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Almog M, Musallam N, Wagner R, Epov L, Kaly L, Dor V, Kessel A. Cow's milk oral immunotherapy has differentially better long-term adherence than peanut or sesame. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00241-2. [PMID: 38677475 DOI: 10.1016/j.anai.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Affiliation(s)
- Meital Almog
- Division of Allergy & Clinical Immunology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Nadira Musallam
- Division of Allergy & Clinical Immunology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Roni Wagner
- Division of Allergy & Clinical Immunology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Larisa Epov
- Division of Allergy & Clinical Immunology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Vika Dor
- Division of Allergy & Clinical Immunology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Aharon Kessel
- Division of Allergy & Clinical Immunology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Keret S, Mazareeb J, Snir A, Shouval A, Awisat A, Kaly L, Rosner I, Rozenbaum M, Boulman N, Hardak E, Slobodin G, Rimar D. Von Willebrand factor: a possible biomarker for disease activity in vasculitis. Scand J Rheumatol 2024:1-9. [PMID: 38314784 DOI: 10.1080/03009742.2024.2302679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/04/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Inflammation markers, e.g. C- reactive protein (CRP) and sedimentation rate, can be normal despite active vasculitis. Von Willebrand factor (vWF) is secreted from endothelial cells in response to vascular damage. Some reports suggest increased vWF levels in vasculitis. This study aimed to evaluate vWF serum concentration in vasculitis patients as a possible biomarker of disease activity and to review the current literature. METHOD Adult patients with systemic vasculitis were prospectively enrolled. Disease activity was recorded using the Birmingham Vasculitis Activity Score (BVAS) version 3. Blood group-adjusted vWF antigen serum level was evaluated at diagnosis and, when available, after treatment. RESULTS Twenty-five vasculitis patients were compared to 15 healthy controls. The mean age of patients was 56 ± 17 years and 56% were women. Forty percent had anti-neutrophil cytoplasmic autoantibody-associated vasculitis, 20% giant cell arteritis, 16% polyarteritis nodosa, 8% Takayasu arteritis, and the rest had other vasculitides. The mean disease duration was 3.4 ± 4.8 years. Mean vWF was higher in patients with active vasculitis than in healthy controls (212 ± 81% vs 106 ± 26%, p < 0.001). vWF levels directly correlated with BVAS. In 13 patients with active vasculitis who reached remission or low disease activity after treatment, vWF level at follow-up decreased significantly. In three out of five patients who were treated with interleukin-6 inhibitors, vWF was elevated despite normal CRP levels, while vasculitis was clinically active. CONCLUSION vWF antigen serum level is increased in active vasculitis and could potentially serve as a biomarker for active disease.
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Affiliation(s)
- S Keret
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - J Mazareeb
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - A Snir
- Hematology Laboratory, Bnai Zion Medical Center, Haifa, Israel
| | - A Shouval
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - A Awisat
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - L Kaly
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - I Rosner
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - M Rozenbaum
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - N Boulman
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - E Hardak
- Pulmonary Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - G Slobodin
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - D Rimar
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
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Keret S, Henig I, Zuckerman T, Kaly L, Shouval A, Awisat A, Rosner I, Rozenbaum M, Boulman N, Dortort Lazar A, Molad Y, Sabbah F, Naffaa ME, Hardak E, Slobodin G, Rimar D. Outcomes in progressive systemic sclerosis treated with autologous hematopoietic stem cell transplantation compared with combination therapy. Rheumatology (Oxford) 2023:kead457. [PMID: 37672021 DOI: 10.1093/rheumatology/kead457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVES Autologous hematopoietic stem cell transplantation (AHSCT) has been shown to improve long-term survival for early diffuse progressive systemic sclerosis (SSc) compared with cyclophosphamide. Cyclophosphamide, however, does not provide a long-term benefit in SSc. The combination of mycophenolate mofetil (MMF) and rituximab is a potent alternative regimen. We aimed to retrospectively compare the outcomes of SSc patients who underwent AHSCT to patients who met the eligibility criteria for AHSCT but received upfront combination therapy with MMF and rituximab. METHODS Repeated assessments of modified Rodnan Skin Score (mRSS), forced vital capacity (FVC), and diffusing capacity (DLCO) values were conducted. Clinical improvement was defined as an mRSS decrease > 25% or an FVC increase > 10%. Event-free survival (EFS) was defined in the absence of persistent major organ failure or death. RESULTS Twenty-one SSc patients in the combination therapy group were compared with sixteen in the AHSCT group. Age, sex and disease duration were similar between the two groups. Clinical improvement at 12 months was seen in 18 (86%) patients in the combination group compared with 13 (81%) in the AHSCT group (p= 0.7). The hazard ratio for EFS at 24 months favored the combination group (HR = 0.09, P= 0.04). During follow-up, both groups exhibited a significant and comparable reduction in mRSS and an increase in FVC values at each time interval up to 24 months. CONCLUSION MMF and rituximab compared with AHSCT in SSc patients eligible for AHSCT resulted in similar skin and lung clinical improvement with a better safety profile at 24 months.
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Affiliation(s)
- Shiri Keret
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Israel Henig
- Department of Hematology and Bone Marrow Transplantation, Rambam Medical Center, Haifa, Israel
| | - Tsila Zuckerman
- Department of Hematology and Bone Marrow Transplantation, Rambam Medical Center, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Aniela Shouval
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Abid Awisat
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Itzhak Rosner
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Michael Rozenbaum
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Nina Boulman
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | | | - Yair Molad
- Institute of Rheumatology, Rabin Medical Center, Petah Tikva, Israel
| | - Firas Sabbah
- Rheumatology Unit, Baruch Padeh Medical Center, Poriya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Mohammad E Naffaa
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Rheumatology Unit, Galilee Medical Center, Nahariya, Israel
| | - Emilia Hardak
- Pulmonary Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Doron Rimar
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
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Balbir-Gurman A, Awisat A, Keret S, Silawy A, Kaly L, Rosner I, Rozenbaum M, Boulman N, Shouval A, Rimar D, Slobodin G. Giant Cell Arteritis: State of the Art in Diagnosis, Monitoring, and Treatment. Rambam Maimonides Med J 2023; 14:RMMJ.10496. [PMID: 37116064 PMCID: PMC10147399 DOI: 10.5041/rmmj.10496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
Giant cell arteritis (GCA) is the most prevalent subtype of vasculitis in adults. In recent years, there has been substantial improvement in the diagnosis and treatment of GCA, mainly attributed to the introduction of highly sensitive diagnostic tools, incorporation of modern imaging modalities for diagnosis and monitoring of large-vessel vasculitis, and introduction of highly effective novel biological therapies that have revolutionized the field of GCA. This article reviews state-of-the-art approaches for the diagnosis, monitoring, and treatment options of GCA.
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Affiliation(s)
| | - Abid Awisat
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Shiri Keret
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Amal Silawy
- Rheumatology Clinic, Maccabi Health Services, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Itzhak Rosner
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | | | - Nina Boulman
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Aniela Shouval
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Doron Rimar
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
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Bleicher I, Ben Yehuda D, Yossef F, Sagi S, Sagi-Dain L, Kaly L. COVID-19 vaccination during pregnancy – short- and long-term outcomes of a prospective cohort study. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Rimar D, Awisat A, Kaly L, Slobodin G, Rosner I, Rozenbaum M, Ginsberg S, Starosvetsky E, Alpert A, Shen-Orr S. Response to: ‘Tofacitinib for the treatment of polyarteritis nodosa: a literature review’. Correspondence on ‘Tofacitinib for polyarteritis nodosa: a tailored therapy’ by Rimar et al. Ann Rheum Dis 2022; 81:e205. [DOI: 10.1136/annrheumdis-2020-218790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 08/16/2020] [Indexed: 11/04/2022]
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Keret S, Slobodin G, Awisat A, Kaly L, Rosner I, Rosenbaum M, Boulman N, Shouval A, Rimar D. AB0646 G- CSF treatment for refractory digital ulcers in systemic sclerosis. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundDigital ulcers (DU) are a common manifestation of systemic sclerosis (SSc). Despite combination vasodilator therapy, refractory DU are not rare. Granulocyte-colony stimulating factor (G-CSF) had not been evaluated for SSc DU heretofore.ObjectivesTo evaluate the efficacy and safety of G-CSF for refractory SSc DU.MethodsAdult SSc patients with chronic resistant DU despite treatment with maximal tolerated doses of prostacyclin analogue, endothelin receptor antagonist and PDE5 inhibitor, were treated with three consecutive daily doses of G-CSF. Evaluation of DU healing, DUCAS score, antibiotics use, side effects and hospitalizations, was performed.ResultsTen patients (90% females), mean age 53.5 ± 11.1 years were treated. Fifty percent of the patients had a diffuse SSc disease. All patients suffered from chronic (80%), or recurrent (20%) DU. G-CSF treatment resulted in complete resolution of most DU, after an average of 1.57± 0.76 months. DU recurrence occurred in two patients, after a mean period of two months. The number of DU decreased from 2.23±2.20 at baseline, to 0.84±0.80 at one month (p value= 0.04), and 0.50±0.67 at 3 months (p value= 0.015). DUCAS score dropped from 6.84±1.62 before the treatment, to 1.76±2.00 and 1.16±2.55 at one and three months, respectively (p value <0.0001). No serious adverse events were observed.ConclusionG- CSF treatment was found to be beneficial for refractory SSc DU, resulting in DU healing and sustained remission in most cases. No significant side effects were observed. Future trials are needed to evaluate the efficacy and safety of this therapy.References[1]Denton CP, Khanna D. Systemic sclerosis. Lancet. 2017;390(10103):1685-1699.[2]Mouthon L, Mestre-Stanislas C, Bérezné A, et al. Impact of digital ulcers on disability and health-related quality of life in systemic sclerosis. Annals of the Rheumatic diseases 2010; 69:214-217.[3]Hughes M, Pauling JD. Exploring the patient experience of digital ulcers in systemic sclerosis. Semin Arthritis Rheum. 2019;48(5):888-894.[4]Matucci-Cerinic M, Krieg T, Guillevin L, et al. Elucidating the burden of recurrent and chronic digital ulcers in systemic sclerosis: long-term results from the DUO Registry. Ann Rheum Dis. 2016;75(10):1770-1776.[5] Steen V, Denton CP, Pope JE, Matucci-Cerinic M. Digital ulcers: overt vascular disease in systemic sclerosis. Rheumatology (Oxford). 2009;48 Suppl 3:iii19-24.[6]Roberts AW. G-CSF: a key regulator of neutrophil production, but that's not all! Growth Factors. 2005;23(1):33-41.[7]Phillipson M, Kubes P. The Healing Power of Neutrophils. Trends Immunol. 2019;40(7):635-647.[8]Giuggioli D, Magistro R, Colaci M, Franciosi U, Caruso A, Ferri C. The treatment of skin ulcers in systemic sclerosis: use of granulocyte-colony stimulating factor (G-CSF) in 26 patients. Reumatismo. 2006;58(1):26-30.Table 1.Patients’ characteristics:ParameterSSc IDUMean age at DU onset (years) ±SD53.5 ± 11.1Female gender (N, %)9, 90%AntibodiesATA (N, %)3, 30%ACA (N, %)5, 50%Negative2, 20%Diffuse SSc subtype (N, %)5, 50%Treatment (N, %)bosentan10, 100%sildenafil6, 60%CCB2, 20%iloprost10, 100%Mean Number of DU- baseline2.23 ± 2.20Mean Number of DU – 1 month ±SD0.84 ± 0.80Mean Number of DU – 3 months ±SD0.50 ± 0.67Mean DU duration before G-CSF (months)±SD4.77 ± 4.53Mean time to heal- (months)±SD1.57 ± 0.75Mean DUCAS before ±SD6.84 ± 1.62Mean change in DUCAS- 1M ±SD5.07 ± 2.75Mean change in DUCAS- 3M ±SD5.58 ± 2.53Adverse reactions (N, %)0, 0%Abrreviations: SD- standard deviation, DU- digital ulcers, SSc- systemic sclerosis, ATA- anti topoisomerase antibodies, ACA- anti centromere antibodies, CCB- calcium channel blockers, G- CSF- Granulocyte-colony stimulating factor, DUCAS- digital ulcer clinical assessment score.Disclosure of InterestsNone declared
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Zisman D, Safieh M, Simanovich E, Feld J, Kinarty A, Zisman L, Gazitt T, Haddad A, Elias M, Rosner I, Kaly L, Rahat MA. Tocilizumab (TCZ) Decreases Angiogenesis in Rheumatoid Arthritis Through Its Regulatory Effect on miR-146a-5p and EMMPRIN/CD147. Front Immunol 2021; 12:739592. [PMID: 34975837 PMCID: PMC8714881 DOI: 10.3389/fimmu.2021.739592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 11/29/2021] [Indexed: 01/25/2023] Open
Abstract
Background Angiogenesis is a major contributor to the development of inflammation during Rheumatoid arthritis (RA), as the vascularization of the pannus provides nutrients and oxygen for the infiltrating immune cells and proliferating synoviocytes. Tocilizumab (TCZ) is an anti-IL-6 receptor antibody that is used in the treatment of RA patients, and has been shown to exert anti-inflammatory effects. However, its effects on angiogenesis are not fully elucidated, and the molecular mechanisms regulating this effect are unknown. Methods We evaluated the concentrations of several pro- and anti-angiogenic factors and the expression levels of several microRNA molecules that are associated with RA and angiogenesis in serum samples obtained from 40 RA patients, before and 4 months after the initiation of TCZ treatment. Additionally, we used an in vitro co-culture system of fibroblasts (the HT1080 cell line) and monocytes (the U937 cell line) to explore the mechanisms of TCZ action. Results Serum samples from RA patients treated with TCZ exhibited reduced circulating levels of EMMPRIN/CD147, enhanced expression of circulating miR-146a-5p and miR-150-5p, and reduced the angiogenic potential as was manifested by the lower number of tube-like structures that were formed by EaHy926 endothelial cell line. In vitro, the accumulation in the supernatants of the pro-angiogenic factors EMMPRIN, VEGF and MMP-9 was increased by co-culturing the HT1080 fibroblasts and the U937 monocytes, while the accumulation of the anti-angiogenic factor thrombospondin-1 (Tsp-1) and the expression levels of miR-146a-5p were reduced. Transfection of HT1080 cells with the miR-146a-5p mimic, decreased the accumulation of EMMPRIN, VEGF and MMP-9. When we neutralized EMMPRIN with a blocking antibody, the supernatants derived from these co-cultures displayed reduced migration, proliferation and tube formation in the functional assays. Conclusions Our findings implicate miR-146a-5p in the regulation of EMMPRIN and propose that TCZ affects angiogenesis through its effects on EMMPRIN and miR-146a-5p.
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Affiliation(s)
- Devy Zisman
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Rheumatology, Carmel Medical Center, Haifa, Israel
| | - Mirna Safieh
- Department of Rheumatology, Carmel Medical Center, Haifa, Israel
- Immunotherapy Laboratory, Carmel Medical Center, Haifa, Israel
| | | | - Joy Feld
- Department of Rheumatology, Carmel Medical Center, Haifa, Israel
| | - Amalia Kinarty
- Immunotherapy Laboratory, Carmel Medical Center, Haifa, Israel
| | - Liron Zisman
- Immunotherapy Laboratory, Carmel Medical Center, Haifa, Israel
| | - Tal Gazitt
- Department of Rheumatology, Carmel Medical Center, Haifa, Israel
| | - Amir Haddad
- Department of Rheumatology, Carmel Medical Center, Haifa, Israel
| | - Muna Elias
- Department of Rheumatology, Carmel Medical Center, Haifa, Israel
| | - Itzhak Rosner
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Rheumatology Unit, Bnei Zion Medical Center, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnei Zion Medical Center, Haifa, Israel
| | - Michal A. Rahat
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Immunotherapy Laboratory, Carmel Medical Center, Haifa, Israel
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Zisman D, Safieh M, Simanovich E, Feld J, Kinarty A, Zisman L, Gazitt T, Haddad A, Elias M, Rosner I, Kaly L, Amit Rahat M. POS0613 TOCILIZUMAB DECREASES ANGIOGENESIS IN RHEUMATOID ARTHRITIS THROUGH ITS REGULATORY EFFECT ON EMMPRIN/CD147. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Angiogenesis is an important contributor to the development of Rheumatoid arthritis (RA). Tocilizumab (TCZ), an anti-IL-6 receptor antibody, is an immunosuppressant used in the treatment of RA patients, but its effects on angiogenesis and the molecular mechanisms regulating new blood vessel formation are not fully elucidated.Objectives:To evaluate the concentrations of pro- and anti-angiogenic factors in serum samples of RA patients, before and after the initiation of TCZ treatment and to explore in an in vitro co-culture system the mechanisms of TCZ action.Methods:We evaluated the concentrations of EMMPRIN, VEGF, MMP-9, IL-6, NGAL, endostatin and thrombospondin-1 (Tsp-1) using commercial ELISA kits from 40 RA patients, before and 4 months after the initiation of TCZ treatment. The levels of secreted EMMPRIN, VEGF MMP-9 and Tsp-1 were measured in an in vitro co-culture system of HT1080 fibroblasts and U937 monocytes with and without addition of anti-EMMPRIN blocking antibody. In the tube formation assay serum samples and supernatnats from the co-cultures were added to endothelial layer. Images were obtained after 6 hours of incubation and the number of closed lumens were counted in two separate fields. In the wound assay, supernatants from the co-cultures, with or without the addition of the anti-EMMPRIN antibody were added to the endothelial layer after scratching. The scratch site area was measured immediately and compared to the area after 24 hours of incubation to assess the distance of cell migration.Results:Study population included 40 RA patients, 33 (82.5%) females, mean age of 57.5±11.1 years, disease duration of 7.7±5.6 years, and 53.9% positive for rheumatoid factor initiating treatment with TCZ. In this patient cohort, 25/40 (62.5%) patients were classified as “responders” according to EULAR criteria.Following 4 mounts of treatment, statistically significant reductions in the levels of EMMPRIN/CD147 (p=0.035), without significant changes in serum levels of MMP-9, VEGF, MMP-3 and MMP-7 and of the anti-angiogenetic factors Tsp-1 and endostatin were found. A statistically significant decrease in the ratio between the pro-angiogenic factor EMMPRIN and the anti-angiogenic factor Tsp-1 that was calculated for each patient 4 months after initiating TCZ was found(p=0.031). The decrease in angiogenesis was manifested by the reduced number of closed lumen tube-like structures formed by EaHy926 endothelial cell line after incubation with serum samples 4 months after initiation of TCZ, relative to the number of closed lumens formed prior to TCZ initiation (p=0.007). The ratio between EMMPRIN and Tsp-1 was significantly reduced in the responding patients versus non-responders (p=0.033), while the levels of VEGF, MMP-9, Tsp-1, and EMMPRIN were unchanged.In vitro, the accumulation of the pro-angiogenic factors EMMRPIN, VEGF and MMP-9 in the supernatants was increased in the co-culture, while the accumulation of the anti-angiogenic factor Tsp-1 was decreased. When EMMPRIN was neutralized with a blocking antibody, supernatants derived from these co-cultures exhibited reduced migration, proliferation, and tube-like structure formation in functional assays.Conclusion:Our findings suggest an important role for EMMPRIN in mediating pro-angiogenic signals in RA patients, with EMMPRIN/Tsp-1 ratio serving as a marker of angiogenesis in RA. When administered to RA patients, TCZ in turn, exerts an anti-angiogenic effect through its regulation of EMMRPIN/CD147 levels.Disclosure of Interests:None declared
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Abstract
PURPOSE To reassess the diagnostic approach to a patient with a monoarticular disease in light of the up-to-date medical literature and to examine the practical utility of traditional and newer imaging tools in the setting of monoarthritis. RESULTS The monoarticular disease can represent a medical emergency on the one hand and be a diagnostic conundrum on the other. The management rules of patients with monoarthritis have been established long ago, but various pitfalls still lead physicians off the right diagnosis at times. Septic, pseudoseptic arthritis and hemarthrosis are the most common diagnoses made in patients with an acute presentation, and a decision not to perform a diagnostic arthrocentesis is the most prevalent cause of misdiagnosis in this setting. Many rheumatic and infectious diseases can present with more indolent monoarthritis; careful history and physical examination frequently provide clues to the straightforward diagnosis in some cases, but the extensive investigation is needed in others. Imaging methods become indispensable in individuals with the non-inflammatory monoarticular disease, with magnetic resonance imaging being the gold standard for diagnosing pigmented villonodular synovitis, lipoma arborescence, avascular necrosis, or neuropathic arthropathy. CONCLUSIONS A great variety of medical disorders can present as a monoarticular disease. The disease presentation dictates different diagnostic behavior, while knowing the available imaging methods' diagnostic potential should further shorten the diagnostic process.
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Affiliation(s)
- Shiri Keret
- Internal Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnai-Zion Medical Center and Technion, Haifa, Israel; Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Aniela Shouval
- Rheumatology Unit, Bnai-Zion Medical Center and Technion, Haifa, Israel
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai-Zion Medical Center and Technion, Haifa, Israel; Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Kaly L, Bilder I, Rozenbaum M, Boulman N, Rimar D, Awisat A, Rosner I, Hussein H, Silawy A, Gaspar T, Slobodin G. Acute Gout Sacroiliitis. Isr Med Assoc J 2021; 23:191-192. [PMID: 33734634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Igor Bilder
- Department of Radiology, Bnai Zion Medical Center, Haifa, Israel
| | - Michael Rozenbaum
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nina Boulman
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Doron Rimar
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Abid Awisat
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Itzhak Rosner
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Haya Hussein
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Amal Silawy
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Tamar Gaspar
- Department of Radiology, Bnai Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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12
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Vadasz Z, Balbir Gurman A, Meroni P, Farge D, Levi Y, Ingegnoli F, Braun-Moscovici Y, Rosner I, Slobodin G, Rozenbaum M, Jiries N, Kaly L, Boulman N, Zilber K, Ginsberg S, Awisat A, Goldberg Y, Lurie M, Ghigna MR, Guignabert C, Humbert M, Rimar D. Lysyl oxidase-a possible role in systemic sclerosis-associated pulmonary hypertension: a multicentre study. Rheumatology (Oxford) 2020; 58:1547-1555. [PMID: 30770717 DOI: 10.1093/rheumatology/kez035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 01/09/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Lysyl oxidase (LOX) is an extracellular enzyme that cross-links collagen fibrils. LOX was found to be increased in serum of SSc patients and was suggested to be related to skin fibrosis, yet a vascular source of LOX has been demonstrated in idiopathic pulmonary arterial hypertension (iPAH). We aimed to validate elevated LOX serum levels in SSc and to study its correlation with clinical characteristics and investigate its main source at the tissue level. METHODS A total of 86 established SSc patients were compared with 86 patients with very early diagnosis of systemic sclerosis (VEDOSS), 110 patients with primary RP (PRP) and 80 healthy controls. LOX serum levels were determined by ELISA. Five lung and 12 skin biopsies from SSc patients were stained for LOX and compared with controls. RESULTS Serum levels of LOX in SSc were significantly higher than in VEDOSS, PRP and healthy controls (P < 0.001). LOX inversely correlated with the diffusing capacity of the lung for carbon monoxide diffusing capacity (DLCO) in diffuse SSc (r = -0.376, P = 0.02). Patients with moderate to severe estimated systolic PAH had higher LOX levels (P < 0.01). Lung biopsies demonstrated intense LOX staining in SSc patients with PAH that was predominantly located in the endothelium of the remodelled pulmonary vessels. CONCLUSION Serum LOX levels are increased in established SSc and inversely correlate with the DLCO. LOX is elevated in patients with moderate to severe PAH and is located in the proliferating endothelium in lung arterioles, suggesting a possible role for LOX in SSc-associated PAH.
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Affiliation(s)
- Zahava Vadasz
- Division of Allergy and Clinical Immunology, Bnai-Zion Medical Center, Haifa, Israel
| | | | - Pierluigi Meroni
- Department of Clinical Sciences and Community Health, University of Milan, Division of Rheumatology, Milan, Italy
| | - Dominique Farge
- Internal Medicine, St-Louis Hospital, AP-HP, CRMR for Rare Systemic Autoimmune Diseases, Paris, France.,Internal Medicine, McGill University, Montreal, Québec, Canada
| | - Yair Levi
- Department of Medicine E, Meir Medical Center, Kfar-Saba, Israel
| | - Francesca Ingegnoli
- Department of Clinical Sciences and Community Health, University of Milan, Division of Rheumatology, Milan, Italy
| | | | - Itzhak Rosner
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | | | - Nizar Jiries
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Nina Boulman
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Karina Zilber
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Shira Ginsberg
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Abid Awisat
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Yair Goldberg
- Department of Statistics, University of Haifa, Haifa, Israel
| | - Michael Lurie
- Pathology Department, Bnai-Zion Medical Center, Haifa, Israel
| | - Maria-Rosa Ghigna
- Pathology Department, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.,INSERM UMR_S 999, Le Plessis-Robinson, France.,Faculté de Médecine, Université Paris-Sud and Université Paris-Saclay, Kremlin-Bicêtre, France
| | - Christophe Guignabert
- INSERM UMR_S 999, Le Plessis-Robinson, France.,Faculté de Médecine, Université Paris-Sud and Université Paris-Saclay, Kremlin-Bicêtre, France
| | - Marc Humbert
- INSERM UMR_S 999, Le Plessis-Robinson, France.,Faculté de Médecine, Université Paris-Sud and Université Paris-Saclay, Kremlin-Bicêtre, France.,AP-HP Hôpital Bicêtre, Service de Pneumologie, Le Kremlin-Bicêtre, France
| | - Doron Rimar
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
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13
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Rimar D, Butbul Aviel Y, Gefen A, Nevo N, Shen-Orr SS, Starosvetsky E, Rosner I, Rozenbaum M, Kaly L, Boulman N, Slobodin G, Zuckerman T. Autologous Hematological Stem Cell Transplantation for Systemic Sclerosis in Israel. Isr Med Assoc J 2020; 22:104-110. [PMID: 32043328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Autologous hematological stem cell transplantation (HSCT) is a novel therapy for systemic sclerosis (SSc) that has been validated in three randomized controlled trials. OBJECTIVES To report the first Israeli experience with HSCT for progressive SSc and review the current literature. METHODS Five SSc patients who were evaluated in our department and were treated by HSCT were included. Medical records were evaluated retrospectively. Demographic, clinical, and laboratory data were recorded. Continuous data are presented as the mean ± standard deviation. Categorical variables are presented as frequencies and percentages. RESULTS Five SSc patients were treated with HSCT. Four patients were adults (mean age 53 ± 12 years) and one was a 12-year-old pediatric patient. All patients were female. HSCT was initiated 1.4 ± 0.8 years after diagnosis. Two patients were RNA POLIII positive, two were anti-topoisomerase 1 positive, and one only antinuclear antibodies positive. All patients had skin and lung involvement. The mean modified Rodnan Skin Score was 29 ± 4.7 before HSCT, which improved to 10.4 ± 9.6 after HSCT. The forced vital capacity improved from 68 ± 13% to 90 ± 28%. Diffusing capacity of the lungs for carbon monoxide increased by 6%. Among severe adverse events were cyclophosphamide-related congestive heart failure, antithymocyte globulin-related capillary leak syndrome, and scleroderma renal crisis. All symptoms completely resolved with treatment without sequela. No treatment related mortality was recorded. CONCLUSIONS HSCT is an important step in the treatment of progressive SSc in Israel. Careful patient selection reduces treatment related morbidity and mortality.
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Affiliation(s)
- Doron Rimar
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | | | - Aharon Gefen
- Pediatric Hematology Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Neta Nevo
- Pediatric Hematology Oncology, Rambam Health Care Campus, Haifa, Israel
| | - Shai S Shen-Orr
- Department of Immunology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Elina Starosvetsky
- Department of Immunology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Itzhak Rosner
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | | | - Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Nina Boulman
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Tsila Zuckerman
- Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
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14
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Awisat A, Rosner I, Rimar D, Rozenbaum M, Boulman N, Kaly L, Silawy A, Jiries N, Ginsberg S, Hussein H, Slobodin G. Crowned dens syndrome, yet another rheumatic disease imposter. Clin Rheumatol 2019; 39:571-574. [PMID: 31713735 DOI: 10.1007/s10067-019-04822-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/17/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Crowned dens syndrome (CDS) is defined as acute cervical or occipital pain due to a local inflammatory reaction related to calcifications in the ligaments surrounding the odontoid process. Virtually, all previous descriptions of CDS have related to calcium pyrophosphate dehydrate (CPPD) arthropathy. METHODS We prospectively identified a total of twenty-four consecutive inpatients with Crowned dens syndrome from January 2016 to December 2017 in our institution. RESULTS All patients (age range 54 to 87 years, 67% females) presented with acute onset pain in the upper neck and/or occiput accompanied with extreme neck stiffness. Most patients (79%) had elevated inflammatory markers. Four patients underwent temporal artery biopsy, which was negative for arteritis in all cases, and one was subjected to lumbar puncture, which was non-contributory. Seventeen patients (71%) had known rheumatic disease on presentation: 10 patients had the diagnosis of calcium pyrophosphate dehydrate arthropathy, 3 patients had ankylosing spondylitis, 2 patients had rheumatoid arthritis, 1 patient had Behcet's disease, and 1 suffered from Familial Mediterranean Fever. In 4 more patients, crowned dens syndrome was the presenting symptom of calcium pyrophosphate dehydrate disease. All patients were treated with glucocorticoids as 0.5 mg/kg prednisone plus colchicine 0.5 mg bid resulting in dramatic improvement in both clinical (head/neck pain alleviated and cervical spinal mobility regained) and laboratory measures. CONCLUSIONS Crowned dens syndrome should be considered, and craniocervical junction imaged in the context of acute cervical or occipital pain with stiffness and elevated inflammation markers not only in patients previously diagnosed with calcium pyrophosphate dehydrate arthropathy but also in diverse clinical settings.Key Points• This report highlights that crowned dens syndrome should be considered in various clinical setting besides calcium pyrophosphate dehydrate (CPPD) arthropathy.• Vigilance to this syndrome allows rapid treatment and may spare the patient unnecessary invasive procedures (i.e., temporal artery biopsy or lumbar puncture).
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Affiliation(s)
- Abid Awisat
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel.
| | - Itzhak Rosner
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Doron Rimar
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michael Rozenbaum
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel
| | - Nina Boulman
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel
| | - Amal Silawy
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel
| | - Nizar Jiries
- Internal medicine B, Bnai Zion Medical Center, 3339419, Haifa, Israel
| | - Shira Ginsberg
- Internal medicine B, Bnai Zion Medical Center, 3339419, Haifa, Israel
| | - Haya Hussein
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai Zion Medical Center, 47 Elyahu Golumb St, 3339419, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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15
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Hoffman E, Rahat MA, Feld J, Elias M, Rosner I, Kaly L, Lavie I, Gazitt T, Zisman D. Effects of Tocilizumab, an Anti-Interleukin-6 Receptor Antibody, on Serum Lipid and Adipokine Levels in Patients with Rheumatoid Arthritis. Int J Mol Sci 2019; 20:ijms20184633. [PMID: 31540528 PMCID: PMC6770905 DOI: 10.3390/ijms20184633] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 09/14/2019] [Accepted: 09/16/2019] [Indexed: 12/11/2022] Open
Abstract
Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease. Dyslipidemia is a known adverse effect of tocilizumab (TCZ), an anti-interleukin-6 receptor antibody used in RA treatment. We aimed to assess the effect of TCZ on lipid profile and adipokine levels in RA patients. Height, weight, disease activity scores, lipid profile and atherogenic indices (AI), leptin, adiponectin, resistin, interleukin-6, and high-sensitivity C-reactive protein (CRP) were measured before and four months after initiation of TCZ in 40 RA patients and 40 healthy controls. Following TCZ treatment, total cholesterol, high density lipoprotein (HDL), and triglycerides were significantly elevated, but no significant changes in weight, body mass index (BMI), low density lipoprotein (LDL), and AI were observed. Compared with controls, significantly higher adiponectin levels were measured in the RA group at baseline. Following TCZ treatment, resistin levels and the leptin-to-adiponectin ratio increased, adiponectin levels decreased, and leptin levels remained unchanged. No correlation was found between the change in adipokine serum levels and changes in the disease activity indices, nor the lipid profile. In conclusion, the changes observed suggest a protective role for TCZ on the metabolic and cardiovascular burden associated with RA, but does not provide a mechanistic explanation for this phenomenon.
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Affiliation(s)
- Elinoar Hoffman
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel.
- The Immunotherapy Laboratory, Carmel Medical Center, Haifa 3436212, Israel.
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa 3109601, Israel.
| | - Michal A Rahat
- The Immunotherapy Laboratory, Carmel Medical Center, Haifa 3436212, Israel.
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa 3109601, Israel.
| | - Joy Feld
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel.
| | - Muna Elias
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel.
| | - Itzhak Rosner
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa 3109601, Israel.
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, 3339419, Israel.
| | - Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, 3339419, Israel.
| | - Idit Lavie
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa 3109601, Israel.
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa 3436212, Israel.
| | - Tal Gazitt
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel.
| | - Devy Zisman
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel.
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa 3109601, Israel.
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16
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Rimar D, Rimar O, Rosner I, Rozenbaum M, Kaly L, Boulman N, Slobodin G. Nailfold Video Capillaroscopy: Beyond Systemic Sclerosis. Isr Med Assoc J 2019; 21:499-502. [PMID: 31507130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Doron Rimar
- Rheumatology Unit, Bnai Zion Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ori Rimar
- Rheumatology Unit, Bnai Zion Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Itzhak Rosner
- Rheumatology Unit, Bnai Zion Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michael Rozenbaum
- Rheumatology Unit, Bnai Zion Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nina Boulman
- Rheumatology Unit, Bnai Zion Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai Zion Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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17
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Ginsberg S, Rosner I, Slobodin G, Rozenbaum M, Kaly L, Jiries N, Boulman N, Awisat A, Hussein H, Novofastovski I, Silawy A, Rimar D. Infliximab for the treatment of refractory polyarteritis nodosa. Clin Rheumatol 2019; 38:2825-2833. [PMID: 30972576 DOI: 10.1007/s10067-019-04474-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 12/30/2018] [Revised: 01/29/2019] [Accepted: 02/07/2019] [Indexed: 01/22/2023]
Abstract
Polyarteritis nodosa (PAN) is a necrotizing vasculitis predominantly affecting medium and small size arteries. Cyclophosphamide, a drug with narrow therapeutic range and poor safety profile, constitutes the treatment of choice for PAN vasculitis with major organ involvement. To describe our clinical experience in treating refractory PAN with infliximab (a TNF inhibitor), a drug with good tolerability and better safety profile than cyclophosphamide. Twenty-six PAN patients were admitted to our rheumatology unit between 2006 and 2017, of whom nine patients, with severe and refractory disease, were treated with infliximab after failure of standard treatment. We describe herein the patients' characteristics, clinical manifestations, severity and response to infliximab treatment and review the current literature. Complete remission was defined as the absence of features of active disease and withdrawal of prednisone therapy. Significant improvement was defined as clinical improvement and prednisone dose reduction of at least 50% or a 50% reduction in immune modulatory medications other than prednisone. After 4 months of treatment, 8/9 (89%) patients achieved significant improvement, with two of them achieving complete remission. We suggest that anti-TNF agents, and in particular infliximab, are relatively safe and efficacious treatment options in refractory PAN. A randomized controlled trial should be done in order to objectively evaluate infliximab in PAN.
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Affiliation(s)
- Shira Ginsberg
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel.
- Internal Medicine B Department, Bnai Zion Medical Center, 47 Eliyahu Golomb Street, 33048, Haifa, Israel.
| | - Itzhak Rosner
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | | | - Lisa Kaly
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Nizar Jiries
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
- Internal Medicine B Department, Bnai Zion Medical Center, 47 Eliyahu Golomb Street, 33048, Haifa, Israel
| | - Nina Boulman
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Abid Awisat
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Haya Hussein
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | | | - Amal Silawy
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Doron Rimar
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
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18
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Kaly L, Slobodin G, Rimar D, Rozenbaum M, Boulman N, Ginsberg S, Awisat A, Zilber K, Hussein H, Rosner I. Central retinal vein occlusion in temporal arteritis: red sign or red herring? Rheumatology (Oxford) 2018; 57:1055. [PMID: 29361164 DOI: 10.1093/rheumatology/kex479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lisa Kaly
- Rheumatology Department, Bnai Zion Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel
| | - Gleb Slobodin
- Rheumatology Department, Bnai Zion Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel
| | - Doron Rimar
- Rheumatology Department, Bnai Zion Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel
| | - Michael Rozenbaum
- Rheumatology Department, Bnai Zion Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel
| | - Nina Boulman
- Rheumatology Department, Bnai Zion Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel
| | - Shira Ginsberg
- Internal Medicine/Rheumatology Department, Bnai Zion Medical Center, Haifa, Israel
| | - Abed Awisat
- Rheumatology Department, Bnai Zion Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel
| | - Karin Zilber
- Internal Medicine/Rheumatology, Hillel Yaffe Medical Center, Haifa, Israel
| | - Haya Hussein
- Rheumatology Department, Bnai Zion Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel
| | - Izthak Rosner
- Rheumatology Department, Bnai Zion Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel
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19
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Raitter R, Rimer D, Boulman N, Kaly L, Rozenbaum M, Rosner I, Odeh M, Slobodin G. [SUSTAINABILITY OF RITUXIMAB IN CONCOMMITANT TREATMENT WITH METHOTREXATE OR LEFLUNOMIDE IN PATIENTS WITH RHEUMATOID ARTHRITIS]. Harefuah 2017; 156:415-417. [PMID: 28786274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Rituximab is a biologic agent approved for the treatment of rheumatoid arthritis (RA) in combination with methotrexate (MTX) or leflunomide (LEF). However, limited data in the literature suggests that rituximab may have the same efficacy profile whether used in combination with MTX or as monotherapy. The aim of our study is to compare the sustainability of rituximab as monotherapy to combined therapy with MTX or LEF in Israeli patients with RA. METHODS A total of 35 RA patients treated with rituximab combined with MTX or LEF were compared with 26 RA patients treated with rituximab monotherapy regarding sustainability of rituximab treatment and its relationship to some patient and disease-related factors. RESULTS There was no difference in patient-related and disease-related parameters between patients treated with rituximab as monotherapy or combined with MTX/LEF. The survival of rituximab was similar in both groups (88.5% in the monotherapy group and 82.6% in the combined therapy group, p=NS), with similar percentages of patients discontinuing this biologic agent, whether due to inefficacy or side effects. CONCLUSIONS Rituximab may be considered as a biologic monotherapy in RA patients. Further prospective studies, evaluating sustainability of rituximab as a monotherapy in patients with RA are warranted.
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Affiliation(s)
- Ravit Raitter
- Department of Internal Medicine A, Bnai Zion Medical Center, Haifa
| | - Doron Rimer
- Rheumatology Unit, Bnai Zion Medical Center, Haifa
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa
| | - Nina Boulman
- Rheumatology Unit, Bnai Zion Medical Center, Haifa
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa
| | - Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, Haifa
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa
| | - Michael Rozenbaum
- Rheumatology Unit, Bnai Zion Medical Center, Haifa
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa
| | - Itzhak Rosner
- Rheumatology Unit, Bnai Zion Medical Center, Haifa
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa
| | - Majed Odeh
- Department of Internal Medicine A, Bnai Zion Medical Center, Haifa
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa
| | - Gleb Slobodin
- Department of Internal Medicine A, Bnai Zion Medical Center, Haifa
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa
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20
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Awisat A, Slobodin G, Jiries N, Rozenbaum M, Rimar D, Boulman N, Kaly L, Zilber K, Ginsberg S, Rosner I. Pseudoseptic Arthritis with Low Synovial Fluid Glucose in Familial Mediterranean Fever. Isr Med Assoc J 2017; 19:461-462. [PMID: 28786265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Abid Awisat
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nizar Jiries
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | | | - Doron Rimar
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nina Boulman
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Karina Zilber
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Shira Ginsberg
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Itzhak Rosner
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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21
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Rimar D, Slobodin G, Rosner I, Rozenbaum M, Kaly L, Boulman N, Jiries N, Awisat A, Vadasz Z. [THE ROLE OF SEMAPHORIN 7A IN SYSTEMIC SCLEROSIS]. Harefuah 2017; 156:418-421. [PMID: 28786275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Semaphorins are a large group of membrane bound and secreted proteins. The semaphorins were first recognized for their important role in neurodevelopment and specifically their repulsive axonal growth guidance during embryonic development. Recently, semaphorins have also been found to have an important role in the regulation of the immune system, thus denoted as "immune semaphorins". Semaphorin 7A is a membrane bound protein which mediated its effect by two receptors: the β1 integrin subunit and plexin C1. Interactions between semaphorin 7A and its receptors contribute to inflammation and immunity by the stimulation of macrophage chemotaxis and cytokine production, regulation of dendritic cell migration and modulation of T cell function. Recently, semaphorin 7A has been found to have a role in the induction of fibrosis by tumor growth factor β1 (TGF β1). TGFβ1 activates semaphorin 7A and its receptors plexin C1 and β1 integrin subunit and induces proliferation of fibroblasts, lung fibrosis and remodeling in mice. A small study of 4 patients with systemic sclerosis (SSc) has recently demonstrated increased expression of semaphorin 7A mRNA on fibroblasts and B lymphocytes in peripheral blood. AIMS To evaluate the expression of semaphorin 7A on regulatory T cells and B cells from peripheral blood of patients with SSc compared to healthy controls and to try and correlate the expression of semaphorin 7A with pulmonary fibrosis, skin fibrosis and other clinical characteristics of SSc patients. METHODS Twenty six SSc patients were compared to 10 healthy controls. The expression of semaphorin 7A was evaluated by flow cytometry analysis of B cells using monoclonal antibodies to CD 108 and CD 19 and on peripheral regulatory T cells using monoclonal antibodies to CD 3 and CD 108. The analysis was conducted using flow-cytometry. Demographic, clinical and laboratory data were prospectively collected. Further data collection included: Systolic pulmonary artery pressure as assessed by echocardiography, lung function tests including diffusing capacity, nailfold video capillaroscopy pattern, modified Rodnan skin score (MRSS), Valentini activity index and Medsger severity score. Pulmonary involvement was determined by high resolution CT scan if it was suspected, according to impaired lung functions or auscultatory findings. RESULTS Ten patients with diffused SSC (8 of whom suffered from pulmonary fibrosis) and 16 patients with limited disease were compared with 10 healthy controls. There was no difference between the groups with regard to age, gender, BMI or smoking habits. Semaphorin 7A expression on regulatory T cells was not different between SSc patients and healthy controls 4.2±6.5 % vs. 2.3±1.1 % (p< 0.35) nor was a difference found between SSC patients with diffuse disease compared to limited disease 2.5±8 % vs. 5.1±14 % (p< 0.3). Comparing the expression of semaphorin 7A on B cells did not reveal a difference between SSc patients and healthy controls as well 9.7±9.4 % vs. 4.9±1.7% (p< 0.12). No correlation was found between skin score, activity score or severity score and levels of expression of sempahorin 7A on B cells or regulatory T cells. CONCLUSIONS In this small scale study we were not able to validate the role of semaphorin 7A as a mediator of fibrosis in SSc, as was suggested by a previous pilot study. Larger scale studies and investigation of semaphorin 7A on other peripheral cells and in tissues are needed in order to delineate the exact role of semaphorin as a mediator of fibrosis in SSc.
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Affiliation(s)
- Doron Rimar
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Itzhak Rosner
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Michael Rozenbaum
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Nina Boulman
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Nizar Jiries
- Division of Allergy and Clinical Immunology, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Abid Awisat
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Zahava Vadasz
- Division of Allergy and Clinical Immunology, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
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Ginsberg S, Rosner I, Rozenbaum M, Slobodin G, Zilber K, Boulman N, Kaly L, Awisat A, Jiries N, Beyar-Katz O, Rimar D. Autoinflammatory associated vasculitis. Semin Arthritis Rheum 2016; 46:367-371. [DOI: 10.1016/j.semarthrit.2016.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/07/2016] [Accepted: 07/15/2016] [Indexed: 12/01/2022]
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Zilber K, Gorenberg M, Rimar D, Boulman N, Kaly L, Rozenbaum M, Rosner I, Slobodin G. Radionuclide Methods in the Diagnosis of Sacroiliitis in Patients with Spondyloarthritis: An Update. Rambam Maimonides Med J 2016; 7:RMMJ.10264. [PMID: 27824544 PMCID: PMC5101011 DOI: 10.5041/rmmj.10264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Sacroiliitis, inflammation of the sacroiliac joint (SIJ), is the hallmark of ankylosing spondylitis and spondyloarthritis (SpA) in general. The arsenal of recommended diagnostic modalities for imaging of the SIJ is scanty and, in practice, includes only conventional X-rays and magnetic resonance imaging (MRI). This review suggests that bone scintigraphy, particularly single-photon emission computed tomography (SPECT) with calculation of indices, or SPECT in combination with low-dose computed tomography (CT) can be a sensitive and specific tool for the diagnosis of sacroiliitis and can be used as part of the individualized approach to the diagnosis of axial SpA. In addition, [18F]fluoride positron emission tomography (PET)/CT imaging and immunoscintigraphy, using labeled monoclonal anti-cytokine antibodies, are promising methods of current scientific interest in this field.
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Affiliation(s)
- Karina Zilber
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Miguel Gorenberg
- Department of Nuclear Medicine, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Doron Rimar
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Nina Boulman
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michael Rozenbaum
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Itzhak Rosner
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Rimar D, Rosner I, Slobodin G, Rozenbaum M, Kaly L, Boulman N, Vadasz Z. Lysyl Oxidase in Systemic Sclerosis: Getting Under the Skin. Isr Med Assoc J 2016; 18:534-536. [PMID: 28471599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Doron Rimar
- Rheumatology Unit, Bnai Zion Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Itzhak Rosner
- Rheumatology Unit, Bnai Zion Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai Zion Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michael Rozenbaum
- Rheumatology Unit, Bnai Zion Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nina Boulman
- Rheumatology Unit, Bnai Zion Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Zahava Vadasz
- Division of Allergy and Clinical Immunology, Bnai Zion Medical Center, affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Rimar D, Rosner I, Slobodin G, Rozenbaum M, Halasz K, Jiries N, Kaly L, Boulman N, Vadasz Z. Semaphorin 3A, a potential immune regulator in familial Mediterranean fever. Clin Exp Rheumatol 2016; 34:S52-S55. [PMID: 27157528] [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] [Received: 10/12/2015] [Accepted: 03/24/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Semaphorin 3A (sema3A) plays a regulatory role in immune responses with effects on both T and B regulatory cells. Familial Mediterranean fever (FMF) is an autoinflammatory disease, yet a possible role for regulatory T and B cells has been described. METHODS 17 FMF patients during attack and then in remission, 8 FMF patients with smoldering disease and 12 healthy controls were enrolled. Sema3A in serum and its expression on regulatory T and B cells was evaluated. Clinical parameters of FMF patients were assessed. RESULTS Semaphorin 3A serum level was lower in FMF patients during attack, smoldering disease or remission than healthy controls, (242.3±9.8 ng/ ml vs. 258.9±11.5 ng/ml vs. 232.5±22.7 ng/ml vs. 323.3±160.2 ng/ml, respectively p<0.05). This decrease was specifically noted on regulatory B and T cells in FMF patients during attack and in smoldering disease and normalized in remission. CONCLUSIONS Sema3A expression on T and B regulatory lymphocytes is low in FMF patients during attack and in smoldering disease compared to the expression in remission and healthy controls. These results are in line with previous descriptions suggesting a possible role of regulatory T cells in termination of FMF attacks. Further studies are needed to verify these preliminary findings.
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Affiliation(s)
- Doron Rimar
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Itzhak Rosner
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Michael Rozenbaum
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Katy Halasz
- Division of Allergy and Clinical Immunology, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Nizar Jiries
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Nina Boulman
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - Zahava Vadasz
- Division of Allergy and Clinical Immunology, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel.
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Rimar D, Alpert A, Starosvetsky E, Rosner I, Slobodin G, Rozenbaum M, Kaly L, Boulman N, Awisat A, Ginsberg S, Zilber K, Shen-Orr SS. Tofacitinib for polyarteritis nodosa: a tailored therapy. Ann Rheum Dis 2016; 75:2214-2216. [PMID: 27558986 DOI: 10.1136/annrheumdis-2016-209330] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 07/14/2016] [Accepted: 08/09/2016] [Indexed: 01/18/2023]
Affiliation(s)
- Doron Rimar
- Rheumatology Unit, Faculty of Medicine, Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ayelet Alpert
- Department of Immunology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Elina Starosvetsky
- Department of Immunology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Itzhak Rosner
- Rheumatology Unit, Faculty of Medicine, Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Faculty of Medicine, Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michael Rozenbaum
- Rheumatology Unit, Faculty of Medicine, Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Faculty of Medicine, Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nina Boulman
- Rheumatology Unit, Faculty of Medicine, Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel
| | - Abid Awisat
- Rheumatology Unit, Faculty of Medicine, Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shira Ginsberg
- Rheumatology Unit, Faculty of Medicine, Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel
| | - Karina Zilber
- Rheumatology Unit, Faculty of Medicine, Bnai Zion Medical Center, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shai S Shen-Orr
- Department of Immunology, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Faculty of Biology, Technion-Israel Institute of Technology, Haifa, Israel
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Rimar D, Alpert A, Starosvetsky E, Rosner I, Slobodin G, Rozenbaum M, Kaly L, Boulman N, Awisat A, Shen Orr S. AB0539 Tofacitinib for Polyarteritis Nodosa – A Tailored Therapy. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rimar D, Balbir Gurman A, Meroni P, Farge D, Levy Y, Rosner I, Slobodin G, Jiries N, Rozenbaum M, Kaly L, Boulman N, Zilber K, Ginsberg S, Awisat A, Vadasz Z. FRI0244 Lysyl Oxidase as A Biomarker in Systemic Sclerosis– A Multicenter Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hirsch J, Rosner I, Rimar D, Kaly L, Rozenbaum M, Boulman N, Slobodin G. Tocilizumab Efficacy in a Patient with Positive Anti-CCP Chronic Lyme Arthritis. N Am J Med Sci 2016; 8:194-6. [PMID: 27213145 PMCID: PMC4866477 DOI: 10.4103/1947-2714.179960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CONTEXT Lyme arthritis, a manifestation of tick-borne Lyme disease, can prove to be refractory to classic treatment. CASE REPORT We present a case of a 48-year-old male, diagnosed with chronic Lyme arthritis, refractory to recurrent and prolonged courses of doxycycline, ceftriaxone, as well as hydroxychloroquine and methotrexate. The patient responded partially to tumor necrosis factor (TNF)-alpha blockade by etanercept and, finally, entered long-term remission after his treatment was switched to tocilizumab. CONCLUSION Off label treatment by biologic disease modifying antirheumatic drugs can be considered in selected patients with severe antibiotic-resistant Lyme arthritis.C.
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Affiliation(s)
- Julianna Hirsch
- Department of Medicine, Technion Institute of Technology, Bnai Zion Medical Center, Haifa, Israel
| | - Itzhak Rosner
- Department of Medicine, Technion Institute of Technology, Bnai Zion Medical Center, Haifa, Israel
- Department of Rheumatology, Bnai Zion Medical Center, Haifa, Israel
| | - Doron Rimar
- Department of Medicine, Technion Institute of Technology, Bnai Zion Medical Center, Haifa, Israel
- Department of Rheumatology, Bnai Zion Medical Center, Haifa, Israel
| | - Lisa Kaly
- Department of Medicine, Technion Institute of Technology, Bnai Zion Medical Center, Haifa, Israel
- Department of Rheumatology, Bnai Zion Medical Center, Haifa, Israel
| | - Michael Rozenbaum
- Department of Medicine, Technion Institute of Technology, Bnai Zion Medical Center, Haifa, Israel
- Department of Rheumatology, Bnai Zion Medical Center, Haifa, Israel
| | - Nina Boulman
- Department of Medicine, Technion Institute of Technology, Bnai Zion Medical Center, Haifa, Israel
- Department of Rheumatology, Bnai Zion Medical Center, Haifa, Israel
| | - Gleb Slobodin
- Department of Medicine, Technion Institute of Technology, Bnai Zion Medical Center, Haifa, Israel
- Department of Internal Medicine A, Bnai Zion Medical Center, Haifa, Israel
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Rozenbam M, Rimar D, Kaly L, Slobodin G, Awisat A, Rosner I. Variant CAPS in an adult- the use of genetics. Pediatr Rheumatol Online J 2015. [PMCID: PMC4597327 DOI: 10.1186/1546-0096-13-s1-p27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Rimar D, Rosner I, Slobodin G, Boulman N, Kaly L, Rozenbaum M, Vadasz Z. Semaphorin 3A, a potential immune regulator in Familial Mediterranean Fever. Pediatr Rheumatol Online J 2015. [PMCID: PMC4597259 DOI: 10.1186/1546-0096-13-s1-o46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Slobodin G, Rimar D, Boulman N, Kaly L, Rozenbaum M, Rosner I, Odeh M. Entheseal involvement in systemic disorders. Clin Rheumatol 2015; 34:2001-10. [PMID: 26354427 DOI: 10.1007/s10067-015-3068-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 08/30/2015] [Indexed: 12/11/2022]
Abstract
The objective of this study is to review the data on entheseal involvement in systemic disorders. A Pubmed search utilizing the indexing terms "enthesis" and "enthesitis" was conducted and the data pertinent to the aim of the review was extracted and organized in accordance with the preplanned structure of the manuscript. A number of cadaver-based studies, as well as studies using ultrasonography and magnetic resonance imaging, have detailed new distinct aspects of enthesis physiology and pathology in a variety of rheumatic and non-rheumatic systemic disorders. Major progress has been done in characterization of separate components of the enthesis organ, imaging of entheses, elaboration of the role and features of entheseal disease in spondyloarthropathies, juvenile idiopathic arthritis, osteoarthritis, familial Mediterranean fever, hyperuricemia, and other systemic conditions. The knowledge acquired and summarized herein shows that entheses can be affected in various ways in variety of medical disorders with different pathogenesis. Better understanding of the risk factors, mechanisms and natural history of enthesopathies is warranted. The current progress in the understanding of entheseal involvement in systemic disorders represents just the first step in resolving the entheses-related enigmas.
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Affiliation(s)
- Gleb Slobodin
- Internal Medicine A, Bnai Zion Medical Center, 47 Golomb St, Haifa, Israel. .,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Doron Rimar
- Rheumatology, Bnai Zion Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Nina Boulman
- Rheumatology, Bnai Zion Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Lisa Kaly
- Rheumatology, Bnai Zion Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michael Rozenbaum
- Rheumatology, Bnai Zion Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Itzhak Rosner
- Rheumatology, Bnai Zion Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Majed Odeh
- Internal Medicine A, Bnai Zion Medical Center, 47 Golomb St, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Rimar D, Nov Y, Rosner I, Slobodin G, Rozenbaum M, Halasz K, Haj T, Jiries N, Kaly L, Boulman N, Vadasz Z. Semaphorin 3A: an immunoregulator in systemic sclerosis. Rheumatol Int 2015; 35:1625-30. [PMID: 25895648 DOI: 10.1007/s00296-015-3269-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 01/17/2015] [Accepted: 04/09/2015] [Indexed: 12/24/2022]
Abstract
ABSTARCT Semaphorin 3A (sema3A) plays a regulatory role in immune responses, mainly affecting the activation of regulatory T cells. It has been found to correlate with disease activity in rheumatoid arthritis and systemic lupus erythematosus (SLE). To investigate the expression of sema3A in patients with systemic sclerosis (SSc) compared to healthy controls and SLE disease controls and to correlate it with clinical characteristics, 27 SSc patients, 42 SLE patients and 28 healthy controls were enrolled. Serum level of sema3A was measured by ELISA, and expression of sema3A on regulatory T cells was evaluated by FACS analysis. SSc patients were evaluated for demographics, clinical manifestations, routine laboratory results, nailfold videocapillaroscopy, pulmonary function tests, echocardiograms, modified Rodnan skin score, and disease activity and severity scores. Serum levels of semaphorin 3A were lower in SSc compared to healthy controls 14.38 ± 5.7 versus 27.14 ± 8.4 ng/ml, p < 0.0001 and similar to SLE 15.7 ± 4.3 ng/ml. The expression of semaphorin 3A on regulatory T cells was also lower in SSc compared to healthy controls 61.7 ± 15.7 versus 88.7 ± 3. 7 % (p < 0.0001). Semaphorin 3A serum level inversely correlated with the duration of disease: r = -0.4, p = 0.036 and with low C4 level r = 0.66, p = 0.026. SCL-70 antibody positivity was associated with a lower semaphorin 3A level (difference in mean of 3.44, p = 0.06). Sema3A expression is low in SSc serum and more specifically on regulatory T cells. This may help explain the reduced activation of regulatory T cells in SSc.
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Affiliation(s)
- Doron Rimar
- Rheumatology Unit, Faculty of Medicine, Bnai Zion Medical Center, Technion, POB 4940, 31048, Haifa, Israel.
| | - Yuval Nov
- Division of Statistics, Haifa University, Haifa, Israel.
| | - Itzhak Rosner
- Rheumatology Unit, Faculty of Medicine, Bnai Zion Medical Center, Technion, POB 4940, 31048, Haifa, Israel.
| | - Gleb Slobodin
- Rheumatology Unit, Faculty of Medicine, Bnai Zion Medical Center, Technion, POB 4940, 31048, Haifa, Israel.
| | - Michael Rozenbaum
- Rheumatology Unit, Faculty of Medicine, Bnai Zion Medical Center, Technion, POB 4940, 31048, Haifa, Israel.
| | - Katy Halasz
- Division of Allergy and Clinical Immunology, Faculty of Medicine, Bnai Zion Medical Center, Technion, POB 4940, 31048, Haifa, Israel.
| | - Tharwat Haj
- Division of Allergy and Clinical Immunology, Faculty of Medicine, Bnai Zion Medical Center, Technion, POB 4940, 31048, Haifa, Israel.
| | - Nizar Jiries
- Rheumatology Unit, Faculty of Medicine, Bnai Zion Medical Center, Technion, POB 4940, 31048, Haifa, Israel.
| | - Lisa Kaly
- Rheumatology Unit, Faculty of Medicine, Bnai Zion Medical Center, Technion, POB 4940, 31048, Haifa, Israel.
| | - Nina Boulman
- Rheumatology Unit, Faculty of Medicine, Bnai Zion Medical Center, Technion, POB 4940, 31048, Haifa, Israel.
| | - Zahava Vadasz
- Division of Allergy and Clinical Immunology, Faculty of Medicine, Bnai Zion Medical Center, Technion, POB 4940, 31048, Haifa, Israel.
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Rozenbaum M, Kaly L, Rimar D, Slobodin G, Boulman N, Jiries N, Rosner I. AB0931 Anti-TNF Agents in Intractable Familial Mediterranean Fever with Axial Spondylarthropathy: Four Cases. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rimar D, Rosner I, Slobodin G, Boulman N, Rozenbaum M, Halasz K, Haj T, Jiries N, Kaly L, Vadasz Z. AB0195 Semaphorin 3A as A Possible Immunoregulator in Systemic Sclerosis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rimar D, Rosner I, Nov Y, Slobodin G, Rozenbaum M, Halasz K, Haj T, Jiries N, Kaly L, Boulman N, Daood R, Vadasz Z. Brief report: lysyl oxidase is a potential biomarker of fibrosis in systemic sclerosis. Arthritis Rheumatol 2014; 66:726-30. [PMID: 24574233 DOI: 10.1002/art.38277] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 11/07/2013] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Fibrosis is a major cause of morbidity and mortality in systemic sclerosis (SSc). Levels of lysyl oxidase (LOX), an extracellular enzyme that stabilizes collagen fibrils, have been found to be elevated in the skin of SSc patients, but have not been evaluated in the serum or correlated with the clinical parameters. We undertook this study to evaluate serum LOX levels in SSc patients and to correlate these levels with clinical parameters of SSc. METHODS SSc patients were evaluated for demographic features, clinical manifestations, routine laboratory tests, serum autoantibodies, serum LOX concentrations, and nailfold capillaroscopy patterns. They underwent pulmonary function testing, echocardiography, and high-resolution computed tomography scans of the lung, assessment of skin fibrosis by the modified Rodnan skin thickness score (MRSS), and assessment of disease severity and activity by the Medsger severity scale and the Valentini activity index. RESULTS Twenty-six SSc patients were evaluated and compared with 25 healthy controls and with 9 disease control patients with primary myelofibrosis. Almost 62% of the SSc patients (16 of 26) had limited cutaneous SSc (lcSSc), while 38% had diffuse cutaneous SSc (dcSSc) (10 of 26); 31% of the patients (8 of 26) had lung involvement. The LOX concentration in SSc patients was higher than that in healthy controls and similar to that in disease controls (P < 0.0001), and it was significantly higher in patients with dcSSc than in those with lcSSc (P = 0.006). The LOX concentration correlated with the MRSS in patients without lung fibrosis. CONCLUSION This study is the first to demonstrate high serum LOX levels in SSc patients that correlate specifically with skin fibrosis. These correlations suggest that LOX levels may serve as a novel biomarker of fibrosis. Future studies are warranted to determine whether LOX is a potential therapeutic target in SSc.
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Slobodin G, Kaly L, Peri R, Kessel A, Rosner I, Toubi E, Rimar D, Boulman N, Rozenbaum M, Odeh M. Higher expression of latency-associated peptide on the surface of peripheral blood monocytes in patients with rheumatoid arthritis may be protective against articular erosions. Inflammation 2014; 36:1075-8. [PMID: 23605471 DOI: 10.1007/s10753-013-9639-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Latency-associated peptide (LAP) forms small latent complexes with transforming growth factor beta 1 (TGF-β1). TGF-β-LAP complexes can be detected on the surfaces of immune cells and have been recently shown to play a role in immune regulation through TGF-β1-mediated functions. A study was undertaken to investigate the correlation of LAP expression on the surface of immune cells and presence of articular erosions in patients with rheumatoid arthritis (RA). Venous blood was obtained from patients with severe RA as well as from healthy control subjects. Surface expression of LAP on peripheral blood mononuclear cells was analyzed by flow cytometry, measured as flow cytometric intensity separately on CD14(+) and CD14(-) cells, and compared between RA patients and healthy subjects. Patients with RA demonstrated higher surface expression of LAP on both CD14(+) and CD14(-) mononuclear cells than healthy individuals. Patients with erosive RA had significantly reduced intensity of anti-LAP staining on the CD14(+) cells when compared to RA patients without erosions (p = 0.01). The intensity of anti-LAP staining on CD14(-) cells was not different between groups of RA patients. Higher expression of LAP on the surface of the cells of monocyte lineage may be protective of formation of articular erosions in RA. Further studies are needed to elaborate the mechanism of this phenomenon.
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Affiliation(s)
- Gleb Slobodin
- Internal Medicine A, Bnai Zion Medical Center, P.O. Box 4940, Haifa, 31048, Israel,
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Kaly L, Boulman N, Rimar D, Slobodin G, Rosner I, Rozenbaum M. P01-009 – 2 years of colchicine IV in intractable FMF. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952261 DOI: 10.1186/1546-0096-11-s1-a13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Affiliation(s)
- Doron Rimar
- Department of Rheumatology, Bnai Zion Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Rimar D, Rosner I, Slobodin G, Rozenbaum M, haj T, Jiries N, Kaly L, Boulman N, Vadas Z. AB0141 Lysyl oxidase is correlated with fibrosis in systemic sclerosis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kaly L, Rosner I. Tocilizumab - a novel therapy for non-organ-specific autoimmune diseases. Best Pract Res Clin Rheumatol 2013; 26:157-65. [PMID: 22424201 DOI: 10.1016/j.berh.2012.01.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 01/04/2012] [Indexed: 01/01/2023]
Abstract
In the past decade, tocilizumab, an anti interleukin-6 agent, has been successfully developed as a therapeutic agent for the treatment of rheumatoid arthritis and systemic onset juvenile idiopathic arthritis. In addition to countering inflammation, tocilizumab is also known affect B cell as well as T cell function, thus modulating immune function, and impact osteoclasts, as well as vascular endothelial growth factor. As such, its efficacy is currently being explored in a large number of autoiommune conditions including a number of vasculitides, systemic lupus erythematosus, systemic sclerosis, polymyositis, graft versus host disease, relapsing polychondritis, as well as Behcet's syndrome, spondyloarthropathies, and tumor necrosis factor receptor associated periodic syndrome.
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Affiliation(s)
- Lisa Kaly
- Bnai Zion Medical Center, Haifa, Israel
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Rozenbaum M, Boulman N, Rimar D, Kaly L, Rosner I, Slobodin G. Uncommon transient osteoporosis of pregnancy at multiple sites associated with cytomegalovirus infection: is there a link? Isr Med Assoc J 2011; 13:709-711. [PMID: 22279710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Michael Rozenbaum
- Department of Rheumatology, Bnai Zion Medical Center affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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