolone against prednisolone alone in the treatment of patients with either new ENL or chronic and recurrent ENL.

Methods and Results

Thirteen patients with new ENL and twenty patients with chronic ENL were recruited into two double-blinded randomised controlled trials. Patients were randomised to receive ciclosporin and prednisolone or prednisolone treatment only. Patients with acute ENL had a delay of 16 weeks in the occurrence of ENL flare-up episode, with less severe flare-ups and decreased requirements for additional prednisolone. Patients with chronic ENL on ciclosporin had the first episode of ENL flare-up 4 weeks earlier than those on prednisolone, as well as more severe ENL flare-ups requiring 2.5 times more additional prednisolone. Adverse events attributable to prednisolone were more common that those attributable to ciclosporin.

Conclusions

This is the first clinical trial on ENL management set in the African context, and also the first trial in leprosy to use patients’ assessment of outcomes. Patients on ciclosporin showed promising results in the management of acute ENL in this small pilot study. But ciclosporin, did not appear to have a significant steroid–sparing effects in patients with chronic ENL, which may have been due to the prolonged use of steroids in these patients in combination with a too rapid decrease of steroids in patients given ciclosporin. Further research is needed to determine whether the promising results of ciclosporin in acute ENL can be reproduced on a larger scale.     

Microfauna associated with algal mats in melt ponds of the Ross Ice Shelf

Summary The microfauna of benthic algal mats in eight ponds of diverse chemistry on the Ross Ice Shelf was examined. Tardigrades, nematodes and rotifers were successfully extracted from algal material by a modified Baermann funnel technique, which was robust enough to use under field conditions. Seven species of rotifer (of which 6 were bdelloids) and one species of nematode and tardigrade were found, all of which are cosmopolitan to Antarctic lentic ecosystems. Philodina sp. was the only invertebrate to occur in all ponds sampled. Rotifers were the most abundant invertebrates with average densities in all ponds of 4.26×10⁵ individuals/m², whereas nematodes were least abundant with densities of 4.96×10⁴ individuals/m². Total invertebrate densities and densities of individual taxa were significantly different in each of the 8 ponds, and of those measured environmental parameters were most strongly associated with conductivity. Cores taken from four ponds 2 cm into underlying substratum revealed that most animals live within the algal mats, with underlying sediment supporting a minimal population.     

Fatty acid utilization during development of the rat

The effects of dimethyl sulphoxide and glycerol on ox brain microsomal Na(+)+K(+)-stimulated adenosine triphosphatase (EC 3.6.1.3), K(+)-stimulated p-nitrophenyl phosphatase and K(+)-dependent muscle pyruvate kinase (EC 2.7.1.40) were studied. Dimethyl sulphoxide at concentrations below 20% (v/v) was found to stimulate the p-nitrophenyl phosphatase and pyruvate kinase by increasing their affinity for K(+) but to inhibit the Na(+)+K(+)-stimulated adenosine triphosphatase. The latter enzyme activity was also inhibited by glycerol, which like dimethyl sulphoxide, stimulated the K(+)-activated p-nitrophenyl phosphatase at a wide range of concentrations. The solvent effects were promptly reversed by dilution. Similarity was found between glycerol and dimethyl sulphoxide, on one hand, and ATP, on the other, in their stimulatory effect and their ability to increase the ouabain- and oligomycin-sensitivity of the K(+)-stimulated p-nitrophenyl phosphatase. However, only the solvents, not the ATP, increased the binding of K(+) by the microsomes. From the above findings it is suggested that solvents may act on K(+)-dependent enzymes by altering the state of solvation of the activating cation as well as by changing the enzyme structure.     

Studies of glucagon resistance in large rat adipocytes: 125I-labeled glucagon binding and lipolytic capacity

This study is concerned with potential modifications of large fat cells from adult rats (400-450 g) that make them resistant to stimulation by glucagon. The lipolytic capacity and (125)I-labeled glucagon-binding capability of these cells were compared with these properties of small glucagon-sensitive cells from young rats (130-160 g). As determined by maximal stimulation with theophylline, dibutyryl cAMP, or epinephrine, the lipolytic capacity of large cells was not markedly different from small cells, which suggests that an alteration contributing to glucagon insensitivity is not present in the enzymes involved with hormone-mediated lipolysis. Glucagon-binding studies did indicate a difference between the two cell types. Both large cells and particulate fractions from large cells bound less (125)I-labeled glucagon than small cells or small-cell particles. That diminished binding is not a consequence of glucagon degradation is indicated by the similar amounts of (125)I-labeled glucagon degraded by both cell types. The decrease in (125)I-labeled glucagon binding was not as marked as the decrease in lipolytic response to glucagon stimulation. This lack of correlation and the relationship between elevated phosphodiesterase levels and glucagon insensitivity described in the accompanying report suggest that diminished binding explains only in part the marked resistance to glucagon found in large cells.     

Biochemical characterization and messenger specificity of polypeptide chain initiation factors from Escherichia coli

Three protein factors are required for maximum poly(U, G)- or AUG-directed binding of fMet-tRNA to ribosomes. The same three factors are both necessary and sufficient for “natural” mRNA-directed binding of fMet-tRNA to ribosomes. Bound fMet-tRNA cosediments with the 70S ribosome as does bound mRNA. All three factors are required for the fMet-tRNA and GTP-dependent binding of mRNA to the 70S initiation complex.     

The role of cell surface sialic acid in insulin receptor function and insulin action

Removal of cell surface sialic acid from adipocytes with neuraminidase inhibits insulin action. Here, we have examined the effects of mild neuraminidase treatment (5 milliunits/ml, 12 degrees C, 15 min) on insulin receptor structure and function. Neuraminidase treatment sufficient to cause greater than 90% loss of insulin stimulatable lipogenesis had no effect on 125I-insulin binding, tyrosine kinase activity of partially purified insulin receptors, insulin receptor phosphorylation in intact cells, or insulin-induced receptor internalization. However, recycling of the insulin receptor to the plasma membrane was inhibited by 50%. Recycled receptors in neuraminidase-treated cells were unable to mediate insulin action in contrast to recycled receptors from non-neuraminidase-treated cells. Furthermore, when insulin receptors were protected from exposure to neuraminidase, by inducing receptor internalization prior to neuraminidase treatment, the cells were still unable to respond to insulin. Analysis of the alpha and beta subunits of the receptor from neuraminidase-treated cells, affinity-labeled with 125I-insulin, or labeled by autophosphorylation, and subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis failed to indicate any changes in the holoreceptor or the individual subunits. This suggests there was no detectable release of sialic acid from the receptor. From this data we conclude that loss of sialic acid from nonreceptor glycoconjugates leads to loss of insulin action and inhibition of receptor recycling. The insulin receptor does not appear to be involved in this inhibitory effect. These findings suggest that an uncharacterized plasma membrane glycoprotein is essential in transmitting the "signal" of insulin binding to the cellular effector system.     

Prophase chromosome unique band sequences: definition and utilization

Extensive experience with the analysis of human prophase chromosomes and studies into the complexity of prophase banding patterns have suggested that at least some prophase chromosomal segments can be accurately identified and characterized independently of the morphology of the chromosome as a whole. The feasibility of identifying and analyzing specified prophase chromosome segments was thus investigated as an alternative approach to prophase chromosome analysis based on whole-chromosome recognition. Through the use of prophase idiograms at the 850-band stage (Francke, 1981) and a systematic comparison system, we have demonstrated that it is possible to divide the 24 human prophase idiograms into a set of 94 unique band sequences, each of which has a banding pattern that is recognizable and distinct from any other nonhomologous chromosome portion. The use of a unique band sequence approach in prophase chromosome analysis is expected to increase efficiency and sensitivity through more effective use of available banding information.     

Production and HPLC analysis of black tea theaflavins and thearubigins during in vitro oxidation

A model fermentation system has been designed which utilizes pure catechins and partially purified polyphenol oxidase (EC 1.14.18.1 from green tea shoots. HPLC analysis of the products formed during in vitro oxidation has demonstrated a close similarity between this system and in vivo oxidation occurring during factory fermentation. Furthermore, changes in theaflavin and thearubigin levels, revealed by time courses of fermentation, show in vitro and in vivo systems to be qualitatively similar, although the former system produces considerably higher levels of both components. The model fermentation system, therefore, appears to be a suitable experimental system for studying the formation of theaflavin and thearubigin pigments under strictly controlled conditions. In preliminary experiments the theaflavins have been identified on HPLC profiles by enzymic oxidation of the relevant catechin pairs. Similarly, major coloured components other than theaflavins, which are considered to be thearubigins, have been shown to be formed by the oxidation and reaction of two gallocatechins (epigallocatechin and epigallocatechin gallate). The model fermentation system, in conjunction with HPLC as described in this paper, provides a means whereby precise data on theaflavin and thearubigin formation can be obtained and, in the case of the thearubigins, one which could yield additional structural information.