Mycophenolate mofetil in the treatment of lupus nephritis

Lupus nephritis is a complication of systemic lupus erythematosus, which has significant morbidity and mortality. The accepted standard of treatment for severe lupus nephritis is cyclophosphamide for induction of remission. This has significant adverse effects including severe infection and amenorrhea. In addition, although cyclophosphamide induces remission, long-term mortality does not seem to be altered. Mycophenolate mofetil (MMF) is an immunosuppressive agent originally used in solid organ transplantation, which has been compared with cyclophosphamide in trials for lupus nephritis. Randomized trials with MMF have been relatively small, although pooled data seem to suggest that it is at least as effective as cyclophosphamide in inducing remission. In addition, MMF has also been associated with a reduced risk of infection and amenorrhea, although this finding is not universal. MMF appears to be associated with more diarrhea compared with cyclophosphamide. MMF is likely to be a useful treatment for lupus nephritis, although available trial data are limited due to the small size of previous studies. A large trial (the Aspreva Lupus Management Study) is currently underway to attempt to establish the place of MMF in treatment of lupus nephritis

New HST WFC3/UVIS observations augment the stellar-population complexity of omega Centauri

We used archival multi-band Hubble Space Telescope observations obtained with the Wide-Field Camera 3 in the UV-optical channel to present new important observational findings on the color-magnitude diagram (CMD) of the Galactic globular cluster omega Centauri. The ultraviolet WFC3 data have been coupled with available WFC/ACS optical-band data. The new CMDs, obtained from the combination of colors coming from eight different bands, disclose an even more complex stellar population than previously identified. This paper discusses the detailed morphology of the CMDs.Comment: 17 pages, 14 figures (11 in low res), 3 tables. Accepted for publication in AJ on June 19, 201

Development of antigen-specific ELISA for circulating autoantibodies to extracellular matrix protein 1 in lichen sclerosus

Lichen sclerosus is a common, acquired chronic inflammatory skin disease of unknown etiology, although circulating autoantibodies to the glycoprotein extracellular matrix protein 1 (ECM1) have been detected in most patients’ sera. We have examined the nature of ECM1 epitopes in lichen sclerosus sera, developed an ELISA system for serologic diagnosis, and assessed clinicopathological correlation between ELISA titer and disease. Epitope-mapping studies revealed that lichen sclerosus sera most frequently recognized the distal second tandem repeat domain and carboxyl-terminus of ECM1. We analyzed serum autoantibody reactivity against this immunodominant epitope in 413 individuals (95 subjects with lichen sclerosus, 161 normal control subjects, and 157 subjects with other autoimmune basement membrane or sclerosing diseases). The ELISA assay was highly sensitive; 76 of 95 lichen sclerosus patients (80.0%) exhibited IgG reactivity. It was also highly specific (93.7%) in discriminating between lichen sclerosus and other disease/control sera. Higher anti-ECM1 titers also correlated with more longstanding and refractory disease and cases complicated by squamous cell carcinoma. Furthermore, passive transfer of affinity-purified patient IgG reproduced some histologic and immunopathologic features of lichen sclerosus skin. This new ELISA is valuable for the accurate detection and quantification of anti-ECM1 autoantibodies. Moreover, the values may have clinical significance in patients with lichen sclerosus

NGC 2419: a large and extreme second generation in a currently undisturbed cluster

We analyse complementary HST and SUBARU data for the globular cluster NGC 2419. We make a detailed analysis of the horizontal branch (HB), that appears composed by two main groups of stars: the luminous blue HB stars ---that extend by evolution into the RR Lyrae and red HB region--- and a fainter, extremely blue population. We examine the possible models for this latter group and conclude that a plausible explanation is that they correspond to a significant (~30 %) extreme second generation with a strong helium enhancement (Y~0.4). We also show that the color dispersion of the red giant branch is consistent with this hypothesis, while the main sequence data are compatible with it, although the large observational error blurs the possible underlying splitting. While it is common to find an even larger (50 -- 80) percentage of second generation in a globular cluster, the presence of a substantial and extreme fraction of these stars in NGC 2419 might be surprising, as the cluster is at present well inside the radius beyond which the galactic tidal field would be dominant. If a similar situation had been present in the first stages of the cluster life, the cluster would have retained its initial mass, and the percentage of second generation stars should have been quite small (up to ~10 %). Such a large fraction of extreme second generation stars implies that the system must have been initially much more massive and in different dynamical conditions than today. We discuss this issue in the light of existing models of the formation of multiple populations in globular clusters.Comment: 14 pages, 14 figures (5 in low resolution format), 3 tables, accepted for publication in MNRA

Fortnightly Fluctuations in the O-C Diagram of CS 1246

Dominated by a single, large-amplitude pulsation mode, the rapidly-pulsating hot subdwarf B star CS 1246 is a prime candidate for a long-term O-C diagram study. We collected nearly 400 hours of photometry with the PROMPT telescopes over a time span of 14 months to begin looking for secular variations in the pulse timings. Interestingly, the O-C diagram is dominated by a strong sinusoidal pattern with a period of 14.1 days and an amplitude of 10.7 light-seconds. Underneath this sine wave is a secular trend implying a decrease in the 371.7-s pulsational period of Pdot = -1.9 x 10^-11, which we attribute to the evolution of the star through the H-R diagram. The sinusoidal variation could be produced by the presence of a low-mass companion, with m sin i ~ 0.12 Msun, orbiting the subdwarf B star at a distance of 20 Rsun. An analysis of the combined light curve reveals the presence of a low-amplitude first harmonic to the main pulsation mode.Comment: Accepted for publication in MNRAS. 11 pages, 8 figures, 5 table