RESUMEN
Previous studies of experimental diabetes have demonstrated changes in the levels of specific salivary proteins. The present study is part of a larger effort aimed at elucidating the mechanism(s) by which insulin regulates salivary protein expression in the rat parotid gland. Diabetes was induced in 2-3-month-old male Fischer 344 rats by injection of streptozotocin (STZ). After 30 days one group of rats was given insulin for 7 days. Untreated rats served as controls. As previously observed, parotid acinar cells from diabetic rats accumulated lipid and contained occasional crystalloid lysosomes. Quantitative immunogold labeling of secretory granules in diabetic glands revealed decreases of 30-60% for proline-rich-proteins (PRPs), amylase and parotid secretory protein (PSP), but labeling for acidic epididymal glycoprotein (AEG) was unchanged. The response to insulin treatment was variable: amylase and PSP labeling were partly restored, but PRP and AEG labeling showed little change. Photoaffinity labeling of cyclic AMP receptor proteins (cARP) showed changes in several tissues including a consistent increase in the diabetic parotid gland. Immunogold labeling of secretory granules with antibody to cARP was similar in control and diabetic parotids, but nuclear and cytoplasmic label was decreased in diabetic acinar cells. These results indicate that STZ-diabetes and insulin reconstitution cause variable changes in the expression of parotid secretory proteins. Changes in cARP levels suggest that the insulin and cyclic AMP pathways may interact in regulating expression of salivary secretory proteins.
Asunto(s)
Diabetes Mellitus Experimental/metabolismo , Glándula Parótida/química , Glándula Parótida/enzimología , alfa-Globulinas/análisis , Amilasas/análisis , Animales , AMP Cíclico/metabolismo , Proteínas Secretorias del Epidídimo , Masculino , Metaloproteínas/análisis , Microscopía Inmunoelectrónica , Glándula Parótida/ultraestructura , Ratas , Ratas Endogámicas F344 , Receptores de AMP Cíclico/análisis , Receptores de AMP Cíclico/metabolismo , Proteínas y Péptidos Salivales/análisis , Hormonas Testiculares/análisisRESUMEN
OBJECTIVES: To isolate and characterize human synovial endothelial cells and to determine the effects of cytokines and fibroblast growth factor on human synovial endothelial (HSE) cell hyaluronic acid production. METHODS: Endothelial cells were isolated from primary cultures of human synovial cells by fluorescent activated cell sorting based on the incorporation of a fluorescent derivative of acetylated low-density lipoprotein (DiI-Ac-LDL). Identity of endothelial cells was confirmed by positive immunostaining for von Willebrand factor (vWf), cytokeratins, endoglin, and reactivity with the lectin ulex europeans agglutinin (UEA). Hyaluronic acid production was measured by a radioligand-binding assay. RESULTS: HSE cells were isolated and maintained in long-term culture. The identity of the cultured cells as endothelial was based on uniform uptake of a (DiI-Ac-LDL), immunoreactivity for vWf, and endoglin and the binding of the lectin UEA. In addition, small blood vessels in the synovium were stained selectively with anticytokeratin antibodies K462 (cytokeratin 19 specific) and K8.13 (reactive for cytokines 1, 5, 6, 7, 8, 10, 11, and 18). Isolated HSE cells also demonstrated immunoreactivity with these cytokeratin antibodies. The cytokeratins identified by the monoclonal antibody clone K8.13 demonstrated a diffuse, fibrillar staining pattern. The cytokeratin distribution revealed with monoclonal antibody K4.62 (cytokeratin 19) was also fibrillar; however, the majority of cells also demonstrated numerous punctuate cytoplasmic vesicular structures. Treatment of HSE cells with interleukin-1 alpha (IL-1 alpha) or acidic fibroblasts growth factor (aFGF), but not tumor necrosis factor (TNF alpha), dramatically reduced the vesicular structures staining with the K4.62 antibody. HSE cells produced hyaluronic acid (HA) at a constitutive rate of 200-800 ng/10(5) cells/24 h, which could be upregulated when the cells were incubated with either IL-1 alpha or aFGF. HA production was not significantly increased when HSE cells were incubated with TNF alpha, IL-4 or interferon-gamma. CONCLUSIONS: Synovial microvascular endothelial cells produce and secrete HA and endothelial HA secretion is upregulated by IL-1 and aFGF. IL-1 and aFGF also reduce the number of vesicular-like structures immunoreactive with a monoclonal antibody to cytokeratin 19. These studies suggest that cytokine stimulation of local endothelial secretion and/or accumulation of HA may influence leukocyte adhesion to the synovial endothelium.
Asunto(s)
Citocinas/farmacología , Endotelio Vascular/metabolismo , Sustancias de Crecimiento/farmacología , Ácido Hialurónico/biosíntesis , Queratinas/biosíntesis , Membrana Sinovial/irrigación sanguínea , Adulto , Anticuerpos Monoclonales/inmunología , Antígenos CD , Biomarcadores , Células Cultivadas , Endoglina , Femenino , Factor 1 de Crecimiento de Fibroblastos/farmacología , Técnica del Anticuerpo Fluorescente , Colorantes Fluorescentes , Humanos , Interleucina-1/farmacología , Lipoproteínas LDL/metabolismo , Microcirculación , Persona de Mediana Edad , Receptores de Superficie Celular , Factor de Necrosis Tumoral alfa/farmacología , Molécula 1 de Adhesión Celular Vascular/análisis , Factor de von Willebrand/análisisRESUMEN
OBJECTIVE: To characterize the effects of interleukin-1 alpha (IL-1) on prostanoid biosynthesis by human rheumatoid synovium microvessel endothelium (HSE). METHODS: HSE cells were treated with cytokines, metabolic inhibitors, and steroids under various conditions, and prostaglandin biosynthesis was determined by radioimmunoassay. Newly synthesized cyclooxygenase (COX) was quantitated by immunoprecipitation of metabolically labeled HSE cell lysates. The effects of IL-1 on levels of messenger RNA (mRNA) for COX II were also determined. RESULTS: IL-1 induced an increase in COX activity (as assessed by prostaglandin E2 release) that was dose- and time-dependent and was blocked by cycloheximide, actinomycin D, and dexamethasone. IL-1 induced a selective increase in COX II mRNA and biosynthesis of COX II protein that was blocked by dexamethasone. CONCLUSION: IL-1 treatment of HSE cells induces COX II, as demonstrated by both Northern blotting and immunoprecipitation. The induction of COX II expression provides, at least in part, a mechanism for the pronounced increase in prostanoid synthesis observed in HSE cells following incubation with IL-1. The selective up-regulation of HSE COX II by inflammatory cytokines such as IL-1 suggests that development of specific pharmaceutical inhibitors for this novel isozyme may provide significant new therapeutic advantages in the treatment of RA.
Asunto(s)
Endotelio Vascular/enzimología , Interleucina-1/farmacología , Prostaglandina-Endoperóxido Sintasas/biosíntesis , Membrana Sinovial/enzimología , Células Cultivadas , Inhibidores de la Ciclooxigenasa/farmacología , Dinoprostona/biosíntesis , Endotelio Vascular/citología , Endotelio Vascular/efectos de los fármacos , Inducción Enzimática/efectos de los fármacos , Humanos , Microcirculación , Prostaglandina-Endoperóxido Sintasas/efectos de los fármacos , ARN Mensajero/biosíntesis , ARN Mensajero/efectos de los fármacos , Membrana Sinovial/irrigación sanguínea , Membrana Sinovial/efectos de los fármacos , Factores de TiempoRESUMEN
We have found that sera from patients with early stages of Lyme disease contain predominant immunoglobulin M reactivity to a major 23-kDa protein (p23) from Borrelia burgdorferi 2591 isolated in Connecticut. To characterize this immunodominant antigen, we cloned and sequenced p23 and found it to be 83% identical by nucleotide sequence and 75% identical by amino acid sequenced to pC (recently renamed OspC), an abundantly expressed protein on the outer surface of PKo, a European strain of B. burgdorferi (B. Wilske, V. Preac-Mursic, S. Jauris, A. Hofmann, I. Pradel, E. Soutschek, E.Schwab, G. Will, and G. Wanner, Infect. Immun. 61:2182-2191, 1993). In addition, immunoelectron microscopy localized p23 to the outer membrane, confirming that p23 is the strain 2591 homolog of OspC. The North American strain B31, commonly used in serologic assays for Lyme disease, does not express OspC. Northern (RNA) blot analysis detected low levels of ospC mRNA in B31, and DNA sequencing of the ospC gene from B31 revealed a 54-bp deletion in the upstream regulatory region, possibly accounting for the low transcriptional activity of ospC. The ospC coding region from B31 was cloned and antibody-reactive OspC was expressed in Escherichia coli. An immunoglobulin M enzyme-linked immunosorbent assay using recombinant OspC as the target antigen shows promise for the serodiagnosis of early stages of Lyme disease.
Asunto(s)
Antígenos Bacterianos , Proteínas de la Membrana Bacteriana Externa , Proteínas Bacterianas/genética , Grupo Borrelia Burgdorferi/genética , Secuencia de Aminoácidos , Anticuerpos Antibacterianos/biosíntesis , Anticuerpos Monoclonales , Proteínas Bacterianas/inmunología , Secuencia de Bases , Grupo Borrelia Burgdorferi/inmunología , Grupo Borrelia Burgdorferi/aislamiento & purificación , Clonación Molecular , ADN Bacteriano/genética , Ensayo de Inmunoadsorción Enzimática/métodos , Expresión Génica , Genes Bacterianos , Humanos , Inmunoglobulina M/biosíntesis , Enfermedad de Lyme/diagnóstico , Enfermedad de Lyme/inmunología , Enfermedad de Lyme/microbiología , Microscopía Inmunoelectrónica , Datos de Secuencia Molecular , América del Norte , Proteínas Recombinantes de Fusión/genética , Proteínas Recombinantes de Fusión/inmunología , Homología de Secuencia de Aminoácido , Transcripción GenéticaRESUMEN
OBJECTIVE: To examine the regulation of intercellular adhesion molecule 1 (ICAM-1) in human synovial microvascular endothelial cells (HSE) and human umbilical vein endothelial cells (HUVE) upon exposure to a variety of agents. METHODS: Cultured endothelial cells were treated with various cytokines alone and in combination. The expression of ICAM-1 was evaluated at several levels, including an investigation of messenger RNA (mRNA) and surface protein expression. RESULTS: Treatment of HSE with interleukin-1 alpha (IL-1 alpha) or tumor necrosis factor alpha (TNF alpha) resulted in minimal increases in ICAM-1 expression, in contrast to findings with HUVE. Incubation of HUVE or HSE with IL-1 or TNF in combination with interferon-gamma (IFN gamma) greatly potentiated the increase in ICAM-1 surface expression. The synergistic effect of IFN gamma and TNF was confirmed by several methods, including a cell-based enzyme-linked immunosorbent assay, fluorescence-activated cell sorting, immunofluorescence staining, and determination of mRNA levels. IFN gamma also augmented the actions of several other agonists on HSE, i.e., IL-4, lipopolysaccharide, and TNF beta/lymphotoxin. Immunoprecipitation of TNF alpha + IFN gamma-stimulated, 125I-labeled HSE cells with anti-ICAM-1 revealed a single 90-kd band, similar in size to ICAM-1 from HUVE treated in an identical manner. Unexpectedly, IFN gamma alone was a potent stimulus for HSE ICAM-1 mRNA synthesis, but was relatively ineffective in HUVE. CONCLUSION: These studies indicate that IFN gamma plays a critical synergistic role in the regulation of ICAM-1 expression in human synovial endothelial cells.
Asunto(s)
Artritis Reumatoide/metabolismo , Moléculas de Adhesión Celular/metabolismo , Citocinas/farmacología , ARN Mensajero/metabolismo , Membrana Sinovial/metabolismo , Venas Umbilicales/metabolismo , Adolescente , Adulto , Moléculas de Adhesión Celular/efectos de los fármacos , Moléculas de Adhesión Celular/genética , Células Cultivadas , Endotelio/efectos de los fármacos , Endotelio/metabolismo , Endotelio Vascular/efectos de los fármacos , Endotelio Vascular/metabolismo , Femenino , Regulación de la Expresión Génica , Humanos , Molécula 1 de Adhesión Intercelular , Persona de Mediana Edad , ARN Mensajero/efectos de los fármacos , Membrana Sinovial/efectos de los fármacos , Factores de Tiempo , Venas Umbilicales/efectos de los fármacosRESUMEN
The effects of the inflammatory cytokines, tumor necrosis factor (TNF alpha), interleukin-1 alpha (IL-1), and gamma interferon (IFN gamma) on macro- and microvessel-derived endothelial cell proteolytic, adhesion protein and prostaglandin synthetic activities were compared. TNF alpha treatment of human umbilical vein endothelial (HUVE) cells induced urokinase-type plasminogen (uPA) activity, increased HUVE uPA-dependent extracellular matrix (ECM) degradation, and accelerated matrix remodeling and endothelial differentiation into tubes or cord-like structures. All of the aforementioned effects of TNF alpha on HUVE uPA-dependent activities were abrogated by co- or pretreatment with IFN gamma. In contrast, endothelium derived from human lung (HLE) exhibited high constitutive uPA and uPA-dependent matrix degradation and rapid tube formation in Matrigel, activities all unaffected by TNF alpha or IFN gamma. Endothelium derived from human rheumatoid synovium (HSE) exhibited uPA-dependent activities intermediate between the HLE and HUVE. TNF alpha or IL-1 treatment of HUVE potently induced surface ICAM-1 expression, whereas these cytokines were relatively ineffective on HLE and HSE ICAM-1 expression. Co-incubation with IFN gamma synergistically elevated TNF alpha or IL-1 induced ICAM-1 expression in HUVE, HLE, and HSE. The major prostaglandin synthesized by HUVE was PGI2, in contrast to HLE and HSE which produced PGE2 as the major product. Although cytokine treatment increased prostanoid production in all three cell types, HLE were not responsive to IL-1, and HSE demonstrated the greatest increase in prostaglandin synthetic capacity. These studies underline important differences not only in the "constitutive" activities expressed by EC from different vascular beds, but also in the responsiveness to proinflammatory cytokines alone or in combination. These observations further emphasize the need to study the endothelial cell derived from the vascular bed of interest rather than extrapolate from results obtained with HUVE or other macrovessel-derived endothelium.
Asunto(s)
Moléculas de Adhesión Celular/biosíntesis , Endotelio Vascular/fisiología , Proteínas de la Matriz Extracelular/metabolismo , Interferón gamma/farmacología , Interleucina-1/farmacología , Factor de Necrosis Tumoral alfa/farmacología , 6-Cetoprostaglandina F1 alfa/análisis , 6-Cetoprostaglandina F1 alfa/biosíntesis , Adolescente , Adulto , Artritis Reumatoide/fisiopatología , Células Cultivadas , Niño , Córnea , Dinoprostona/análisis , Dinoprostona/biosíntesis , Endopeptidasas/metabolismo , Endotelio Vascular/efectos de los fármacos , Endotelio Vascular/fisiopatología , Matriz Extracelular/metabolismo , Humanos , Inflamación/fisiopatología , Molécula 1 de Adhesión Intercelular , Microcirculación , Circulación Pulmonar , Proteínas Recombinantes/farmacología , Membrana Sinovial/irrigación sanguínea , Venas Umbilicales , Activador de Plasminógeno de Tipo Uroquinasa/biosíntesisRESUMEN
Spirochetes are agents of neurologic disease that may utilize specific neural cell surface molecules for adhesion. Borrelia burgdorferi, the etiologic agent of Lyme disease, bound to galactocerebroside (GalCer) in numbers that were two- to threefold greater than to ceramide and glucocerebroside, and four- to fivefold greater than to sphingosine, psychosine, sulfatide, cholesterol, and three membrane phospholipids. The adherence was greater to GalCer and ceramide with a higher content of alpha-hydroxyl fatty acids. Treponema phagedenis Reiter and Borrelia hermsii also bound to GalCer. The binding of B burgdorferi to GalCer was inhibited in a concentration-dependent manner by rabbit polyclonal and murine monoclonal antibodies to this glycosphingolipid component of myelin. The monoclonal antibody to GalCer also inhibited adhesion of the organisms to Schwann cells. Neither free D or L monosaccharides nor the lectin peanut agglutinin inhibited binding. Since B burgdorferi and other spirochetes cause neurologic disease, these results suggest a role for GalCer as a binding site in both the central and peripheral nervous systems.
Asunto(s)
Grupo Borrelia Burgdorferi/metabolismo , Galactosilceramidas/metabolismo , Spirochaetaceae/metabolismo , Animales , Adhesión Bacteriana/fisiología , Células Cultivadas , Ensayo de Inmunoadsorción Enzimática , Glicoesfingolípidos/metabolismo , Fosfolípidos/metabolismo , Ensayo de Unión Radioligante , Ratas , Ratas Endogámicas Lew , Células de Schwann/metabolismo , Células de Schwann/microbiologíaRESUMEN
BACKGROUND: The characteristics of a Spanish strain of Borrelia burgdorferi, the spirochete which causes Lyme's disease, and which, up to the present, has not been isolated in Spain, are described. METHODS: The organism was obtained from ticks (Ixodes ricinus) from the northern part of Spain. It was studied in culture by dark field microscopy and the internal structure observed by electron transmission. The antigenic composition was analyzed under polyacrylamide electrophoresis, immunoblot and reactivity against monoclonal antibodies. Plasmid analysis was carried out by Southern blot. RESULTS: In culture the length of the organism is somewhat shorter than normal. It grows slowly and tends to autoagglutinate. It has 6-13 periplasmic flagella. The antigenic analysis of this microorganism through immunoblot and reactivity against different monoclonal antibodies showed differences with regards to other North American strains, with the most significant being the composition of certain proteins of the surface of the organism. These differences may have clinical repercussion. DNA analysis by Southern blot demonstrated slight differences in regard to the composition of plasmids compared to other strains analyzed. CONCLUSIONS: Borrelia burgdorferi exists in Spain. The isolated strain shows peculiar characteristics with respect to others analyzed. The availability of an autochthonous strain may allow more reliable serological diagnosis in Spain.
Asunto(s)
Grupo Borrelia Burgdorferi/aislamiento & purificación , Animales , Anticuerpos Antibacterianos/análisis , Grupo Borrelia Burgdorferi/química , Grupo Borrelia Burgdorferi/inmunología , Grupo Borrelia Burgdorferi/ultraestructura , ADN Bacteriano/análisis , Electroforesis en Gel de Poliacrilamida , Ensayo de Inmunoadsorción Enzimática , Técnica del Anticuerpo Fluorescente , Immunoblotting , Microscopía Electrónica , España , Garrapatas/microbiología , Estados UnidosRESUMEN
A cytotoxic effect, as measured by 51Cr release, was detected after a 6-h incubation with two strains of Borrelia burgdorferi with neonatal rat primary brain cultures and with astroglial enriched cultures derived from the primary rat brain cells. A low-passage strain, J31, induced a significantly greater cytotoxic effect than did strain B31 in long-term in vitro culture. Live spirochetes and sonicates of both strains induced cytotoxicity, whereas heat-killed organisms did not. The degree of injury was greater in the primary brain than in the astroglial enriched cultures. Scanning electron microscopy revealed marked contraction of the membrane sheets and bleb production by the oligodendroglia of primary brain cultures after incubation with B. burgdorferi. The astroglial layer appeared unharmed.
Asunto(s)
Grupo Borrelia Burgdorferi/patogenicidad , Neuroglía/microbiología , Animales , Animales Recién Nacidos , Astrocitos/microbiología , Astrocitos/ultraestructura , Grupo Borrelia Burgdorferi/ultraestructura , Encéfalo/citología , Células Cultivadas , Microscopía Electrónica de Rastreo , Neuroglía/ultraestructura , Oligodendroglía/microbiología , Oligodendroglía/ultraestructura , RatasRESUMEN
The chronic inflammatory condition that develops after infection by B. burgdorferi is a complex process resulting from host responses to a limited number of organisms. Amplification mechanisms driven by potent proinflammatory molecules, i.e., IL-1, may explain the vigorous response to a paucity of organisms. Spirochete dissemination to distant locations involves adherence to and penetration across endothelium and may be facilitated by host responses that increase vessel permeability. The apparent lack of tissue tropism in Lyme disease is reflected in the organism's ability to adhere to different eucaryotic cell types in vitro and the wide distribution of B. burgdorferi in various organs of infected humans and experimentally infected animals. While phagocytosis and complement activation have been observed in vitro, the specific immune response that develops in humans is inefficient in eradicating the organisms, which may possess some mechanism(s) to evade this response. There is significant evidence for host autoreactivity based on antigenic cross-reactivity between the 41-kDa flagellar subunit and stress proteins of the spirochetes and endogenous host cell components. Although the outer surface proteins appear to be suitable candidates as targets for vaccination in animal studies, fundamental differences in the immune response to spirochetal components may preclude their use in humans.
Asunto(s)
Grupo Borrelia Burgdorferi/fisiología , Enfermedad de Lyme/microbiología , Animales , Anticuerpos Antibacterianos/biosíntesis , Adhesión Bacteriana , Grupo Borrelia Burgdorferi/inmunología , Humanos , Inmunidad Celular , Enfermedad de Lyme/inmunología , FagocitosisRESUMEN
A 30-year old female underwent kidney transplantation after unsuccessful 3-year dialysis for renal cortex necrosis. Immunosuppression was achieved with cyclosporin followed by azathioprine with prednisone. The patient conceived after 22 months with kidney transplantation. Mild decrease in arterial blood pressure and marked increased in glomerular filtration rate were seen during the first three months of pregnancy. Arterial blood pressure increased but insignificantly at the end of pregnancy. That time, gradual decrease in creatinine clearance was observed. An increase in serum bilirubin and alkaline phosphatase was noted. Pregnancy was terminated by cesarean section on the 38th week. Newborn was female, full-termed, viable, with body weight of 3,300 g. All examined parameters were normalized after delivery. Described case indicates that transplanted kidney functioning during pregnancy is similar to that in healthy women.
Asunto(s)
Trasplante de Riñón/fisiología , Embarazo/fisiología , Adulto , Cesárea , Femenino , Tasa de Filtración Glomerular/fisiología , Humanos , Recién Nacido , Periodo PosoperatorioRESUMEN
This article will review the known factors which are host derived or borne out of the interaction between Borrelia burgdorferi and the cells of the various organ systems in order to understand the process of infection B. burgdorferi as an arthropod-borne pathogen must adapt to various and diverse environments in its life cycle. In the invertebrate vector, this organism must tolerate the conditions of the tick midgut as well as the conditions after systemic dissemination. In the vertebrate host, this organism which resides initially in the skin, spreads hematogenously to the heart, brain, joints, and possibly to other tissues as well. At each site of infection, this organism must survive to induce the chronic course of illness characteristic of Lyme borreliosis. Evidence will be presented for the adhesion of B. burgdorferi to cells of diverse origins which suggests that the initiation of cellular injury may lack specificity. Other host non-specific responses will be reviewed.
Asunto(s)
Vectores Arácnidos/microbiología , Grupo Borrelia Burgdorferi/fisiología , Enfermedad de Lyme/microbiología , Garrapatas/microbiología , Animales , Anticuerpos Antibacterianos/biosíntesis , Linfocitos B/inmunología , Adhesión Bacteriana , Grupo Borrelia Burgdorferi/inmunología , Reacciones Cruzadas , HumanosRESUMEN
During the pathogenesis of Lyme disease, Borrelia burgdorferi spreads hematogenously from the site of a tick bite to several tissues throughout the body. The specific mechanism of spirochete emigration is presently unknown. Using cultured human umbilical vein endothelial cells, we found that Borrelia burgdorferi bound to the endothelial cells and to the subendothelial matrix. Low passage isolates adhered 22-30-fold greater than a strain maintained in culture continuously. Spirochete binding to subendothelial matrix was inhibited 48-63% by pretreatment of the matrix with anti-fibronectin antiserum. Spirochete migration across endothelial monolayers cultured on amniotic membrane was increased when the monolayers were damaged by chemical or physical means. Electron microscopic examination of spirochete-endothelial interactions demonstrated the presence of spirochetes in the intercellular junctions between endothelial cells as well as beneath the monolayers. Scanning electron microscopy identified a mechanism of transendothelial migration whereby spirochetes pass between cells into the amniotic membrane at areas where subendothelium is exposed.
Asunto(s)
Adhesión Bacteriana , Grupo Borrelia Burgdorferi/fisiología , Endotelio Vascular/microbiología , Amnios/citología , Amnios/microbiología , Amnios/ultraestructura , Borrelia/aislamiento & purificación , Grupo Borrelia Burgdorferi/aislamiento & purificación , Grupo Borrelia Burgdorferi/ultraestructura , Células Cultivadas , Endotelio Vascular/ultraestructura , Femenino , Humanos , Microscopía Electrónica , Microscopía Electrónica de Rastreo , Embarazo , Venas UmbilicalesAsunto(s)
Fitosteroles/uso terapéutico , Esclerodermia Localizada/tratamiento farmacológico , Esclerodermia Sistémica/tratamiento farmacológico , Vitamina E/uso terapéutico , Adolescente , Adulto , Anciano , Cápsulas , Niño , Combinación de Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fitosteroles/administración & dosificación , Extractos Vegetales/administración & dosificación , Extractos Vegetales/uso terapéutico , Vitamina E/administración & dosificaciónRESUMEN
Two typical cases of lipo-atrophy of the ankles are described, one case of atrophy of the ankles with associated atrophy of the whole extremity, and one case of localized atrophy of the knee. For comparison, we present one case of atrophy in a diabetic patient due to insulin injections but developing at distant sites, and in one case, a child in whom atrophy followed antibiotic injections. Primary inflammatory vascular changes in the subcutaneous tissue were demonstrated in atrophy of the ankles, as in the early period of insulin-induced lipo-atrophy. Attention is called to the possible relation of the described lipo-atrophies.