11
Duke University
Medical Center
Intercom
VOL. 25, NO. 4
JAN. 27, 1978
DURHAM, N.C.
^Exciting’ discovery offers new treatment possibilities
By David Williamson
Scientists at Duke have succeeded in
identifying and isolating a protein
enzyme that they believe plays a major
role in the body's ability to deal with cell
damage.
The researchers, who called the
discovery "very exciting," said it may
offer "a whole new strategy" for treating
inflammatory diseases such as psoriasis,
in which too many white blood cells
accumulate in the outer layer of the skin.
Dr. Gerald Lazarus, chief of the
Division of Dermatology, and Drs.
Charlotte Thomas and Fred Yost Jr.
conducted the experiments.
In an interview, Lazarus explained that
when human tissue has been damaged,
white blood cells known as
polymorphonuclear leukocytes are
attracted to the injury to clear away dead
cells and other biological debris.
Under normal circumstances, the white
cell accumulation is a healthy response to
tissue damage, but when too many of
them gather, as in psoriasis, a patient can
develop massive, painful and disfiguring
skin lesions.
The scientist said he and his colleagues
theorized that the damaged tissue must
be releasing or activating a chemical
substance that breaks up certain
"complement" proteins, which in turn
attract the white cells.
Link with enzyme
Using a variety of human cells, the
researchers were able to purify an
enzyme that causes a massive
accumulation of leukocytes when injected
into laboratory mice.
They found that skin lesions of
psoriatic patients contain significantly
more of the enzyme, which they call
"chemotactic proteinase," than does
unaffected skin from the same patients.
A skin disease known as pityriasis
rubra pilaris offered further evidence of
the link between the enzyme and white
Surgery helps give infant 'every chance in life'
(The following was compiled from Associated
Press stories and is used with theAP's permission.)
A six-week-old infant became the
youngest patient in Duke's history to
undergo surgery to correct Crouzon's
disease, when a team of physicians
performed the high-risk procedure
earlier this month.
And he may be the youngest ever to
jHfieive the extensive facial surgery that
involves manipulating the brain back
from the skull so doctors can cut the facial
bones and move them into proper
alignment, thereby correcting this
eolT^enital birth defect.
Clayton Briley, who was born Dec. 2,
now has gone home to Battleboro with
nothing but an ear-to-ear scar across his
scalp to mark his ordeal.
He'll avoid a lot of physical and
emotional anguish that Crouzon's could
have caused.
Small people, big problems
Operating on such a young child poses
special problems.
"Children start losing body heat, so you
have to keep the area around the
operating table warm," according to Dr.
Robert H. Wilkins, professor and chief of
the Division of Neurosurgery and a
member of the team that operated on
Clayton.
Another hazard is that even small
changes in blood pressure can send the
infant into shock.
"We had an excellent anesthesia team
(monitoring the child)," Dr. Calvin R.
Peters said, "That really helped us get
through so quickly."
Peters is assistant professor of plastic
and maxillofacial surgery.
The surgery took less time also because
the infant's head was smaller and the
bones were softer than those of older
children for whom the operation can take
12-14 hours. For Clayton, it lasted six.
Openings are closed
Crouzon's affects what doctors call
sutures in the baby's skull — the openings
where the skull hasn't closed yet. These
normally show up at birth as soft spots on
a baby's head.
(Continued on page 2)
cells, Lazarus said.
The physician called the disease "a dead
ringer for psoriasis" except that it doesn't
include the latter's characteristic build-up
of leukocytes. Laboratory examinations
of pityriasis tissue showed no increase in
chemotactic proteinase either.
Universal mechanism
"Since the enzyme is found in many
tissues of the body and is not just specific
for psoriasis, we believe it is a universal
mechanism," he said. "That's why it's
jjotentially very important.
"Inhibition of the enzyme may be able
to prevent excessive inflammatory cell
accumulation in a wide variety of diseases
including psoriasis," he added.
The scientist said that he, Thomas and
Dr. Robert Gilgor, an assistant professor
of dermatology, are currently studying
the effects of various enzyme inhibitors
on psoriasis patients at the Psoriasis
Treatment Center and Clinical Research
Unit.
Preliminary results have been
"extremely encouraging," Lazarus said.
May be similar
to diabetes treatment
He likened a possible new psoriasis
treatment to the way physicians treat
diabetes.
"We can't cure diabetes yet because we
can't repair the genetic defect that causes
it," he explained. "We can make our
patients better though by giving them
insulin.
"Similarly, we may not understand
what caused the increased activity of the
enzyme, but if we know it's increased and
that it has a pharmacological effect, then
we can deal with it pharmacologically."
The Duke scientists published their
findings in recent issues of "Nature" and
"Science."
w
/■
LOOK MA, PURPLE PANDA! - Having to
spend part of the holidays in the hospital is
bad enough for anyone, but it's especially
trying if you are a child. Representatives
from the Duke Children's Classic appealed
to Mister Rogers' Neighborhood for help in
spreading holiday cheer to children who
were hospitalized. Mister Rogers
responded by sending 250 records, posters
and Purple Panda photos to be distributed
in the pediatric playroom during the
Christmas season. Patients Chip Corell
(left) and Tim Kearney obviously like their
records and photos. (Photos by Parker Herring)
J