Early diagnosis of Alzheimer's disease using infrared spectroscopy of isolated blood samples followed by multivariate analyses.

Alzheimer's disease (AD) is the most common cause of dementia, particularly in the elderly. The disease is characterized by cognitive decline that typically starts with insidious memory loss and progresses relentlessly to produce global impairment of all higher cortical functions. Due to better living conditions and health facilities in developed countries, which result in higher overall life spans, these countries report upward trends of AD among their populations. There are, however, no specific diagnostic tests for AD and clinical diagnosis is especially difficult in the earliest stages of the disease. Early diagnosis of AD is frequently subjective and is determined by physicians (generally neurologists, geriatricians, and psychiatrists) depending on their experience. Diagnosing AD requires both medical history and mental status testing. Having trouble with memory does not mean you have AD. AD has no current cure, but treatments for symptoms are available and research continues. In this study, we investigated the potential of infrared microscopy to differentiate between AD patients and controls, using Fourier transform infrared (FTIR) spectroscopy of isolated blood components. FTIR is known as a quick, safe, and minimally invasive method to investigate biological samples. For this goal, we measured infrared spectra from white blood cells (WBCs) and plasma taken from AD patients and controls, with the consent of the patients or their guardians. Applying multivariate analysis, principal component analysis (PCA) followed by linear discriminant analysis (LDA), it was possible to differentiate among the different types of mild, moderate, and severe AD, and the controls, with 85% accuracy when using the WBC spectra and about 77% when using the plasma spectra. When only the moderate and severe stages were included, an 83% accuracy was obtained using the WBC spectra and about 89% when using the plasma spectra.

Vitamin D: an instrumental factor in the anti-phospholipid syndrome by inhibition of tissue factor expression.

BACKGROUND AND AIMS: Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterised by thrombosis, obstetric complications and the presence of anti-phospholipid antibodies such as anti-ß2GPI-Abs. These antibodies may set off the coagulation cascade via several mechanisms, including the induction of tissue factor (TF) expression. Vitamin D has recently emerged as an immunomodulator that might exert an anti-thrombotic effect. Therefore, we studied serum vitamin D levels in a cohort of APS patients, as well as the effect of vitamin D in an in vitro model of APS-mediated thrombosis. METHODS: Serum vitamin D levels were measured in 179 European APS patients and 141 healthy controls using the LIAISON chemiluminescent immunoassay, and the levels were evaluated in conjunction with a wide spectrum of clinical manifestations. In an vitro model, anti-ß2GPI antibodies were purified from four patients with APS to evaluate the expression of TF in activated starved human umbilical vein endothelial cells. The effect of vitamin D (1,25-dihydroxyvitamin D, 10 nm) on anti-ß2GPI-Abs mediated TF expression was analysed by immunoblot. RESULTS: Vitamin D deficiency (serum level ≤15 ng/ml) was documented in 49.5% of our APS patients versus 30% of controls (p<0.001) and was significantly correlated with thrombosis (58% vs 42%; p<0.05), neurological and ophthalmic manifestations, pulmonary hypertension, livedo reticularis and skin ulcerations. In vitro vitamin D inhibited the expression of TF induced by anti-ß2GPI-antibodies. CONCLUSIONS: Vitamin D deficiency is common among APS patients and is associated with clinically defined thrombotic events. Vitamin D inhibits anti-ß2GPI-mediated TF expression in vitro. Thus, vitamin D deficiency might be associated with decreased inhibition of TF expression and increased coagulation in APS. Evaluation of vitamin D status and vitamin D supplementation in APS patients should be considered.

Prolactin's role in the pathogenesis of the antiphospholipid syndrome.

Increased levels of serum prolactin have been reported in patients with various autoimmune diseases and have been associated with lupus disease activity. Currently, there is a lack of data regarding hyperprolactinaemia in patients with the antiphospholipid syndrome. Hence, this study was carried out in order to evaluate the prevalence and clinical significance of hyperprolactinaemia in antiphospholipid syndrome. A total of 172 European patients with antiphospholipid syndrome and 100 geographically and sex-matched healthy controls were included in the study; none had obvious causes of hyperprolactinaemia. All patients underwent clinical assessment for disease manifestations, in addition to laboratory assessment for serum prolactin, antiphospholipid antibodies and some other biomarkers of autoimmune diseases. The tests were performed utilizing the LIAISON® Analyzer (DiaSorin, Sallugia Italy). Hyperprolactinaemia was detected in 21/172 patients with antiphospholipid syndrome and 0/100 controls (p < 0.001). This significant difference was present in both genders and was obvious even after subgrouping the patients into primary and secondary antiphospholipid syndrome. When clinical features were compared, hyperprolactinaemia was associated with reproductive failure, including early and late pregnancy loss (p < 0.05), as well as intrauterine growth retardation (p < 0.05). Hyperprolactinaemia was negatively related to arthralgias, venous thrombosis, pulmonary microthrombosis, pulmonary hypertension in both primary antiphospholipid syndrome and antiphospholipid syndrome secondary to other diseases, and to neurological manifestations in primary antiphospholipid syndrome (p<0.05). The data indirectly imply that prolactin may play a role in the pathogenesis of antiphospholipid syndrome, especially antiphospholipid syndrome-related reproductive failure.

Medical cannabis: Another piece in the mosaic of autoimmunity?

Legalization of cannabis' medicinal use is rapidly increasing worldwide, raising the need to evaluate medical implications of cannabis. Currently, evidence supports cannabis and its active ingredients as immune-modulating agents, affecting T-cells, B-cells, monocytes, and microglia cells, causing an overall reduction in pro-inflammatory cytokine expression and an increase in anti-inflammatory cytokines. Due to the supporting evidence of cannabinoids as an immune-modulating agent, research focusing on cannabinoids and autoimmunity has emerged. Several clinical trials in multiple sclerosis, inflammatory bowel disease, and fibromyalgia suggest cannabis' effectiveness as an immune-modulator. However, contradicting results and lack of large-scale clinical trials obscure these results. Although lacking clinical research, in vitro and in vivo experiments in rheumatoid arthritis, diabetes type 1, and systemic sclerosis demonstrate a correlation between disease activity and cannabinoids.

Documentation of the dietetic care process: developing a sectoral, tailored system.

Use of electronic health records necessitates a systematic approach for documentation of the Dietetic Care Process (DCP). However, no standardized system exists in Israel. The authors propose a novel documentation system developed by an expert advisory committee and tailored to a specific patient population. In this pilot study, 12 experienced Israeli Registered Dietitians (RDs) (median years of practice=23.0; s.d.=8.8; practice in geriatric populations median=13.0; s.d.=8.5) were recruited to evaluate the new tool for DCP documentation. Participants completed an explanatory short course online and evaluated the utility of the tool. There was full agreement that the proposed tool is necessary and an effective method for documenting the DCP within geriatric populations in clinical practice. In conclusion, a novel, tailored and sectoral tool designed for standardized documentation of dietetic care was recommended for implementation by an experienced group of RDs with substantive clinical experience in geriatric populations.