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Paz Y, Levy Y, Grosman-Rimon L, Shinfeld A. Nonpharmacological interventions for 'no-option' refractory angina patients. J Cardiovasc Med (Hagerstown) 2024; 25:13-22. [PMID: 37942734 DOI: 10.2459/jcm.0000000000001566] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Refractory angina pectoris (RAP) defined as chronic anginal chest pain because of coronary artery disease (CAD) is a major problem. The increase in the number of patients with RAP in recent years is because of the increasing aging population and improved survival rates among patients with CAD. Management of patients with RAP is often extremely challenging. In this review, we present several interventional approaches for RAP, including device therapies, lifestyle intervention, and cell therapies. Some of these treatments are currently used in the management of RAP, whereas other treatments are under investigation.
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Affiliation(s)
- Yoav Paz
- General Intensive Care Unit, Sourasky Medical Center, Tel Aviv, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University
| | - Yair Levy
- Department of Medicine, Meir Hospital, Kfar-Saba, Israel
| | - Liza Grosman-Rimon
- School of Graduate Studies, Levinsky-Wingate Academic College, Wingate Institute, Netanya, Israel
| | - Amihay Shinfeld
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
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2
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Liran R, Garra W, Carmi O, Levy Y, Einbinder Y. A Severe Acute Kidney Injury Following Zoledronic Acid Therapy Leading to Chronic Hemodialysis Treatment: A Case Report. Isr Med Assoc J 2023; 25:828-829. [PMID: 38142324] [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] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Affiliation(s)
- Rotem Liran
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Wakar Garra
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Or Carmi
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Levy
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Einbinder
- Department of Nephrology, Meir Medical Center, Kfar Saba, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shir-az O, Berl A, Mann D, Bilal BS, Levy Y, Shalom A. Treatment of Scleroderma-Related Microstomia Using Hyaluronic Acid: An Interventional Study. Life (Basel) 2023; 13:2176. [PMID: 38004316 PMCID: PMC10671914 DOI: 10.3390/life13112176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Systemic sclerosis (SSc) or scleroderma is a rare, systemic, autoimmune connective tissue disease. It causes increased collagen synthesis, leading to multi-organ sclerosis, including the skin and joints. Patients' overall health and quality of life are harmed dramatically. Involvement of the face and, especially, the oral opening can limit patients' ability to speak and eat, oral hygiene, and cosmetic appearance. Profhilo® (NAHYCO®) is an over-the-counter product consisting of pure hyaluronic acid. It is used to improve skin quality by increasing collagen production and adipocyte vitality. This interventional study evaluated the results of perioral injections of hyaluronic acid in terms of improved skin quality, elasticity, and increased oral opening. Patients diagnosed with SSc received an injection of one syringe of Profhilo® (2 mL of hyaluronic acid) at each of two clinic visits at one-month intervals. The oral opening was measured between the upper and lower central incisors before and after treatment. Quality of life was assessed using the modified Rodnan Skin Score and Health Assessment Questionnaire-Disability Index. A total of 14 patients received the first treatment, and 11 received the second treatment. The mean oral opening increased from 31.6 mm (range 17-50 mm) prior to therapy to 35.8 mm (range 21-56) 2 months following the second injection. Statistical analysis showed that there was a significant increase in the oral opening as observed one week (36.2 mm, p = 0.011), one month (36.2 mm, p = 0.007), and three months (31.6 mm, p = 0.023) after the second injection, at the 5-month follow-up. Treatment of SSc patients' perioral area with Profhilo® can result in significant improvements in oral opening and quality of life.
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Affiliation(s)
- Ofir Shir-az
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel; (O.S.-a.); (D.M.); (B.S.B.); (A.S.)
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Ariel Berl
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel; (O.S.-a.); (D.M.); (B.S.B.); (A.S.)
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Din Mann
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel; (O.S.-a.); (D.M.); (B.S.B.); (A.S.)
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Biader Samih Bilal
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel; (O.S.-a.); (D.M.); (B.S.B.); (A.S.)
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Yair Levy
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Avshalom Shalom
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel; (O.S.-a.); (D.M.); (B.S.B.); (A.S.)
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
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4
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Garra W, Levy Y. Prevalence of anti-synthetase antibodies among systemic sclerosis patients. Eur J Intern Med 2023; 117:98-102. [PMID: 37453844 DOI: 10.1016/j.ejim.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND we aimed to estimate the prevalence of Amino acyl-transfer ribonucleic acid synthetase antibodies (Anti-ARS); myositis specific antibodies, among patients with systemic sclerosis (SSc), to evaluate the clinical associations of anti-ARS antibodies in SSc patients and to identify risk factors for development of interstitial lung disease (ILD) in SSc. METHODS A prospective study of 71 systemic sclerosis patients in our rheumatology clinic in Israel. Sera were tested for myositis antibodies. Data on patients clinical and serological manifestations and treatment were collected and compared according to anti-ARS antibodies and ILD. RESULTS Prevalence of anti-ARS antibodies was 6% (4/71) with anti PL-7, anti- OJ and Jo-1 positivity. Anti Ro-52 was found in 27%, anti-PM/Scl 75, anti-PM/Scl 100 and anti-SRP in 6%, anti-Ku in 3%, anti-Mi-2 beta and anti-Mi-2 alfa in 4%, anti- NXP2 and anti-TIF1gamma in 1%. ILD complication was observed in 42% of patients and was associated with anti RNAP-III, anti Scl-70 and Anti-ARS antibodies. In multiple logistic regression, anti Scl-70 was associated with 6-fold higher risk for ILD. CONCLUSION Anti-ARS antibodies were observed in 6% of SSc patients. All of them had ILD. Due to the low prevalence of anti-ARS, this study could not describe clinical associations of anti-ARS antibodies in SSc patients.
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Affiliation(s)
- Wakar Garra
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba 4428164, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yair Levy
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba 4428164, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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5
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Garra W, Levy Y. Nocardial Infection after Treatment with Anti-TNF Alpha in a Patient with Psoriatic Arthropathy. Isr Med Assoc J 2023; 25:704-705. [PMID: 37847004] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Wakar Garra
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Levy
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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6
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Spiera R, Kuwana M, Khanna D, Hummers L, Frech TM, Stevens W, Matucci-Cerinic M, Kafaja S, Distler O, Jun JB, Levy Y, Leszcyzński P, Gordon J, Steen V, Lee EB, Jankowski T, Litinsky I, Chung L, Hsu V, Mayes M, Sandorfi N, Simms RW, Finzel S, de Vries-Bouwstra J, Constantine S, Dgetluck N, Dinh Q, Bloom BJ, Furst DE, White B, Denton CP. Efficacy and Safety of Lenabasum, a Cannabinoid Type 2 Receptor Agonist, in a Phase 3 Randomized Trial in Diffuse Cutaneous Systemic Sclerosis. Arthritis Rheumatol 2023; 75:1608-1618. [PMID: 37098795 DOI: 10.1002/art.42510] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 02/22/2023] [Accepted: 03/14/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVE This phase 3 study was undertaken to investigate the efficacy and safety of lenabasum, a cannabinoid type 2 receptor agonist, in patients with diffuse cutaneous systemic sclerosis (dcSSc). METHODS A multinational double-blind study was conducted in 365 dcSSc patients who were randomized and dosed 1:1:1 with lenabasum 20 mg, lenabasum 5 mg, or placebo, each twice daily and added to background treatments, including immunosuppressive therapies (IST). RESULTS The primary end point, the American College of Rheumatology combined response index in dcSSc (CRISS) at week 52 for lenabasum 20 mg twice a day versus placebo, was not met, with CRISS score of 0.888 versus 0.887 (P = 0.4972, using mixed models repeated measures [MMRM]). The change in the modified Rodnan skin thickness score (MRSS) at week 52 for lenabasum 20 mg twice a day versus placebo was -6.7 versus -8.1 (P = 0.1183, using MMRM). Prespecified analyses showed higher CRISS scores, greater improvement in MRSS, and lower decline in forced vital capacity in patients on background mycophenolate and those who were taking IST for ≤1 year. No deaths or excess in serious or severe adverse events related to lenabasum were observed. CONCLUSION A benefit of lenabasum in dcSSc was not demonstrated. Most patients were treated with background IST, and treatment with mycophenolate mofetil in particular was associated with better outcomes. These findings support the use of IST in the treatment of dcSSc and highlight the challenge of demonstrating a treatment effect when investigational treatment is added to standard of care IST. These findings have relevance to trial design in SSc, as well as to clinical care.
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Affiliation(s)
| | - Masataka Kuwana
- Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | | | - Laura Hummers
- John Hopkins University School of Medicine, Baltimore, Maryland
| | - Tracy M Frech
- University of Utah and Salt Lake City VA Health Care System, Salt Lake City, Utah
| | - Wendy Stevens
- St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, and Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
| | - Suzanne Kafaja
- David Geffen School of Medicine at University of California, Los Angeles (UCLA)
| | - Oliver Distler
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jae-Bum Jun
- Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Yair Levy
- Meir Medical Center, Kfar Saba, Israel
| | | | | | - Virginia Steen
- Georgetown University School of Medicine, Washington, DC
| | - Eun Bong Lee
- Seoul National University College of Medicine, Seoul, South Korea
| | - Tomasz Jankowski
- Klinika Reumatologii Ukladowych Chorob Tkanki Lacznej Szpital Uniwersytecki, Bydgozzcz, Poland
| | | | - Lorina Chung
- Stanford University School of Medicine and Palo Alto VA Health Care System, Palo Alto, California
| | - Vivien Hsu
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Maureen Mayes
- McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Nora Sandorfi
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Robert W Simms
- Boston University School of Medicine, Boston, Massachusetts
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, University Medical Center, Universitätsklinikum Freiburg, Freiburg, Germany
| | | | | | | | - Quinn Dinh
- Corbus Pharmaceuticals, Inc., Norwood, Massachusetts
| | | | - Daniel E Furst
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy, David Geffen School of Medicine at UCLA, Los Angeles, California, and University of Washington, Seattle, UK
| | - Barbara White
- Corbus Pharmaceuticals, Inc., Norwood, Massachusetts
| | - Christopher P Denton
- UCL Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
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7
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Aerssens D, Miret-Casals L, Gomez D, Sousa-Neves D, Levy Y, De Vleesschouwer M, Manicardi A, Madder A. Photo-induced crosslinking uncovers an antiparallel strand orientation in heterodimeric (EIAALEK) 3/(KIAALKE) 3 and (EIAALEK) 3/(RIAALRE) 3 coiled-coil systems. Org Biomol Chem 2023. [PMID: 37394986 DOI: 10.1039/d2ob02181a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
We describe for the first time the co-existence of the parallel and antiparallel conformation of the heterodimeric E3/K3 and E3/R3 coiled-coil systems in solution. The introduction of a furanylated amino acid in the (EIAALEK)3 sequence allowed, upon photo-induced covalent crosslinking, freezing of the respective coiled-coil complexes present in solution. The occurrence of both parallel and antiparallel conformations in solution was supported by computational simulations and further confirmed by fluorescence experiments based on pyrene-pyrene stacking.
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Affiliation(s)
- D Aerssens
- Organic and Biomimetic Chemistry Research Group, Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281-S4, Gent 9000, Belgium.
| | - L Miret-Casals
- Organic and Biomimetic Chemistry Research Group, Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281-S4, Gent 9000, Belgium.
| | - D Gomez
- Department of Biology and Chemistry, New York University, New York 10003, USA
| | - D Sousa-Neves
- Organic and Biomimetic Chemistry Research Group, Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281-S4, Gent 9000, Belgium.
| | - Y Levy
- Department of Structural Biology, Weizmann Institute of Science, Rehovot, Israel
| | - M De Vleesschouwer
- Organic and Biomimetic Chemistry Research Group, Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281-S4, Gent 9000, Belgium.
| | - A Manicardi
- Organic and Biomimetic Chemistry Research Group, Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281-S4, Gent 9000, Belgium.
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Viale delle Scienze, 17/A, I-43124 Parma, Italy
| | - A Madder
- Organic and Biomimetic Chemistry Research Group, Department of Organic and Macromolecular Chemistry, Ghent University, Krijgslaan 281-S4, Gent 9000, Belgium.
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8
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Talalai E, Gorobets D, Halpert G, Tsur AM, Heidecke H, Levy Y, Watad A, Blank M, Michaelevski I, Shoenfeld Y, Amital H. Functional IgG Autoantibodies against Autonomic Nervous System Receptors in Symptomatic Women with Silicone Breast Implants. Cells 2023; 12:1510. [PMID: 37296631 PMCID: PMC10252975 DOI: 10.3390/cells12111510] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
The association between the clinical picture of symptomatic women with silicone breast implants (SBI) and dysregulated immunity was in dispute for decades. In the current study, we describe for the first time the functional activity of purified IgG antibodies derived from symptomatic women with SBIs (suffering from subjective/autonomic-related symptoms), both in vitro and in vivo. We found that IgGs, derived from symptomatic women with SBIs, dysregulate inflammatory cytokines (TNFα, IL-6) in activated human peripheral blood mononuclear cells, compared to healthy-women-derived IgGs. Importantly, behavioral studies conducted following intracerebroventricular injection of IgGs derived from symptomatic women with SBIs (who have dysregulated circulating level of IgG autoantibodies directed against autonomic nervous system receptors) into mice brains demonstrated a specific and transient significant increment (about 60%) in the time spent at the center of the open field arena compared with mice injected with IgG from healthy women (without SBIs). This effect was accompanied with a strong trend of reduction of the locomotor activity of the SBI-IgG treated mice, indicating an overall apathic-like behavior. Our study is the first to show the potential pathogenic activity of IgG autoantibodies in symptomatic women with SBIs, emphasizing the importance of these antibodies in SBI-related illness.
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Affiliation(s)
- Efrosiniia Talalai
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.T.); (A.M.T.); (A.W.); (M.B.); (Y.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Denis Gorobets
- Department of Molecular Biology, Ariel University, Ariel 40700, Israel; (D.G.); (I.M.)
| | - Gilad Halpert
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.T.); (A.M.T.); (A.W.); (M.B.); (Y.S.); (H.A.)
- Department of Molecular Biology, Ariel University, Ariel 40700, Israel; (D.G.); (I.M.)
| | - Avishai M. Tsur
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.T.); (A.M.T.); (A.W.); (M.B.); (Y.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
- Department of Medicine ‘B’, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
- Israel Defense Forces, Medical Corps, Ramat Gan 91905, Israel
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91031, Israel
| | | | - Yair Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
- Department of Medicine E, Meir Medical Center, Kfar Saba 44281, Israel
| | - Abdulla Watad
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.T.); (A.M.T.); (A.W.); (M.B.); (Y.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
- Department of Medicine ‘B’, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
| | - Miri Blank
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.T.); (A.M.T.); (A.W.); (M.B.); (Y.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Izhak Michaelevski
- Department of Molecular Biology, Ariel University, Ariel 40700, Israel; (D.G.); (I.M.)
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.T.); (A.M.T.); (A.W.); (M.B.); (Y.S.); (H.A.)
- Reichman University, Herzelia 46101, Israel
| | - Howard Amital
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (E.T.); (A.M.T.); (A.W.); (M.B.); (Y.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
- Department of Medicine ‘B’, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
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9
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Kohon MY, Zaaroor Levy M, Hornik-Lurie T, Shalom A, Berl A, Drucker L, Levy Y, Tartakover Matalon S. αvβ3 Integrin as a Link between the Development of Fibrosis and Thyroid Hormones in Systemic Sclerosis. Int J Mol Sci 2023; 24:ijms24108927. [PMID: 37240272 DOI: 10.3390/ijms24108927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Systemic sclerosis (SSc) is an autoimmune disease characterized by fibrosis of the skin and internal organs. Key players mediating fibrosis are myofibroblasts (MF) that, following transforming growth factor β (TGFβ) exposure, produce a collagen-rich extracellular matrix (ECM) that induces myofibroblast differentiation. Myofibroblasts express αvβ3 integrin (a membrane receptor for thyroid hormones) and miRNA-21 that promotes deiodinase-type-3 expression (D3), causing the degradation of triiodothyronine (T3) that attenuates fibrosis. We hypothesized that αvβ3 affects the fibrotic processes through its thyroid hormones (THs) binding site. To test this, dermal fibroblasts (DF) were cultured with/without TGFβ and removed with a base, leaving only normal/fibrotic ECMs in wells. Then, DF were cultured on the ECMs with/without tetrac (αvβ3 ligand, T4 antagonist), and evaluated for pro-fibrotic characteristics, αvβ3, miRNA-21, and D3 levels. Blood free-T3 (fT3), miRNA-21 levels, and the modified Rodnan skin score (MRSS) were evaluated in SSc patients. We found that the "fibrotic-ECM" significantly increased the pro-fibrotic characteristics of DF and the levels of miRNA-21, D3, and αvβ3, compared to the "normal-ECM." Tetrac significantly inhibited the effects of the "fibrotic-ECM" on the cells. In accordance with tetrac's effect on D3/miRNA-21, a negative correlation was found between the patients' fT3 to miRNA-21 levels, and to the development of pulmonary arterial hypertension (PAH). We conclude that occupying the THs binding site of αvβ3 may delay the development of fibrosis.
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Affiliation(s)
- Maia Yamila Kohon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Autoimmune Research Laboratory, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Mor Zaaroor Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Autoimmune Research Laboratory, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Tzipi Hornik-Lurie
- Data Research Department, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Avshalom Shalom
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Ariel Berl
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Liat Drucker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Oncogenetics Laboratory, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Yair Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Autoimmune Research Laboratory, Meir Medical Center, Kfar Saba 4428164, Israel
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Shelly Tartakover Matalon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Autoimmune Research Laboratory, Meir Medical Center, Kfar Saba 4428164, Israel
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10
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Zukerstein M, Levy Y. Enhancement of the spectral broadening efficiency for circular polarization states in the high absorption regime for Gaussian and doughnut-shaped beams in fused silica. Opt Express 2023; 31:16295-16302. [PMID: 37157711 DOI: 10.1364/oe.485881] [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] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We experimentally investigate the spectral broadening in fused silica in the multiphoton absorption regime. Under standard conditions of laser irradiation, linear polarization of laser pulses is more advantageous for supercontinuum generation. However, with high non-linear absorption, we observe more efficient spectral broadening for circular polarizations for both Gaussian and doughnut-shaped beams. The multiphoton absorption in fused silica is studied by measuring the total transmission of laser pulses and by the intensity dependence of the self-trapped exciton luminescence observation. The strong polarization dependence of multiphoton transitions fundamentally affects the broadening of the spectrum in solids.
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11
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Garra W, Carmi O, Kivity S, Levy Y. Catastrophic antiphospholipid syndrome in lupus-associated immune thrombocytopenia treated with eltrombopag A case series and literature review. Medicine (Baltimore) 2023; 102:e32949. [PMID: 36820549 PMCID: PMC9907943 DOI: 10.1097/md.0000000000032949] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Eltrombopag, a thrombopoietin receptor (TPO-R) agonist, is considered a second-line treatment for patients with refractory immune thrombocytopenia (ITP). Systemic lupus erythematosus (SLE) is frequently associated with ITP. In some cases, thrombocytopenia in SLE patients is attributed to concurrent antiphospholipid antibodies (APLA). Currently, data regarding treatment with TPO-R agonists for ITP in SLE or APLA patients are limited. The incidence of SLE flare or antiphospholipid syndrome while on TPO-R agonists has not been well-studied. CASES We report 2 cases of female patients with SLE and concurrent triple positive APLA, without thrombotic events in their medical history, in our rheumatology clinic, who were treated for refractory ITP with eltrombopag. Both developed catastrophic antiphospholipid syndrome a few weeks after beginning treatment with eltrombopag. They were admitted to the intensive care unit and treated with solumedrol, plasmapheresis, anticoagulation and rituximab. CONCLUSIONS We describe a severe possible side-effect of eltrombopag as a trigger of catastrophic antiphospholipid syndrome, a rare initial manifestation of antiphospholipid syndrome, in SLE patients with APLA. We suggest that APLA should be tested before initiating eltrombopag in patients with SLE-associated ITP. The safety of this treatment should be considered in these cases.
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Affiliation(s)
- Wakar Garra
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- * Correspondence: Wakar Garra, Department of Internal Medicine E, Meir Medical Center, 59 Tshernichovsky St., Kfar Saba 4428164 Israel (e-mail: )
| | - Or Carmi
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
| | - Shaye Kivity
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
| | - Yair Levy
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
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12
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Battey E, Ross JA, Hoang A, Wilson DGS, Han Y, Levy Y, Pollock RD, Kalakoutis M, Pugh JN, Close GL, Ellison-Hughes GM, Lazarus NR, Iskratsch T, Harridge SDR, Ochala J, Stroud MJ. Myonuclear alterations associated with exercise are independent of age in humans. J Physiol 2023. [PMID: 36597809 DOI: 10.1113/jp284128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/19/2022] [Indexed: 01/05/2023] Open
Abstract
Age-related decline in skeletal muscle structure and function can be mitigated by regular exercise. However, the precise mechanisms that govern this are not fully understood. The nucleus plays an active role in translating forces into biochemical signals (mechanotransduction), with the nuclear lamina protein lamin A regulating nuclear shape, nuclear mechanics and ultimately gene expression. Defective lamin A expression causes muscle pathologies and premature ageing syndromes, but the roles of nuclear structure and function in physiological ageing and in exercise adaptations remain obscure. Here, we isolated single muscle fibres and carried out detailed morphological and functional analyses on myonuclei from young and older exercise-trained individuals. Strikingly, myonuclei from trained individuals were more spherical, less deformable, and contained a thicker nuclear lamina than those from untrained individuals. Complementary to this, exercise resulted in increased levels of lamin A and increased myonuclear stiffness in mice. We conclude that exercise is associated with myonuclear remodelling, independently of age, which may contribute to the preservative effects of exercise on muscle function throughout the lifespan. KEY POINTS: The nucleus plays an active role in translating forces into biochemical signals. Myonuclear aberrations in a group of muscular dystrophies called laminopathies suggest that the shape and mechanical properties of myonuclei are important for maintaining muscle function. Here, striking differences are presented in myonuclear shape and mechanics associated with exercise, in both young and old humans. Myonuclei from trained individuals were more spherical, less deformable and contained a thicker nuclear lamina than untrained individuals. It is concluded that exercise is associated with age-independent myonuclear remodelling, which may help to maintain muscle function throughout the lifespan.
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Affiliation(s)
- E Battey
- Centre for Human & Applied Physiological Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, UK
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - J A Ross
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - A Hoang
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - D G S Wilson
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Y Han
- Centre for Human & Applied Physiological Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Y Levy
- Centre for Human & Applied Physiological Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - R D Pollock
- Centre for Human & Applied Physiological Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - M Kalakoutis
- Centre for Human & Applied Physiological Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Randall Centre for Cell and Molecular Biophysics, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - J N Pugh
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - G L Close
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - G M Ellison-Hughes
- Centre for Human & Applied Physiological Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - N R Lazarus
- Centre for Human & Applied Physiological Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - T Iskratsch
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
- Randall Centre for Cell and Molecular Biophysics, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - S D R Harridge
- Centre for Human & Applied Physiological Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - J Ochala
- Centre for Human & Applied Physiological Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M J Stroud
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, UK
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13
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Paz Y, Grosman-Rimon L, Levy Y, Shinfeld A. The Coronary Sinus Reducer Stent for the Treatment of Refractory Angina Pectoris: From the Conception of Innovation to Clinical Application. Cardiol Rev 2022; Publish Ahead of Print:00045415-990000000-00061. [PMID: 36728718 DOI: 10.1097/crd.0000000000000516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Neovasc Coronary Sinus Reducer Stent (CSRS) was developed for the treatment of patients who continue to suffer from disabling symptoms despite optimal medical therapy. This patient population with refractory angina symptoms is expected to grow, since life expectancy of individuals with atherosclerotic coronary artery disease is increasing. In this paper, we discussed the development of a novel device the CSRS and the upside-down strategy to rebuild a retrograde coronary pressure that was attenuated by the atherosclerotic disease.
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Affiliation(s)
- Yoav Paz
- From the General Intensive Care Unit, Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liza Grosman-Rimon
- The Academic College at Wingate, Wingate Institute, Netanya, Israel Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Levy
- Department of Internal Medicine, Meir Medical Center, Kfar Saba, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amihay Shinfeld
- Department of Internal Medicine, Meir Medical Center, Kfar Saba, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Eliaz D, Paul S, Benyamin D, Cernescu A, Cohen SR, Rosenhek-Goldian I, Brookstein O, Miali ME, Solomonov A, Greenblatt M, Levy Y, Raviv U, Barth A, Shimanovich U. Micro and nano-scale compartments guide the structural transition of silk protein monomers into silk fibers. Nat Commun 2022; 13:7856. [PMID: 36543800 PMCID: PMC9772184 DOI: 10.1038/s41467-022-35505-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Silk is a unique, remarkably strong biomaterial made of simple protein building blocks. To date, no synthetic method has come close to reproducing the properties of natural silk, due to the complexity and insufficient understanding of the mechanism of the silk fiber formation. Here, we use a combination of bulk analytical techniques and nanoscale analytical methods, including nano-infrared spectroscopy coupled with atomic force microscopy, to probe the structural characteristics directly, transitions, and evolution of the associated mechanical properties of silk protein species corresponding to the supramolecular phase states inside the silkworm's silk gland. We found that the key step in silk-fiber production is the formation of nanoscale compartments that guide the structural transition of proteins from their native fold into crystalline β-sheets. Remarkably, this process is reversible. Such reversibility enables the remodeling of the final mechanical characteristics of silk materials. These results open a new route for tailoring silk processing for a wide range of new material formats by controlling the structural transitions and self-assembly of the silk protein's supramolecular phases.
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Affiliation(s)
- D. Eliaz
- grid.13992.300000 0004 0604 7563Department of Molecular Chemistry and Materials Science, Faculty of Chemistry, Weizmann Institute of Science, 7610001 Rehovot, Israel
| | - S. Paul
- grid.10548.380000 0004 1936 9377Department of Biochemistry and Biophysics, Stockholm University, Svante Arrhenius väg 16C, 10691 Stockholm, Sweden
| | - D. Benyamin
- grid.9619.70000 0004 1937 0538Institute of Chemistry, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Givat Ram, Jerusalem, 9190401 Israel
| | - A. Cernescu
- grid.431971.9Neaspec—Attocube Systems AG, Eglfinger Weg 2, Haar, 85540 Munich Germany
| | - S. R. Cohen
- grid.13992.300000 0004 0604 7563Department of Chemical Research Support, Weizmann Institute of Science, 7610001 Re-hovot, Israel
| | - I. Rosenhek-Goldian
- grid.13992.300000 0004 0604 7563Department of Chemical Research Support, Weizmann Institute of Science, 7610001 Re-hovot, Israel
| | - O. Brookstein
- grid.13992.300000 0004 0604 7563Department of Molecular Chemistry and Materials Science, Faculty of Chemistry, Weizmann Institute of Science, 7610001 Rehovot, Israel
| | - M. E. Miali
- grid.13992.300000 0004 0604 7563Department of Molecular Chemistry and Materials Science, Faculty of Chemistry, Weizmann Institute of Science, 7610001 Rehovot, Israel
| | - A. Solomonov
- grid.13992.300000 0004 0604 7563Department of Molecular Chemistry and Materials Science, Faculty of Chemistry, Weizmann Institute of Science, 7610001 Rehovot, Israel
| | - M. Greenblatt
- grid.13992.300000 0004 0604 7563Department of Chemical and Structural Biology, Weizmann Institute of Science, 7610001 Rehovot, Israel
| | - Y. Levy
- grid.13992.300000 0004 0604 7563Department of Chemical and Structural Biology, Weizmann Institute of Science, 7610001 Rehovot, Israel
| | - U. Raviv
- grid.9619.70000 0004 1937 0538Institute of Chemistry, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Givat Ram, Jerusalem, 9190401 Israel
| | - A. Barth
- grid.10548.380000 0004 1936 9377Department of Biochemistry and Biophysics, Stockholm University, Svante Arrhenius väg 16C, 10691 Stockholm, Sweden
| | - U. Shimanovich
- grid.13992.300000 0004 0604 7563Department of Molecular Chemistry and Materials Science, Faculty of Chemistry, Weizmann Institute of Science, 7610001 Rehovot, Israel
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15
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Maliah A, Parikh R, Tayer-Shifman OE, Kimhi O, Gepstein R, Halperin T, Levy Y, Levy C, Basson YPP, Kivity S. Steroid treatment suppresses the CD4 + T-cell response to the third dose of mRNA COVID-19 vaccine in systemic autoimmune rheumatic disease patients. Sci Rep 2022; 12:21056. [PMID: 36474011 PMCID: PMC9727118 DOI: 10.1038/s41598-022-25642-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Prolonged steroid treatment has a suppressive effect on the immune system, however, its effect on the cellular response to mRNA vaccine is unknown. Here we assessed the impact of prolonged steroid treatment on the T-cell and humoral response to the SARS-CoV-2 spike (S) peptide following the third dose of the BNT162b2 vaccine in systemic autoimmune rheumatic disease patients. We found that CD4 T-cell response to the S peptide in patients on high-dose long-term steroid treatment showed significantly less S-peptide specific response, compare to low-dose or untreated patients. Remarkably, these results were not reflected in their humoral response, since almost all patients in the cohort had sufficient antibody levels. Moreover, S-peptide activation failed to induce significant mRNA levels of IFNγ and TNFα in patients receiving high-dose steroids. RNA-sequencing datasets analysis implies that steroid treatments' inhibitory effect of nuclear factor kappa-B signaling may interfere with the activation of S-specific CD4 T-cells. This reveals that high-dose steroid treatment inhibits T-cell response to the mRNA vaccine, despite having sufficient antibody levels. Since T-cell immunity is a crucial factor in the immune response to viruses, our findings highlight the need for enhancing the efficiency of vaccines in immune-suppressive patients, by modulation of the T-cell response.
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Affiliation(s)
- Avishai Maliah
- grid.12136.370000 0004 1937 0546Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, 69978 Tel Aviv, Israel
| | - Roma Parikh
- grid.12136.370000 0004 1937 0546Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, 69978 Tel Aviv, Israel
| | - Oshrat E. Tayer-Shifman
- grid.415250.70000 0001 0325 0791Rheumatology Unit, Meir Medical Center, Tchernichovsky St 59, Kfar Saba, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oded Kimhi
- grid.415250.70000 0001 0325 0791Department of Internal Medicine A, Meir Medical Center, Kfar Saba, Israel
| | - Raz Gepstein
- grid.415250.70000 0001 0325 0791Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
| | - Tami Halperin
- grid.12136.370000 0004 1937 0546Department of Infectious Diseases, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yair Levy
- grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel ,grid.415250.70000 0001 0325 0791Department of Internal Medicine E, Meir Medical Center, Kfar Saba, Israel
| | - Carmit Levy
- grid.12136.370000 0004 1937 0546Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, 69978 Tel Aviv, Israel
| | - Yael Pri-Paz Basson
- grid.415250.70000 0001 0325 0791Rheumatology Unit, Meir Medical Center, Tchernichovsky St 59, Kfar Saba, Israel
| | - Shaye Kivity
- grid.415250.70000 0001 0325 0791Rheumatology Unit, Meir Medical Center, Tchernichovsky St 59, Kfar Saba, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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16
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Pri-Paz Basson Y, Tayer-Shifman OE, Naser R, Tartakover Matalon S, Kimhi O, Gepstein R, Halperin T, Ziv-Baran T, Ziv A, Parikh R, Kivity S, Levy Y. Immunogenicity and safety of the mRNA-based BNT162b2 vaccine in systemic autoimmune rheumatic diseases patients. Clin Rheumatol 2022; 41:3879-3885. [PMID: 36050514 PMCID: PMC9436715 DOI: 10.1007/s10067-022-06348-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/08/2022] [Accepted: 08/20/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The COVID-19 outbreak has led to the rapid development and administration of the COVID-19 vaccines worldwide. Data about the immunogenicity and adverse effects of the vaccine on patients with systemic autoimmune rheumatic diseases (SARDs) is emerging. AIM To evaluate Pfizer/BioNTech (BNT162b2) mRNA-based vaccine second-dose immunogenicity and safety, and the relation between them, in patients with SARDs. METHODS A total of one hundred forty tow adults who received two doses of the BNT162b2 vaccine were included in the study. The SARDs group included Ninety-nine patients and the control group (forty-three participants) comprised a mixture of healthy participants and patients who were seen at the rheumatology clinic for non-SARDs. Anti-SARS-CoV-2 IgG antibodies against the Spike protein were evaluated using a SARS-CoV-2 IgG immunoassay. A level of > 150 AU/mL was considered positive. An adverse effects questionnaire was given to the participants upon their first visit to the clinic after their BNT162b2 vaccination. RESULTS Of the 142 participants, 116 were seropositive (81.7%) and 26 (18.3%) were seronegative. Of the seronegative participants, 96.2% were SARDs patients. The proportion of seropositivity in the SARDs patients treated with any immunosuppressant was significantly lower (69.9%) compared to the control group and SARDs patients not receiving immunosuppressants (96.8%). A significant negative correlation between seronegativity and treatment with rituximab, mycophenolate mofetil (MMF), and prednisone was found in the SARDs group (p = 0.004, 0.044, 0.007 respectively). No fever was observed following the BNT162b2 vaccine in seronegative patients, and the frequency of musculoskeletal adverse effects upon the second dose of the BNT162b2 vaccine was significantly higher in seropositive compared to seronegative patients and in the control group compared to the SARDs patients (p = 0.045, p = 0.02 respectively). CONCLUSION A decline in the immunogenicity to the second dose of BNT162b2 mRNA is seen in patients with SARDs, especially in patients treated with rituximab, MMF, and prednisone. Adverse effects of the vaccine including fever and musculoskeletal symptoms might be a signal for the acquisition of immunity in those patients. KEY POINTS • BNT162b2 mRNA vaccine is less immunogenic in SARDs patients compared to the control group. • Rituximab, prednisone, and mycophenolate mofetil significantly reduced immunogenicity to the vaccine. • There is a correlation between immunogenicity and adverse effects of the vaccine.
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Affiliation(s)
- Yael Pri-Paz Basson
- Rheumatology Unit, Meir medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oshrat E Tayer-Shifman
- Rheumatology Unit, Meir medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rawand Naser
- Rheumatology Unit, Meir medical Center, Kfar Saba, Israel
| | - Shelly Tartakover Matalon
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Autoimmune Research Laboratory, Meir Medical Center, Kfar Saba, Israel
| | - Oded Kimhi
- Department of Internal Medicine A, Meir Medical Center, Kfar Saba, Israel
| | - Raz Gepstein
- Department of Ophthalmology, Meir medical center, Kfar Saba, Israel
| | - Tamar Halperin
- Department of Infectious Diseases, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amit Ziv
- Pediatric Rheumatology Unit, Meir medical center, Kfar Saba, Israel
| | - Roma Parikh
- Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shaye Kivity
- Rheumatology Unit, Meir medical Center, Kfar Saba, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Yair Levy
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba, Israel
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17
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Meridor K, Rotman-Pikielny P, Carmi O, Werner M, Levy Y. Thyroid Disorders in Patients with Systemic Sclerosis: Biochemical and Sonographic Characteristics. A Prospective Cohort Study. Isr Med Assoc J 2022; 24:732-736. [PMID: 36436040] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Patients with systemic sclerosis (SSc) are at increased risk for autoimmune thyroid diseases, but information regarding thyroid nodules and cancer in SSc is scarce. Objectives: To evaluate the thyroid gland in patients with SSc at a single Israeli center. METHODS Thyroid workup was conducted in consecutive SSc patients: thyroid-stimulating hormone (TSH), free thyroxine (fT4), anti-thyroid peroxidase, and anti-thyroglobulin antibodies, as well as thyroid ultrasound and fine needle aspiration (FNA) when appropriate. RESULTS Fifty patients, mean age 51.3 ± 13.5 years (44 women) were evaluated. Ten were previously diagnosed with thyroid disease. Median TSH level was 2.0 (normal range 0.23-4 mIU/l) and median fT4 level was 1.0 (normal range 0.8-2.0 ng/dL). Among the 40 thyroid disorder-naive patients, 3 had subclinical hypothyroidism and 5 had positive anti-thyroid antibodies; 22 (44%) had 1-6 thyroid nodules, which were ≥ 1 cm in 12 (24%). Accordingly, six patients underwent FNA, and five were diagnosed as colloid nodules and one as papillary carcinoma. CONCLUSIONS New cases of clinically significant autoimmune thyroid disease were not detected in our cohort of patients with SSc. Nevertheless, almost half had thyroid nodules. The clinical significance of these findings and their relation to thyroid cancer remains to be determined.
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Affiliation(s)
- Katya Meridor
- Department of Medicine E, Meir Medical Center, Kfar Saba, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pnina Rotman-Pikielny
- Endocrinology, Meir Medical Center, Kfar Saba, Israel , Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Or Carmi
- Department of Medicine E, Meir Medical Center, Kfar Saba, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Myriam Werner
- Diagnostic Imaging, Meir Medical Center, Kfar Saba, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Levy
- Department of Medicine E, Meir Medical Center, Kfar Saba, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Zaaroor Levy M, Rabinowicz N, Yamila Kohon M, Shalom A, Berl A, Hornik-Lurie T, Drucker L, Tartakover Matalon S, Levy Y. MiRNAs in Systemic Sclerosis Patients with Pulmonary Arterial Hypertension: Markers and Effectors. Biomedicines 2022; 10:biomedicines10030629. [PMID: 35327430 PMCID: PMC8945806 DOI: 10.3390/biomedicines10030629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Pulmonary arterial hypertension (PAH) is a major cause of death in systemic sclerosis (SSc). Early detection may improve patient outcomes. Methods: We searched for circulating miRNAs that would constitute biomarkers in SSc patients with PAH (SSc-PAH). We compared miRNA levels and laboratory parameters while evaluating miRNA levels in white blood cells (WBCs) and myofibroblasts. Results: Our study found: 1) miR-26 and miR-let-7d levels were significantly lower in SSc-PAH (n = 12) versus SSc without PAH (SSc-noPAH) patients (n = 25); 2) a positive correlation between miR-26 and miR-let-7d and complement-C3; 3) GO-annotations of genes that are miR-26/miR-let-7d targets and that are expressed in myofibroblast cells, suggesting that these miRNAs regulate the TGF-β-pathway; 4) reduced levels of both miRNAs accompanied fibroblast differentiation to myofibroblasts, while macitentan (endothelin receptor-antagonist) increased the levels. WBCs of SSc-noPAH and SSc-PAH patients contained equal amounts of miR-26/miR-let-7d. During the study, an echocardiograph that predicted PAH development, showed increased pulmonary artery pressure in three SSc-noPAH patients. At study initiation, those patients and an additional SSc-noPAH patient, who eventually developed PAH, had miR-let-7d/miR-26 levels similar to those of SSc-PAH patients. This implies that reduced miR-let-7d/miR-26 levels might be an early indication of PAH. Conclusions: miR-26 and miR-let-7d may be serological markers for SSc-PAH. The results of our study suggest their involvement in myofibroblast differentiation and complement pathway activation, both of which are active in PAH development.
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Affiliation(s)
- Mor Zaaroor Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (M.Z.L.); (N.R.); (M.Y.K.); (A.S.); (A.B.); (L.D.)
- Autoimmune Research Laboratory, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Noa Rabinowicz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (M.Z.L.); (N.R.); (M.Y.K.); (A.S.); (A.B.); (L.D.)
- Autoimmune Research Laboratory, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Maia Yamila Kohon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (M.Z.L.); (N.R.); (M.Y.K.); (A.S.); (A.B.); (L.D.)
- Autoimmune Research Laboratory, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Avshalom Shalom
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (M.Z.L.); (N.R.); (M.Y.K.); (A.S.); (A.B.); (L.D.)
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Ariel Berl
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (M.Z.L.); (N.R.); (M.Y.K.); (A.S.); (A.B.); (L.D.)
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel
| | | | - Liat Drucker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (M.Z.L.); (N.R.); (M.Y.K.); (A.S.); (A.B.); (L.D.)
- Oncogenetic Laboratory, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Shelly Tartakover Matalon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (M.Z.L.); (N.R.); (M.Y.K.); (A.S.); (A.B.); (L.D.)
- Autoimmune Research Laboratory, Meir Medical Center, Kfar Saba 4428164, Israel
- Correspondence: (S.T.M.); (Y.L.); Tel./Fax: +972-9-74721992 (S.T.M.)
| | - Yair Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (M.Z.L.); (N.R.); (M.Y.K.); (A.S.); (A.B.); (L.D.)
- Autoimmune Research Laboratory, Meir Medical Center, Kfar Saba 4428164, Israel
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba 4428164, Israel
- Correspondence: (S.T.M.); (Y.L.); Tel./Fax: +972-9-74721992 (S.T.M.)
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Delimpasi S, Mateos MV, Auner HW, Gavriatopoulou M, Dimopoulos MA, Quach H, Pylypenko H, Hájek R, Leleu X, Dolai TK, Sinha DK, Venner CP, Benjamin R, Garg MK, Doronin V, Levy Y, Moreau P, Chai Y, Arazy M, Shah J, Shacham S, Kauffman MG, Richardson PG, Grosicki S. Efficacy and tolerability of once-weekly selinexor, bortezomib, and dexamethasone in comparison with standard twice-weekly bortezomib and dexamethasone in previously treated multiple myeloma with renal impairment: Subgroup analysis from the BOSTON study. Am J Hematol 2022; 97:E83-E86. [PMID: 34882831 DOI: 10.1002/ajh.26434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 01/03/2023]
Affiliation(s)
| | | | - Holger W. Auner
- The Hugh and Josseline Langmuir Centre for Myeloma Research Imperial College London London UK
| | - Maria Gavriatopoulou
- Alexandra Hospital, School of Medicine National and Kapodistrian University of Athens Athens Greece
| | | | - Hang Quach
- St. Vincent's Hospital University of Melbourne Fitzroy Victoria Australia
| | - Halyna Pylypenko
- Department of Hematology Cherkassy Regional Oncological Center Cherkassy Ukraine
| | - Roman Hájek
- Department of Hemato‐oncology, University Hospital Ostrava University of Ostrava Ostrava Czech Republic
| | - Xavier Leleu
- Department of Hematology CHU la Miletrie and Inserm CIC 1402 Poitiers France
| | | | - Dinesh Kumar Sinha
- State Cancer Institute Indira Gandhi Institute of Medical Sciences Patna India
| | | | | | | | - Vadim Doronin
- City Clinical Hospital #40 Moscow Russian Federation
| | - Yair Levy
- Baylor University Medical Center Dallas Texas USA
| | | | - Yi Chai
- Karyopharm Therapeutics Newton Massachusetts USA
| | - Melina Arazy
- Karyopharm Therapeutics Newton Massachusetts USA
| | - Jatin Shah
- Karyopharm Therapeutics Newton Massachusetts USA
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Meridor K, Berookhim J, Levy Y. Low dose naloxone for pruritus in systemic sclerosis: Case series and literature review. Medicine (Baltimore) 2022; 101:e28653. [PMID: 35089206 PMCID: PMC8797570 DOI: 10.1097/md.0000000000028653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/04/2022] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Pruritus is a common symptom in patients with systemic sclerosis and has a tremendous effect on the quality of life. Nevertheless, current therapeutic options are limited. The pathogenesis of pruritus in systemic sclerosis is not completely understood; however, opiate-mediated neurotransmission has been postulated to be involved. PATIENT CONCERNS AND DIAGNOSIS We describe 4 female patients with systemic sclerosis suffering from severe pruritus, with an average 5D-itch score of 22.75. INTERVENTION AND OUTCOMES Low-dose oral naloxone was initiated, followed by a significant improvement in the level of pruritus, reaching an average 5D-itch score of 7.5, after 6 and 12 months of treatment. None of the patients experienced side effects. LESSONS Low-dose naloxone plays an important role in the management of pruritus in systemic sclerosis.
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Pri-Paz Basson Y, Tayer-Shifman OE, Naser R, Tartakover Matalon S, Kimhi O, Gepstein R, Halperin T, Ziv-Baran T, Ziv A, Parikh R, Kivity S, Levy Y. Correction to: Immunogenicity and safety of the mRNA-based BNT162b2 vaccine in systemic autoimmune rheumatic diseases patients. Clin Rheumatol 2022; 41:3925. [PMID: 36251175 PMCID: PMC9828834 DOI: 10.1007/s10067-022-06412-8] [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] [Indexed: 01/12/2023]
Affiliation(s)
- Yael Pri-Paz Basson
- Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oshrat E Tayer-Shifman
- Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rawand Naser
- Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
| | - Shelly Tartakover Matalon
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Autoimmune Research Laboratory, Meir Medical Center, Kfar Saba, Israel
| | - Oded Kimhi
- Department of Internal Medicine A, Meir Medical Center, Kfar Saba, Israel
| | - Raz Gepstein
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
| | - Tamar Halperin
- Department of Infectious Diseases, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amit Ziv
- Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
| | - Roma Parikh
- Department of Human Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shaye Kivity
- Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Yair Levy
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba, Israel
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Abstract
Purpose
This paper aims to introduce the concept of cybersecurity footprint.
Design/methodology/approach
Characteristics of cybersecurity footprint are presented based on documented cases, and the domino effect of cybersecurity is illustrated. Organizational and individual cybersecurity footprints are outlined. Active and passive – digital vs cybersecurity footprints are then reviewed. Taxonomy of aware/unaware vs active/passive cybersecurity footprints are presented, followed by brief discussion of the implications for future research.
Findings
The concept of cybersecurity footprint is defined, and the evidence from prior cyber incidents is shown to emphasize the concept. Smaller organizations may have a large cybersecurity footprint, whereas larger organizations may have smaller one. Cyberattacks are focusing on the individuals or small organizations that are in the supply chain of larger organizations causing the domino effect.
Practical implications
Implications of cybersecurity footprint to individuals, organizations, societies and governments are discussed. The authors present organizations with ways to lower cybersecurity footprint along with recommendations for future research.
Social implications
Cybersecurity has a significant social implication worldwide, as the world is becoming cyber dependent. With the authors’ introduction of the cybersecurity footprint concept and call to further understand how organizations can measure and reduce it, the authors envision it as another perspective of assessing cyber risk and further help mitigate future cyber incidents.
Originality/value
This paper extends the existing information and computer security body of knowledge on the concept of cybersecurity footprint with illustrated cases.
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Nussinovitch U, Gendelman O, Rubin S, Levy Y, Vishnevskia Dai V, Livneh A, Lidar M. Autonomic Nervous System Indices in Patients with Systemic Sclerosis without Overt Cardiac Disease. Isr Med Assoc J 2021; 23:651-656. [PMID: 34672448] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Systemic sclerosis (SSc) is a connective tissue disease that may affect the heart and the autonomic nervous system (ANS). There is little knowledge regarding the degree of ANS involvement in SSc patients with unknown cardiac disease. OBJECTIVES To evaluate cardiac and pupillary autonomic functions in patients before cardiac involvement has emerged. METHODS The study comprised 19 patients with SSc and 29 healthy controls. Heart rate variability (HRV) analysis for time and frequency domains, as well as deep breathing test and Ewing maneuvers, were performed in all patients. Automated pupillometry for the evaluation of pupillary diameter and pupillary light reflex was completed in 8 SSc patients and 21 controls. RESULTS Both groups had similar characteristics, except for medications that were more commonly or solely prescribed for SSc patients. Compared with control subjects, the SSc patients had significantly lower HRV parameters of NN50 (15.8 ± 24.4 vs. 33.9 ± 33.1, P = 0.03), pNN50 (4.9 ± 7.4% vs.10.8 ± 10.8%, P = 0.03), and triangular index (11.7 ± 3.4 vs. 15.7 ± 5.8, P = 0.02). Abnormal adaptive responses in heart rate changes were recorded during deep breathing tests and Ewing maneuvers. There was no significant difference in any of the pupillometric indices or other HRV parameters within groups. CONCLUSIONS SSc patients may manifest cardiac autonomic dysfunction, while their autonomic pupillary function is seemingly spared. The role of certain medications, the significance of differential organ involvement, as well as the prognostic value of our findings should be evaluated in future studies.
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Affiliation(s)
- Udi Nussinovitch
- Division of Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA
| | - Omer Gendelman
- Department of Rheumatology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shiri Rubin
- Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Levy
- Medicine E, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Viktoria Vishnevskia Dai
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Livneh
- Department of Rheumatology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Merav Lidar
- Department of Rheumatology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gendelman O, Kuntzman Y, Shovman O, Langevitz P, Tsur AM, Erez D, Levy Y, Amital H. Tumor-like Lesions in Patients with Granulomatosis with Polyangiitis: A Case Series. Isr Med Assoc J 2021; 23:350-352. [PMID: 34155847] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Granulomatosis with polyangiitis (GPA) is a rare small vessel vasculitis. It usually involves the respiratory tract and kidney. Rarely, tumor-resembling inflammatory changes ensue. OBJECTIVES To report three unique cases of GPA presenting with tumor-like lesions in various organs. METHODS We presented three cases of GPA. Case 1 presented with typical upper respiratory symptoms of GPA and a mediastinal mass. Case 2 presented with low back pain, a large retroperitoneal mass, and nodular skin lesions. Case 3 presented with epigastric pain and a paravertebral inflammatory mass. RESULTS The patients were treated successfully with rituximab. CONCLUSIONS Clinicians should be aware of this presentation of granulomatosis with polyangiitis, which is known as Tumefaction Wegener's granulomatosis.
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Affiliation(s)
- Omer Gendelman
- Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Kuntzman
- Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ora Shovman
- Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pnina Langevitz
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avishai M Tsur
- Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Erez
- Department of Medicine D, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Levy
- Department of Medicine E, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Howard Amital
- Department of Medicine B, Sheba Medical Center, Tel Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Spiera R, Kuwana M, Khanna D, Hummers L, Frech T, Stevens W, Gordon J, Kafaja S, Matucci-Cerinic M, Distler O, Lee EB, Levy Y, Jun JB, Constantine S, Dgetluck N, White B, Furst D, Denton C. OP0171 PHASE 3 TRIAL OF LENABASUM, A CB2 AGONIST, FOR THE TREATMENT OF DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS (DCSSC). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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:Lenabasum is an oral CB2 agonist that attenuates inflammation and fibrosis in SSc animal models and showed clinical benefit with acceptable safety in a Phase 2 trial in dcSSc.Objectives:Test efficacy and safety of lenabasum in a Phase 3 trial in dcSSc.Methods:Subjects ≥18 years old with disease duration ≤ 6 years were randomized 1:1:1 to lenabasum 5 mg, 20 mg, or placebo (PBO), all BID, with stable background immunosuppressant therapy (IST) allowed. The primary efficacy endpoint was ACR CRISS score, and secondary endpoints were ΔmRSS, ΔHAQ-DI, and ΔFVC, all at Week 52 for lenabasum 20 mg vs PBO.Results:363 adults were dosed; 37 (10%) stopped study drug early, with only 1 subject (PBO cohort) stopping due to adverse event (AE). Baseline demographics were similar among groups. Disease duration was ≤ 3 years in 60% and 66%, mean mRSS score was 22.0 and 23.3, and background IST was used by 89% and 84% of lenabasum 20 mg and PBO groups, respectively.Safety results showed serious AEs and severe AEs occurred in 9.2% and 5.8% vs 14.6% and 13.0%, respectively, of lenabasum 20 mg and PBO groups.Efficacy results (Table) demonstrated:Table 1.Primary and secondary efficacy endpoints and post-hoc analyses, Week 52Group, by IST treatmentCohortNΔmRSS, mean (SD)ΔFVC% mean (SD)ΔFVC, mL mean (SD)ΔHAQ-DI mean (SD)ACR CRISS medianmITT population, MMRM primary analysis methodAllPlacebo123-8.1 (7.72)-1.0 (8.68)-51 (317)-0.13 (0.468)0.887Lenabasum 20 mg120-6.7 (6.59)-1.6 (6.91)-78 (265)-0.13 (0.436)0.888Placebo subjects, per protocol completers, LOCFNo ISTPlacebo16-2.3 (9.4)-2.8 (7.4)-97 (244)0.12 (0.34)0.417All ISTPlacebo97-8.9 (7.07)-1.0 (9.2)-43 (330)-0.17 (0.474)0.936MMF, no other ISTPlacebo29-10.7 (8.1)-0.58 (7.1)-37 (235)-0.12 (0.456)0.935MMF ≤ 2 years, no other ISTPlacebo23-11.7 (8.1)-0.3 (6.0)-41 (197)-0.13 (0.495)0.935Non-MMF ≤ 2 yearsPlacebo24-6.7 (6.2)-1.4 (7.87)-52 (281)-0.15 (0.357)0.931Post-hoc comparisons, per protocol completers, LOCFNo ISTPlacebo16-2.3 (9.4)-2.8 (7.4)-97 (244)0.12 (0.34)0.417Lenabasum 20 mg10-6.3 (6.02)-2.3 (5.58)-99 (209)-0.06 (0.498)0.811Established IST1Placebo26-6.1 (5.35)-4.6 (10.11)-170 (350)-0.17 (0.445)0.619Lenabasum 20 mg38-7.4 (5.08)-0.4 (5.70)2-21 (233)3-0.07 (0.357)0.941Established IST, subjects with ILDPlacebo22-5.9 (5.28)-3.7 (5.43)-133 (206)-0.10 (0.372)0.553Lenabasum 20 mg33-7.2 (5.70)-1.0 (10.5)-47 (365)-0.06 (0.391)0.8192 P = 0.0386 two-sample t-test; 3 P = 0.0481 two-sample t-test; other comparisons were not significant• No significant differences were seen in primary and secondary efficacy endpoints. Primary MMRM analyses with treatment-by-time-by-subgroup interactions showed that background mycophenolate (MMF) significantly influenced the outcome•oSubjects on no IST with disease duration ≤3 years were only 7% of PBO subjects and showed little improvement on PBO, in line with other dcSSc trials in which IST was restricted. Post-hoc subgroup analyses of these subjects on no IST suggested improvement in ΔmRSS and ΔHAQ-DI, for lenabasum 20 mg vs PBO•uUnexpectedly high improvement occurred in PBO subjects receiving IST, notably those on MMF started within 2 years of baseline•nPost-hoc analyses of subjects on established IST (MMF or, if no MMF, ≥ 1 non-MMF IST started > 2 years before baseline) suggested improvement in ΔFVC% (nominal P = 0.0386) and ΔFVC mL (nominal P = 0.0481) for lenabasum 20 mg vs PBO. Improvement in FVC was also seen in subjects on established IST who had ILD at baseline, lenabasum 20 mg vs PBO•mACR CRISS score demonstrated a ceiling effect and correlated most highly with ΔmRSS (r = -0.739) and moderately with MDGA (-0.432), HAQ-DI (-0.362), FVC% (0.366), and PtGA (-0.288)Conclusion:Lenabasum was safely used in this study. Unexpectedly high improvement on background IST, especially MMF, has not been previously reported at this level. The primary endpoint was not met. Post-hoc analyses showed greater improvement in lenabasum- vs PBO-treated subjects who were not on background IST and those on established IST, including subjects with ILD.Disclosure of Interests:Robert Spiera Consultant of: Abbvie, Roche-Genetech, GSK, CSL Behring, Sanofi, Janssen, Chemocentryx, Formation Biologics, Mitsubishi Tanabe, Grant/research support from: Roche-Genetech, GSK, Boehringer Ingelheim, Chemocentryx, Corbus, Formation Biologics, Sanofi, Inflarx, Astra Zeneca, Kadmon, Masataka Kuwana Speakers bureau: Boehringer-Ingelheim, Chugai, Janssen, Consultant of: Boehringer-Ingelheim, Chugai, Corbus, Grant/research support from: Boehringer-Ingelheim, Chugai, MBL, Ono Pharmaceuticals, Tanabe-Mitsubishi, Dinesh Khanna Shareholder of: Eicos Sciences, Inc (less than 5%). Leadership/Equity position – Chief Medical Officer, CiviBioPharma/Eicos Sciences, Inc, Consultant of: Acceleron, Actelion, Abbvie, Amgen, Bayer, Boehringer Ingelheim, CSL Behring, Corbus, Gilead, Galapagos, Genentech/Roche, GSK, Horizon, Merck, Mitsubishi Tanabe Pharma, Sanofi-Aventis, and United Therapeutics, Grant/research support from: NIH, Immune Tolerance Network, Bayer, BMS, Horizon, Pfizer, Laura Hummers Consultant of: CSL Behring, Boehringer Ingelheim, Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals. Corbus, Boehringer Ingelheim, Medpace, Kadmon, Cumberland, CSL Behring, Tracy Frech Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Wendy Stevens Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Jessica Gordon Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals. Research funding for EICOS Pharmaceuticals and Cumberland Pharmaceuticals., Suzanne Kafaja Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Marco Matucci-Cerinic Consultant of: Actelion, Janssen, Inventiva, Bayer, Biogen, Boehringer, CSL Behring, Corbus, Galapagos, Mitsubishi, Samsung, Regeneron, Acceleron, MSD, Chemomab, Lilly, Pfizer, Roche, Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Oliver Distler Consultant of: Consultancy relationship and/or has received research funding in the area of potential treatments for systemic sclerosis and its complications from (last three years): Abbvie, Acceleron Pharma, Amgen, AnaMar, Arxx Therapeutics, Baecon Discovery, Blade Therapeutics, Bayer, Boehringer Ingelheim, ChemomAb, Corbus Pharmaceuticals, CSL Behring, Galapagos NV, Glenmark Pharmaceuticals, GSK, Horizon (Curzion) Pharmaceuticals, Inventiva, iQvia, Italfarmaco, iQone, Kymera Therapeutics, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Serodapharm, Topadur, Target Bioscience and UCB., Eun Bong Lee Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Yair Levy Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Jae-Bum Jun Consultant of: Consultant to Boehringer Ingelheim Korea, Jeil Pharma, Dae Woong Pharma, Kwangdong Pharma, and Sama Pharma., Grant/research support from: Investigator for study sponsored by Corbus Pharmaceuticals, Scott Constantine Employee of: Employee of Corbus Pharmaceuticals, Nancy Dgetluck Employee of: Employee of Corbus Pharmaceuticals, Barbara White Employee of: Employee and stockholder of Corbus Pharmaceuticals, Daniel Furst Consultant of: Corbus, Galapagos, Pfizer, CSL Behring, Mitsubishi Tanabi, Actelion, Amgen, Novartis, Roche/Genentech, Gilead, Talaris, and Boehringer Ingelheim., Grant/research support from: grants from Corbus, Galapagos, GSK, Pfizer, Talaris, CSL Behring, Mitsubishi Tanabi, Christopher Denton Consultant of: Consultancy fees and/or honoraria from Corbus, Actelion, GlaxoSmithKline, Bayer, Sanofi, Galapagos, Inventiva, Boehringer Ingelheim, Roche, CSL Behring, Acceleron, Horizon, Arxx Therapeutics
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Meridor K, Shoenfeld Y, Tayer-Shifman O, Levy Y. Lupus acute cardiomyopathy is highly responsive to intravenous immunoglobulin treatment: Case series and literature review. Medicine (Baltimore) 2021; 100:e25591. [PMID: 33950936 PMCID: PMC8104142 DOI: 10.1097/md.0000000000025591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/31/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Intravenous immunoglobulin (IVIg) is currently used with considerable success for the treatment of many autoimmune diseases, including systemic lupus erythematosus (SLE). Among its various indications, IVIg has also been found to be beneficial in myocarditis, whether or not it is associated with an autoimmune disease. Nevertheless, data regarding IVIg treatment for myocarditis/cardiomyopathy in patients with SLE are sparse. The objective of this case series was to describe our experience with IVIg as a treatment for lupus myocarditis and to review the literature for IVIg for this indication. PATIENT CONCERNS We report 5 female patients with SLE, who presented with signs of acute heart failure including pulmonary congestion and arrhythmias. DIAGNOSIS Echocardiography demonstrated new reduced left ventricular ejection fraction of 20% to 30%. Two patients underwent coronary artery angiography, which demonstrated normal coronary arteries, supporting the diagnosis of myocarditis or nonischemic cardiomyopathy. INTERVENTIONS High-dose IVIg treatment was initiated in all 5 patients. OUTCOMES Following the treatment, clinical and echocardiographic improvement in cardiac function occurred within a few days to 1 month. This dramatic improvement persisted for several years. CONCLUSION Based on our case series, we believe that IVIg has an important role in the management of lupus acute cardiomyopathy. This safe, well-tolerated optional treatment should be considered, especially in severe cases.
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Affiliation(s)
- Katya Meridor
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba
- Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel HaShomer
- Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oshrat Tayer-Shifman
- Rheumatology Unit, Meir Medical Center, Kfar Saba
- Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Levy
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba
- Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Erez D, Shoenfeld Y, Natour A, Dovrish Z, Tayer-Shifman OE, Levy Y. Clinical experience with biologic treatment in resistant eosinophilic fasciitis: Case reports and review of the literature. Medicine (Baltimore) 2021; 100:e25359. [PMID: 33787639 PMCID: PMC8021286 DOI: 10.1097/md.0000000000025359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/11/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Eosinophilic fasciitis (EF) is an uncommon connective tissue disorder characterized by limb and trunk erythema, with symmetrical thickening of the skin. Its pathogenesis is poorly understood. Treatment consists mainly of glucocorticoids. Yet, no randomized trials have evaluated therapies for this rare disease and the optimal treatment modality remains unclear. Although most patients show partial or complete response to glucocorticoids, many relapse upon drug tapering, while others either do not respond at all or fail to sustain prolonged remission. Second-line therapy for this rare disorder includes mainly methotrexate (MTX), azathioprine, cyclosporine and hydroxychloroquine. Recently, several attempts using rituximab and intravenous immunoglobulins (IVIG) have shown good clinical results. PATIENT CONCERNS The three patients had good clinical response to glucocorticoid treatment, followed by disease flare when the drug dose was tapered. Adding methotrexate in all patients and azathioprine to patient 3 did not lead to remission. DIAGNOSES EF was diagnosed in all patients based on clinical presentation accompanied by fascia biopsy that demonstrated eosinophilic fasciitis. INTERVENTIONS The patients were successfully treated with rituximab or IVIG, achieving sustained remission. OUTCOMES The three cases had good clinical response to glucocorticoid treatment, followed by disease flare when the drug dose was tapered. The patients were then successfully treated with rituximab or IVIG, achieving sustained remission. LESSONS This review of three cases of EF supports the results of previous reports, suggesting addition of rituximab and IVIG is an effective treatment for patients with refractory disease.
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Affiliation(s)
- Daniel Erez
- Department of Medicine D, Meir Medical Center, Kfar Saba
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Yehuda Shoenfeld
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- St. Petersburg State University, St. Petersburg, Russia
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer
| | - Ayman Natour
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Department of Medicine E, Meir Medical Center
| | - Zamir Dovrish
- Department of Medicine D, Meir Medical Center, Kfar Saba
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Oshrat E. Tayer-Shifman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Rheumatology Service, Meir Medical Center, Kfar Saba, Israel
| | - Yair Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Department of Medicine E, Meir Medical Center
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Halpert G, Watad A, Tsur AM, Dotan A, Quiros-Lim HE, Heidecke H, Gilburd B, Haik J, Levy Y, Blank M, Amital H, Shoenfeld Y. Autoimmune dysautonomia in women with silicone breast implants. J Autoimmun 2021; 120:102631. [PMID: 33799099 DOI: 10.1016/j.jaut.2021.102631] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/07/2021] [Accepted: 03/12/2021] [Indexed: 12/13/2022]
Abstract
IMPORTANCE AND OBJECTIVES There is unmet medical need to understand the pathogenic mechanism of the panoply of clinical manifestations associated with silicone breast implants (SBIs) such as severe fatigue, widespread pain, palpitations, dry mouth and eyes, depression, hearing loss etc. We aimed to determine whether autoantibodies against the autonomic nervous system receptors can explain the enigmatic and subjective clinical manifestation reported by women with SBIs. RESULTS Circulating level of autoantibodies against G protein-coupled receptors (GPCRs) of the autonomic nervous system (adrenergic, muscarinic, endothelin and angiotensin receptors) have been evaluated in symptomatic women with SBIs using an ELISA method. These women with SBIs addressed our clinic due to various subjective and autonomic-related manifestations such as chronic severe fatigue, cognitive impairment, widespread pain, memory loss, sleep disorders, palpitations, depression, hearing abnormalities etc. We report for the first time, a significant reduction in the sera level of anti-β1 adrenergic receptor (p < 0.001), anti-angiotensin II type 1 receptor (p < 0.001) and anti-endothelin receptor type A (p = 0.001) autoantibodies in women with SBIs (n = 93) as compared with aged matched healthy women (n = 36). Importantly, anti-β1 adrenergic receptor autoantibody was found to significantly correlate with autonomic-related manifestations such as: sleep disorders and depression in women with SBIs. CONCLUSIONS Chronic immune stimulation by silicone material may lead to an autoimmune dysautonomia in a subgroup of potentially genetically susceptible women with SBIs. The appearance of autoantibodies against GPCRs of the autonomic nervous system serve as an explanation for the subjective autonomic-related manifestations reported in women with SBIs.
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Affiliation(s)
- Gilad Halpert
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat- Gan, 52621, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Abdulla Watad
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat- Gan, 52621, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Medicine 'B' and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel
| | - Avishai M Tsur
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat- Gan, 52621, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel; Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Arad Dotan
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat- Gan, 52621, Israel
| | - Hector Enrique Quiros-Lim
- Department of Plastic and Reconstructive Surgery. The Chaim Sheba Medical Center at Tel Hashomer. Ramat Gan. Israel
| | | | - Boris Gilburd
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat- Gan, 52621, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Josef Haik
- Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Plastic and Reconstructive Surgery. The Chaim Sheba Medical Center at Tel Hashomer. Ramat Gan. Israel; College of Health and Medicine. University of Tasmania, Sydney, NSW, Australia; Institute for Health Research. University of Notre Dame, Fremantle, Australia
| | - Yair Levy
- Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Medicine E, Meir Medical Center, Kfar Saba, Israel
| | - Miri Blank
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat- Gan, 52621, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Howard Amital
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat- Gan, 52621, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Medicine 'B' and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat- Gan, 52621, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shochet GE, Pomerantz A, Shitrit D, Bardenstein-Wald B, Ask K, Surber M, Rabinowicz N, Levy Y, Benchetrit S, Edelstein E, Zitman-Gal T. Galectin-3 levels are elevated following nintedanib treatment. Ther Adv Chronic Dis 2020; 11:2040622320968412. [PMID: 33708368 PMCID: PMC7907712 DOI: 10.1177/2040622320968412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022] Open
Abstract
Background and Aims: Idiopathic pulmonary fibrosis (IPF) is a common and severe form of pulmonary fibrosis. Nintedanib, a triple angiokinase inhibitor, is approved for treating IPF. Galectin 3 (Gal-3) activates a variety of profibrotic processes. Currently, the Gal-3 inhibitor TD139 is being tested in phase II clinical trials. Since this treatment is given ‘on top’ of nintedanib, it is important to estimate its effect on Gal-3 levels. Therefore, we evaluated the impact of nintedanib on Gal-3 expression using both in vitro and in vivo models, in addition to serum samples from patients with IPF. Methods: Gal-3 levels were evaluated in IPF and control tissue samples, primary human lung fibroblasts (HLFs) following nintedanib treatment (10–100 nM, quantitative polymerase chain reaction), and in a silica-induced fibrosis mouse model with/without nintedanib (0.021–0.21 mg/kg) by immunohistochemistry. In addition, Gal-3 levels were analyzed in serum samples from 41 patients with interstitial lung disease patients with/without nintedanib treatment by ELISA. Results: Nintedanib addition to HLFs resulted in significant elevations in Gal-3, phospho-signal transducer and activator of transcription 3 (pSTAT3), as well as IL-8 mRNA levels (p < 0.05). Gal-3 expression was higher in samples from IPF patients compared with non-IPF controls at the protein and mRNA levels (p < 0.05). In the in vivo mouse model, Gal-3 levels were increased following fibrosis induction and even further increased with the addition of nintedanib, mostly in macrophages (p < 0.05). Patients receiving nintedanib presented with higher Gal-3 serum levels compared with those who did not receive nintedanib (p < 0.05). Conclusion: Nintedanib elevates Gal-3 levels in both experimental models, along with patient samples. These findings highlight the possibility of using combined inhibition therapy for patients with IPF.
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Affiliation(s)
- Gali Epstein Shochet
- Pulmonary Department, Meir Medical Center, 59 Tchernichovsky Street, Kfar Saba 4428164, Israel
| | - Alon Pomerantz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Shitrit
- Pulmonary Department, Meir Medical Center, Kfar Saba, Israel
| | | | - Kjetil Ask
- McMaster University, Hamilton, ON, Canada
| | | | - Noa Rabinowicz
- Internal Medicine E Department, Meir Medical Center, Kfar Saba, Israel
| | - Yair Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Tali Zitman-Gal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Couffignal C, Kolta S, Flamant M, Cazanave C, Haymann JP, Mentré F, Duval X, Leport C, Raffi F, Chêne G, Salamon R, Moatti JP, Pierret J, Spire B, Brun-Vézinet F, Fleury H, Masquelier B, Peytavin G, Garraffo R, Costagliola D, Dellamonica P, Katlama C, Meyer L, Salmon D, Sobel A, Cuzin L, Dupon M, Le Moing V, Marchou B, May T, Morlat P, Rabaud C, Waldner-Combernoux A, Hardel L, Reboud P, Couffin-Cadiergues S, Marchand L, Assuied A, Carrieri P, Habak S, Couturier F, Jadand C, Perrier A, Préau M, Protopopescu C, Schmit J, Chennebault J, Faller J, Magy-Bertrand N, Chirouze C, Humbert P, Longy-Boursier, Neau D, Granier P, Ansart S, Verdon R, Merrien D, Chevojon P, Sobel A, Levy Y, Piroth L, Perronne C, Froguel E, Ceccaldi J, Chidiac C, Grégoire V, Reynes J, Fuzibet JG, Arsac P, Bouvet E, Bricaire F, Monsonego J, Girard P, Guillevin L, Herson S, Molina J, Pialoux G, Sain O, Sellier P, Roblot F, Bani-Sadr F, Michelet C, Lucht F, Debord C, Martin T, De Jaureguiberry J, Bernard L. Nevirapine Use Is Associated with Higher Bone Mineral Density in HIV-1 Positive Subjects on Long-Term Antiretroviral Therapy. AIDS Res Hum Retroviruses 2020; 36:399-405. [PMID: 31891665 DOI: 10.1089/aid.2019.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We assessed bone mineral density (BMD) in a cohort of human immunodeficiency virus (HIV)-positive patients after a median of 11 years of combination antiretroviral therapy (cART) and evaluated the respective role of HIV infection and antiretroviral drugs (ARVs). A cross-sectional study of 162 participants (131 male) from the ANRS-C08 cohort was performed with bone dual-energy X-ray absorptiometry (DXA) scans and renal assessment. The window of exposure to ARVs was defined as an exposure of more than six cumulative months during the last 3 years before the DXA evaluation to account for a cumulative exposure that could affect bone remodeling. The association with low BMD (Z-score < -2) was assessed by a multiple logistic regression model. The study population was 50 years (median), hepatitis C virus (HCV) (18%), and hepatitis B virus (HBV) (8%) coinfection with HIV-RNA <50 c/mL in 89%, median CD4 of 619/mm3. Prevalence of low BMD was 18% in males and 6% in females. The factors associated with a Z-score < -2 in males were uric acid renal loss [adjusted odds ratio (aOR): 6.1; 95% confidence interval (CI): 1.2-31.5; p = .03], HCV coinfection (aOR: 4.0; 95% CI: 1.3-12.2; p = .02), and less frequent window of exposure to nevirapine (NVP) (aOR: 0.1; 95% CI: 0.02-0.6; p = .01). For the full study sample, there was a strong positive association between duration of exposure to NVP and lumbar spine Z-score (p = .004). HIV-positive patients exposed to long-term cART have a high incidence of low BMD. Tenofovir disoproxil fumarate and ritonavir-boosted protease inhibitors did not seem to be associated with increased risk of low BMD, whereas NVP exposure appeared to have an independent positive association.
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Affiliation(s)
- Camille Couffignal
- Infection, Antimicrobials, Modeling, Evolution (IAME) UMR 1137, INSERM and Université of Paris, Paris, France
| | - Sami Kolta
- Department of Rheumatology, University Hospital Cochin, Assistance Publique–Hôpitaux de Paris, INSERM UMR-1153, Paris, France
| | - Martin Flamant
- Department of Physiology, University Hospital Bichat, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Charles Cazanave
- Infectious Diseases Department, University Hospital Bordeaux, Bordeaux, France
| | - Jean-Philippe Haymann
- Department of Physiology, University Hospital Tenon, and INSERM UMR_S1155, Paris, France
| | - France Mentré
- Infection, Antimicrobials, Modeling, Evolution (IAME) UMR 1137, INSERM and Université of Paris, Paris, France
| | - Xavier Duval
- Infection, Antimicrobials, Modeling, Evolution (IAME) UMR 1137, INSERM and Université of Paris, Paris, and INSERM CIC1425, Paris, France
| | - Catherine Leport
- Unité COREB (Coordination du Risque Epidémique et Biologique), Assistance Publique–Hôpitaux de Paris, Paris, France
| | - François Raffi
- Infectious Diseases Department, University Hospital Hotel-Dieu, and INSERM CIC 1413, University of Nantes, Nantes, France
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Erez D, Abarbuch E, Natour A, Meyer A, Natour A, Dovrish Z, Levy Y. Audiological disturbances in patients with primary antiphospholipid syndrome. Lupus 2020; 29:533-538. [DOI: 10.1177/0961203320904780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Antiphospholipid syndrome (APS) is an autoimmune disease of hypercoagulability state in the presence of antibodies against phospholipids. Many neurological deficits related to APS have been described. Sensory neural hearing loss has been described only anecdotally, mostly in case reports. This study investigated a possible association between hearing disorders and APS. Methods Seventeen patients (aged 20–80 years) diagnosed with primary APS were evaluated for evidence of hearing disorders. All had otoscopy, full audiometry test, brainstem evoked response audiometry and otoacoustic emissions testing, and completed a questionnaire. Hearing levels were compared to the standard hearing levels of the general population by age group. Results Of the 17 APS patients, 10 (age groups 20–29 and 50–59) had significantly reduced hearing levels in all or part of the tested frequencies compared to standard levels. Three patients (age group 60–69) had better hearing levels at low frequencies compared to standard hearing levels. Conclusion These findings support the existence of hearing disorders in primary APS.
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Affiliation(s)
- Daniel Erez
- Department of Medicine D, Meir Medical Centre, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Abarbuch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology Head and Neck Surgery, Meir Medical Centre, Kfar Saba, Israel
| | - Amed Natour
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology Head and Neck Surgery, Meir Medical Centre, Kfar Saba, Israel
| | - Avraham Meyer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine E, Meir Medical Centre, Kfar Saba, Israel
| | - Aiman Natour
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine E, Meir Medical Centre, Kfar Saba, Israel
| | - Zamir Dovrish
- Department of Medicine D, Meir Medical Centre, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Levy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine E, Meir Medical Centre, Kfar Saba, Israel
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Sirotkin T, Natour A, Wand O, Levy Y. Fatal consequences of therapeutic thoracentesis in patients with systemic sclerosis. Sarcoidosis Vasc Diffuse Lung Dis 2020; 37:e2020006. [PMID: 33264375 PMCID: PMC7690058 DOI: 10.36141/svdld.v37i3.9567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/09/2020] [Indexed: 11/23/2022]
Abstract
Systemic sclerosis (SSc) is a systemic autoimmune disease, characterized by systemic fibrosis and involvement of visceral organs. Pulmonary complications are common and a leading cause of death. Pleural effusions, however, are rare. Thoracentesis is a common procedure, performed to reveal the cause of pleural effusion or to drain it and relieve dyspnea. Although generally considered a low-risk intervention, complications of thoracentesis can lead to increased morbidity and mortality. We describe three patients with SSc and symptomatic pleural effusion who required thoracentesis. All patients deteriorated shortly after the procedure and died. We assume that patients with SSc are at high-risk to develop complications after thoracentesis, most likely due to the low compliant lungs and the low elastance of the pleura. In this population, thoracentesis should be done with high caution, while measuring the pleural pressure - invasively, or with noninvasive surrogates. Further studies are required to determine mechanisms of the complication. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (3): e2020006).
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Affiliation(s)
- Tsvi Sirotkin
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba, Israel
| | - Aiman Natour
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba, Israel
| | - Ori Wand
- Department of Pulmonology, Meir Medical Center, Kfar Saba, Israel; Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yair Levy
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba, Israel
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Meridor K, Levy Y. Systemic sclerosis induced by CNS stimulants for ADHD: A case series and review of the literature. Autoimmun Rev 2020; 19:102439. [DOI: 10.1016/j.autrev.2019.102439] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/12/2019] [Indexed: 11/26/2022]
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Orvain C, Lin YL, Jean-Louis F, Hocini H, Hersant B, Bennasser Y, Ortonne N, Hotz C, Wolkenstein P, Boniotto M, Tisserand P, Lefebvre C, Lelièvre JD, Benkirane M, Pasero P, Levy Y, Hüe S. Un stress réplicatif spontané des cellules souches du follicule pileux serait à l’origine de l’inflammation dans l’hidradénite suppurée. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.072] [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: 11/26/2022]
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ori wand, Natur A, Levy Y, Sirotkin T. FATAL CONSEQUENCES OF THERAPEUTIC THORACENTESIS IN PATIENTS WITH SYSTEMIC SCLEROSIS. Chest 2019. [DOI: 10.1016/j.chest.2019.08.287] [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: 11/30/2022] Open
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Hepner Y, Nacasch N, Natur A, Levy Y. [CRYOGLOBULINEMIA AND ENDOCARDITIS AS A PRESENTATION OF COXIELLA BURNETII (Q-FEVER) INFECTION]. Harefuah 2019; 158:579-582. [PMID: 31507108] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
An infection with Coxiella burnetii (Q FEVER) can be manifested as an autoimmune or rheumatologic disease as it was presented in our patient, showing cryoglobulinemia and massive destruction of the aortic valve. In the differential diagnosis we must consider an infection with Coxiella burnatii which may change the course of the disease and may cause life-threatening manifestations.
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Affiliation(s)
- Yael Hepner
- Internal Medicine Department H, Meir Medical Center, Kfar Saba affiliated to the Faculty of Medicine at Tel Aviv University
| | - Naomi Nacasch
- Nephrology Institute, Meir Medical Center, Kfar Saba affiliated to the Faculty of Medicine at Tel Aviv University
| | - Aiman Natur
- Internal Medicine Department H, Meir Medical Center, Kfar Saba affiliated to the Faculty of Medicine at Tel Aviv University
| | - Yair Levy
- Internal Medicine Department H, Meir Medical Center, Kfar Saba affiliated to the Faculty of Medicine at Tel Aviv University
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Amitai Komem D, Sukenik Halevy R, Griton Y, Shnaker A, Levy Y, Weissmann J, Fajer S. A Rare Case of 7 Simultaneous Arterial Dissections and Review of The Literature. Vasc Endovascular Surg 2019; 53:617-622. [DOI: 10.1177/1538574419864783] [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: 12/30/2022]
Abstract
Objective: Spontaneous multiple artery dissection is a relatively rare phenomenon. Early clinical signs are often nonspecific, making it difficult to diagnose. Case Report: This is a case of a 51-year-old female who presented with spontaneous dissection of 4 visceral arteries, both iliac arteries, and of the right internal carotid artery. The patient underwent urgent successful endovascular repair. Later complications included acute respiratory distress syndrome and pneumonia after massive blood transfusion. She recovered gradually and was discharged after 21 days. Due to this rare presentation, genetic investigation was performed in search of a connective tissue disorder. Results revealed a new COL3A1 subtype mutation. The pathogenicity of this variant remains unclear. Conclusion: We recommend a high index of suspicion for visceral artery dissection in the differential diagnosis for abdominal pain with concurrent uncontrolled hypertension. Early diagnosis and intervention are crucial to reducing the mortality rate.
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Affiliation(s)
- Daphna Amitai Komem
- Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rivka Sukenik Halevy
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Genetics Institute, Meir Medical Center, Kfar Saba, Israel
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | - Yigal Griton
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Unit of Interventional Radiology, Meir Medical Center, Kfar Saba, Israel
| | - Ali Shnaker
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Vascular Surgery Unit, Meir Medical Center, Kfar Saba, Israel
| | - Yair Levy
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine E, Meir Medical Center, Kfar Saba, Israel
| | - Jonathan Weissmann
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Vascular Surgery Unit, Meir Medical Center, Kfar Saba, Israel
| | - Simone Fajer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Vascular Surgery Unit, Meir Medical Center, Kfar Saba, Israel
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Affiliation(s)
- Yair Levy
- Philosophy, Tel Aviv University, Tel Aviv, Israel
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Lhomme E, Hejblum B, Lacabaratz C, Wiedemann A, Lelièvre J, Levy Y, Thiebaut R, Richert L. Évaluation de l’immunogénicité cellulaire dans les essais cliniques vaccinaux : un modèle bivarié pour mieux prendre en compte la réponse non spécifique. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.03.079] [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: 11/25/2022] Open
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40
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Alharthi S, Levy Y, Wang L, Hur I. Employees’ Mobile Cyberslacking and Their Commitment to the Organization. Journal of Computer Information Systems 2019. [DOI: 10.1080/08874417.2019.1571455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Yair Levy
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Ling Wang
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Inkyoung Hur
- Nova Southeastern University, Fort Lauderdale, FL, USA
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Blackwood-Brown C, Levy Y, D’Arcy J. Cybersecurity Awareness and Skills of Senior Citizens: A Motivation Perspective. Journal of Computer Information Systems 2019. [DOI: 10.1080/08874417.2019.1579076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Yair Levy
- Nova Southeastern University, Fort Lauderdale, FL, USA
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Abstract
PurposeUsers’ mistakes due to poor cybersecurity skills result in up to 95 per cent of cyber threats to organizations. Threats to organizational information systems continue to result in substantial financial and intellectual property losses. This paper aims to design, develop and empirically test a set of scenarios-based hands-on tasks to measure the cybersecurity skills of non-information technology (IT) professionals.Design/methodology/approachThis study was classified as developmental in nature and used a sequential qualitative and quantitative method to validate the reliability of the Cybersecurity Skills Index (CSI) as a prototype-benchmarking tool. Next, the prototype was used to empirically test the demonstrated observable hands-on skills level of 173 non-IT professionals.FindingsThe importance of skills and hands-on assessment appears applicable to cybersecurity skills of non-IT professionals. Therefore, by using an expert-validated set of cybersecurity skills and scenario-driven tasks, this study established and validated a set of hands-on tasks that measure observable cybersecurity skills of non-IT professionals without bias or the high-stakes risk to IT.Research limitations/implicationsData collection was limited to the southeastern USA and while the sample size of 173 non-IT professionals is valid, further studies are required to increase validation of the results and generalizability.Originality/valueThe validated and reliable CSI operationalized as a tool that measures the cybersecurity skills of non-IT professionals. This benchmarking tool could assist organizations with mitigating threats due to vulnerabilities and breaches caused by employees due to poor cybersecurity skills.
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Abstract
The treatment of systemic sclerosis (SSc) presents a clinical challenge because of the progressive nature of the disease, relatively poor prognosis, and lack of a proven treatment. In the last 10 years, several studies demonstrated the importance of interleukin 6 (IL6) as a pivotal cytokine in the development of fibrosis and angiopathy, especially in SSc. Tocilizumab, an IL6 receptor antibody, has shown promising results for patients with SSc. A total of 16 patients with SSc were treated with tocilizumab; 14 were female and 2 were male, with a median age of 45.5 years and median disease duration of 31.5 months. Ten patients had anti-SCl-70, none had anticentromere, and two had antipolymerase. Tocilizumab treatment was provided as long as the patient's condition improved. Total treatment duration was 30.33 patient-years. Median treatment duration was 18.5 months, and 3 patients were treated for a period of 4 years and longer. Ten patients were treated with tocilizumab to the date of data collection. All were feeling good and maintained the achieved improvement throughout the treatment period. Improvement was recorded in 12 patients (75%). Mean reduction in modified Rodnan skin score was 11 points (p < 0.001), musculoskeletal and joint involvement improved in 75% and 80% of patients, respectively, and improvement in lung function was recorded in 46%. Patients with early SSc responded better to tocilizumab (p = 0.01). This is the largest reported case series of tocilizumab treatment in patients with SSc. The treatment was without significant side-effects and was beneficial for most patients, especially in early disease. The present study reinforces previous findings regarding the efficacy of tocilizumab in treating SSc.
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Affiliation(s)
- Galia Zacay
- Department of Medicine E, Meir Hospital, Kfar Saba, Israel; Sackler School of Medicine, University of Tel Aviv, Israel
| | - Yair Levy
- Department of Medicine E, Meir Hospital, Kfar Saba, Israel; Sackler School of Medicine, University of Tel Aviv, Israel.
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Meridor K, Levy Y. Immunoglobulin G4-Related Disease Presenting with Clinical Similarity to Churg-Strauss Syndrome. Isr Med Assoc J 2019; 21:124-125. [PMID: 30772966] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Katya Meridor
- Department of Internal Medicine, Meir Medical Center, Kfar Saba, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Levy
- Department of Internal Medicine, Meir Medical Center, Kfar Saba, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abu-Shakra M, Zisman D, Balbir-Gurman A, Amital H, Levy Y, Langevitz P, Tishler M, Molad Y, Aamar S, Roser I, Avshovich N, Paran D, Reitblat T, Mader R, Savin H, Friedman J, Lieberman N, Ehrlich S. Effect of Tocilizumab on Fatigue and Bone Mineral Density in Patients with Rheumatoid Arthritis. Isr Med Assoc J 2018; 20:239-244. [PMID: 29629732] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Chronic fatigue is common among patients with rheumatoid arthritis (RA), affecting quality of life. Osteoporosis is a prevalent co-morbidity in RA patients. OBJECTIVES To assess the effect of long-term treatment with tocilizumab on fatigue and bone mineral density (BMD) in RA patients with inadequate response to synthetic or biologic disease-modifying anti-rheumatic drugs. METHODS In this multicenter, open-label, non-controlled, single-arm study, patients ≥ 18 years of age received intravenous tocilizumab 8 mg/kg every 4 weeks for 96 weeks. The primary outcome was the change in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue score from baseline to weeks 24, 48, 72, and 96. BMD was assessed before and 96 weeks after treatment. RESULTS The study comprised 145 patients (mean age 53.4 ± 13.4 years, 83.4% women). Of these, 88 (60.7%) completed the 2 year treatment period. The mean FACIT-Fatigue score improved consistently starting from week 4 and showed a statistically significant increase of 5.0 ± 9.7, 6.8 ± 10.5, 7.3 ± 10.9, and 7.3 ± 10.4 from baseline to weeks 24, 48, 72, and 96, respectively (P < 0.0001). Mean BMD of femoral neck and total spine remained stable. Disease activity, acute phase reactants, and composite efficacy measures decreased during the study, while hemoglobin levels increased. Adverse events and serious adverse events were as expected for the known and previously described data. CONCLUSIONS Tocilizumab therapy for 2 years significantly and clinically decreased fatigue. BMD remained stable and no new safety issue was reported.
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Affiliation(s)
- Mahmoud Abu-Shakra
- Rheumatic Diseases Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Devy Zisman
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Alexandra Balbir-Gurman
- Rheumatology Unit, Rambam Medical Center, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Howard Amital
- Department of Medicine 'B' and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Levy
- Department of Internal Medicine E, 6Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pnina Langevitz
- Department of Rheumatology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Tishler
- Department of Internal Medicine B; Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Molad
- Rheumatology Unit, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Suhail Aamar
- Rheumatology Service, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Itzhak Roser
- Rheumatology Unit, Bnai Zion Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nina Avshovich
- Department of Internal Medicine D, Hillel Yaffe Medical Center, Hadera, Israel
| | - Daphna Paran
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tatiana Reitblat
- Rheumatology Unit, Barzilai Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Reuven Mader
- Rheumatology Unit, Emek Medical Center, Afula, Israel Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hillel Savin
- Department of Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
| | | | | | - Sharon Ehrlich
- Roche Pharmaceuticals (Israel) Ltd, Hod Hasharon, Israel
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Curtis-Wetton E, Ross J, Levy Y, Vilchez J, Ochala J. What is wrong with nuclei in Transportin 3 (TPNO3)-related muscular dystrophy? Neuromuscul Disord 2018. [DOI: 10.1016/s0960-8966(18)30315-8] [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: 10/17/2022]
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Altaf S, Sakib S, Levy Y, Sadler M. Abstract No. 681 Predictability of D-dimer levels in detecting pulmonary embolism in the sickle cell population. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.726] [Citation(s) in RCA: 1] [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: 10/17/2022] Open
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Guillevin L, Leon A, Levy Y, Bletry O, Gayraud M, Andreu G, Godeau P. Treatment of Progressive Systemic Sclerosis with Plasma Exchange. Seven Cases. Int J Artif Organs 2018. [DOI: 10.1177/039139888300600608] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Seven patients, 4 women and 3 men afflicted with severe progressive systemic sclerosis (PSS) were treated with Plasma Exchange after failure of different other treatment. All patients presented Raynaud phenomenon and arthritis, 6 patients presented extensive skin lesions, 5 of them digestive manifestations, 3 pulmonary fibrosis. In one case PSS was associated with polymyositis, one patient presented bilateral recurrent cornea ulcerations, (Sjögren Syndrom) and one patient numerous skin ulcerations. In 5 patients adjuvant corticosteroid therapy was given during the course of PE. In 3 patients PE must be stopped after one or two sessions because of insufficient venous access. Among the 4 other patients 8 to 20 PE were performed: the patient with cornea ulcerations became blind during the treatment, skin ulcerations and severe Raynaud phenomenon did not improved in two other patients. Benefit of PE was noted in only one patient with regressive myositis, and improvement of articular and cutaneous symptoms. Therefore, PE are not useful in most patients afflicted with PSS, they are difficult to realize in numerous patients and did not improve clinical symptoms in most cases.
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Affiliation(s)
- L. Guillevin
- Hôpital Avicenne - Université Paris XIII Bobigny - France
| | - A. Leon
- Hôpital Avicenne - Université Paris XIII Bobigny - France
| | - Y. Levy
- Hôpital Avicenne - Université Paris XIII Bobigny - France
| | - O. Bletry
- Hôpital de la Pitie Salpetriere Paris, France
| | - M. Gayraud
- Hôpital Avicenne - Université Paris XIII Bobigny - France
| | - G. Andreu
- Hôpital Avicenne - Université Paris XIII Bobigny - France
| | - P. Godeau
- Hôpital de la Pitie Salpetriere Paris, France
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Abstract
Serological tests of 35 patients suffering from inflammatory bowel disease were compared to those of 35 healthy controls. The tests were performed using the indirect immunoperoxidase assay. Ninety-three per cent of 15 patients with Crohn's disease had IgG antibodies against Chlamydia, compared to 26% in the control group. In the 20 patients with ulcerative colitis, 45% had IgG antibodies against Chlamydia, compared to 10% in the control group. High serum titres of IgG antibodies were found in most of the patients with inflammatory bowel disease, mainly with Crohn's disease, while weak reactions appeared in most of the controls in which antibodies were detected. These results suggest a high incidence of Chlamydia infection in the studied patients with inflammatory bowel disease, especially in those with Crohn's disease. The possible association between Chlamydia trachomatis and inflammatory bowel disease is discussed.
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Affiliation(s)
- R Orda
- Department of Surgery A, Assaf Harofeh Medical Center, Zerifin, Israel
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