Effect of splenectomy on type-1/type-2 cytokine gene expression in a patient with adult idiopathic thrombocytopenic purpura (ITP)

BACKGROUND: In view of clinical observations and laboratory results that support a central role of the spleen in idiopathic thrombocytopenic purpura (ITP) pathophysiology, we studied the effect of splenectomy on type-1 and type-2 cytokine gene expression in an adult ITP case, refractory to conservative treatment. CASE PRESENTATION: The patient was subjected to splenectomy 9 months after the diagnosis with complete response, attaining platelet counts over 150 × 10(6)/L within 10 days after the operation. Two consecutive blood samples were obtained from the patient, 3 and 7 months after the splenectomy for the purposes of this study. A control group consisted of 11 healthy adults. Peripheral blood mononuclear cells were prepared from each blood sample and cultured in vitro for 8 h with the addition of the mitogens phorbol myristate acetate and ionomycin. Total cellular RNA extracted from 10(6 )cells was submitted to semiquantitave reverse transcriptase-polymerase chain reaction (RT-PCR) for the amplification of IL-2, IFN-γ, IL-4, IL-5, and IL-10 metagraphs. The PCR products were run on ethidium-stained agarose gels, photographed and quantified by densitometry. A steep decrease of type-1 cytokine expression (IL-2, IFN-γ) and their calculated sum expressing Th1 activity was observed at 7 months post-splenectomy compared to 3 months post-splenectomy, in parallel with a rise of platelet count from 190 × 10(6)/L to 265 × 10(6)/L. The change of type-2 cytokine expression (IL-4, IL-5, IL-10) was slight and the Th2 activity (IL-4+IL-5) remained largely unchanged. The Th1/Th2 ratio, that reflects the pathogenic disease-specific T-cell immune deviation, was accordingly reduced 7 months post-splenectomy (Th1/Th2 = 1.3) compared to 3 months (Th1/Th2 = 3.5). CONCLUSIONS: The reduction of the Th1/Th2 cytokine ratio that was observed over time after splenectomy was accompanied by full clinical remission. Nevertheless, the persistence of a type-1 polarization, even after several months following spleen removal, is suggestive of a more basic abnormality of the immune function in these patients

Aerobic and anaerobic energy expenditure during rest and activity in montane Bufo b. boreas and Rana pipiens

The relations of standard and active aerobic and anaerobic metabolism and heart rate to body temperature ( T b ) were measured in montane groups of Bufo b. boreas and Rana pipiens maintained under field conditions. These amphibians experience daily variation of T b over 30°C and 23°C, respectively (Carey, 1978). Standard and active aerobic and anaerobic metabolism, heart rate, aerobic and anaerobic scope are markedly temperature-dependent with no broad plateaus of thermal independence. Heart rate increments provide little augmentation of oxygen transport during activity; increased extraction of oxygen from the blood probably contributes importantly to oxygen supply during activity. Development of extensive aerobic capacities in Bufo may be related to aggressive behavior of males during breeding. Standard metabolic rates of both species are more thermally dependent than comparable values for lowland relatives. Thermal sensitivity of physiological functions may have distinct advantages over thermally compensated rates in the short growing season and daily thermal fluctuations of the montane environment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47726/1/442_2004_Article_BF00348070.pd