Repeat treatment of acute hereditary angioedema attacks with open-label icatibant in the FAST-1 trial.

Hereditary angioedema (HAE) is characterized by potentially life-threatening recurrent episodes of oedema. The open-label extension (OLE) phase of the For Angioedema Subcutaneous Treatment (FAST)-1 trial (NCT00097695) evaluated the efficacy and safety of repeated icatibant exposure in adults with multiple HAE attacks. Following completion of the randomized, controlled phase, patients could receive open-label icatibant (30 mg subcutaneously) for subsequent attacks. The primary end-point was time to onset of primary symptom relief, as assessed by visual analogue scale (VAS). Descriptive statistics were reported for cutaneous/abdominal attacks 1-10 treated in the OLE phase and individual laryngeal attacks. Post-hoc analyses were conducted in patients with ≥ 5 attacks across the controlled and OLE phases. Safety was evaluated throughout. During the OLE phase, 72 patients received icatibant for 340 attacks. For cutaneous/abdominal attacks 1-10, the median time to onset of primary symptom relief was 1·0-2·0 h. For laryngeal attacks 1-12, patient-assessed median time to initial symptom improvement was 0·3-1·2 h. Post-hoc analyses showed the time to onset of symptom relief based on composite VAS was consistent across repeated treatments with icatibant. One injection of icatibant was sufficient to treat 88·2% of attacks; rescue medication was required in 5·3% of attacks. No icatibant-related serious adverse events were reported. Icatibant provided consistent efficacy and was well tolerated for repeated treatment of HAE attacks.

Acute edema blisters in a hereditary angioedema cutaneous attack.

Hereditary angioedema is a rare autosomal dominant disease characterized by recurrent episodes of acute edema affecting the skin and the respiratory and digestive tracts. Acute edema blisters or hydro-static bullae develop after rapid accumulation of interstitial fluid usually associated to cardiac insufficiency. Lesions contain sterile fluid and break up easily resolving without scars. Blisters disappear when fluid accumulation resolves. We describe a patient developing recurrent acute edema blisters as a consequence of cutaneous hereditary angioedema attacks.

Factors involved in the generation of memory CD8+ T cells in patients with X-linked lymphoproliferative disease (XLP).

UNLABELLED: We have analysed the phenotype of T lymphocytes in two X-linked lymphoproliferative disease (XLP) patients with the same SH2D1A mutation differing in initial exposure to Epstein-Barr virus (EBV) and treatment. While memory T lymphocytes (with low CCR7 and CD62L expression) prevailed in both XLP patients, in patient 9, who developed acute infectious mononucleosis (AIM) and received B cell ablative treatment, the predominant phenotype was that of late effector CD8 T cells (CD27-, CD28-, CCR7-, CD62L-, CD45 RA+, perforin+), while in patient 4 (who did not suffer AIM) the prevalent phenotype of CD8 T lymphocytes was similar to that of normal controls (N) or to that of adult individuals who recovered from AIM: CD27+ , CD28+, CCR7-, CD62L-, CD45 RO+ and perforin-. CD57 expression (related to senescence) was also higher in CD8 T cells from patient 9 than in patient 4, AIM or N. Persistently high EBV viral load was observed in patient 9. The results obtained from this limited number of XLP patients suggest that events related to the initial EBV encounter (antigen load, treatment, cytokine environment) may have more weight than lack of SH2D1A in determining the long-term differentiation pattern of CD8 memory T cells.

Urticaria cronica con alteraciones de la funcion tiroidea y anticuerpos antiperoxidasa tiroidea / Chronic urticaria with alterations of the thyroid function and thyroid peroxidase antibodies

La urticaria crónica es una enfermedad frecuente, caracterizada por la presencia de ronchas y/o angioedema con una duración superior a las 6 semanas. En un número importante de pacientes se comporta como una enfermedad autoinmune asociada frecuentemente con alteraciones en la función tiroidea y com la presencia de anticuerpos antitiroideos. Presentamos una serie de 70 pacientes consecutivos con diagnóstico de urticaria crónica a los cuales les investigamos la función tiroidea y la presencia de anticuerpos antiperoxidasa tiroidea. Siete (10%) tenían diagnóstico de enfermedad tiroidea previa al momento de la consulta. A los 63 pacientes restantes se les estudió los niveles de tirotrofina sérica, 11 de los cuales (17%) presentaron valores anormales, que sumados a los 7 con enfermedad previa llegan a 18 (26%) con función tiroidea alterada. A 61 pacientes se les investigo anticuerpos antiperoxidasa tiroidea, 22 (36%) fueron positivos. De 57 pacientes sin diagnóstico de patología tiroidea previa al momento de la consulta por urticaria, a los que se les estudió tanto los niveles de tirotrofina sérica como la presencia de anticuerpos antiperoxidasa tiroidea, 24 (42%) presentaron alguno de los estudios alterados. El alto porcentaje de alteraciones tiroideas en nuestra serie de pacientes resalta la necesidad de estudiar la función tiroidea y la presencia de anticuerpos antiperoxidasa tiroidea en pacientes con urticaria crónica.

Urticaria cronica con alteraciones de la funcion tiroidea y anticuerpos antiperoxidasa tiroidea / Chronic urticaria with alterations of the thyroid function and thyroid peroxidase antibodies

La urticaria crónica es una enfermedad frecuente, caracterizada por la presencia de ronchas y/o angioedema con una duración superior a las 6 semanas. En un número importante de pacientes se comporta como una enfermedad autoinmune asociada frecuentemente con alteraciones en la función tiroidea y com la presencia de anticuerpos antitiroideos. Presentamos una serie de 70 pacientes consecutivos con diagnóstico de urticaria crónica a los cuales les investigamos la función tiroidea y la presencia de anticuerpos antiperoxidasa tiroidea. Siete (10%) tenían diagnóstico de enfermedad tiroidea previa al momento de la consulta. A los 63 pacientes restantes se les estudió los niveles de tirotrofina sérica, 11 de los cuales (17%) presentaron valores anormales, que sumados a los 7 con enfermedad previa llegan a 18 (26%) con función tiroidea alterada. A 61 pacientes se les investigo anticuerpos antiperoxidasa tiroidea, 22 (36%) fueron positivos. De 57 pacientes sin diagnóstico de patología tiroidea previa al momento de la consulta por urticaria, a los que se les estudió tanto los niveles de tirotrofina sérica como la presencia de anticuerpos antiperoxidasa tiroidea, 24 (42%) presentaron alguno de los estudios alterados. El alto porcentaje de alteraciones tiroideas en nuestra serie de pacientes resalta la necesidad de estudiar la función tiroidea y la presencia de anticuerpos antiperoxidasa tiroidea en pacientes con urticaria crónica. (AU)

[Kikuchi-Fujimoto necrotizing lymphadenitis. Report of 2 cases]. / Linfadenitis necrotizante de Kikuchi-Fujimoto. Presentación de dos casos.

Kikuchi-Fujimoto disease (KFD) is a form of necrotizing lymphadenitis. The disease is a usually benign, self limited cause of lymph node enlargement affecting predominantly young women. Several other clinical manifestations have been described, though the only consistent findings are a macular eruption and a fever. Occasionally, the disease has presented as a fever of unknown origin. Lymph node specimens show areas of necrosis without neutrophilic infiltration. Lymphocyte mediated apoptotic mechanisms are responsible for the necrosis observed. Clinically, it should be differentiated from many different conditions, including infections such as cat scratch disease and rheumatological diseases like Still's disease and Systemic Lupus Erythematosus. Pathologically, it should be differentiated from lymphomas. KFD is widely known in the Far East, but very rare in Latin America. As a matter of fact, we have only detected four reported cases from Argentina, Brazil and Chile. We here describe two additional cases from Argentina. Both occurred in young women. One had a mediastinal compromise and a recurrent course, only observed in 4% of cases. The second one had a classical cervical presentation. The diagnosis in both was made by lymph node biopsy, although, in areas of great prevalence, an aspiration may be sufficient to establish the disease. We anticipate that the real prevalence of this unusual disease is highly underrepresented.

Linfadenitis necrotizante de Kikuchi-Fujimoto. Presentación de dos casos. / [Kikuchi-Fujimoto necrotizing lymphadenitis. Report of 2 cases]

Kikuchi-Fujimoto disease (KFD) is a form of necrotizing lymphadenitis. The disease is a usually benign, self limited cause of lymph node enlargement affecting predominantly young women. Several other clinical manifestations have been described, though the only consistent findings are a macular eruption and a fever. Occasionally, the disease has presented as a fever of unknown origin. Lymph node specimens show areas of necrosis without neutrophilic infiltration. Lymphocyte mediated apoptotic mechanisms are responsible for the necrosis observed. Clinically, it should be differentiated from many different conditions, including infections such as cat scratch disease and rheumatological diseases like Stills disease and Systemic Lupus Erythematosus. Pathologically, it should be differentiated from lymphomas. KFD is widely known in the Far East, but very rare in Latin America. As a matter of fact, we have only detected four reported cases from Argentina, Brazil and Chile. We here describe two additional cases from Argentina. Both occurred in young women. One had a mediastinal compromise and a recurrent course, only observed in 4

of cases. The second one had a classical cervical presentation. The diagnosis in both was made by lymph node biopsy, although, in areas of great prevalence, an aspiration may be sufficient to establish the disease. We anticipate that the real prevalence of this unusual disease is highly underrepresented.

[Effect of complement type 1 receptor pre-binding on the phagocytosis mediated by Fc receptor]. / Efecto del pre-ligamiento del receptor de complemento tipo I en la fagocitosis mediada por el receptor para Fc.

As a result of IgG-Fc interaction, sheep erythrocytes sensitized with IgG (E-IgG) are constitutively phagocytosed by resting PMN, although in low numbers. The low efficiency of the system can be improved by opsonization with C3b, since the combination of C3b and IgG makes a powerful opsonic signal. It is accepted that the mechanism of C3b enhancement of IgG mediated phagocytosis is achieved by increasing the adherence of the targets to the phagocyte. Recently, a non-opsonic role for C3b enhancement of IgG mediated phagocytosis has been proposed, in cultured human monocytes. These cells, when adhered on glass surfaces precoated with C3b, showed a marked increase in E-IgG internalization. The effect was dose dependent and it was reproduced utilizing a monoclonal antibody against CR1 (C3b receptor). In the present work we studied the existence of this phenomenon in resting neutrophils and in neutrophils stimulated with two kinds of agents: a phorbol ester (PDBu), which activates the CR1 and fMLP, which increases the expression of this receptor. In previous experiments we determined that the adherence of resting neutrophils on different concentrations of iC3 (which binds CR1 and exerts the same effect that C3b), did not increase the phagocytosis of the E-IgG, using as a control neutrophils adhered on the same concentrations of human serum albumin (HSA) (data not shown).(ABSTRACT TRUNCATED AT 250 WORDS)

Efecto del pre-ligamiento del receptor de complemento tipo I en la fagocitosis mediada por el receptor para Fc / Effect of complement type I receptor pre-ligament in the phagocytosis mediated by Fc receptor

El preligamiento del receptor de C3b (CR1) con su ligando potencia la fagocitosis mediada por el receptor para Fc (FcR) en monocitos cultivados, pero no en monocitos frescos. Nuestros estudios se dirigieron a establecer si la cooperación CR1-FcR ocurre en neutrófilos en reposo o activados. Activando neutrófilos con dosis de 1 a 5 ng/ml de PDBu observamos estimulación de la fagocitosis via Fc, mientras que a concentraciones mayores hubo una inhibición de la misma. La adherencia de las células sobre C3 inactivado (iC3) en forma simultánea al tratamiento con dosis estimulatorias o subinhibitorias de PDBu no incrementó la ingestión de eritrocitos de carnero sensibilizados con IgG (E-IgG); aun variando la cantidad de anticuerpo sensibilizante o estimulando a las células con PDBu durante distintos tiempos. La estimulación de los neutrófilos con diferentes concentraciones de fMLP en forma simultánea a la adherencia sobre iC3 tampoco incrementó la fagocitosis de los blancos mediada por el FcR. La comunicación entre el CR1 y el FcR difere en neutrófilos y monocitos, hecho que podría relacionarse con el mecanismo de activación del CR1 y la clase de FcR encontrado en cada tipo de celular

Efecto del pre-ligamiento del receptor de complemento tipo I en la fagocitosis mediada por el receptor para Fc. / [Effect of complement type 1 receptor pre-binding on the phagocytosis mediated by Fc receptor]

As a result of IgG-Fc interaction, sheep erythrocytes sensitized with IgG (E-IgG) are constitutively phagocytosed by resting PMN, although in low numbers. The low efficiency of the system can be improved by opsonization with C3b, since the combination of C3b and IgG makes a powerful opsonic signal. It is accepted that the mechanism of C3b enhancement of IgG mediated phagocytosis is achieved by increasing the adherence of the targets to the phagocyte. Recently, a non-opsonic role for C3b enhancement of IgG mediated phagocytosis has been proposed, in cultured human monocytes. These cells, when adhered on glass surfaces precoated with C3b, showed a marked increase in E-IgG internalization. The effect was dose dependent and it was reproduced utilizing a monoclonal antibody against CR1 (C3b receptor). In the present work we studied the existence of this phenomenon in resting neutrophils and in neutrophils stimulated with two kinds of agents: a phorbol ester (PDBu), which activates the CR1 and fMLP, which increases the expression of this receptor. In previous experiments we determined that the adherence of resting neutrophils on different concentrations of iC3 (which binds CR1 and exerts the same effect that C3b), did not increase the phagocytosis of the E-IgG, using as a control neutrophils adhered on the same concentrations of human serum albumin (HSA) (data not shown).(ABSTRACT TRUNCATED AT 250 WORDS)

Efecto del pre-ligamiento del receptor de complemento tipo I en la fagocitosis mediada por el receptor para Fc / Effect of complement type I receptor pre-ligament in the phagocytosis mediated by Fc receptor

El preligamiento del receptor de C3b (CR1) con su ligando potencia la fagocitosis mediada por el receptor para Fc (FcR) en monocitos cultivados, pero no en monocitos frescos. Nuestros estudios se dirigieron a establecer si la cooperación CR1-FcR ocurre en neutrófilos en reposo o activados. Activando neutrófilos con dosis de 1 a 5 ng/ml de PDBu observamos estimulación de la fagocitosis via Fc, mientras que a concentraciones mayores hubo una inhibición de la misma. La adherencia de las células sobre C3 inactivado (iC3) en forma simultánea al tratamiento con dosis estimulatorias o subinhibitorias de PDBu no incrementó la ingestión de eritrocitos de carnero sensibilizados con IgG (E-IgG); aun variando la cantidad de anticuerpo sensibilizante o estimulando a las células con PDBu durante distintos tiempos. La estimulación de los neutrófilos con diferentes concentraciones de fMLP en forma simultánea a la adherencia sobre iC3 tampoco incrementó la fagocitosis de los blancos mediada por el FcR. La comunicación entre el CR1 y el FcR difere en neutrófilos y monocitos, hecho que podría relacionarse con el mecanismo de activación del CR1 y la clase de FcR encontrado en cada tipo de celular (AU)

Partial neutralization of a lupus anticoagulant by human immunoglobulin.

In a patient with a Lupus Anticoagulant (LA) and recurrent fetal loss, we observed a significant shortening of the APTT after high-dose intravenous immunoglobulin infusion (IVIg). The LA activity present in patient's serum and purified IgG was partially neutralized by IVIg in a dose-dependent way. In addition, IgG purified from IVIg and its F(ab')2 fragment neutralized LA activity of the patient's IgG. In both cases, the neutralization was dose-dependent and it was obtained with similar molar ratios. The "in vitro" neutralization of LA activity and the immediate shortening of the APTT after IVIg infusion, might be mediated through idiotype/antiidiotype interactions. On the other hand, the long-lasting effect of IVIg in this patient indicates that it may induce specific inhibition of autoantibody synthesis. We believe that IVIg should be considered as a therapeutic alternative for LA-related clinical disorders.

Piomiositis tropical: tres casos en un área templada en pacientes inmunosuprimidos / Tropical pyomyositis: 3 cases in immunosuppressed patients living in a moderate climate zone

Se presentan tres pacientes atendidos en un hospital general de la ciudad de Mar del Plata, que padecieron piomiositis "tropical". El cuadro clínico, germen causal, antecedentes de trauma y resultados de la tomografía computada guardaban similitud con los casos estudiados en áreas tropicales. A diferencia de éstos, no se observó eosinofilia en ningún caso y los tres pacientes padecían enfermedades o habían recibido drogas capaces de inducir inmunosupresión. Esto podría alertar a la posibilidad que estados de inmunosupresión sean un factor más de riesgo (junto con trauma e infección) para adquirir esta enfermedad en áreas no tropicales

Piomiositis tropical: tres casos en un área templada en pacientes inmunosuprimidos / Tropical pyomyositis: 3 cases in immunosuppressed patients living in a moderate climate zone

Se presentan tres pacientes atendidos en un hospital general de la ciudad de Mar del Plata, que padecieron piomiositis "tropical". El cuadro clínico, germen causal, antecedentes de trauma y resultados de la tomografía computada guardaban similitud con los casos estudiados en áreas tropicales. A diferencia de éstos, no se observó eosinofilia en ningún caso y los tres pacientes padecían enfermedades o habían recibido drogas capaces de inducir inmunosupresión. Esto podría alertar a la posibilidad que estados de inmunosupresión sean un factor más de riesgo (junto con trauma e infección) para adquirir esta enfermedad en áreas no tropicales (AU)