1
|
Jayasekara H, Wickramarathne JS, Liyanage DS, Jayasinghe PA. Opsoclonus-myoclonus-ataxia syndrome associated with bacterial urinary tract infection. BMJ Case Rep 2024; 17:e261533. [PMID: 39179267 DOI: 10.1136/bcr-2024-261533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2024] Open
Abstract
Opsoclonus-myoclonus-ataxia syndrome (OMAS) is a rare acquired neurological disorder characterized by opsoclonus, focal or diffuse myoclonus, truncal instability and associated other cerebellar signs and ataxia. While predominantly affecting children, it can rarely manifest in adults and could be associated with infections, paraneoplastic syndrome, drugs or other neurological disorders. We present a case of an elderly gentleman presenting with OMAS associated with a culture-positive urinary tract infection with Escherichia coli, successfully treated with antibiotics and immunoglobulins resulting in significant recovery.
Collapse
Affiliation(s)
- Hasara Jayasekara
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | | | | |
Collapse
|
2
|
Liu P, Liu H, Sang Y, Zhu L, Zhang P, Pang C, Wang Y, Bai L. Triptolide regulates neutrophil function through the Hippo signaling pathway to alleviate rheumatoid arthritis disease progression. J Transl Autoimmun 2024; 8:100242. [PMID: 38765902 PMCID: PMC11101680 DOI: 10.1016/j.jtauto.2024.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/13/2024] [Accepted: 05/01/2024] [Indexed: 05/22/2024] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammatory changes in the joints, the etiology of which is unclear. It is now well established that regulated cell death (RCD) and migration of neutrophils play an important role in the pathogenesis of RA. Tripterygium wilfordii Hook.f (TwHF) is a total saponin extracted from the root of Tripterygium wilfordii Hook.f, a plant of the family Wesleyanaceae, which has strong anti-inflammatory and immunomodulatory effects and has been used as a basic drug in the clinical treatment of RA. Despite the good efficacy of TwHF treatment, the mechanism of action of TwHF remains unclear. Several studies have demonstrated that the drug tripterygium glycosides, in which TwHF is the main ingredient, has achieved excellent efficacy in the clinical treatment of RA. Investigations have also found that TwHF can affect cellular RCD, cell migration, cell proliferation, and the apoptosis-related Hippo signaling pathway. In this study, we first analyzed the RCD and migration differences of neutrophils in patients with RA through network pharmacology and transcriptome analysis. Subsequently, we used electron microscopy, immunofluorescence, and other methods to identify the RCD phenotype of neutrophils. In collagen-induced arthritis (CIA) model, we demonstrated that Triptolide (the main active ingredient in TwHF) could alleviate the progression of arthritis by reducing the bone destruction and the infiltration of neutrophils. Furthermore, in vitro experiments showed that Triptolide induced neutrophil apoptosis, inhibited the formation of neutrophil extracellular traps (NETs), and impeded the neutrophil migration process in a Hippo pathway-dependent manner. Taken together, these findings indicate that Triptolide has potential for treating RA and provide theoretical support for the clinical application of TwHF, as a traditional Chinese medicine, in RA.
Collapse
Affiliation(s)
- Pengyuan Liu
- Baotou Medical College, Inner Mongolia University of Science and Technology. Baotou 014000,China
| | - Huiyang Liu
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Baotou Medical College, Baotou 014010, China
| | - Yali Sang
- Baotou Medical College, Inner Mongolia University of Science and Technology. Baotou 014000,China
| | - Lingyan Zhu
- The Central Lab, the First Affiliated Hospital of Baotou Medical College, Baotou 014010, China
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Baotou Medical College, Baotou 014010, China
| | - Peiyao Zhang
- Baotou Medical College, Inner Mongolia University of Science and Technology. Baotou 014000,China
| | - Chunyan Pang
- The Central Lab, the First Affiliated Hospital of Baotou Medical College, Baotou 014010, China
- Inner Mongolia Autoimmune Key Laboratory, Baotou 014010, China
| | - Yongfu Wang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Baotou Medical College, Baotou 014010, China
- Inner Mongolia Autoimmune Key Laboratory, Baotou 014010, China
| | - Li Bai
- The Central Lab, the First Affiliated Hospital of Baotou Medical College, Baotou 014010, China
- Inner Mongolia Autoimmune Key Laboratory, Baotou 014010, China
| |
Collapse
|
3
|
Olasupo OO, Noronha N, Lowe MS, Ansel D, Bhatt M, Matino D. Non-clotting factor therapies for preventing bleeds in people with congenital hemophilia A or B. Cochrane Database Syst Rev 2024; 2:CD014544. [PMID: 38411279 PMCID: PMC10897951 DOI: 10.1002/14651858.cd014544.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND Management of congenital hemophilia A and B is by prophylactic or on-demand replacement therapy with clotting factor concentrates. The effects of newer non-clotting factor therapies such as emicizumab, concizumab, marstacimab, and fitusiran compared with existing standards of care are yet to be systematically reviewed. OBJECTIVES To assess the effects (clinical, economic, patient-reported, and adverse outcomes) of non-clotting factor therapies for preventing bleeding and bleeding-related complications in people with congenital hemophilia A or B compared with prophylaxis with clotting factor therapies, bypassing agents, placebo, or no prophylaxis. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, electronic databases, conference proceedings, and reference lists of relevant articles and reviews. The date of the last search was 16 August 2023. SELECTION CRITERIA Randomized controlled trials (RCTs) evaluating people with congenital hemophilia A or B with and without inhibitors, who were treated with non-clotting factor therapies to prevent bleeds. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed studies for eligibility, assessed risk of bias, and extracted data for the primary outcomes (bleeding rates, health-related quality of life (HRQoL), adverse events) and secondary outcomes (joint health, pain scores, and economic outcomes). We assessed the mean difference (MD), risk ratio (RR), 95% confidence interval (CI) of effect estimates, and evaluated the certainty of the evidence using GRADE. MAIN RESULTS Six RCTs (including 397 males aged 12 to 75 years) were eligible for inclusion. Prophylaxis versus on-demand therapy in people with inhibitors Four trials (189 participants) compared emicizumab, fitusiran, and concizumab with on-demand therapy in people with inhibitors. Prophylaxis using emicizumab likely reduced annualized bleeding rates (ABR) for all bleeds (MD -22.80, 95% CI -37.39 to -8.21), treated bleeds (MD -20.40, 95% CI -35.19 to -5.61), and annualized spontaneous bleeds (MD -15.50, 95% CI -24.06 to -6.94), but did not significantly reduce annualized joint and target joint bleeding rates (AjBR and AtjBR) (1 trial; 53 participants; moderate-certainty evidence). Fitusiran also likely reduced ABR for all bleeds (MD -28.80, 95% CI -40.07 to -17.53), treated bleeds (MD -16.80, 95% CI -25.80 to -7.80), joint bleeds (MD -12.50, 95% CI -19.91 to -5.09), and spontaneous bleeds (MD -14.80, 95% CI -24.90 to -4.71; 1 trial; 57 participants; moderate-certainty evidence). No evidence was available on the effect of bleed prophylaxis using fitusiran versus on-demand therapy on AtjBR. Concizumab may reduce ABR for all bleeds (MD -12.31, 95% CI -19.17 to -5.45), treated bleeds (MD -10.10, 95% CI -17.74 to -2.46), joint bleeds (MD -9.55, 95% CI -13.55 to -5.55), and spontaneous bleeds (MD -11.96, 95% CI -19.89 to -4.03; 2 trials; 78 participants; very low-certainty evidence), but not target joint bleeds (MD -1.00, 95% CI -3.26 to 1.26). Emicizumab prophylaxis resulted in an 11.31-fold increase, fitusiran in a 12.5-fold increase, and concizumab in a 1.59-fold increase in the proportion of participants with no bleeds. HRQoL measured using the Haemophilia Quality of Life Questionnaire for Adults (Haem-A-QoL) physical and total health scores was improved with emicizumab, fitusiran, and concizumab prophylaxis (low-certainty evidence). Non-serious adverse events were higher with non-clotting factor therapies versus on-demand therapy, with injection site reactions being the most frequently reported adverse events. Transient antidrug antibodies were reported for fitusiran and concizumab. Prophylaxis versus on-demand therapy in people without inhibitors Two trials (208 participants) compared emicizumab and fitusiran with on-demand therapy in people without inhibitors. One trial assessed two doses of emicizumab (1.5 mg/kg weekly and 3.0 mg/kg bi-weekly). Fitusiran 80 mg monthly, emicizumab 1.5 mg/kg/week, and emicizumab 3.0 mg/kg bi-weekly all likely resulted in a large reduction in ABR for all bleeds, all treated bleeds, and joint bleeds. AtjBR was not reduced with either of the emicizumab dosing regimens. The effect of fitusiran prophylaxis on target joint bleeds was not assessed. Spontaneous bleeds were likely reduced with fitusiran (MD -20.21, 95% CI -32.12 to -8.30) and emicizumab 3.0 mg/kg bi-weekly (MD -15.30, 95% CI -30.46 to -0.14), but not with emicizumab 1.5 mg/kg/week (MD -14.60, 95% CI -29.78 to 0.58). The percentage of participants with zero bleeds was higher following emicizumab 1.5 mg/kg/week (50% versus 0%), emicizumab 3.0 mg/kg bi-weekly (40% versus 0%), and fitusiran prophylaxis (40% versus 5%) compared with on-demand therapy. Emicizumab 1.5 mg/kg/week did not improve Haem-A-QoL physical and total health scores, EQ-5D-5L VAS, or utility index scores (low-certainty evidence) when compared with on-demand therapy at 25 weeks. Emicizumab 3.0 mg/kg bi-weekly may improve HRQoL measured by the Haem-A-QoL physical health score (MD -15.97, 95% CI -29.14 to -2.80) and EQ-5D-5L VAS (MD 9.15, 95% CI 2.05 to 16.25; 1 trial; 43 participants; low-certainty evidence). Fitusiran may result in improved HRQoL shown as a reduction in Haem-A-QoL total score (MD -7.06, 95% CI -11.50 to -2.62) and physical health score (MD -19.75, 95% CI -25.76 to -11.94; 1 trial; 103 participants; low-certainty evidence). The risk of serious adverse events in participants without inhibitors also likely did not differ following prophylaxis with either emicizumab or fitusiran versus on-demand therapy (moderate-certainty evidence). Transient antidrug antibodies were reported in 4% (3/80) participants to fitusiran, with no observed effect on antithrombin lowering. A comparison of the different dosing regimens of emicizumab identified no differences in bleeding, safety, or patient-reported outcomes. No case of treatment-related cancer or mortality was reported in any study group. None of the included studies assessed our secondary outcomes of joint health, clinical joint function, and economic outcomes. None of the included studies evaluated marstacimab. AUTHORS' CONCLUSIONS Evidence from RCTs shows that prophylaxis using non-clotting factor therapies compared with on-demand treatment may reduce bleeding events, increase the percentage of individuals with zero bleeds, increase the incidence of non-serious adverse events, and improve HRQoL. Comparative assessments with other prophylaxis regimens, assessment of long-term joint outcomes, and assessment of economic outcomes will improve evidence-based decision-making for the use of these therapies in bleed prevention.
Collapse
Affiliation(s)
- Omotola O Olasupo
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Canada
| | - Noella Noronha
- Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, Canada
| | - Megan S Lowe
- Department of Health Sciences, McMaster University, Hamilton, Canada
| | | | - Mihir Bhatt
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster University, Hamilton, Canada
| | - Davide Matino
- Department of Internal Medicine, McMaster University, Hamilton, Canada
| |
Collapse
|
4
|
Shah NS, Pathak J, Shah PC, Bharmal UF, Ansari MI. A Rare Case of Opsoclonus Myoclonus Ataxia Syndrome Post Viral Illness. Cureus 2023; 15:e40396. [PMID: 37456490 PMCID: PMC10345879 DOI: 10.7759/cureus.40396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Opsoclonus myoclonus ataxia syndrome (OMAS) is a rare inflammatory neurological disorder characterized by ocular, motor, behavioral, language, and sleep disturbances. It usually affects infants and young children but may affect adults. A 28-year-old male was brought to our emergency ward with complaints of involuntary spontaneous eye movements and jerky movements of limbs with imbalance while walking. He had a history of short febrile illness 10 days prior. His magnetic resonance imaging (MRI) of the brain, cerebrospinal fluid (CSF) analysis, and other routine investigations were normal. The patient was treated with injectable methylprednisolone (1 g) given for five days along with other supportive therapy. A significant reduction in the opsoclonus, myoclonus, and ataxia was seen on a six-month follow-up. OMAS should be identified early to avoid the use of inappropriate medications, and immunotherapy must be provided as early as possible in order to prevent irreversible neurological damage.
Collapse
Affiliation(s)
- Nauka S Shah
- Department of Medicine, Baroda Medical College, Maharaja Sayajirao (MS) University, Vadodara, IND
| | - Jaya Pathak
- Department of Internal Medicine, Baroda Medical College, Maharaja Sayajirao (MS) University, Vadodara, IND
| | - Purva C Shah
- Department of Internal Medicine, Baroda Medical College, Maharaja Sayajirao (MS) University, Vadodara, IND
| | - Ummayhany F Bharmal
- Department of Medicine, Baroda Medical College, Maharaja Sayajirao (MS) University, Vadodara, IND
| | - Maliha I Ansari
- Department of Internal Medicine, Pramukhswami Medical College, Anand, IND
| |
Collapse
|
5
|
Guzzardo GM, Sidonio R, Callaghan MU, Regling K. Early stage clinical trials for the treatment of hemophilia A. Expert Opin Investig Drugs 2022; 31:1169-1186. [PMID: 36265129 DOI: 10.1080/13543784.2022.2138742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Hemophilia A is a severe bleeding disorder affecting about 1 in 5,000 males. The gold standard for prophylaxis and treatment of acute bleeding has been factor (F) VIII concentrate. A multitude of treatment modalities are now available and under clinical investigation. AREAS COVERED This review discusses ongoing/recently completed early-phase clinical trials registered on ClinicalTrials.gov in patients with hemophilia A through April 2022. These new pipeline therapies are focused on addressing the safety and efficacy of new factor-related products, non-factor related products, and gene therapy options for hemophilia. EXPERT OPINION Current standard of care effectively prevents and treats acute bleeding and has significantly improved the quality of life in hemophilia. The biggest challenges in the improvement of care are treatment-related burden and the burden of cost in developing countries. New drugs under development are likely to enter practice by the end of this decade and address many of the unmet needs particularly of those with severe disease. Data is limited in unique populations (e.g. congenital/inherited FVIII inhibitors, non-severe hemophilia A, women/girls with hemophilia and children) which are important areas for future research; additional clinical trials and long-term outcome data are necessary prior to incorporating these new therapies in our treatment arsenal.
Collapse
Affiliation(s)
- Gianna M Guzzardo
- Pediatric Hematology Oncology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Robert Sidonio
- Pediatric Hematology Oncology, Emory University and Aflac Cancer and Blood Disorders, Atlanta, GA, USA
| | - Michael U Callaghan
- Agios Pharmaceuticals, Cambridge, MA, USA.,Department of Pediatrics, Central Michigan University School of Medicine, Mount Pleasant, MI, USA
| | - Katherine Regling
- Pediatric Hematology Oncology, Children's Hospital of Michigan, Detroit, MI, USA.,Department of Pediatrics, Central Michigan University School of Medicine, Mount Pleasant, MI, USA
| |
Collapse
|
6
|
Zhao J, Jiang P, Guo S, Schrodi SJ, He D. Apoptosis, Autophagy, NETosis, Necroptosis, and Pyroptosis Mediated Programmed Cell Death as Targets for Innovative Therapy in Rheumatoid Arthritis. Front Immunol 2022; 12:809806. [PMID: 35003139 PMCID: PMC8739882 DOI: 10.3389/fimmu.2021.809806] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/13/2021] [Indexed: 01/13/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory joint disease that can lead to clinical manifestations of systemic diseases. Its leading features include chronic synovial inflammation and degeneration of the bones and joints. In the past decades, multiple susceptibilities for rheumatoid arthritis have been identified along with the development of a remarkable variety of drugs for its treatment; which include analgesics, glucocorticoids, nonsteroidal anti-inflammatory medications (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), and biologic response modifiers (bDMARDs). Despite the existence of many clinical treatment options, the prognosis of some patients remains poor due to complex mechanism of the disease. Programmed cell death (PCD) has been extensively studied and ascertained to be one of the essential pathological mechanisms of RA. Its dysregulation in various associated cell types contributes to the development of RA. In this review, we summarize the role of apoptosis, cell death-associated neutrophil extracellular trap formation, necroptosis, pyroptosis, and autophagy in the pathophysiology of RA to provide a theoretical reference and insightful direction to the discovery and development of novel therapeutic targets for RA.
Collapse
Affiliation(s)
- Jianan Zhao
- Guanghua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Rheumatology, Shanghai Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ping Jiang
- Guanghua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Rheumatology, Shanghai Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shicheng Guo
- Department of Medical Genetics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Steven J Schrodi
- Department of Medical Genetics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Dongyi He
- Department of Rheumatology, Shanghai Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Arthritis Institute of Integrated Traditional and Western Medicine, Shanghai Chinese Medicine Research Institute, Shanghai, China
| |
Collapse
|
7
|
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: This review aims to assess the effects (clinical, economic, patient‐reported and adverse outcomes) of non‐clotting factor therapies for preventing bleeding and bleeding‐related complications in people with hemophilia A or B compared to prophylaxis with clotting factor therapies, bypassing agents, placebo or no prophylaxis.
Collapse
|
8
|
Jiang L, Liu Y, Zhang L, Santoro C, Rodriguez A. Rituximab for treating inhibitors in people with inherited severe hemophilia. Cochrane Database Syst Rev 2020; 8:CD010810. [PMID: 32761818 PMCID: PMC8407108 DOI: 10.1002/14651858.cd010810.pub4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hemophilia A and B are inherited coagulation disorders characterized by a reduced or absent level of factor VIII or factor IX respectively. The severe form is characterized by a factor level less than 0.01 international units (IU) per milliliter. The development of inhibitors in hemophilia is the main complication of treatment, because the presence of these antibodies, reduces or even nullifies the efficacy of replacement therapy, making it very difficult to control the bleeding. People with inhibitors continue to have significantly higher risks of morbidity and mortality, with considerable treatment costs. Given the wide 'off-label' use of rituximab for treating people with hemophilia and inhibitors, its efficacy and safety need to be evaluated. This is an update of a previously published Cochrane Review. OBJECTIVES To assess the efficacy and safety of rituximab for treating inhibitors in people with inherited severe hemophilia A or B. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, complied from electronic database searches and handsearching of journals and conference abstract books. We searched the reference lists of relevant articles and reviews and also searched for ongoing or unpublished studies. We also undertook further searches of other bibliographic databases and trial registries. Date of last search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register: 19 March 2020. SELECTION CRITERIA Randomized controlled trials and controlled clinical trials investigating the efficacy and safety of rituximab for treating inhibitors in people with hemophilia. DATA COLLECTION AND ANALYSIS No randomized controlled trials matching the selection criteria were eligible for inclusion. MAIN RESULTS No randomized controlled trials on rituximab for treating inhibitors in people with hemophilia were identified. AUTHORS' CONCLUSIONS We were unable to identify any relevant trials on the efficacy and safety of rituximab for treating inhibitors in people with hemophilia. The research evidence available is from case reports and case series. Randomized controlled trials are needed to evaluate the efficacy and safety of rituximab for this condition. However, prior to the publication of any possible future randomized controlled trials, meta-analysis of case reports and case series may provide some evidence.
Collapse
Affiliation(s)
- Lucan Jiang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
- Ethics Committee, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yi Liu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Lingli Zhang
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Cristina Santoro
- Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy
| | - Armando Rodriguez
- Association for the Promotion of Multimedia Education, Zagreb, Croatia
| |
Collapse
|
9
|
Legeay C, Bittencourt H, Haddad E, Spiesser-Robelet L, Thépot-Seegers V, Therrien R. A Retrospective Study on Infusion-Related Reactions to Rituximab in a Heterogeneous Pediatric Population. J Pediatr Pharmacol Ther 2017; 22:369-374. [PMID: 29042839 DOI: 10.5863/1551-6776-22.5.369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To assess risks and outcomes of infusion-related reactions to rituximab in a heterogeneous pediatric population. METHODS All patients who received rituximab between July 2010 and July 2012 were retrieved from the pharmacy software and included for analysis. Data were collected according to 4 categories: demographic data, infusion data, infusion-related reactions, and biological data considered as risk factors (i.e., absolute lymphocyte count, lactate dehydrogenase levels). RESULTS Sixty-seven patients treated for a total of 17 different indications were included. A total of 282 rituximab infusions were administered. Forty-three, mostly grade 1 or 2, infusion-related reactions occurred in 30 patients. Reactions occurred in 39.2% "first-dose" infusions, but this rate dropped drastically to 2.7% in subsequent doses. In multivariate analysis, high absolute lymphocyte count was the only risk factor for infusion-related reaction (OR = 1.03; 95% CI: 1.01-1.06; p = 0.014). CONCLUSIONS Rituximab infusion-related reactions in a heterogeneous pediatric population were frequent on first infusion, but rare in subsequent ones. Overall, these reactions were mild and manageable through pharmacological treatment. Patients with an elevated absolute lymphocyte count before infusion were at greater risk for an infusion-related reaction.
Collapse
Affiliation(s)
- Clément Legeay
- Department of Pharmacy (CL, RT), CHU Ste Justine, University of Montreal, Montréal, Quebec, Canada; Department of Oncology-Haematology (HB), CHU Ste Justine, University of Montreal, Montréal, Quebec, Canada; Department of Pediatrics, Department of Microbiology, Infectiology and Immunology (EH), University of Montreal, Montreal, Quebec, Canada; Department of Pharmacy (JSR), CHU d'Angers, University of Angers, Angers, France; Department of Medical Information (VTS), CHU d'Angers, University of Angers, Angers, France
| | - Henrique Bittencourt
- Department of Pharmacy (CL, RT), CHU Ste Justine, University of Montreal, Montréal, Quebec, Canada; Department of Oncology-Haematology (HB), CHU Ste Justine, University of Montreal, Montréal, Quebec, Canada; Department of Pediatrics, Department of Microbiology, Infectiology and Immunology (EH), University of Montreal, Montreal, Quebec, Canada; Department of Pharmacy (JSR), CHU d'Angers, University of Angers, Angers, France; Department of Medical Information (VTS), CHU d'Angers, University of Angers, Angers, France
| | - Elie Haddad
- Department of Pharmacy (CL, RT), CHU Ste Justine, University of Montreal, Montréal, Quebec, Canada; Department of Oncology-Haematology (HB), CHU Ste Justine, University of Montreal, Montréal, Quebec, Canada; Department of Pediatrics, Department of Microbiology, Infectiology and Immunology (EH), University of Montreal, Montreal, Quebec, Canada; Department of Pharmacy (JSR), CHU d'Angers, University of Angers, Angers, France; Department of Medical Information (VTS), CHU d'Angers, University of Angers, Angers, France
| | - Laurence Spiesser-Robelet
- Department of Pharmacy (CL, RT), CHU Ste Justine, University of Montreal, Montréal, Quebec, Canada; Department of Oncology-Haematology (HB), CHU Ste Justine, University of Montreal, Montréal, Quebec, Canada; Department of Pediatrics, Department of Microbiology, Infectiology and Immunology (EH), University of Montreal, Montreal, Quebec, Canada; Department of Pharmacy (JSR), CHU d'Angers, University of Angers, Angers, France; Department of Medical Information (VTS), CHU d'Angers, University of Angers, Angers, France
| | - Valérie Thépot-Seegers
- Department of Pharmacy (CL, RT), CHU Ste Justine, University of Montreal, Montréal, Quebec, Canada; Department of Oncology-Haematology (HB), CHU Ste Justine, University of Montreal, Montréal, Quebec, Canada; Department of Pediatrics, Department of Microbiology, Infectiology and Immunology (EH), University of Montreal, Montreal, Quebec, Canada; Department of Pharmacy (JSR), CHU d'Angers, University of Angers, Angers, France; Department of Medical Information (VTS), CHU d'Angers, University of Angers, Angers, France
| | - Roxane Therrien
- Department of Pharmacy (CL, RT), CHU Ste Justine, University of Montreal, Montréal, Quebec, Canada; Department of Oncology-Haematology (HB), CHU Ste Justine, University of Montreal, Montréal, Quebec, Canada; Department of Pediatrics, Department of Microbiology, Infectiology and Immunology (EH), University of Montreal, Montreal, Quebec, Canada; Department of Pharmacy (JSR), CHU d'Angers, University of Angers, Angers, France; Department of Medical Information (VTS), CHU d'Angers, University of Angers, Angers, France
| |
Collapse
|
10
|
Jiang L, Liu Y, Zhang L, Santoro C, Rodriguez A. Rituximab for treating inhibitors in people with inherited severe hemophilia. Cochrane Database Syst Rev 2017; 7:CD010810. [PMID: 28685500 PMCID: PMC6483299 DOI: 10.1002/14651858.cd010810.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hemophilia A and B are inherited coagulation disorders characterized by a reduced or absent level of factor VIII or factor IX respectively. The severe form is characterized by a factor level less than 0.01 international units (IU) per milliliter. The development of inhibitors in hemophilia is the main complication of treatment, because the presence of these antibodies, reduces or even nullifies the efficacy of replacement therapy, making it very difficult to control the bleeding. People with inhibitors continue to have significantly higher risks of morbidity and mortality, with considerable treatment costs. Given the wide 'off-label' use of rituximab for treating people with hemophilia and inhibitors, its efficacy and safety need to be evaluated. This is an update of a previously published Cochrane Review. OBJECTIVES To assess the efficacy and safety of rituximab for treating inhibitors in people with inherited severe hemophilia A or B. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, complied from electronic database searches and handsearching of journals and conference abstract books. We searched the reference lists of relevant articles and reviews and also searched for ongoing or unpublished studies. We also undertook further searches of other bibliographic databases and trial registries.Date of last search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register: 16 February 2017. SELECTION CRITERIA Randomized controlled trials and controlled clinical trials investigating the efficacy and safety of rituximab for treating inhibitors in people with hemophilia. DATA COLLECTION AND ANALYSIS No randomized controlled trials matching the selection criteria were eligible for inclusion. MAIN RESULTS No randomized controlled trials on rituximab for treating inhibitors in people with hemophilia were identified. AUTHORS' CONCLUSIONS We were unable to identify any relevant trials on the efficacy and safety of rituximab for treating inhibitors in people with hemophilia. The research evidence available is from case reports and case series. Randomized controlled trials are needed to evaluate the efficacy and safety of rituximab for this condition. However, prior to the publication of any possible future randomized controlled trials, meta-analysis of case reports and case series may provide some evidence.
Collapse
Affiliation(s)
- Lucan Jiang
- West China Second University Hospital, Sichuan UniversityDepartment of PharmacyNo. 17, Section Three, Ren Min Nan Lu AvenueRoadChengduSichuanChina610041
- Sichuan University, Ministry of EducationKey Laboratory of Birth Defects and Related Diseases of Women and ChildrenChengduChina
- West China Second University Hospital, Sichuan UniversityEvidence‐Based Pharmacy CenterChengduChina
- Sichuan UniversityWest China School of PharmacyChengduChina
| | - Yi Liu
- West China Second University Hospital, Sichuan UniversityDepartment of PharmacyNo. 17, Section Three, Ren Min Nan Lu AvenueRoadChengduSichuanChina610041
- Sichuan University, Ministry of EducationKey Laboratory of Birth Defects and Related Diseases of Women and ChildrenChengduChina
- West China Second University Hospital, Sichuan UniversityEvidence‐Based Pharmacy CenterChengduChina
- Sichuan UniversityWest China School of PharmacyChengduChina
| | - Lingli Zhang
- West China Second University Hospital, Sichuan UniversityDepartment of PharmacyNo. 17, Section Three, Ren Min Nan Lu AvenueRoadChengduSichuanChina610041
- Sichuan University, Ministry of EducationKey Laboratory of Birth Defects and Related Diseases of Women and ChildrenChengduChina
- West China Second University Hospital, Sichuan UniversityEvidence‐Based Pharmacy CenterChengduChina
| | - Cristina Santoro
- Sapienza University of RomeDepartment of Cellular Biotechnology and HematologyVia Benevento 6RomeItaly00161
| | - Armando Rodriguez
- Association for the Promotion of Multimedia EducationBa?ćanska 6ZagrebCroatia10110
| | | |
Collapse
|
11
|
Past, Present, and Future of Antifungal Drug Development. TOPICS IN MEDICINAL CHEMISTRY 2016. [DOI: 10.1007/7355_2016_4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
12
|
Sehgal VN, Pandhi D, Khurana A. Biologics in dermatology: adverse effects. Int J Dermatol 2015; 54:1442-60. [PMID: 26147909 DOI: 10.1111/ijd.12802] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 01/13/2014] [Accepted: 06/25/2014] [Indexed: 12/13/2022]
Abstract
Biologics are a group of drugs that precisely affect certain specific steps in the immune response and are an extremely useful group when used in an appropriate setting. However, their use can often be a double-edged sword. Careful patient selection and thorough knowledge of adverse effects is a key to their successful use in various disorders. The initial enthusiasm has gradually given way to a more cautious approach wherein a balance is sought between clinical usefulness and expected side effects. The adverse effects of the biologics most commonly used in dermatology have been carefully listed for ready reference. The plausible causes of the adverse reactions are succinctly outlined along with their incriminating factor(s). Besides, in brief, the attention has been focused on their management. The content should provide an essential didactic content for educating the practitioner.
Collapse
Affiliation(s)
- Virendra N Sehgal
- Dermato-Venereology (Skin/VD) Center, Sehgal Nursing Home, Delhi, India
| | - Deepika Pandhi
- Department of Dermatology and STD, University College of Medical Sciences, and Associated Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Ananta Khurana
- Department of Dermatology and STD, Dr RML hospital and PGIMER, New Delhi, India
| |
Collapse
|
13
|
Liu Y, Zhang L, Santoro C, Song J, Rodriguez A, Wang L. Rituximab for treating inhibitors in people with inherited severe hemophilia. Cochrane Database Syst Rev 2015:CD010810. [PMID: 25841099 DOI: 10.1002/14651858.cd010810.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hemophilia A and B are inherited coagulation disorders characterized by a reduced or absent level of factor VIII or factor IX respectively. The severe form is characterized by a factor level less than 0.01 international units (IU) per milliliter. The development of inhibitors in hemophilia is the main complication of treatment, because the presence of these antibodies, reduces or even nullifies the efficacy of replacement therapy, making it very difficult to control the bleeding. People with inhibitors continue to have significantly higher risks of morbidity and mortality, with considerable treatment costs. Given the wide 'off-label' use of rituximab for treating people with hemophilia and inhibitors, its efficacy and safety need to be evaluated. OBJECTIVES To assess the efficacy and safety of rituximab for treating inhibitors in people with inherited severe hemophilia A or B. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, complied from electronic database searches and handsearching of journals and conference abstract books. We searched the reference lists of relevant articles and reviews and also searched for ongoing or unpublished studies.Date of last search: 27 January 2015. SELECTION CRITERIA Randomized controlled trials and controlled clinical trials investigating the efficacy and safety of rituximab for treating inhibitors in people with hemophilia. DATA COLLECTION AND ANALYSIS No randomized controlled trials matching the selection criteria were eligible for inclusion. MAIN RESULTS No randomized controlled trials on rituximab for treating inhibitors in people with hemophilia were identified. AUTHORS' CONCLUSIONS We were unable to identify any relevant trials on the efficacy and safety of rituximab for treating inhibitors in people with hemophilia. The research evidence available is from case reports and case series. Randomized controlled trials are needed to evaluate the efficacy and safety of rituximab for this condition. However, prior to the publication of any possible future randomized controlled trials, meta-analysis of case reports and case series may provide some evidence.
Collapse
Affiliation(s)
- Yi Liu
- Department of Pharmacy, Evidence-based Pharmacy Center, West China Second University Hospital, Sichuan University, No. 20, Section 4, Renmin Road South, Chengdu, Sichuan, China, 610041
| | | | | | | | | | | |
Collapse
|
14
|
Smith EMD, Foster HE, Beresford MW. The development and assessment of biological treatments for children. Br J Clin Pharmacol 2015; 79:379-94. [PMID: 24750505 PMCID: PMC4345949 DOI: 10.1111/bcp.12406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 04/11/2014] [Indexed: 12/14/2022] Open
Abstract
The development of biological agents with specific immunological targets has revolutionized the treatment of a wide variety of paediatric diseases where traditional immunosuppressive agents have been partly ineffective or intolerable. The increasing requirement for pharmaceutical companies to undertake paediatric studies has provided impetus for studies of biologics in children. The assessment of biological agents in children to date has largely relied upon randomized controlled trials using a withdrawal design, rather than a parallel study design. This approach has been largely used due to ethical concerns, including use of placebo treatments in children with active chronic disease, and justified on the basis that treatments have usually already undergone robust assessment in related adult conditions. However, this study design limits the reliability of the data and can confuse the interpretation of safety results. Careful ongoing monitoring of safety and efficacy in real-world practice through national and international biologics registries and robust reporting systems is crucial. The most commonly used biological agents in children target tumour necrosis factor-α, interleukin-1, interleukin-6 and cytotoxic lymphocyte-associated antigen-4. These agents are most frequently used in paediatric rheumatic diseases. This review discusses the development and assessment of biologics within paediatric rheumatology with reference to the lessons learned from use in other subspecialties.
Collapse
Affiliation(s)
- Eve M D Smith
- Institute of Translational Medicine, University of LiverpoolLiverpool, UK
| | - Helen E Foster
- Paediatric Rheumatology, Institute of Cellular Medicine, Newcastle UniversityNewcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle Hospitals NHS Foundation TrustNewcastle upon Tyne, UK
| | - Michael W Beresford
- Institute of Translational Medicine, University of LiverpoolLiverpool, UK
- Alder Hey Children's NHS Foundation TrustLiverpool, UK
| |
Collapse
|
15
|
Berrada K, Abourazzak FE, El Mezouar I, Lazrak F, Aradoini N, Tahiri L, Harzy T. A successful treatment of juvenile idiopathic arthritis with rituximab: A report of two cases. Eur J Rheumatol 2014; 1:164-166. [PMID: 27708906 DOI: 10.5152/eurjrheumatol.2014.140049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/10/2014] [Indexed: 02/01/2023] Open
Abstract
Juvenile idiopathic arthritis (JIA) is defined as arthritis of unknown cause that starts before 16 years of age and lasts at least 6 weeks. It is the most common chronic inflammatory disease in childhood and often persists through adulthood and can lead to severe disability. Biologics are an important therapeutic option for treating patients with JIA. The efficiency of rituximab has not been proven for this indication. Its use has rarely been reported in the literature. We report two new cases of severe and refractory polyarticular JIA with positive rheumatoid factor affecting two African females aged 17 and 18 years successfully treated with rituximab. According to our experience, the use of rituximab in the treatment of JIA, especially in severe polyarticular forms with positive rheumatoid factor, might be a good alternative. Larger therapeutic trials should be conducted in this direction in order to prove the effectiveness of this biotherapy for this indication.
Collapse
Affiliation(s)
- Khadija Berrada
- Department of Rheumatology, CHU Hassan II University Hospital, Fez, Morocco
| | | | - Imane El Mezouar
- Department of Rheumatology, CHU Hassan II University Hospital, Fez, Morocco
| | - Faiza Lazrak
- Department of Rheumatology, CHU Hassan II University Hospital, Fez, Morocco
| | - Nacira Aradoini
- Department of Rheumatology, CHU Hassan II University Hospital, Fez, Morocco
| | - Latifa Tahiri
- Department of Rheumatology, CHU Hassan II University Hospital, Fez, Morocco
| | - Taoufik Harzy
- Department of Rheumatology, CHU Hassan II University Hospital, Fez, Morocco
| |
Collapse
|
16
|
McEvoy MT, Shander A. Anemia, bleeding, and blood transfusion in the intensive care unit: causes, risks, costs, and new strategies. Am J Crit Care 2013; 22:eS1-13; quiz eS14. [PMID: 24186829 DOI: 10.4037/ajcc2013729] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The definition of anemia is controversial and varies with the sex, age, and ethnicity of the patient. Anemia afflicts half of hospitalized patients and most elderly hospitalized patients. Acute anemia in the operating room or intensive care unit is associated with increased morbidity as well as other adverse outcomes, including death. The risks of anemia are compounded by the added risks associated with transfusion of red blood cells, the most common treatment for severe anemia. The causes of anemia in hospitalized patients include iron deficiency, suppression of erythropoietin and iron transport, trauma, phlebotomy, coagulopathies, adverse effects of and reactions to medications, and stress-induced gastrointestinal bleeding. The types and causes of anemia and the increased health care utilization and costs associated with anemia and undetected internal bleeding are described. The potential benefits and risks associated with transfusion of red blood cells also are explored. Last, the strategies and new tools to help prevent anemia, allow earlier detection of internal bleeding, and avoid unnecessary blood transfusions are discussed.
Collapse
Affiliation(s)
- Michael T. McEvoy
- Michael T. McEvoy is a critical care registered nurse in the Department of Cardiothoracic Surgery at Albany Medical Center in Albany, New York. Aryeh Shander is an anesthesiologist in the Department of Anesthesiology, Critical Care Medicine, Pain Management, and Hyperbaric Medicine at Englewood Hospital and Medical Center in Englewood, New Jersey
| | - Aryeh Shander
- Michael T. McEvoy is a critical care registered nurse in the Department of Cardiothoracic Surgery at Albany Medical Center in Albany, New York. Aryeh Shander is an anesthesiologist in the Department of Anesthesiology, Critical Care Medicine, Pain Management, and Hyperbaric Medicine at Englewood Hospital and Medical Center in Englewood, New Jersey
| |
Collapse
|
17
|
Ferrara M, Bertocco F, Ferrara D, Capozzi L. Chronic immune thrombocytopenic purpura in childhood: pathogenetic mechanisms and management. Hematology 2013; 17:363-6. [DOI: 10.1179/1607845412y.0000000011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Mara Ferrara
- Department of PediatricsSecond University of Naples, Naples, Italy
| | | | - Dolores Ferrara
- Department of PediatricsSecond University of Naples, Naples, Italy
| | - Laura Capozzi
- Department of PediatricsSecond University of Naples, Naples, Italy
| |
Collapse
|
18
|
Burchard PR, Malhotra S, Kaur P, Tsongalis GJ. Detection of the FCGR3a polymorphism using a real-time polymerase chain reaction assay. Cancer Genet 2013; 206:130-4. [PMID: 23680410 DOI: 10.1016/j.cancergen.2013.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/18/2013] [Accepted: 03/18/2013] [Indexed: 10/26/2022]
Abstract
The fragment crystallizable (Fc) region of the immunoglobulin G, low affinity III A receptor (FCGR3a, also known as CD16) belongs to the Fc gamma receptor family (FCGR), which plays an important role in immunoinflammatory processes. It is a low affinity, transmembrane receptor that is mainly expressed in monocytes, natural killer cells, and macrophages. It has been implicated in various inflammatory conditions, and recently a polymorphism (rs396991) in this gene has been shown to influence response to rituximab (anti-CD20) therapy in various disorders. We evaluated two molecular methods to genotype this polymorphism. Archived, formalin-fixed, paraffin-embedded samples from 26 biopsies of diffuse large B-cell lymphoma were retrieved and DNA was extracted. The samples were tested for the FCGR3a polymorphism using real-time polymerase chain reaction (PCR) followed by melt curve analysis or by a standard TaqMan allelic discrimination assay using the ABI 7500 FAST real-time PCR instrument. With the TaqMan allelic discrimination assay, we found that 16 cases were the wild type genotype, homozygous phenylalanine (F/F), for the FCGR3a receptor, whereas two cases had the homozygous valine (V/V) polymorphism and eight cases were heterozygous with a V/F genotype. Results with the real-time PCR followed by melt curve analysis were similar for 25 cases; however, four samples did not have sufficient DNA for the melt curve analysis method, and the result from one sample was discordant. The new TaqMan assay offers several advantages over previously published assays, such as faster turnaround time and ease of interpretation. These performance characteristics make it highly suitable for use in a clinical laboratory.
Collapse
Affiliation(s)
- Paul R Burchard
- Department of Pathology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | | | | |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW In spite of impressive improvements in short-term outcomes for intestine transplant recipients, late allograft loss continues to plague the field. Attention has mostly been focused on T-cell-mediated cellular mechanisms of allograft rejection to explain these losses; however, as in other forms of solid-organ transplantation, especially kidney and heart, antibody-mediated mechanisms of acute and chronic allograft injury are increasingly being implicated. In this review, the mechanisms of B-cell- and humoral-mediated allograft injury will be briefly discussed along with the limited evidence that exist for invoking antibody-mediated rejection (AMR) as important in intestine transplantation. RECENT FINDINGS The presence of donor-specific antibody has been reported to increase the incidence and severity of intestine allograft rejection and to worsen the overall prognosis for graft and patient. C4d staining in intestine biopsies is unreliable, and currently it is not possible to diagnose AMR with certainty in intestine transplantation. Treatment of presumed AMR in intestine recipients is purely anecdotal at this time. SUMMARY Further basic and clinical research needs to be conducted to more confidently diagnose and treat AMR in intestinal transplantation.
Collapse
|
20
|
|