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Piskin D, Arici ZS, Konukbay D, Romano M, Makay B, Ayaz N, Bilginer Y, Berard RA, Poyrazoglu H, Kasapcopur O, Laxer RM, Speechley K, Demirkaya E. Number of Episodes Can Be Used as a Disease Activity Measure in Familial Mediterranean Fever. Front Pediatr 2022; 10:822473. [PMID: 35573940 PMCID: PMC9091585 DOI: 10.3389/fped.2022.822473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/28/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the number of episodes in the past 12 months as an indicator of the overall disease activity status in Familial Mediterranean fever (FMF). METHODS In this cross-sectional study, patients were recruited from tertiary pediatric hospitals. Demographic data, main clinical symptoms of the episodes, treatment modalities, and genetic mutations were recorded. The patients were grouped as no episodes (Group 1), 1-4 episodes (Group 2), and more than 4 episodes (Group 3) according to the number of episodes in the past 12 months. The Pediatric Quality Life Inventory (PedsQL), the Children's Depression Inventory (CDI), and the Wong-Baker FACES Pain Rating Scale (FACES) scores were compared between groups. Concurrent validity between the number of episodes and the patient-reported outcome measures (PROMs) was assessed using Spearman's rank correlation coefficient (ρ). RESULTS A total of 239 patients were included. There were 74 patients (31%) in Group 1, 99 (41.4%) in Group 2, and 66 (27.6%) in Group 3. Groups were similar according to age, age at diagnosis, gender, consanguinity, family history, history of amyloidosis, clinical symptoms, and in terms of allele frequency (p > 0.05). According to PROMs completed by parents, moderate correlations were found between the number of episodes and the PedsQL score (ρ = -0.48; 95% CI = -0.58 to -0.35, p < 0.001) and between the number of episodes and the Wong-Baker FACES score (ρ = 0.47, 95% CI = 0.35-0.57, p < 0.001). CONCLUSION The number of episodes was positively and moderately correlated with patient- and parent-reported outcomes in our cohort. The number of episodes in patients with FMF can be used as a single measure to assess disease activity.
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Affiliation(s)
- David Piskin
- Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada.,Department of Paediatrics and Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | | | - Dilek Konukbay
- Gulhane Faculty of Nursing, University of Health Sciences, Ankara, Turkey
| | - Micol Romano
- Division of Paediatric Rheumatology, Department of Paediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Canadian Behcet's and Autoinflammatory Diseases Center (CAN BE AID), University of Western Ontario, London, ON, Canada
| | - Balahan Makay
- Pediatric Rheumatology Unit, Dokuz Eylül University, ízmir, Turkey
| | - Nuray Ayaz
- Department of Pediatric Rheumatology, Istanbul University Medical School, Istanbul, Turkey
| | - Yelda Bilginer
- Pediatric Rheumatology Unit, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Roberta A Berard
- Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada.,Division of Paediatric Rheumatology, Department of Paediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Canadian Behcet's and Autoinflammatory Diseases Center (CAN BE AID), University of Western Ontario, London, ON, Canada
| | - Hakan Poyrazoglu
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ozgur Kasapcopur
- Pediatric Rheumatology Unit, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ronald M Laxer
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Kathy Speechley
- Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada.,Department of Paediatrics and Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Erkan Demirkaya
- Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada.,Department of Paediatrics and Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Division of Paediatric Rheumatology, Department of Paediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.,Canadian Behcet's and Autoinflammatory Diseases Center (CAN BE AID), University of Western Ontario, London, ON, Canada
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Sapudom J, Alatoom A, Mohamed WKE, Garcia-Sabaté A, McBain I, Nasser RA, Teo JCM. Dendritic cell immune potency on 2D and in 3D collagen matrices. Biomater Sci 2021; 8:5106-5120. [PMID: 32812979 DOI: 10.1039/d0bm01141j] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Dendritic cells (DCs) are antigen-presenting cells capable of either activating the immune response or inducing and maintaining immune tolerance. Understanding how biophysical properties affect DC behaviors will provide insight into the biology of a DC and its applications. In this work, we studied how cell culture dimensionality (two-dimensional (2D) and three-dimensional (3D)), and matrix density of 3D collagen matrices modulate differentiation and functions of DCs. Besides, we aimed to point out the different conceptual perspectives in modern immunological research, namely tissue-centric and cell-centric perspectives. The tissue-centric perspective intends to reveal how specific microenvironments dictate DC differentiation and in turn modulate DC functionalities, while the cell-centric perspective aims to demonstrate how pre-differentiated DCs behave in specific microenvironments. DC plasticity was characterized in terms of cell surface markers and cytokine secretion profiles. Subsequently, antigen internalization and T cell activation were quantified to demonstrate the cellular functions of immature DCs (iDCs) and mature DCs (mDCs), respectively. In the tissue-centric perspective, we found that expressed surface markers and secreted cytokines of both iDCs and mDCs are generally higher in 2D culture, while they are regulated by matrix density in 3D culture. In contrast, in the cell-centric perspective, we found enhanced expression of cell surface markers as well as distinct cytokine secretion profiles in both iDCs and mDCs. By analyzing cellular functions of cells in the tissue-centric perspective, we found matrix density dependence in antigen uptake by iDCs, as well as on mDC-mediated T cell proliferation in 3D cell culture. On the other hand, in the cell-centric perspective, both iDCs and mDCs appeared to lose their functional potentials to internalization antigen and T cell stimulation. Additionally, mDCs from tissue- and cell-centric perspectives modulated T cell differentiation by their distinct cytokine secretion profiles towards Th1 and Th17, respectively. In sum, our work emphasizes the importance of dimensionality, as well as collagen fibrillar density in the regulation of the immune response of DCs. Besides this, we demonstrated that the conceptual perspective of the experimental design could be an essential key point in research in immune cell-material interactions and biomaterial-based disease models of immunity.
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Affiliation(s)
- Jiranuwat Sapudom
- Laboratory for Immuno Bioengineering Research and Applications, Division of Engineering, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | - Aseel Alatoom
- Laboratory for Immuno Bioengineering Research and Applications, Division of Engineering, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | - Walaa K E Mohamed
- Laboratory for Immuno Bioengineering Research and Applications, Division of Engineering, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | - Anna Garcia-Sabaté
- Laboratory for Immuno Bioengineering Research and Applications, Division of Engineering, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | - Ian McBain
- Laboratory for Immuno Bioengineering Research and Applications, Division of Engineering, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.
| | - Rasha A Nasser
- Department of Microbiology Immunology, College of Medicine, United Arab Emirates University, United Arab Emirates
| | - Jeremy C M Teo
- Laboratory for Immuno Bioengineering Research and Applications, Division of Engineering, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates. and Department of Biomedical and Mechanical Engineering, Tandon School of Engineering, New York University, USA
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Wang M, Zhao Y, Hu W, Zhao D, Zhang Y, Wang T, Zheng Z, Li X, Zeng S, Liu Z, Lu L, Wan Z, Hu K. Treatment of COVID-19 Patients with Prolonged Post-Symptomatic Viral Shedding with Leflunomide -- a Single-Center, Randomized, Controlled Clinical Trial. Clin Infect Dis 2020; 73:e4012-e4019. [PMID: 32955081 PMCID: PMC7543328 DOI: 10.1093/cid/ciaa1417] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/19/2020] [Indexed: 12/17/2022] Open
Abstract
Objective To evaluate the efficacy and safety of leflunomide, an approved dihydroorotate dehydrogenase inhibitor, to treat COVID-19 patients with prolonged post-symptomatic viral shedding. Methods We conducted a prospective, randomized, controlled, open-label trial involving hospitalized adult COVID-19 patients with prolonged PCR positivity. Patients were randomly assigned to receive either leflunomide (50 mg, q12h, three consecutive times, orally; then 20 mg, once daily for 8 days), in addition to nebulized interferon alpha 2a (IFN α-2a, 3 million IU each time, twice daily for 10 days), or nebulized IFN α-2a alone for 10 days. The primary end point was the duration of viral shedding. Results A total of 50 COVID-19 patients with prolonged PCR positivity were randomized into 2 groups; 26 were assigned to the leflunomide group, and 24 were assigned to the interferon alone group. Treatment with leflunomide was not associated with a difference from the interferon alone group in the duration of viral shedding (hazard ratio for negative RT-PCR, 0.70; 95% confidence interval, 0.391-1.256; P=0.186). In addition, the patients given leflunomide did not have a substantially shorter length of hospital stay than patients treated with interferon alone, with median (IQRs) durations of 29.0 (19.3-47.3) days and 33.0 (29.3-42.8) days, respectively, P=0.170. Two leflunomide recipients were unable to complete the full 10-day course of administration due to adverse events. Conclusions In COVID-19 patients with prolonged PCR positivity, no benefit in terms of the duration of viral shedding was observed with the combined treatment of leflunomide and IFN α-2a beyond IFN α-2a alone.
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Affiliation(s)
- Mengmei Wang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Zhangzhidong, Wuhan, China
| | - Yang Zhao
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Zhangzhidong, Wuhan, China
| | - Weihua Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Zhangzhidong, Wuhan, China
| | - Dong Zhao
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Zhangzhidong, Wuhan, China
| | - Yunting Zhang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Zhangzhidong, Wuhan, China
| | - Tao Wang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Zhangzhidong, Wuhan, China
| | - Zhishui Zheng
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Zhangzhidong, Wuhan, China
| | - Xiaochen Li
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Zhangzhidong, Wuhan, China
| | - Shaolin Zeng
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Zhangzhidong, Wuhan, China
| | - Zhenlian Liu
- East Campus, Renmin Hospital of Wuhan University, Donghu High-tech District, Wuhan, China
| | - Li Lu
- East Campus, Renmin Hospital of Wuhan University, Donghu High-tech District, Wuhan, China
| | - Zhihui Wan
- East Campus, Renmin Hospital of Wuhan University, Donghu High-tech District, Wuhan, China
| | - Ke Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Zhangzhidong, Wuhan, China
- Corresponding author. Address correspondence and reprint requests to Dr. Ke Hu (E-mail: , Tel: 86-27-27-88041911-82215. Fax: 86-27-88042292)
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Lwin MN, Serhal L, Holroyd C, Edwards CJ. Rheumatoid Arthritis: The Impact of Mental Health on Disease: A Narrative Review. Rheumatol Ther 2020; 7:457-471. [PMID: 32535834 PMCID: PMC7410879 DOI: 10.1007/s40744-020-00217-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Indexed: 02/06/2023] Open
Abstract
Over 60% of rheumatoid arthritis (RA) patients achieve a good response after 12 months of treatment when following the European league against rheumatism (EULAR) guidelines for treatment. However, almost half of patients still suffer from moderate to severe disease activity despite this. In addition, mental health problems may remain despite reduced measures of inflammation systemically and within joints. Depression is two times more common in RA patients than in the general population, and intriguingly a bi-directional relationship with RA has been shown in cross-sectional studies. Chronic inflammation impairs the physiological responses to stress including effective coping behaviours, resulting in depression, which leads to a worse long-term outcome in RA. In RA patients, the pain score is not always solely related to inflammatory arthritis and immunological disease activity by Bąk et al. (Patient Prefer Adherence 13:223-231, [1]). Non-inflammatory pain secondary to anxiety, depression, sleep disturbance and the psychosocial situation needs to be considered whilst fibromyalgia, mechanical pain and neuropathic pain can also contribute to overall pain scores by Chancay et al. (Women's Midlife Health 5:3, [2]). Hence, the UK National Institute for Health and Care Excellence (NICE) guideline for the management of RA included psychological interventions for fatigue, low mood and social well-being (NICE NG100, 2018) [3], and the NICE clinical guidelines (CG91) [4] suggest managing mental health and depression in chronic medical conditions to improve treatment outcomes. This is a narrative review of the impact of mental health on RA disease activity in terms of patient-reported outcomes (PROs).
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Affiliation(s)
- May N Lwin
- University Hospital Southampton, Southampton, UK.
| | - Lina Serhal
- University Hospital Southampton, Southampton, UK
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