Hungarian Immunology

[Cyclosporin A therapy of autoimmune urticaria]

IRINYI Beatrix, ZEHER Margit, HUNYADI János, SZEGEDI Andrea

JANUARY 10, 2004

Hungarian Immunology - 2004;3(01)

[INTRODUCTION - In chronic idiopathic urticaria the etiology is unknown in spite of extensive investigations. In 27-50% of these cases autoimmune mechanisms are detected in the background. CASE REPORT - The authors demonstrate the case of an autoimmune urticaria patient with positive autologous serum skintest, who responded well to cyclosporin A therapy. CONCLUSION - According to the observation and the relevant literature, the authors also found small dose cyclosporin A therapy useful and safe in treating therapy resistant chronic urticaria.]

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[Intracytoplasmic cytokines in dermatomyositis]

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[OBJECTIVE - To investigate the intracellular and soluble cytokine levels in peripheral blood of patients with active and inactive dermatomyositis (DM). Methods The frequency of the intracellular IFN-g, IL- 4 and IL-10 expression of CD4+ or CD8+ cells were determined by flow cytometry. We measured the concentrations of soluble cytokines with commercial ELISAs. RESULTS - In active DM we observed decreased IFNg expression of CD4+ and CD8+ cells. These prominent changes disappeared in the inactive stage of the disease. In DM we could not detect a significant change in the intracellular IL-4 cytokine expression either in the active or in the inactive form. The IL-10 expression was elevated in the inactive state of the patients. CONCLUSION - We can state that a difference between aDM and iDM seems to exist in the level of peripheral blood lymphocytes and their intracellular cytokine content.]

Hungarian Immunology

[TNF-α blocking therapy in rheumatoid arthritis]

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[We conducted the first Hungarian open-label study using infliximab (Remicade) in 62 rheumatoid arthritis (RA) patients. The mean disease duration was 8.7 years. Patients receiving methotrexate for at least 3 months with active RA were included in the study. All patients received concomittant methotrexate treatment. Results indicated a 61%, 35% and 18% improvement in ACR20, ACR50 and ACR70, respectively. In most patients, dramatic improvement was seen as soon as after the first or second infusion.]

Hungarian Immunology

[Gene therapy as a treatment for rheumatoid arthritis]

JAMES M. Woods

[A clear understanding of the pathogenic events and/or environmental conditions that lead to the development of rheumatoid arthritis has not been accomplished. In recent years, some of the most capable therapies have targeted individual proteins, such as proinflammatory cytokines, which contribute to persistent inflammation. The success of these therapies in some patients underscores the importance of having a solid pathophysiologic knowledge of the mechanisms at play in the diseased joint. Targeting the joint therapeutically with proteins or other agents has presented many challenges in the treatment of rheumatoid arthritis. To circumvent these obstacles, the idea of providing transgenes to cells of the synovial lining was born. This use of gene therapy, as a delivery vehicle rather than replacement of a genetic deficit, has had many successes in preclinical animal studies. Preliminary results of the first Phase I clinical trial in humans suggests that an ex vivo approach can be safe and enable transgene expression. This review provides a consolidated overview of many of the successful gene therapy strategies undertaken for the treatment of animal models of arthritis. The focus is on: 1. joint targeting strategies, including discussion on the local and systemic approaches as well as the contralateral joint; 2. the applicability of viral vectors, including comparison of adenoviral, retroviral, adeno-associated, and herpes simplex viruses; 3. timing and dosage of treatment; and 4. targets and candidate proteins that have been examined, including targeting proinflammatory cytokines or the use of anti-inflammatory cytokines.]

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Hungarian Immunology

[Experiences on cyclosporin-A treated childhood atopic dermatitis resistant to other therapies]

SZAKOS Erzsébet, SZEGEDI Andrea, SÓLYOM Enikõ, HUNYADI János

[BACKGROUND - Cases of six children suffering from serious form (resistant to conventional therapy) of atopic dermatitis are presented and the experiences regard of treatment with cyclosporin A (Sandimmun Neoral-microemulsion form) are summarised. PATIENTS - The average age of the 4-16 year-old children (three girls, three boys) was 9.9 years. The skin process started at infantile age. The cyclosporin A was used during 12-85 weeks, in a maximal dose of 3.5-5 mg/body weight kg/day. The patients received locally creams or ointments to moisture their skin continuously and if it was necessary, corticosteroid creams or ointments for a few days. RESULTS - The therapeutic response was excellent in five cases and poor in one case. The short time therapies resulted transient, the long time therapies long acting effect. There was no side effect indicating the stop of cyclosporin A therapy. Three children presented body weight elevation slightly higher than the age-related physiologic change. Epstein-Barr and cytomegalovirus infection with severe submandibular lymphadenopathy appeared in a patient and transient hypertrichosis in the case treated for 85 weeks. DISCUSSION - The authors propose treating severe childhood atopic dermatitis resistent to other therapeutic possibilities with cyclosporin A. The adequate follow up, monitoring of clinical and bloodchemical parameters are important.]

Clinical Neuroscience

A rare entity of acquired idiopathic generalised anhidrosis which has been successfully treated with pulse steroid therapy: Does the histopathology predict the treatment response?

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Acquired idiopathic generalised anhidrosis is an uncommon sweating disorder characterized by loss of sweating in the absence of any neurologic, metabolic or sweat gland abnormalities. Although some possible immunological and structural mechanisms have been proposed for this rare entity, the definitive pathophysiology is still un­clear. Despite some successfully treated cases with systemic corticosteroid application, the dose and route of steroid application are controversial. Here, we present a 41-year-old man with lack of genera­lised sweating who has been successfully treated with high dose pulse intravenous prednisolone. We have discussed his clinical and histopathological findings as well as the treatment options in view of the current literature.

Clinical Neuroscience

[Zonisamide: one of the first-line antiepileptic drugs in focal epilepsy ]

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Clinical Neuroscience

Effects of valproate, carbamazepine and levetiracetam on Tp-e interval, Tp-e/QT and Tp-e/QTc ratio

YASAR Altun, ERDOGAN Yasar

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