Hungarian Immunology

[Alpha calcidol treatment in patients with psoriatic arthropathy: clinical and immunological effects]

GAÁL János, LAKOS Gabriella, ALEKSZA Magdolna, KISS Judit, HORVÁTH Irén, HORKAY Edit, NAGY Georgina, SZEGEDI Andrea

OCTOBER 20, 2007

Hungarian Immunology - 2007;6(05)

[OBJECTIVE - Our objective was to describe the functional changes of the immune system also to evaluate the clinical parameters during systemic alphacalcidol (1αOH vitamin D3) treatment in patients with psoriatic arthropathy. PATIENTS AND METHOD - Nineteen patients with peripheral polyarticular form of psoriatic arthropathy were investigated. Ten patients were treated with daily 2×25 mcg alphacalcidol per os for 6 months and the other 9 patients served as controls. Three visits (at start, 3 and 6 months later) were carried out during the study, changes in the laboratory and clinical parameters were examined and analysed statistically in the treated and control groups. RESULTS - In the peripheral blood of the treated group a statistically significant decrease in the percentage of CD3/CD69 positive activated and CD8 positive IFNγ producing T cells was observed and the serum level of IFNγ also showed a significant decrease during the first 3 months. Another three months later no change in the above mentioned variables could be detected. Additionally, there was a significant decrease in the clinical activity of the disease using DAS28 score during the whole 6 months follow up period. In the control group no significant changes were observed. CONCLUSION - Our results show that systemic alphacalcidol treatment has a notable immune modulatory effect on patients with psoriatic arthropathy. This effect is manifested in short-term temporary decrease of type 1 immune responses and continuous decrease in the disease activity.]

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Clinical Neuroscience

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JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

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