Interaction of inflammatory cytokines and erythropoeitin in iron metabolism and erythropoiesis in anaemia of chronic disease

In chronic inflammatory conditions increased endogenous release of specific cytokines (TNFα, IL-1, IL-6, IFNγ and others) is presumed. It has been shown that those of monocyte lineage play a key role in cytokine expression and synthesis. This may be associated with changes in iron metabolism and impaired erythropoiesis and may lead to development of anaemia in patients with rheumatoid arthritis. Firstly, increased synthesis of acute phase proteins, like ferritin, during chronic inflammation is proposed as the way by which the toxic effect of iron and thereby the synthesis of free oxy-radicals causing the damage on the affected joints, may be reduced. This is associated with a shift of iron towards the mononuclear phagocyte system which may participate in the development of anaemia of chronic disease. Secondly, an inhibitory action of inflammatory cytokines (TNFα, IL-1), on proliferation and differentiation of erythroid progenitors as well as on synthesis of erythropoietin has been shown, thereby also contributing to anaemia. Finally, chronic inflammation causes multiple, complex disturbances in the delicate physiologic equilibrium of interaction between cytokines and cells (erythroid progenitors, cells of mononuclear phagocyte system and erythropoietin producing cells) leading to development of anaemia of chronic disease (Fig. 1)

The co-operative reform process in Tanzania and Sri Lanka

This article reports on findings from a three year study of co-operatives in Sri Lanka and Tanzania. The article asks three questions: why do co-operative sectors need reforming; what is the co-operative reform process; and why has reform succeeded in some countries but not others? It provides a short history of co-operatives in three phases: the colonial period, the post-colonial nationalist period and the period of market liberalisation. It shows that the control exercised by colonial governments was deepened under nationalist governments, with co-operatives becoming parastatals. Liberalisation brought a sustained attempt by international agencies to reassert the distinctive nature of co-operatives as member-owned businesses. However, co-ops were ill-prepared to adjust to a competitive market and the lifting of government regulation; many failed, some were corrupted, while a few became truly member-controlled. The article draws on documentary analysis and key informant interviews to provide accounts of the reform process in Tanzania and Sri Lanka. It finds that the process is incomplete and often contested