Immunological Features Of Patients Research Articles

Bullous pemphigoid induced by dipeptidyl peptidase-4 inhibitors. Eight cases with clinical and immunological characterization.

Dipeptidyl peptidase-4 (DPP-4) inhibitors have increasingly been identified as causative agents of bullous pemphigoid. The clinical and immunological characteristics of this pemphigoid variant are still unclear. The objective of our study was to analyze the clinical and immunological features of patients with pemphigoid induced by DPP-4 inhibitors. All patients diagnosed with DPP-4 inhibitor-associated bullous pemphigoid at dermatology departments in three Spanish centers during the period 2013 to 2015 were included. ELISA assays for the NC16A domain of BP180 and BP230 were performed. Immunoblot studies using epidermal/dermal extracts and the C-terminal, NC16A and LAD-1 regions of BP180 were also carried out. A total of eight patients were identified (5 treated with vildagliptin, 2 with linagliptin, and one with sitagliptin). Of these, four presented the classical inflammatory phenotype of bullous pemphigoid and four a noninflammatory phenotype. The ELISA for BP180 (NC16A domain) was positive in six patients at diagnosis. Most patients reacted to more than one BP180 antigenic site (LAD-1 and/or C-terminal domain) on the immunoblot. Two patients showed no reaction against the NC16A domain of BP180 on either the ELISA or immunoblot but recognized either LAD-1 or both LAD-1 and the C-terminal domain. Only one of the NC16A-negative patients had a noninflammatory subtype of bullous pemphigoid. Patients with DPP-4 inhibitor-induced BP may present either an inflammatory or a noninflammatory phenotype of BP. IgG response against other BP180 regions different from the NC16A domain, such as LAD-1 and the C-terminal domain, could be pathogenically relevant to the onset of DPP-4 inhibitor-induced BP.

Undifferentiated Connective Tissue Disease and Interstitial Lung Disease: Trying to Define Patterns

ObjectivesTo identify clinical or immunological features in patients with undifferentiated connective tissue disease (UCTD) associated interstitial lung disease (ILD), in order to group them and recognize different functional and high resolution computed tomography (HRCT) behavior. MethodsRetrospective cohort study. Patients meeting Kinder criteria for UCTD were included. We defined the following predictive variables: ‘highly specific’ connective tissue disease (CTD) manifestations (Raynaud's phenomenon, dry eyes or arthritis), high antinuclear antibody (ANA) titer (above 1:320), and ‘specific’ ANA staining patterns (centromere, cytoplasmic and nucleolar patterns). We evaluated the following outcomes: change in the percentage of the predicted forced vital capacity (FVC%) during the follow-up period, and HRCT pattern. ResultsSixty-six patients were included. Twenty-nine (43.94%) showed at least one ‘highly specific’ CTD manifestation, 16 (28.57%) had a ‘specific’ ANA staining pattern and 29 (43.94%) high ANA titer. Patients with ‘highly specific’ CTD manifestations were younger (mean [SD] 52 years [14.58] vs 62.08 years [9.46], P<.001), were more likely men (10.34% vs 48.65%, P<.001) and showed a smaller decline of the FVC% (median [interquartile range] 1% [−1 to 10] vs −6% [−16 to −4], P<.006). In the multivariate analysis, the presence of highly specific manifestations was associated with improvement in the FVC% (B coefficient of 13.25 [95% confidence interval, 2.41 to 24.09]). No association was observed in relation to the HRCT pattern. ConclusionThe presence of ‘highly specific’ CTD manifestations was associated with female sex, younger age and better functional behavior. These findings highlight the impact of the clinical features in the outcome of patients with UCTD ILD.

Charakterystyka kliniczna i immunologiczna pacjentów z niezróżnicowaną chorobą tkanki łącznej i dominującą manifestacją skórną

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Celińska-Löwenhoff M, Pastuszczak M, Stec-Polak M, Tyrak K, Wojas-Pelc A, Musiał J. Clinical and immunological characteristics of patients with undifferentiated connective tissue disease and dominating skin manifestation. Dermatology Review/Przegląd Dermatologiczny. 2018;105(6):701-709. doi:10.5114/dr.2018.80838. APA Celińska-Löwenhoff, M., Pastuszczak, M., Stec-Polak, M., Tyrak, K., Wojas-Pelc, A., & Musiał, J. (2018). Clinical and immunological characteristics of patients with undifferentiated connective tissue disease and dominating skin manifestation. Dermatology Review/Przegląd Dermatologiczny, 105(6), 701-709. https://doi.org/10.5114/dr.2018.80838 Chicago Celińska-Löwenhoff, Magdalena, Maciej Pastuszczak, Magdalena Stec-Polak, Katarzyna Tyrak, Anna Wojas-Pelc, and Jacek Musiał. 2018. "Clinical and immunological characteristics of patients with undifferentiated connective tissue disease and dominating skin manifestation". Dermatology Review/Przegląd Dermatologiczny 105 (6): 701-709. doi:10.5114/dr.2018.80838. Harvard Celińska-Löwenhoff, M., Pastuszczak, M., Stec-Polak, M., Tyrak, K., Wojas-Pelc, A., and Musiał, J. (2018). Clinical and immunological characteristics of patients with undifferentiated connective tissue disease and dominating skin manifestation. Dermatology Review/Przegląd Dermatologiczny, 105(6), pp.701-709. https://doi.org/10.5114/dr.2018.80838 MLA Celińska-Löwenhoff, Magdalena et al. "Clinical and immunological characteristics of patients with undifferentiated connective tissue disease and dominating skin manifestation." Dermatology Review/Przegląd Dermatologiczny, vol. 105, no. 6, 2018, pp. 701-709. doi:10.5114/dr.2018.80838. Vancouver Celińska-Löwenhoff M, Pastuszczak M, Stec-Polak M, Tyrak K, Wojas-Pelc A, Musiał J. Clinical and immunological characteristics of patients with undifferentiated connective tissue disease and dominating skin manifestation. Dermatology Review/Przegląd Dermatologiczny. 2018;105(6):701-709. doi:10.5114/dr.2018.80838.

Клинико-иммунологические параллели при острых кишечных инфекциях, вызванных условно-патогенными энтеробактериями

Клинико-иммунологические параллели при острых кишечных инфекциях, вызванных условно-патогенными энтеробактериями

Клинико-иммунологические особенности пациентов с различными формами аллергических ринитов при сенсибилизации микробными, бытовыми и пыльцевыми аллергенами

Клинико-иммунологические особенности пациентов с различными формами аллергических ринитов при сенсибилизации микробными, бытовыми и пыльцевыми аллергенами

Increased proportion of a CD38highIgD+ B cell subset in peripheral blood is associated with clinical and immunological features in patients with primary Sjögren's syndrome

We investigated the correlation between the increased proportion of peripheral B cell subsets and clinical and immunological features in primary Sjögren's syndrome (pSS). We found that the proportion of CD19+ B cells was significantly increased in pSS as compared with HC and was correlated with serum IgG levels. Moreover, in vitro IgG production by CD19+ B cells was significantly increased in pSS and was positively and significantly correlated with serum IgG levels. FACS analysis revealed that the proportions of peripherally CD38highIgD+ B cells and CD38highIgD− B cells were significantly increased in pSS. In addition, the proportion of CD38highIgD+ B cells positively correlated with ESSDAI scores and serum levels of IgG, anti-Ro/SSA and anti-La/SSB antibodies while that of CD38highIgD− B cells showed no correlation with these parameters. Our data suggest that increased proportion of CD38highIgD+ B cells in pSS is involved in IgG overproduction including autoantibodies, and correlates with disease progression.

Latent Autoimmune Diabetes in Adults in North Indian Region: Assessment of β-Cell Function, Metabolic and Immunological Features

We undertook a study to assess β-cell function, metabolic and immunological features of patients with latent autoimmune diabetes in adults (LADA) and investigate heterogeneity within LADA based on low and high glutamic acid decarboxylase autoantibodies (GADA) titers. A total of 139 patients with adult-onset diabetes were examined cross-sectionally in the National capital region of Northern India. Medical history of all subjects was reviewed with the aim of collecting clinical data. Glucose, glycosylated hemoglobin, lipid profile, creatinine, C-peptide, and GADA were measured in 10-12 hrs fasting blood sample. Assessment of metabolic features revealed lower mean systolic blood pressure in subjects with LADA than in those with type 2 diabetes (DM2). Mean triglyceride levels were lower in LADA subjects compared to DM2 subjects. Compared to DM2 subjects, prevalence of metabolic syndrome (MS) was also lower in LADA subjects. Compared to GADA-low, all GADA-high patients were male, had lower waist circumference, fasting C-peptide (FCP), and prevalence of MS. Compared to DM2 patients, GADA-high patients were younger, had lower age at onset, body mass index, waist circumference, systolic blood pressure, triglycerides, FCP, and prevalence of MS. The rate of patients on insulin was higher in GADA-high compared to DM2. There were no significant differences between characteristics of DM2 and GADA-low patients. Our results indicate that LADA patients have distinct metabolic features with lower residual β-cell function than DM2 patients. GADA titer is important parameter in defining the severity of the disease as patients with high GADA titer tend to have significant β-cell impairment.

Multicolor Flow Cytometry for the Diagnosis of Primary Immunodeficiency Diseases.

Primary immunodeficiency diseases (PIDDs) are rare inherited diseases that impair the human immune system. We established a multicolor flow cytometric assay to comprehensively evaluate the immune status and immunological characteristics of patients with PIDDs. Fifty-nine normal controls and 75 patients with PIDDs, including X-linked severe combined immunodeficiency (X-SCID), X-linked agammaglobulinemia (XLA), X-linked hyper IgM syndrome (X-HIGM), ataxia telangiectasia (AT), Wiskott-Aldrich syndrome (WAS), hyper IgE syndrome (HIES), and chronic mucocutaneous candidiasis disease (CMCD), were enrolled in this study. Immunophenotyes were evaluated by multicolor flow cytometry using seven different panels that allowed the detection of major leukocyte populations in peripheral blood. Multicolor flow cytometry revealed distinct leukocyte populations and immunological features of patients with X-SCID, XLA, X-HIGM, AT, WAS, HIES, and CMCD. Immunophenotyping by multicolor flow cytometry is useful to evaluate immune status and contributes to the diagnosis and management of patients with PIDDs.

HBV/HCV dual infection impacts viral load, antibody response, and cytokine expression differently from HBV or HCV single infection.

Hepatitis B virus/hepatitis C virus (HBV/HCV) dual infection is common among high-risk individuals. To characterize the virological and immunological features of patients with HBV/HCV dual infection, we enrolled 1,049 individuals who have been identified as injection drug users. Patients were divided into single and dual infection groups according to the serological markers. We found the average HCV RNA level was significantly lower; however, HBV viral load was significantly higher in HBV/HCV dual-infected patients (n = 42) comparing HCV single infection (n = 340) or HBV single infection (n = 136). The level of anti-HBs in patients who experienced spontaneous HBV clearance was higher than that in HCV single-infected patients with HBV spontaneous clearance. The level of anti-HCV E2 in HBV/HCV dual infection was lower than that detected in HCV single infection. Serum levels of IL-6, IL-8, and TNF-α were significantly lower in HBV/HCV dual-infected patients than in patients infected with HBV or HCV alone. Taken together, two viral replications are imbalanced in dual infected patients. The anti-HBs and anti-HCV E2 antibody production were impaired and proinflammatory IL-6, IL-8, and TNF-α also downregulated due to dual infection. These findings will help further understanding the pathogenesis of HBV/HCV dual infection.

P226 Clinical and immunological features of patients with igg subclass deficiency and treatment with immunoglobulin replacement

There is limited data regarding the clinical and immunological features of IgG subclass deficiency and subsequent response to immunoglobulin therapy. The objective of this study was to examine the data and to follow up the response of patients with IgG subclass deficiency to immunoglobulin therapy.

Evolución de las características epidemiológicas y clínicas de pacientes adultos del programa nacional al inicio de la terapia anti-retroviral en la Cohorte Chilena de SIDA, 2001-2015

Chilean AIDS Cohort is the oldest and extensive in Latin America and one of most numerous and with longer follow up time to international level. Records information from 14,873 patients out of approximately 22,000 in antiretroviral therapy in the public system and its results have allowed to know the national reality and have contributed to the adoption of public policies.To describe the demographic, clinical and immunological characteristics of patients who have started ART in Chile and its evolution over the past 15 years.The cases were stratified by five-year periods: 2001-2005, 2006-2010 and 2011-2015. The data analysis included calculating proportions, their respective confidence intervals 95% and X² test for significance analysis was applied.17.4% of patients starting ART are women and the proportion has remained relatively constant. The highest proportion of new HIV cases are 30 and 39 years old, nevertheless the layer of 15-29 years demonstrates a significant increase from 21.7 to 36.4% in 2011-2015 especially in men. 12.1% of new cases are older than 50 years old with a stable trend over time; however, women over 50 have increased from 11.0 to 15.6%. Antiretroviral therapy initiation with CD4+ T lymphocytes less than 200 cells/mm³ has decreased from 79.7 to 42.4% and in stage C from 45.4 to 22.6%. Late presentation to antiretroviral therapy is higher in men but this gap has narrowed in the last five years. Pneumocystis jiroveci, wasting syndrome, tuberculosis, Kaposi's sarcoma and esophageal candidiasis are the most common opportunistic diseases without significant changes in the three-year periods analyzed. In the last five years, 15.5% of opportunistic diseases occurs in patients with CD4+ TL > 200 cells/mm3.Despite the limitations of observational studies present report describes the characteristics and evolution of the epidemics in Chile in the last 15 years. The infection occurs at younger ages in men, whereas in women there is an increase over 50 years old. Despite advances in treatment access have reduced late presentation to therapy, important challenges remain to achieve more timely initiation of antiretroviral therapy in accordance with WHO 90-90-90 goals.

PM109 Clinical-Laboratory and Immunological Characteristics of Patients With Chronic Heart Failure of Various Etiologies

PM109 Clinical-Laboratory and Immunological Characteristics of Patients With Chronic Heart Failure of Various Etiologies

Clinical, Endocrinological and Immunological Characteristics of Japanese Patients With Autoimmune Polyglandular Syndrome Type 3a

Background: Autoimmune polyglandular syndrome (APS) is an autoimmune disease that involves multiple organ failure. In APS3, autoimmune thyroid disease occurs with other autoimmune diseases, but not with Addison disease. APS3a is defined as APS3 including autoimmune diabetes. The information about clinical backgrounds of APS3a is very limited. We studied to understand clinical, endocrinological and immunological characteristics of Japanese patients with APS3a. Methods: We reviewed our previously published case reports about APS3a, and picked up patients with type 1 diabetes and autoimmune diabetes, who showed the positivity for anti-glutamic acid decarboxylase antibody (anti-GAD ab) or anti-islet antigen 2 antibody (anti-IA2 ab) or anti-thyroglobulin antibody (anti-TG ab) or anti-thyroid peroxidase antibody (anti-TPO ab) or anti-thyroid stimulating hormone receptor antibody (anti-TR ab) between January 2010 and January 2016. We collected data including age, sex, anti-GAD ab, anti-IA2 ab, HbA1c, serum fasting C-peptide immunoreactivity (CPR), urinary CPR, treatment for diabetes, anti-TPO ab, anti-TG ab, anti-TR ab, thyroid stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), findings of thyroid ultrasonography and treatment for thyroid diseases. Results: Present study revealed a remarkable female predominance in APS3a. Among patients with autoimmune diabetes, slowly progressive insulin-dependent diabetes mellitus (SPIDDM) was the most common type of diabetes, and almost 80% of patients with APS3a showed the positivity for anti-GAD ab. Among patients with autoimmune thyroid diseases, almost 80% of patients had possible Hashimoto thyroiditis. Almost 70% of patients with APS3a showed the positivity for anti-TPO ab. Almost 20% of APS3a patients had possible Grave’s disease, and 83% of patients with possible Grave’s disease showed overt Grave’s disease. In patients with possible Grave’s disease, the positive rate of anti-TR ab was 100%. Conclusion: We revealed clinical, endocrinological and immunological characteristics of patients with APS3a in Japan. J Endocrinol Metab. 2016;6(2):46-51 doi: http://dx.doi.org/10.14740/jem348e

Characterization of clinical and immunological features in patients coinfected with dengue virus and HIV

The pathogenesis of dengue in subjects coinfected with HIV remains largely unknown. We investigate clinical and immunological parameters in coinfected DENV/HIV patients. According to the new dengue classification, most coinfected DENV/HIV patients presented mild clinical manifestations of dengue infection. Herein, we show that DENV/HIV coinfected patients had higher CD8 T cells percentages reflected as a lower CD4/CD8 ratio. Furthermore, CCR5 expression on CD4 T cells and CD107a expression on both T subsets were significantly higher in coinfected patients when compared with monoinfected DENV and HIV individuals respectively. Increased inflammatory response was observed in treated HAART coinfected patients despite undetectable HIV load. These data indicate that DENV infection may influence the clinical profile and immune response in individuals concomitantly infected with HIV.

Clinical and Immunologic Characteristics of Patients with Chronic Graft-Versus-Host Disease Persisting Seven or More Years after Diagnosis

BackgroundChronic graft-versus-host disease (cGVHD) is a leading cause of morbidity and mortality after allogeneic hematopoietic stem cell transplant (SCT). Median duration of systemic immunosuppression (IS) for cGVHD is approximately 2 years; however, 15% of patients still require IS 7 years after SCT. Previous studies identified factors that were associated with longer duration of IS or cGVHD. Our aim was to identify clinical and immunologic factors associated with cGVHD that is persistent ≥7 years after cGVHD diagnosis.MethodsPatients were drawn from a prospective cross-sectional study of the natural history of cGVHD at the National Institutes of Health (NCT00092235). A cohort of patients who enrolled on the study ≥7 years from the time of cGVHD diagnosis, and thus had persistent cGVHD (pcGVHD), was compared to those who enrolled <1 year from cGVHD diagnosis. Univariate analysis was performed, and significant factors were used in multivariable logistic regression. With a large number of exploratory variables, all p-values<0.005 were considered statistically significant; 0.005≤p <0.05 represented strong trends.ResultsThere were 38 patients with pcGVHD and 83 control patients <1 year from cGVHD diagnosis. The two groups did not differ in age or performance status. Factors that were significantly associated with pcGVHD (Table 1) included: bone marrow (BM) stem cell source (result divergent from previous studies), myeloablative conditioning, greater lung involvement, lower ferritin, lower IS, positive ENA (autoantibody panel), higher CD19 cells, CD4 cells, and immunoglobulin levels. Factors with a trend towards significance included female donor, higher Lee cGVHD symptom scale scores, more sclerotic skin involvement and less erythematous skin involvement, and more active cGVHD as determined by therapeutic intent at the time of evaluation. Interestingly, there were no differences in factors associated with disease severity (NIH global severity, clinician and patient rated severity, number of organs involved and organ scores), other inflammatory markers (ESR, CRP), functional capacity, distance from home to the transplant center, nor other factors identified in previous studies (bilirubin, HLA disparity). In a multivariable analysis that included 11 variables, BM stem cells, +ENA, higher NIH lung score, higher platelets, and higher IgA levels were significant independent predictors of pcGVHD.ConclusionsAlthough cGVHD is often self-limited, late forms requiring long duration of IS exist, and the predictive factors or underlying pathogenesis are unknown. Our analysis of cGVHD patients who enrolled on a clinical trial ≥7 years after diagnosis showed more lung and sclerotic skin involvement, less inflammatory signs, and higher B cells, immunoglobulins, and autoantibodies. These new findings suggest that pcGVHD may reflect irreversible damage rather than an active immune process; however, standardly accepted measures of disease severity were not associated with pcGVHD, suggesting that further tools are needed to differentiate accumulated damage from active disease. Distance from transplant center, which may contribute to access to care, was not associated, although increasing IS was recommended more frequently for pcGVHD patients. Factors that were previously identified as associated with longer duration of IS were not different or conflicted with our findings, suggesting that further study is needed. To further elucidate potential immune dysfunction in patients with pcGVHD, our ongoing studies are measuring BAFF, cytokine, and chemokine levels. Our results contribute to further hypotheses in the pathogenesis and contributing factors in patients who have pcGVHD.Table 1Univariate analysis - factors significantly associated with pcGVHD≥7 years from diagnosis (N=38)<1 year from diagnosis (N=83)p-valueBM stem cells (% patients)5811<.0001Myeloablative conditioning (% patients)8645<.0001+ENA (% patients)181.001NIH lung score (% with 2-3)5022.002Intensity of IS (% with mod/high)4780.0005Prednisone mg/kg/day*00.2.001Lee cGVHD symptom scale - breathing score*52.001FEV1*6993.001Platelets*278193<.0001Albumin*43.5<.0001Ferritin*1501240<.0001CD4 cells*534327.002CD19 cells*26687.0004IgG*756516.0005IgA*14532<.0001*median DisclosuresNo relevant conflicts of interest to declare.

CLINICAL, LABORATORY AND IMMUNOLOGICAL FEATURES IN PATIENTS OF SYSTEMIC LUPUS ERYTHEMATOSUS

Objective: To describe the clinical, laboratory and immunological features in patients with systemic lupus erythematosus (SLE). Methods: This was a descriptive cross-sectional study of 120 SLE patients admitted to Rheumatology department of Cho Ray Hospital and 60 healthy subjects on routine exams from November 2013 to July 2015. Results: Of the 120 patients, 114 were females (95.0%) and 6 were males (5.0%), giving a female to male ratio of 19:1. The patients’ age varied from 16 to 64 years old, mean 27.86. The systematic symptoms include: hypertension (4.2%), oedema (35.8%), fatique (78.3%) and fever (66.7%). The clinical criteria include: photosensitivity (80%), malar rash (69,2%), discoid rash (2,5%), nasal DLE (9.2%), oral DLE (30.0%), alopecia (55.8%), arthritis (45.8%), serositis: cardiac effusion (5.8%), pleural effusion (9.2%), renal: proteinuria per day (39.2%), hematuria (53.3%), neurologic: psychosis (3.3%), headache (7.5%), anemia (66.7%), leukopenia (22.5%), lymphopenia (28.3%), thrombocytopenia (10.0%). The immunological criteria include: positive ANA (97.5%), positive anti-dsDNA (90.0%), positive anti Sm (36.7%), positive anti cardiolipin IgG (18.3%), positive anti cardiolipin IgM (6.7%), positive direct Coomb test (20.0%). Hypocomplementemia of C3: sensitivity (95.0%), specificity (88.3%). Hypocomplementemia of C4: sensitivity (81.7%), specificity (96.7%).Conclusions: C3, C4 in serum are good tests for diagnosing Systemic Lupus Erythematosus according to SLICC 2012, hypocomplementemia of C3 and C4 have high sensitivity and specificity. Keywords:SystemicLupusErythematosus,C3,C4.

Clinical and Immunologic Characteristics of Patients With ANCA-Associated Glomerulonephritis Combined With Membranous Nephropathy: A Retrospective Cohort Study in a Single Chinese Center.

The concurrent antineutrophil cytoplasmic antibody-associated glomerulonephritis (ANCA-GN) and membranous nephropathy (MN) have been increasingly documented, mainly in case studies and case series; however, the differences of clinical and pathologic characteristics as well as outcomes between ANCA-GN patients with and without MN remain unclear.The current study investigated the clinical and immunologic features of patients with combined ANCA-GN and MN in a large cohort.Twenty-seven of 223 patients had combined ANCA-GN and MN; they had significantly higher levels of initial serum creatinine, higher Birmingham Vasculitis Activity Score and poorer renal outcome than ANCA-GN patients without MN (P < 0.05). ANCA-GN patients with MN could recognize the light chain of myeloperoxidase more frequently than those without MN (P < 0.05). The prevalence of circulating anti-PLA2R antibodies and glomerular PLA2R deposits was significantly lower in patients with combined ANCA-GN and MN than that in patients with idiopathic MN (P < 0.05). Compared with the idiopathic MN patients, the patients with combined ANCA-GN and MN had significantly higher recognition frequency of immunoglobulin (Ig) G2 and IgG3, and significantly lower recognition frequency of IgG4 (P < 0.05).Patients with combined ANCA-GN and MN had distinct clinical features and a different pathogenesis of MN.

Paraneoplastic Neurological Syndromes and Glutamic Acid Decarboxylase Antibodies.

Little is known of glutamic acid decarboxylase antibodies (GAD-abs) in the paraneoplastic context. Clinical recognition of such cases will lead to prompt tumor diagnosis and appropriate treatment. To report the clinical and immunological features of patients with paraneoplastic neurological syndromes (PNS) and GAD-abs. Retrospective case series study and immunological investigations conducted in February 2014 in a center for autoimmune neurological disorders. Fifteen cases with GAD65-abs evaluated between 1995 and 2013 who fulfilled criteria of definite or possible PNS without concomitant onconeural antibodies were included in this study. Analysis of the clinical records of 15 patients and review of 19 previously reported cases. Indirect immunofluorescence with rat hippocampal neuronal cultures and cell-based assays with known neuronal cell-surface antigens were used. One hundred six patients with GAD65-abs and no cancer served as control individuals. Eight of the 15 patients with cancer presented as classic paraneoplastic syndromes (5 limbic encephalitis, 1 paraneoplastic encephalomyelitis, 1 paraneoplastic cerebellar degeneration, and 1 opsoclonus-myoclonus syndrome). When compared with the 106 non-PNS cases, those with PNS were older (median age, 60 years vs 48 years; P = .03), more frequently male (60% vs 13%; P < .001), and had more often coexisting neuronal cell-surface antibodies, mainly against γ-aminobutyric acid receptors (53% vs 11%; P < .001). The tumors more frequently involved were lung (n = 6) and thymic neoplasms (n = 4). The risk for an underlying tumor was higher if the presentation was a classic PNS, if it was different from stiff-person syndrome or cerebellar ataxia (odds ratio, 10.5; 95% CI, 3.2-34.5), or if the patient had coexisting neuronal cell-surface antibodies (odds ratio, 6.8; 95% CI, 1.1-40.5). Compared with the current series, the 19 previously reported cases had more frequent stiff-person syndrome (74% vs 13%; P = .001) and better responses to treatment (79% vs 27%; P = .005). Predictors of improvement in the 34 patients (current and previously reported) included presentation with stiff-person syndrome and the presence of a thymic tumor. Patients with GAD-abs must be screened for an underlying cancer if they have clinical presentations different from those typically associated with this autoimmunity or develop classic PNS. The risk for cancer increases with age, male sex, and the presence of coexisting neuronal cell-surface antibodies.

Different effect of smoking on genders in Crohn's disease.

Smoking is a well-established environmental risk factor in Crohn's disease (CD). The study was aimed to investigate possible gender differences in the effect of smoking on the course of CD, with a special focus on selected immune parameters such as Th1/Th2/Th17 cytokines and regulatory T cells (Tregs). A group of 55 adults with CD was enrolled to the study. The analysis of clinical, demographic and immunological characteristics of patients was performed according to their smoking status and gender. Values were considered significant when p≤0.05. Patients who smoked, particularly females, more frequently suffered from a moderate-to-severe form of the disease, requiring glucocorticoid and immunosuppressive therapies. Smokers, particularly females, were also hospitalized and underwent surgeries more frequently than non-smokers. Cytometric analysis showed higher levels of serum proinflammatory cytokines and lower levels of peripheral Tregs in female smokers and former smokers, comparing to males from these subgroups. Presented results demonstrate that in all investigated subgroups, particularly however among current smokers and former smokers, female patients seemed to be more affected by CD. Females developed more severe form of the disease and experienced the onset earlier than men. The imbalance between pro- and anti-inflammatory factors observed in CD patients was also more distinct in female smokers and former smokers, comparing to males, and could substantially contribute to the severity of the disease. Exposure to smoking seems to be one of the environmental factors contributing to the gender differences in CD.

Autoantibodies in Systemic Lupus Erythematosus, on Black African Subject, in Abidjan

Aim: To determine the clinical and immunological characteristics of patients with systemic erythematosus lupus in Abidjan. Patients and Method: We studied 117 patients’ files with systemic lupus erythematosus aged 12 to 73 years old, who fulfilled the American College of Rheumatology (ACR)’s criteria. Antinuclear autoantibodies (ANA) were searched by indirect immunofluorescence. Anti-DNA native autoantibodies, extractable nuclear anti-antigens autoantibodies (anti-Sm, anti-SSA, anti-SSB and anti-RNP) and anti-phospholipids autoantibodies have been searched by ELISA technic. Results: The most frequent clinical manifestations were: articular damages (86.32%), cutaneous and mucosal lesions (71.79%) and fever (76.67%). Kidney damages have been noticed in 40.17%. Neurologic manifestations have been observed in 36.75%. Pericarditis and pleurisies have been noticed in 22.22% and 11.97% of cases, and anaemia in 86.32% of cases. ANA have been detected in 94.12% of cases, anti-DNA native’s autoantibodies in 73.53% and anti-Sm autoantibodies in 75% of cases. Anti-SSA and anti-SSB autoantibodies were respectively in 75% and 56.25% of cases. Anti-RNP autoantibodies were in all the patients, and anti-phospholipids autoantibodies were in 37.50% of cases. Conclusion: Systemic lupus erythematosus of Ivorian black subject is characterised by high prevalence of autoantibodies, mostly Anti-RNP.