Mechanistic study of idiosyncratic drug-induced hepatitis (DIH) continues to be a challenging problem because of the lack of animal models. The inability to produce this type of hepatotoxicity in animals, and its relative rarity in humans, may be linked to the production of antiinflammatory factors that prevent drug-protein adducts from causing liver injury by immune and nonimmune mechanisms. We tested this hypothesis by using a model of acetaminophen (APAP)-induced liver injury in mice. After APAP treatment, a significant increase was observed in serum levels of interleukin (IL)-4, IL-10, and IL-13, cytokines that regulate inflammatory mediator production and cell-mediated autoimmunity. When IL-10 knockout (KO) mice were treated with APAP, most of these mice died within 24 to 48 hours from liver injury. This increased susceptibility to APAP-induced liver injury appeared to correlate with an elevated expression of liver proinflammatory cytokines, tumor necrosis factor (TNF)-␣, and IL-1, as well as inducible nitric oxide synthase (iNOS). In this regard, mice lacking both IL-10 and iNOS genes were protected from APAP-induced liver injury and lethality when compared with IL-10 KO mice. All strains, including wild-type animals, generated similar amounts of liver APAPprotein adducts, indicating that the increased susceptibility of IL-10 KO mice to APAP hepatotoxicity was not caused by an enhanced formation of APAP-protein adducts. Epidemiologic studies reveal that as many as 25% of fulminant hepatitis cases in intensive care units are caused by DIH. 1 It is also the major reason for removal of new drugs from clinical development and widespread use. 2 Although DIH can be very severe, the incidence for any given drug is usually low. It has been hypothesized that this idiosyncratic nature of DIH is either caused by a metabolic idiosyncrasy, in which patients who develop toxicity metabolize the drug to reactive metabolites to a greater extent than most others, 3 or an immunologic idiosyncrasy (druginduced allergic hepatitis [DIAH]), in which the immune system of patients who develop DIH react against protein adducts of drugs or other neoantigens formed in the liver. 3,4 These 2 mechanisms are not mutually exclusive and might both contribute to the initiation of DIH. 3 However, the demonstration of specific antibodies and sensitized T cells that react with drugs, their metabolites, or specific protein neoantigens and/or autoantigens supports the immunologic basis of DIH. [2][3][4][5][6] The host-dependent, idiosyncratic nature of DIH is poorly understood, but may be related to a variety of factors that in most individuals either fail to promote or, in fact, protect against DIH. For example, genetic polymorphisms in the specific repertoire of major histocompatibility complex class I and II antigens and/or Band T-cell receptors may render the immune cells from most individuals incapable of satisfactorily binding or presenting protein adducts of drugs or their derived peptides and, therefore, unable to lead to immunopatholog...

Expansion of the polyglutamine (polyQ) tract in human TATA-box binding protein (TBP) causes the neurodegenerative disease spinocerebellar ataxia 17 (SCA17). It remains unclear how the polyQ tract regulates normal protein function and induces selective neuropathology in SCA17. We generated transgenic mice expressing polyQ-expanded TBP. These mice showed weight loss, progressive neurological symptoms and neurodegeneration before early death. Expanded polyQ tracts reduced TBP dimerization but enhanced the interaction of TBP with the general transcription factor IIB (TFIIB). In SCA17 transgenic mice, the small heat shock protein HSPB1, a potent neuroprotective factor, was downregulated, and TFIIB occupancy of the Hspb1 promoter was decreased. Overexpression of HSPB1 or TFIIB alleviated mutant TBP-induced neuritic defects. These findings implicate the polyQ domain of TBP in transcriptional regulation and provide insight into the molecular pathogenesis of SCA17.

TATA binding protein (TBP), a universal transcription factor, is broadly required by nuclear RNA polymerases for the initiation of transcription. TBP contains a polymorphic polyglutamine tract in its N-terminal region, and expansion of this tract leads to spinocerebellar ataxia type 17 (SCA17), one of nine dominantly inherited neurodegenerative diseases caused by polyglutamine expansion in the affected proteins. The expanded polyglutamine proteins are ubiquitously expressed, but cause selective and characteristic neurodegeneration in distinct brain regions in each disease. Unlike many other polyglutamine proteins, whose functions are not yet fully understood, TBP is a well-characterized transcription factor that is restricted to the nucleus. Thus, investigating how mutant TBP mediates neuropathology should help elucidate the mechanisms by which transcriptional dysregulation contributes to neuronal dysfunction and/or neurodegeneration in polyglutamine diseases. To this end, we characterized cellular and mouse models expressing polyQ-expanded TBP. The cell model exhibits characteristic features of neuronal dysfunction, including decreased cell viability and defective neurite outgrowth. We found that the high-affinity nerve growth factor receptor, TrkA, is down-regulated by mutant TBP in cells. Down-regulation of TrkA also occurs in the cerebellum of SCA17 transgenic mice prior to Purkinje cell degeneration. Mutant TBP binds more Sp1, reduces its occupancy of the TrkA promoter and inhibits the activity of the TrkA promoter. These findings suggest that the transcriptional down-regulation of TrkA by mutant TBP contributes to SCA17 pathogenesis.

We report a case of bilateral solar retinopathy following the Great American Eclipse on August 21, 2017. We summarize findings on multimodal imaging and risk factors associated with solar retinopathy. Methods: A teenage boy presented with painless vision loss 4 days following viewing a total solar eclipse. Funduscopic examination, optical coherence tomography, and fluorescein angiography revealed findings characteristic of solar retinopathy. Multifocal electroretinography was also performed. We add to the literature the first reported case of solar retinopathy following the Great American Eclipse. Results: The patient was observed with serial examinations over several weeks. Gradual trend toward visual recovery was noted on imaging. Conclusions: In combination with clinical history of sungazing and funduscopic examination, distinct findings on imaging help secure a diagnosis of solar retinopathy. Visual symptoms in solar retinopathy generally improve over time. Appropriate protective measures with counseling and filtered eyewear are recommended for eclipse viewers.