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Organolead compounds are of interest mainly as catalysts and organolead halides have proved to be very efficient materials for solar cells. Two organolead(IV) dimethylarsinates, namely catena-poly[[triphenyllead(IV)]-µ-chlorido-[triphenyllead(IV)]-µ-dimethylarsinato-κ2O:O'], [Pb2(C6H5)6(C2H6AsO2)Cl]n or [(Ph3Pb)2Cl(O2AsMe2)], (1), and poly[chlorido(µ3-dimethylarsinato-κ3O:O,O':O')diphenyllead(IV)], [Pb(C6H5)2(C2H6AsO2)Cl]n or [(Ph2ClPb)(O2AsMe2)], (2), together with the triphenyllead(IV) diphenylphosphinate catena-poly[[triphenyllead(IV)]-µ-diphenylphosphinato-κ2O:O'], [Pb(C6H5)3(C12H10O2P)]n or [(Ph3Pb)(O2PPh2)], (3), have been synthesized and characterized by single-crystal X-ray diffraction, IR spectroscopy and mass spectrometry. In (1), a chain structure was found with alternating chloride and Pb-O-As-O-Pb arsinate bridges between five-coordinate PbIV atoms. In (2), bidentate and chelate-like bonded dimethylarsinate ligands form double chains with heptacoordinated PbIV atoms. In (3), a pentacoordinated PbIV atom is connected by Pb-O-P-O-Pb phosphinate bridges to form a linear chain. Obviously, the steric demand of the phenyl ligands at PbIV reduces the possibility of interconnections via polydentate ligands to one dimension only. Thus, no metal-organic frameworks (MOF) are formed but instead various chain structures are observed.

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The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the German language. The reading comprehension of the questionnaire was tested in 10 JIA parents and patients. The participating centres were asked to collect demographic and clinical data along the JAMAR questionnaire in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the three Likert assumptions, floor/ceiling effects, internal consistency, Cronbach's alpha, interscale correlations, test-retest reliability, and construct validity (convergent and discriminant validity). A total of 319 JIA patients (2.8% systemic, 36.7% oligoarticular, 23.5% RF negative polyarthritis, and 37% other categories) and 100 healthy children were enrolled in eight centres. The JAMAR components discriminated well healthy subjects from JIA patients. All JAMAR components revealed good psychometric performances. In conclusion, the German version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and in clinical research.

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OBJECTIVES: Etanercept, a recombinant TNF receptor fusion protein, has been approved for the treatment of resistant polyarticular course juvenile idiopathic arthritis at a dosage of 0.4 mg/kg twice weekly in children older than 4 years. In adult patients, efficacy and safety of etanercept 25 mg twice weekly was comparable with 50 mg once weekly. Therefore, safety and efficacy of etanercept once weekly 0.8 mg/kg up to 50 mg s.c. was evaluated in a 3 month open label trial. METHODS: Twenty patients 4 to 17 years old received 0.8 mg of etanercept per kilogram of body weight subcutaneously once weekly for 3 months in an open multicentre trial. Active polyarticular disease was defined by the presence of five or more active joints with swelling, alternatively with pain or tenderness combined with limitation of motion. Safety assessments were based on adverse events (AEs) reports. Efficacy was assessed using the PedACR30/50/70 criteria. RESULTS: At the start of treatment the patients showed high disease activity. A rapid reduction of all disease activity parameters was observed. A PedACR30/50/70 response was reached by 75%/35%/10% of patients after 4 weeks, 90%/75%/35% after 8 weeks and 95%/75%/75% after 12 weeks of treatment. There were 37 AEs, none of them serious, with injection site reactions and minor infections being the most frequent. There was no drop out. Long-term follow-up of the patients will be carried out in the German JIA Registry. CONCLUSION: Treatment with etanercept once weekly using a double dosage leads to a significant improvement of disease activity in patients with active polyarticular course juvenile idiopathic arthritis and is well tolerated.

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BACKGROUND: The impact of the polymorphic amino acids 16 and 27 of the beta 2-adrenoceptor (beta 2-AR) on the susceptibility to bronchodilator tolerance remains unclear since clinical studies thus far have shown discordant results. Tolerance towards the effects of inhaled beta 2-AR agonists generally is more easily shown for systemic parameters than for airway effects and can be substantial. This study evaluates whether differences exist between position 16 homozygous genotyped asthmatics, in tolerance development towards airway responses and the systemic effect hypokalemia. METHODS: Twenty patients were genotyped for amino acids 16 and 27 of the beta 2-AR gene. Time-effect curves for FEV1 and serum potassium concentration were constructed after s.c. administration of terbutaline after two-week treatment periods with either terbutaline inhalation or matching placebo in a double-blind, randomised and cross-over design. Statistical analysis was done by a repeated measures multivariate analysis on area under time-effect curve (AUC). MAIN RESULTS: Pre-treatment with inhaled terbutaline did not influence the improvement in FEV1 in response to s.c. terbutaline and there were no significant differences between Arg-16 and Gly-16 individuals in this respect. Pre-treatment with inhaled terbutaline resulted in an overall increase of baseline plasma potassium before administration of s.c. terbutaline (3.78-3.95 mmol/L, p=0.034). However, this effect appeared to be solely confined to the Arg-16 homozygous individuals, leading to a statistically highly significant difference between the Arg-16 and Gly-16 subjects (p=0.005). However, there was no genotype related difference in the decrease in plasma potassium response to s.c. terbutaline relative to baseline. CONCLUSION: In patients carrying the Arg-16 genotype the development of hypokalemia by s.c. terbutaline is attenuated after pre-treatment with inhaled terbutaline, be it on the basis of higher baseline values.

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BACKGROUND: In vitro and some in vivo studies suggested that genetic haplotypes may have an impact on beta2-agonist mediated airway responses in asthmatics. Due to strong linkage disequilibrium the single nucleotide polymorphisms (SNPs) in the beta2-adrenoceptor gene result in only a limited number of haplotypes. We intended to evaluate the impact of beta2-adrenoceptor haplotypes on beta2-agonist mediated airway responses and the development of tolerance in mild to moderate asthmatics. METHODS: Patients were genotyped for the part of the beta2-adrenoceptor gene with a known bearing on receptor function and regulation. Cumulative dose response curves of fenoterol versus PD20 methacholine and FEV1 were constructed after 2 week treatment periods with either terbutaline or placebo in a double blind, randomised and cross-over design. Analysis of the dose response curves was based on a repeated measurement analysis of covariance. RESULTS: In our study population comprising 45 asthmatic patients, we found three limited allelic haplotypes, resulting in six different genotypes. Our data support the existence of differences between these six genotypes both in the shape of the dose response relationship of the beta2-adrenoceptor agonist fenoterol as well as in the propensity to develop tolerance for these effects by pre-treatment with terbutaline. However, this could only be substantiated for the endpoint PD20 methacholine. CONCLUSION: Between beta2-adrenoceptor genotypes differences exist both in baseline beta2-agonist induced airway responses as well as in the propensity to develop tolerance during maintenance beta2-agonist therapy. The net differences after two weeks of therapy are, however, of magnitudes that are unlikely to be of clinical significance.

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UNLABELLED: The prognosis in some forms of idiopathic interstitial pneumonia (IIP), especially idiopathic pulmonary fibrosis (IPF) and fibrotic nonspecific interstitial pneumonia (NSIP), is still poor. A minority of patients will respond to immunosuppressive treatment. In patients with IPF or fibrotic NSIP, pulmonary (67)Ga scintigraphy may be useful for predicting response to therapy and prognosis. The objective of the present study was to evaluate whether semiquantitative (67)Ga scintigraphy can be used to predict responsiveness to therapy with high-dose corticosteroids in a well-defined population of patients with IIP (IPF and fibrotic NSIP). METHODS: This study was performed in a tertiary referral center. We prospectively performed (67)Ga scintigraphy in 23 consecutive patients previously diagnosed with IIP (IPF and fibrotic NSIP) before and after treatment with 3 monthly courses of high-dose methylprednisolone. Lung function tests and bronchoalveolar lavage (BAL) were performed before and after these 3 courses, and patients were monitored for 1 y after the start of the treatment. RESULTS: During follow-up, 5 patients died, none during the first 3 mo. Although pulmonary (67)Ga uptake significantly decreased after treatment (P = 0.001), there was no correlation between either initial (67)Ga uptake or change in (67)Ga uptake on treatment and 1-y prognosis. This finding was independent of prior immunosuppressive treatment, diagnosis of IPF or NSIP, or whether initial (67)Ga uptake was elevated or not. BAL cellularity was correlated with neither pulmonary (67)Ga uptake nor response to treatment. CONCLUSION: Pulmonary (67)Ga uptake cannot be used to predict response to corticosteroid treatment or prognosis in patients with IIP. Apparently, the (inflammatory) process influenced by treatment with methylprednisolone does not determine the progression of disease. This finding supports the hypothesis that although inflammation is present in IPF and fibrotic NSIP, it is neither the hallmark of the disease nor the major factor determining prognosis.

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BACKGROUND: Human studies have demonstrated that allergen immunotherapy induces memory suppressive responses and IL-10 production by allergen-specific T cells. Previously, we established a mouse model in which allergen immunotherapy was effective in the suppression of allergen-induced asthma manifestations. OBJECTIVE: In this study, we examined whether immunotherapy induces a long-lasting effect and investigated the role of IL-10 in successful immunotherapy. METHODS: Ovalbumin-sensitized BALB/c mice were treated with 3 injections of ovalbumin (1 mg, subcutaneous) on alternate days. After a short interval (1 week) and after a long interval (5 weeks), mice were challenged by ovalbumin inhalation, and subsequently, airway reactivity, airway eosinophilia, ovalbumin-specific IgE, and T(H)2 cytokine profile were measured. Flow cytometry and blocking of IL-10 receptors in vivo were used to gain insight in the role of IL-10 in the beneficial effects of allergen immunotherapy. RESULTS: After a long interval between ovalbumin immunotherapy and ovalbumin challenge, the development of airway eosinophilia and hyperresponsiveness to methacholine were as strongly suppressed as after a short interval. These suppressive effects coincided with significantly reduced serum ovalbumin-specific IgE levels and T(H)2 cytokine production. On immunotherapy, the IL-5:IL-10 ratio in the bronchoalveolar lavage fluid shifted toward IL-10. In ovalbumin-restimulated lung cell and thoracic lymph node cultures from these mice, IL-5 levels dramatically decreased, whereas the percentage of IL-10(+)CD4(+) T cells was not affected. Finally, in mice treated with mAb against IL-10 receptors, the beneficial effects of immunotherapy were largely abrogated. CONCLUSION: These data demonstrate that allergen immunotherapy induces a memory suppressive effect in which IL-10 is essential.

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