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Culerrier J, Nguyen Y, Karadag O, Yasar Bilge S, Kronbichler A, Jayne D, Régent A, Teixeira V, Marchand-Adam S, Duffau P, Oro S, Droumaguet C, Andre B, Luca L, Lechtman S, Aouba A, Lebas C, Servettaz A, Puéchal X, Terrier B. Caractéristiques et évolution des vascularites associées aux ANCA induites par les antithyroïdiens de synthèse comparativement aux formes primitives : étude rétrospective multicentrique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Shin JI, Kim SE, Lee MH, Kim MS, Lee SW, Park S, Shin YH, Yang JW, Song JM, Moon SY, Kim SY, Park Y, Suh DI, Yang JM, Cho SH, Jin HY, Hong SH, Won HH, Kronbichler A, Koyanagi A, Jacob L, Hwang J, Tizaoui K, Lee KH, Kim JH, Yon DK, Smith L. COVID-19 susceptibility and clinical outcomes in autoimmune inflammatory rheumatic diseases (AIRDs): a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci 2022; 26:3760-3770. [PMID: 35647859 DOI: 10.26355/eurrev_202205_28873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This meta-analysis aims to assess the susceptibility to and clinical outcomes of COVID-19 in autoimmune inflammatory rheumatic disease (AIRD) and following AIRD drug use. MATERIALS AND METHODS We included observational and case-controlled studies assessing susceptibility and clinical outcomes of COVID-19 in patients with AIRD as well as the clinical outcomes of COVID-19 with or without use of steroids and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs). RESULTS Meta-analysis including three studies showed that patients with AIRD are not more susceptible to COVID-19 compared to patients without AIRD or the general population (OR: 1.11, 95% CI: 0.58 to 2.14). Incidence of severe outcomes of COVID-19 (OR: 1.34, 95% CI: 0.76 to 2.35) and COVID-19 related death (OR: 1.21, 95% CI: 0.68 to 2.16) also did not show significant difference. The clinical outcomes of COVID-19 among AIRD patients with and without csDMARD or steroid showed that both use of steroid (OR: 1.69, 95% CI: 0.96 to 2.98) or csDMARD (OR: 1.35, 95% CI: 0.63 to 3.08) had no effect on clinical outcomes of COVID-19. CONCLUSIONS AIRD does not increase susceptibility to COVID-19, not affecting the clinical outcome of COVID-19. Similarly, the use of steroids or csDMARDs for AIRD does not worsen the clinical outcome.
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Affiliation(s)
- J I Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Choi MJ, Yang JW, Lee S, Kim JY, Oh JW, Lee J, Stubbs B, Lee KH, Koyanagi A, Hong SH, Ghayda RA, Hwang J, Dragioti E, Jacob L, Carvalho AF, Radua J, Thompson T, Smith L, Fornaro M, Stickley A, Bettac EL, Han YJ, Kronbichler A, Yon DK, Lee SW, Shin JI, Lee E, Solmi M. Suicide associated with COVID-19 infection: an immunological point of view. Eur Rev Med Pharmacol Sci 2021; 25:6397-6407. [PMID: 34730221 DOI: 10.26355/eurrev_202110_27013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) is a pandemic and leading cause of death. Beyond the deaths directly caused by the virus and the suicides related to the psychological response to the dramatic changes as socioeconomic related to the pandemic, there might also be suicides related to the inflammatory responses of the infection. Infection induces inflammation as a cytokine storm, and there is an increasing number of studies that report a relationship between infection and suicide. MATERIALS AND METHODS We searched the World Health Organization status report and the PubMed database for keywords (COVID-19, suicide, infection, inflammation, cytokines), and reviewed five cytokine pathways between suicide and inflammation using two meta-analyses and two observational studies starting from November 31, 2020, focusing on the relationship between suicide and inflammation by infection. First, we discussed existing evidence explaining the relationship between suicidal behaviors and inflammation. Second, we summarized the inflammatory features found in COVID-19 patients. Finally, we highlight the potential for these factors to affect the risk of suicide in COVID-19 patients. RESULTS Patients infected with COVID-19 have high amounts of IL-1β, IFN-γ, IP10, and MCP1, which may lead to Th1 cell response activation. Also, Th2 cytokines (e.g., IL-4 and IL-10) were increased in COVID-19 infection. In COVID-19 patients, neurological conditions, like headache, dizziness, ataxia, seizures, and others have been observed. CONCLUSIONS COVID-19 pandemic can serve as a significant environmental factor contributing directly to increased suicide risk; the role of inflammation by an infection should not be overlooked.
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Affiliation(s)
- M J Choi
- Yonsei University College of Medicine, Seoul, Republic of Korea.
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Lee HJ, Jeong GH, Li H, Kim MS, Kim JS, Park SJ, Han YJ, Lee KH, Kronbichler A, Hong SH, Ghayda RA, Luchini C, Nottegar A, Koyanagi A, Smith L, Jacob L, Dragioti E, Radua J, Cargnin S, Terrazzino S, Thompson T, Yon DK, Lee SW, Yang JM, Wasuwanich P, Shin JI, Gamerith G. Efficacy and safety of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) monotherapy for advanced EGFR-mutated non-small cell lung cancer: systematic review and meta-analysis. Eur Rev Med Pharmacol Sci 2021; 25:6232-6244. [PMID: 34730203 DOI: 10.26355/eurrev_202110_26993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE It is controversial whether there is efficacy or safety benefit of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) in advanced EGFR-mutated non-small cell lung cancer (NSCLC) compared to standard chemotherapy. We aim to assess the efficacy and safety of EGFR-TKIs compared to other chemotherapeutics in EGFR-mutated NSCLC. MATERIALS AND METHODS Up to April 27th, 2020, PubMed, Embase, Medline, Scopus, Cochrane library, and ClinicalTrials.gov were searched for articles or trials meeting the inclusion criteria. After filtering, 230 eligible studies were initially identified. Data extraction followed PRISMA and included outcomes were progression-free survival (PFS), overall survival (OS), and severe adverse events (SAEs). Direct and indirect meta-analyses were generated in the context of log-linear mixed-effects models, with fixed effects for each relative comparison and random effects for each study. RESULTS The results showed that EGFR-TKI therapy had improved PFS with a hazard ratio (HR) of 0.40 (95% CI: 0.36-0.44, p<0.001) compared to standard chemotherapy. Nevertheless, the EGFR-TKIs showed no benefit on OS (HR: 0.96, 95% CI: 0.83-1.10, p=0.556). In the analysis of adverse events, EGFR-TKIs had fewer SAEs than standard chemotherapy (HR: 0.29, 95% CI: 0.26-0.33, p<0.001). CONCLUSIONS Our systemic review indicates that EGFR-TKI therapy has improved PFS, and reduced SAEs compared to standard chemotherapy in advanced EGFR-mutated NSCLC.
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Affiliation(s)
- H J Lee
- Yonsei University College of Medicine, Seoul, Republic of Korea.
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Han KH, Lee KH, Park SJ, Yu R, Kim SH, Lee IR, Han SY, Kim HS, Kronbichler A, Li H, Koyanagi A, Jacob L, Shin JI, Kim JH, Smith L. Hypocomplementemia (C3) as an independent predictor for children with acute post-streptococcal glomerulonephritis: a long-term observation. Eur Rev Med Pharmacol Sci 2021; 25:5674-5683. [PMID: 34604959 DOI: 10.26355/eurrev_202109_26786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to examine the altering patterns in clinical characteristics and severity of acute post-streptococcal glomerulonephritis (APSGN) in children. PATIENTS AND METHODS We analyzed the medical records of 119 children who were diagnosed with APSGN from 1987 to 2018, retrospectively. The patients were divided into two groups: Group I (n=72, before 1998) and Group II (n=47, after 1998). Clinical, radiologic, and laboratory findings were compared between the two groups. RESULTS The clinical manifestations, including vomiting (20.8% vs. 4.3%, p=0.014), oliguria (40.3% vs. 19.1%, p=0.016), and generalized edema (86.1% vs. 63.8%, p=0.005), were statistically less frequent since 1998. Pulmonary edema on chest X-ray (22.7% vs. 4.4%, p=0.014) was less frequent in Group II than in Group I. The level of BUN (23.3±19.3 vs. 18.8±11.2, p=0.009) was lower in Group II than in Group I, while that of creatinine was not significantly different between the two groups. C3 level was an independent factor for predicting the development of edema (odds ratio [OR]: 1.034, 95% CI: 1.010-1.060, p=0.006) and acute nephritic symptoms (≥2) (OR: 0.974, 95% CI: 0.952-0996, p=0.020). It was also negatively correlated with an increasing number of acute nephritic symptoms, including oliguria and edema, in patients with APSGN (R=-0.182, p=0.048). CONCLUSIONS This study demonstrated that APSGN had favorable clinical manifestations and severity over the past 30 years. The monitoring of C3 levels can be used to assess the disease severity and risk of complications, including edema and oliguria, which are decreasing in South Korean children.
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Affiliation(s)
- K H Han
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Republic of Korea.
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Jeong DY, Lee J, Kim JY, Lee KH, Li H, Lee JY, Jeong GH, Yoon S, Park EL, Hong SH, Kang JW, Song TJ, Leyhe T, Eisenhut M, Kronbichler A, Smith L, Solmi M, Stubbs B, Koyanagi A, Jacob L, Stickley A, Thompson T, Dragioti E, Oh H, Brunoni AR, Carvalho AF, Kim MS, Yon DK, Lee SW, Yang JM, Ghayda RA, Shin JI, Fusar-Poli P. Empirical assessment of biases in cerebrospinal fluid biomarkers of Alzheimer's disease: an umbrella review and re-analysis of data from meta-analyses. Eur Rev Med Pharmacol Sci 2021; 25:1536-1547. [PMID: 33629323 DOI: 10.26355/eurrev_202102_24862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Alzheimer's disease (AD) is a leading cause of years lived with disability in older age, and several cerebrospinal fluid (CSF) markers have been proposed in individual meta-analyses to be associated with AD but field-wide evaluation and scrutiny of the literature is not available. MATERIALS AND METHODS We performed an umbrella review for the reported associations between CSF biomarkers and AD. Data from available meta-analyses were reanalyzed using both random and fixed effects models. We also estimated between-study heterogeneity, small-study effects, excess significance, and prediction interval. RESULTS A total of 38 meta-analyses on CSF markers from 11 eligible articles were identified and reanalyzed. In 14 (36%) of the meta-analyses, the summary estimate and the results of the largest study showed non-concordant results in terms of statistical significance. Large heterogeneity (I2≥75%) was observed in 73% and small-study effects under Egger's test were shown in 28% of CSF biomarkers. CONCLUSIONS Our results suggest that there is an excess of statistically significant results and significant biases in the literature of CSF biomarkers for AD. Therefore, the results of CSF biomarkers should be interpreted with caution.
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Affiliation(s)
- D Y Jeong
- Yonsei University College of Medicine, Seoul, Republic of Korea.
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Abou Ghayda R, Duck-Young Park D, Lee JY, Kim JY, Lee KH, Hong SH, Yang JW, Kim JS, Jeong GH, Kronbichler A, Koyanagi A, Jacob L, Oh H, Li H, Yang JM, Kim MS, Lee SW, Yon DK, Shin JI, Smith L. Body mass index and mortality in patients with cardiovascular disease: an umbrella review of meta-analyses. Eur Rev Med Pharmacol Sci 2021; 25:273-286. [PMID: 33506916 DOI: 10.26355/eurrev_202101_24393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Although many previous meta-analyses of epidemiological studies have demonstrated a relationship between body mass index (BMI) and mortality, inconsistent findings among cardiovascular disease patients have been observed. Thus, we performed an umbrella review to understand the strength of evidence and validity of claimed associations between BMI and mortality in patients with cardiovascular diseases. MATERIALS AND METHODS We comprehensively re-analyzed the data of meta-analyses of observational studies and randomized controlled trials on associations between BMI and mortality among patients with cardiovascular diseases. We also assessed the strength of evidence of the re-analyzed outcomes, which were determined from the criteria including statistical significance of the p-value of random-effects, as well as fixed-effects meta-analyses, small-study effects, between-study heterogeneity, and a 95% prediction interval. RESULTS We ran comprehensive re-analysis of the data from the 21 selected studies, which contained a total of 108 meta-analyses; 23 were graded as convincing evidence and 12 were suggestive, 42 were weak, and 23 were non-significant. CONCLUSIONS Underweight increased mortality in acute coronary syndrome (ACS), heart failure, and after therapeutic intervention for patients with cardiovascular diseases. Overweight, on the other hand decreased mortality in patient's ACS, atrial fibrillation, and heart failure with convincing evidence.
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Affiliation(s)
- R Abou Ghayda
- Urology Institute, University Hospital System, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Kim JS, Lee KH, Kim GE, Kim S, Yang JW, Li H, Hong SH, Ghayda RA, Kronbichler A, Koyanagi A, Jacob L, Shin JI, Smith L. Clinical characteristics and mortality of patients with hematologic malignancies and COVID-19: a systematic review. Eur Rev Med Pharmacol Sci 2020; 24:11926-11933. [PMID: 33275265 DOI: 10.26355/eurrev_202011_23852] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Hematologic cancer patients with Coronavirus Disease 2019 (COVID-19) tend to have a more serious disease course than observed in the general population. Herein, we comprehensively reviewed existing literature and analyzed clinical characteristics and mortality of patients with hematologic malignancies and COVID-19. MATERIALS AND METHODS Through searching PubMed until June 03, 2020, we identified 16 relevant case studies (33 cases) from a total of 45 studies that have reported on patients with COVID-19 and hematologic malignancies. We investigated the clinical and laboratory characteristics including type of hematologic malignancies, initial symptoms, laboratory findings, and clinical outcomes. Then, we compared those characteristics and outcomes of patients with hematologic malignancies and COVID-19 to the general population infected with COVID-19. RESULTS The median age was 66-year-old. Chronic lymphocytic leukemia was the most common type of hematologic malignancy (39.4%). Fever was the most common symptom (75.9%). Most patients had normal leukocyte counts (55.6%), lymphocytosis (45.4%), and normal platelet counts (68.8%). In comparison to patients with COVID-19 without underlying hematologic malignancies, dyspnea was more prevalent (45.0 vs. 24.9%, p=0.025). Leukocytosis (38.9 vs. 9.8%, p=0.001), lymphocytosis (45.4 vs. 8.2%, p=0.001), and thrombocytopenia (31.3 vs. 11.4%, p=0.036) were significantly more prevalent and lymphopenia (18.2 vs. 57.4%, p=0.012) less prevalent in patients with hematologic malignancies. There were no clinical and laboratory characteristics predicting mortality in patients with hematologic malignancies. Mortality was much higher in patients with hematologic malignancies compared to those without this condition (40.0 vs. 3.6%, p<0.001). CONCLUSIONS Co-occurrence of hematologic malignancies and COVID-19 is rare. However, due to the high mortality rate from COVID-19 in this vulnerable population, further investigation on tailored treatment and management is required.
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Affiliation(s)
- J S Kim
- Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
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Moiseev S, Lee JM, Zykova A, Bulanov N, Novikov P, Gitel E, Bulanova M, Safonova E, Shin JI, Kronbichler A, Jayne DRW. The alternative complement pathway in ANCA-associated vasculitis: further evidence and a meta-analysis. Clin Exp Immunol 2020; 202:394-402. [PMID: 32691878 DOI: 10.1111/cei.13498] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/12/2020] [Accepted: 07/12/2020] [Indexed: 12/11/2022] Open
Abstract
We compared the common pathway components C3a, C5a and membrane attack complex (MAC), also known as C5b-9, and the alternative pathway components factor B and properdin in patients with ANCA-associated vasculitis (AAV) and healthy controls, and conducted a meta-analysis of the available clinical evidence for the role of complement activation in the pathogenesis of AAV. Complement components were evaluated in 59 patients with newly diagnosed or relapsing granulomatosis with polyangiitis or microscopic polyangiitis and 36 healthy volunteers. In 28 patients, testing was repeated in remission. Next, we performed a meta-analysis by searching databases to identify studies comparing complement levels in AAV patients and controls. A random-effects model was used for statistical analyses. The median concentrations of MAC, C5a, C3a and factor B were higher in active AAV patients (P < 0·001). Achievement of remission was associated with reductions in C3a (P = 0·005), C5a (P = 0·035) and factor B levels (P = 0·045), whereas MAC and properdin levels did not change. In active AAV, there were no effects of ANCA specificity, disease phenotype, previous immunosuppression or disease severity on complement levels. A total of 1122 articles were screened, and five studies, including this report, were entered into the meta-analysis. Plasma MAC, C5a and factor B in patients with active AAV were increased compared to patients in remission (excluding factor B) and controls. Changes in C3a were of borderline significance. Our findings and the results of the meta-analysis support activation of the complement system predominantly via the alternative pathway in AAV patients.
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Affiliation(s)
- S Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia.,Lomonosov Moscow State University, Moscow, Russia
| | - J M Lee
- Department of Pediatrics, Chungnam National University Hospital and College of Medicine, Daejeon, Korea
| | - A Zykova
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia.,Lomonosov Moscow State University, Moscow, Russia
| | - N Bulanov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - P Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - E Gitel
- Central Laboratory, Sechenov First Moscow State Medical University, Moscow, Russia
| | - M Bulanova
- Vladimir Regional Clinical Hospital, Vladimir, Russia
| | - E Safonova
- Lomonosov Moscow State University, Moscow, Russia
| | - J I Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea.,Division of Pediatric Nephrology, Severance Children's Hospital, Seoul, South Korea.,Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, South Korea
| | - A Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - D R W Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
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Affiliation(s)
- A Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - P Gauckler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
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Zykova A, Novikov P, Bulanov N, Kronbichler A, Gitel E, Novikova O, Bulanova M, Safonova E, Moiseev S. SAT0268 COMPLEMENT ACTIVATION VIA ALTERNATIVE PATHWAY IN ANCA-ASSOCIATED VASCULITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:There is increasing evidence that the complement system, in particular the alternative pathway, plays a crucial role in the pathogenesis of ANCA-associated vasculitis (AAV) [1]. Efficacy of C5a receptor antagonists indicates that chemoattraction mediated by C5a plays a key role in the inflammatory process observed in AAV [2]. Another promising research object are regulatory proteins such as factor B [3].Objectives:To study complement activation via the alternative pathway in patients with active ANCA-associated vasculitis.Methods:59 patients with newly diagnosed (n=35) or relapsing GPA or MPA (n=24) were enrolled in this prospective study. Median BVAS v.3 at the time of AAV onset was 16.5 (9.5; 20). In 28 patients activation of complement was reassessed during sustained remission (BVAS v.3 = 0) after a median of 16 months. Thirty six age-and gender-matched healthy volunteers comprised the control group. Levels of complement components (C3, C5, C3a, C5a, vitronectin, factor B and factor P) were measured by ELISA (Cloud Inc.). Data were not normally distributed, therefore, values are given as medians and IQRs and nonparametric statistical tests were used.Results:The concentrations of C5, C3, vitronectin and CFB were significantly higher in patients with active AAV than control group. There were no significant differences in the levels of factor P in patients with active AAV and control group (388000 (371960; 417150)) vs 416000 (400200; 437000), ng/ml, p >0.05) (Fig. 1).Fig 1.Concentration of complement components in patients with active AAV and healthy controls (*p<0.05)Serum level of C5a and C3a were higher in patients with active AAV than in healthy controls (22.9 (14.4; 33.0) vs 3.0 (0.35; 6.73), ng/ml, p<0.001; 21436 (11395; 21436) vs 1224.5 (798.5; 1947.7), ng/ml, p<0.001). Patients with active AAV had significantly higher MAC levels than healthy controls (24646 (15342; 46681) vs 3305.5 (2780.2; 3777.5), mAU/ml, p<0.001).The levels of complement components were similar in PR3-ANCA and MPO-ANCA disease, and severe and non-severe AAV. C5a/C5 and C3a/C3 ratios were not influenced by disease activity, severity or ANCA type.After immunosuppressive treatment concentrations of C5, C3, and their activated products, C5a, C3a significantly decreased (Fig. 2). However, concentrations of regulatory proteins such as factor B, factor P and vitronectin were unaffected. Interestingly, that there was no significant difference in MAC levels before and after immunosuppressive treatment (24646 (15342; 46681) vs 20057.4 (19709.3; 41477.6), mAU/ml, p=0.925).Fig 2.Concentration of complement components in patients with active disease and remission (*p<0.001)Conclusion:The complement system plays an important role in AAV. While treatment affects some component, some remain unchanged and are not dependent on AAV severity or ANCA serotype.References:[1]Jennette JC, Xiao H, Hu P. Complement in ANCA-Associated Vasculitis. Seminars in Nephrology 2013; 33 (6): 557 – 564[2]Schreiber A, Xiao H, Jennette JC et al. C5a receptor mediates neutrophil activation and ANCA-induced glomerulonephritis. J Am Soc Nephrol 2009; 20(2): 289-298.[3]Gou SJ, Yuan J, Chen M et al. Circulating complement activation in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis. Kidney Int 2013; 83(1): 129-137.Disclosure of Interests:Anastasiia Zykova Grant/research support from: This work was supported by the 5-100 Project, Sechenov University, Moscow, Pavel Novikov Grant/research support from: This work was supported by the 5-100 Project, Sechenov University, Moscow, Nikolai Bulanov Grant/research support from: This work was supported by the 5-100 Project, Sechenov University, Moscow, Andreas Kronbichler Grant/research support from: This work was supported by unrestricted grant from the Austrian Society of Rheumatology., Evgeny Gitel: None declared, Oxana Novikova: None declared, Mayra Bulanova: None declared, Elizaveta Safonova: None declared, Sergey Moiseev Grant/research support from: This work was supported by the 5-100 Project, Sechenov University, Moscow
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Windpessl M, Burgstaller S, Kronbichler A, Pieringer H, Kalev O, Karrer A, Wallner M, Thaler J. Progressive Multifocal Leukoencephalopathy Following Combined Rituximab-Based Immune-Chemotherapy for Post-transplant Lymphoproliferative Disorder in a Renal Transplant Recipient: A Case Report. Transplant Proc 2018; 50:881-883. [PMID: 29661457 DOI: 10.1016/j.transproceed.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/17/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Transplant recipients are at risk of developing progressive multifocal leukoencephalopathy (PML), an opportunistic infection due to reactivation of JC virus. Post-transplant lymphoproliferative disorders (PTLDs) represent a common malignancy in this population, and antiCD20-therapy has become an established component of its treatment. CASE PRESENTATION We describe the first case of a renal allograft transplant recipient with PTLD who received rituximab-based immune-chemotherapy and developed PML shortly thereafter. Despite early suspicion and diagnosis, the disease ran a relentlessly progressive course, and the patient succumbed to his illness shortly thereafter. CONCLUSION PML should be strongly suspected whenever unusual neurologic symptoms appear in the context of immunosuppression. Clinicians and patients should be aware of the potential for PML after rituximab therapy.
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Affiliation(s)
- M Windpessl
- Department of Internal Medicine IV, Hematology, Oncology and Nephrology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
| | - S Burgstaller
- Department of Internal Medicine IV, Hematology, Oncology and Nephrology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - A Kronbichler
- Department of Internal Medicine IV, Nephrology and Hypertension, Medical University of Innsbruck, Innsbruck, Austria
| | - H Pieringer
- Academic Research Unit, 2nd Department of Medicine, Kepler University Hospital, Med Campus III, Linz, Austria; Paracelsus Private Medical University, Salzburg, Austria
| | - O Kalev
- Department of Neuropathology, Kepler University Hospital, Neuromed Campus, Linz, Austria
| | - A Karrer
- Department of Radiology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - M Wallner
- Department of Internal Medicine IV, Hematology, Oncology and Nephrology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - J Thaler
- Department of Internal Medicine IV, Hematology, Oncology and Nephrology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
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Welzl K, Weinberger B, Kronbichler A, Sturm G, Kern G, Mayer G, Grubeck-Loebenstein B, Koppelstaetter C. How immunosuppressive therapy affects T cells from kidney transplanted patients of different age: the role of latent cytomegalovirus infection. Clin Exp Immunol 2014; 176:112-9. [PMID: 24028181 DOI: 10.1111/cei.12205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2013] [Indexed: 01/31/2023] Open
Abstract
The average age of patients receiving renal transplantation is increasing as programmes have been established which support the donation of organs from elderly donors to older recipients. Little is known about the effect of immunosuppressive therapy on the immune system of older patients. In this study, T cell function and the composition of the T cell repertoire were analysed in immunosuppressed renal transplant recipients of different age and cytomegalovirus (CMV) status in comparison to age- and CMV-matched controls. Independent of age and CMV status, the production of interleukin (IL)-2 and interferon (IFN)-γ by T cells was decreased in the patient groups and autologous serum from patients was capable of inhibiting the proliferation of CD3⁺ T cells. CXCR5 expression on T cells was increased in patients versus controls reflecting reduced endogenous IL-2 signalling under immunosuppressive therapy. In CMV-seronegative patients kidney transplantation and immunosuppressive therapy did not induce changes in the CD8⁺ T cell pool, but there was a moderate increase in CD4⁺CD28⁻ effector T cells when compared to age-matched controls. In contrast, latent CMV infection triggered a shift from early to late differentiated CD4⁺ and CD8⁺ T cells in patients and controls. This shift was most pronounced in elderly transplant patients under immunosuppressive therapy. In conclusion, our results demonstrate that immunosuppressive therapy following kidney transplantation is effective in patients older than 65 years. Latent CMV infection, however, accelerates age-related changes in the T cell repertoire in elderly people under immunosuppressive therapy. These patients should therefore be monitored with special care.
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Affiliation(s)
- K Welzl
- Immunology Division, Research Institute of Biomedical Aging Research, University of Innsbruck, Innsbruck, Austria; Division of Nephrology, Department of Internal Medicine IV, Innsbruck Medical University, Innsbruck, Austria
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Proletov I, Sipovskii V, Smirnov A, Hayashi N, Akiyama S, Okuyama H, Matsui Y, Fujimoto K, Atsumi H, Adachi H, Yamaya H, Maruyama S, Imai E, Matsuo S, Yokoyama H, Prasad N, Jaiswal A, Agarwal V, Yadav B, Rai M, Shin DH, Han IM, Moon SJ, Yoo TH, Faria B, Henriques C, Matos AC, Daha MR, Pestana M, Seelen M, Lundberg S, Carlsson MC, Leffler H, Pahlsson P, Segelmark M, Camilla R, Donadio ME, Loiacono E, Peruzzi L, Amore A, Chiale F, Vergano L, Gallo R, Boido A, Conrieri M, Bianciotto M, Bosetti FM, Mengozzi G, Puccinelli MP, Guidi C, Lastauka I, Coppo R, Nishiwaki H, Hasegawa T, Nagayama Y, Komukai D, Kaneshima N, Sasai F, Yoshimura A, Wang CL, Wei XY, Lv L, Jia NY, Vagane AM, Knoop T, Vikse BE, Reisaeter AV, Bjorneklett R, Mezzina N, Brunini F, Trezzi B, Gallieni M, D'Amico M, Stellato T, Santoro D, Ghiggeri GM, Radice A, Sinico RA, Kronbichler A, Kerschbaum J, Mayer G, Rudnicki M, Elena GS, Paula Jara CE, Jorge Enrique RR, Manuel P, Paek J, Hwang E, Park S, Caliskan Y, Aksoy A, Oztop N, Ozluk Y, Artan AS, Yazici H, Kilicaslan I, Sever MS, Yildiz A, Ihara K, Iimori S, Okado T, Rai T, Uchida S, Sasaki S, Stangou M, Bantis C, Skoularopoulou M, Toulkeridis G, Labropoulou I, Kasimatis S, Kouri NM, Papagianni A, Efstratiadis G, Mircescu G, Stancu S, Zugravu A, Petrescu L, Andreiana I, Taran L, Suzuki T, Iyoda M, Yamaguchi Y, Watanabe M, Wada Y, Matsumoto K, Shindo-Hirai Y, Kuno Y, Yamamoto Y, Saito T, Iseri K, Shibata T, Gniewek K, Krajewska M, Jakuszko K, Koscielska-Kasprzak K, Klinger M, Nunes AT, Ferreira I, Neto R, Mariz E, Pereira E, Frazao J, Praca A, Sampaio S, Pestana M, Kim HJ, Lee JE, Proletov I, Galkina O, Bogdanova E, Zubina I, Sipovskii V, Smirnov A, Oliveira CBL, Oliveira ASA, Carvalho CJB, Sette LHBC, Fernandes GV, Cavalcante MA, Valente LM, Ismail G, Andronesi A, Jurubita R, Bobeica R, Finocchietti D, Cantaluppi V, Medica D, Daidola G, Colla L, Besso L, Burdese M, Segoloni GP, Biancone L, Camussi G, Goto S, Nakai K, Ito J, Fujii H, Tasaki K, Suzuki T, Fukami K, Hara S, Nishi S, Hayami N, Ubara Y, Hoshino J, Takaichi K, Suwabe T, Sumida K, Mise K, Wang CL, Tian YQ, Wang H, Saganova E, Proletov I, Galkina O, Bogdanova E, Zubina I, Sipovskii V, Smirnov A, Stancu S, Mandache E, Zugravu A, Petrescu L, Avram A, Mircescu G, Angelini C, Reggiani F, Podesta MA, Cucchiari D, Malesci A, Badalamenti S, Laganovi M, Ars E, ivko M, eljkovic Vrki T, Cori M, Karanovi S, Torra R, Jelakovi B, Jia NY, Wang CL, Zhang YH, Nan L, Nagasawa Y, Yamamoto R, Shinzawa M, Hamahata S, Kida A, Yahiro M, Kuragano T, Shoji T, Hayashi T, Nagatoya K, Yamauchi A, Isaka Y, Nakanishi T, Ivkovic V, Premuzic V, Laganovic M, Dika Z, Kos J, Zeljkovic Vrkic T, Fistrek Prlic M, Zivko M, Jelakovic B, Gigliotti P, Leone F, Lofaro D, Papalia T, Mollica F, Mollica A, Vizza D, Perri A, Bonofilgio R, Meneses G, Viana H, Santos MC, Ferreira C, Calado J, Carvalho F, Remedio F, Nolasco F, Caliskan Y, Oztop N, Aksoy A, Ozluk Y, Artan AS, Turkmen A, Kilicaslan I, Yildiz A, Sever MS, Nagaraju SP, Kosuru S, Parthasarathy R, Bairy M, Prabhu RA, Guddattu V, Koulmane Laxminarayana SL, Oruc A, Gullulu M, Acikgoz E, Aktas N, Yildiz A, Gul B, Premuzic V, Laganovic M, Ivkovic V, Coric M, Zeljkovic Vrkic T, Fodor L, Dika Z, Kos J, Fistrek Prlic M, Zivko M, Jelakovic B, Bale CB, Dighe TA, Kate P, Karnik S, Sajgure A, Sharma A, Korpe J, Jeloka T, Ambekar N, Sadre A, Buch A, Mulay A, Merida E, Huerta A, Gutierrez E, Hernandez E, Sevillano A, Caro J, Cavero T, Morales E, Moreno JA, Praga M. PRIMARY AND SECONDARY GLOMERULONEPHRITIDES 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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