[ANCA-associated vasculitides at Mexico City's metropolitan Eastern area]. / Vasculitis asociadas a ANCA en la zona metropolitana oriente de la Ciudad de México.

BACKGROUND: The anti-neutrophil cytoplasmic antibody-associated (ANCA) vasculitides includes granulomatosis with polyangiitis (Wegener's) (GPW), Chrug-Strauss syndrome (CSS) and microscopic polyangiitis (MPA). Since it has low incidence in our field, there are a few published papers. The aim of this study was to report the clinical characteristics, activity and damage of these vasculitides in Mexico City's metropolitan eastern area. METHODS: We studied 28 cases with ANCA-associated vasculitis in the aforementioned area. The classification was made according to the ACR 1990 criteria, the Chapel Hill 2012 consensus, and the EULAR 2007 recommendations. We collected demographic data, as well as data of clinical manifestations, laboratory, management and outcomes. The activity was established using the Birmingham Vasculitis Activity Score (BVAS) and the damage using the Vasculitis Damage Index (VDI). We used paired t test and 95% confidence intervals (95% CI). RESULTS: 15 females and 13 males were included, 20 with GPW and 8 with CCS. The mean age was 50.1 ± 12.7 years, and the evolution time was 69 ± 49.6 months. We didn't find cases of MAP. 23 patients (82.1%) had general symptoms. The initial and final BVAS means were 10.5 and 1.5 (p < 0.001) and the global VDI was 2.4. CONCLUSIONS: The presence of ANCA-associated vasculitides is rare in the eastern Metropolitan area of Mexico City. GPW was predominant over CCS, and MPA was absent. They are multi-system vasculitides with high scores of initial activity and moderate damage.

Introducción: las vasculitis asociadas a anticuerpos anticitoplasma de neutrófilo (ANCA) incluyen la granulomatosis con poliangeítis (GPW), el síndrome de Churg-Strauss (SChS) y la poliangeítis microscópica (PAM). Como son de baja incidencia, los informes son escasos. El objetivo fue reportar las características clínicas, la actividad y el daño de casos con estas vasculitis en la zona oriente de la Ciudad de México. Métodos: Se incluyeron 28 casos. La clasificación de las vasculitis se hizo según los criterios ACR 1990, Chapel Hill 2012 y EULAR 2007. Se recabaron datos demográficos, manifestaciones clínicas, de laboratorio, tratamientos y evolución clínica. Se determinó el puntaje de actividad de Birmingham (BVAS) y el daño de la vasculitis (VDI). Se utilizó la prueba t pareada e intervalos de confianza al 95% (IC 95%). Resultados: 15 mujeres y 13 hombres fueron incluidos, 20 con GPW y 8 con SChS, con edad de 50.1 ± 12.7 años y evolución de 69 ± 49.6 meses. No hubo casos con PAM. Presentaron ataque al estado general 23 (82.1%). Los promedios BVAS inicial y final fueron: 10.5 y 1.5 (p < 0.001) y el VDI global fue de 2.4. Conclusiones: las vasculitis asociadas a ANCA son raras en esta zona de la Ciudad de México. Predominaron los casos de GPW sobre SChS y fueron nulos para PAM. Tienen presentación multisistémica, altos puntajes de actividad inicial y daño moderado.

Function of Treg Cells Decreased in Patients With Systemic Lupus Erythematosus Due To the Effect of Prolactin.

Prolactin has different functions, including cytokine secretion and inhibition of the suppressor effect of regulatory T (Treg) cells in healthy individuals. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by defects in the functions of B, T, and Treg cells. Prolactin plays an important role in the physiopathology of SLE. Our objective was to establish the participation of prolactin in the regulation of the immune response mediated by Treg cells from patients with SLE. CD4CD25CD127 cells were purified using magnetic beads and the relative expression of prolactin receptor was measured. The functional activity was evaluated by proliferation assay and cytokine secretion in activated cells, in the presence and absence of prolactin. We found that both percentage and function of Treg cells decrease in SLE patients compared to healthy individuals with statistical significance. The prolactin receptor is constitutively expressed on Treg and effector T (Teff) cells in SLE patients, and this expression is higher than in healthy individuals. The expression of this receptor differs in inactive and active patients: in the former, the expression is higher in Treg cells than in Teff cells, similar to healthy individuals, whereas there is no difference in the expression between Treg and Teff cells from active patients. In Treg:Teff cell cocultures, addition of prolactin decreases the suppressor effect exerted by Treg cells and increases IFNγ secretion. Our results suggest that prolactin plays an important role in the activation of the disease in inactive patients by decreasing the suppressor function exerted by Treg cells over Teff cells, thereby favoring an inflammatory microenvironment.

[Relapsing polychondritis: clinical and therapeutic analysis of 15 Mexican cases]. / Policondritis recidivante: análisis de 15 casos.

BACKGROUND: relapsing polychondritis (RP) is a rare multisystem disease of unknown etiology, characterized by recurrent episodes of inflammation and cartilage destruction. The aim was to present fifteen cases, analyzed in a clinical and therapeutic perspective. METHODS: fifteen cases from three different cities of Mexico, diagnosed with Damiani criteria, were included. Clinical features, treatment given and outcome were recorded. RESULTS: nine men and six women with mean age of 52.4 years met the criteria for RP; the average change was 86.7 months. The dominant clinical manifestations were: 83 % auricular chondritis, 66 % dysphonia, 60 % arthritis and 53 % with eye involvement. Treatment included: 93 % received corticosteroids, 60 % received methotrexate, 46 % received no steroidal anti-inflammatory treatment, 46 % received immunosuppressant therapy, and two cases received biologic therapy. The clinical course showed 34 relapses in 12 cases. Complications included hoarseness in seven cases, tracheal stenosis in six case, and hearing loss in three cases. There were five deaths, three from respiratory complications, one from renal failure and another from a cerebral vascular event. CONCLUSIONS: the fifteen cases with RP presented were characterized by multisystem clinical courses and serious respiratory complications. The diagnostic and therapeutic situations merited highly medical specialized approaches.

Prolactin promoter polymorphism (-1149 G/T) is associated with anti-DNA antibodies in Mexican patients with systemic lupus erythematosus.

Prolactin (PRL) is a 23-kDa protein hormone that is synthesized mainly by the anterior pituitary gland. However, PRL can also be synthesized and secreted by extrapituitary tissues, particularly immune cells. A biallelic polymorphism (-1149 G/T) in the prolactin promoter has been shown to be functionally important, as modulation of prolactin expression has been associated with SLE in some populations. We have performed an association study using Mexican patients with SLE. We used qPCR to determine the SNP allele and genotype frequencies. We did not find statistically significant differences in allele and genotype frequencies between patients and healthy controls. However, we found a statistically significant association between the G allele and the presence of anti-dsDNA antibodies in serum (Allele frequency (G): P = 0.005; Genotyping frequency (GG): P = 0.001, OR = 7.8, 95% CI 3.59-27.1). Our data demonstrate that the prolactin promoter polymorphism -1149 G/T does not significantly contribute to SLE disease susceptibility but does predispose carriers to other immunological changes.

[Human trichinosis. A case simulating polymyositis]. / Triquinosis humana. Un caso que simula polimiositis.

The human trichinosis is a cosmopolitan rare zoonosis in Mexico. It presents clinically, with an infectious toxic pattern. Typical symptomatology includes: fever, diarrhea, facial edema and myalgias, which can resemble other illnesses like typhoid fever, angioneurotic edema, septicemia, rheumatic disease-like vasculitis and dermato-polymyositis. The treatment is based on the use of antiparasites. In this paper a trichinosis case is described in a woman, 29 years old who lives in the metropolitan area, with a clinical pattern that suggest polymyositis. The diagnosis was confirmed through a muscle biopsy. The treatment was albendazole and prednisone with successful results.

Effect of prolactin on lymphocyte activation from systemic lupus erythematosus patients.

The aim was to explore the role of prolactin (PRL) in the lymphocyte activation process in systemic lupus erythematosus (SLE) patients in an in vitro model. Peripheral blood mononuclear cells (PBMCs) were isolated from SLE patients and healthy individuals. The mRNA for PRL and its receptor obtained by standard techniques, with an appropriate primer, were subjected to polymerase chain reaction (PCR) and visualized. The PBMCs were cultured with (a) medium alone as a negative control, (b) unspecific mitogen as a positive control, (c) PRL alone, (d) mitogen plus PRL, (e) mitogen plus antibody anti-PRL, and (f) mitogen plus a nonrelated antibody. Then CD69 and CD154 were determined by flow cytometry analysis. Twelve inactive and 15 active SLE patients were studied. Twenty-five percent of the active patients displayed hyperprolactinemia. Under basal conditions CD69 expression was associated with disease activity. The PBMCs activated in vitro were capable of producing and secreting PRL, measured by mRNA and Nb2 assay. In a similar way, the mRNA for the PRL receptor was visualized. Cells from SLE patients cultivated with PRL alone did not display increased CD69 and CD154 expression. The addition of PRL to the unspecific stimulated culture does not have an additive effect. In contrast, the addition of antibodies against PRL in order to block the autocrine PRL resulted in a striking reduction of CD69 and CD154 expression.

[Wegener's granulomatosis: state of carrier of Staphylococcus aureus and combined therapy]. / Granulomatosis de Wegener estado de portador de Staphylococcus aureus y terapéutica combinada.

A series of five cases with Wegener's granulomatosis (WG) is presented: two women and three men with an average age of 37 years old, with an average time of evolution of the disease of 5 years and systemic clinical presentation (respiratory, renal and ocular affection); the ANCA were positive; three of them were carriers of Staphylococcus aureus. All the patients received combined therapy composed by trimethoprim-sulfamethoxazole-cyclophosphamide (TMS-CFM) during approximately 29 months of follow- up, except for a pregnant patient. The patients showed a satisfactory clinical evolution with improvement of the manifestations of the disease. We suggest that, due to its benefits, the combination of TMS-CFM can be useful as a therapeutic alternative in WG.

[Relapsing polychondritis. A case report of a patient treated with methotrexate and celecoxib]. / Policondritis recidivante tratada con metotrexate y celecoxib. Reporte de un caso.

Relapsing polychondritis is a rare illness in which the cartilaginous tissues such as auricles, nose, laryngotracheal structures, joints and others, are affected. Customary treatment is based on corticosteroids and traditional antiinflammatory agents including aspirin and indomethacin. We describe a case of relapsing polychondritis in an 82-year-old man with associated diabetes mellitus and special features treated successfully with alternative therapy based on methotrexate and celecoxib.

Prolactina como inmunomodulador / Prolactin how immunomodulator

El propósito de la presente revisión es explorar el papel de la prolactina como inmunomodulador en la respuesta inmune. La prolactina tiene función trófica en la proliferación de los linfocitos. Las células del sistema inmunitario tienen receptores en su superficie para la prolactina, más aún, los linfocitos son capaces de sintetizar y secretar prolactina. Diferentes estados en el nivel de prolactina ejercen una respuesta diferente en el sistema inmunitario, la disminución en la prolactina provoca un deterioro en la respuesta inmunitaria, mientras que el aumento de la prolactina ejerce un incremento de la respuesta inmunitaria. Las alteraciones en la prolactina se han descrito en muchas enfermedades con fondo inmunológico, como el lupus eritematoso sistémico, el síndrome de Reiter, artritis por adyuvantes, uveítis, transplante de órganos. La acumulación de pruebas al momento actual del papel que juega la prolactina como inmunomodulador puede tener un profundo impacto clínico en las enfermedades autoinmunitarias pero aún están en camino de determinarse