H. Lobeck

Follow-up of recurrent hepatitis B and delta infection in liver allograft recipients after treatment with recombinant interferon-α

Reinfection of the graft with hepatitis B virus (HBV) and hepatitis delta virus (HDV) is a potential complication in patients undergoing orthotopic liver transplantation (OLT). Therefore, we added recombinant interferon-alpha (rIFNa) to the standard immunosuppressive regimen in 11 patients who received transplants following liver failure attributed to cirrhosis B (n = 10, with HDV co-infection in four cases) or fulminant hepatitis B (n = 1). Patients were treated with rIFNa for periods ranging from 2 to 3 months between the first and the 13th month after OLT. All patients received immunosuppressive treatment with low-dose corticosteroids, azathioprine and cyclosporine. Anti-HBs hyperimmune globulin was also administered. None of the patients showed evidence of severe allograft rejection. Seven patients suffered HBV reinfection of the graft with histological signs of acute hepatitis in five cases and transition to chronic hepatitis in one patient. Treatment with rIFNa did not prevent or reduce HBV replication. Reinfection of the graft with HDV was demonstrated by PCR in four patients co-infected with HDV. During treatment with rIFNa liver biopsy specimens from three reinfected patients were transiently negative for HDV antigen but not for HDV RNA, and the sera from two patients were transiently negative for HDV RNA. The data indicate that rIFNa can reduce HDV replication in reinfected liver allografts.

Disseminated Cytomegalovirus Infection of the Female Genital Tract (With 1 color plate)

A woman with severe immunosuppression provoked by the acquired immunodeficiency syndrome developed a disseminated cytomegalovirus infection of the genital tract. Using in situ hybridization and the APAAP technique, cytomegalovirus was detected in epithelial and endothelial cells as well as in macrophages in the vulva, the vagina and the cervix uteri.

Epstein-Barr virus DNA and epithelial markers in nasopharyngeal carcinoma

Abstract. Nasopharyngeal carcinoma (NPC) belongs to the most common malignant tumours in certain parts of the world, e.g. South-East Asia. The undifferentiated type of NPC is associated with genomic Epstein-Barr virus (EBV) DNA. In normal epithelia of the nasopharynx cytokeratins (CK) 4, 5, 6, 13, 14, 15 and 19 are expressed. The aim of this study was to analyse the expression pattern of cytokeratins in NPC in the presence of EBV infection. Twenty primary or metastatic tumours from 13 patients suffering from a NPC were evaluated (formalin-fixed, paraffin-embedded). 35S-labelled probes were used to detect EBV DNA in the tissue sections. Fourteen specimens (70%) were EBV positive. All positive specimens were undifferentiated NPC. All NPC were identified with broad-spectrum anti-CK antibody. Using a panel of anti-CK antibodies, there was no specific CK-expression pattern in NPC. In summary, undifferentiated NPC are strongly associated with EBV. The cytoskeleton of undifferentiated NPC reveals no specific pattern of CK expression.

Interleukin-2 Rezeptor Antikörper versus ATG zur Induktionstherapie nach Lebertransplantation — Ergebnisse einer prospektiv randomisierten Studie

Die effektive Verhutung akuter, zellularer Abstosungsreaktionen ist eine wesentliche Voraussetzung des Erfolgs der Organtransplantation. Interleukin-2 (IL-2) kommt eine zentrale Rolle bei der Abstosungsreaktion zu, indem es nach Antigenprasentation in aktivierten T-Zellen zur IL-2 Produktion, vermehrter Expression des IL-2 Rezeptors auf der Zelloberflache und im Sinne eines positiven ”feedback” Mechanismus zu weiterer Zellproliferation, IL-2 Produktion und Expression des IL-2 Rezeptors kommt. Eine Reihe verschiedener monoklonaler Antikorper gegen den IL-2 Rezeptor (IL2r-mAK) zur Verhutung dieses Mechanismus wurden in den letzten Jahren entwickelt und klinisch eingesetzt [1, 3]. BT563, ein muriner IL2 vom Isotyp IgG1-k wurde erstmals von Otto u. Mitarb. nach Lebertransplantation eingesetzt [4] und hatte sich in der eigenen Erfahrung im historischen Vergleich mit ATG-Therapie als mindestens gleich effektiv bei deutlich verbesserter Vertraglichkeit erwiesen [5]. Im Rahmen einer prospektiv randomisierten Studie wurde die Effizienz und Vertraglichkeit eines IL2r-mAK mit einem polyklonalen Antithymozytenglobulin (ATG) in der Induktionstherapie nach Lebertransplantation verglichen.