539 research outputs found
Persistence of pathogenic B cell clones and relapse of cryoglobulinemic vasculitis in HCV-cured patients
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The manufacture and usage of immunoglobulins for therapeutic use – The Dark Side of the Moon
No full textabstract non disponibil
Might IgA be a biomarker of disease activity in Takayasu arteritis
No full textTakayasu arteritis is a systemic vasculitis of the large vessels and mainly affects Japanese and Southeast Asian women in the second and third decades of life. Inflammatory infiltrate affects the full thickness of the vessel wall, inducing progressive lumen stenosis and occlusion. The main biomarkers of disease activity are the ESR, CRP and serum levels of circulating cytokines. This case report describes the clinical history of a young woman with Takayasu disease with high serum levels of IgA at onset. IgA remained elevated with persistence of disease activity, and normalized only when the patient was treated with an anti-TNF agent (infliximab), which also induced a clinical response in the vasculitis. IgA levels, together with other inflammatory parameters, may be considered a biomarker of disease activity. Learning points: This case report highlights the need to increase the number of humoral markers used to assess disease course in Takayasu arteritis (TA).IgA may be considered a biomarker of TA disease activity.Serum IgA levels may be helpful to identify TA patients not responding to traditional therapy
Stranger in our Midst::The Becoming of the Queer God in the Theology of Marcella Althaus-Reid
No full textThis is the author accepted manuscript. The final version is available from the publisher via the link in this record.Book description: Marcella Althaus-Reid was one of the most fascinating and controversial theologians of the twentieth and early twenty-first century. Her strong personality and her iconoclastic work inspired a whole generation of theologians in the UK and worldwide. Marcella's creative life was cut short by her death from cancer in 2009. Yet she lives on, not least in those who have been inspired by her work and continue to engage with it. "Dancing Theology in Fetish Boots" draws together a number of world-class scholars and others who engage with the main themes of Marcella's work and show how the critical and controversial conversations which Marcella has begun can and do continue. It is therefore far more than a Festschrift, but a celebration of an intellectual life Marcella-style
The VH1-69-expressing marginal zone B cells expanded in HCV-associated mixed cryoglobulinemia display proliferative anergy irrespective of CD21low phenotype.
No full textThe case for cost-effectively treating cryoglobulinemic vasculitis with interferon-free anti-hepatitis C virus therapy.
No full text.Mixed cryoglobulinemia (MC) vasculitis affects approximately
5% of individuals with chronic hepatitis C virus (HCV) infection
and ranges from mild to life-threatening.1 Sustained virological
response leads to remission of vasculitis and reduced mortality, but
the response rate to interferon-based regimens is low for frequent
intolerance and ineligibility.1 Interferon-ineligible/intolerant/nonresponder
patients with severe organ damage require salvage treatments
with rituximab (RTX) or plasma exchange; however, these
treatments are expensive and provide only temporary benefit.1,2
Both the American Association for the Study of Liver Diseases
(http://www.hcvguidelines.org/full-report/when-and-whom-initiatehcv-
therapy) and the European Association for the Study of the
Liver (http://www.easl.eu/_newsroom/latest-news/easl-recommendations-
on-treatment-of-hepatitis-c-2014) recommend prioritizing
anti-HCV treatment in patients with MC vasculitis, but the impact
of the severity of vasculitis on indication for early treatment is not
thoroughly addressed.
We performed a retrospective chart review of 58 patients with
HCV-associated MC vasculitis followed at our institution (Supporting
Methods). Interferon-based therapy led to sustained virological
response in 11 patients (19%) (Supporting Fig. S1).
Vasculitis was stratified into mild/moderate (purpura, peripheral
neuropathy) and severe (nephropathy, chronic skin ulcers). Thirty
interferon-ineligible/intolerant/nonresponder patients with chronic
hepatitis, stable through follow-up, were selected; eight of them
had severe vasculitis and 22 mild/moderate vasculitis (Supporting
Fig. S1). The healthcare history, costs, and outcomes were compared
in these two groups (Table 1); only hospitalizations and
treatments related to complications of vasculitis were considered.
Patients with severe vasculitis stayed in hospital a mean of 16.59
days/year and were all treated with RTX, plasma exchange, or
both. Two of eight patients with severe vasculitis died from its
complications, one from intestinal vasculitis and one from endstage
renal disease and systemic infection resulting from infected
skin ulcers. Patients with mild/moderate vasculitis stayed in hospital
0.66 days/year; only two of 22 were treated with RTX, and
none died. Thus, healthcare cost overall and risk of death were
higher in patients with severe MC compared to those with
mild/moderate disease. Furthermore, there did not appear to be an
association of use of either plasma exchange or RTX with cost
(Supporting Table S1), which may have been related more to severity
of illness than to response to treatment.
Hagan et al.3 surmise a 12-week treatment with sofosbuvir/simeprevir,
at a drug cost of $150,000, as the state-of-the-art, most costeffective
therapy for interferon-ineligible/intolerant HCV-infected individuals.
Given the relatively high cost of care and the poor response/
high risk of death in patients with severe MC, prioritization of these
patients for treatment with interferon-free therapy should be considered;
and studies to determine tolerability and efficacy are warranted
CD21 low B cells are predictive markers of new digital ulcers in systemic sclerosis
No full textThe objective of this study was to evaluate the predictive role of CD21low B cells as markers of new digital ulcers in systemic sclerosis patients. Peripheral blood B cell subpopulations and clinical assessments have been evaluated in 74 systemic sclerosis patients at baseline and after a 12-month follow-up. After a 12-month follow-up, 23 (31.1%) systemic sclerosis patients developed new digital ulcers. The median percentage of CD21low B cells was significantly higher in patients with than without new digital ulcers [10.1 (4.3-13.6) versus 4.8 (3.5-7.4); p < 0.01]. The 10% cut-off shows good diagnostic accuracy [area under the curve (AUC) = 0.732, confidence interval (CI) = 0.587-0.878; P = 0.01]. Kaplan-Meier curves show a significantly reduced free survival from new digital ulcers in systemic sclerosis patients with CD21low B cells ≥ 10% (p < 0.0001). In multivariate analysis, CD21low B cells ≥ 10%, modified Rodnan skin score (mRSS) and systolic pulmonary arterial pressure (sPAP) are associated with the development of new digital ulcers. We hypothesize that CD21low B cells are a predictive marker of new digital ulcers in systemic sclerosis patients
The Marginal Zone B Cells Clonally Expanded in Hepatitis C-Related Mixed Cryoglobulinemia Display the Functional and Molecular Signatures of Anergy Induced by Continual B Cell Receptor Signaling
No full textReplicative senescence prevents the differentiation of B-cells to antibody producine cells in common variable immunodeficiency
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