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Free radicals and inflammation. P G Winyard, D R Blake, C H Evans. (Pp 272; DM238.) Basle: Birkhauser Verlag AG, 2000. ISBN 3-7643-5851-3.
Understanding the genesis, propagation, and persistence of the inflammatory process in arthritis is one of the most challenging problems facing biologists and clinical investigators. Our understanding of the role of free radicals in inflammation has increased dramatically over the past decade. Searches for key words such as “reactive oxygen species and inflammation” in the PubMed database turn up 1000 papers—900 of which will have been written within the past 10 years! It is obvious that oxidative stress is involved in the pathogenesis of human inflammatory diseases. However, these systems are complex, and there is increasing evidence that reactive oxygen species also play a part in almost every stage of the body's defence and repair processes. Moreover, there is a physiological oxidant/antioxidant equilibrium, and one of the mechanisms proposed for inflammation is the uncoupling of this equilibrium as a result of changes in the microenvironment. This complexity makes it helpful to have a book summarising this topic, particularly for those without the time to keep up to date with new and sometimes controversial data. The authors aim to fulfil this ambitious goal.
There are 16 chapters which are generally well illustrated and well referenced up to 1998. Some of them focus on bone and joint diseases, and those entitled “Nitric oxide and inflammatory joint diseases”, “Nitric oxide and bone destruction” and “Reactive metabolites of oxygen and nitrogen, adhesion molecule expression and chronic joint inflammation” are of particular interest to rheumatologists. These chapters review the evidence for the involvement of NO in both acute and chronic inflammation, and also discuss osteoblast and osteoclast activity.
Free Radicals and Inflammation is intended not only for rheumatologists but also for biologists. The biochemistry of NO and H2O2 is discussed in detail. The enzyme systems involved in the regulation of the synthesis and activity of free radicals are also dealt with in detail, as shown by the three chapters devoted to NADPH oxidase, xanthine oxidoreductase, and thioredoxin systems.
There are chapters on gene regulation by free radicals, which is perhaps one of the most exciting topics in this field today. The chapter on the regulation of metalloproteinase expression by reactive oxygen species is particularly outstanding. The rationale for the use of antioxidants in the treatment of arthritis is strongly argued.
However, it is regrettable that poor organisation results in a collection of unrelated chapters rather than a unified synthesis of the subject. Another weakness is the relatively limited space allocated to therapeutics. Some chapters include interesting data on the prospects for new drugs, but it would have been more helpful to have a section devoted to therapy.
To summarise, biologists, students and rheumatologists are given a useful account of the vast amount of information now available about this complex system.
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