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Simsek I, Swearingen C, Ghandehari H, Kennedy S, Tambiah J, Yazici Y, Skrepnik N. POS0278 A MULTICENTER, OBSERVATIONAL, EXTENSION STUDY EVALUATING THE SAFETY, TOLERABILITY, AND EFFICACY OF A SINGLE LORECIVIVINT INJECTION IN KNEE OA SUBJECTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Lorecivivint (LOR), a novel intra-articular (IA) CLK2/DYRK1A inhibitor that modulates the Wnt pathway, is in development as a knee osteoarthritis (OA) treatment.Objectives:Subjects from two consecutive Phase 2 trials were followed up in a 5-year, pooled, observational study that evaluated the safety and exploratory efficacy of a single LOR injection that was previously administered into the target knee joint of subjects with moderate to severe knee OA. The study was terminated in its third year, as relevant long-term safety information became limited in the absence of repeated LOR administration. The primary objective evaluated the incidence of serious adverse events (SAEs). Safety data for all doses and a post hoc efficacy analysis for the pivotal dose (0.07 mg LOR) are reported.Methods:This was a Phase 3, multicenter, observational, extension study of completer subjects (OA-05; NCT02951026) from two Phase 2 trials of LOR: a 12-month Phase 2a trial (OA-02; NCT02536833)1 and a 6-month Phase 2b trial (OA-04; NCT03122860)2. Subjects received a single LOR or control (placebo or vehicle) injection at their parent-study baseline visit (OA-02 or OA-04 Visit 0 in this analysis). Pooled data from clinic visits at 6, 12, 24, and 36 months contributed to the extension-study (OA-05) analysis. SAEs, knee-related adverse events (AEs), and AEs of newly diagnosed conditions requiring treatment were collected as safety outcomes. Efficacy was assessed by target knee WOMAC Pain and Function subscores and radiographic medial joint space width (mJSW). A post hoc analysis was performed for 0.07 mg LOR versus control to assess responses in a subject subgroup (unilateral symptoms, no widespread pain, 18-month post-injection radiograph at study termination). Baseline-adjusted ANCOVA was performed using data from both the current and parent studies at 0, 3, 6, 12, and 18 months.Results:Of 703 subjects, 119 (17%) subjects discontinued prior to study termination. Subjects had a mean age of 60.7 years and mean BMI of 29.1 kg/m2, and 61% were female. The majority of subjects had KL 3 (61.2%) OA. The safety analysis set included 495 LOR-treated subjects and 208 control subjects. There were 169 AEs reported by 110 [15.6%] subjects. Four AEs were considered to be related to study drug and were reported by 3 (0.6%) subjects across LOR groups; no subjects withdrew from the study due to a treatment-related AE. The most common AEs were osteoarthritis (28 [4.0%] subjects) and arthralgia (25 [3.6%] subjects); incidence was similar between LOR and control groups. During the study, 68 SAEs were reported by 38 (5.4%) subjects, and no SAEs were considered to be related to treatment by investigator. One death occurred in the control group. Post hoc efficacy analyses demonstrated that subjects in the 0.07 mg LOR group (n=59) showed greater improvements from baseline in both WOMAC Pain and Function at 6 and 12 months versus subjects in the control group (n=70) (Figure 1; Day 0):6 months:Pain: -8.16, 95% CI [-15.60, -0.71], P=0.032Function: -9.47, 95% CI [-17.09, -1.84], P=0.01512 months:Pain: -8.51, 95% CI [-15.17, -1.85], P=0.013Function: -9.62, 95% CI [-16.83, -2.42], P=0.009No mJSW progression was observed in any group over 18 months.Limitations to this analysis include 1) subjects from LOR and control groups were “completers,” therefore, more likely to be responders, and 2) subjects could have been on any medication or treatment in the extension study.Conclusion:From these data, LOR appeared to be safe and well tolerated. A post hoc-analyzed subset of completer subjects treated with a single 0.07 mg LOR injection reported durable symptom improvements in WOMAC Pain and Function for up to at least 12 months versus control subjects.References:[1]Yazici Y, et al. Arthritis Rheumatol. 2020.[2]Yazici Y, et al. ACR meeting. 2019. Abstract L03.Disclosure of Interests:Ismail Simsek Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Christopher Swearingen Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Heli Ghandehari Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Sarah Kennedy Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Jeyanesh Tambiah Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Yusuf Yazici Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Nebojsa Skrepnik Consultant of: Pfizer, Regeneron, Orthofix, Grant/research support from: Samumed, LLC
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Yazici Y, McAlindon TE, Gibofsky A, Lane NE, Lattermann C, Skrepnik N, Swearingen CJ, Simsek I, Ghandehari H, DiFrancesco A, Gibbs J, Tambiah JRS, Hochberg MC. A Phase 2b randomized trial of lorecivivint, a novel intra-articular CLK2/DYRK1A inhibitor and Wnt pathway modulator for knee osteoarthritis. Osteoarthritis Cartilage 2021; 29:654-666. [PMID: 33588087 DOI: 10.1016/j.joca.2021.02.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/13/2021] [Accepted: 02/07/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Lorecivivint (LOR; SM04690), an investigational Wnt pathway modulator, previously demonstrated patient-reported and radiographic outcome improvements vs placebo in clinically relevant subjects with moderate to severe knee osteoarthritis (OA). This study's objective was to identify effective LOR doses. DESIGN Subjects in this 24-week, Phase 2b, multicenter, randomized, double-blind, placebo (PBO)-controlled trial received an intra-articular injection of 2 mL LOR (0.03, 0.07, 0.15, or 0.23 mg), PBO, or dry-needle sham. The primary efficacy endpoints were changes in Pain NRS [0-10], WOMAC Pain [0-100], WOMAC Function [0-100], and radiographic mJSW outcomes, which were measured using baseline-adjusted analysis of covariance at Week 24. Multiple Comparison Procedure-Modeling (MCP-Mod) was performed for dose modeling. RESULTS In total, 695/700 subjects were treated. Pain NRS showed significant improvements vs PBO after treatment with 0.07 mg and 0.23 mg LOR at Weeks 12 (-0.96, 95% CI [-1.54, -0.37], P = 0.001; -0.78 [-1.39, -0.17], P = 0.012) and 24 (-0.70 [-1.34, -0.06], P = 0.031; -0.82 [-1.51, -0.12], P = 0.022). Additionally, 0.07 mg LOR significantly improved WOMAC Pain and Function subscores vs PBO at Week 12 (P = 0.04, P = 0.021), and 0.23 mg LOR significantly improved both WOMAC subscores at Week 24 (P = 0.031, P = 0.017). No significant differences from PBO were observed for other doses. No radiographic progression was observed in any group at Week 24. MCP-Mod identified 0.07 mg LOR as the lowest effective dose. CONCLUSION This 24-week Phase 2b trial demonstrated the efficacy of LOR on PROs in knee OA subjects. The optimal dose for future studies was identified as 0.07 mg LOR.
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Affiliation(s)
- Y Yazici
- Samumed, LLC, San Diego, CA, USA; New York University School of Medicine, New York, NY, USA.
| | | | - A Gibofsky
- Weill Cornell Medical College, New York, NY, USA
| | - N E Lane
- University of California Davis Medical School, Burlingame, CA, USA
| | | | - N Skrepnik
- Tucson Orthopaedic Institute, Tucson, AZ, USA
| | | | - I Simsek
- Samumed, LLC, San Diego, CA, USA
| | | | | | - J Gibbs
- Samumed, LLC, San Diego, CA, USA
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Simsek I, Swearingen C, Kennedy S, Tambiah J, Damatarca C, Yazici Y, Lane N, Hochberg M. OP0188 INTEGRATED SAFETY SUMMARY OF THE NOVEL, INTRA-ARTICULAR AGENT LORECIVIVINT (SM04690), A CLK/DYRK1A INHIBITOR THAT MODULATES THE WNT PATHWAY, IN SUBJECTS WITH KNEE OSTEOARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Concerns over the safety of available osteoarthritis (OA) treatments have led to revision of treatment guidelines and highlight the need for new therapies. Lorecivivint (LOR; SM04690) is an intra-articular (IA), small-molecule CLK/DYRK1A inhibitor that modulates the Wnt pathway and is in development as a potential disease-modifying treatment for knee OA.1,2Objectives:To evaluate pooled early-phase LOR clinical data for safety, including bone health-related adverse events (AEs).Methods:Safety data were pooled from 3 randomized controlled trials (one Phase 1, two Phase 2) evaluating 4 doses (0.03 mg, 0.07 mg, 0.15 mg, 0.23 mg) of a single IA injection of LOR in subjects with moderately to severely symptomatic knee OA. Two trials (NCT02095548;NCT03122860) evaluated subjects for 24 weeks and one trial (NCT02536833) for 52 weeks. AEs, serious AEs (SAEs), and bone health AEs were categorized by Medical Dictionary for Regulatory Activities (MedDRA) classification. Incidences of AEs and SAEs were compared between the combined LOR-treated group (subjects who received any dose of LOR) and a control group (subjects not treated with LOR).Results:This analysis includes 848 LOR-treated and 360 control subjects. The incidence of AEs was similar in LOR-treated (350/848 [41.3%]) and control subjects (138/360 [38.3%]). Incidence of SAEs was 20/848 (2.4%) in LOR-treated and 4/360 (1.1%) in control subjects. The most commonly reported AE in LOR-treated subjects was arthralgia (treated 7.6%, control 7.2%) and was the only AE reported at >5% in either group (Fig. 1). Target-knee arthralgia was the most common joint-specific AE (treated 6.5%, control 5.3%) (Fig. 2). No AEs in other joints exceeded an incidence of 2% in either group. In all categories, individual AEs were reported at similar rates between groups and no SAEs were deemed related to LOR by investigators.Figure 1.Adverse event summary for events occurring in at least 1% of the treated population (N=1208).Figure 2.Joint-specific adverse event summary, subcategorized by affected joint, for events occurring in at least 1% of the treated population (N=1208).There were 16 bone health-related AEs in 9/848 (1.1%) LOR-treated and 3/360 (0.8%) control subjects. Of the bone health AEs, 2 were osteopenia/osteoporosis in 2 LOR-treated postmenopausal women and 14 were fractures in 10 subjects (7 LOR-treated, 3 control). All fractures (3 patellar [1 target knee, 2 non-target knee], 3 vertebral, 2 foot, 2 wrist, 2 rib, 1 fibula, 1 hand) were adjudicated and determined to be caused by trauma; all healed uneventfully within the expected time frame.Conclusion:In exposure to date of 848 subjects, IA LOR for the treatment of knee OA appeared to be safe and well tolerated. These data support the continued evaluation of LOR as a potential treatment for knee OA.References:[1]Deshmukh V, et al.Osteoarthritis Cartilage. 2017.[2]Deshmukh V, et al.Osteoarthritis Cartilage. 2019.Disclosure of Interests:Ismail Simsek Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Christopher Swearingen Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Sarah Kennedy Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Jeyanesh Tambiah Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Cristina Damatarca Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Yusuf Yazici Shareholder of: Samumed, LLC, Grant/research support from: Bristol-Myers Squibb, Celgene, and Genentech, Consultant of: Celgene and Sanofi, Employee of: Samumed, LLC, Nancy Lane Consultant of: Samumed, LLC, Marc Hochberg: None declared
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Kennedy S, Swearingen C, Simsek I, Tambiah J. FRI0380 ITEMS DRIVING WOMAC PAIN SUBSCORE CHANGES DUE TO LORECIVIVINT, A POTENTIAL DISEASE-MODIFYING TREATMENT FOR KNEE OSTEOARTHRITIS: A POST HOC ANALYSIS OF PHASE 2B TRIAL DATA. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Knee osteoarthritis (OA) is a disease characterized by pain, loss of function, and structural deformities, leading to a heterogeneous disease state that can confound patient-reported outcomes (PROs). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain subscore addresses this reporting variability by capturing multiple pain items related to ‘active’ and ‘static’ subject states. We hypothesize that measurement of these ‘active’ versus ‘static’ pain items may demonstrate differential effect sizes when assessing treatment benefit. Lorecivivint (LOR; SM04690), a small-molecule, intra-articular CLK/DYRK1A inhibitor that modulates the Wnt pathway, is currently in development as a potential disease-modifying treatment for knee OA.1,2Objectives:To test the hypothesis, a post hoc analysis of Pain NRS, the WOMAC Pain subscore, and individual WOMAC PROs (items A1–A5) from a Phase 2b LOR trial was performed to examine effect size (ES) changes.Methods:The original 24-week Phase 2b trial has been previously reported. In this study, pain was assessed using the weekly average of daily Pain NRS and WOMAC Pain subscore. In the post hoc analysis, items A1–A5 (pain walking on a flat surface? [A1], going up/downstairs? [A2], at night in bed? [A3], sitting or lying down? [A4], and while standing? [A5]) were individually analyzed for subjects treated with 0.07 mg LOR and compared with the primary study outcomes of mean Pain NRS and summed mean WOMAC Pain subscore at Week 12. Baseline-adjusted analysis of covariance for WOMAC A1–A5 scores was conducted on LOR-treated subjects compared with placebo (PBO) in 1) the Full Analysis Set (FAS) of all dosed subjects and 2) a target population of subjects with fixed baseline joint space width (JSW) [2–4] mm without widespread pain (Widespread Pain Index [WPI] ≤4, Symptom Severity Score Question 2≤2).Results:In this analysis, 231 subjects (KL grade 3 63.2%) were included. The primary study analysis demonstrated efficacy of LOR compared with PBO for Pain NRS and WOMAC Pain, with respective effect sizes of 0.450 and 0.293 (Figure). In the target population, Pain NRS and WOMAC A effect sizes increased (0.637 and 0.410, respectively). Each WOMAC A item showed less of an effect size than Pain NRS at Week 12. Treatment with 0.07 mg LOR compared with PBO showed significant improvements in effect sizes of WOMAC A1 (FAS: ES=0.315,P=0.028; target population: ES=0.421,P=0.035) and A2 (FAS: ES=0.392,P=0.006; target population: ES=0.510,P=0.011). A3–A5 did not show statistical improvement for LOR compared with PBO.Figure.Effect sizes for 0.07 mg LOR compared with PBO for the FAS and target population at Week 12.Conclusion:In the post hoc analysis, Pain NRS exhibited the greatest effect size of tested PROs after treatment with 0.07 mg LOR compared with PBO. These effect sizes were enhanced in the target population with fixed baseline JSW and without widespread pain for all scores relative to the FAS. WOMAC ‘active’ questions demonstrated greater effect sizes with LOR treatment than ‘static’ questions and the full WOMAC Pain domain, providing support for the hypothesized dimensional constructs in knee OA pain assessment.References:[1]Deshmukh V, et al.Osteoarthritis Cartilage. 2017.[2]Deshmukh V, et al.Osteoarthritis Cartilage. 2019.Disclosure of Interests:Sarah Kennedy Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Christopher Swearingen Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Ismail Simsek Shareholder of: Samumed, LLC, Employee of: Samumed, LLC, Jeyanesh Tambiah Shareholder of: Samumed, LLC, Employee of: Samumed, LLC
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Cebe F, Bulbul M, Simsek I, Cebe MA, Ozturk B. Effect of Erbium:yttrium aluminum garnet laser on bond strength of a total-etch adhesive system to caries-affected dentin on gingival wall. Niger J Clin Pract 2019; 20:734-740. [PMID: 28656929 DOI: 10.4103/1119-3077.181321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE To assess the effect of the erbium:yttrium aluminum garnet (Er:YAG) laser on bond strength of a total-etch adhesive system to the caries-affected dentin on the gingival wall. MATERIALS AND METHODS Ten human molars with proximal carious lesions were randomly divided into two groups. In the first group, the carious dentin was removed with a bur, whereas in the second group it was removed with the Er:YAG laser. Carious lesions were excavated with one of these two techniques until laser fluorescence values decreased to 15 in the center of the lesions. The teeth were then restored with a total-etch adhesive system (Adper Single Bond 2) and composite resin (Filtek Z250). Five teeth from each group were sectioned to obtain 1 mm2 stick-shaped microtensile specimens from each tooth. Twenty-five specimens were obtained for each group with using this technique. The data were analyzed in independent-samples t-test (α = 0.05). For each removal technique, one sample was analyzed using scanning electron microscopy. RESULTS No statistically significant differences were found between the bond strength of the Er:YAG laser and the bur-treated groups (P > 0.05). CONCLUSION The Er:YAG laser treatment did not negatively affect the bonding performance of the total-etch adhesive system to caries-affected dentin on the gingival wall.
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Affiliation(s)
- F Cebe
- Department of Restorative Dentistry, Faculty of Dentistry, Abant Izzet Baysal University, Bolu, Turkey
| | - M Bulbul
- Department of Prosthodontics, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
| | - I Simsek
- Department of Prosthodontics, Faculty of Dentistry, Adıyaman University, Adıyaman, Turkey
| | - M A Cebe
- Department of Restorative Dentistry, Faculty of Dentistry, Abant Izzet Baysal University, Bolu, Turkey
| | - B Ozturk
- Department of Restorative Dentistry, Faculty of Dentistry, Selcuk University, Konya, Turkey
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Bolgul BS, Ayna B, Simsek I, Celenk S, Seker O, Kilinc G. Leakage testing for different adhesive systems and composites to permanent teeth. Niger J Clin Pract 2017; 20:787-791. [PMID: 28791970 DOI: 10.4103/1119-3077.171417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To explore the microleakage of different adhesive systems and flowable composites to permanent teeth. SUBJECTS AND METHODS In this study, a total of 84 human premolar teeth were used. Class V cavities were prepared on the buccal surfaces. The teeth were randomly assigned to six groups of 14 teeth each as follows: The first group - etch-rinse adhesive applied and cavities filled with flowable composite, the second group - etch-rinse adhesive applied and cavities filled with bulk-fill resin composite, the third group - one-stage self-etch (SE) adhesive applied and cavities filled with flowable composite, the fourth group - one-stage SE adhesive applied and cavities filled with bulk-fill resin composite, the fifth group - two-stage SE adhesive applied and cavities filled with flowable composite, and the sixth group - two-stage SE adhesive applied and cavities filled with bulk-fill resin composite. All specimens were then stored for 24 h at 37°C in distilled water. Teeth were then thermocycled for 500 cycles between 5°C and 55°C prior to immersion in 0.5% basic fuchsin for 24 h. Two mesiodistal cuts of each tooth were photographed for leakage with a digital camera. The dye infiltrated surface for each specimen was measured and data were collected with a software program. Statistical evaluations were done by nonparametric Kruskal-Wallis test and Mann-Whitney U-test. RESULTS There were statistically significant differences in mean microleakage ratio among the groups (P < 0.05). The first group had shown significantly increased microleakage areas than the other four groups (third, fourth, fifth, and sixth groups) (P < 0.05), except for the second group (P > 0.05). It was also no significant different between the mean microleakage areas of group fourth and group fifth (P > 0.05). The sixth group had exhibited the lowest microleakage areas, and it was statistically significant (P < 0.05) compared to the other groups. CONCLUSION In this study, it has been found that the use of total etch adhesive systems resulted in high leakage values.
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Affiliation(s)
- B S Bolgul
- Department of Pedodontics, Dental Faculty, Mustafa Kemal University, Hatay, Turkey
| | - B Ayna
- Department of Pedodontics, Dental Faculty, Dicle University, Diyarbakir, Turkey
| | - I Simsek
- Department of Pedodontics, Dental Faculty, Dicle University, Diyarbakir, Turkey
| | - S Celenk
- Department of Pedodontics, Dental Faculty, Dicle University, Diyarbakir, Turkey
| | - O Seker
- Department of Restorative, Dental Faculty, Mustafa Kemal University, Hatay, Turkey
| | - G Kilinc
- Department of Pedodontics, Dokuz Eylül University, Izmir, Turkey
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Cinar M, Cinar F, Acikel C, Yilmaz S, Cakar M, Horne R, Simsek I. AB0559 Reliability and Validity of The Turkish Translation of The Beliefs about Medicines Questionnaire (BMQ-T) in Patients with Behçet's Disease. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cinar M, Caliskan E, Yilmaz S, Boru A, Simsek I, Arca E, Cakar M, Pay S, Erdem H. SAT0407 Dermoscopic Changes in Melanocytic nevi in Patients with Ankylosing Spondylitis Using Tumor Necrosis factor-alpha Inhibitors: A Prospective Cohort Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tascilar K, Hatemi G, Inanc N, Simsek I, Swearingen C, Cinar M, Ugurlu S, Yilmaz S, Ozen G, Pay S, Direskeneli H, Yazici Y. SAT0593 Discrepancy between Patients and Physicians on Global Disease Assessment of RA and Its Determinants: An Analysis from The TRAV Cohort. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yilmaz S, Cinar M, Sanal H, Cakar M, Dilmen S, Simsek I. AB0701 The Diagnostic Value of Sacroiliac Provocation Tests in Spondyloarthritis and Their Relationship with Magnetic Resonance Imaging Findings: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cinar F, Cinar M, Yilmaz S, Acikel C, Erdem H, Pay S, Simsek I. AB0658 Cross-Cultural Adaptation, Reliability, and Validity of the Turkish Version of the Compliance Questionnaire on Rheumatology (CQR-T) in Patients with Behçet's Disease. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Karaaslan Y, Simsek I. Is osteoporosis a real disease? Clin Exp Rheumatol 2014; 32:19. [PMID: 25417804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 10/21/2014] [Indexed: 06/04/2023]
Affiliation(s)
- Y Karaaslan
- Hitit University Medical Faculty, Çorum, Turkey.
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Yilmaz S, Cinar M, Simsek I, Erdem H, Pay S. THU0378 Tocilizumab in the Treatment of Patients with AA Amyloidosis Secondary to Familial Mediterranean Fever: CASE Series: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yilmaz S, Kendirlioglu S, Kaba K, Ozdemir U, Ozturk M, Simsek I. SAT0583 The CASE of “Case Reports” in Rheumatology Literature. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cinar M, Yilmaz S, Cinar F, Koca S, Erdem H, Pay S, Dinc A, Yazici Y, Simsek I. THU0089 A Patient Reported Outcome Measures-Based Composite Index (RAPID3) for the Assessment of Disease Activity in Ankylosing Spondylitis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Simsek I, Yilmaz S, Sanal HT, Cinar M, Erdem H, Pay S. THU0463 Protracted Febrile Myalgia of Familial Mediterranean Fever can be Reliably Detected by Magnetic Resonance Imaging: A Comprehensive Analysis of 20 Cases. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Demirkaya E, Acikel C, Tufan A, Kucuk A, Berdeli A, Gul A, Onat AM, Delibas A, Duzova A, Dinc A, Yavascan O, Kasapcopur O, Makay B, Goker B, Sozeri B, Kisacik B, Comak E, Unsal E, Erken E, Gunal E, Baskin E, Yalcinkaya F, Yildiz F, Gok F, Basbozkurt G, Ozcelik G, Demircin G, Poyrazoglu H, Erdem H, Direskeneli H, Ozer H, Ozdogan H, Simsek I, Dursun I, Gokce I, Tunca M, Gurgoze M, Cakar N, Akinci N, Ayaz N, Donmez O, Ozkaya O, Topaloglu R, Kavukcu S, Yuksel S, Akar S, Bakkaloglu S, Emre S, Senel S, Erten S, Yavuz S, Kalman S, Kasifoglu T, Kalyoncu U, Tabel Y, Ekinci Z, Ozen S. PW01-025 – Definition of colchicine resistance in FMF. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952434 DOI: 10.1186/1546-0096-11-s1-a78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Simsek I, Yilmaz S, Cinar M, Erdem H, Pay S. Response to Zizzo et al. Clin Genet 2013; 83:582-3. [DOI: 10.1111/cge.12135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 02/21/2013] [Indexed: 11/28/2022]
Affiliation(s)
- I Simsek
- Division of Rheumatology; Gulhane School of Medicine; Ankara; Turkey
| | - S Yilmaz
- Division of Rheumatology; Gulhane School of Medicine; Ankara; Turkey
| | - M Cinar
- Division of Rheumatology; Gulhane School of Medicine; Ankara; Turkey
| | - H Erdem
- Division of Rheumatology; Gulhane School of Medicine; Ankara; Turkey
| | - S Pay
- Division of Rheumatology; Gulhane School of Medicine; Ankara; Turkey
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Cinar F, Unver V, Cinar M, Yilmaz S, Simsek I, Tosun N, Erdem H, Yilmaz F, Pay S, Dinc A. AB0836 Coping behaviors for activities of daily living in women who have hands affected due to systemic sclerosis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kisacik B, Basar N, Ercan S, Pehlivan Y, Yilmaz S, Simsek I, Erdem H, Ozer O, Pay S, Dinc A, Onat A. AB0008 Familial mediterranean fever (FMF) gene mutations (MEFV): are they a risk factor for coronary artery disease? Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yilmaz S, Cinar M, Karadag O, Simsek I, Erdem H, Pay S, Dinc A. AB0333 The performance of new and old classification criteria for rheumatoid arthritis in a turkish cohort with early-undifferentiated inflammatory arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Simsek I, Inanc N, Hatemi G, Pay S, Erdem H, Yilmaz S, Cinar M, Can M, Tascilar K, Ugurlu S, Cakir N, McCracken W, Swearingen C, Direskeneli H, Yazici Y. AB1339 Similar disease activity levels in US and turkish RA patients despite more biologic and methotrexate use in the US than turkey. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hatemi G, Inanc N, Simsek I, Tascilar K, Ugurlu S, Can M, Pay S, Erdem H, Yilmaz S, Cinar M, Cakir N, McCracken W, Swearingen C, Direskeneli H, Yazici Y. AB1332 Agreement in physician and patient reported measures for ra activity among US and turkish RA patients: More similar than not. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Inanc N, Hatemi G, Simsek I, Ozen G, Tascilar K, Ugurlu S, Pay S, Erdem H, Yilmaz S, Cinar M, Swearingen CJ, Direskeneli H, Yazici Y. SAT0067 Moderate/Severe Disease Activity vs Low Disease Activity/Remission: Patient Characteristics and Differences Among Patients from United States and Turkey. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cinar M, Cinar F, Yilmaz S, Simsek I, Erdem H, Pay S. FRI0444 Thoughts and perceptions about their medications of patients with ankylosing spondylitis using TNF inhibitors. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Yilmaz S, Sener K, Simsek I, Cinar M, Gumral R, Erdem H, Kubar A, Pay S. AB0740 The frequency of occult hepatitis b infection in rheumatic diseases and the role of anti-hbc test in routine practice. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.3062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cinar M, Akar H, Yilmaz S, Simsek I, Karkucak M, Sagkan RI, Erdem H, Avci IY, Acikel C, Musabak U, Tunca Y, Pay S. THU0351 The Role of Endoplasmic Reticulum Aminopeptidase 1 (ERAP1) in the Pathogenesis of Ankylosing Spondylitis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Inanc N, Hatemi G, Simsek I, Can M, Tascilar K, Ugurlu S, Pay S, Erdem H, Yilmaz S, Cinar M, Cakir N, McCracken W, Swearingen C, Direskeneli H, Yazici Y. AB1368 Insights from a routine care rheumatoid arthritis registry in turkey (TRAV): A third of rheumatoid arthritis patients are in remission/low disease activity and 1/5 are on biologic agents. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kamali S, Pay S, Inanc N, Simsek I, Hamuryudan V. FRI0193 Current therapy of rheumatoid arthritis in turkey: rheumatologists’ perspective. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Simsek I, Yildiz B, Yilmaz S, Cinar M, Sanal HT, Onay A, Erdem H, Pay S. FRI0458 Utility of new asas classification criteria for axial and peripheral spondylarthritis in routine clinical care: a cohort study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hamdemirci N, Koruglu B, Simsek I, Parlar O, Usumez A. Bond Strength of Resin Cement to Zirconia Ceramic with Different Surface Treatments. Med Oral Patol Oral Cir Bucal 2012. [DOI: 10.4317/medoral.17643633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tyndall AJ, Bannert B, Vonk M, Airo P, Cozzi F, Carreira PE, Bancel DF, Allanore Y, Muller-Ladner U, Distler O, Iannone F, Pellerito R, Pileckyte M, Miniati I, Ananieva L, Gurman AB, Damjanov N, Mueller A, Valentini G, Riemekasten G, Tikly M, Hummers L, Henriques MJ, Caramaschi P, Scheja A, Rozman B, Ton E, Kumanovics G, Coleiro B, Feierl E, Szucs G, Von Muhlen CA, Riccieri V, Novak S, Chizzolini C, Kotulska A, Denton C, Coelho PC, Kotter I, Simsek I, de la Pena Lefebvre PG, Hachulla E, Seibold JR, Rednic S, Stork J, Morovic-Vergles J, Walker UA. Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. Ann Rheum Dis 2010; 69:1809-15. [DOI: 10.1136/ard.2009.114264] [Citation(s) in RCA: 795] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Gonen C, Sarioglu S, Akpinar H, Simsek I. From white points to yellow plaques: magnifying endoscopic features of duodenal lymphangiectasia. Endoscopy 2009; 41:655-6; author reply 657. [PMID: 19588296 DOI: 10.1055/s-0029-1214879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Pay S, Musabak U, Cobankara V, Sagkan RI, Simsek I, Keskin F, Erdem H, Kose O, Dinc A. IFNAR1 and IFNAR2 polymorphisms in patients with Behçet's disease. Clin Exp Rheumatol 2009; 27:S110-S111. [PMID: 19796549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Pay S, Pekel A, Simsek I, Musabak U, Erdem H, Dinc A, Kose O. Pronounced interferon-alpha production from plasmacytoid dendritic cells in patients with Behçet's disease following CpG D ODN stimulation. Clin Exp Rheumatol 2009; 27:S37-S42. [PMID: 19796531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Several lines of evidence point to a polarized T-helper-1 (Th1) immune response in Behçet's disease (BD). Interferon (IFN)-alpha which has an ability to promote strong Th1 type immune response has been shown to increase in patients with BD. In order to clarify if plasmacytoid dendritic cells (pDCs) abnormally respond to a stimulus in patients with BD, we investigated the levels of intracellular IFN-alpha and beta in pDCs with or without CpG D ODN stimulation. METHODS The study population consisted of 8 patients with clinically active BD, 8 ankylosing spondilitis (AS) patients having active disease and 11 healthy volunteers. pDC subsets in peripheral blood mononuclear cells (PBMCs) cultures were analysed by flow cytometry. RESULTS The percentage of IFN-alpha+ pDCs in unstimulated PBMCs cultures from patients BD was significantly higher (p=0.036) than in AS and HC. But this difference disappeared in stimulated PBMCs cultures (p=0.167). The mean fluorescence intensity (MFI) of IFN-alpha+ pDCs in stimulated PBMCs cultures of BD patients was significantly higher than those from patients with AS and HC. The percentage of IFN-beta+ pDCs in unstimulated PBMCs cultures from patients with BD and AS was significantly higher (p=0.004) than in HC. But this difference was not significant in stimulated PBMCs cultures (p=0.694). When compared to healthy subjects, the MFI of IFN-beta + pDCs in unstimulated and stimulated PBMCs cultures from patients with BD and AS was not different (p=0.287, p=0.152, respectively). In patients with BD, the percentage and MFI of IFN-alpha+ pDCs were higher (p=0.012 for all) in stimulated PBMCs cultures as compared to unstimulated ones. CONCLUSION We suggest that increased frequency of IFN-alpha+ pDC in BD patients and the higher sensitiveness of these cells to CpG D ODN stimulus contribute to high serum IFN-alpha levels found in these patients which eventually resulted in Th1 type immune response.
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Affiliation(s)
- S Pay
- Gulhane Military School of Medicine, Ankara, Turkey.
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Keskin F, Pay S, Musabak U, Sagkan RI, Erdem H, Simsek I, Kose O, Dinc A, Sengul A. IL-18 promoter polymorphisms confer susceptibility to Behçet's disease, particularly to the mucocutaneous form, in a Turkish population. Clin Exp Rheumatol 2009; 27:S108-S109. [PMID: 19796548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Simsek I, Cinar M, Erdem H, Pay S, Meric C, Dinc A. Efficacy of plasmapheresis in the treatment of refractory toxic epidermal necrolysis–like acute cutaneous lupus erythematosus. Lupus 2008; 17:605-6. [DOI: 10.1177/0961203308089341] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- I Simsek
- Division of Rheumatology, Gulhane Military School of Medicine, Ankara, Turkey
| | - M Cinar
- Department of Internal Medicine, Gulhane Military School of Medicine, Ankara, Turkey
| | - H Erdem
- Division of Rheumatology, Gulhane Military School of Medicine, Ankara, Turkey
| | - S Pay
- Division of Rheumatology, Gulhane Military School of Medicine, Ankara, Turkey
| | - C Meric
- Department of Internal Medicine, Gulhane Military School of Medicine, Ankara, Turkey
| | - A Dinc
- Division of Rheumatology, Gulhane Military School of Medicine, Ankara, Turkey
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Pay S, Simsek I, Erdem H, Pekel A, Musabak U, Sengul A, Dinc A. Dendritic cell subsets and type I interferon system in Behçet's disease: does functional abnormality in plasmacytoid dendritic cells contribute to Th1 polarization? Clin Exp Rheumatol 2007; 25:S34-S40. [PMID: 17949549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Several lines of evidence point to a polarized T-helper-1 (Th1) immune response in Behçet's disease (BD). However, it is not yet clear which factors are involved in the proposed Th1 mediated pathogenesis of BD. Dendritic cells (DCs) are antigen presenting cells which play a crucial role in the polarization of immune response. No previous study has examined the possible role of DCs in the pathogenesis of BD. We conducted both quantitative and functional analysis of the peripheral blood DC subsets in BD patients with different clinical presentations. METHODS Thirty-eight patients with BD, 12 healthy controls (HC), and 12 patients with undifferentiated spondylarthritis (uSpA) were enrolled in the study. Peripheral blood DC subsets were analysed by flow cytometry and were further characterized for maturation with CCR7. Serum levels of interferon (IFN)-alpha and IFN-b were measured by ELISA. RESULTS BD patients had a decreased percentage of plasmacytoid DCs (pDCs) compared to HC (p = 0.036). IFN-alpha levels were found to be increased in BD patients as compared to HC and uSPA (p < 0.001, p = 0.005, respectively). BD patients had decreased levels of IFN-Beta as compared to HC and uSpA (p = 0.013, p = 0.004, respectively). No difference was found between HC and patients with uSpA regarding IFN-Beta levels. Subgroup analysis of BD patients disclosed normalization of percentage of pDCs and the level of IFN-Beta in patients receiving IFN-alpha-2b. CONCLUSION We suggest abnormalities in pDCs and type I IFNs appear to be a master switch leading to the pathogenicity in BD by directing immune response towards Th1.
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Affiliation(s)
- S Pay
- Division of Rheumatology, Gulhane Military School of Medicine, Ankara, Turkey.
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Pay S, Abbasov T, Erdem H, Musabak U, Simsek I, Pekel A, Akdogan A, Sengul A, Dinc A. Serum MMP-2 and MMP-9 in patients with Behçet's disease: do their higher levels correlate to vasculo-Behçet's disease associated with aneurysm formation? Clin Exp Rheumatol 2007; 25:S70-S75. [PMID: 17949555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Basic and clinical studies have revealed a strong correlation between matrix metalloproteinases (MMPs), particularly MMP-2 and MMP-9, and the formation of abdominal aortic aneurysms. In addition, previous studies have clearly shown that MMP-2 and MMP-9 play an important role in the pathogenesis of vasculitis characterized by aneurysm formation such as Kawasaki disease, temporal arteritis and Takayasu arteritis. Depending on those findings, we hypothesized that circulating MMP-2 and MMP-9 could be useful markers to demonstrate vascular aneurysmatic involvement in patients with Behçet's disease (BD). METHODS Fifty-eight patients with BD, and 20 healthy controls were enrolled in the study. We assessed the disease activity of patients according to the Leeds activity score system. We compared the Leeds activity scores of patients with their serum levels of MMP2 and MMP-9. Patients with BD were categorized as active (total activity score > or = 5) or inactive (total activity score < 5). Patients were further categorized with respect to their extent of involvement as muco-cutaneous or systemic. Patients with systemic involvement were subdivided into ocular or vascular involvement. Patients with vascular involvement were subgrouped as thrombotic or aneurysmatic involvement. The levels of MMP-2 and MMP-9 were measured by ELISA. RESULTS Serum MMP-9 but not MMP-2 levels were significantly higher both in patients with active and inactive disease as compared to healthy controls (p = 0.008 and 0.013 respectively). We found positive correlation between Leeds activity score and serum MMP-2 levels in patients with vascular involvement (p = 0.035 and r = 0.485), and serum MMP-9 levels in active BD patients (p = 0.003 and r = 0.599). The serum levels of MMP-2 and MMP-9 in patients with systemic involvement were higher than those of healthy controls but not patients with mucocutaneous involvement (p = 0.046 and 0.002 respectively). The serum levels of MMP-2 in patients with vascular involvement were found to be higher than those of healthy controls and patients with mucocutaneous involvement (p = 0.001 and 0.003, respectively) but not different in those with ocular involvement. The serum levels of MMP-9 in patients with vascular involvement were found to be higher than those of healthy controls and ocular disease (p = 0.001 and 0.033 respectively) but not different in those with mucocutaneous involvement. The serum levels of MMP-2 in patients with aneurysmatic involvement were found to be higher than those of healthy controls, mucocutaneous and ocular involvement (p = 0.004, 0.008 and 0.004 respectively). The serum levels of MMP-2 in patients with thrombotic involvement were found to be higher than those of healthy controls and mucocutaneous (p = 0.018 and 0.033 respectively) but not ocular involvement. The serum levels of MMP-9 in patients with aneurysmatic involvement were found to be higher than those of healthy controls, mucocutaneous and ocular involvement (p = 0.001, 0.048 and 0.007 respectively). The serum levels of MMP-9 in patients with thrombotic involvement were found to be higher than those of healthy controls but not mucocutaneous and ocular involvement (p = 0.046). CONCLUSIONS We concluded that serum MMP-2 and MMP-9 levels can be used as an activity indicator for vasculo-Behçet's or active Behçet's patients, respectively. But they can not be used as a marker reflecting the systemic involvement of patients with BD. The systemic expressions of MMP-2 and MMP-9 were strongly associated with vasculo-Behçet's disease, particularly aneurysmatic involvement, suggesting their pathogenetic roles in vasculo-Behçet's disease complicated with aneurysm formation.
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Affiliation(s)
- S Pay
- Division of Rheumatology, Gulhane Military School of Medicine, Ankara, Turkey.
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Pay S, Musabak U, Simsek I, Erdem H, Pekel A, Sengul A, Dinc A. Synovial lymphoid neogenetic factors in Behçet's synovitis: do they play a role in self-limiting and subacute course of arthritis? Clin Exp Rheumatol 2007; 25:S21-S26. [PMID: 17949547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Lymphoid neogenesis seems to play an important role in the persistence of chronic inflammation and has been shown in various disorders characterized by chronic inflammation including rheumatoid arthritis. Arthritis of Behçet's disease is characterized by non-erosive arthritis in which the disease course is considered to be subacute and self limiting. However, molecular mechanisms underlying those features of Behçet's arthritis have not been defined yet. In order to determine the contribution of lymphoid neogenesis in the disease course of Behçet's arthritis, we investigated the synovial fluid (SF) levels of CXCL 12, CXCL 13, CCL 21 homeostatic chemokines and the percentage of SF naive lymphocytes expressing their receptors such as CXCR4+ and CCR7+. We further measured the SF TGF-Beta and INF-Beta levels which are known to contribute lymphoid neogenesis via leading persistent expression of CXCR4 on T cells and inhibiting T cell apoptosis, respectively. METHODS Fifty-one [15 BD, 17 RA, and 19 osteoarthritis (OA)] patients with at least one- sided knee arthritis were enrolled in the study. Patients with BD constituted the study group, and RA, OA patients were used as positive and negative control groups, respectively. The SF levels of CXCL 12, CXCL 13, CCL 21, TGF-Beta and INF-Beta were measured by ELISA. CXCR4, CCR7 chemokine receptors on SF lymphocytes were tested by Flow- cytometry. Kruskal-Wallis test and Mann-Whitney U test were used for statistical analysis where appropriate. RESULTS Synovial fluid CCL 21 levels were found to be increased in RA patients as compared to BD and OA patients (p = 0.003, and p = 0.013, respectively). No significant difference was detected between BD and OA patients with respect to CCL 21 levels. Both CXCL 12 and CXCL 13 SF levels were found to be higher in RA and BD patients as compared to OA patients (CXCL-12; p = 0.012, and p = 0.024), (CXCL 13; p < 0.001, and p = 0.007). However, no difference with regard to SF levels of both CXCL 12 and CXCL 13 were found between RA and BD patients. Percentages of both CD3+CXCR4+ lymphocytes and CD3+CCR7+ lymphocytes in the SF of RA patients were detected to be increased as compared to those of BD and OA patients (CD3+CXCR4+; p = 0.019, p = 0.048, respectively), (CD3+CCR7+; p = 0.023, p = 0.001, respectively). However, no differences with respect to the percentages of SF lymphocytes expressing CD3+CXCR4+ or CD3+CCR7+ were found between BD and OA patients. Both TGF-Beta and INF-Beta SF levels were found to be higher in RA patients as compared to BD and OA patients (TGF-Beta; p = 0.041, and p = 0.003), (INF-Beta; p = 0.012, and p = 0.016). However, no differences with regard to SF levels of both TGF-Beta and INF-Beta were found between BD and OA patients. CONCLUSION Considering the subacute, self limiting and non-erosive course of arthritis observed in BD, our finding of detection of lower levels of CCL21 and TGF-Beta1 and IFN-Beta in BD patients, seems to prevent the development of LN and chronic inflammation in Behçet's synovitis. In support of this view, percentages of SF naïve T lymphocytes were found to be lower in BD patients comparing with those of the RA. Absence of tertiary lymphoid structures in BD patients, may explain the spontaneous resolution of Behçet's arthritis in most of the cases.
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Affiliation(s)
- S Pay
- Division of Rheumatology, Gulhane Military School of Medicine, Ankara, Turkey.
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Pay S, Musabak U, Erdem H, Simsek I, Pekel A, Sengul A, Dinc A. Chimerical anti-TNF-alpha, infliximab, inhibits neutrophil chemotaxis and production of reactive oxygen species by blocking the priming effect of mononuclear cells on neutrophils. Immunopharmacol Immunotoxicol 2006; 27:187-98. [PMID: 16114504 DOI: 10.1081/iph-200067702] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Clinical experience with anti-tumor necrosis factor alpha (anti-TNF-alpha) agents implies that these agents can cause a rapid onset amelioration of the symptoms and laboratory parameters in some inflammatory diseases. Precise explanation of this fast antiinflammatory action is not known. The aim of our study is to investigate the direct and indirect effects of anti-TNF agents on the chemotaxis and reactive oxygen species (ROS) production of neutrophils. For this purpose, isolated neutrophil cultures (INCs) and mixed leukocyte cultures were prepared from the venous blood of healthy subjects. Those cultures were separated to different groups according to the presence of anti-TNF or the stimulation of phytohemagglutinin (PHA). In this study, anti-TNF treatment did not change the migration ability of neutrophils in INCs. However, we established that chimerical anti-TNF-alpha, infliximab, inhibits neutrophil chemotaxis and production of ROS by blocking the priming effect of PHA-stimulated circulating mononuclear cells. These results may explain, at least partly, the rapid onset antiinflammatory actions of these agents observed in clinical practice.
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Affiliation(s)
- S Pay
- Department of Rheumatology, Gulhane Military School of Medicine, Ankara, Turkey
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Abstract
In this study, we examined peripheral insulin resistance in patients with Behçet's disease (BD) characterized by chronic inflammation and endothelial dysfunction. Fourteen patients with BD and 15 healthy controls were recruited to the study. Insulin resistance was investigated by the hyperinsulinaemic-euglycaemic glucose clamp technique. BD patients displayed an enhanced rate of insulin resistance compared to healthy controls (P = 0.014). The insulin sensitivity (M), measured as the glucose utilization rate under steady-state conditions of euglycaemia, was significantly decreased (P = 0.001) in BD patients compared to the controls (4.09 +/- 0.16 vs. 5.60 +/- 0.27 mg/kg/min). The C-reactive protein (CRP) level, but not the erythrocyte sedimentation rate (ESR), was significantly related to the presence of insulin resistance (CRP: r(s) = 0.589, P = 0.27; ESR: r(s) = 0444, P = 0112), whereas no relationship was found between the M-value and ESR or CRP. We conclude that patients with BD exhibit peripheral insulin resistance; this could be explained as the diverse consequences of inflammation and endothelial dysfunction in BD.
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Affiliation(s)
- H Erdem
- Division of Rheumatology of the Department of Medicine, Gulhane Military Medical Academy, Etlik, Ankara, Turkey.
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Musabak U, Pay S, Erdem H, Simsek I, Pekel A, Dinc A, Sengul A. Serum interleukin-18 levels in patients with Behçet’s disease. Is its expression associated with disease activity or clinical presentations? Rheumatol Int 2005; 26:545-50. [PMID: 16205927 DOI: 10.1007/s00296-005-0029-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Accepted: 07/07/2005] [Indexed: 10/25/2022]
Abstract
Interleukin (IL)-18 is a proinflammatory cytokine which plays a crucial role in T helper (Th)1 type immune response. The aim of this study is to investigate the relationship of serum levels of IL-18 with disease activity and clinical presentations in patients with Behcet's disease (BD). Sixty patients with BD and 20 healthy controls were included in the study. Patients were grouped as having active or inactive disease according to the Leeds activity score. They were also separated as a systemic involvement or mucocutaneous symptoms only. Patients with systemic involvement were further grouped according to the presence of ocular, articular and vascular involvement. IL-18 levels were significantly higher in all patient subgroups as compared to healthy controls and found to be correlated with the activity score in patients having active disease. In conclusion, this cytokine participates in the pathogenesis of BD and its levels are correlated with the disease activity. Detection of increased levels of IL-18 in patients with inactive disease implies that Th1 activation and subclinical inflammation persist during the inactive period of the disease.
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Affiliation(s)
- U Musabak
- Department of Immunology, Gulhane Military School of Medicine, Ankara, Turkey.
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Bozoglu E, Dinc A, Erdem H, Pay S, Simsek I, Kocar IH. Vascular endothelial growth factor and monocyte chemoattractant protein-1 in Behçet's patients with venous thrombosis. Clin Exp Rheumatol 2005; 23:S42-8. [PMID: 16273763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Vascular lesions can involve both arterial and venous systems which are often the major causes complicating the disease course of Behçet's disease (BD). Vascular endothelial growth factor (VEGF) is a stimulant of angiogenesis secondary to ischemia while monocyte chemoattractant protein 1 (MCP-1) is induced by shear stresses leading to vascular collateral development. MCP-1 has been also shown to contribute to the recanalization of venous thrombi. Tumor necrosis factor-alpha (TNF-alpha) is known to play a major role in the pathogenesis of BD. Furthermore, up-regulation of secreted MCP-1 and VEGF was observed following stimulation with TNF-alpha. In view of the above functions of VEGF, MCP-1 and TNF-alpha, we hypothesized that these factors may be important in the pathogenesis of thrombosis seen in BD. METHODS A total of 36 patients with a diagnosis of BD were studied. BD patients were separated into 3 groups with respect to vascular involvement. Group BD-AT (n = 9) with acute thrombosis, BD-CT (n = 12) with chronic thrombosis and BD-MC (n = 15) with mucocutaneous involvement only. The control group (group H) was comprised of 20 healthy persons. In addition, patients with acute, DC-AT (n= 11) and patients with chronic DC-CT (n = 9) thrombosis without BD served as disease controls. Serum measurements of VEGF MCP-1 and TNF-alpha were performed by quantitative sandwich ELISA. The acute phase reactants, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also measured. RESULTS The levels of VEGF were significantly higher in the patients in group BD-AT than either in group BD-CT or BD-MC (p = 0.03 and p < 0.001, respectively). However, no significant difference was found for VEGF levels of thrombotic patients regarding the cause (BD-AT vs. DC-AT, p = 0.063; BD-CT vs. DC-CT, p = 0.084) or the stage of thrombosis (DC-AT vs. DC-CT, p > 0.05). Both BD patients and disease controls with acute thrombosis had significantly higher levels of MCP-1 as compared to corresponding chronic thrombosis patients (BD-AT vs. DC-CT; p < 0.001; DC-AT vs. DC-CT, p < 0.001). Patients with BD and disease controls had significantly higher serum TNF-alpha level when compared with healthy subjects. No significant difference with respect to serum TNF-alpha level was noted when patient subgroups with BD and disease controls were compared with each other Serum levels of VEGF, MCP-1, and TNF-alpha were not found to be correlated with either ESR or CRP (p > 0.05). CONCLUSIONS Increased levels of VEGF and MCP-1 detected in BD thrombosis suggest the possible role of those angiogenic cytokines in the pathogenesis. Although not specific for BD, detection of VEGF or MCP-1 levels seems to serve as an assay for differentiation of BD patients with acute thrombosis from chronic.
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Affiliation(s)
- E Bozoglu
- Department of Internal Medicine, Gulhane Military School of Medicine, Ankara, Turkey
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Dinc A, Bayir A, Simsek I, Erdem H, Pay S, Turan M. The proportional Venn diagram of Behçet's disease-related manifestations among young adult men in Turkey. Clin Exp Rheumatol 2005; 23:S86-90. [PMID: 16273772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To determine the frequency of the features associated with Behçet's disease (BD) in a young men population and generate a proportional Venn diagram of those features. METHODS Data was collected from 3714 otherwise healthy men recruited for military service at the entrance. Study was conducted in a two-step procedure. Firstly, all participants were questioned by a general practitioner via using visual Behçet's questionnaire. Those participants, in whom at least one BD-related manifestation of the disease (oral ulcer, genital ulcer, folliculitis, erythema nodosum, uveitis, venous involvement of the lower extremities) have been demonstrated, were further examined by a rheumatologist at the second-stage of the study. RESULTS The areas of intersection among the 6 individual BD-related manifestations produced 63 mutually exclusive symptom groups. Sixteen out 63 of these groups were functionally operative in our study population. Forty-seven (1.2%) of the all participants were considered to have at least 1 of the BD-related manifestation after examined by rheumatologist. The prevalence rates of the individual manifestations among the study population were as follows; oral ulcer 29 (0.78%), folliculitis 31 (0.83%), genital ulcer 9 (0.24%), venous involvement 13 (0.35%), erythema nodosum 4 (0.10%) and uveitis 3 (0.08%). The group consisting of oral ulcer with folliculitis was the largest proportion of participants followed by the group having oral ulcer only, accounting for 0.29% and 0.18%, respectively. Four (0.1%) of the participants were fulfilled the International Study Group for BD criteria following rheumatologic and ophthalmologic examinations. After excluding the group having oral ulcer with folliculitis, additional 12 cases had features suggesting BD though they didn't fulfill the International Study Group for BD criteria. CONCLUSION The Venn diagram of this study demonstrates that International Study Group for BD criteria can detect almost the quarter of 16 cases suspected as having BD. We suggest that the application of information regarding the frequencies of individual BD-related manifestations and their association with each other in a general population might serve as a helpful tool for physicians while making diagnosis.
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Affiliation(s)
- A Dinc
- Department of Medicine, Division of Rheumatology, Gülhane Military School of Medicine, Etlik-Ankara, Turkey.
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Abstract
We aimed to determine the sexual problems and the prevalence of erectile dysfunction (ED) in patients with chronic liver disease by means of International Index of Erectile Function (IIEF). A total of 81 patients with stable chronic liver disease were included in the study. Patients were grouped as mild to moderate (Child Pugh A and B) (n=10), chronic hepatitis (hepatitis B, C and D) (n=28) and carriers (n=43) according to the type of their chronic liver disease. All patients were asked to complete a questionnaire including IIEF and demographics. The IIEF domain scores were calculated and ED grading was determined on erectile function domain. IIEF domain scores were compared between these groups. The mean age was 54.8 +/- 10.8 y. Using the IIEF, the prevalence of any ED was 50.6% for all patients, and 50, 50, and 51.1% for cirrhosis, chronic hepatitis and carriers, respectively. The IIEF domain scores were not significantly different among the patient groups. Sexual functions did not appear to be affected by the stable chronic liver disease.
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Affiliation(s)
- I Simsek
- Department of Gastroenterology, Dokuz Eylul University School of Medicine, Inciralti, Izmir, Turkey
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Simsek I, Mas MR, Yasar M, Ozyurt M, Saglamkaya U, Deveci S, Comert B, Basustaoglu A, Kocabalkan F, Refik M. Inhibition of inducible nitric oxide synthase reduces bacterial translocation in a rat model of acute pancreatitis. Pancreas 2001; 23:296-301. [PMID: 11590326 DOI: 10.1097/00006676-200110000-00011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Translocation of bacteria from the gut into pancreatic necrosis is an important factor in the development of septic complications and mortality in acute pancreatitis. S-methylisothiourea (SMT) is an inducible nitric oxide synthase inhibitor that has been shown to decrease bacteria] translocation in sepsis and thermal injury. AIM To investigate whether SMT could affect bacterial translocation in acute necrotizing pancreatitis. METHODOLOGY Forty-five Sprague-Dawley rats were studied. Acute pancreatitis was induced in Group I and Group II by injection of taurocholate and trypsin into the common biliopancreatic duct. Group III underwent laparotomy with the manipulation (but not cannulation) of the pancreas and received saline injection. Group I rats received normal saline as a placebo, and Group II rats received SMT after surgery for 2 days. At 48 hours, blood was drawn for serum amylase determinations. Bacterial translocation to mesenteric lymph nodes and distant sites (pancreas, liver, and peritoneum) were examined. A point scoring system of histologic features was used to evaluate the severity of pancreatitis. RESULTS Plasma amylase levels and pancreatic histologic score were significantly reduced in Group II rats given SMT compared with those in Group I rats given saline (p < 0.01, p < 0.05, respectively). All Group I rats had bacterial translocation to mesenteric lymph nodes compared with 7 of 12 rats in Group II (p < 0.05). There was no difference in bacterial translocation to distant organs between the two groups, although rates tended to be lower in Group II compared with Group I (p > 0.05). Bacterial counts in the pancreas were significantly reduced in Group II rats compared with those in Group I rats (p < 0.05). CONCLUSION Treatment with SMT appears to have ameliorated the course of acute pancreatitis; however, mortality was not affected.
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Affiliation(s)
- I Simsek
- Department of Internal Medicine, Gulhane School of Medicine, Ankara, Turkey.
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Abstract
A 46-year-old woman with a sudden sight loss due to infarction of the occipital lobes is reported. The association of pulmonary disease, digital ischaemia, polyneuropathy and peripheral eosinophilia led to a diagnosis of Churg-Strauss syndrome. Her vision partially improved by a treatment with steroids and monthly i.v. cyclophosphamide. To our knowledge, this is the first case of CSS with a sudden loss of vision due to bilateral occipital infarction.
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Affiliation(s)
- A Dinç
- Division of Rheumatology, Gülhane School of Medicine, Ankara, Turkey.
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50
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Pay S, Dinc A, Simsek I, Can C, Erdem H. Sulfasalazine-induced angioimmunoblastic lymphadenopathy developing in a patient with juvenile chronic arthritis. Rheumatol Int 2000; 20:25-7. [PMID: 11149657 DOI: 10.1007/s002960000056] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We describe a patient with juvenile chronic arthritis who developed reactive angioimmunoblastic lymphadenopathy, induced by sulfasalazine. Development of angioimmunoblastic lymphadenopathy although rare, is a very serious side effect of sulfasalazine treatment, and patients treated with this drug should be watched carefully.
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Affiliation(s)
- S Pay
- GATA Romatoloji Bilim Dah, Etlik, Ankara, Turkey.
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