1,569 research outputs found
Vitamin D in Rheumatoid Arthritis: potential implications for disease control and comorbidities management
No full textBackground. Vitamin D is able to regulate the activity of immune system in vitro; whether this action has some relevance in vivo is still a matter of debate. Aim. To investigate the potential role of vitamin D in the pathogenesis and in the management of Rheumatoid Arthritis (RA) and its comorbidities, in particular insulin resistance. Methods. We investigated the expression of tha main target genes implicated in vitami D metabolism on synovial samples obtained from RA and Osteoarthritis (OA) patients; moreover, we evaluated the expression of the CYP27B1, the activating enzyme of vitamin D metabolism, by synovial fibroblasts (SF) of RA patients in vitro. We also investigated, in vivo, the relevance of visceral obesity, assessed by ultrasounds, in the prediction of cardiovascular risk and glucose metabolism in the general population. Finally, we evaluated the cross-sectional association between glucose metabolism
parameters and vitamin D plasma concentration in severely obese diabetic subjects. Results. In the present study we failed to demonstrate significant differences in vitamin D metabolism between RA and OA patients; however, we demonstrated that SF express CYP27B1 under inflammatory state, being potentially able to locally activate vitamin D. Moreover we confirmed that visceral obesity, a well known risk factor for hypovitaminosis D, is the main determinant of insulin resistance and is a strong predictor of cardiovascular risk. Finally, we demonstrated that vitamin D in severely obese type 2 diabetes mellitus patients predicts glycemic control. Conclusions. Our data support the hypothesis that the local conversion of vitamin D could be exploited for therapeutic use in RA; finally, the improvement of vitamin D status might have beneficial effects on different comorbidities related to RA, in particular insulin resistance
Commenting on “Prognostic and diagnostic significance of copeptin in acute exacerbation of chronic obstructive pulmonary disease and acute heart failure: data from ACE 2 study” by Jacob A. Winther and colleagues
No full textAbstract We would like to comment on the article entitled “Prognostic and diagnostic significance of copeptin in acute exacerbation of chronic obstructive pulmonary disease and acute heart failure: data from ACE 2 study” by Jacob A. Winther and colleagues, in the light of the results of a multicentric study published in 2014 by Vetrone F. et al., in which 336 patients with dyspnea were enrolled in the Emergency Departments of three University Hospitals in Italy. These two studies confirm the prognostic role of copeptin in patients with dyspnea due to heart failure but, while Winther et al. performed the copeptin measurements only at admission, Vetrone et al. evaluated the time-course of copeptin plasma concentration from the admission to the hospital discharge. The results showed a better performance of copeptin measured at discharge as prognostic biomarker compared to copeptin at hospital admission; similarly, a lower reduction or an increase in copeptin concentration from admission to discharge was a strong prognostic predictor of unfavorable outcome. In our opinion this is a very important result, opening new perspectives for the use of copeptin as prognostic marker in HF patients
Osteoporose na artrite reumatoide: papel do sistema vitamina D/hormônio paratireóideo
No full textResumoA osteoporose é uma característica extra‐articular bem estabelecida da artrite reumatoide (AR). A inflamação sistêmica parece ser essencial para causar uma alteração em múltiplos sistemas homeostáticos implicados na saúde óssea, como as vias RANK/RANKL/osteoprotegerina e Wnt/β catenina; vários outros fatores causais têm sido implicados, como o uso crônico de corticosteroides. Como a vitamina D exerce funções imunorreguladoras importantes, tem‐se afirmado que o desarranjo do sistema vitamina D/hormônio paratireóideo (HPT), um determinante bem conhecido da saúde óssea, pode desempenhar um papel patogênico na autoimunidade; estudos com animais e dados clínicos apoiam essa hipótese. Além disso, os pacientes com AR parecem ser relativamente refratários à supressão de HPT induzida pela vitamina D. Portanto, a ligação entre a AR e a osteoporose pode ser em parte causada por alterações no sistema vitamina D/HPT. Uma melhor compreensão da fisiopatologia desse sistema pode ser crucial para prevenir e curar a osteoporose em pacientes com doenças inflamatórias/autoimunes. A maior evidência da correlação clínica de cooperação e interdependência entre a vitamina D e o HPT é que a correção da deficiência de vitamina D, pelo menos nas doenças autoimunes, deve ser orientada para a supressão do HPT.AbstractOsteoporosis is a well‐established extra‐articular feature of Rheumatoid Arthritis (RA). Systemic inflammation seems to play a crucial role in causing an alteration of multiple homeostatic systems implied in bone health, such as the RANK/RANKL/Osteoprotegerin and Wnt/β catenin pathways; several other causal factors have been called into question, including the chronic use of corticosteroids. Since vitamin D exerts important immune‐regulatory roles, it has been claimed that derangement of the vitamin D/parathyroid hormone (PTH) system, a well‐known determinant of bone health, may play a pathogenic role in autoimmunity; animal models and clinical data support this hypothesis. Furthermore, RA patients seem to be relatively refractory to vitamin D‐induced PTH suppression. Therefore, the link between RA and osteoporosis might in part be due to alterations in the vitamin D/PTH system. A better understanding of the pathophysiology of this system may be crucial to prevent and cure osteoporosis in patients with inflammatory/autoimmune diseases. A major clinical correlate of the strict cooperation and interdependence between vitamin D and PTH is that correction of the vitamin D deficiency, at least in autoimmune diseases, should be targeted to PTH suppression
The Gas6/TAM System and Multiple Sclerosis
No full textGrowth arrest specific 6 (Gas6) is a multimodular circulating protein, the biological actions of which are mediated by the interaction with three transmembrane tyrosine kinase receptors: Tyro3, Axl, and MerTK, collectively named TAM. Over the last few decades, many progresses have been done in the understanding of the biological activities of this highly pleiotropic system, which plays a role in the regulation of immune response, inflammation, coagulation, cell growth, and clearance of apoptotic bodies. Recent findings have further related Gas6 and TAM receptors to neuroinflammation in general and, specifically, to multiple sclerosis (MS). In this paper, we review the biology of the Gas6/TAM system and the current evidence supporting its potential role in the pathogenesis of MS
Long-term remission of corticosteroid- and cyclophosphamide-resistant Henoch-Schönlein purpura with rituximab
No full textCandidate Biomarkers of Liver Fibrosis: A Concise, Pathophysiology-oriented Review
No full textRepair of sustained liver injury results in fibrosis (i.e. the accumulation of extracellular matrix proteins), and ultimately the complete distortion of parenchymal architecture of the liver, which we call cirrhosis. Detecting and staging of fibrosis is thus a mainstay in the management of chronic liver diseases, since many clinically relevant decisions, such as starting treatment and/or monitoring for complications including hepatocellular carcinoma, may depend on it. The gold standard for fibrosis staging is liver biopsy, the role of which, however, is questioned nowadays because of cost, hazards and poor acceptance by patients. On the other hand, imaging techniques and/or measurement of direct and indirect serum markers have not proved to be completely satisfactory under all circumstances as alternatives to liver biopsy. Making progress in this field is now more crucial than ever, since treatments for established fibrosis appear on the horizon. Fine dissection of the pathways involved in the pathophysiology of liver diseases has put forward several novel candidate biomarkers of liver fibrosis, such as growth arrest-specific6, Mac-2-binding protein, osteopontin, placental growth factor, growth/differentiation factor 15 and hepatocyte growth factor. All molecules have been suggested to have potential to complement or substitute methods currently used to stage liver diseases. Here, we review the pros and cons for their use in this setting
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