Dramatic secukinumab-mediated improvements in refractory leprosy-related neuritis via the modulation of T helper 1 (Th1) and T helper 17 (Th17) immune pathways

A 39-year-old woman was diagnosed with relapsed multibacillary leprosy and refractory neuritis. Here, we describe an evident loss of therapeutic effectiveness after the third pulse of corticosteroids, which may be attributed to tachyphylaxis and the posterior modulation of interferon- γ (IFN-γ), tumor necrosis factor- α (TNF-α,) interleukin-17A (IL-17A), and IL-12/23p40 after the induction phase of secukinumab. In this case, plasma cytokine analysis showed that secukinumab induced a reduction in IL-17 concomitant with impressive clinical improvements in the patient's neural function. Interestingly, secukinumab induced reductions in cytokines related to Th1 responses and earlier stages of the Th17 response, including IL-23/12.

Quantification of lipid bodies in monocytes from patients with periodontitis

OBJECTIVES

For the first time in the history of periodontics, the production of lipid bodies by monocytes was assessed from blood of patients with periodontitis in comparison to systemically healthy individuals. The purpose of this study was to compare the lipid body frequency within monocytes between healthy patients and those with periodontal disease.

MATERIALS AND METHODS

A total of 30 participants (11 males and 19 females), were divided between orally healthy control subjects (C, n = 16) and periodontitis subjects (P, n = 14), in a cross-sectional study. Both groups were systemically healthy. The following clinical periodontal parameters were assessed: probing depth, clinical attachment level, visible plaque index and gingival bleeding on probing index. Blood samples were collected to obtain monocytes containing lipid bodies, which were analyzed by light microscopy.

RESULTS

The periodontitis group demonstrated a higher corpuscular index than the control group (nonopsonized p = .0296 or opsonized p = .0459; Mann-Whitney). The frequency of monocyte cells containing lipid bodies (basal p = .0147, opsonized p = .0084 or nonopsonized, p = .026; Mann-Whitney) was also higher compared to those observed in healthy individuals.

CONCLUSIONS

The data suggest that periodontitis may contribute to a higher production of lipid bodies. It was also hypothesized that a major production of lipid bodies by monocytes in severe periodontitis, compared to orally healthy subjects, could interfere with the innate immune response or represents a higher reservoir of cholesterol esters within macrophages and a major risk to systemic implications, such as atherosclerosis.

Evaluation of a new automated enzyme fluoroimmunoassay using recombinant plasmid dsDNA for the detection of anti-dsDNA antibodies in SLE

ELISA methods to detect anti-double-stranded DNA (anti-dsDNA) antibodies are highly sensitive, but are less specific for the diagnosis of SLE than the immunofluorescence test on Crithidia luciliae (CLIFT) and the Farr assay because they also detect low-avidity antibodies. This study evaluated the specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of a new automated fluoroimmunoassay (EliA dsDNA; Pharmacia, Freiburg, Germany). We compared the results with those obtained using a commercial CLIFT and an in-house anti-dsDNA IgG ELISA method, and verified its putative ability to detect only high-avidity anti-dsDNA antibodies. Sera from 100 SLE patients and 120 controls were studied. The control group included 20 healthy donors, 70 patients with other rheumatic diseases (32 systemic sclerosis (SSc); 18 primary Sjögren syndrome (pSS), 20 rheumatoid arthritis (RA)), and 30 patients with various infectious diseases (ID). Anti-dsDNA avidity was estimated using an ELISA method based upon the law of mass action, and a simplified Scatchard plot analysis for data elaboration; the apparent affinity constant (Kaa) was calculated and expressed as arbitrary units (L/U). Sensitivity, specificity, PPV, and NPV for SLE were 64%, 95.8%, 93.8% and 72.7%, respectively, for the EliA anti-dsDNA assay; 55%, 99.2%, 98.5%, and 68.8%, respectively, for the CLIFT; and 64%, 93.3%, 90.6%, and 72.3%, respectively, for the in-house ELISA. Although EliA anti-dsDNA was positive mainly in SLE patients with high- (Kaa>80 L/U) and intermediate- (Kaa 30-80 L/U) avidity antibodies (45.3% and 49.9%, respectively), it was also positive in five (7.8%) SLE patients with low-avidity anti-dsDNA antibodies, and five controls (three SSc, one pSS, and one ID) (mean Kaa = 16.4 +/- 9.04 L/U). In conclusion, EliA anti-dsDNA assay showed a higher sensitivity than the CLIFT, and a good specificity and PPV for SLE. Its putative ability to detect only high-avidity anti-dsDNA antibodies remains questionable.