1062

stimulated the growth of some intracellular bacteria. Other groups have shown a clear stimulation of parasite growth with cytokines.6.7 On the basis of these observations, and on the emerging clinical support for their importance to man, we urge caution in the widespread application of cytokine-based immunotherapy, especially for immunocompromised patients. Whether antibiotic cover will be sufficient to prevent these infectious complications remains to be established. Pulmonary Research Unit, Centre Hospitaller Universitaire de Sherbrooke, Sherbrooke J1 H 5N4, Canada, and 19 Buckingham Gate, London SW1, UK

M. DENIS E. O. GREGG

1.

Jablons D, Bolton E, Martins S, et al. Interleukin-2 based immunotherapy alters circulating neutrophil Fc receptor expression and chemotaxis. J Immunol 1990,

2.

Klempner MS, Noring R, Mier JW, Atkins MB An acquired chemotactic defect in neutrophils from patients receiving interleukin-2 immunotherapy. N Engl J Med

We have investigated twice as many ulcerative colitis patients did Murch et al, who quantified endothelin-1 by radioimmunoassay. The presence of a similar amount of endothelin-1 in colonic mucosa of patients with active ulcerative colitis and in controls challenges the hypothesis that endothelin-1 may have a role in the pathogenesis of ulcerative colitis. Thus, the hypothesis, although highly attractive, should be tested further before definite conclusions can be drawn.

as

Gluten-based food

144: 3630-36.

1990; 332: 959-65 3. Denis M, Campbell D, Gregg EO. Interleukin-2 and granulocyte-macrophage colony stimulating factor stimulate growth of a virulent strain of Escherichia coli Infect Immun 1991; 59: 1853-56. 4. Denis M, Gregg EO Recombinant tumour necrosis factor-alpha decreases whereas recombinant interleukm-6 increases growth of a virulent strain of Mycobacterium avium in human macrophages Immunology 1990, 71: 139-41. 5. Denis M, Gregg EO. Identification of cytokines which enhance (CSF-1, IL-3) or restrict (IFN&ggr;) growth of intramacrophage Listeria monocytogenes. Immunol Lett 1991; 27: 237-42. 6 Mazingue C, Cottrez-Detoeuf F, Louis J, et al. In vitro and in vivo effects of interleukin-2 on the protozoan parasite Leishmania Eur J Immunol 1989; 19: 487-92 7.

Kongshavin PAL, Ghadirian E Enhancing and suppressive effects of tumor necrosis factor/cachectin on Trypanosoma musculi growth Parasite Immunol 1989, 10: 581-87.

Colonic endothelin-1 immunoreactivity in active ulcerative colitis SIR,-We have also investigated Dr Murch and colleagues’ hypothesis (Feb 15, p 381) that endothelin-1, a potent vasoconstrictor, may have a role in the pathogenesis of inflammatory bowel disease. Colonoscopic biopsies were done in nine patients with active ulcerative colitis, three patients with ulcerative colitis in remission, and eight healthy controls. All ulcerative colitis patients were receiving only sulphasalazine at the time of biopsy. Controls had colonoscopy for rectal bleeding due to haemorrhoids. All patients underwent flexible sigmoidoscopy (Olympus CFP10S sigmoidoscope) of the distal 50 cm of the colon. Biopsy specimens were obtained from an area 10-15 cm above the anal verge in controls and in patients in remsision, and from sites of active disease in patients with active ulcerative colitis. Immediately on excision biopsy specimens were frozen in liquid nitrogen and afterwards weighed and homogenised in 10 volumes of 2 molar acetic acid containing 10 mmol/1 mercaptoethanol and phenylmethylsulfonylfluoride (1 ug/ml). The homogenate was centrifuged at 4°C. The supernatant was kept and the pellet resuspended and centrifuged. Supernatants were combined and kept at - 20°C until lyophilised. After lyophilisation the protein was resuspended in borate buffer, pH 84.

internal

Endothelin-1 was measured by radioimmunoassay (Nichols Institute Diagnostics, Netherlands). Endothelin-I was quantified by a competitive radioimmunoassay with radioiodinared tracer and polyclonal antibody. Bound and free protein were separated by a second antibody solid-phase system, followed by centrifugation; sensitivity of the assay was 1 pg/ml and crossreactivities were: endothelin-I 100%, endothelin-2 52%, endothelin-3 96%, big endothelin 7%, angiotensin II less than 0-1%, corticotropin less than 0-1%, and vasopressin less than 0 1 %. Differences between the various groups were evaluated by Student’s t test for unpaired data and confirmed by the Mann-Whitney test. Endothelin-1was detected in colonic mucosa of controls, as well as in patients with ulcerative colitis. Mean endothelin-1 content in colonic mucosa of controls was 5-7 (SEM 0-3) pg/mg wet weight tissue. Mean endothelin-I content in inflamed colonic mucosa of nine patients with active ulcerative colitis was 4-7 (0-6) and did not differ from that in colonic mucosa of controls. In three ulcerative colitis patients in remission, mean endothelin-I content was 2-9 (0-8) pg/mg wet tissue.

DANIEL RACHMILEWITZ RAMI ELIAKIM ZVI ACKERMAN FANNY KARMELI

Department of Medicine, Hadassah University Hospital, PO Box 24035, Jerusalem 91240. Israel

coatings

SIR,-In the European Community about 20 million tonnes of derived basically from mineral oil, are needed annually, much of it destined for the rubbish-bin. Less

polyethenes/polypropenes, pollutant

packagings

considerations have led

required,

are

and

environmental

development of completely biodegradable "plastic" coatings derived from gluten. These gluten-derived packagings seem likely to replace plastic material on the Dutch market and in the rest of Europe too. The Dutch Horticultural Society plans to provide our fruits and vegetables with an edible gluten-derived coating, the launching of which awaits the results of experiments in Germany. It is not obligatory to label gluten additives in foodstuffs for sale. Increasing the dietary gluten content of a whole population without a clear labelling system may to

the

have several consequences. The Dutch Coeliac Disease Society estimates the prevalence of biopsy-proven coeliac disease in the Netherlands to be 12 per 100 000, a rate that is lower than that in neighbouring countries but which is increasing rapidly. The low rate is at least partly due to underdiagnosis,l which means that people in the Netherlands with as yet undiagnosed coeliac disease will incur extra risks if the dietary gluten content increases. A life-long strict gluten-free diet is recommended in coeliac disease and the ingestion of very small amounts of gluten, even without the accompaniment of clinical or serological responses, induces changes that are detectable morphometrically.3 For the sake of all recognised gluten-sensitive Europeans-and gluten-sensitive Europeans yet to be identified-a united European approach is needed to keep gluten pollution at a distance. This should include giving gluten an E-number with an obligation to label. Department of Hepatogastroenterology, Rijnstate Hospital, Arnhem

TIM L. TH. A. JANSEN

Dutch Coeliac Disease Utrecht

LOES KÖHLER PETER H. Z. KARSSEN CYP G. J. WAGENAAR

Society,

Department of Hepatogastroenterology, 6814 HK, Arnhem, Netherlands

CHRIS J. J. MULDER

Jansen TLTA, Wagenaar CGJ, Mulder CJJ. Coeliac disease in the Netherlands. In. Mearin ML, Mulder CJJ, eds. Coeliac disease: 40 years gluten-free. Dordrecht. Kluwer, 1991. 169-79. 2. Holmes GKT, Prior P, Lane MR, et al. Malignancy in coeliac disease effect of a gluten-free diet. Gut 1989; 30: 333-40. 3 Mayer M, Greco L, Troncone R, et al. Compliance of adolescents with coelic disease with a gluten free diet. Gut 1991, 32: 881-85. 1.

Three-dimensional fetal ultrasound SIR,-A conventional ultrasound scan presents a difficult challenge to those seeking a three-dimensional image. However, the requirements1 can be met by adapting existing equipment. A compact position sensor attached to the probe provides continuous spatial location tracking without interfering with the freehand technique of the ultrasonographer. This electromagnetic device (Polhemus Inc) has a source generator and sensor receiver both with three orthogonal coils and provides position on x, y, and z axes to within 0 25 mm and angular orientation accurate to about 02°.-’A variety of transducers may be used. A simple calibration procedure is needed to provide registration with different transducer/display

Colonic endothelin-1 immunoreactivity in active ulcerative colitis.

1062 stimulated the growth of some intracellular bacteria. Other groups have shown a clear stimulation of parasite growth with cytokines.6.7 On the b...
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