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Li H, Zhang G, Wang H, Chen H, Liu X, Zheng C, Lin L, Li L. Ultrasound-guided microwave ablation for the treatment of idiopathic granulomatous mastitis: comparison with surgical excision. BMC Womens Health 2024; 24:248. [PMID: 38637788 PMCID: PMC11025156 DOI: 10.1186/s12905-024-03070-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) results in notable clinical symptoms and breast deformity. This study aimed to evaluate the clinical feasibility of microwave ablation (MWA) for the treatment of IGM through comparison with surgical excision. METHODS From June 2016 to December 2020, a total of 234 consecutive patients admitted to the hospital were retrospectively included in this study. IGM was pathologically confirmed via breast biopsy in all included patients. These patients were divided into the MWA group (n = 91) and surgical group (n = 143) based on the type of treatment. Patients in both groups received oral prednisone prior to intervention. The clinical remission rate, recurrence rate, operative pain, complications, and BREAST Q score were compared between the two groups. RESULTS There were 340 lesions in the MWA group, and 201 lesions in the surgical group were ultimately included. Significant differences in the complete remission rate (96.7% vs. 86.7%, p = 0.020), recurrence rate (3.3% vs. 13.3%, p = 0.020), operation time (48.7±14.6 min vs. 68.1±36.4 min, p < 0.001), postoperative pain (p < 0.001) and postoperative BREAST Q score (p < 0.001) were observed between the MWA and surgical groups. CONCLUSIONS Microwave ablation is feasible for the treatment of IGM, due to its high curative rate and low recurrence rate. Because of the minimal invasiveness of MWA and sufficient preservation of the gland and contour of the breast, patients are more satisfied with the appearance of the breast. Therefore, for patients with complex conditions requiring surgery, MWA is a good alternative treatment.
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Affiliation(s)
- Hang Li
- The School of Clinical Medicine, Fujian Medical University, Fujian, 350000, China
- Department of Breast Surgery, Affiliated Hospital of Putian University, Fujian, 351100, China
| | - Guoliang Zhang
- Department of Thyroid Surgery, Affiliated Hospital of Putian University, Fujian, 351100, China
| | - Hongling Wang
- Department of General Surgery, Xiamen Xinkaiyuan Hospital, Fujian, 361000, China
| | - Haiying Chen
- The School of Clinical Medicine, Fujian Medical University, Fujian, 350000, China
| | - Xiaoli Liu
- Department of Pathology, Affiliated Hospital of Putian University, Fujian, 351100, China
| | - Chuansheng Zheng
- The School of Clinical Medicine, Fujian Medical University, Fujian, 350000, China
| | - Lisheng Lin
- Department of Breast Surgery, Affiliated Hospital of Putian University, Fujian, 351100, China
| | - Lihong Li
- The School of Clinical Medicine, Fujian Medical University, Fujian, 350000, China.
- Department of Breast Surgery, Affiliated Hospital of Putian University, Fujian, 351100, China.
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Matsegora NA, Kaprosh AV, Vasylyeva TI, Antonenko PB, Antonenko K. The Effect of Immunoglobulin G on the Humoral Immunity in Patients with Tuberculosis/HIV Coinfection. AIDS Res Hum Retroviruses 2024; 40:246-252. [PMID: 38164121 DOI: 10.1089/aid.2023.0074] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Previously, an increase in clinical effectiveness of the antituberculosis treatment (ATT) and antiretroviral therapy (ART) in case of additional immunoglobulin G (IgG) administration in patients with multidrug-resistant tuberculosis (MDR-TB)/HIV coinfection was reported. The aim of this study was to investigate the impact of IgG administration in addition to the standard second-line ATT and ART on the humoral immunity status in patients with MDR-TB/HIV coinfection immune deficiency. The study involved 52 patients living with HIV with MDR-TB coinfection and CD4+ lymphocyte cell count below 50 cells/μCL. Patients in the control group and intervention group received the second-line ATT and ART; in addition, patients in the intervention group received IgG intravenously. The humoral immunity status was evaluated by measurement of IgA, IgE, IgG, and IgM in plasma. The standard ATT and ART resulted in a two-step change in humoral immunity: IgM, IgG, IgA, and IgE levels gradually increased to a maximal level at the 5-month mark and started to gradually decrease after the 8-month mark. Addition of IgG to the standard therapy resulted in a steeper decrease in the immunoglobulin level in serum, especially IgG, compared with standard therapy alone, allowing for an earlier initiation of ART in patients in the intervention group.
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Affiliation(s)
- Nina A Matsegora
- Department of Phthisiopulmonology and Odesa National Medical University, Odesa, Ukraine
| | - Antonina V Kaprosh
- Department of Phthisiopulmonology and Odesa National Medical University, Odesa, Ukraine
| | - Tetyana I Vasylyeva
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA
| | - Petro B Antonenko
- Department of Pharmacology and Pharmacognosy, Odesa National Medical University, Odesa, Ukraine
| | - Kateryna Antonenko
- Department of Pharmacology and Pharmacognosy, Odesa National Medical University, Odesa, Ukraine
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Wang X, He X, Liu J, Zhang H, Wan H, Luo J, Yang J. Immune pathogenesis of idiopathic granulomatous mastitis: from etiology toward therapeutic approaches. Front Immunol 2024; 15:1295759. [PMID: 38529282 PMCID: PMC10961981 DOI: 10.3389/fimmu.2024.1295759] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 02/22/2024] [Indexed: 03/27/2024] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a noncancerous, chronic inflammatory disorder of breast with unknown causes, posing significant challenges to the quality of life due to its high refractoriness and local aggressiveness. The typical symptoms of this disease involve skin redness, a firm and tender breast mass and mastalgia; others may include swelling, fistula, abscess (often without fever), nipple retraction, and peau d'orange appearance. IGM often mimics breast abscesses or malignancies, particularly inflammatory breast cancer, and is characterized by absent standardized treatment options, inconsistent patient response and unknown mechanism. Definite diagnosis of this disease relies on core needle biopsy and histopathological examination. The prevailing etiological theory suggests that IGM is an autoimmune disease, as some patients respond well to steroid treatment. Additionally, the presence of concurrent erythema nodosum or other autoimmune conditions supports the autoimmune nature of the disease. Based on current knowledge, this review aims to elucidate the autoimmune-favored features of IGM and explore its potential etiologies. Furthermore, we discuss the immune-mediated pathogenesis of IGM using existing research and propose immunotherapeutic strategies for managing this condition.
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Affiliation(s)
- Xiaoli Wang
- Breast Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiujing He
- Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Tumor Targeted and Immune Therapy, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Junzhi Liu
- West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Haiyan Zhang
- Department of Breast Surgery, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China
| | - Hangyu Wan
- Department of Breast Surgery, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China
| | - Jing Luo
- Department of Breast Surgery, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China
| | - Jiqiao Yang
- Breast Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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Zhang Q, Zhang W, Lv J, Zhang Z, Zhao Y. The Effect of Local Steroid Administration on Idiopathic Granulomatous Mastitis: A Systematic Review andMeta-Analysis. J Surg Res 2024; 295:511-521. [PMID: 38071781 DOI: 10.1016/j.jss.2023.11.024] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/12/2023] [Accepted: 11/13/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Idiopathic granulomatous mastitis (IGM) is a rare, benign inflammatory breast disease. Corticosteroids and surgery are the primary treatment options, and a growing number of publications have shown the effectiveness of local steroid administration (intralesional injection and topical corticosteroids). However, less is known about the specific details and effects of this treatment approach. The purpose of this meta-analysis was to summarize the details and evaluate the efficacy of local steroid administration for IGM. METHODS The PubMed, Embase, Cochrane Library, and SinoMed databases were systematically searched from inception to July 2023 to identify relevant randomized controlled trials. The quality of the included studies was assessed, and meta-analysis and subgroup analysis were conducted to obtain the pooled effect sizes of the outcomes of interest. RESULTS Eight trials comprising 613 patients were included. Local steroid administration included intralesional injection and topical steroid ointment, and control groups were mainly given systemic therapy (oral steroid) and surgical treatment. The meta-analysis showed that local steroid administration had a significant effect on the response rate (risk ratio [RR] = 1.35, 95% CI = [1.14-1.59], P = 0.0004). The incidence of side effects was also lower than that of systemic treatment (RR = 0.24, 95% CI = [0.13-0.43], P<0.0001). There was no difference in the recurrence rate (RR = 0.8, 95% CI = [1.42-1.51], P = 0.48). CONCLUSIONS Local steroid administration can increase the RR and decrease the incidence of side effects for IGM patients. There is no significant difference in the recurrence rate between the local steroid administration group and the control group. Further studies are needed to identify the effect in different stages and among pregnant women.
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Affiliation(s)
- Qiushi Zhang
- Department of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Wentao Zhang
- Department of Breast Surgery, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jing Lv
- Department of Breast Surgery, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Zhenxiang Zhang
- Department of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Yanli Zhao
- Department of Nursing and Health, Zhengzhou University, Zhengzhou, China.
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Altan M, Li QZ, Wang Q, Vokes NI, Sheshadri A, Gao J, Zhu C, Tran HT, Gandhi S, Antonoff MB, Swisher S, Wang J, Byers LA, Abdel-Wahab N, Franco-Vega MC, Wang Y, Lee JJ, Zhang J, Heymach JV. Distinct patterns of auto-reactive antibodies associated with organ-specific immune-related adverse events. Front Immunol 2023; 14:1322818. [PMID: 38152395 PMCID: PMC10751952 DOI: 10.3389/fimmu.2023.1322818] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023] Open
Abstract
The roles of preexisting auto-reactive antibodies in immune-related adverse events (irAEs) associated with immune checkpoint inhibitor therapy are not well defined. Here, we analyzed plasma samples longitudinally collected at predefined time points and at the time of irAEs from 58 patients with immunotherapy naïve metastatic non-small cell lung cancer treated on clinical protocol with ipilimumab and nivolumab. We used a proteomic microarray system capable of assaying antibody reactivity for IgG and IgM fractions against 120 antigens for systemically evaluating the correlations between auto-reactive antibodies and certain organ-specific irAEs. We found that distinct patterns of auto-reactive antibodies at baseline were associated with the subsequent development of organ-specific irAEs. Notably, ACHRG IgM was associated with pneumonitis, anti-cytokeratin 19 IgM with dermatitis, and anti-thyroglobulin IgG with hepatitis. These antibodies merit further investigation as potential biomarkers for identifying high-risk populations for irAEs and/or monitoring irAEs during immunotherapy treatment. Trial registration ClinicalTrials.gov identifier: NCT03391869.
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Affiliation(s)
- Mehmet Altan
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Quan-Zhen Li
- Department of Immunology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Qi Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Natalie I. Vokes
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jianjun Gao
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Chengsong Zhu
- Department of Immunology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Hai T. Tran
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Saumil Gandhi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Mara B. Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Stephen Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jing Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lauren A. Byers
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Noha Abdel-Wahab
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Maria C. Franco-Vega
- Department of Hospital Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Yinghong Wang
- Department of Gastroenterology Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - J. Jack Lee
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jianjun Zhang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - John V. Heymach
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Kaya MN, Tekgöz E, Çolak S, Kılıç Ö, Çınar M, Yılmaz S. Drug-free remission is an achievable target with immunosuppressive treatment in idiopathic granulomatous mastitis. Ir J Med Sci 2023; 192:2815-2819. [PMID: 36928595 DOI: 10.1007/s11845-023-03338-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease, in which there is no clear established treatment algorithm. Several physicians keep away from using immunosuppressive (IS) treatments in routine clinical practice. AIMS This study aimed to evaluate the rates of drug-free remission of the patients with IGM in a period of 3-year follow-up. METHODS This retrospective study conducted with 55 biopsy-proven IGM patients, who were followed up between February, 2011, and November, 2021, in rheumatology outpatient clinic of Gulhane Training and Research Hospital. The demographic and clinical characteristics of the patients were obtained from patients' files. The 3-year follow-up data were assessed for long-term outcome analyses. RESULTS There were 55 female patients with a mean age of 36.8 ± 6.3 years. Fifty-four (98.1%) patients were in drug-free remission at the end of 3 years. The median duration of drug-free remission in patients receiving methotrexate (MTX), only corticosteroid (CS), and azathioprine was 19.7, 32.9, and 14.7 months, respectively. The drug-free remission duration for the patient who received cyclosporine A as IS was 28.3 months. The median duration of IS treatment was 15.8 months, and the median duration of treatment with CS and other IS combination was 6.7 months. Recurrence was observed in 4 (80%) patients without IS therapy after surgery, of whom MTX was used in 3 (75%) patients and achieved remission. CONCLUSIONS IS agents provide high rate of prolonged drug-free remission and should be considered a part of routine medical care of the patients with IGM.
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Affiliation(s)
- Mehmet Nur Kaya
- Rheumatology Department, Gulhane Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey.
| | - Emre Tekgöz
- Rheumatology Department, Gulhane Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Seda Çolak
- Rheumatology Department, Gulhane Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Özlem Kılıç
- Rheumatology Department, Gulhane Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Muhammet Çınar
- Rheumatology Department, Gulhane Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Sedat Yılmaz
- Rheumatology Department, Gulhane Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
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Moldoveanu D, Lee C, Hesley G. Framework and guide for intralesional steroid injections in idiopathic granulomatous mastitis. Eur J Radiol 2023; 168:111118. [PMID: 37804652 DOI: 10.1016/j.ejrad.2023.111118] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Literature on how to perform intralesional steroid injections, a valuable therapy for idiopathic granulomatous mastitis (IGM), is limited. This technical note offers a detailed technical guide on intralesional steroid injections for IGM and provides a framework for long-term follow-up. METHODS Ultrasound characterization of IGM severity considering breadth, depth, and ancillary findings was used to guide steroid dosing and injection frequency. Clinical and sonographic breast diagrams were designed for accurate longitudinal tracking of IGM. A step-by-step guide for ultrasound-guided IGM aspirations and intralesional steroid injections was developed. RESULTS A detailed approach for ultrasound-guided IGM interventions with clinical and sonographic breast diagrams for longitudinal follow-up is now in practice. CONCLUSIONS The treatment approach described provides a framework for multidisciplinary treatment of IGM and offers insights that may contribute to the ongoing development and improvement of management strategies for this challenging disease.
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Affiliation(s)
- Dan Moldoveanu
- Department of Surgery, Breast and Melanoma Surgical Oncology, Mayo Clinic, 200 First St SW, Rochester MN, 55905, United States.
| | - Christine Lee
- Department of Radiology, Breast Imaging and Intervention, Mayo Clinic, 200 First St SW, Rochester MN, 55905, United States. https://twitter.com/MayoRadiology
| | - Gina Hesley
- Department of Radiology, Breast Imaging and Intervention, Mayo Clinic, 200 First St SW, Rochester MN, 55905, United States.
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Fang W, Qingqing Z, Qihui L, Bing Z, Xinyue H, Jie X. Safety and Efficacy of Oral Hydroxychloroquine in the Treatment of Ophthalmic Disease Associated with Sjögren's Syndrome. Altern Ther Health Med 2023; 29:656-662. [PMID: 37678871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Background Dry eye disease is common among patients with primary Sjögren's syndrome (pSS). Hydroxychloroquine (HCQ), known for its immunomodulatory effects and minimal adverse effects, has emerged as a pivotal treatment option for pSS. Nonetheless, conflicting evidence exists regarding the therapeutic efficacy of HCQ in managing dry eye disease associated with pSS. Objectives To evaluate the safety and efficacy of oral hydroxychloroquine in treating dry eye disease associated with pSS. Methods A prospective randomized controlled study was conducted, enrolling pSS patients with moderate to severe dry eye disease. Participants were randomly assigned to an oral HCQ group and an observation group. Various scales (ESSDAI, ESSPRI, OSDI, and SPEED questionnaire score), dry eye-related tests (OSS score, TBUT, and Schirmer test I), ophthalmology-specific tests (BCVA, SD-OCT RT, field of view, latency and amplitudes for multifocal ERG ring 1 and ring 2), whole body protein levels (serum IgA, IgG, and IgM), and blood glucose were assessed before and after 12 months of treatment. Results Pairwise comparison of the observed indicator baseline revealed no statistical significance (P > .05). After 12 months, the HCQ group exhibited notable improvements in ESSPRI, serum IgA, and Schirmer test I results compared to the control group (P < .05). Both groups demonstrated significant improvements in BCVA, OSDI, SPEED scores, and dry eye-associated examinations compared to baseline (P < .05). Serum IgG and IgM levels decreased in the HCQ group after 12 months of treatment, but without statistical significance (P > .05). None cases of HCQ retinopathy were reported during follow-up. Conclusions Oral HCQ was demonstrated safety and efficacy in managing pSS-related dry eye disease. Treatment with Oral HCQ markedly reduced the ESSPRI score, improve patients' systemic dryness symptoms, and greatly decreased blood IgA levels. Combined with topical cyclosporin, HCQ improved Schirmer test I scores and alleviated ocular surface inflammation and dry eye signs and symptoms.
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Almehizia AA, Khattab AENA, Darwish AM, Al-Omar MA, Naglah AM, Bhat MA, Kalmouch A. Anti-inflammatory activity of novel derivatives of pyrazolo [3,4d] pyridazine against digestive system inflammation. Naunyn Schmiedebergs Arch Pharmacol 2023; 396:2729-2739. [PMID: 37126195 DOI: 10.1007/s00210-023-02493-7] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023]
Abstract
The digestive system is exposed to severe inflammation as a result of taking some medications that have gastrointestinal side effects. Sixty Swiss-albino male mice were randomly distributed into six groups to treat inflammations of the colon, stomach, and small intestine caused by taking high doses of diclofenac (D), with two novel synthesized compounds, pyrazolo [3,4 d] pyridazine derivatives (Co1 and Co2). Myeloperoxidase enzyme activity was determined in the colon and small intestinal tissues. Serum contents of TNF-α, IL-22, IgG, and IgM were determined by ELISA. Histopathological examinations of the colon, small intestinal, and stomach tissues were microscopically analyzed. TNF-α, IL-22, and TNFSF11 gene expression were measured in the colon, intestinal, and spleen using qRT-PCR. Diclofenac caused surface columnar epithelial cell loss, focal necrosis of the gastric mucosa, inflammatory cell infiltration, and congested blood vessels in the stomach, colon, and small intestinal tissues. Co1 component was found to be better than Co2 component in reducing the focal necrosis of gastric mucosa and improving the histological structures of the stomach, colon, and small intestinal tissues. After 14 days, the activity of the myeloperoxidase enzyme was increased in group D and decreased in groups DCo1, DCo2, Co1, and Co2. Serum concentrations of TNF-α and IgG were increased, while IL-22 and IGM were reduced in the D, DCo1, and DCo2 groups compared with the Co1 and control groups. TNF-α gene was upregulated in the D group and downregulated in the Co1 group, while the IL-22 gene was downregulated in the D group and upregulated in the Co1 group compared with the control group. The CO1 component may be useful in reducing digestive system inflammation.
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Affiliation(s)
- Abdulrahman A Almehizia
- Drug Exploration and Development Chair (DEDC), Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Abd El-Nasser A Khattab
- Genetics and Cytology Department, Biotechnology Research Institute, National Research Centre, Dokki, Giza, Egypt
| | - Ahmed Mohamed Darwish
- Cell Biology Department, Biotechnology Research Institute, National Research Centre, Dokki, Giza, Egypt.
| | - Mohamed A Al-Omar
- Drug Exploration and Development Chair (DEDC), Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Ahmed M Naglah
- Drug Exploration and Development Chair (DEDC), Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Mashooq A Bhat
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Atef Kalmouch
- Peptide Chemistry Department, Chemical Industries Institute, National Research Centre, Dokki, Giza, Egypt
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Tascini C, Cotrufo M, Sozio E, Fanin M, Dellai F, Zanus Forte A, Cesselli D, DE Stefanis P, Ripoli A, Sbrana F, Giuliano S, Fabris M, Girardis M, Curcio F, Bassi F. Potential role of IgM-enriched immunoglobulin as adjuvant treatment in severe SARS-CoV-2 infection. Minerva Anestesiol 2023; 89:884-894. [PMID: 37822148 DOI: 10.23736/s0375-9393.23.17244-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Severe COVID-19 patients are characterized by a dysregulated host response to an infection, with uncontrolled pro- and anti- inflammatory pathway activation. Consistent proportion of patients require admission in intensive care units and are at risk of progression to severe forms of disease. These patients are generally admitted during later stages of the disease, when effective antiviral and monoclonal antibody are not indicated. We aimed to assess the potential role of IgM-enriched intra venous immunoglobulins (IGAM) preparations in this setting. METHODS This retrospective, observational case-controlled study was conducted at a single-center University Hospital of Udine in the Friuli Venezia Giulia Region of Italy. Patients referring to the center between March 2020 and April 2021 was included. During the study period, patient who received Pentaglobin® IGAM treatment (N.=56), administered as compassionate use, was compared with a control group (N.=169) to assess, by propensity score analysis, clinical outcome. RESULTS Untreated controls required, respect to patient treated with IGAM therapy, longer time to hospitalization with no significant differences in death and orotracheal intubation requirement. Significant differences in the two cohort were in: SOFA was higher in treated, while D-dimer and P/F ratio was better in the treatment cohort. Multivariate logistic regression analysis performed on the "matched sample," obtained by a weighting propensity score approach, identify, as significant protective factor for death outcome, the Pentaglobin® treatment (0.820 [0.698-0.963], P=0.016) and low C-reactive protein (1.001 [1.000-1.002], P=0.031) value while the delay of onset hospitalization is associate with a worst outcome (0.983 [0.967-0.999], P=0.041). CONCLUSIONS The present study offers a significant insight concerning the use of IgM-enriched immunoglobulin preparations in patients with SARS-CoV-2 severe infection and also could identifying the specific immunological and biochemical profile of the patient who can more benefit from this therapeutic option.
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Affiliation(s)
- Carlo Tascini
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy -
- Department of Medical Area (DAME), University of Udine, Udine, Italy -
| | - Marco Cotrufo
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy
| | - Emanuela Sozio
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy
| | - Matteo Fanin
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy
| | - Fabiana Dellai
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy
| | - Agnese Zanus Forte
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy
| | - Daniela Cesselli
- Institute of Clinical Pathology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Paola DE Stefanis
- Section of Anesthesia and Resuscitation2, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy
| | - Andrea Ripoli
- Department of Bioengineering, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Francesco Sbrana
- Lipoapheresis Unit, Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Simone Giuliano
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy
| | - Martina Fabris
- Institute of Clinical Pathology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Massimo Girardis
- Department of Anesthesia and Intensive Care, University Hospital of Modena, Modena, Italy
| | - Francesco Curcio
- Institute of Clinical Pathology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy
| | - Flavio Bassi
- Section of Anesthesia and Resuscitation2, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), Udine, Italy
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11
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Zhang A, Chen S, Lin R. Combined use of total glucosides of paeony and hydroxychloroquine in primary Sjögren's syndrome: A systematic review. Immun Inflamm Dis 2023; 11:e1044. [PMID: 37904705 PMCID: PMC10587734 DOI: 10.1002/iid3.1044] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/14/2023] [Accepted: 09/30/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVE To assess the effectiveness and safety of the total glucosides of paeony (TGP) combined with hydroxychloroquine (HCQ) on the treatment of primary Sjögren's syndrome (pSS) by conducting a meta-analysis. METHODS Eight databases were searched for randomized controlled trials (RCTs) reporting the use of TGP combined with HCQ for pSS, which are before May 10, 2022. Meta-analyses were performed on disappeared clinical symptoms (dry mouth and dry eyes), Schirmer's test, saliva flow test, erythrocyte sedimentation rate (ESR), index of immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), and adverse events (AEs). The Revman 5.4 software was used for this meta-analysis. RESULTS Seven RCTs which included 632 participants were identified. The pooled results showed significant differences in clinical symptoms disappear (dry mouth and dry eyes) (p = .0004), IgM (p < .00001), IgA (p < .00001), salivary flow rate (p < .00001) and Schirmer's test (p = .02) in the comparison of TGP combined with HCQ and HCQ alone. For the IgG and ESR, both pooled and subgroup analyses showed that TGP + HCQ was superior to HCQ alone. For the safety analysis, no significant differences in AEs (p = .39) was revealed. The more frequently seen adverse reactions were diarrhea, vomit and there was no severe adverse events were reported in TGP + HCQ group. CONCLUSION Therefore, TGP + HCQ can be considered to be a potentially valid and safe combination for the treatment of pSS in the clinic.
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Affiliation(s)
- Aiping Zhang
- Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical UniversityHangzhouChina
| | - Shilei Chen
- Zhuji Maternal and Child Health HospitalShaoxingChina
| | - Riyang Lin
- Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical UniversityHangzhouChina
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12
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Chen L, Zhang Y, Qin N, Han R, Li Y. Atypical chronic inflammatory demyelinating polyradiculoneuropathy with ophthalmoplegia and anti-sulfatide IgM positivity. J Int Med Res 2023; 51:3000605231193575. [PMID: 37812511 PMCID: PMC10563483 DOI: 10.1177/03000605231193575] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/17/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a heterogeneous group of chronic immune-mediated polyradiculoneuropathies. The clinical presentation of CIDP is mainly characterized by a classic peripheral demyelinating sensory-motor type and persists for a minimum of 2 months. However, CIDP may also present with atypical symptoms.Case presentation: This report presents the case of a patient with CIDP with ophthalmoplegia and anti-sulfatide IgM antibodies. Maintenance intravenous immunoglobulin and glucocorticoid therapies were administered to the patient in accordance with the clinical, laboratory, and electrophysiological findings, which were indicative of CIDP. The treatment partially improved the symptoms, and no recurrence was detected throughout the 3-month monitoring phase. CONCLUSIONS This study combines a retrospective analysis and a literature review to explore the possible mechanism of CIDP.
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Affiliation(s)
- Li Chen
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Yanjun Zhang
- Department of Neurology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Nan Qin
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Ranran Han
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuwang Li
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
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13
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Ren Y, Zhang J, Zhang J, Guo R. Combining intralesional steroid injection with oral steroids in patients with idiopathic granulomatous mastitis. Medicine (Baltimore) 2023; 102:e34055. [PMID: 37327292 PMCID: PMC10270520 DOI: 10.1097/md.0000000000034055] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory breast disease. Currently, there is no international standard for steroid use in IGM, particularly for intralesional steroid injections. This study aimed to determine whether patients with IGM who received oral steroids could benefit from intralesional steroid injection. We analyzed 62 patients with IGM whose main clinical presentation was mastitis masses and who received preoperative steroid therapy. Group A (n = 34) received combined steroid treatment: oral steroids (starting dose, 0.25 mg/kg/d; tapered off) and intralesional steroid injection (20 mg per session). Group B (n = 28) received oral steroids only (starting dose, 0.5 mg/kg/d; tapered off). Both groups underwent lumpectomy at the end of steroid treatment. We analyzed the preoperative treatment time, preoperative mass maximum diameter reduction rate, side effects, postoperative satisfaction, and rate of IGM recurrence. The mean age of the 62 participants was 33.6 ± 2.3 (range, 26-46) years, and all had unilateral disease. We found that oral steroids combined with intralesional steroid injection yielded better therapeutic effects than did oral steroids alone. The median maximum diameter reduction of the breast mass was 52.06% in group A and 30.00% in group B (P = .002). Moreover, the use of intralesional steroids reduced the duration of oral steroid use; the median durations of preoperative steroid therapy were 4 and 7 weeks in groups A and B, respectively (P < .001). Group A patients were more satisfied (P = .035) with the postoperative results, including postoperative appearance and function. No statistically significant between-group differences were noted regarding side effects and recurrence rates. Preoperative administration of oral steroids combined with intralesional steroid injection yielded better therapeutic effects than did oral steroids alone and may be an effective future treatment for IGM.
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Affiliation(s)
- Yun Ren
- Department of Breast Surgery, Changzhi People’s Hospital Affiliated to Shanxi Medical University, Changzhi, Shanxi Province, China
| | - Jiao Zhang
- Department of Diagnostic Radiology, Changzhi People’s Hospital Affiliated to Shanxi Medical University, Changzhi, Shanxi Province, China
| | - Jindan Zhang
- Department of Breast Surgery, Changzhi People’s Hospital Affiliated to Shanxi Medical University, Changzhi, Shanxi Province, China
| | - Ruqi Guo
- Department of Breast Surgery, Changzhi People’s Hospital Affiliated to Shanxi Medical University, Changzhi, Shanxi Province, China
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14
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Vanovčanová L, Minariková E. An updated perspective on diagnostics and treatment of idiopathic granulomatous mastitis. Ceska Gynekol 2023; 88:435-441. [PMID: 38171916 DOI: 10.48095/cccg2023435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
AIM To present our experiences with the anti-inflammatory treatment of idiopathic granulomatous mastitis (IGM) and highlight the imaging and anamnestic specifics of its diagnosis. METHODS Patients with acute inflammatory breast disease underwent ultrasound examination followed by a collection of anamnestic data, and histological analysis of the process was performed using core-cut bio psy, confirming IGM. Subsequently, anti-inflammatory treatment was administered, consisting of a combination of colchicine, vitamin E, and local compresses made from an infusion of Plantago lanceolata. We also recorded any additional treatments administered extra muros prior to histological analysis (such as antibio tics, surgical intervention, and time from onset of symptoms to confirmation of diagnosis). We analyzed the effect of the anti-inflammatory treatment administered, including the onset of improvement, adverse effects, recurrences, and duration of treatment required for symptom resolution. RESULTS Between 2016 and 2022, we diagnosed and histologically confirmed IGM in 53 patients through bio psy. Of these, 45 (84.9%) underwent the anti-inflammatory treatment we proposed, while eight (15.1%) opted for a different form of therapy. Currently, 27 patients (60%) are without treatment and clinical manifestations. The average duration of treatment was 34 months, and improvement in the clinical condition was observed within 2-8 weeks (average of 3 months). Four patients (14.81%) reported dyspepsia as an adverse effect. Recurrence occurred in five patients (18.52%) after 1-36 months (average of 7 months). Patients (22, 81.48%) who completed the treatment are without difficulties for 3-70 months (average of 34 months). The remaining 18 patients (40%) are currently undergoing treatment, lasting 3-41 months (average of 19 months). CONCLUSION Anti-inflammatory treatment with colchicine, along with supportive therapy (compresses made from an infusion of Plantago lanceolata and vitamin E), represents a promising trend in the therapy of IGM, with minimal adverse effects.
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15
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Patel V, Balasubramaniam D, Cavero-Chavez V, Cuervo-Pardo L, Sanchez-Alvarez C. Clinical Presentation of Schnitzler's Syndrome: A Rare Autoimmune Disease. J Investig Med High Impact Case Rep 2023; 11:23247096231220480. [PMID: 38130124 DOI: 10.1177/23247096231220480] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Schnitzler's Syndrome (SS) is a rare late-onset acquired autoinflammatory disorder which consists of chronic urticaria associated with a monoclonal IgM-kappa gammopathy, arthralgias, skeletal hyperostosis, lymphadenopathy, and recurrent constitutional symptoms. The average age of diagnosis is 51 years with a slight male predominance with a male to female ratio of 1.6. Diagnosis of SS requires the presence of 2 major criteria including chronic urticaria and monoclonal IgM along with at least two of the following minor criteria: recurrent intermittent fevers, bone pain, arthralgias, elevated erythrocyte sedimentation rate (ESR), neutrophilic dermal infiltrate on skin biopsy, and leukocytosis or elevated C-reactive protein (CRP). Early diagnosis and clinical awareness are paramount in SS as it is associated with a 15-20% risk of lymphoproliferative malignancy. The median overall survival is 12.8 years. We present a case of a 39-year-old female with new onset urticaria associated with recurrent fevers and joint pain. Symptoms were refractory to steroids, and high dose antihistamines. Multi-disciplinary evaluation resulted in the ultimate diagnosis of Schnitzler's Syndrome. The patient was ultimately treated with canakinumab (Il-1 inhibitor), with near resolution of symptoms. This case demonstrates the importance of a broad differential diagnosis and maintaining a high clinical suspicion for rare diseases when presented with a complex form of an otherwise common condition.
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16
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Tang L, Lan J, Jiang X, Huang R, Pang Q, Wu S, Wan F, Zhong G, Tang Z, Hu L. Curcumin antagonizes inflammation and autophagy induced by arsenic trioxide through immune protection in duck spleen. Environ Sci Pollut Res Int 2022; 29:75344-75355. [PMID: 35653021 DOI: 10.1007/s11356-022-20691-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
Arsenic is a toxic heavy metal widely found in the natural environment and has adverse effects on the health of waterfowl and human. Curcumin (CUR), a natural pigment of the golden spice turmeric, exhibits excellent anti-tumor, anti-inflammatory and anti-oxidant activities. But the effects of CUR on duck spleen exposed to arsenic remain largely unknown. In this study, 75 ducks were divided randomly into Control, L-ATO, M-ATO, H-ATO and CUR + H-ATO groups to systematically analyze the underlying role of CUR. The results showed that arsenic trioxide (ATO) led to growth retardation of ducks, hyaline degeneration and sparse cell arrangement on their spleen. And in the ATO-exposed ducks, the levels of immunoglobulins (Ig; IgA, IgG, IgM) in the serum and the expression of autophagy-related genes (Atg5, P62, LC3I, LC3II, LC3II/I, Beclin-1) were significantly upregulated compared with the control ducks. Moreover, ATO also activated NF-κB signal pathway and upregulated the expression of pro-inflammatory cytokines (TNF-α, IFN-γ, IL-1β, IL-2, IL-18). Meanwhile, application of CUR alleviated the ATO toxicity with the release of growth inhibition, and the reduced hyaline degeneration and distortion of the spleen capsule. CUR also suppressed ATO-induced NF-κB activation, pro-inflammatory cytokine addition and expression of autophagy-related genes. Overall, these results suggested that CUR might exert a protective effect against ATO-induced immunosuppression in ducks via anti-inflammation and autophagy restoring.
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Affiliation(s)
- Lixuan Tang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Juan Lan
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Xuanxuan Jiang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Riming Huang
- Guangdong Provincial Key Laboratory of Food Quality and Safety, College of Food Science, South China Agricultural University, Guangzhou, 510642, China
| | - Qiling Pang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Shaofeng Wu
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Fang Wan
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Gaolong Zhong
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Zhaoxin Tang
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China
| | - Lianmei Hu
- College of Veterinary Medicine, South China Agricultural University, Guangzhou, 510642, China.
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Kaedbey R, Forward N, Sehn LH, Shafey M, Doucette S, Chen CI. A Canadian Perspective on the Treatment of Waldenström Macroglobulinemia. Curr Oncol 2022; 29:7122-7139. [PMID: 36290837 PMCID: PMC9600063 DOI: 10.3390/curroncol29100560] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/17/2022] [Accepted: 09/26/2022] [Indexed: 01/13/2023] Open
Abstract
Waldenström macroglobulinemia (WM) is a slowly progressing B-cell non-Hodgkin lymphoma characterized by monoclonal IgM gammopathy in the blood and infiltration of the bone marrow by clonal lymphoplasmacytic cells. As an incurable disease, the goals for therapy for WM are to relieve symptoms, slow disease progression, prevent organ damage, and maintain quality of life. However, given the rarity of WM, clinical trials comparing treatments for WM are limited and there is no definitive standard of care. The selection of first-line WM therapy is thus based on patient factors, disease characteristics, and drug access, with bendamustine-rituximab and Bruton's tyrosine kinase (BTK) inhibitor therapy considered preferred treatments. Other treatments such as proteasome inhibitor- or purine analogue-based therapy, alternative chemoimmunotherapy, and autologous stem cell transplantation are generally reserved for the relapsed setting but may be used in rare circumstances in earlier lines of therapy. This paper summarizes the efficacy and safety of these WM therapies and discusses considerations for treatment from a Canadian perspective.
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Affiliation(s)
- Rayan Kaedbey
- Department of Hematology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Nicholas Forward
- Department of Medicine, Dalhousie University/Nova Scotia Health, Halifax, NS B3H 2Y9, Canada
| | - Laurie H. Sehn
- Department of Medical Oncology, BC Cancer Centre for Lymphoid Cancer, Vancouver, BC V5Z 4E6, Canada
| | - Mona Shafey
- Department of Medicine, Division of Hematology, Foothills Medical Centre and University of Calgary, Calgary, AB T2N 2T9, Canada
| | | | - Christine I. Chen
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Avenue, Suite 6-225, Toronto, ON M5G 2M9, Canada
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18
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Kumar V, Das BK, Swain HS, Chowdhury H, Roy S, Bera AK, Das R, Parida SN, Dhar S, Jana AK, Behera BK. Outbreak of Ichthyophthirius multifiliis associated with Aeromonas hydrophila in Pangasianodon hypophthalmus: The role of turmeric oil in enhancing immunity and inducing resistance against co-infection. Front Immunol 2022; 13:956478. [PMID: 36119096 PMCID: PMC9478419 DOI: 10.3389/fimmu.2022.956478] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/05/2022] [Indexed: 01/27/2023] Open
Abstract
Ichthyophthirius multifiliis, a ciliated parasite causing ichthyophthiriasis (white spot disease) in freshwater fishes, results in significant economic loss to the aquaculture sector. One of the important predisposing factors for ichthyophthiriasis is low water temperature (i.e., below 20°C), which affects the health and makes freshwater fishes more susceptible to parasitic infections. During ichthyophthiriasis, fishes are stressed and acute immune reactions are compromised, which enables the aquatic bacterial pathogens to simultaneously infect the host and increase the severity of disease. In the present work, we aimed to understand the parasite–bacteria co-infection mechanism in fish. Later, Curcuma longa (turmeric) essential oil was used as a promising management strategy to improve immunity and control co-infections in fish. A natural outbreak of I. multifiliis was reported (validated by 16S rRNA PCR and sequencing method) in Pangasianodon hypophthalmus from a culture facility of ICAR-CIFRI, India. The fish showed clinical signs including hemorrhage, ulcer, discoloration, and redness in the body surface. Further microbiological analysis revealed that Aeromonas hydrophila was associated (validated by 16S rRNA PCR and sequencing method) with the infection and mortality of P. hypophthalmus, confirmed by hemolysin and survival assay. This created a scenario of co-infections, where both infectious agents are active together, causing ichthyophthiriasis and motile Aeromonas septicemia (MAS) in P. hypophthalmus. Interestingly, turmeric oil supplementation induced protective immunity in P. hypophthalmus against the co-infection condition. The study showed that P. hypophthalmus fingerlings supplemented with turmeric oil, at an optimum concentration (10 ppm), exhibited significantly increased survival against co-infection. The optimum concentration induced anti-stress and antioxidative response in fingerlings, marked by a significant decrease in cortisol and elevated levels of superoxide dismutase (SOD) and catalase (CAT) in treated animals as compared with the controls. Furthermore, the study indicated that supplementation of turmeric oil increases both non-specific and specific immune response, and significantly higher values of immune genes (interleukin-1β, transferrin, and C3), HSP70, HSP90, and IgM were observed in P. hypophthalmus treatment groups. Our findings suggest that C. longa (turmeric) oil modulates stress, antioxidant, and immunological responses, probably contributing to enhanced protection in P. hypophthalmus. Hence, the application of turmeric oil treatment in aquaculture might become a management strategy to control co-infections in fishes. However, this hypothesis needs further validation.
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Affiliation(s)
- V. Kumar
- Aquatic Environmental Biotechnology and Nanotechnology (AEBN) Division, Indian Council of Agricultural Research (ICAR)-Central Inland Fisheries Research Institute (CIFRI), Barrackpore, India
| | - B. K. Das
- Indian Council of Agricultural Research (ICAR)-Central Inland Fisheries Research Institute (CIFRI), Barrackpore, India
- *Correspondence: B. K. Das, ; B. K. Behera,
| | - H. S. Swain
- Fisheries Enhancement and Management (FEM) Division, Indian Council of Agricultural Research (ICAR)-Central Inland Fisheries Research Institute (CIFRI), Barrackpore, India
| | - H. Chowdhury
- Reservoir and Wetland Fisheries (RWF) Division, Indian Council of Agricultural Research (ICAR)-Central Inland Fisheries Research Institute (CIFRI), Barrackpore, India
| | - S. Roy
- Aquatic Environmental Biotechnology and Nanotechnology (AEBN) Division, Indian Council of Agricultural Research (ICAR)-Central Inland Fisheries Research Institute (CIFRI), Barrackpore, India
| | - A. K. Bera
- Fisheries Resource Assessment and Informatics (FRAI) Division, Indian Council of Agricultural Research (ICAR)-Central Inland Fisheries Research Institute (CIFRI), Barrackpore, India
| | - R. Das
- Fisheries Enhancement and Management (FEM) Division, Indian Council of Agricultural Research (ICAR)-Central Inland Fisheries Research Institute (CIFRI), Barrackpore, India
| | - S. N. Parida
- Aquatic Environmental Biotechnology and Nanotechnology (AEBN) Division, Indian Council of Agricultural Research (ICAR)-Central Inland Fisheries Research Institute (CIFRI), Barrackpore, India
| | - S. Dhar
- Aquatic Environmental Biotechnology and Nanotechnology (AEBN) Division, Indian Council of Agricultural Research (ICAR)-Central Inland Fisheries Research Institute (CIFRI), Barrackpore, India
| | - A. K. Jana
- Aquatic Environmental Biotechnology and Nanotechnology (AEBN) Division, Indian Council of Agricultural Research (ICAR)-Central Inland Fisheries Research Institute (CIFRI), Barrackpore, India
| | - B. K. Behera
- Aquatic Environmental Biotechnology and Nanotechnology (AEBN) Division, Indian Council of Agricultural Research (ICAR)-Central Inland Fisheries Research Institute (CIFRI), Barrackpore, India
- *Correspondence: B. K. Das, ; B. K. Behera,
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Chen PH, Tung HH, Lin CH, Huang KP, Ni YL, Lin CY. A case report of secondary synchronous diagnosis of multiple myeloma and systemic lupus erythematosus after breast cancer treatment: A CARE-compliant article. Medicine (Baltimore) 2022; 101:e30320. [PMID: 36107602 PMCID: PMC9439846 DOI: 10.1097/md.0000000000030320] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Breast cancer (BC) is the most diagnosed cancer worldwide. Multiple myeloma (MM) is a hematologic malignancy characterized by the overproduction of monoclonal antibodies in the bone marrow. Systemic lupus erythematosus (SLE) is distinguished by the aberrant activity of the immune system with heterogeneous clinical manifestations. The coexistence of more than one major illness in a patient can present a diagnostic challenge for clinical physicians, especially when the comorbid diseases share a similar clinical presentation. Herein, we report an unusual case of secondary synchronous diagnosis of MM and SLE after BC treatment. PATIENT CONCERNS A 69-year-old female patient with breast cancer experienced severe skin itching and rashes on the face, anterior chest wall, back, and trunk for two days before admission. She had high levels of immunoglobulin and anti-nuclear antibodies; low levels of complements 3 and 4; positive anti-cardiolipin-IgM, anti-beta 2 glycoprotein-1 (anti-β2GP1) antibodies, and lupus anticoagulant results at serological testing. DIAGNOSIS The postoperative pathology report showed ductal carcinoma in situ in the right breast. SLE was confirmed based on the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) criteria. IgG-κ type multiple myeloma was confirmed by bone marrow biopsy, and the patient was synchronously diagnosed with SLE and MM after BC treatment. INTERVENTIONS Glucocorticoids and immunosuppressive agents, including intravenous hydrocortisone (5 g every 8 hours) and oral hydroxychloroquine (Plaquenil) (200 mg twice daily) were administered to treat SLE. One capsule of thalidomide 50 mg was administered orally every night at bedtime for MM. OUTCOMES The patient died two days later, shortly after the administration of drugs, due to multiple organ failures secondary to pneumonia and respiratory failure. CONCLUSION This is a case of MM and SLE after BC treatment. The present challenge was the early detection and accurate diagnosis of the secondary major illnesses, as the clinical manifestations were similar and non-specific between these two diseases. Awareness and prompt recognition of the common clinical symptoms of SLE and MM should be considered by clinical physicians to avoid delayed diagnoses and facilitate early treatment for a better prognosis.
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Affiliation(s)
- Pei-Hsin Chen
- Department of Nursing, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan
- School of Nursing, National Yang Ming Cho Tung University, Taipei City, Taiwan
| | - Heng-Hsin Tung
- School of Nursing, National Yang Ming Cho Tung University, Taipei City, Taiwan
| | - Chin-Husan Lin
- Department of pathology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan
| | - Kuan-Po Huang
- Department of hematology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan
| | - Yung-Lun Ni
- Department of chest medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan
| | - Chin-Yao Lin
- Department of Breast Medical Center, Taichung Tzi-Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan
- *Correspondence: Chin-Yao Lin, MD, Department of Breast Medical Center, Taichung Tzu-Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 88, Sec. 1, Fengxing Rd., Tanzi Dist., Taichung City 427, Taiwan (e-mail: )
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Pomlok K, Pata S, Kulaphisit M, Pangnuchar R, Wipasa J, Smith DR, Kasinrerk W, Lithanatudom P. An IgM monoclonal antibody against domain 1 of CD147 induces non-canonical RIPK-independent necroptosis in a cell type specific manner in hepatocellular carcinoma cells. Biochim Biophys Acta Mol Cell Res 2022; 1869:119295. [PMID: 35598753 DOI: 10.1016/j.bbamcr.2022.119295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
CD147/Basigin/EMMPRIN is overexpressed in several cancerous tissues and it has been shown to induce matrix metalloproteinases (MMPs) whose expression is associated with cancer metastasis. Thus, targeting CD147 with monoclonal antibodies (mAbs) potentially has therapeutic applications in cancer immunotherapy. Here, we report the use of anti-CD147 mAbs targeting domain 1 of CD147, namely M6-1D4 (IgM), M6-1F3 (IgM), M6-2F9 (IgM) and M6-1E9 (IgG2a), against several human cancer cell lines. Strikingly, IgM but not IgG mAbs against CD147, especially clone M6-1D4, induced acute cellular swelling, and this phenomenon appeared to be specifically found with hepatocellular carcinoma (HCC) cells. Furthermore, molecular investigation upon treating HepG2 cells with M6-1D4 showed unfolded protein response (UPR) activation, autophagosome accumulation, and cell cycle arrest, but without classic apoptosis related features. More interestingly, prolonged M6-1D4 treatment (24 h) resulted in irreversible oncosis leading to necroptosis. Furthermore, treatment with a mixed lineage kinase domain-like psuedokinase (MLKL) inhibitor and partial knockout of MLKL resulted in reduced sensitivity to necroptosis in M6-1D4-treated HepG2 cells. Surprisingly however, the observed necroptotic signaling axis appeared to be non-canonical as it was independent of receptor-interacting serine/threonine-protein kinase (RIPK) phosphorylation. In addition, no cytotoxic effect on human dermal fibroblast (HDF) was observed after incubation with M6-1D4. Taken together, this study provides clues to target CD147 in HCC using mAbs, as well as sheds new light on a novel strategy to kill cancerous cells by the induction of necroptosis.
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Affiliation(s)
- Kumpanat Pomlok
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand; Ph.D.'s Degree Program in Biology (International Program), Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Supansa Pata
- Clinical Immunology Branch, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Mattapong Kulaphisit
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand; Ph.D.'s Degree Program in Biology (International Program), Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Rachan Pangnuchar
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Jiraprapa Wipasa
- Center for Molecular and Cell Biology for Infectious Diseases, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Duncan R Smith
- Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Watchara Kasinrerk
- Clinical Immunology Branch, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Pathrapol Lithanatudom
- Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand; Center of Excellence in Bioresources for Agriculture, Industry and Medicine, Department of Biology, Faculty of Science, Chiang Mai University, Chiang Mai 50200, Thailand.
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21
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Bellucci M, Germano F, Grisanti S, Castellano C, Tazza F, Mobilia EM, Visigalli D, Novi G, Massa F, Rossi S, Durando P, Cabona C, Schenone A, Franciotta D, Benedetti L. Case Report: Post-COVID-19 Vaccine Recurrence of Guillain–Barré Syndrome Following an Antecedent Parainfectious COVID-19–Related GBS. Front Immunol 2022; 13:894872. [PMID: 35924236 PMCID: PMC9339669 DOI: 10.3389/fimmu.2022.894872] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/24/2022] [Indexed: 01/14/2023] Open
Abstract
Guillain–Barré syndrome (GBS) is an autoimmune neurological disorder often preceded by viral illnesses or, more rarely, vaccinations. We report on a unique combination of postcoronavirus disease 2019 (COVID-19) vaccine GBS that occurred months after a parainfectious COVID-19–related GBS. Shortly after manifesting COVID-19 symptoms, a 57-year-old man developed diplopia, right-side facial weakness, and gait instability that, together with electrophysiology and cerebrospinal fluid examinations, led to a diagnosis of post-COVID-19 GBS. The involvement of cranial nerves and IgM seropositivity for ganglioside GD1b were noteworthy. COVID-19 pneumonia, flaccid tetraparesis, and autonomic dysfunction prompted his admission to ICU. He recovered after therapy with intravenous immunoglobulins (IVIg). Six months later, GBS recurred shortly after the first dose of the Pfizer/BioNTech vaccine. Again, the GBS diagnosis was confirmed by cerebrospinal fluid and electrophysiology studies. IgM seropositivity extended to multiple gangliosides, namely for GM3/4, GD1a/b, and GT1b IgM. An IVIg course prompted complete recovery. This case adds to other previously reported observations suggesting a possible causal link between SARS-CoV-2 and GBS. Molecular mimicry and anti-idiotype antibodies might be the underlying mechanisms. Future COVID-19 vaccinations/revaccinations in patients with previous para-/post-COVID-19 GBS deserve a reappraisal, especially if they are seropositive for ganglioside antibodies.
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Affiliation(s)
- Margherita Bellucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Francesco Germano
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Stefano Grisanti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Chiara Castellano
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Francesco Tazza
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | | | | | - Giovanni Novi
- IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Federico Massa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Silvia Rossi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Paolo Durando
- IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | | | - Angelo Schenone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS, Ospedale Policlinico San Martino, Genova, Italy
| | - Diego Franciotta
- IRCCS, Ospedale Policlinico San Martino, Genova, Italy
- *Correspondence: Diego Franciotta,
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22
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Hirano Y, Iwata H, Tsujuwaki M, Mai S, Mai Y, Imafuku K, Izumi K, Koga H, Ujiie H. Super-resolution imaging detects BP180 autoantigen in immunoglobulin M pemphigoid. J Dermatol 2022; 49:374-378. [PMID: 34845743 DOI: 10.1111/1346-8138.16260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/03/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 12/01/2022]
Abstract
Bullous pemphigoid is generally caused by immunoglobulin (Ig)G autoantibodies against hemidesmosomal BP180 and/or BP230. Recently, the concept of IgM pemphigoid has been proposed. A 23-year-old Japanese woman presented with a 4-month history of severely itchy papules showing subepidermal separations with mild neutrophil infiltration. Direct immunofluorescence (DIF) revealed IgM deposits at the dermoepidermal junction, but neither IgG nor IgA deposits. Indirect immunofluorescence on 1 M NaCl-split skin demonstrated deposits on the epidermal side. The optical density (OD) value of a modified IgM enzyme-linked immunosorbent assay for full-length BP180, but not for BP180-NC16A, was increased. The patient was diagnosed with IgM pemphigoid and was treated with diphenyl sulfone at 50 mg/day without recurrence. To confirm the precise autoantigen, we tried to obtain super-resolution imaging. The deposition pattern of IgM autoantibodies seemed to be oriented parallel to that of BP180. The detailed images detect DIF deposits apart from BP180-NC16A staining, but are close to type VII collagen-NC1 staining. This result suggests that the IgM autoantibodies in the patient might target the C-terminus of BP180. IgM pemphigoid is still not a widely accepted concept, and the clinical course remains unknown. We will carefully follow-up the patient. Super-resolution images may help to detect precise autoantigens in autoimmune blistering diseases.
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Affiliation(s)
- Yoko Hirano
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroaki Iwata
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masumi Tsujuwaki
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shoko Mai
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yosuke Mai
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Keisuke Imafuku
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kentaro Izumi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Koga
- Department of Dermatology, Kurume University School of Medicine, Fukuoka, Japan
| | - Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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23
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Höpting M, Budde U, Tiede A, Grube M, Hahn J, Herr W, Heimerl S, Hart C. Distinct Mechanisms of IgM-Antibody-Mediated Acquired von Willebrand Syndrome and Successful Treatment with Recombinant von Willebrand Factor in One Patient. Acta Haematol 2022; 145:454-457. [PMID: 35086107 PMCID: PMC9501758 DOI: 10.1159/000522236] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/17/2022] [Indexed: 11/19/2022]
Abstract
Acquired von Willebrand Syndrome (AVWS) is a rare coagulation disorder which can be associated with IgM paraproteinaemia. Recently, recombinant von Willebrand factor (rVWF) has become available for the treatment of bleedings in patients with inherited von Willebrand disease, but experience in patients with AVWS is limited. We report on 2 patients with AVWS with underlying IgM paraproteinaemia with distinct underlying pathomechanisms. In 1 patient, the paraprotein built unspecific complexes with von Willebrand factor (VWF). In the other patient, we were able to detect an IgM antibody against VWF. Bleeding in this patient was successfully treated with rVWF. To our knowledge, this is the first report about the successful use of rVWF in a patient with AVWS with the detection of a VWF-specific antibody.
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Affiliation(s)
- Matthias Höpting
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Ulrich Budde
- Medilys Laborgesellschaft mbH, Asklepios Klinik Hamburg-Altona, Hamburg, Germany
| | - Andreas Tiede
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Matthias Grube
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Joachim Hahn
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Herr
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
| | - Susanne Heimerl
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Christina Hart
- Department of Hematology and Oncology, Internal Medicine III, University Hospital Regensburg, Regensburg, Germany
- *Christina Hart,
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24
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Zhang J, Zhang H, Sun L. Therapeutic antibodies for COVID-19: is a new age of IgM, IgA and bispecific antibodies coming? MAbs 2022; 14:2031483. [PMID: 35220888 PMCID: PMC8890389 DOI: 10.1080/19420862.2022.2031483] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/09/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 12/23/2022] Open
Abstract
Early humoral immune responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are dominated by IgM and IgA antibodies, which greatly contribute to virus neutralization at mucosal sites. Given the essential roles of IgM and IgA in the control and elimination of SARS-CoV-2 infection, the mucosal immunity could be exploited for therapeutic and prophylactic purposes. However, almost all neutralizing antibodies that are authorized for emergency use and under clinical development are IgG antibodies, and no vaccine has been developed to boost mucosal immunity for SARS-CoV-2 infection. In addition to IgM and IgA, bispecific antibodies (bsAbs) combine specificities of two antibodies in one molecule, representing an important alternative to monoclonal antibody cocktails. Here, we summarize the latest advances in studies on IgM, IgA and bsAbs against SARS-CoV-2. The current challenges and future directions in vaccine design and antibody-based therapeutics are also discussed.
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Affiliation(s)
- Jingjing Zhang
- Department of Pathogens and Infectious Disease Prevention and Control, School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107China
| | - Han Zhang
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, Yunnan, China, 650118
| | - Litao Sun
- Department of Pathogens and Infectious Disease Prevention and Control, School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107China
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25
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Krásný J, Šach J, Daňková E. ATYPICAL FORMS OF EYE TOXOPLASMOSIS IN CHILDHOOD. CASE REPORTS. Cesk Slov Oftalmol 2022; 78:258-270. [PMID: 36220366 DOI: 10.31348/2022/27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
AIM To present an outline of acquired atypical forms of ocular toxoplasmosis (OT) in childhood, with reference to the 100th anniversary of the discovery of this etiology by Professor Janků from Czechoslovakia, who was first to describe the clinical congenital picture of OT characterised by macular scar. MATERIAL AND METHODS Symptoms of intraocular bilateral neuritis appeared in a 6-year-old girl, with visual acuity (VA) bilaterally 0.1. Toxoplasmic etiology was demonstrated in laboratory tests, and the patient was immunocompetent. Following treatment with macrolide antibiotic and parabulbar application of corticosteroid, the condition was normalised stably at VA 1.0 in both eyes. Bilateral retinal vasculitis was determined in an 8-year-old boy, with VA of 0.25 in the right eye and 0.25 in the left, with a medical history of strabismus detected after suffering from varicella. The examination for toxoplasmosis was negative, but pronounced general hypogammaglobulinaemia classes IgG, IgM and IgA was detected. Immunosuppressive and immunomodulatory therapy did not produce the desired effect, and the condition progressed to retinochoroiditis. Due to blindness and dolorous glaucoma, enucleation of the right eye was performed at the age of 15 years. Histologically toxoplasmic cysts with bradyzoites were detected, a subsequent laboratory test demonstrated toxoplasmic etiology upon a background of persistent regressing hypogammaglobulinaemia. General anti-toxoplasma and subsequent immunosuppressive treatment did not produce the desired effect, and at the age of 22 years the patient lost his sight also in the left eye. CONCLUSION Atypical form of OT intraocular neuritis in an immunocompetent patient had a favourable course, whereas retinal vasculitis with retinochoroiditis in a temporarily immunocompromised patient ended in bilateral blindness.
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26
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Wang BT, Kothambawala T, Wang L, Matthew TJ, Calhoun SE, Saini AK, Kotturi MF, Hernandez G, Humke EW, Peterson MS, Sinclair AM, Keyt BA. Multimeric Anti-DR5 IgM Agonist Antibody IGM-8444 Is a Potent Inducer of Cancer Cell Apoptosis and Synergizes with Chemotherapy and BCL-2 Inhibitor ABT-199. Mol Cancer Ther 2021; 20:2483-2494. [PMID: 34711645 PMCID: PMC9398157 DOI: 10.1158/1535-7163.mct-20-1132] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 07/07/2021] [Accepted: 09/15/2021] [Indexed: 01/07/2023]
Abstract
Death receptor 5 (DR5) is an attractive target for cancer therapy due to its broad upregulated expression in multiple cancers and ability to directly induce apoptosis. Though anti-DR5 IgG antibodies have been evaluated in clinical trials, limited efficacy has been attributed to insufficient receptor crosslinking. IGM-8444 is an engineered, multivalent agonistic IgM antibody with 10 binding sites to DR5 that induces cancer cell apoptosis through efficient DR5 multimerization. IGM-8444 bound to DR5 with high avidity and was substantially more potent than an IgG with the same binding domains. IGM-8444 induced cytotoxicity in a broad panel of solid and hematologic cancer cell lines but did not kill primary human hepatocytes in vitro, a potential toxicity of DR5 agonists. In multiple xenograft tumor models, IGM-8444 monotherapy inhibited tumor growth, with strong and sustained tumor regression observed in a gastric PDX model. When combined with chemotherapy or the BCL-2 inhibitor ABT-199, IGM-8444 exhibited synergistic in vitro tumor cytotoxicity and enhanced in vivo efficacy, without augmenting in vitro hepatotoxicity. These results support the clinical development of IGM-8444 in solid and hematologic malignancies as a monotherapy and in combination with chemotherapy or BCL-2 inhibition.
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Affiliation(s)
| | | | - Ling Wang
- IGM Biosciences Inc., Mountain View, California
| | | | | | | | | | | | | | | | | | - Bruce A Keyt
- IGM Biosciences Inc., Mountain View, California.
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27
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Tabarsi P, Hashemian SMR, Bauhofer A, Savadkoohi AA, Ghadimi S, Haseli S, Dastan F. IgM-enriched immunoglobulin in COVID-19: Case series of 15 severely ill SARS-CoV-2-infected patients. Int Immunopharmacol 2021; 99:107998. [PMID: 34315117 PMCID: PMC8299233 DOI: 10.1016/j.intimp.2021.107998] [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] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/15/2021] [Accepted: 07/17/2021] [Indexed: 12/15/2022]
Abstract
The healthcare system in Iran, like most around the world, is managing thousands of patients hospitalised with COVID-19. In Iran, in-hospital mortality is in the region of 25%, rising to 50–60% in patients admitted to intensive care. Hyperinflammation, characterised by cytokine storm, appears to be a hallmark of severe COVID-19 and to date only the anti-inflammatory drug dexamethasone has been shown to reduce mortality in those hospitalised with the disease. There is a sound scientific rationale behind the use of IgM-enriched immunoglobulin in the management of patients with severe COVID-19. It has been used successfully in the management of hyperinflammation in patients with sepsis and has led to improved radiographic scores in patients with severe cases of severe acute respiratory syndrome coronavirus (SARS-CoV) infection. Recently the successful treatment of a patient with COVID-19 with IgM-enriched immunoglobulin was reported. Here we report the outcome of a further 15 patients hospitalised with COVID-19 treated with IgM-enriched immunoglobulin. Improvements in computed tomography (CT) score were observed in nine patients, indicating that further clinical studies into the use of IgM-enriched immunoglobulin in the treatment of severe COVID-19 are warranted.
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Affiliation(s)
- Payam Tabarsi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Reza Hashemian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Artur Bauhofer
- Corporate Medical Affairs, Biotest AG, Landsteinerstr. 5, 63303 Dreieich, Germany
| | - Ali Amir Savadkoohi
- Anesthesia and Critical Care Department, Chairman of Iranian Critical Care Society, Mehrad Hospital, Tehran, Iran
| | - Somayeh Ghadimi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Haseli
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Dastan
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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28
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Schnaubelt S, Tihanyi D, Strassl R, Schmidt R, Anders S, Laggner AN, Agis H, Domanovits H. Hemophagocytic lymphohistiocytosis in COVID-19: Case reports of a stepwise approach. Medicine (Baltimore) 2021; 100:e25170. [PMID: 33761694 PMCID: PMC9281988 DOI: 10.1097/md.0000000000025170] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The immunologic syndrome induced by severe acute coronavirus disease 2019 (COVID-19) is yet not fully understood. Typical patterns of clinical and laboratory features match secondary hemophagocytic lymphohistiocytosis (sHLH). However, the optimal approach to COVID-19 patients testing positive for sHLH is still unclear. PATIENT CONCERNS Three patients with COVID-19 are reviewed. All showed hyperinflammation and cytokine storm, necessitating intensive care treatment including mechanical ventilation. DIAGNOSIS Secondary hemophagocytic lymphohistiocytosis due to severe COVID-19; diagnosed via HScore. INTERVENTIONS A treatment regimen of methylprednisolone, pentaglobin, and anakinra was developed and administered. OUTCOMES One patient survived the ICU stay. Two other patients, in whom sHLH was diagnosed too late, deceased. LESSONS A routine screening of COVID-19 patients for secondary HLH by using the HScore is feasible; especially those patients deteriorating clinically with no sufficient response to shock management might be at particular high risk. A stepwise therapeutic approach comprising corticosteroids, immunoglobulins and anakinra, accompanied by immunoadsorption, may dampen cytokine storm effects, and potentially reduce mortality.
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Affiliation(s)
| | - Daniel Tihanyi
- Department of Pulmonology, Clinic Penzing, Vienna Healthcare Group
| | - Robert Strassl
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University of Vienna
| | - Ralf Schmidt
- Division of Clinical Virology, Department of Laboratory Medicine, Medical University of Vienna
| | - Sonja Anders
- Department of Pulmonology, Clinic Penzing, Vienna Healthcare Group
| | | | - Hermine Agis
- Department of Internal Medicine I, Medical University of Vienna, Austria
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna
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29
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Gasser R, Cloutier M, Prévost J, Fink C, Ducas É, Ding S, Dussault N, Landry P, Tremblay T, Laforce-Lavoie A, Lewin A, Beaudoin-Bussières G, Laumaea A, Medjahed H, Larochelle C, Richard J, Dekaban GA, Dikeakos JD, Bazin R, Finzi A. Major role of IgM in the neutralizing activity of convalescent plasma against SARS-CoV-2. Cell Rep 2021; 34:108790. [PMID: 33596407 PMCID: PMC7874916 DOI: 10.1016/j.celrep.2021.108790] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [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: 10/19/2020] [Revised: 01/05/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023] Open
Abstract
Characterization of the humoral response to SARS-CoV-2, the etiological agent of COVID-19, is essential to help control the infection. The neutralization activity of plasma from patients with COVID-19 decreases rapidly during the first weeks after recovery. However, the specific role of each immunoglobulin isotype in the overall neutralizing capacity is still not well understood. In this study, we select plasma from a cohort of convalescent patients with COVID-19 and selectively deplete immunoglobulin A, M, or G before testing the remaining neutralizing capacity of the depleted plasma. We find that depletion of immunoglobulin M is associated with the most substantial loss of virus neutralization, followed by immunoglobulin G. This observation may help design efficient antibody-based COVID-19 therapies and may also explain the increased susceptibility to SARS-CoV-2 of autoimmune patients receiving therapies that impair the production of immunoglobulin M (IgM).
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Affiliation(s)
- Romain Gasser
- Centre de recherche du CHUM, Montréal, QC H2X 0A9, Canada; Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC H2X 0A9, Canada
| | - Marc Cloutier
- Héma-Québec, Affaires Médicales et Innovation, Québec, QC G1V 5C3, Canada
| | - Jérémie Prévost
- Centre de recherche du CHUM, Montréal, QC H2X 0A9, Canada; Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC H2X 0A9, Canada
| | - Corby Fink
- Biotherapeutics Research Laboratory, Robarts Research Institute, London, ON NGA 5B7, Canada; Department of Microbiology and Immunology, University of Western Ontario, London, ON N6A 5B7, Canada
| | - Éric Ducas
- Héma-Québec, Affaires Médicales et Innovation, Québec, QC G1V 5C3, Canada
| | - Shilei Ding
- Centre de recherche du CHUM, Montréal, QC H2X 0A9, Canada; Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC H2X 0A9, Canada
| | - Nathalie Dussault
- Héma-Québec, Affaires Médicales et Innovation, Québec, QC G1V 5C3, Canada
| | - Patricia Landry
- Héma-Québec, Affaires Médicales et Innovation, Québec, QC G1V 5C3, Canada
| | - Tony Tremblay
- Héma-Québec, Affaires Médicales et Innovation, Québec, QC G1V 5C3, Canada
| | | | - Antoine Lewin
- Héma-Québec, Affaires Médicales et Innovation, Montréal, QC H4R 2W7, Canada; Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
| | - Guillaume Beaudoin-Bussières
- Centre de recherche du CHUM, Montréal, QC H2X 0A9, Canada; Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC H2X 0A9, Canada
| | - Annemarie Laumaea
- Centre de recherche du CHUM, Montréal, QC H2X 0A9, Canada; Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC H2X 0A9, Canada
| | | | - Catherine Larochelle
- Centre de recherche du CHUM, Montréal, QC H2X 0A9, Canada; Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC H2X 0A9, Canada; Department of Neurosciences, University of Montreal, Montreal, QC H2X 0A9, Canada
| | - Jonathan Richard
- Centre de recherche du CHUM, Montréal, QC H2X 0A9, Canada; Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC H2X 0A9, Canada
| | - Gregory A Dekaban
- Biotherapeutics Research Laboratory, Robarts Research Institute, London, ON NGA 5B7, Canada; Department of Microbiology and Immunology, University of Western Ontario, London, ON N6A 5B7, Canada
| | - Jimmy D Dikeakos
- Department of Microbiology and Immunology, University of Western Ontario, London, ON N6A 5B7, Canada
| | - Renée Bazin
- Héma-Québec, Affaires Médicales et Innovation, Québec, QC G1V 5C3, Canada.
| | - Andrés Finzi
- Centre de recherche du CHUM, Montréal, QC H2X 0A9, Canada; Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC H2X 0A9, Canada; Department of Microbiology and Immunology, McGill University, Montreal, QC H3A 2B4, Canada.
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Vukovic N, van Elsas A, Verbeek JS, Zaiss DMW. Isotype selection for antibody-based cancer therapy. Clin Exp Immunol 2021; 203:351-365. [PMID: 33155272 PMCID: PMC7874837 DOI: 10.1111/cei.13545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/16/2020] [Accepted: 10/29/2020] [Indexed: 01/14/2023] Open
Abstract
The clinical application of monoclonal antibodies (mAbs) has revolutionized the field of cancer therapy, as it has enabled the successful treatment of previously untreatable types of cancer. Different mechanisms play a role in the anti-tumour effect of mAbs. These include blocking of tumour-specific growth factor receptors or of immune modulatory molecules as well as complement and cell-mediated tumour cell lysis. Thus, for many mAbs, Fc-mediated effector functions critically contribute to the efficacy of treatment. As immunoglobulin (Ig) isotypes differ in their ability to bind to Fc receptors on immune cells as well as in their ability to activate complement, they differ in the immune responses they activate. Therefore, the choice of antibody isotype for therapeutic mAbs is dictated by its intended mechanism of action. Considering that clinical efficacy of many mAbs is currently achieved only in subsets of patients, optimal isotype selection and Fc optimization during antibody development may represent an important step towards improved patient outcome. Here, we discuss the current knowledge of the therapeutic effector functions of different isotypes and Fc-engineering strategies to improve mAbs application.
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Affiliation(s)
- N. Vukovic
- Institute of Immunology and Infection ResearchSchool of Biological SciencesUniversity of EdinburghAshworth LaboratoriesEdinburghUK
| | | | - J. S. Verbeek
- Department of Biomedical EngineeringToin University of YokohamaYokohamaJapan
| | - D. M. W. Zaiss
- Institute of Immunology and Infection ResearchSchool of Biological SciencesUniversity of EdinburghAshworth LaboratoriesEdinburghUK
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Jarczak D, Kluge S, Nierhaus A. Use of Intravenous Immunoglobulins in Sepsis Therapy-A Clinical View. Int J Mol Sci 2020; 21:ijms21155543. [PMID: 32756325 PMCID: PMC7432410 DOI: 10.3390/ijms21155543] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 07/03/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/29/2022] Open
Abstract
Sepsis is a life-threatening organ dysfunction, defined by a dysregulated host immune response to infection. During sepsis, the finely tuned system of immunity, inflammation and anti-inflammation is disturbed in a variety of ways. Both pro-inflammatory and anti-inflammatory pathways are upregulated, activation of the coagulation cascade and complement and sepsis-induced lymphopenia occur. Due to the manifold interactions in this network, the use of IgM-enriched intravenous immunoglobulins seems to be a promising therapeutic approach. Unfortunately, there is still a lack of evidence-based data to answer the important questions of appropriate patient populations, optimal timing and dosage of intravenous immunoglobulins. With this review, we aim to provide an overview of the role of immunoglobulins, with emphasis on IgM-enriched formulations, in the therapy of adult patients with sepsis and septic shock.
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Bettoni S, Shaughnessy J, Maziarz K, Ermert D, Gulati S, Zheng B, Mörgelin M, Jacobsson S, Riesbeck K, Unemo M, Ram S, Blom AM. C4BP-IgM protein as a therapeutic approach to treat Neisseria gonorrhoeae infections. JCI Insight 2019; 4:131886. [PMID: 31661468 PMCID: PMC6962029 DOI: 10.1172/jci.insight.131886] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/23/2019] [Indexed: 12/21/2022] Open
Abstract
Gonorrhea is a sexually transmitted infection with 87 million new cases per year globally. Increasing antibiotic resistance has severely limited treatment options. A mechanism that Neisseria gonorrhoeae uses to evade complement attack is binding of the complement inhibitor C4b-binding protein (C4BP). We screened 107 porin B1a (PorB1a) and 83 PorB1b clinical isolates randomly selected from a Swedish strain collection over the last 10 years and noted that 96/107 (89.7%) PorB1a and 16/83 (19.3%) PorB1b bound C4BP; C4BP binding substantially correlated with the ability to evade complement-dependent killing (r = 0.78). We designed 2 chimeric proteins that fused C4BP domains to the backbone of IgG or IgM (C4BP-IgG; C4BP-IgM) with the aim of enhancing complement activation and killing of gonococci. Both proteins bound gonococci (KD C4BP-IgM = 2.4 nM; KD C4BP-IgG 980.7 nM), but only hexameric C4BP-IgM efficiently outcompeted heptameric C4BP from the bacterial surface, resulting in enhanced complement deposition and bacterial killing. Furthermore, C4BP-IgM substantially attenuated the duration and burden of colonization of 2 C4BP-binding gonococcal isolates but not a non-C4BP-binding strain in a mouse vaginal colonization model using human factor H/C4BP-transgenic mice. Our preclinical data present C4BP-IgM as an adjunct to conventional antimicrobials for the treatment of gonorrhea.
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Affiliation(s)
- Serena Bettoni
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jutamas Shaughnessy
- Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Karolina Maziarz
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - David Ermert
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Sunita Gulati
- Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bo Zheng
- Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Susanne Jacobsson
- World Health Organization (WHO) Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Örebro University, Örebro, Sweden
| | - Kristian Riesbeck
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Magnus Unemo
- World Health Organization (WHO) Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Örebro University, Örebro, Sweden
| | - Sanjay Ram
- Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Anna M. Blom
- Department of Translational Medicine, Lund University, Malmö, Sweden
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Wilson CS, Chhabra P, Marshall AF, Morr CV, Stocks BT, Hoopes EM, Bonami RH, Poffenberger G, Brayman KL, Moore DJ. Healthy Donor Polyclonal IgMs Diminish B-Lymphocyte Autoreactivity, Enhance Regulatory T-Cell Generation, and Reverse Type 1 Diabetes in NOD Mice. Diabetes 2018; 67:2349-2360. [PMID: 30131391 PMCID: PMC6198348 DOI: 10.2337/db18-0456] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 08/12/2018] [Indexed: 02/05/2023]
Abstract
Autoimmune diseases such as type 1 diabetes (T1D) arise from unrestrained activation of effector lymphocytes that destroy target tissues. Many efforts have been made to eliminate these effector lymphocytes, but none has produced a long-term cure. An alternative to depletion therapy is to enhance endogenous immune regulation. Among these endogenous alternatives, naturally occurring Igs have been applied for inflammatory disorders but have lacked potency in antigen-specific autoimmunity. We hypothesized that naturally occurring polyclonal IgMs, which represent the majority of circulating, noninduced antibodies but are present only in low levels in therapeutic Ig preparations, possess the most potent capacity to restore immune homeostasis. Treatment of diabetes-prone NOD mice with purified IgM isolated from Swiss Webster (SW) mice (nIgMSW) reversed new-onset diabetes, eliminated autoreactive B lymphocytes, and enhanced regulatory T-cell (Treg) numbers both centrally and peripherally. Conversely, IgM from prediabetic NOD mice could not restore this endogenous regulation, which represents an unrecognized component of T1D pathogenesis. Of note, IgM derived from healthy human donors was similarly able to expand human CD4 Tregs in humanized mice and produced permanent diabetes protection in treated NOD mice. Overall, these studies demonstrate that a potent, endogenous regulatory mechanism, nIgM, is a promising option for reversing autoimmune T1D in humans.
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Affiliation(s)
- Christopher S Wilson
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Preeti Chhabra
- Department of Surgery, University of Virginia, Charlottesville, VA
| | - Andrew F Marshall
- Department of Pediatrics, Ian Burr Division of Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, TN
| | - Caleigh V Morr
- Department of Pediatrics, Ian Burr Division of Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, TN
| | - Blair T Stocks
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Emilee M Hoopes
- Department of Pediatrics, Ian Burr Division of Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, TN
| | - Rachel H Bonami
- Department of Medicine, Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Greg Poffenberger
- Department of Medicine, Division of Endocrinology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Daniel J Moore
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
- Department of Pediatrics, Ian Burr Division of Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, TN
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Langereis JD, van der Flier M, de Jonge MI. Limited Innovations After More Than 65 Years of Immunoglobulin Replacement Therapy: Potential of IgA- and IgM-Enriched Formulations to Prevent Bacterial Respiratory Tract Infections. Front Immunol 2018; 9:1925. [PMID: 30190722 PMCID: PMC6115500 DOI: 10.3389/fimmu.2018.01925] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/06/2018] [Indexed: 11/13/2022] Open
Abstract
Patients with primary immunoglobulin deficiency have lower immunoglobulin levels or decreased immunoglobulin function, which makes these patients more susceptible to bacterial infection. Most prevalent are the selective IgA deficiencies (~1:3,000), followed by common variable immune deficiency (~1:25,000). Agammaglobulinemia is less common (~1:400,000) and is characterized by very low or no immunoglobulin production resulting in a more severe disease phenotype. Therapy for patients with agammaglobulinemia mainly relies on prophylactic antibiotics and the use of IgG replacement therapy, which successfully reduces the frequency of invasive bacterial infections. Currently used immunoglobulin preparations contain only IgG. As a result, concurrent IgA and IgM deficiency persist in a large proportion of agammaglobulinemia patients. Especially patients with IgM deficiency remain at risk for recurrent infections at mucosal surfaces, which includes the respiratory tract. IgA and IgM have multiple functions in the protection against bacterial infections at the mucosal surface. Because of their multimeric structure, both IgA and IgM are able to agglutinate bacteria efficiently. Agglutination allows for entrapment of bacteria in mucus that increases clearance from the respiratory tract. IgA is also important for blocking bacterial adhesion by interfering with bacterial adhesion receptors. IgM in its place is very well capable of activating complement, therefore, it is thought to be important in complement-mediated protection at the mucosal surface. The purpose of this Mini Review is to highlight the latest advances regarding IgA- and IgM-enriched immunoglobulin replacement therapy. We describe the different IgA- and IgM-enriched IgG formulations, their possible modes of action and potential to protect against respiratory tract infections in patients with primary immunoglobulin deficiencies.
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Affiliation(s)
- Jeroen D. Langereis
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, Netherlands
- Radboud Center for Infectious Diseases, Nijmegen, Netherlands
| | - Michiel van der Flier
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, Netherlands
- Radboud Center for Infectious Diseases, Nijmegen, Netherlands
- Pediatric Infectious Diseases and Immunology, Amalia Children's Hospital, Nijmegen, Netherlands
- Expertise Center for Immunodeficiency and Autoinflammation (REIA), Radboudumc, Nijmegen, Netherlands
| | - Marien I. de Jonge
- Section Pediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, Netherlands
- Radboud Center for Infectious Diseases, Nijmegen, Netherlands
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Tascini C, Fraganza F, Salani F, Sozio E, Rossi M, Sbrana F, Carannante N, Chiesa MD, Ripoli A, Bertolino G, Di Pietro M, Bartoloni A, Menichetti F. Potential role of IgM-enriched immunoglobulin as adjuvant treatment for invasive meningococcal disease. Intensive Care Med 2017; 44:261-262. [PMID: 29124316 DOI: 10.1007/s00134-017-4957-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Fiorentino Fraganza
- Intensive Care Unit, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Francesca Salani
- Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Emanuela Sozio
- Emergency Medicine Unit, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Marco Rossi
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | | | - Novella Carannante
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Maria Daniela Chiesa
- Intensive Care Unit, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | | | - Giacomo Bertolino
- Pharmaceutical Department, Azienda Ospedaliera Universitaria Pisana, Santa Chiara, Pisa, Italy
| | - Massimo Di Pietro
- Infectious Diseases Unit, S. Maria Annunziata Hospital, Central Tuscany Health Authority, Florence, Italy
| | - Alessandro Bartoloni
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Menichetti
- Infectious Diseases Clinic, Nuovo Santa Chiara University Hospital, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
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Hamilcikan S, Can E, Buke O, Polat C, Ozcan E. Pentoxifylline and Pentaglobin adjuvant therapies for neonatal nosocomial sepsis in neonates less than 1500g weight. J PAK MED ASSOC 2017; 67:1482-1486. [PMID: 28955060] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To compare different support therapies in very low birth-weight preterm neonates with nosocomial sepsis. METHODS This clinical pilot study was conducted at the Bagcilar Research and Training Hospital, Istanbul, Turkey, from September 2015 to November 2016. Preterm infants appropriately sized for a gestational age of < 32 weeks and < 1,500g were included in the study. Pentaglobin was initiated on the day of diagnosis of nosocomial sepsis to very low birth-weight preterm neonates as a support therapy in addition to antibiotics: 5 ml/kg per day of pentaglobin was infused over a four-hour period on three consecutive days. Pentoxifylline (5 mg/kg every 6 hours) was administered to premature infants with sepsis on three successive days. RESULTS Of the 41 neonates, 19(46.3%) were girls and 22(53.7%) were boys. Vital signs, haematologic tables, peripheral blood smear left shift ratio, and blood-gas parameters did not differ significantly between the groups (p>0.05), but the C-reactive protein (mg/dl) values significantly decreased after pentoxifylline treatment (p<0.05). Coagulase-negative staphylococci were the most frequently isolated bacteria in the two groups (n=4; 19% vs. n=4; 20%). There was no difference in isolated microorganisms. There was no significant difference in intraventricular haemorrhage, necrotising enterocolitis, periventricular leukomalacia or symptomatic patent ductus arteriosus in the neonates when comparing the two groups and no systemic reactions were observed during adjuvant therapy in the preterm neonates (p>0.05). The total duration of hospitalisation was 49.46±13.52 days for the pentaglobin group and 44.21±11.1 days for the pentoxifylline group neonates. CONCLUSIONS Pentoxifylline treatment for nosocomial sepsis decreased C-reactive protein levels and heart rate more than pentaglobin therapy.
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Affiliation(s)
- Sahin Hamilcikan
- University of Health Sciences Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Emrah Can
- University of Health Sciences Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Ovgu Buke
- University of Health Sciences Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Can Polat
- University of Health Sciences Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Esra Ozcan
- University of Health Sciences Bagcilar Training and Research Hospital, Istanbul, Turkey
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Wand S, Klages M, Kirbach C, Warszawska J, Meybohm P, Zacharowski K, Koch A. IgM-Enriched Immunoglobulin Attenuates Systemic Endotoxin Activity in Early Severe Sepsis: A Before-After Cohort Study. PLoS One 2016; 11:e0160907. [PMID: 27504630 PMCID: PMC4978476 DOI: 10.1371/journal.pone.0160907] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/27/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction Sepsis remains associated with a high mortality rate. Endotoxin has been shown to influence viscoelastic coagulation parameters, thus suggesting a link between endotoxin levels and the altered coagulation phenotype in septic patients. This study evaluated the effects of systemic polyspecific IgM-enriched immunoglobulin (IgM-IVIg) (Pentaglobin® [Biotest, Dreieich, Germany]) on endotoxin activity (EA), inflammatory markers, viscoelastic and conventional coagulation parameters. Methods Patients with severe sepsis were identified by daily screening in a tertiary, academic, surgical ICU. After the inclusion of 15 patients, the application of IgM-IVIg (5 mg/kg/d over three days) was integrated into the unit’s standard operation procedure (SOP) to treat patients with severe sepsis, thereby generating “control” and “IgM-IVIg” groups. EA assays, thrombelastometry (ROTEM®) and impedance aggregometry (Multiplate®) were performed on whole blood. Furthermore, routine laboratory parameters were determined according to unit’s standards. Results Data from 26 patients were included. On day 1, EA was significantly decreased in the IgM-IVIg group following 6 and 12 hours of treatment (0.51 ±0.06 vs. 0.26 ±0.07, p<0.05 and 0.51 ±0.06 vs. 0.25 ±0.04, p<0.05) and differed significantly compared with the control group following 6 hours of treatment (0.26 ±0.07 vs. 0.43 ±0.07, p<0.05). The platelet count was significantly higher in the IgM-IVIg group following four days of IgM-IVIg treatment (200/nl ±43 vs. 87/nl ±20, p<0.05). The fibrinogen concentration was significantly lower in the control group on day 2 (311 mg/dl ±37 vs. 475 mg/dl ±47 (p = 0.015)) and day 4 (307 mg/dl ±35 vs. 420 mg/dl ±16 (p = 0.017)). No differences in thrombelastometric or aggregometric measurements, or inflammatory markers (interleukin-6 (IL-6), leukocyte, lipopolysaccharide binding protein (LBP)) were observed. Conclusion Treatment with IgM-enriched immunoglobulin attenuates the EA levels in patients with severe sepsis and might have an effect on septic thrombocytopenia and fibrinogen depletion. Viscoelastic, aggregometric or inflammatory parameters were not influenced. Trial Registration clinicaltrials.gov NCT02444871
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Affiliation(s)
- Saskia Wand
- Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
- Clinic for Anaesthesiology, University Hospital Goettingen, Goettingen, Germany
- * E-mail:
| | - Matthias Klages
- Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christin Kirbach
- Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Joanna Warszawska
- Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Patrick Meybohm
- Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Kai Zacharowski
- Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alexander Koch
- Department of Anesthesia, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany
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Busani S, Damiani E, Cavazzuti I, Donati A, Girardis M. Intravenous immunoglobulin in septic shock: review of the mechanisms of action and meta-analysis of the clinical effectiveness. Minerva Anestesiol 2016; 82:559-572. [PMID: 26474267] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Sepsis is characterized by a complex immune response. In this study we aimed to provide a review of the mechanisms of action of immunoglobulin (Ig) related to sepsis and an updated meta-analysis of the clinical effectiveness of the Ig use in septic patients. EVIDENCE ACQUISITION We performed two separate searches of Medline and other databases with the keywords Ig, sepsis, septic shock, septicemia, septicemia with no language restrictions in order to review the mechanisms of action of Igs in sepsis and to update the previous meta-analysis on the effects of the Ig therapy on the mortality of adult patients with septic shock. EVIDENCE SYNTHESIS Pathogens and toxin clearance, anti-inflammatory effects and anti-apoptotic effects on immune cells seems to be the main mechanisms of action of Ig therapy in sepsis. The meta-analysis of 18 RCTs indicated that the use of intravenous Ig reduces the mortality risk of septic patients (odds ratio=0.50 [95% CI 0.34-0.71], I2=44.68%). Low study quality, heterogeneous dosing regimens and type of Ig preparations, and different control interventions (placebo or albumin) may have influenced our results. CONCLUSIONS Our study showed that the use of intravenous Ig therapy in adult septic patients may have a rationale and seems to be associated with a reduced mortality. Anyway, the treatment effect generally tended to be smaller or less consistent if considering only those studies that were deemed adequate on each indicator. So, the available evidence is not clearly sufficient to support the widespread use of Ig in the treatment of sepsis.
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Affiliation(s)
- Stefano Busani
- Department of Anaesthesia and Intensive Care, University Hospital of Modena, Modena, Italy -
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Ates I, Dogan N, Aksoy M, Halıcı Z, Gündogdu C, Keles MS. The protective effects of IgM-enriched immunoglobulin and erythropoietin on the lung and small intestine tissues of rats with induced sepsis: biochemical and histopathological evaluation. Pharm Biol 2015; 53:78-84. [PMID: 25243880 DOI: 10.3109/13880209.2014.910535] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
CONTEXT Sepsis continues to be a significant problem for critical care patients. OBJECTIVE To evaluate the protective effects of IgM-enriched immunoglobulin and erythropoietin on pulmonary and small intestine tissues in a rat model of intra-abdominal sepsis induced via the cecal ligation and puncture (CLP) method. MATERIALS AND METHODS Male Sprague-Dawley rats were used. Control group (n = 6): surgical procedure was not performed. Laparotomy was only performed in the sham group (n = 6) and CLP was only performed in the sepsis (CLP) group (n = 30). After erythropoietin (2000 U/kg, intraperitoneal) was given in the sepsis + erythropoietin (CLP + EPO) group (n = 30), IgM-enriched immunoglobulin (600 mg/kg, intraperitoneal) was given in the sepsis + pentaglobin (CLP + PEN) group (n = 30), CLP was created. Intracardiac blood samples were collected for biochemical analysis; lung and small intestine tissue samples were removed for histopathological evaluation. RESULTS Plasma TNF-α levels (pg/ml) were similar among CLP, CLP + EPO, and CLP + PEN groups (204.0 ± 52.4, 198.5 ± 17.3, and 214.6 ± 93.6, respectively). The CLP group had higher plasma IL-1β levels (pg/ml) compared with CLP + EPO and CLP + PEN groups (325.1 ± 134.1, 164.3 ± 25.6, and 186.3 ± 26.0, respectively) (p < 0.05). Rats in CLP + EPO and CLP + PEN groups had abolished histopathologic appearance of lung and small intestine tissues compared with rats in the CLP group. DISCUSSION AND CONCLUSION Our findings support the use of EPO and IgM-enriched immunoglobulin in the prevention of lung and small intestine injuries associated with sepsis.
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Affiliation(s)
- Irem Ates
- Department of Anesthesiology and Reanimation, Palandöken State Hospital , Erzurum , Turkey
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Frostegård AG, Su J, Hua X, Vikström M, de Faire U, Frostegård J. Antibodies against native and oxidized cardiolipin and phosphatidylserine and phosphorylcholine in atherosclerosis development. PLoS One 2014; 9:e111764. [PMID: 25473948 PMCID: PMC4256296 DOI: 10.1371/journal.pone.0111764] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 10/01/2014] [Indexed: 12/15/2022] Open
Abstract
Background Antibodies against cardiolipin and phosphatidylserine (anti-CL and anti-PS) are associated with thrombosis. In contrast, we determined that IgM antibodies against oxidized CL and PS (OxCL and OxPS) and phosphorylcholine (anti-PC) could be protection markers for cardiovascular disease (CVD). Methods 226 individuals with established hypertension (diastolic pressure>95 mmHg) from the European Lacidipine Study on Atherosclerosis. Antibodies were tested by ELISA. As a surrogate measure of atherosclerosis, the mean of the maximum intima-media thicknesses (IMT) in the far walls of common carotids and bifurcations was determined by ultrasonography at the time of inclusion and 4 years following inclusion. Results Increases in IMT measures at follow-up were significantly less common in subjects which at baseline had high IgM anti-OxPS and anti-PC at above 75th percentile: OR 0,45, CI (0,23–0,86) and OR 0.37, CI (0,19–0,71), p = 0.0137 respectively and above 90th percentile: OR 0.32, CI (0,12–0,84) and OR 0.39, CI (0,15–1.00), p = 0.050 and OR 0,22, CI (0,08–0,59) p = 0,0029. IgM anti-OxCL was negatively associated with IMT increases (OR, 0.32, CI (0,12–0,84), p = 0231). There were no associations for IgM anti-PS or anti-CL. Anti-PC, as determined herein by a commercial ELISA, was strongly associated with data from our previously published in house ELISA (R = 0,87; p<0,0001).) Anti-PC was also a risk marker at low levels (below 25th percentile; OR = 2,37 (1,16–4,82), p = 0,0177). Conclusions High levels of IgM anti-OxPS and anti-OxCL, but not traditional anti-phospholipid antibodies (anti-PS and anti-CL), are associated with protection against atherosclerosis development. In addition, low IgM anti-PC was a risk marker but high a protection marker.
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Affiliation(s)
- Anna G. Frostegård
- Institute of Environmental Medicine, Unit of Immunology and Chronic Disease, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Jun Su
- Institute of Environmental Medicine, Unit of Immunology and Chronic Disease, Karolinska Institutet, Stockholm, Sweden
| | - Xiang Hua
- Institute of Environmental Medicine, Unit of Immunology and Chronic Disease, Karolinska Institutet, Stockholm, Sweden
| | - Max Vikström
- Institute of Environmental Medicine, Unit of Cardiovascular Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Ulf de Faire
- Institute of Environmental Medicine, Unit of Cardiovascular Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Johan Frostegård
- Institute of Environmental Medicine, Unit of Immunology and Chronic Disease, Karolinska Institutet, Stockholm, Sweden
- Department of Acute Internal Medicine, Huddinge, Karolinska University Hospital, Stockholm, Sweden
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41
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Rossmann FS, Kropec A, Laverde D, Saaverda FR, Wobser D, Huebner J. In vitro and in vivo activity of hyperimmune globulin preparations against multiresistant nosocomial pathogens. Infection 2014; 43:169-75. [PMID: 25428225 PMCID: PMC4382538 DOI: 10.1007/s15010-014-0706-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/13/2014] [Indexed: 11/25/2022]
Abstract
Purpose We compared different immunoglobulin preparations containing IgG (Intraglobin/Intratect) or a mixture of IgG, IgA, and IgM (Pentaglobin) to assess the opsonic and protective efficacy of human immunoglobulin preparations against multiresistent nosocomial pathogens. Materials and methods Clinical isolates of E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis, Enterococcus faecium, and Staphylococcus aureus were tested by opsonophagocytic assay using immunologobulin preparations at dilutions usually obtained in patients. The target antigens of opsonic antibodies were characterized by opsonophagocytic inhibition assays, and the protective efficacy in vivo was tested in a mouse bacteremia model as previously described. Results All strains were killed to at least 50 % by Pentaglobin. One P. aeruginosa strain was not efficiently killed by Intraglobin (23 %) but the other strains were killed by Intraglobin to a similar degree compared to Pentaglobin. Opsonic IgG antibodies against E. faecalis were directed against LTA, while opsonic antibodies in Pentaglobin were primarily directed against other cell wall carbohydrates. In a mouse bacteremia model, Pentaglobin was more protective than Intratect against Staphylococcus aureus, while Intratect reduced colony counts better than normal rabbit serum or saline. Conclusions All tested human immunoglobulin preparations contain opsonic and protective antibodies against targets present on multiresistant Gram-positive and Gram-negative bacteria. Enrichment of these preparations with IgM increases the protective efficacy against some strains, probably due to antibodies directed against cell wall carbohydrates.
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Affiliation(s)
- F. S. Rossmann
- Division of Infectious Diseases, Department of Medicine, University Hospital Freiburg, Freiburg im Breisgau, Germany
- Faculty of Biology, Albert-Ludwigs-University Freiburg, Freiburg University, Freiburg im Breisgau, Germany
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians University, Munich, Germany
- German Center for Infection Research (DZIF), Partnersite Munich, Munich, Germany
| | - A. Kropec
- Division of Infectious Diseases, Department of Medicine, University Hospital Freiburg, Freiburg im Breisgau, Germany
- German Center for Infection Research (DZIF), Partnersite Munich, Munich, Germany
| | - D. Laverde
- Division of Infectious Diseases, Department of Medicine, University Hospital Freiburg, Freiburg im Breisgau, Germany
- German Center for Infection Research (DZIF), Partnersite Munich, Munich, Germany
| | - F. R. Saaverda
- Division of Infectious Diseases, Department of Medicine, University Hospital Freiburg, Freiburg im Breisgau, Germany
- German Center for Infection Research (DZIF), Partnersite Munich, Munich, Germany
| | - D. Wobser
- Division of Infectious Diseases, Department of Medicine, University Hospital Freiburg, Freiburg im Breisgau, Germany
- German Center for Infection Research (DZIF), Partnersite Munich, Munich, Germany
| | - J. Huebner
- Division of Infectious Diseases, Department of Medicine, University Hospital Freiburg, Freiburg im Breisgau, Germany
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians University, Munich, Germany
- German Center for Infection Research (DZIF), Partnersite Munich, Munich, Germany
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Capasso L, Raimondi F. The influence of IgM-enriched immunoglobulin therapy on neonatal mortality and hematological variables in newborn infants with blood culture-proven sepsis. Turk J Pediatr 2014; 56:568. [PMID: 26022600] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Letizia Capasso
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Naples "Federico II," Naples, Italy.
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43
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Abbasoğlu A, Tekindal MA. Reply: To PMID 25341598. Turk J Pediatr 2014; 56:569. [PMID: 26022601] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Aslıhan Abbasoğlu
- Division of Neonatology, Department of Pediatrics, Başkent University Faculty of Medicine, Ankara, Turkey.
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Abbasoğlu A, Ecevit A, Tuğcu AU, Yapakçı E, Tekindal MA, Tarcan A, Ecevit Z. The influence of IgM-enriched immunoglobulin therapy on neonatal mortality and hematological variables in newborn infants with blood culture-proven sepsis. Turk J Pediatr 2014; 56:267-271. [PMID: 25341598] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of this study was to determine the effects of adjuvant immunoglobulin M (IgM)-enriched intravenous immunoglobulin (IVIG) therapy on mortality rate, hematological variables and length of hospital stay in newborn infants with blood culture-proven sepsis. Demographic and clinical features and outcome measures of 63 newborn infants with blood culture-proven sepsis were documented retrospectively from the medical records. The patients were divided into two groups according to their treatment history. The patients in Group 1 received antibiotic therapy only and the patients in Group 2 received both antibiotic and adjuvant IgMenriched IVIG. The study revealed that mortality rates were 28.1% and 12.9% in Group 1 and Group 2, respectively. The mortality rate was lower in Group 2, but the difference between the two groups was not statistically significant (p=0.21). Coagulase-negative Staphylococcus was the most common type of bacteria isolated from the blood culture in both groups. When changing laboratory results were compared between the two groups, hemoglobin, leukocyte count and C-reactive protein levels were different during the first three days of antibiotic treatment. Our study revealed that if diagnosed at an early stage and treated aggressively with appropriate and effective antibiotics, adjuvant IgM-enriched IVIG treatment has no additional benefits in neonatal sepsis.
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Affiliation(s)
- Aslıhan Abbasoğlu
- Division of Neonatology, Başkent University Faculty of Medicine Ankara, Turkey.
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45
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van Leeuwen M, Kemna MJ, de Winther MPJ, Boon L, Duijvestijn AM, Henatsch D, Bos NA, Gijbels MJJ, Tervaert JWC. Passive immunization with hypochlorite-oxLDL specific antibodies reduces plaque volume in LDL receptor-deficient mice. PLoS One 2013; 8:e68039. [PMID: 23874490 PMCID: PMC3713002 DOI: 10.1371/journal.pone.0068039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 05/28/2013] [Indexed: 11/18/2022] Open
Abstract
Aims New strategies to overcome complications of cardiovascular diseases are needed. Since it has been demonstrated that atherosclerosis is an inflammatory disease, modulation of the immune system may be a promising approach. Previously, it was suggested that antibodies may confer protective effects on the development of atherosclerosis. In this study, we hypothesised that passive immunization with anti-oxLDL IgM antibodies specific for hypochlorite (HOCl) may be athero-protective in mice. Methods and Results Monoclonal mouse IgM antibodies were produced and the antibody with specificity for hypochlorite-oxLDL (HOCl-oxLDL) (Moab A7S8) was selected. VH sequence determination revealed that Moab A7S8 is a natural IgM antibody. Atherosclerosis in LDLr−/− mice was induced by a perivascular collar placement around the right carotid artery in combination with feeding a high-fat diet. Subsequently, the mice were treated every six days with 500 µg Moab A7S8, non-relevant IgM or with PBS and the carotid arteries and aortic roots were studied for atherosclerosis. Passive immunization with this Moab A7S8 resulted in a significant reduced plaque volume formation in LDLr−/− mice when compared with PBS treatment (P = 0.002 and P = 0.035). Cholesterol levels decreased by 20% when mice were treated with Moab A7S8 compared to PBS. Furthermore, anti-oxLDL specific IgM and IgG antibody production increased significantly in the Moab A7S8 treated mice in comparison with PBS treated mice. Conclusion Our data show that passive immunization with a natural IgM antibody, directed to HOCl-oxLDL, can reduce atherosclerotic plaque development. We postulate that specific antibody therapy may be developed for use in human cardiovascular diseases.
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Affiliation(s)
- Marcella van Leeuwen
- Internal Medicine, Clinical and Experimental Immunology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michael J. Kemna
- Internal Medicine, Clinical and Experimental Immunology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Menno P. J. de Winther
- Molecular Genetics, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Medical Biochemistry, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | | | - Adriaan M. Duijvestijn
- Internal Medicine, Clinical and Experimental Immunology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Darius Henatsch
- Molecular Genetics, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nico A. Bos
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Marion J. J. Gijbels
- Molecular Genetics, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Medical Biochemistry, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
- Pathology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan Willem Cohen Tervaert
- Internal Medicine, Clinical and Experimental Immunology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
- Immunology Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
- * E-mail:
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Wootla B, Watzlawik JO, Denic A, Rodriguez M. The road to remyelination in demyelinating diseases: current status and prospects for clinical treatment. Expert Rev Clin Immunol 2013; 9:535-49. [PMID: 23730884 DOI: 10.1586/eci.13.37] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Within CNS disorders, demyelinating diseases are among the most devastating and cost intensive due to long-term disabilities affecting relatively young patients. Multiple sclerosis, a chronic inflammatory demyelinating disease in which the persistent inhibitory microenvironment of the resident oligodendrocyte precursor cells abrogates regeneration of myelin sheaths, is the most prominent disease in the spectrum of demyelinating diseases. The essential goal is to stimulate creation of new myelin sheaths on the demyelinated axons, leading to restoration of saltatory conduction and resolving functional deficits. The past few decades witnessed significant efforts to understand the cellular interactions at the lesion site with studies suggesting efficient remyelination as a prerequisite for functional repair. Despite its proven efficacy in experimental models, immunosuppression has not had profound clinical consequences in multiple sclerosis, which argued for a paradigm shift in the design of therapeutics aiming to achieve remyelination. For example, targeting oligodendrocytes themselves may drive remyelination in the CNS. This group and others have demonstrated that natural autoreactive antibodies directed at oligodendrocyte progenitors participate in remyelination. Accordingly, the authors developed a recombinant autoreactive natural human IgM antibody with therapeutic potential for remyelination.
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Affiliation(s)
- Bharath Wootla
- Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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Löscher WN, Woertz A, Wallnöfer M, Wanschitz JV, Luef G. Successful treatment of CANOMAD with IVIg and rituximab. J Neurol 2013; 260:1168-70. [PMID: 23400502 DOI: 10.1007/s00415-013-6867-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 01/31/2013] [Accepted: 02/02/2013] [Indexed: 11/25/2022]
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48
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Yehudai D, Vadasz Z. [IgM enriched immunoglobulins as a therapy for sepsis and autoimmune diseases]. Harefuah 2012; 151:171-188. [PMID: 22519268] [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: 05/31/2023]
Abstract
The importance of natural autoreactive antibodies of the immunogtobulin M (IgM) isotype, raised the issue of the innate immune response being immunoregulatory. These antibodies have low affinity and a wide range of specificity, thus acting as protective autoantibodies. Bearing this in mind, many have proposed the therapeutics potential of IgM enriched intravenous immunoglobulin (IVIg) in sepsis and in autoimmune diseases. We will summarize the emerging knowledge of these natural autoreactive IgM antibodies, their role and mechanisms of action in the above mentioned diseases.
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Cankayali I, Doğan YH, Solak I, Eriş O, Demirgören S, Moral AR. Effects of IgM-enriched immunoglobulin and fluid replacement on nerve conduction velocity in experimental sepsis. ULUS TRAVMA ACIL CER 2010; 16:9-14. [PMID: 20209389] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Neuromuscular abnormalities in sepsis, termed critical illness polyneuropathy (CIP), have been suggested to be induced by inflammatory mechanisms and/or relative hypovolemia. CIP is characterized by early electrophysiological findings before the clinical symptoms. This study aimed to investigate the effect of intravenous immunoglobulin (IVIG) and volume replacement therapies on the possible nerve conduction velocity (NCV) alterations in the early phase of experimental sepsis. METHODS Forty-six Sprague-Dawley rats were randomly assigned to four groups. Cecal ligation/perforation was performed to induce experimental sepsis. NCV was assessed in the tail nerve. RESULTS There was no statistically significant difference in NCV levels within and among the Sham-operated, colloid- and IVIG-treated groups. In the sepsis without treatment group, there was a statistically significant decrease in NCV levels. CONCLUSION NCV is decreased in the early stage of experimental sepsis and it may be accepted as an early electrophysiological sign in CIP. Treatment with either IgM-enriched IVIG or early volume replacement appears to prevent the decrease in NCV in the early phase of experimental sepsis. Results were statistically indistinguishable between the IVIG- and colloid-treated groups. No statistical difference between these groups is noteworthy. There is a need to clarify the mechanisms of action with further randomized, clinical and experimental trials.
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Affiliation(s)
- Ilkin Cankayali
- Department of Anesthesiology and Reanimation, Ege University Faculty of Medicine, Izmir, Turkey.
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50
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Sepbaeva AD, Mikhel'son VA, Degtiareva MV, Marveeva NK, Zhirkova IV. [Immune reaction to anesthesia and surgical injury in neonatal infants]. Anesteziol Reanimatol 2010:37-40. [PMID: 20568332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The impact of surgical injury and anesthesia on cellular and humoral immunity parameters was studied in neonatal infants with surgical pathology. These were found to have immunosuppressive activity, which appeared as evolving absolute lymphopenia and a reduction in the serum concentration of IgG. The magnitude of these changes depends on the functional state of the immune system in the preoperative period and is higher in infants with signs of an infectious-inflammatory process in the preoperative period, which increases the risk of septic complications. Preoperative immune replacement therapy with intravenous immunoglobulins (Pentaglobin) in neonates with severe developmental defects stops a fall in the level of cytotoxic lymphocytes in the early postoperative period.
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