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New neuroscience research company for UK
Why retinas detach in atopic dermatitis cases of retinal detachassociated with atopic dermatitis (148 cases, 206 eyes) have been reported since the first case was described in 1937. The curious feature is that 131 of the patients have been from Japan. According to Yoneda and colleagues from Kyoto University, who described 4 cases and did a literature review (Br y Dermatol 1995; 133: 586-94), in patients with atopic dermatitis retinal detachment occurs at a young age (usually in the second or third decade) and commonly affects both eyes (58 cases). In all patients the atopic dermatitis affected the face, especially the periorbital areas. Detachment in patients with atopic dermatitis was commonest in the temporal area of the retina, as in cases without dermatitis. One theory on the retinal complication is that, since the skin and the retina are both derived from the ectoderm, the detachment could be caused by the retinal oedema due to the allergy causing the dermatitis. Another theory is that the detachment is due to trauma induced by vigorous rubbing and slapping of the periorbital area in response to itch and discomfort. The prevalence of detachments in the temporal area offers support for the slapping theory. To clarify how the retina gets the detached, Kyoto group et (Takahashi al, Br J Ophthalmol 1996; 80: 54-57) have examined the records of 80 of their patients (89
early ment
150
eyes). They related the type of retinal break to whether the lens was clear, whether there was a cataract (rapidly developing cataracts are a known rare complication of atopic dermatitis), and whether the eye was aphakic or pseudophakic. Atrophic holes predominated among patients with clear lenses and retinal dialysis (indicating tears) in the other two groups. The researchers conclude that in some patients with atopic dermatitis the detachment occurs in the same way as it does in young people without dermatitis, and produces atrophic holes. In the others an abnormal immune reaction to the trauma of surgery causes contraction of the remaining part of the posterior capsule and anterior portion of the vitreous, and hence undue traction on the retina. But why are the Japanese so prone to the complication? Prof John Forrester of Aberdeen University, whose research area is autoimmune eye disorders, says that a genetic predisposition is not unlikely since there is a syndrome affecting the eye and the skin that is found almost exclusively among the Japanese. The Vogt-
neuroscience
research has been Cerebrus, set up in the UK. Founded by Chris Evans-the microbiologist turned biotechnology entrepreneur behind Chiroscience and Celsis, two successful research companies-and five neuroscientists with extensive experience in the pharmaceutical industry, Cerebrus expects in time to be able to offer its clients more than 30 complex biological models for screening potential central ner-
company,
vous
system
compounds. Apart
from such contract work, for which the estimated market is jE400 million worldwide, the firm intends to develop its own drug molecules. The has so far secured sufficient funding for the first year and a half, but with backers like EVans
108
and the cause of Bell’s remains a mystery. Among the commonly held beliefs about this diosrder is that it is due to herpes simplex virus 1 (HSV-1), a conviction perhaps strengthened by the fact that Ramsay-Hunt syndrome-the second most common cause of facial paralysis after Bell’s palsy-is caused by reactivated varicella-zoster virus Lancet i: 1933; (see (VZV) 19-22). Using PCR, Murakami et al from Japan have now isolated the HSV-11 genome from facial nerve endoneurial fluid and posterior auricular muscle from patients with Bell’s palsy (Ann Intern Med 1996; 124: 27-30). Researchers collected samples from 14 Bells’s palsy patients undergoing
espite theory, observation,
Dpalsyinvestigation,
nerve-decompression surgery. Samples were also collected from nine patients with Ramsay-Hunt syndrome and 12 others undergoing the same procedure for a variety of unrelated conditions. PCR amplified
to
the HSV-viral genome in 11 of the Bell’s palsy patients and in none of the others. VZV genome remained undetected in any Bell’s palsy or control patients; they were found in
retina.
eight patients with Ramsay-Hunt virus syndrome. Epstein-Barr not in was amplified any genome patient or control.
Koyanagi-Harada syndrome, thought be due to autoimmunity to melanocytes, causes vitiligo and an intraocular inflammation complicated by exudative detachment of the
researchers concluded that although HSV-11 has often been found in human geniculate ganglia at necropsy, its presence in endoneurial fluid indicates-for the first timethat reactivated virus is the cause of Bell’s palsy. This conclusion was seconded in an accompanying editorial (pp 63-65) by J Richard Baringer (University of Utah), who suggested that the new data "would logically argue for the use of acyclovir" as part of the management of Bell’s palsy. In fact, upon reviewing results from research yet in press, Baringer that reported acyclovir plus predThe
Vivien Choo
New neuroscience research company for UK A new
Bell’s palsy is due to herpes simplex virus 1
and Schroders, it will be well finanaced for the next 3 years. It hopes to increase staff numbers to 100-200 over the next 5 years. For now work will be conducted at a laboratory at the Imperial College Science Park at Silwood Park (near Ascot) and at another at the Northwick Park Research Institute (Harrow). The firm’s main competitors will be ITEM-Labo in France and Battelle in Switzerland. Chiroscience focuses on developing single-isomer molecules (as opposed to racemic mixtures), whereas Celsis develops rapid monitoring devices required by the pharmaceutical industry for quality control. Vivien Choo
nisone, as opposed to prednisone alone, seems to have a "modest thera-
peutic advantage in terms of speed and completeness of recovery in patients with Bell palsy". Finally, in view of the new evidence supporting HSV-1 as cause of Bell’s palsy, he suggested that the disorder be renamed "herpetic facial paralysis". David H Frankel
early ment
150
eyes). They related the type of retinal break to whether the lens was clear, whether there was a cataract (rapidly developing cataracts are a known rare complication of atopic dermatitis), and whether the eye was aphakic or pseudophakic. Atrophic holes predominated among patients with clear lenses and retinal dialysis (indicating tears) in the other two groups. The researchers conclude that in some patients with atopic dermatitis the detachment occurs in the same way as it does in young people without dermatitis, and produces atrophic holes. In the others an abnormal immune reaction to the trauma of surgery causes contraction of the remaining part of the posterior capsule and anterior portion of the vitreous, and hence undue traction on the retina. But why are the Japanese so prone to the complication? Prof John Forrester of Aberdeen University, whose research area is autoimmune eye disorders, says that a genetic predisposition is not unlikely since there is a syndrome affecting the eye and the skin that is found almost exclusively among the Japanese. The Vogt-
neuroscience
research has been Cerebrus, set up in the UK. Founded by Chris Evans-the microbiologist turned biotechnology entrepreneur behind Chiroscience and Celsis, two successful research companies-and five neuroscientists with extensive experience in the pharmaceutical industry, Cerebrus expects in time to be able to offer its clients more than 30 complex biological models for screening potential central ner-
company,
vous
system
compounds. Apart
from such contract work, for which the estimated market is jE400 million worldwide, the firm intends to develop its own drug molecules. The has so far secured sufficient funding for the first year and a half, but with backers like EVans
108
and the cause of Bell’s remains a mystery. Among the commonly held beliefs about this diosrder is that it is due to herpes simplex virus 1 (HSV-1), a conviction perhaps strengthened by the fact that Ramsay-Hunt syndrome-the second most common cause of facial paralysis after Bell’s palsy-is caused by reactivated varicella-zoster virus Lancet i: 1933; (see (VZV) 19-22). Using PCR, Murakami et al from Japan have now isolated the HSV-11 genome from facial nerve endoneurial fluid and posterior auricular muscle from patients with Bell’s palsy (Ann Intern Med 1996; 124: 27-30). Researchers collected samples from 14 Bells’s palsy patients undergoing
espite theory, observation,
Dpalsyinvestigation,
nerve-decompression surgery. Samples were also collected from nine patients with Ramsay-Hunt syndrome and 12 others undergoing the same procedure for a variety of unrelated conditions. PCR amplified
to
the HSV-viral genome in 11 of the Bell’s palsy patients and in none of the others. VZV genome remained undetected in any Bell’s palsy or control patients; they were found in
retina.
eight patients with Ramsay-Hunt virus syndrome. Epstein-Barr not in was amplified any genome patient or control.
Koyanagi-Harada syndrome, thought be due to autoimmunity to melanocytes, causes vitiligo and an intraocular inflammation complicated by exudative detachment of the
researchers concluded that although HSV-11 has often been found in human geniculate ganglia at necropsy, its presence in endoneurial fluid indicates-for the first timethat reactivated virus is the cause of Bell’s palsy. This conclusion was seconded in an accompanying editorial (pp 63-65) by J Richard Baringer (University of Utah), who suggested that the new data "would logically argue for the use of acyclovir" as part of the management of Bell’s palsy. In fact, upon reviewing results from research yet in press, Baringer that reported acyclovir plus predThe
Vivien Choo
New neuroscience research company for UK A new
Bell’s palsy is due to herpes simplex virus 1
and Schroders, it will be well finanaced for the next 3 years. It hopes to increase staff numbers to 100-200 over the next 5 years. For now work will be conducted at a laboratory at the Imperial College Science Park at Silwood Park (near Ascot) and at another at the Northwick Park Research Institute (Harrow). The firm’s main competitors will be ITEM-Labo in France and Battelle in Switzerland. Chiroscience focuses on developing single-isomer molecules (as opposed to racemic mixtures), whereas Celsis develops rapid monitoring devices required by the pharmaceutical industry for quality control. Vivien Choo
nisone, as opposed to prednisone alone, seems to have a "modest thera-
peutic advantage in terms of speed and completeness of recovery in patients with Bell palsy". Finally, in view of the new evidence supporting HSV-1 as cause of Bell’s palsy, he suggested that the disorder be renamed "herpetic facial paralysis". David H Frankel