IL17RA gene variants and anti-TNF response among psoriasis patients

Polymorphisms at genes encoding proteins involved in the pathogenesis of psoriasis (Psor) or in the mechanism of action of biological drugs could influence the treatment response. Because the interleukin (IL)-17 family has a central role in the pathogenesis of Psor, we hypothesized that IL17RA variants could influence the response to anti-TNF drugs among Psor patients. To address this issue we performed a cross-sectional study of Psor patients who received the biological treatments for the first time, with a follow-up of at least 6 months. All of the patients were Caucasian, older than 18 years old, with chronic plaque Psor, and had completed at least 24 weeks of anti-TNF therapy (adalimumab, etanercept or infliximab). The treatment response to anti-TNF agents was evaluated according to the achievement of PASI50 and PASI75 at weeks 12 and 24. Those who achieved PASI75 at week 24 were considered good responders. All patients were genotyped for the selected single-nucleotide polymorphisms (SNPs) at IL17RA gene. A total of 238 patients were included (57% male, mean age 46 years). One hundred and five patients received adalimumab, 91 patients etanercept and 42 infliximab. The rs4819554 promoter SNP allele A was significantly more common among responders at weeks 12 (P=0.01) and 24 (P=0.04). We found a higher frequency of AA versus AG+GG among responders, but the difference was only significant at week 12 (P=0.03, odd ratio=1.86, 95% confidence of interval=1.05-3.27). Thus, in the study population, the SNP rs4819554 in the promoter region of IL17RA significantly influences the response to anti-TNF drugs at week 12.

Uncoupling of osteoblast-osteoclast regulation in a chemical murine model of Gaucher disease

Gaucher disease (GD) is caused by mutations in the GBA gene that confer a deficient level of activity of glucocerebrosidase (GCase). This deficiency leads to accumulation of the glycolipid glucocerebroside in the lysosomes of cells of monocyte/macrophage system. Type I GD is the mildest form and is characterized by the absence of neuronopathic affection. Bone compromise in Gaucher disease patients is the most disabling aspect of the disease. However, pathophysiological aspects of skeletal alterations are still poorly understood. The homeostasis of bone tissue is maintained by the balanced processes of bone resorption by osteoclasts and formation by osteoblasts. We decided to test whether bone resorption and/or bone formation could be altered by the use of a chemical in vitro murine model of Gaucher disease. We used two sources of cells from monocyte/macrophages lineage isolated from normal mice, splenocytes (S) and peritoneal macrophages (PM), and were exposed to CBE, the inhibitor of GCase (S-CBE and PM-CBE, respectively). Addition of both conditioned media (CM) from S-CBE and PM-CBE induced the differentiation of osteoclasts precursors from bone marrow to mature and functional osteoclasts. TNF-α could be one of the factors responsible for this effect. On the other hand, addition of CM to an osteoblast cell culture resulted in a reduction in expression of alkaline phosphatase and mineralization process. In conclusion, these results suggest implication of changes in both bone formation and bone resorption and are consistent with the idea that both sides of the homeostatic balance are affected in GD.

[Psychotherapy reasearch: a bridge between theory and clinic]

This paper presents a panorama of current developments in psychotherapy research. Starting by an historical brief review of the evolution of this discipline, the two main streams in which this field is nowadays divided are examined. The first one, represented by those who favor the question of efficacy, promotes the development of empirically validated treatments (EVT) based on experimental studies. Conversely, the other one, represented by those who favor effectiveness, argue for the advisability of following a generalizability criteria that attempts to examine the results of psychotherapy in naturalistic contexts.

[Etiology of acute respiratory infections in 87 hospitalized children]

OBJECTIVE

The aim of this study was to assess the effectiveness of two microbiologic methods: viral culture and serology for the etiologic study of acute respiratory infections in children under 14 years of age admitted to our hospital.

PATIENTS

From January 1992 to December 1993, a prospective study was carried out in 87 patients with a mean age of two years with the following diagnosis: upper respiratory tract infections (URTI) 19, laryngitis 3, bronchitis 18, bronchiolitis 18, and pneumonia 29.

METHOD

Nasopharyngeal aspirates were collected for virologic culture on cell monolayers in 87 patients. Serologic studies by complement fixation test were carried out in 42 patients older than six months.

RESULTS

The etiologic agent was detected in 54 (62%) of the 87 patients, being the most frequent the respiratory sincitial virus (VRS) with 18 cases (20%), followed by adenovirus (ADV) in 17 (19%) and Mycoplasma pneumoniae in 9 cases (11%). Viral culture was positive in 32 (37%), being ADV in 14 (41%), and RSV in 9 (26%). Significative serologic studies were obtained in 25 (60%) of the 42 studied patients, with VRS in 9 (32%) and M. pneumoniae in 9 (32%). Concerning clinical diagnosis, the major effectiveness corresponded to serology in pneumonia (76%), and to viral culture in URTI (63%).

CONCLUSION

Viral culture and serology are useful methods for the detection of etiologic agents in acute respiratory infections. The serology effectiveness increases with age (p < 0.01) and the severity of the clinical diagnosis. Both methods have limited usefulness from clinical point of view.