Immunomodulating Therapies (immunomodulating + therapy)

Distribution by Scientific Domains

Selected Abstracts

Mycoplasma pneumoniae -associated myelitis: a comprehensive review

S. Tsiodras
Myelitis is one of the most severe central nervous system complications seen in association with Mycoplasma pneumoniae infections and both acute transverse myelitis (ATM) as well as acute disseminated encephalomyelitis (ADEM) have been observed. We reviewed all available literature on cases of Mycoplasma spp. associated ATM as well as ADEM with dominant spinal cord pathology and classified those cases according to the strength of evidence implicating M. pneumoniae as the cause. A wide range of data on diagnosis, epidemiology, immunopathogenesis, clinical picture, laboratory diagnosis, neuroimaging and treatment for this rare entity is presented. The use of highly sensitive and specific molecular diagnostic techniques may assist in clearly elucidating the role of M. pneumoniae in ATM/ADEM syndromes in the near future. Immunomodulating therapies may have a role in treating such cases. [source]

Management of systemic lupus erythematosus in the coming decade: potentials and challenges

Hiok Hee CHNG
Abstract The management of systemic lupus erythematosus (SLE) has improved in the past 50 years, but there is still a 3,5-fold increased mortality compared to the general population, with major organ failure due to active disease, infection and cardiovascular disease as the major challenges for the coming decade. Research advances at cellular, molecular and genetic levels enhance our understanding of the immunopathogenic mechanisms of SLE, leading to the development of drugs targeting specific sites of immune dysregulation , with therapies directed at cytokines, B- and T-cells, and their interactions showing promise. Advances are expected in the field of haematopoietic stem cell transplant (HSCT) as a therapeutic option for a subset of patients. Furthermore, some non-traditional immunomodulating therapies like statins, leflunomide and tacrolimus may prove useful as alternative or adjunct treatment in some patients. A better understanding of how current immunosuppressants act at the cellular and molecular level should guide the re-evaluation of the indications, doses and duration of therapy in clinical trials using these agents, many of which have not been subjected to proper double-blinded placebo-controlled studies. Research on triggers of SLE onset and flare of activity continues to yield information helpful in prevention. The evidence on the impact of psychosocial and economic factors on the outcome of SLE is overwhelming and the rheumatology community should enlist the assistance of other healthcare professionals, patient advocates and local health authorities to address these issues pertinent to good patient care and outcome. [source]

Immunomodulation of atherosclerosis: myth and reality

A. Nicoletti
Abstract. Nicoletti A, Caligiuri G & Hansson GK (H˘pital Broussais, Paris, and Karolinska Institute, Stockholm). Immunomodulation of atherosclerosis: myth and reality (Minisymposium). J Intern Med 2000; 247: 397,405. Atherosclerosis is an inflammatory disease which displays features of immune activation both locally and systemically. In the present review, we discuss the evidence for immune activation in human disease and experimental models, and survey candidate antigens associated with atherosclerosis. Studies of atherosclerosis in genetic models of immunodeficiency are analysed, as well as immunomodulating therapies and immunization protocols. Based on recent research, it is concluded that immunomodulation represents an interesting approach to the development of new prevention and treatment methods for atherosclerosis. [source]

Pyoderma gangrenosum of the scalp treated with cyclosporine A

Pasquale Patrone MD
A 56-year-old woman presented with an ulcer, with a depth of 9 mm, on the vertex and frontal parietal regions of the scalp. The lesion had a round shape (diameter, 7 cm), with clear-cut margins and vertical borders sinking vertically to a bottom that was entirely covered with purulent fibrinous yellowish matter and greenish colored necrotic tissue. Other numerous small roundish ulcers were present next to the large ulcer. These had irregular margins with a yellowish fibrinous bottom (Fig. 1). The patient reported the appearance of two small ulcers on the left and on the right frontal parietal regions about 1 year earlier. These had been treated locally with antimicrobials and antiseptics with no result. During the 2 months prior to our evaluation, a few small round-shaped ulcers had appeared on the scalp. These had progressively increased in size and number. Figure Figure 1 . Large ulcer with clear-cut margins, covered by purulent fibrinous matter, and other small roundish ulcers The patient had been an insulin-dependent diabetic for 23 years. Hematochemical examinations showed no significant alterations, except for a rise in glycemia. Urine examination gave normal results. Carcinoembryonic antigen and lymphocytic phenotyping indices were normal. Echographic, endoscopic, and radiocontrast studies of the abdomen did not reveal the presence of lesions either in the gastrointestinal tract or in other organs. Samples of ulcerous tissue were collected from the scalp to perform histologic and microbiologic analysis in search of fungi and bacteria. This last examination revealed the presence of Staphylococcus aureus and Candida parapsylosis. Direct search for mycobacteria was negative. Histology indicated the presence of dermal granulomatous inflammation with giant multinucleate cells, associated with large zones of suppuration and colliquative necrosis. While waiting to complete the diagnostic course, topical antiseptic, antimicrobial, and fibrinolytic therapy was administered; subsequently, as this did not lead to any improvement, systemic treatment with cyclosporine A (5 mg/kg/day) was started. Rapid improvement of the clinical picture occurred. The ulcers appeared cleaner from the first 2 weeks of treatment, radial growth stopped, and the margins were slightly more superficial. The patient continued with immunomodulating therapy at home over a period of 7 months. The dose was progressively reduced until, over a period of about 3 months, complete re-epithelialization of the lesion, with subsequent partial regrowth of the hair, was obtained (Figs 2 and 3). No relapses were observed 1 year after treatment was suspended. Figure 2. Partial re-epithelialization of the lesion with partial regrowth of the hair Figure 3. Scar and hair regrowth [source]