Papers by Joop P van de Merwe
Since the 19th century, searches for the pathogenesis of interstitial cystitis/bladder pain syndr... more Since the 19th century, searches for the pathogenesis of interstitial cystitis/bladder pain syndrome (IC/BPS) have concentrated on the bladder. However, recent work has shown that patients with IC/BPS are more likely than controls to have syndromes with symptoms beyond the bladder and even the pelvis. These findings suggest that research into IC/BPS etiology should not focus only on the bladder. The sequence of investigation of nonbladder syndromes (NBSs) and IC/BPS has been similar to that for most medical research: case series generating hypotheses that are then tested in controlled studies. For instance, an often-cited survey of patients with IC/BPS showed an apparently high prevalence of fibromyalgia (FM), chronic fatigue syndrome (CFS), irritable bowel syndrome (IBS), allergy, asthma, vulvodynia, and several other diseases and syndromes. 1 Recent controlled studies have confirmed most of these findings. We believe that these studies have integrated important facts into the know...
International Journal of Urology, 2003
Workshop 9: Systemic aspects of interstitial cystitis, immunology and linkage with autoimmune dis... more Workshop 9: Systemic aspects of interstitial cystitis, immunology and linkage with autoimmune disorders. It is recognized that interstitial cystitis (IC) is often associated with a number of diseases such as allergies, irritable bowel syndrome, fibromyalgia, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), systemic lupus erythematosus, and Sjögren’s syndrome.
The prevalence of allergies in IC is reported to be between 40 and 80% of patients. The background of the association is not known and does not seem to be the result of a generalized allergic constitution. Some report that treatment of allergy sometimes has a beneficial effect on bladder symptoms. An increased expression of certain growth factors (PD-ECGF, FGF, and VEGF) has been found in the bladder of IC patients. In addition, the expression of CD44 was significantly higher in ulcer type IC than in non-ulcer type. In general, these growth factors are soluble and diffusible under normal conditions but proteoglycans such as CD44 could bind to these growth factors. This may promote the accumulation of growth factors at the sites of inflammation. CD44 expression in ulcer type IC could explain the prolonged and stronger expression of GAG-binding growth factors that promote inflammation.
In the Rotterdam study, a strong association between IC and Sjögren’s syndrome is recognized. In this study, 28% of IC patients have definite or probable Sjögren’s syndrome. This association is much stronger than is generally recognized. This could be due to difficulties in diagnosing Sjögren’s syndrome since a diagnosis usually requires a high index of suspicion.
Sjö gren's syndrome is an autoimmune disease characterized by lymphocytic infiltration of the sal... more Sjö gren's syndrome is an autoimmune disease characterized by lymphocytic infiltration of the salivary glands. In the NOD mouse, a model for this disease, the development of lymphocytic infiltrates in the salivary glands is preceded by an accumulation of dendritic cells (DC). Given the key importance of DC in regulating the immune response, we characterized the DC isolated from NOD salivary glands. These DC lacked membrane expression of CCR5, whereas DC from control salivary glands did express this molecule. The lack of expression was present already prior to the onset of lymphocytic infiltration, indicating that this was not the result of ongoing inflammation. DC from other sources in the NOD mouse also showed a decrease in CCR5 expression. The lack of CCR5 expression in the NOD salivary gland was accompanied by an increase in inflammatory chemokines. Furthermore, DC from CCR5؊/؊ animals or DC treated with a CCR5 antagonist showed increased secretion of IL-12. Interestingly, in Sjö gren's syndrome patients, CCR5 expression on circulating monocytes was decreased and correlated to increased levels of IL-12. These data indicate that CCR5 has regulatory properties and that the lack of CCR5 in NOD DC contributes to the proinflammatory environment in the salivary glands.
Previous studies have shown that the fecal flora of Patients with Crohn's disease (CD) \ , differ... more Previous studies have shown that the fecal flora of Patients with Crohn's disease (CD) \ , differed from the flora of healthy subjects by a iigher number of anaerobic grampositive coccoid rods. Sera from patients with CD agglutinated four strains of coccoid rods (Me44, C18, Me46 and Me47) more frequently and stronger than sera from healthy subjects and patients with other diseases. One of these bacteria, Coprococcus comes strain Me46, was not ingested by neutrophils after coating with specific IgG. In the present study, therefore, the binding of IgG and of Fab and Fc fragments to the four coccoid rods was investigated using immunofluorescence and absorption techniques. Results were compared with those obtained with Staphylococcus aureus strain Cowan I and showed that Me46, like S. aureus, bound (nonspecifically) IgG through its Fc portion whereas strain Me47 bound IgG through the Fab portion. Possible implications of the findings for CD are discussed.
European Journal of Immunology, 1985
Previous studies have shown that the fecal flora of patients with Crohn's disease (CD) di... more Previous studies have shown that the fecal flora of patients with Crohn's disease (CD) differed from the flora of healthy subjects by a higher number of anaerobic gram-positive coccoid rods. Sera from patients with CD agglutinated four strains of coccoid rods (Me44, C18, Me46 and Me47) more frequently and stronger than sera from healthy subjects and patients with other diseases. One of these bacteria, Coprococcus comes strain Me46, was not ingested by neutrophils after coating with specific IgG. In the present study, therefore, the binding of IgG and of Fab and Fc fragments to the four coccoid rods was investigated using immunofluorescence and absorption techniques. Results were compared with those obtained with Staphylococcus aureus strain Cowan I and showed that Me46, like S. aureus, bound (nonspecifically) IgG through its Fc portion whereas strain Me47 bound IgG through the Fab portion. Possible implications of the findings for CD are discussed.
Clinical & Experimental Immunology, 2002
Summary Granulocytes play a major role in host defense against bacterial infections. Severe inbor... more Summary Granulocytes play a major role in host defense against bacterial infections. Severe inborn defects in granulocyte function are associated with fulminant bacterial infections in early childhood. Subtle disturbances in granulocyte function might contribute to an enhanced susceptibility to bacterial infections in adulthood. We investigated chemoattractant (N-formyl-methionyl-leucyl-phenylalanine, fMLP and casein) induced cytoskeletal rearrangements (polarization) of blood granulocytes in 77 adults with chronic and recurrent therapy-resistant infections of the upper and lower airways. These infections could not be explained by B- and/or T-cell defects or local anatomic abnormalities. Besides polarization, chemotaxis of blood granulocytes was measured in 33 patients, as well as granulocyte superoxide production in eight patients. The chemoattractant-induced cytoskeletal rearrangement in patient blood granulocytes was significantly lower as compared to healthy control values with ...
Criteria for the diagnosis of a disease are needed if the disease may be confused with other dise... more Criteria for the diagnosis of a disease are needed if the disease may be confused with other diseases due to overlapping features. This was clearly the case for interstitial cystitis (IC) 30 years ago. Therefore, the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) formulated criteria for diagnosis in 1987 [1]. The NIDDK criteria were specifically designed for research. For research purposes, most scientists will only accept “certain” diagnoses. Consequently, patients had to fulfill many requirements for inclusion, while many conditions existed that excluded patients from a diagnosis. Research criteria, therefore, have a high specificity by design and, consequently, a low sensitivity. The definition of research criteria by the NIDDK can be considered to have been a milestone in the facilitation of research of IC. The NIDDK criteria have been widely used ever since, not only for research but also in clinical settings.
Sjögren's syndrome is a generalised autoimmune disease. It is a disease which is characterise... more Sjögren's syndrome is a generalised autoimmune disease. It is a disease which is characterised by eye and mouth symptoms caused by an abnormal composition and/or impaired production of tear fluid and saliva. Focal inflammatory infiltrate comprising mainly T-lymphocytes occurs in the lacrimal and salivary glands. In addition to the eye and mouth symptoms, many patients also experience general symptoms. However, these are not characteristic of Sjögren's syndrome because they are not present in all patients and are also frequently found in other diseases. These include: fatigue, arthralgia, Raynaud's phenomenon and hypersensitivity vasculitis. Abnormalities in the quantity and composition of tear fluid and saliva may also be due to causes other than Sjögren's syndrome. One important cause is medication, particularly diuretics, β-blockers and tricyclic antidepressants. Inflammation of the lacrimal and salivary glands can likewise have other causes.
Laboratory Investigation, 2003
Sjögren's syndrome is an autoimmune disease in which lymphocytic infiltrates develop in the e... more Sjögren's syndrome is an autoimmune disease in which lymphocytic infiltrates develop in the exocrine glands. Pathogenetic aspects of the disease can be studied in the nonobese diabetic (NOD) mouse strain, a spontaneous model for Sjögren's syndrome. Apoptosis may play a role in the initation phase and in the effector phase of autoimmune diseases. Here, we have examined the role of apoptosis in the development of sialoadenitis in the NOD mouse. Apoptotic cells and the expression of apoptosis-related molecules were studied in submandibular glands (SMG) of NOD and NOD-scid mice before and after the onset of sialoadenitis. Numbers of apoptotic cells were not increased as compared with control mice, at any age. By immunohistochemistry, we demonstrated increased expression of Fas, Fas ligand (FasL), and bcl-2 on SMG epithelial cells of NOD and NOD-scid mice, as early as 3 days of age. mRNA expression of Fas and FasL was also examined in SMG by RQ-PCR. Low-level expression of Fas an...
of CCR5 on dendritic cells promotes a proinflammatory
Inleiding Het syndroom van Sjogren is een gegeneraliseerde auto-immuunziekte. De ziekte is gekenm... more Inleiding Het syndroom van Sjogren is een gegeneraliseerde auto-immuunziekte. De ziekte is gekenmerkt door de klachten van de ogen en van de mond welke worden veroorzaakt door een afwijkende samenstelling en/of verminderde vorming van traanvocht en speeksel. In de traan- en speekselklieren komt een focaal ontstekingsinfiltraat voor van vnl. T-lymfocyten. Naast de klachten van de ogen en mond komen bij veel patienten ook algemene klachten voor. Deze zijn evenwel niet kenmerkend voor het syndroom van Sjogren omdat ze niet bij iedere patient aanwezig zijn en ook vaak bij andere ziekten voorkomen. Dit betreft bv. moeheid, artralgie, het fenomeen van Raynaud en hypersensitivity vasculitis. Afwijkingen in de hoeveelheid en de samenstelling van het traanvocht en speeksel kunnen ook andere oorzaken hebben dan het syndroom van Sjogren. Een belangrijke oorzaak vormen geneesmiddelen, vooral diuretica, β-blockers en tricyclische antidepressiva. Ontstekingen van de traan- en speekselklieren kunn...
Many patients with interstitial cystitis (IC) also have gastrointestinal disorders. Table 1 shows... more Many patients with interstitial cystitis (IC) also have gastrointestinal disorders. Table 1 shows the results of a survey in the United States in which more than 6,000 IC patients were asked what disorders they had in association with their IC. Our own data on IC and Sjogren's syndrome have been added to this list. Two groups of gastrointestinal disorders are included in this list: irritable bowel syndrome and Crohn's disease/ulcerative colitis. Both groups will be discussed here individually. In addition to the above-mentioned disorders, drugs can also be the cause of gastric or intestinal symptoms. In particular, certain painkilling/anti-inflammatory drugs often cause gastrointestinal symptoms or disorders. These will be discussed separately. Crohn's disease Crohn's disease is a chronic inflammatory bowel disease. This disease is known by a variety of names depending on which parts of the intestinal tract are affected. If the disease only occurs in the last section of
Het is aan personen toegestaan dit bestand te printen voor eigen gebruik. Voor elk ander gebruik ... more Het is aan personen toegestaan dit bestand te printen voor eigen gebruik. Voor elk ander gebruik of vermenigvuldiging moet eerst door de auteur toestemming worden verleend.
Immunology Methods Manual, 1996
Hepato-gastroenterology, 1981
The anaerobic fecal flora of patients with Crohn's disease has been found to differ from the ... more The anaerobic fecal flora of patients with Crohn's disease has been found to differ from the flora of healthy subjects by higher numbers of anaerobic gram-negative rods and gram-positive coccoid rods. Agglutinating antibodies against strains of coccoid rods, belonging to species of Eubacterium and Peptostreptococcus were detected in much higher percentages of sera from patients with Crohn's disease than in those from patients with ulcerative colitis, and healthy subjects. On the basis of the results of agglutination reactions with four strains, the probability of Crohn's disease can be estimated. In this paper, the background of the test ist described and its use and limitations are reviewed.
Nederlands tijdschrift voor geneeskunde, Jan 17, 1970
Scandinavian Journal of Gastroenterology, 1988
The obligate anaerobic faecal floras of patients with Crohn's disease, their first-degree... more The obligate anaerobic faecal floras of patients with Crohn's disease, their first-degree relatives, and healthy control subjects were compared. The flora of Crohn's patients contained more anaerobic gram-positive coccoid rods and gram-negative rods than that of healthy subjects; on this basis patients and healthy subjects formed two clusters with minor overlap. Nine of 26 children of Crohn's patients were also included within the Crohn's disease cluster. During 5 to 7 years of follow-up study 3 of them presented with remitting abdominal pain, diarrhoea, or weight loss, and in 1 of them Crohn's disease was diagnosed; none of the 17 children with a normal flora showed symptoms possibly due to Crohn's disease. It is concluded that the abnormal flora may be indigenous to subjects predisposed to Crohn's disease, suggesting a direct or indirect relationship between the abnormal faecal flora and Crohn's disease.
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Papers by Joop P van de Merwe
The prevalence of allergies in IC is reported to be between 40 and 80% of patients. The background of the association is not known and does not seem to be the result of a generalized allergic constitution. Some report that treatment of allergy sometimes has a beneficial effect on bladder symptoms. An increased expression of certain growth factors (PD-ECGF, FGF, and VEGF) has been found in the bladder of IC patients. In addition, the expression of CD44 was significantly higher in ulcer type IC than in non-ulcer type. In general, these growth factors are soluble and diffusible under normal conditions but proteoglycans such as CD44 could bind to these growth factors. This may promote the accumulation of growth factors at the sites of inflammation. CD44 expression in ulcer type IC could explain the prolonged and stronger expression of GAG-binding growth factors that promote inflammation.
In the Rotterdam study, a strong association between IC and Sjögren’s syndrome is recognized. In this study, 28% of IC patients have definite or probable Sjögren’s syndrome. This association is much stronger than is generally recognized. This could be due to difficulties in diagnosing Sjögren’s syndrome since a diagnosis usually requires a high index of suspicion.
The prevalence of allergies in IC is reported to be between 40 and 80% of patients. The background of the association is not known and does not seem to be the result of a generalized allergic constitution. Some report that treatment of allergy sometimes has a beneficial effect on bladder symptoms. An increased expression of certain growth factors (PD-ECGF, FGF, and VEGF) has been found in the bladder of IC patients. In addition, the expression of CD44 was significantly higher in ulcer type IC than in non-ulcer type. In general, these growth factors are soluble and diffusible under normal conditions but proteoglycans such as CD44 could bind to these growth factors. This may promote the accumulation of growth factors at the sites of inflammation. CD44 expression in ulcer type IC could explain the prolonged and stronger expression of GAG-binding growth factors that promote inflammation.
In the Rotterdam study, a strong association between IC and Sjögren’s syndrome is recognized. In this study, 28% of IC patients have definite or probable Sjögren’s syndrome. This association is much stronger than is generally recognized. This could be due to difficulties in diagnosing Sjögren’s syndrome since a diagnosis usually requires a high index of suspicion.