Effect of Ramadan fasting on salivary IgA, serum IgA, IL-17, and IL-22 levels

Background: nutritional factors might affect the number and function of immune cells for instance the production of cytokines and immunoglobulins. Ramadan fasting is intermittent abstinence from eating and drinking for almost four weeks. Aim: The present study aimed to investigate the influence of intermittent fasting on serum IgA, salivary IgA (sIgA), interleukin (IL)-17, and IL-22 levels. Methods: 40 healthy men aged 19-29 years were evaluated before and during the fourth week of Ramadan fasting for IgA levels by the nephelometric method as well as salivary IgA (sIgA), IL-17, and IL-22 amounts using enzyme-linked immunosorbent assay (ELISA). Results: serum IgA levels reduced significantly at the end of Ramadan fasting (225.8 ± 87 vs. 196 ± 70 mg/dl) (p-value<0.001); however, sIgA amounts did not differ between before and the last week of Ramadan. Serum IL-17 reduced significantly (2.93 ± 1.51 vs. 2.17 ± 1.33 pg/ml) (p-value = 0.006) whereas IL-22 levels remained approximately unchanged. Summary: four weeks of intermittent fasting during Ramadan reduced the serum levels of IgA and IL-17 but did not affect the production of sIgA and IL-22. These findings indicate a limited impact of intermittent fasting on mucosal immunity.

Percentage of Th1 and Th17 cells and serum level of IL-17 and IFN-γ cytokines in COVID-19-associated mucormycosis

The considerable number of the 2019 coronavirus disease (COVID-19) patients who developed mucormycosis infections in West and Central Asia urged a need to investigate the underlying causes of this fatal complication. It was hypothesized that an immunocompromised state secondary to the excessive administration of anti-inflammatory drugs was responsible for the outburst of mucormycosis in COVID-19 patients. Therefore, we aimed to study the implication of two major subsets of adaptive immunity T helper (Th)-1 and Th17 cells in disease development. Thirty patients with COVID-19-associated mucormycosis, 38 with COVID-19 without any sign or symptom of mucormycosis, and 26 healthy individuals were included. The percentage of Th1 and Th17 cells in peripheral blood, as well as the serum levels of interleukin (IL)-17 and interferon-gamma (IFN-γ), were evaluated using flow cytometry and ELISA techniques, respectively. Th17 cell percentage in patients with COVID-19-associated mucormycosis was significantly lower than in COVID-19 patients (P-value: <0.001) and healthy subjects (P-value: 0.01). In addition, the serum level of IL-17 in COVID-19 patients was significantly higher than that of healthy individuals (P-value: 0.01). However, neither the frequency of Th1 cells nor the serum level of IFN-γ was different between the study groups. Given the critical role of Th17 cells in the defense against mucosal fungal infections, these findings suggest that low numbers of Th17 and insufficient levels of IL-17 might be a predisposing factor for the development of mucormycosis during or after COVID-19 infection.

Evaluation of Inflammatory Markers in Patients with Depressed Episodes in Major Depressive Disorder and Bipolar Disorder before and after Treatment

Depression is one of the current dilemmas in both developed and developing societies. Studies show that the severity of psychiatric symptoms is directly related to the degree of inflammation caused by cytokines secreted by the immune system. Hence, evaluating serum cytokine levels in patients with depression can help to understand the pathogenesis of the disease and make the best therapeutic decisions. The present study investigated the levels of inflammatory cytokines, tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), and interleukin-6 (IL-6) in patients with major depression or bipolar disorder during depressive episodes (BDDE) before and after a 6-month pharmaceutical intervention. Patients referring to 3 clinics were recruited for the study. The diagnosis of major depression or bipolar disorder in a depressive phase was made according to the Diagnostic and Statistical Manual of Mental Disorders -5(DSM-5) criteria. There was a significant difference in depression levels between the pre-intervention and 6-month follow-up in both groups. After 6 months, IL-1 and IL-6 levels in the bipolar disorder group had decreased while TNF-α levels had increased. There was also a significant difference between pre-intervention and follow-up levels of IL-1.  Serum levels of IL-1 and IL-6 decreased significantly in both groups after the 6-month follow-up, and symptom improvement was observed. TNF-α levels, on the other hand, decreased in the major depression group but increased in the bipolar disorder group. Considering that inflammation is a major outcome of depression, treatment strategies to reduce inflammation could be a practical approach to improving psychiatric symptoms.

DNA Methylation of CD70 Promoter in Juvenile Systemic Lupus Erythematosus

INTRODUCTION

Epigenetic alterations in pathogenesis of systemic lupus erythematosus (SLE) have gained more attention recently in adults. We assessed the methylation of CD70 promoter, a costimulatory molecule on T cells, in juvenile SLE (JSLE), and compared this to that found in controls and the literature of adult SLE patients.

METHODS

DNA methylation status was evaluated on peripheral blood from JSLE patients and healthy controls.

RESULTS

Twenty-five patients with JSLE and 24 healthy controls were compared. JSLE patients had lower unmethylated CpG islands compared to the control group (mean ± SD; 0.78 ± 0.42 vs 10503.80 ± 39796.95). However, the difference was not significant (P-value; 0.22).

CONCLUSION

Despite hypomethylation of CD70 gene promoter in CD4+ T-cells from adult patients with SLE, no statistically significant differences observed in patients with JSLE compared with healthy controls. This may suggest a mechanism different in JSLE patients than in adults.

Expression of Programmed Cell Death 1 and Helios Genes Correlates With rs872071A>G and rs12203592C>T Single-Nucleotide Polymorphisms of InterferonRegulatory Factor 4 in Patients with T-Cell-Mediated Rejection of Renal Allograft

OBJECTIVES

Acute T-cell-mediated rejection of the renal allograft is a serious posttransplant challenge that requires administration of high-dose immunosuppressive drugs with considerable side effects; therefore, specific targeting of T-cell responses may improve both prevention and treatment of T-cell-mediated rejection. A potential candidate for this purpose is interferon regulatory factor 4 because of its implication in differentiation and function of T cells. Our aim was to evaluate the frequency of the rs872071A>G and rs12203592C>T single-nucleotide polymorphisms of the interferon regulatory factor 4 gene and association of these 2 polymorphisms with the gene expression of programmed cell death 1 and Helios in patients with T-cell-mediated rejection versus stable recipients.

MATERIALS AND METHODS

Sixty recipients with T-cell- mediated rejection and 60 age-matched and sexmatched stable recipients were recruited. Two single-nucleotide polymorphisms of interferon regulatory factor 4 gene, as well as the expression of programmed cell death 1 and Helios genes in peripheral blood mononuclear cells, were investigated with real-time polymerase chain reaction.

RESULTS

Programmed cell death 1 gene expression was reduced in patients with T-cell-mediated rejection versus stable recipients (P = .03). The frequency of rs872071A>G and rs12203592C>T single-nucleotide polymorphisms showed no significant difference between groups. Presence of the rs12203592C>T single-nucleotide polymorphism was directly correlated with the expression of programmed cell death 1 gene (P = .049), and rs872071A>G positivity was directly correlated with Helios gene expression (P = .008), which suggests an inhibitory role for interferon regulatory factor 4 on programmed cell death 1 and Helios molecules.

CONCLUSIONS

Programmed cell death 1 gene expression was lower in patients with T-cell-mediated rejection versus stable recipients. Low-expressing singlenucleotide polymorphisms of interferon regulatory factor 4 could enhance the downstream gene expression of programmed cell death 1 and Helios immunoregulatory molecules. Therefore, specific inhibition of interferon regulatory factor 4 may promote tolerance induction in the allograft.

Potential cytotoxicity of PM2.5-bound PAHs and toxic metals collected from areas with different traffic densities on human lung epithelial cells (A549)

Laboratory and epidemiological researches have indicated that ambient air particulate matter have a plays critical role in causing diseases. The current research evaluated the chemical attributes of PM2.5 in the ambient air of the cities of Karaj and Fardis and determined its toxicological effects on human lung epithelial cells (A549). In the study city, 16 points were selected from the two high-traffic and low-traffic points for sampling. A sampling of ambient air was carried out in spring, summer, autumn, and winter 2018-19. Air sampling was performed for 24 h according to the EPA-TO/13A guidelines. To analyze of toxic metals and polycyclic aromatic hydrocarbons (PAHs), ICP-OES and GC-MS were used, respectively, and for cell toxicity analysis, an ELISA reader was used. Then from SPSS, Excel and R software were used for statistical analysis. The results of the current study indicated that the concentration of PAHs carcinogenic in the autumn season in high-traffic stations was the highest and equal to 9.3 ng/m3, and in the spring season in the low-traffic stations, it was the lowest and equal to 5.82 ng/m3. In general, during the period of study, Heavy metals including Zn, Fe, Pb, Cu, and Al had the highest concentration compared to other metals. However, Hg, Cr, As, Pb, Cu, Cd, and Zn were higher concentration in the winter and autumn seasons than in the spring and summer seasons. Cell viability measurements by using MTT showed that low-traffic and high-traffic stations had the highest toxicity in autumn season compared to other seasons. (p < 0.05). In general, high-traffic stations had the highest toxicity than low-traffic stations. The general conclusion of the present study was that PM2.5-bound PAHs and toxic metals, due to their high concentration, were toxic pollutants in air for residents of Karaj and Fardis. Also, the high concentration of PM2.5 caused the mitochondrial activity of A549 cells to stop and this stop was more significant in cold seasons and high-traffic areas.

Baricitinib: From Rheumatoid Arthritis to COVID-19

Baricitinib is a JAK1/2 inhibitor that was first approved for treating moderate to severe rheumatoid arthritis (RA) but that later showed considerable efficacy in the control of exaggerated inflammatory responses that occur in a wide range of diseases. There is a growing body of evidence, obtained from clinical trials and case reports, demonstrating clinical and paraclinical improvement in patients following administration of baricitinib including RA, systemic lupus erythematosus, psoriasis, atopic dermatitis, alopecia areata, interferon‐mediated autoinflammatory diseases, graft‐versus‐host disease, diabetic kidney disease, and, recently, coronavirus disease‐19. However, despite overall encouraging results, many adverse effects have been observed in baricitinib‐treated patients, ranging from simple infections to increased risk of malignancies, particularly in long‐term use. The significant efficacy of baricitinib, versus the probable adverse effects, urge further investigation before establishing it as a part of standard therapeutic protocols. Here, we have provided a review of the studies that have used baricitinib for treating various inflammatory disorders and summarized the advantages and disadvantages of its administration.

Comparing IRF-4 Gene Expression Between Acute T cell- Mediated Rejection and Stable Renal Transplant Recipients

INTRODUCTION

Renal transplant rejection is one of the clinical challenges, which usually requires administration of immunosuppressive drugs causing serious side effects. Therefore, invention of effective and specific therapeutics is necessary to control undesired immune responses particularly T-cell reactions to allograft. Interferon Regulatory Factor-4 (IRF-4) due to its implication on T cells differentiation and function might be targeted to treat T cell-mediated cellular rejection (TCMR). The aim of this study was to investigate the association between IRF-4 gene expression and acute TCMR, as well as to examine the correlation between IRF-4 gene expression and cellular expression of Programmed cell death-1 (PD-1) and Helios molecules.

METHODS

Peripheral blood samples were obtained from 30 patients with biopsy proven acute TCMR and 30 stable recipients. IRF-4 gene expression was quantified using RT-PCR, and cellular expression of PD-1 and Helios were evaluated with flowcytometry.

RESULTS

IRF-4 gene expression was significantly increased in acute TCMR patients compared with stable recipients (P < .05). Helios protein expression was slightly decreased in TCMR group but this was not statistically significant. There was a negative correlation between IRF-4 gene expression and PD-1 as well as Helios frequency in the whole studied population.

CONCLUSION

IRF-4 expression increases in acute TCMR which might also lead to a diminished expression of downstream immunoregulatory molecules such as PD-1 and Helios. Therefore, specific inhibition of IRF-4 may be helpful in managing acute TCMR.

Investigating the possible association between NLRP3 gene polymorphisms and myasthenia gravis

INTRODUCTION

In this case-control study, we investigated the association between nucleotide oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3) single-nucleotide polymorphisms (SNPs) rs10754558, rs3806265, rs4612666, and rs35829419 and myasthenia gravis (MG).

METHODS

Samples from MG patients were selected from a previous study conducted in our neuromuscular clinic, which investigated the association between human leukocyte antigen (HLA) class II genes and MG. Genetic data of controls were also available from another study. The NLRP3 SNPs genotyping was performed using the TaqMan method.

RESULTS

A total of 93 blood samples from eligible Iranian patients with MG and 56 samples from healthy controls were obtained. The NLRP3 rs3806265 "C" allele was significantly more frequent in MG patients (P < .001; odd ratio [OR] = 2.33, 95% confidence interval [CI]: 1.4-4.0) than controls. The "CC" genotype of this SNP was found in 18.27% of patients, but none of the controls (P < .001). The distribution of other SNPs was similar between the groups.

DISCUSSION

These preliminary results suggest that there might be some associations between the NLRP3 gene polymorphism and MG.

Diagnostic accuracy of two-dimensional coronary angiographic derived fractional flow reserve

Background

Non-invasive fractional flow reserve (NiFFR) is an emerging method for evaluating the functional significance of a coronary lesion during diagnostic coronary angiography (CAG). The method relies on the computational flow dynamics and the 3D reconstruction of the vessel extracted from CAG. In the present study, we sought to evaluate the diagnostic performance and applicability of 2D-based NiFFR.

Methods

In this prospective observational study, we evaluated 2D-based NiFFR in 279 candidates for invasive CAG and invasive FFR. NiFFR was calculated via 2 methods: variable NiFFR, in which the contrast transport time was extracted from the angiographic view, and fixed NiFFR, in which a prespecified frame count was applied.

Results

The final analysis was performed on 245 patients (250 lesions). Variable NiFFR had an area under the receiver operating characteristic curve of 81.5%, an accuracy of 80.0%, a sensitivity of 82.2%, a specificity of 82.2%, a negative predictive value of 91.4%, and a positive predictive value of 63.6%. The mean difference between FFR and NiFFR was −0.0244 ±0.0616 (P≤0.0001). A pressure wire-free hybrid strategy was possible in 68.8% of our population with variable NiFFR.

Conclusions

Our 2D-based NiFFR yielded results comparable to those derived from 3D-based software. Our findings should, however, be confirmed in larger trials.

Pressure wire-free hybrid strategy

Funding Acknowledgement

Type of funding source: None

Comparison between cheatham-platinum stent and self-expandable uncovered nitinol stent in patients with coarctation of aorta – a randomized controlled trial

Background

Endovascular treatment is considered the main therapeutic approach for native coarctation of aorta (CoA) in adult patients. Balloon-expandable stents (BE) have been introduced as the primary choice for coarctoplasty. However during the recent years, self-expandable (SE) stents with acceptable radial force have been suggested as an alternative. Still, no randomized controlled (RCT) trials have compared the efficacy and safety of both strategies.

Methods

The present study is a prospective, single center, parallel-group, open-label RCT on patients with native CoA (Figure). Patients were randomized into Bare Cheatham-Platinum Stents and Uncovered Nitinol Stent (SE). All patients were scheduled to be followed in 1-, 6-, 12-month and 36-month intervals. The present report, focuses on the one-year outcome of the study.

Results

Of 101 patients with native CoA referred to our center, 93 patients have been randomized into BE- (47 patients) and SE-arm (46 patients). One year follow up is scheduled to be completed on March 2020. In the preliminary analysis of 62 patients, 1 intraprocedural stent migration has occurred in each group. No aortic perforation was detected in the study. Vascular access site complications were similar between the two groups (3 (6.3%) in BE versus 1 (2.1%) in SE, p value= 0.432). One nonfatal stroke occurred in BE group. No mortality or bailout surgical repair happened in one year study in the two groups. One patient with re-coarctations were detected during one year follow up in each of the groups (p value=0.210). No aortic pseudoaneurysm or aneurysmal formation were observed in 12-month follow up aortic CT angiography.

Conclusion

The preliminary results showed no significant difference in efficacy and safety of both treatment modalities. The final result is pending.

Study Flow Chart

Funding Acknowledgement

Type of funding source: None

Association of ADAM33 T1 Polymorphism With Subgroups of Pediatric Asthma Patients in Iran

There is strong evidence on the interaction of several genetic variations and environmental conditions in the etiology of asthma. Association of a disintegrin and metalloproteinase 33 (ADAM33) with asthma risk is not clear and shows diversity between nations and ethnicities. Several single nucleotide polymorphisms (SNP) of the ADAM33 gene are introduced and studied according to the disease onset and characteristics. The aim of our study is to determine the association of ADAM33 rs2280091 polymorphism and pediatric asthma in the Iranian population. A total of 63 asthma patients (aged 6-18) and 86 healthy controls were enrolled in our study. Asthma type, classification, and severity were defined. SNPs of the ADAM33 gene at rs2280091 (T1) were analyzed. Pulmonary function tests, total blood eosinophil count, and IgE count were also assessed. T1 genotype and allele frequencies were not associated with asthma risk in Iranian pediatric asthma. Atopic asthma subgroup and patients with normal eosinophil count showed association with ADAM33 rs2280091. Moreover, asthma patients with AG genotype showed lower pulmonary functions.

The Assessment of Relations between Socioeconomic Status and Number of Complications among Type 2 Diabetic Patients

BACKGROUND

The prevalence of diabetes mellitus among Iranian aged 25-64 estimated to be about 7.7%. The aim of current study was the assessment of socioeconomic status of diabetic patients and their complications.

METHODS

A cross sectional study was conducted on type 2 diabetic patients with complications in four major teaching hospitals affiliated to Tehran University of Medical Sciences (TUMS) during July 2009 to March 2010. All patients (530) were interviewed through a questionnaire with 85% response rate (450 patients). Skilled nurses were assigned as responsible for data collection. Collected data analyzed by Exact Fisher and χ2 tests using SPSS version 11.5.

RESULTS

The majority of patients had experienced one or more complications. Findings revealed that 50%, 33.6% and 16.4% of the patients suffered from one, two, and three complications of type 2 diabetes, respectively. Patients with cardiovascular complications included 22.2%, with both cardiovascular and eye complications (12.7%), and with cardiovascular, eye and foot ulcer together 14% of the respondents. Frequency of complications demonstrated significant relation with sex, age, educational level, type of occupation, duration of diabetes (P<0.001) and social class (P=0.002). The majority of patients (54.2%) belonged to low income group.

CONCLUSION

It seems patients with low socioeconomic status face more challenges in their social environment together with less psychological support. Health care systems are responsible to empower them to control their illness and feel a better life to live.