Advancement in therapeutic strategies for immune-mediated oral diseases

BACKGROUND

Immune-mediated diseases are a diverse group of conditions characterized by alteration of cellular homeostasis and inflammation triggered by dysregulation of the normal immune response. Several immune-mediated diseases exhibit oral signs and symptoms. Traditionally, these conditions are treated with corticosteroids or immunosuppressive agents, including azathioprine, cyclophosphamide, and thalidomide. Recent research into the developmental pathways of these diseases has led to the exploration of novel approaches in treatment. This review examines newer treatment modalities for the management of immune-mediated diseases with oral presentations. Topical calcineurin inhibitors (TCIs) such as tacrolimus and pimecrolimus have been employed successfully in managing oral lichen planus and pemphigus vulgaris. Biologic agents, comprising monoclonal antibodies, fusion proteins, and recombinant cytokines, can provide targeted therapy with fewer adverse effects. Neutraceutical agents comprising aloe vera, curcumin, and honey are commonly used in traditional medicine and offer a holistic approach. They may have a place as adjuvants to current standard therapeutic protocols. Photodynamic therapy (PDT) and low-level laser therapy (LLLT) utilize a specific wavelength of light to achieve desired cellular change. While the use of PDT in immune-mediated diseases is contentious, LLLT has shown positive results. Newer therapeutic modalities involve kinase inhibitors, S1P₁ receptor modulators, MSCs, and iRNA providing targeted treatment of specific diseases.

Polysaccharide-Drug Conjugates: A Tool for Enhanced Cancer Therapy

Cancer is one of the most widespread deadly diseases, following cardiovascular disease, worldwide. Chemotherapy is widely used in combination with surgery, hormone and radiation therapy to treat various cancers. However, chemotherapeutic drugs can cause severe side effects due to non-specific targeting, poor bioavailability, low therapeutic indices, and high dose requirements. Several drug carriers successfully overcome these issues and deliver drugs to the desired sites, reducing the side effects. Among various drug delivery systems, polysaccharide-based carriers that target only the cancer cells have been developed to overcome the toxicity of chemotherapeutics. Polysaccharides are non-toxic, biodegradable, hydrophilic biopolymers that can be easily modified chemically to improve the bioavailability and stability for delivering therapeutics into cancer tissues. Different polysaccharides, such as chitosan, alginates, cyclodextrin, pullulan, hyaluronic acid, dextran, guar gum, pectin, and cellulose, have been used in anti-cancer drug delivery systems. This review highlights the recent progress made in polysaccharides-based drug carriers in anti-cancer therapy.

Diagnostic yield of Electroanatomic voltage mapping in guiding Endomyocardial biopsies; a comparison with an MRI-guided approach

Background

Electroanatomic voltage mapping (EVM) is a promising modality for guiding Endomyocardial biopsies (EMB). Previous experiences on this techniques have reported safety and feasibility of this approach. These reports however, resulted limited by sample size or imperfect designs, preventing reliable comparisons of the effectiveness of this new methods with a conventional or a cardiac magnetic resonance (CMR) imaging guided approach.

Aim

We now report the largest cohort of patients undergoing EVM-guided EMB in order to show its diagnostic yield and comparing it with a cardiac magnetic resonance (CMR) guided approach.

Methods

One-hundred and sixty-two consecutive patients undergoing EMB at our Institution from 2010 to 2019 were included. Pathological areas identified at EVM and CMR underwent EMB. According to EMB results, CMR and EVM sensitivity and specificity regarding the identification of pathological substrates of myocardium were evaluated.

Results

A gadolinium-enhanced CMR had been performed in 143 (88.9%) of the population and yielded pathological findings in 121 (85.8%) of such cases. Late gadolinium enhancement (LGE) was present in 94 (70%) of the patients, while EVM identified areas of low voltages in 61%. Right (73%), left (19%) or both ventricles (8%) underwent sampling. EVM proved to have similar sensitivity to CMR (74% vs. 77%; P=0.479), with non-significantly higher specificity (70% vs. 47% P=0.738). In 12 patients with EMB-proven cardiomyopathy, EVM identified pathological areas, which had been undetected at CMR evaluation (concordance rate 53.8%; k = 0.26). Sensitivity of pooled EVM and CMR was as high as 95%. Five cases (3,8%) of cardiomyopathies were undetected by both CMR and EVM. Complications rate was low (4,9%), mostly vascular access related, with no patients requiring urgent management.

Conclusion

EVM proved to be a promising tool for targeted-EMB due to its sensitivity and specificity in identifying myocardial pathological substrates. EVM demonstrated to have an accuracy similar to CMR. EVM and CMR together conferred EMB a positive predictive value of 89%.

Funding Acknowledgement

Type of funding source: None