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Xie Y, Jin C, Sang H, Liu W, Wang J. Ivermectin Protects Against Experimental Autoimmune Encephalomyelitis in Mice by Modulating the Th17/Treg Balance Involved in the IL-2/STAT5 Pathway. Inflammation 2023; 46:1626-1638. [PMID: 37227550 PMCID: PMC10209955 DOI: 10.1007/s10753-023-01829-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/21/2023] [Accepted: 04/30/2023] [Indexed: 05/26/2023]
Abstract
Multiple sclerosis (MS), a T-cell-mediated autoimmune disease that affects the central nervous system (CNS), is characterized by white matter demyelination, axon destruction, and oligodendrocyte degeneration. Ivermectin, an anti-parasitic drug, has anti-inflammatory, anti-tumor, and antiviral properties. However, to date, there are no in-depth studies on the effect of ivermectin on the function effector of T cells in murine experimental autoimmune encephalomyelitis (EAE), an animal model of MS. Here, we conducted in vitro experiments and found that ivermectin inhibited the proliferation of total T cells (CD3+) and their subsets (CD4+ and CD8+ T cells) as well as T cells secreting the pro-inflammatory cytokines IFN-γ and IL-17A; ivermectin also increased IL-2 production and IL-2Rα (CD25) expression, which was accompanied by an increase in the frequency of CD4+CD25+Foxp3+ regulatory T cells (Treg). Importantly, ivermectin administration reduced the clinical symptoms of EAE mice by preventing the infiltration of inflammatory cells into the CNS. Additional mechanisms showed that ivermectin promoted Treg cells while inhibiting pro-inflammatory Th1 and Th17 cells and their IFN-γ and IL-17 secretion; ivermectin also upregulated IL-2 production from MOG35-55-stimulated peripheral lymphocytes. Finally, ivermectin decreased IFN-γ and IL-17A production and increased IL-2 level, CD25 expression, and STAT5 phosphorylation in the CNS. These results reveal a previously unknown etiopathophysiological mechanism by which ivermectin attenuates the pathogenesis of EAE, indicating that it may be a promising option for T-cell-mediated autoimmune diseases such as MS.
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Affiliation(s)
- Yu Xie
- Infection and Immunity Institute and Translational Medical Center of Huaihe Hospital, Henan University, 115 Ximen Street, Kaifeng, 475000, China
- School of Medicine, Nankai University, Tianjin, 300071, China
| | - Chaolei Jin
- Infection and Immunity Institute and Translational Medical Center of Huaihe Hospital, Henan University, 115 Ximen Street, Kaifeng, 475000, China
| | - Hongzhen Sang
- Infection and Immunity Institute and Translational Medical Center of Huaihe Hospital, Henan University, 115 Ximen Street, Kaifeng, 475000, China
| | - Wenhua Liu
- Infection and Immunity Institute and Translational Medical Center of Huaihe Hospital, Henan University, 115 Ximen Street, Kaifeng, 475000, China
| | - Junpeng Wang
- Infection and Immunity Institute and Translational Medical Center of Huaihe Hospital, Henan University, 115 Ximen Street, Kaifeng, 475000, China.
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2
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Lupia T, Crisà E, Gaviraghi A, Rizzello B, Di Vincenzo A, Carnevale-Schianca F, Caravelli D, Fizzotti M, Tolomeo F, Vitolo U, De Benedetto I, Shbaklo N, Cerutti A, Fenu P, Gregorc V, Corcione S, Ghisetti V, De Rosa FG. Overlapping Infection by Strongyloides spp. and Cytomegalovirus in the Immunocompromised Host: A Comprehensive Review of the Literature. Trop Med Infect Dis 2023; 8:358. [PMID: 37505654 PMCID: PMC10385408 DOI: 10.3390/tropicalmed8070358] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
Strongyloides and cytomegalovirus co-infections are rarely reported, even though they are distinguished by high morbidity and mortality, especially in immunocompromised hosts. We narratively reviewed the literature on reported cases of Strongyloides and CMV co-infections in immunosuppressed patients. Most cases occurred in males with a median age of 47 (IQR, 37-59). Strongyloides/CMV co-infections occurred among immunocompromised hosts, especially in solid organ transplants and hematological or rheumatological diseases. Most of the patients underwent a course of steroid treatment before the diagnosis of co-infections. Other common immunomodulatory agents were tacrolimus and mycophenolate. The first clinical manifestations of co-infections were mainly gastrointestinal, followed by respiratory symptoms. CMV was, in most patients, co-infected with an isolated reactivation, although Strongyloides manifested especially as hyperinfection syndrome. Ganciclovir and ivermectin are the mainstays of CMV and Strongyloides treatment. However, the treatment mortality reported in this narrative review is around 52.4%. Interestingly secondary bacterial infections are common in CMV/Strongyloides-infected patients.
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Affiliation(s)
- Tommaso Lupia
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy
| | - Elena Crisà
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Alberto Gaviraghi
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Barbara Rizzello
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | | | - Fabrizio Carnevale-Schianca
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Daniela Caravelli
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Marco Fizzotti
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Francesco Tolomeo
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Umberto Vitolo
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Ilaria De Benedetto
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Nour Shbaklo
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | | | - Piero Fenu
- Healthcare Management, IRCCS Candiolo, 10100 Candiolo, Italy
| | - Vanesa Gregorc
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
- School of Medicine, Tufts University, Boston, MA 02111, USA
| | - Valeria Ghisetti
- Microbiology Unit, Amedeo di Savoia Hospital, 10100 Turin, Italy
| | - Francesco Giuseppe De Rosa
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
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Hashiba Y, Umekita K, Kimura M, Iwao C, Iwao K, Kariya Y, Kubo K, Miyauchi S, Kudou R, Rikitake Y, Kawaguchi T, Matsuda M, Takajo I, Inoue E, Hidaka T, Okayama A. High incidence of serious infections requiring hospitalisation in human T-cell leukaemia virus type 1-positive rheumatoid arthritis: A case-controlled observational study. Mod Rheumatol 2022; 32:866-874. [PMID: 34897491 DOI: 10.1093/mr/roab077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES We aimed to assess the clinical features of human T-cell leukaemia virus type 1 (HTLV-1)-positive rheumatoid arthritis (RA) patients. Furthermore, we investigated the impact of HTLV-1 infection on incidences of serious infections requiring hospitalisation (SIH) and malignancies. METHODS A total of 150 sex- and age-matched HTLV-1-negative and 50 HTLV-1-positive RA patients were enrolled from the HTLV-1 RA Miyazaki Cohort Study. Clinical and laboratory data were collected from this cohort database. The incidence rate (IR) for SIH and malignancies from 2015 to 2020 was analysed. RESULTS The median age and female ratio in the study population were 70 years old and 80%, respectively. Although no differences were found in inflammatory marker values between the two groups, the patient global assessment and Health Assessment Questionnaire scores were higher in HTLV-1-positive RA patients. In HTLV-1-negative RA patients, the IR for SIH was 6.37/100 person-years (PY) and 1.32/100 PY for malignancies. In HTLV-1-positive RA patients, SIH occurred in 11.1/100 PY and malignancies in 2.46/100 PY. The crude IR ratio comparing SIH between two groups was 1.74 (95% confidence interval, 1.04-2.84), which was a significant increase. CONCLUSIONS HTLV-1-positive RA patients may worsen RA symptoms. HTLV-1 may be a risk factor for SIH.
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Affiliation(s)
- Yayoi Hashiba
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
- Institute of Rheumatology, Zenjinkai Shimin-no-Mori Hospital, Miyazaki, Japan
| | - Kunihiko Umekita
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Masatoshi Kimura
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Chihiro Iwao
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kosho Iwao
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yumi Kariya
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kazuyoshi Kubo
- Institute of Rheumatology, Zenjinkai Shimin-no-Mori Hospital, Miyazaki, Japan
| | - Shunichi Miyauchi
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Risa Kudou
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yuki Rikitake
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Takeshi Kawaguchi
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Motohiro Matsuda
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Ichiro Takajo
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
| | - Eisuke Inoue
- Showa University Research Administration Center, Showa University, Tokyo, Japan
| | - Toshihiko Hidaka
- Institute of Rheumatology, Zenjinkai Shimin-no-Mori Hospital, Miyazaki, Japan
| | - Akihiko Okayama
- Department of Respirology, Rheumatology, Infectious Diseases and Neurology, Internal Medicine, University of Miyazaki, Miyazaki, Japan
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Iwamoto N, Araki T, Umetsu A, Takatani A, Aramaki T, Ichinose K, Terada K, Hirakata N, Ueki Y, Kawakami A, Eguchi K. The Association of Increase of Human T-Cell Leukemia Virus Type-1 (HTLV-1) Proviral Load (PVL) With Infection in HTLV-1-Positive Patients With Rheumatoid Arthritis: A Longitudinal Analysis of Changes in HTLV-1 PVLs in a Single Center Cohort Study. Front Immunol 2022; 13:887783. [PMID: 35603142 PMCID: PMC9120818 DOI: 10.3389/fimmu.2022.887783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objective We evaluated changes of HTLV-1 proviral loads (PVLs) during treatment for rheumatoid arthritis (RA) and investigated whether these changes affect the clinical course in HTLV-1-positive RA patients. Methods A total of 41 HTLV-1-positive RA patients were analyzed. Their clinical picture including disease activity [Disease Activity Score in 28 joints-erythrocyte sedimentation rate (DAS28-ESR), DAS28-CRP, simplified disease activity index (SDAI), and clinical disease activity index (CDAI)] and comorbidity were evaluated over a 2-year period. PVLs from peripheral blood mononuclear cells were investigated by real-time polymerase chain reaction (PCR). We investigated whether HTLV-1 PVLs is altered, or which clinical characteristics affect changes of HTLV1-PVLs during 2-year treatment. Results Clinical disease activity was not changed during the 2-year observational period. The mean HTLV-1 PVL value change from baseline to 2 years was -1.2 copies/1000 PBMCs, which was not statistically significant. No baseline clinical characteristics influenced changes in HTLV-1 PVL. However, a numerical change of HTLV-1 PVLs was increased in 4 patients initiating the new biological/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) at 2−10 months after starting the new b/ts DMARDs (numerical increase was 24.87 copies/1000 PBMCs). Infection occurred in 4 patients, and 3 of those patients showed an increased HTLV-1 PVL. Univariate analysis revealed an association between increase of HTLV-1 PVL and incidence of infection. Conclusions Over 2 years, HTLV-1 PVL did not significantly change in our HTLV-1-positive RA patients. Individual changes in HTLV-1 PVL were correlated with incidence of infection but not disease activity which indicate that we may take precaution toward infection at the uptick of HTLV-1 PVL in HTLV-1-positive RA patients.
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Affiliation(s)
- Naoki Iwamoto
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan
| | - Takeshi Araki
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan
| | - Ayaka Umetsu
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan
| | - Ayuko Takatani
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan
| | | | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan
| | - Kaoru Terada
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan
| | | | - Yukitaka Ueki
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Katsumi Eguchi
- Department of Rheumatology, Sasebo Chuo Hospital, Sasebo, Japan
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Fallahzadeh MA, Rico NT, Vahhab E, He H, Elhamahmi DA, Sandkovsky U. Strongyloides stercoralis and cytomegalovirus coinfection in a patient with a transplanted kidney. Proc AMIA Symp 2021; 35:190-192. [DOI: 10.1080/08998280.2021.1997262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - Nina T. Rico
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- Transplant Nephrology, Baylor University Medical Center, Dallas, Texas
| | - Elham Vahhab
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Huang He
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Dina Abdelwahab Elhamahmi
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- Transplant Nephrology, Baylor University Medical Center, Dallas, Texas
| | - Uriel Sandkovsky
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- Division of Infectious Diseases, Baylor University Medical Center, Dallas, Texas
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