Increased levels of circulating IL-16 and apoptosis markers are related to the activity of Whipple's disease.PLoS ONE. 2007 Jun 6;2(6):e494.

BACKGROUND: Whipple's disease (WD) is an infectious disease caused by Tropheryma whipplei, which replicates in macrophages and induces the release of interleukin (IL)-16, a substrate of caspase 3, and macrophage apoptosis. The disease is characterized by intestinal, cardiac or neurological manifestations; its diagnosis is based on invasive analysis requiring tissue biopsies or cerebrospinal fluid puncture. The disease progression is slow and often complicated by relapses despite empirical antibiotic treatment. METHODOLOGY/PRINCIPAL FINDINGS: We monitored circulating levels of IL-16 and nucleosomes in 36 French patients with WD; among them, some patients were enrolled in a longitudinal follow-up. As compared to control subjects, the circulating levels of both IL-16 and nucleosomes were increased in untreated patients with WD presenting as intestinal, cardiac or neurological manifestations. This finding was specific to WD since the circulating levels of IL-16 and nucleosomes were not increased in patients with unrelated inflammatory diseases such as inflammatory bowel disease or Q fever endocarditis. We also found that increased levels of IL-16 and nucleosomes were related to the activity of the disease. Indeed, successful antibiotic treatment decreased those levels down to those of control subjects. In contrast, patients who suffered from relapses exhibited circulating levels of IL-16 and nucleosomes as high as those of untreated patients. CONCLUSIONS/SIGNIFICANCE: Circulating levels of both IL-16 and nucleosomes were increased in WD. This finding provides simple and non-invasive tools for the diagnosis and the prognosis of WD.

Whipple's disease.Schweiz Rundsch Med Prax. 2007 Jan 10;96(1-2):13-7.

Whipple's disease is a rare infectious disorder affecting mostly middle aged men. The causative organism, Tropheryma whipplei, recently has been cultivated and phylogenetically identified as an actinomycete. The rareness of the disease despite the ubiquitous occurence of T. whipplei presumably is related to a predisposing defect in cellular immunity. The diagnosis usually can be established by small bowel biopsy, but is frequently delayed due to protean clinical manifestations. The initiation of antibiotic treatment in most cases results in clinical remission, however, a significant number of patients is refractory to antimicrobial therapy or has a relapsing course.

Current concepts of immunopathogenesis, diagnosis and therapy in Whipple's disease.Curr Med Chem. 2006;13(24):2921-6.

Whipple's disease (WD) is a rare chronic infectious disorder caused by the rod- shaped bacterium Tropheryma whipplei. The disorder is characterized clinically by arthralgia, abdominal pain, diarrhea, malabsorbtion and progressive weight loss. Other important sites of infection include the heart (resulting in the clinical picture of endocarditis and heart failure) and the central nervous system (CNS) (manifestations include confusion, memory loss, focal cranial nerve signs, nystagmus and ophtalmoplegia). The bacterium is presumed to be ubiquitously present. A defect in cellular immune response may predispose patients for an infection with T. whipplei and this might explain the rarity of the disorder despite the ubiquitous bacterial presence. The presumed immunological defect is likely to be quite specific for T. whipplei, since patients are not generally affected by other infections. Decreased production of Interleukin(IL)-12, IL-2 and Interferon (IFN)-g accompanied by an increased secretion of IL-4 are the main features of this defective immunological response. The finding of periodic acid-Schiff (PAS)-positive macrophages in the lamina propria of tissue samples obtained by duodenal biopsy usually establishes the diagnosis. The PAS-positive inclusions represent the remnants of the bacteria. Attempts to isolate the causative agent were unsuccessful for nearby 100 years after the first recognition of the disease. In the year 2000, the bacterium was finally successfully grown on a human fibroblast cell line. Untreated WD patients suffer from a chronic progressive disorder which possibly leads to death. Most patients show a fast clinical improvement to antibiotic therapy, but clinical relapses are described frequently. There is a number of patients, unable to eradicate the bacterium even after several antibiotic treatments and patients with CNS disease, in both of whom alternative therapy strategies are necessary.