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The effect of inflammatory cytokines on the in-vitro synthesis of erythropoietin by HepG2 cells was evaluated. Monocyte-conditioned medium, and the cytokines interleukin-1 beta, interleukin-6 and tumour necrosis factor-alpha all reduced synthesis of erythropoietin. The steroidal anti-inflammatory drug, dexamethasone, did not affect cytokine-mediated erythropoietin inhibition. Dexamethasone did cause a reduction in the secretion of erythropoietin inhibitory cytokines from monocytes. These results point to a possible therapeutic approach in the treatment of anaemia caused by suppression of erythropoietin synthesis by monocytic cytokines.

The kinetics of in vitro cellular proliferation against a PPD of Mycobacterium tuberculosis or streptococcal antigen (streptokinase-streptodornase) was evaluated in pleural fluid and peripheral blood mononuclear cells (PBMC) from patients with tuberculous and non-tuberculous pleuritis. The peak proliferative response to PPD by mononuclear cells from pleural fluid occurred earlier (day 3) in 65% of patients with tuberculosis, a finding not seen in non-tuberculous effusions. Spontaneous lymphocyte proliferation of both peripheral blood lymphocytes and pleural effusion lymphocytes was frequently observed, irrespective of etiology. However, 20 of 21 tuberculous patients manifesting spontaneous lymphocyte proliferation had accelerated kinetics of proliferation to PPD, which was antigen-specific. These results suggest that spontaneous lymphocyte proliferation occurs as a response to antigen stimulation at the site of disease, and is not a non-specific response to inflammation. Furthermore, enhanced reactivity against mycobacterial antigen, manifested by accelerated kinetics of proliferation, has diagnostic potential in patients with pleural effusions.