Hungarian Immunology

[Biological therapy of arthritis and systemic autoimmune diseases - 2007]

SZEKANECZ Zoltán, TAMÁSI László

JANUARY 20, 2007

Hungarian Immunology - 2007;6(01-02)

[Biological therapy acts at a specific point of inflammation. Today, rheumatoid arthritis is the prototype disease in this context due to the relatively high number of accessible patients and wellstandardized follow-up tools. However, apart from this disease, biological therapy has been introduced to the treatment of other diseases including various forms of arthritis, such as ankylosing spondylitis and psoriatic arthritis, as well as systemic autoimmune disorders, such as lupus, scleroderma, inflammatory myopathies and Sjogren’s syndrome. Anti-tumor necrosis factor-α (TNF-α) agents play a central role in biological therapy as these agents have been successfully tried in most of these diseases. However, when seeking for specific targets for biologicals, specific pathogenic factors of the given disease should be determined. For example, while anti-TNF agents seem to be most effective in various types of arthritis, anti-B cell therapy may be the first choice in other autoimmune conditions, such as lupus, Sjogren’s syndrome or dermatomyositis. It is important to consider the specific characteristics of the administered agents as there may be differences regarding side-effects.]

COMMENTS

0 comments

Further articles in this publication

Hungarian Immunology

[The immunmodulatory effect of 1,25 dihydroxyvitamin D3]

SZEGEDI Andrea, NAGY Georgina, BARÁTH Sándor, GAÁL János

[1,25 dihydroxyvitamin D3, the biologically active metabolite of vitamin D3 plays an important role not only in bone and calcium metabolism but in differentiation of many cells and in the immunomodulation. It exerts its biological effects via vitamin D receptor (VDR) expressed in antigen-presenting cells and activated T cells. VDR is a member of the superfamily of nuclear hormone receptors. The receptor- ligand interaction activates nuclear transcription factors or the receptor binds directly to vitamin D responsive elements in the promoter regions of cytokine genes. Dendritic cells (DC) are the primary targets of vitamin D3; it inhibits the differentiation and maturation of DCs, and hereby DC-dependent T cell activation. These immunomodulatory activities have been demonstrated in vitro and in different models of autoimmune diseases and transplantation in vivo. In this report we review the regulatory effects of active vitamin D3 on the immune system and the latest results emphasizing the immunomodulatory role of 1,25 dihydroxyvitamin D3 which might be utilized more in therapy.]

Hungarian Immunology

[In vitro methods for measuring phagocytosis and killing of bacteria by neutrophil granulocytes]

RADA Balázs

[Accounting for about two-thirds of our white blood cells, neutrophilic granulocytes are key members of the innate immune system of the human body. They are terminally differentiated cells equipped with numerous antimicrobial weapons. Neutrophils are the first to arrive at sites of infections; their main mission is to phagocytose and destroy bacteria and funghi entering the human body. They fullfill a central role in both the inflammatory response of the body and the coordination of the innate and acquired immune systems’ function. Their deficient performance leads to impaired resistance of the host against microbes and to higher frequency of infections; their uncontrolled function, in turn, may damage our own tissues. Because of all of this, it is highly important from both basic and clinical perspective that we know as much as possible about the function of our neutrophilic granulocytes. In this paper methods available for measuring phagocytic and killing capacities of human neutrophils are reviewed. Each method has its advantages and disadvantages. The method chosen mainly depends on experimental tools available and informations needed.]

Hungarian Immunology

[Autoimmunity as a result of escape from RNA surveillance]

SEMSEI Imre, DARISE Farris, BACHMANN Michael

[The pathomechanisms of autoimmune diseases are still unknown. Numerous factors are thought to play a role in the formation of the diseases (genetic arrangement, hormonal factors, exogen and endogen viruses, etc.) and many hypotheses have been formulated to explain the role of these factors. Most of the theories suspect that disturbance of the immune system is the clue but according to other researchers the immune system performs properly and one has to find other alterations that could be blamed for the formation of the autoimmune diseases. The aim of our present work is to show that certain genetic alterations together with the mistake of the RNA surveillance system could lead to autoimmune reactions. Results of immune research conducted in the past two decades revealed that there are mutations in the hot spot region of exon 7 of the La gene in the peripheral lymphocytes of patients suffering from certain autoimmune diseases (Sjögren's syndrome, SLE). RNAs originated from the mutant gene contain premature termination codon and therefore the RNA surveillance mechanism should get rid of these RNAs in order to prevent the formation of mutant proteins. However, because of the mistake of the surveillance system mutant proteins are formed that could finally lead to the autoimmune reactions.]

Hungarian Immunology

[The relationship between metabolic diseases and the immune system]

SIPKA Sándor, PARAGH György, FÜLÖP Péter, MAGYAR Pál, ENDRE László, GALUSKA László

Hungarian Immunology

[An interview with writer Pál Békés]

SZEKANECZ Zoltán, SZŰCS Gabriella, SZÁNTÓ Sándor, SZABÓ Zoltán

All articles in the issue

Related contents

Clinical Neuroscience

CANOMAD syndrome with respiratory failure

SALAMON András, DÉZSI Lívia, RADICS Bence, VARGA Tímea Edina, HORTOBÁGYI Tibor, TÖMÖSVÁRI Adrienn, VÉCSEI László, KLIVÉNYI Péter, RAJDA Cecília

CANOMAD (chronic ataxic neuropathy, ophthalmoplegia, M-protein agglutination, disialosyl antibodies) syndrome is a rare polyneuropathy. IgM paraproteins react with ganglioside-containing disialylated epitopes resulting in dorsal root ganglionopathy and B-lymphocyte infiltration of cranial and peripheral nerves. Clinical features include ataxia, slight muscle weakness, areflexia, sensory- and cranial nerve symptoms. Case studies have reported the efficacy of rituximab and intravenous immunoglobulin (IVIg) treatments. We present the case of a 57-year-old man, who had difficulty walking, with numbness and clumsiness in all limbs. He had areflexia, vibratory sensation loss and ataxia. Laboratory tests showed IgM monoclonal components and disialosyl antibodies in the serum. Nerve conduction studies indicated severe sensorimotor demyelinating polyneuroradiculopathy. Despite IVIg and rituximab treatments, the patient’s disease course gradually worsened and he died of respiratory failure. Neuropathological examination revealed dorsal column- and dorsal root atrophy with mixed mononuclear cell infiltration. This article aims to draw attention to this syndrome, and the use of early potent immunosuppressive treatment to improve patients’ quality of life.

Clinical Oncology

[Cancer-treatment induced peripheral neuropathy]

DEMETER Gyula

[Peripheral neuropathy is caused by structural or functional damage of nervous system. The pathophysiology is not well known. Its clinical features are established but there is a need to standardize CIPN assessment, also considering that health care providers and patients frequently have a different perception of CIPN severity. Neurotoxicity caused by traditional chemotherapy is widely recognized in patients with cancer. The adverse effects of newer therapeutics, such as targeting and immunotherapeutic agents, need more information for the proper management. This review addresses the main neurotoxicities of cancer treatments with a focus on the newer therapeutics. Recognition of these patterns of toxicity is important because drug discontinuation or dose adjustment might prevent further neurological injury. Treatment is symptomatic. For prevention or treatment there is need for further basic research outcomes.]

Lege Artis Medicinae

[Infectious diseases associated with biological therapy]

KÁDÁR János

[The use of biological therapeutic agents increases the risk of certain infectious diseases. The greatest hazards are the reactivation of tuberculosis or hepatitis B infection and the development of sepsis. The degree of risk is comparable to that experienced with the use of routine DMARD therapy: in case of an adequate choice of treatment the risk is equal to or slightly higher than that of conventional treatment. However, this hazard is definitely smaller than that associated with the use of corticosteroids at doses necessary to reach the required immunosuppressive effect. This article provides a brief summary of potential infectious illnesses on the basis of the literature.]

Lege Artis Medicinae

[Efficiency and safety of the vaccination against H1N1 influenza virus in inflammatory bowel disease]

FARKAS Klaudia, JANKOVICS István, MELLES Márta, NAGY Ferenc, SZEPES Zoltán, WITTMANN Tibor, MOLNÁR Tamás

[INTRODUCTION - Inactivated influenza and H1N1 vaccination is recommended yearly for patients with inflammatory bowel disease receiving immunosuppressive therapy; however, immunomodulator and biological therapy might impair the immune response to the vaccination. In our study, we assessed whether immunity can develop in response to H1N1 influenza vaccination in patients receiving immunomodulator and/or biological therapy. We also assessed the occurrence of side effects after the immunisation in these patients. PATIENTS AND METHODS - In our prospective study, blood samples were obtained from 24 patients (12 Crohn’sdisease, 12 ulcerative colitis) one month after immunisation against influenza A/California/ 07/2009 (H1N1) virus. At the time of vaccination, all patients have been receiving immunomodulator and/or biological therapy for at least three month. Antiviral antibodies were detected by using microneutralisation assay. The safety of the vaccination was assessed by questionnaires. RESULTS - Every patient developed complete immunity against influenza A (H1N1) virus, independently from the type of immunosuppressive therapy. Regarding side effects, local symptoms occurred in six patients and systemic symptoms in another six patients. Mild diarrhea occurred in five patients. Moderate exacerbation of the disease was observed in 2 patients with Crohn’s disease and in one patient with ulcerative colitis. CONCLUSIONS - According to our results, immunocompromised patients with IBD can be safely advised to receive the vaccination. In our study, all patients developed adequate immunity according to microneutralisation titers.]

Lege Artis Medicinae

[Rituximab therapy in rheumatoid arthritis]

SÜTŐ Gábor

[Rheumatoid arthritis is a chronic, lifelong disease that causes severe joint deformity, reduces quality of life, and, if not treated appopriately, leads to disability and substantial premature mortality. Its treatment is a multistep procedure, where different grades of treatment options follow each other. Besides traditional, diseasemodifying antirheumatic drugs (DMARDs) and biological therapies inhibiting TNF, a new therapautic option is the use of a chimeric antibody, rituximab, which inhibits B lymphocyte function. This drug is an effective and safe choice for those patients who have received various anti- TNF therapies or do not tolerate TNF inhibition.]