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Hakimian D, Amer J, Jammal A, Shafrir A, Milgrom Y, Masarowah M, Hazou W, Ishay Y, Imam A, Francis A, Khalaileh A, Safadi R. Weaker SARS-CoV-2 vaccine responses in nonalcoholic fatty liver disease with advanced liver fibrosis. Vaccine X 2023; 15:100359. [PMID: 37885772 PMCID: PMC10598407 DOI: 10.1016/j.jvacx.2023.100359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 10/28/2023] Open
Abstract
Background SARS-CoV-2 vaccine responses that could harbor potential risks to chronic liver diseased patients. Aims To assess immune response following Pfizer's SARS-CoV-2 vaccine in patients with different liver fibrosis severities of nonalcoholic fatty liver disease (NAFLD). Methods Clinical and histological (NAS-score and fibrosis stage) characteristics of NAFLD patients before vaccine were correlated with serologic vaccine responses of two doses of the BNT162b2. Serum SARS-CoV-2 spike immunoglobulins (anti-S) were assessed on day seven following immunization (Liaison assay). Results The mean-age of patients (n = 157) was 56.9 ± 13.2 years (46.5 % males). 94.8 % had a positive response (anti-S levels ≥ 19 AU/ml). The anti-S cutoff of 200 AU/ml used to separate strong vs. weak responses. A strong response (anti-S titers ≥ 200 AU/ml) was observed in 93/157 (59.2 %) patients with a mean-age of 53.1 ± 13.8 years (45.2 % males). A weak response (anti-S titers < 200 AU/ml) was observed in 64/157 (40.8 %) cases with a mean-age of 62.3 ± 10.2 years (p < 0.0001). The strong response subgroup had lower metabolic comorbidities, including glucose hemostasis, hypertension, and dyslipidemia (p < 0.04). Moreover, the strong response subgroup had fibrosis stages F0-F2 (75.3 % vs. 56.3 %) and lower rates of advanced stages F3-F4 (24.7 % vs. 43.8 %). The F0-F2 subgroups had significantly higher rates of strong responses than the F3-F4 stages. The anti-S ≥ 200 and anti-S ≥ 400 AU/ml response achieved in 66 % and 36.8 % of the F0-F2 population was significantly higher than the 45.1 % (p = 0.006) and 23.5 % (p = 0.05) in the F3-F4 population, respectively. The Fib-4 calculations and Fibroscan evaluations were consistent with histologic fibrosis assessment. Conclusion Advanced liver fibrosis (assessed by histology, Fib-4, or Fibroscan) is a risk factor for lower response to Pfizer's BNT162b2 vaccine, and patients should be prioritized for the vaccine booster against SARS-CoV-2.
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Affiliation(s)
- David Hakimian
- Hadassah Medical Center, Liver insitute, Hadassah-Hebrew University Medical Center, Israel
| | - Johnny Amer
- Hadassah Medical Center, Liver insitute, Hadassah-Hebrew University Medical Center, Israel
| | - Alaa Jammal
- Hadassah Medical Center, Liver insitute, Hadassah-Hebrew University Medical Center, Israel
| | - Asher Shafrir
- Hadassah Medical Center, Liver insitute, Hadassah-Hebrew University Medical Center, Israel
| | - Yael Milgrom
- Hadassah Medical Center, Liver insitute, Hadassah-Hebrew University Medical Center, Israel
| | - Mohammad Masarowah
- Hadassah Medical Center, Liver insitute, Hadassah-Hebrew University Medical Center, Israel
| | - Wadi Hazou
- Hadassah Medical Center, Liver insitute, Hadassah-Hebrew University Medical Center, Israel
- Hadassah Medical Center, Department of Surgery, Jerusalem, Israel
| | - Yuval Ishay
- Hadassah Medical Center, Liver insitute, Hadassah-Hebrew University Medical Center, Israel
| | - Ashraf Imam
- Hadassah Medical Center, Department of Surgery, Jerusalem, Israel
| | - Adi Francis
- Hadassah Medical Center, Cardiac Care Unit, Holy Family Hospital, Bar-Ilan University, Nazareth, Israel
| | - Abed Khalaileh
- Hadassah Medical Center, Department of Surgery, Jerusalem, Israel
| | - Rifaat Safadi
- Hadassah Medical Center, Liver insitute, Hadassah-Hebrew University Medical Center, Israel
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2
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Kolben Y, Kenig A, Kessler A, Ishay Y, Weksler-Zangen S, Eisa M, Ilan Y. Serum Levels of Adropin Improve the Predictability of MELD and Child-Pugh Score in Cirrhosis: Results of Proof-of-Concept Clinical Trial. Transpl Int 2023; 36:11176. [PMID: 37334012 PMCID: PMC10274576 DOI: 10.3389/ti.2023.11176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023]
Abstract
Adropin is a peptide that was suggested to have a role in cirrhosis. The present study aimed to determine the ability to use serum adropin levels to improve their prediction accuracy as an adjunct to the current scores. In a single-center, proof-of-concept study, serum adropin levels were determined in thirty-three cirrhotic patients. The data were analyzed in correlation with Child-Pugh and MELD-Na scores, laboratory parameters, and mortality. Adropin levels were higher among cirrhotic patients that died within 180 days (1,325.7 ng/dL vs. 870.3 ng/dL, p = 0.024) and inversely correlated to the time until death (r 2 = 0.74). The correlation of adropin serum levels with mortality was better than MELD or Child-Pough scores (r 2 = 0.32 and 0.38, respectively). Higher adropin levels correlated with creatinine (r 2 = 0.79. p < 0.01). Patients with diabetes mellitus and cardiovascular diseases had elevated adropin levels. Integrating adropin levels with the Child-Pugh and MELD scores improved their correlation with the time of death (correlation coefficient: 0.91 vs. 0.38 and 0.67 vs. 0.32). The data of this feasibility study suggest that combining serum adropin with the Child-Pugh score and MELD-Na score improves the prediction of mortality in cirrhosis and can serve as a measure for assessing kidney dysfunction in these patients.
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Affiliation(s)
- Yotam Kolben
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Department of Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Ariel Kenig
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Department of Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Asa Kessler
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Department of Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Yuval Ishay
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Department of Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Sarah Weksler-Zangen
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Department of Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Mualem Eisa
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Department of Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Yaron Ilan
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Department of Medicine, Hadassah Medical Center, Jerusalem, Israel
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3
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Forkosh E, Ishay Y, Schwartz A, Talmon A, Ben-Chetrit E. Oral ulcers, uveitis and thrombosis are looking for a diagnosis…. Clin Exp Rheumatol 2022; 40:1593-1597. [DOI: 10.55563/clinexprheumatol/l02h5f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Esther Forkosh
- Department of Medicine A, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Yuval Ishay
- Department of Medicine A, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Asaf Schwartz
- Department of Medicine A, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Aviv Talmon
- Allergy Unit, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Eldad Ben-Chetrit
- Rheumatology Unit, Hadassah Hebrew University Medical Centre, Jerusalem, Israel.
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4
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Kolben Y, Azmanov H, Ishay Y, Orenbuch-Harroch E, Milgrom Y. Hemorrhagic Fever with Renal Syndrome Caused by Hantavirus Infection: First Reported Case in Israel. Isr Med Assoc J 2022; 24:621-622. [PMID: 36168171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Yotam Kolben
- Departments of Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Henny Azmanov
- Departments of Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Yuval Ishay
- Departments of Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Efrat Orenbuch-Harroch
- Departments of Microbiolog, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Yael Milgrom
- Departments of Gastroenterology and Liver Diseases, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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5
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Gelman R, Potruch A, Oster Y, Ishay Y, Gur C, Beeri R, Strahilevitz J. Native aortic valve Staphylococcus warneri endocarditis after COVID-19 infection: a case report and a review of literature. APMIS 2022; 130:270-275. [PMID: 35218080 PMCID: PMC9111267 DOI: 10.1111/apm.13217] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/05/2022] [Indexed: 01/09/2023]
Abstract
We report a case of Staphylococcus warneri native valve endocarditis in an immunocompetent healthy adult, without known risk factors for infective endocarditis, two months following COVID‐19 infection, who recovered with conservative treatment. Additionally, we reviewed previous cases of native valve endocarditis caused by Staphylococcus warneri and summarized the main clinical implications.
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Affiliation(s)
- Ram Gelman
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Assaf Potruch
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Yonatan Oster
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Clinical Microbiology and Infectious Diseases, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Yuval Ishay
- Department of Gastroenterology and Liver Diseases, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Chamutal Gur
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Ronen Beeri
- Diagnostic Cardiology Unit, Heart Institute, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Jacob Strahilevitz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Clinical Microbiology and Infectious Diseases, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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6
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Ishay Y, Potruch A, Schwartz A, Berg M, Jamil K, Agus S, Ilan Y. A digital health platform for assisting the diagnosis and monitoring of COVID-19 progression: An adjuvant approach for augmenting the antiviral response and mitigating the immune-mediated target organ damage. Biomed Pharmacother 2021; 143:112228. [PMID: 34649354 PMCID: PMC8455249 DOI: 10.1016/j.biopha.2021.112228] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), which is a respiratory illness associated with high mortality, has been classified as a pandemic. The major obstacles for the clinicians to contain the disease are limited information availability, difficulty in disease diagnosis, predicting disease prognosis, and lack of disease monitoring tools. Additionally, the lack of valid therapies has further contributed to the difficulties in containing the pandemic. Recent studies have reported that the dysregulation of the immune system leads to an ineffective antiviral response and promotes pathological immune response, which manifests as ARDS, myocarditis, and hepatitis. In this study, a novel platform has been described for disseminating information to physicians for the diagnosis and monitoring of patients with COVID-19. An adjuvant approach using compounds that can potentiate antiviral immune response and mitigate COVID-19-induced immune-mediated target organ damage has been presented. A prolonged beneficial effect is achieved by implementing algorithm-based individualized variability measures in the treatment regimen.
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Affiliation(s)
- Yuval Ishay
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
| | - Assaf Potruch
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
| | - Asaf Schwartz
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
| | - Marc Berg
- Altus Care powered by Oberon Sciences, Denmark, Israel; Department of Pediatrics, Lucile Packard Children's Hospital, Stanford, USA.
| | - Khurram Jamil
- Altus Care powered by Oberon Sciences, Denmark, Israel.
| | - Samuel Agus
- Altus Care powered by Oberon Sciences, Denmark, Israel.
| | - Yaron Ilan
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
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7
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Ishay Y, Potruch A, Weksler-Zangen S, Shabat Y, Ilan Y. Augmented antiviral T cell immunity by oral administration of IMM-124E in preclinical models and a phase I/IIa clinical trial: A method for the prevention and treatment of COVID-19. Drug Dev Res 2021; 83:615-621. [PMID: 34596893 PMCID: PMC8652907 DOI: 10.1002/ddr.21890] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/17/2021] [Accepted: 09/25/2021] [Indexed: 01/08/2023]
Abstract
Biological adjuvants that target the gut immune system are being developed for modulating the immune system. Hyperimmune bovine colostrum (HBC), produced by harvesting the bovine colostrum of dairy cows immunized to exogenous antigens, has been shown to modulate the immune responses and alleviate immune‐mediated organ damages. The aim of the present study was to determine the ability of HBC to promote antiviral interferonγ (IFNγ) T cell responses. In a preclinical study, mice were orally administered with HBC for 5 days and tested for the number of T cell clones secreting IFNγ in response to viral antigens of the swine flu, New Caledonia influenza, and cytomegalovirus. In a phase I/IIa clinical trial, five healthy volunteers were treated for 5 days with HBC followed by testing the anti‐coronavirus disease (COVID‐19) immunity. In the preclinical study, oral administration of HBC augmented the number of T cell clones secreting IFNγ in response to viral antigens. In the clinical trial, oral administration of HBC to healthy males significantly increased the number of anti‐COVID‐19 spike protein IFNγ positive T cell clones. Oral administration of HBC provides a novel method for augmenting antiviral responses. Its high‐safety profile makes it ideal for all disease stages and for pre‐emptive therapy among medical personnel and other workers who are at a high risk of exposure to infections. The relatively low cost of HBC is expected to minimize care provider burdens, costs, and enable its global application.
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Affiliation(s)
- Yuval Ishay
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Assaf Potruch
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Sarah Weksler-Zangen
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Yehudit Shabat
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Yaron Ilan
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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8
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Ishay Y, Kolben Y, Kessler A, Ilan Y. Role of circadian rhythm and autonomic nervous system in liver function: a hypothetical basis for improving the management of hepatic encephalopathy. Am J Physiol Gastrointest Liver Physiol 2021; 321:G400-G412. [PMID: 34346773 DOI: 10.1152/ajpgi.00186.2021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Hepatic encephalopathy (HE) is a common, incapacitating complication of cirrhosis that affects many patients with cirrhosis. Although several therapies have proven effective in the treatment and prevention of this condition, several patients continue to suffer from covert disease or episodes of relapse. The circadian rhythm has been demonstrated to be pivotal for many body functions, including those of the liver. Here, we explore the impact of circadian rhythm-dependent signaling on the liver and discuss the evidence of its impact on liver pathology and metabolism. We describe the various pathways through which circadian influences are mediated. Finally, we introduce a novel method for improving patient response to drugs aimed at treating HE by utilizing the circadian rhythm. A digital system that introduces a customization-based technique for improving the response to therapies is presented as a hypothetical approach for improving the effectiveness of current medications used for the treatment of recurrent and persistent hepatic encephalopathy.
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Affiliation(s)
- Yuval Ishay
- Department of Medicine, Faculty of Medicine, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Yotam Kolben
- Department of Medicine, Faculty of Medicine, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Asa Kessler
- Department of Medicine, Faculty of Medicine, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Yaron Ilan
- Department of Medicine, Faculty of Medicine, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
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9
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Kolben Y, Ishay Y, Azmanov H, Rokney A, Baum M, Amit S, Nir-Paz R. Right-sided endocarditis caused by polyclonal Staphylococcus aureus infection. Eur J Med Res 2021; 26:91. [PMID: 34380556 PMCID: PMC8356449 DOI: 10.1186/s40001-021-00549-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
We present a case of bacterial endocarditis with both methicillin-sensitive and methicillin-resistant Staphylococcus aureus, which based on typing, originated from two distinct clones. Such a case may be misinterpreted by microbiology lab automation to be a monoclonal multi-drug resistant Staphylococcus aureus, while simple microbiology techniques will instantly reveal distinct clonality.
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Affiliation(s)
- Yotam Kolben
- Department of Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Yuval Ishay
- Department of Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Henny Azmanov
- Department of Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Assaf Rokney
- Government Central Laboratories, Ministry of Health, Jerusalem, Israel
| | - Moti Baum
- Government Central Laboratories, Ministry of Health, Jerusalem, Israel
| | - Sharon Amit
- Department of Microbiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ran Nir-Paz
- Department of Microbiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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10
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Kharouf F, Ishay Y, Kenig A, Bitan M, Ben-Chetrit E. Incidence and course of COVID-19 hospitalizations among patients with familial Mediterranean fever. Rheumatology (Oxford) 2021; 60:SI85-SI89. [PMID: 34293118 PMCID: PMC8344485 DOI: 10.1093/rheumatology/keab577] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/09/2021] [Indexed: 12/21/2022] Open
Abstract
Objectives To evaluate the incidence of hospitalization for COVID-19 in patients with familial Mediterranean fever (FMF), as compared with the general population, and to compare the disease course between FMF inpatients, and age, sex, ethnicity, and comorbidity-matched non-FMF COVID-19 inpatients. Methods We used electronic medical records (EMR) to obtain data about the total number of the insured population and the number of FMF patients in the two largest health management organizations (HMOs) in Jerusalem, Clalit and Meuhedet. The total number of COVID-19 inpatients at the Hadassah Medical Center, including those with FMF, for the period between the 1 February 2020, and the 10 March 2021 was retrieved from the EMR of Hadassah. COVID-19 course was compared between the FMF inpatient group and age, sex, ethnicity, and comorbidity-matched non-FMF COVID-19 inpatients. Each FMF inpatient was matched with 2 non-FMF controls. Results We found no statistically significant difference in the odds of hospitalization for COVID-19 between FMF patients and the non-FMF population (0.46% vs 0.41%; p= 0.73). Furthermore, we found similar disease severity and therapeutic approach in FMF COVID-19 inpatients and matched non-FMF COVID-19 inpatients. Conclusions Neither FMF, nor baseline colchicine therapy appear to affect the incidence of hospitalization for COVID-19 or the disease course, in terms of severity and therapeutic approach.
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Affiliation(s)
- Fadi Kharouf
- Department of Medicine, Hadassah Medical Center and the Faculty of Medicine, the Hebrew University, Jerusalem, Israel.,Rheumatology Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Yuval Ishay
- Department of Medicine, Hadassah Medical Center and the Faculty of Medicine, the Hebrew University, Jerusalem, Israel.,The Institute of Gastroenterology and Liver Diseases, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Ariel Kenig
- Department of Medicine, Hadassah Medical Center and the Faculty of Medicine, the Hebrew University, Jerusalem, Israel
| | - Menachem Bitan
- Jerusalem District, Meuhedet Health Medical Organization, Jerusalem, Israel, and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Eldad Ben-Chetrit
- Rheumatology Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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11
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Ishay Y, Kenig A, Tsemach-Toren T, Amer R, Rubin L, Hershkovitz Y, Kharouf F. Autoimmune phenomena following SARS-CoV-2 vaccination. Int Immunopharmacol 2021; 99:107970. [PMID: 34280851 PMCID: PMC8270741 DOI: 10.1016/j.intimp.2021.107970] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 01/06/2023]
Abstract
Vaccines represent an attractive possible solution to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. Widespread vaccine distribution has yet to occur in most countries, partially due to public concerns regarding possible side effects. While studies indicate the vaccine is exceptionally safe, rare systemic side effects remain possible. In Israel, where a large percentage of the population has been rapidly vaccinated, such adverse events may be more apparent. We report a series of patients presenting with de-novo or flares of existing autoimmune conditions associated with the Pfizer BNT162b2 mRNA SARS-CoV-2 vaccine. All patients were assessed in our tertiary care center in Israel and had no history of previous SARS-COV-2 infection. We observed that while immune phenomena may occur following vaccination, they usually follow a mild course and require modest therapy. We briefly expound on the theoretical background of vaccine related autoimmunity and explore future research prospects.
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Affiliation(s)
- Yuval Ishay
- Department of Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel; Gastroenterology Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Ariel Kenig
- Department of Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Tehila Tsemach-Toren
- Department of Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel; Rheumatology Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Radgonde Amer
- Department of Ophthalmology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Limor Rubin
- Department of Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel; Allergy and Clinical Immunology Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Yoav Hershkovitz
- Department of Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Fadi Kharouf
- Department of Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel; Rheumatology Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
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12
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Gelman R, Kharouf F, Ishay Y, Gural A. Cold Agglutinin-Mediated Autoimmune Hemolytic Anemia in Association with Antiphospholipid Syndrome. Acta Haematol 2021; 144:693-697. [PMID: 34000726 DOI: 10.1159/000516295] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/29/2021] [Indexed: 01/15/2023]
Abstract
Antiphospholipid syndrome and cold agglutinin-mediated autoimmune hemolytic anemia are 2 distinct immune-mediated hematologic disorders. While no clear association exists between these 2 entities, complement activation is known to occur in both of them. Herein, we report a unique case of cold agglutinin hemolytic anemia in a patient with a known primary antiphospholipid syndrome.
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Affiliation(s)
- Ram Gelman
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Fadi Kharouf
- Rheumatology Unit, Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Yuval Ishay
- Department of Gastroenterology and Liver Diseases, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Alexander Gural
- Department of Hematology and Transfusion Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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13
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Kenig A, Ishay Y, Kharouf F, Rubin L. Treatment of B-cell depleted COVID-19 patients with convalescent plasma and plasma-based products. Clin Immunol 2021; 227:108723. [PMID: 33838340 PMCID: PMC8024218 DOI: 10.1016/j.clim.2021.108723] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 01/05/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 infected patients, receiving background anti-CD20 therapy, were treated with convalescent plasma or plasma-based products. Eight patients were included in the study, presenting with prolonged disease course and delayed viral clearance. CP/plasma-based products were offered as an add-on therapy to standard medical treatment. All patients showed remarkable clinical and laboratory improvement. In addition, polymerase chain reaction from nasopharyngeal swabs rapidly converted to negative following plasma administration. This study emphasizes the therapeutic efficacy of convalescent plasma and plasma-based products in a subgroup of immunocompromised patients with iatrogenic B-cell depletion.
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Affiliation(s)
- Ariel Kenig
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Yuval Ishay
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel; The Gastroenterology Unit, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Fadi Kharouf
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel; Rheumatology Unit, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Limor Rubin
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel; Allergy and Clinical Immunology Unit, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
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14
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Ishay Y, Rotnemer-Golinkin D, Ilan Y. The role of the sphingosine axis in immune regulation: A dichotomy in the anti-inflammatory effects between sphingosine kinase 1 and sphingosine kinase 2-dependent pathways. Int J Immunopathol Pharmacol 2021; 35:20587384211053274. [PMID: 34789044 PMCID: PMC8645305 DOI: 10.1177/20587384211053274] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/21/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Sphingosine kinase has been identified as playing a central role in the immune cascade, being a common mediator in the cellular response to a variety of signals. The different effects of sphingosine kinase 1 and 2 (SphK1 and SphK2, respectively) activity have not been completely characterized. Aim: To determine the different roles played by SphK1 and SphK2 in the regulation of immune-mediated disorders. Methods: Nine groups of mice were studied. Concanavalin A (ConA) injection was used to induce immune-mediated hepatitis. Mice were treated with SphK1 inhibitor (termed SphK-I) and SphK2 inhibitor (termed ABC294640), prior to ConA injection, and effects of treatment on liver enzymes, subsets of T lymphocytes, and serum levels of cytokines were observed. Results: While liver enzyme elevation was ameliorated by administration of SphK1 inhibitor, SphK2 inhibitor-treated mice did not show this tendency. A marked decrease in expression of CD25+ T-cells and Foxp+ T-cells was observed in mice treated with a high dose of SphK1 inhibitor. Alleviation of liver damage was associated with a statistically significant reduction of serum IFNγ levels in mice treated with SphK1 inhibitor and not in those treated with SphK2 inhibitor. Conclusions: Early administration of SphK1 inhibitor in a murine model of immune-mediated hepatitis alleviated liver damage and inflammation with a statistically significant reduction in IFN-γ levels. The data support a dichotomy in the anti-inflammatory effects of SphK1 and SphK2, and suggests that isoenzyme-directed therapies can improve the effect of targeting these pathways.
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Affiliation(s)
- Yuval Ishay
- Department of Medicine, Hadassah-Hebrew University Medical
Center, Jerusalem Israel
| | | | - Yaron Ilan
- Department of Medicine, Hadassah-Hebrew University Medical
Center, Jerusalem Israel
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15
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Perles Z, Ishay Y, Nir A, Gavri S, Golender J, Ta-Shma A, Abu-Zahira I, Natsheh J, Elchalal U, Mevorach D, Rein AJ. Immune-Mediated Fetal Complete Atrioventricular Block: Can Dexamethasone Therapy Revert the Process? Isr Med Assoc J 2020; 11:711-716. [PMID: 33249793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Fetal complete atrioventricular block (CAVB) is usually autoimmune mediated. The risk of developing CAVB is 2% to 3% in anti-Ro/SS-A seropositive pregnancies and it increases 10 times after previous CAVB in siblings. Despite being a rare complication, CAVB carries a 20% mortality rate and substantial morbidity, as about 65% of newborns will eventually need life-long pacing. Once found, fetal CAVB is almost always irreversible, despite aggressive immunotherapy. This poor outcome prompted some research groups to address this situation. All groups followed anti-Ro/SS-A seropositive pregnancies on a weekly basis during the second trimester of pregnancy and tried to detect first degree atrioventricular block (AVB) using accurate echocardiographic tools, assuming they may characterize the initiation of the immune damage to the A-V conduction system, at which point the process might still be reversible. Some of the groups treated fetuses with first degree AVB with maternal oral fluorinated steroids. We summarized the results of all groups, including our group. We describe a case of a fetus that developed CAVB 6 days after normal sinus rhythm (NSR), who under aggressive dexamethasone therapy gradually reverted to NSR. This fetus had a previous sibling with CAVB. We assumed the immune damage to the conduction system in this small group of fetuses with a previous CAVB sibling may have occurred more quickly than usual. We therefore recommend a twice-weekly follow-up with these fetuses.
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Affiliation(s)
- Zeev Perles
- Department of Pediatric Cardiology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Yuval Ishay
- Department of Internal Medicine B, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Amiram Nir
- Department of Pediatric Cardiology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Sagui Gavri
- Department of Pediatric Cardiology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Julius Golender
- Department of Pediatric Cardiology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Asaf Ta-Shma
- Department of Pediatric Cardiology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Ibrahim Abu-Zahira
- Department of Pediatric Cardiology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Juma Natsheh
- Department of Neonatology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Uriel Elchalal
- Department of Obstetrics and Gynecology Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Dror Mevorach
- Department of Internal Medicine B, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Azaria Jjt Rein
- Department of Pediatric Cardiology, Hadassah Hebrew University Hospital, Jerusalem, Israel
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16
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Ishay Y, Kessler A, Schwarts A, Ilan Y. Antibody response to SARS-Co-V-2, diagnostic and therapeutic implications. Hepatol Commun 2020; 4:1731-1743. [PMID: 32904861 PMCID: PMC7461510 DOI: 10.1002/hep4.1600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/30/2020] [Accepted: 08/17/2020] [Indexed: 12/16/2022] Open
Abstract
The immune response against SARS-CoV-2 is comprised of both cellular and humoral arms. While current diagnostic methods are mainly based on PCR, they suffer from insensitivity. Therefore, antibody-based serological tests are being developed to achieve higher sensitivity and specificity. Current efforts in treating SARS-CoV-2 infection include blocking of viral entry into the host cells, prohibiting viral replication and survival in the host cells, or reducing the exaggerated host immune response. Administration of convalescent plasma containing anti-viral antibodies was proposed to improve the outcome in severe cases. In this paper, we review some of the aspects associated with the development of antibodies against SARS-CoV-2 and their potential use for improved diagnosis and therapy.
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Affiliation(s)
- Yuval Ishay
- Department of Medicine Hebrew University-Hadassah Medical Center Jerusalem Israel
| | - Asa Kessler
- Department of Medicine Hebrew University-Hadassah Medical Center Jerusalem Israel
| | - Asaf Schwarts
- Department of Medicine Hebrew University-Hadassah Medical Center Jerusalem Israel
| | - Yaron Ilan
- Department of Medicine Hebrew University-Hadassah Medical Center Jerusalem Israel
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17
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Ishay Y, Nachman D, Khoury T, Ilan Y. The role of the sphingolipid pathway in liver fibrosis: an emerging new potential target for novel therapies. Am J Physiol Cell Physiol 2020; 318:C1055-C1064. [PMID: 32130072 DOI: 10.1152/ajpcell.00003.2020] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sphingolipids (SL) are a family of bioactive lipids and a major cellular membrane structural component. SLs include three main compounds: ceramide (Cer), sphingosine (Sp), and sphingosine-1-phosphate (S-1P), all of which have emerging roles in biological functions in cells, especially in the liver. They are under investigation in various liver diseases, including cirrhosis and end-stage liver disease. In this review, we provide an overview on the role of SLs in liver pathobiology and focus on their potential role in the development of hepatic fibrosis. We describe recent evidence and suggest SLs are a promising potential therapeutic target for the treatment of liver disease and fibrosis.
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Affiliation(s)
- Yuval Ishay
- Department of Internal Medicine A, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dean Nachman
- Department of Internal Medicine A, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tawfik Khoury
- Gastroenterology and Liver Units, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yaron Ilan
- Gastroenterology and Liver Units, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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18
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Ishay Y, Zimran A, Szer J, Dinur T, Ilan Y, Arkadir D. Combined beta-glucosylceramide and ambroxol hydrochloride in patients with Gaucher related Parkinson disease: From clinical observations to drug development. Blood Cells Mol Dis 2016; 68:117-120. [PMID: 27866808 DOI: 10.1016/j.bcmd.2016.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 10/11/2016] [Accepted: 10/17/2016] [Indexed: 12/17/2022]
Abstract
Both patients with non-neuronopathic Gaucher disease (GD) and heterozygous GBA mutation carrier are at increased risk for Parkinson disease (PD). The risk for PD in these groups does not linearly increase with glucosylceramide (GC) accumulation or with acid β-glucocerebrosidase (GCase) activity. This observation, together with other clinical systemic observations raises the possibility that extra-cellular GC actually has beneficial, anti-inflammatory, properties. Based on this hypothesis, we suggest here that the administration of supplementary oral GC to GBA carriers at risk for PD may slow inflammatory-driven secondary neuronal death. Such a treatment may act synergistically in GBA carriers once given in combination with an agent that prevent the primary pathologic process that leads to cell death. Ambroxol hydrochloride, a pharmacological chaperone, which reduces endoplasmic reticulum (ER) stress induced by accumulation of mutant misfolded GCase could serve as such an agent. The efficacy of this combined therapy, derived from clinical observations, in vivo and in vitro studies, should be evaluated in clinical trials.
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Affiliation(s)
- Yuval Ishay
- Department of Medicine, Hadassah Medical Center and the Hebrew University, Jerusalem, Israel
| | - Ari Zimran
- Gaucher Clinic, Shaare Zedek Medical Center and the Hebrew University, Jerusalem, Israel
| | - Jeffrey Szer
- Department of Clinical Hematology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Tama Dinur
- Gaucher Clinic, Shaare Zedek Medical Center and the Hebrew University, Jerusalem, Israel
| | - Yaron Ilan
- Department of Medicine, Hadassah Medical Center and the Hebrew University, Jerusalem, Israel
| | - David Arkadir
- Department of Neurology, Hadassah Medical Center and the Hebrew University, Jerusalem, Israel.
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