ABSTRACT
Analysis of gut barrier status, monocyte and lymphocyte activation and T regulatory (Treg) cells at diagnosis before and after therapy, in patients with multiple sclerosis (MS). Analysis of differential effects of interferon beta (IFN-ß), glatiramer acetate (GA) and natalizumab. Thirty-five patients with untreated MS were included. Gut barrier status (serum concentrations of intestinal fatty acid binding protein), monocyte (serum levels of soluble CD14, soluble CD163 and interleukin 6) and T lymphocyte activation (CD4 + DR+ and CD8 + DR+) and Treg (CD4 + CD25highFoxP3+) cells were analyzed. Patients with clinical isolated syndrome and relapsing-remitting forms were treated with IFN-ß or GA, and immune characteristics were reevaluated following up after 6 months. A sample of 56 stable RR MS patients, in treatment with IFN-ß, GA or natalizumab, and 50 healthy individuals were included as controls. Gut barrier status was similar in MS patients and healthy controls. Untreated patients with relapsing-remitting and primary progressive patterns of MS showed increased serum levels of soluble CD14. At baseline, significant increases in activated T lymphocytes and Treg were detected in patients. A significant decrease of CD4 + DR+, CD8 + DR+, and Treg percentages after 6 months of therapy was observed. In previously treated patients, IFN-ß, GA, or natalizumab therapies were associated with a comparable cell proportion of activated lymphocytes and Treg. MS patients have a baseline state characterized by monocyte and lymphocyte activation, not related with gut barrier lesion. An increase in Treg number, correlated with activated T CD8+ lymphocytes, was detected. Treatment with IFN-ß, GA or natalizumab was associated with a comparable decrease in activated lymphocytes and Treg. Graphical Abstract á .
Subject(s)
Glatiramer Acetate/pharmacology , Interferon-beta/pharmacology , Lymphocyte Activation/drug effects , Monocytes/drug effects , Multiple Sclerosis, Chronic Progressive/drug therapy , Multiple Sclerosis, Relapsing-Remitting/drug therapy , Natalizumab/pharmacology , T-Lymphocyte Subsets/drug effects , Adult , Case-Control Studies , Fatty Acid-Binding Proteins/blood , Female , Gene Expression Regulation/drug effects , Glatiramer Acetate/therapeutic use , Humans , Interferon-beta/therapeutic use , Male , Middle Aged , Monocytes/immunology , Monocytes/metabolism , Multiple Sclerosis/drug therapy , Multiple Sclerosis, Chronic Progressive/immunology , Multiple Sclerosis, Relapsing-Remitting/immunology , NF-kappa B/metabolism , Natalizumab/therapeutic use , Nerve Tissue Proteins/biosynthesis , Nerve Tissue Proteins/genetics , Prospective Studies , Signal Transduction/drug effects , T-Lymphocyte Subsets/immunology , T-Lymphocyte Subsets/metabolismABSTRACT
In the elderly, pneumonia often has a less florid clinical presentation and is frequently complicated by decompensation of concomitant diseases. Elderly patients have special characteristics in terms of the pathogens involved in pneumonia; they are at greater risk of multiresistant bacterial infections because of their frequent contact with the health services. Lung infections in immunosuppressed individuals have different causes depending on the immune deficiency in question. Admission to hospital or ambulatory treatment will be decided after stratifying the risk; this treatment will be determined by the characteristics at the time of onset of the pneumonia, the local epidemiological situation in terms of the percentage of antibiotic resistance in the area, and the clinical particularities.