Molecular signatures of atherosclerotic plaques: An up-dated panel of protein related markers.

Atherosclerosis remains the leading cause of ischemic syndromes such as myocardial infarction or brain stroke, mainly promoted by plaque rupture and subsequent arterial blockade. Identification of vulnerable or high-risk plaques constitutes a major challenge, being necessary to identify patients at risk of occlusive events in order to provide them with appropriate therapies. Clinical imaging tools have allowed the identification of certain structural indicators of prone-rupture plaques, including a necrotic lipidic core, intimal and adventitial inflammation, extracellular matrix dysregulation, and smooth muscle cell depletion and micro-calcification. Additionally, alternative approaches focused on identifying molecular biomarkers of atherosclerosis have also been applied. Among them, proteomics has provided numerous protein markers currently investigated in clinical practice. In this regard, it is quite uncertain that a single molecule can describe plaque rupture, due to the complexity of the process itself. Therefore, it should be more accurate to consider a set of markers to define plaques at risk. Herein, we propose a selection of 76 proteins, from classical inflammatory to recently related markers, all of them identified in at least two proteomic studies analyzing unstable atherosclerotic plaques. Such panel could be used as a prognostic signature of plaque instability.

A protocol for induction of tolerance to apomorphine in patients with parkinson disease and hypersensitivity to apomorphine

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Monoclonal antibody desensitization in a patient with a generalized urticarial reaction following denosumab administration.

Denosumab is a human monoclonal antibody indicated for the treatment of osteoporosis in postmenopausal women with a high risk of fractures. To our knowledge, no cases of desensitization to this drug have been described in the literature. We report the first case of generalized urticarial reaction and facial angioedema after therapy with denosumab. A subcutaneous desensitization protocol was successfully completed in this patient. Rapid desensitization is a promising method for the delivery of denosumab after a hypersensitivity reaction, and should be considered in osteoporosis treatment when no acceptable therapeutic alternatives are available.

Immediate hypersensitivity and delayed hypersensitivity to clopidogrel.

Clopidogrel is a new antiplatelet prescribed for the secondary prevention of atherosclerotic events. The literature shows that the clinical manifestations of clopidogrel hypersensitivity include urticaria1, skin rash2-4, and angioedema5. The precise immunological mechanism underlying clopidogrel hypersensitivity has not been established. We describe two cases of hypersensitivity reaction due to clopidogrel. The first constituted an immediate reaction after clopidogrel intake. In this case we demonstrated type 1 hypersensitivity using cutaneous tests. The second case represented a delayed hypersensitivity reaction confirmed by oral challenge testing, in which good tolerance to other antiplatelet drugs such as ticlopidine was demonstrated.

Immediate hypersensitivity and delayed hypersensitivity to Clopidogrel / Hipersensibilidad inmediata e hipersensibilidad retardada al clopidogrel

Clopidogrel is a new antiplatelet prescribed for the secondary prevention of atherosclerotic events. The literature shows that the clinical manifestations of clopidogrel hypersensitivity include urticaria1, skin rash2-4, and angioedema5. The precise immunological mechanism underlying clopidogrel hypersensitivity has not been established. We describe two cases of hypersensitivity reaction due to clopidogrel. The first constituted an immediate reaction after clopidogrel intake. In this case we demonstrated type 1 hypersensitivity using cutaneous tests. The second case represented a delayed hypersensitivity reaction confirmed by oral challenge testing, in which good tolerance to other antiplatelet drugs such as ticlopidine was demonstrated

El Clopidogrel (Plavit), es un nuevo antiagregante plaquetario, indicado en la prevención secundaria de eventos ateroescleróticos. En la bibliografía, las manifestaciones clínicas descritas por hipersensibilidad al clopidogrel incluyen urticaria, rash cutáneo y angioedema. El mecanismo inmunológico preciso de la hipersensibilidad al Clopidogrel no ha sido elucidado. Describimos dos casos de reacciones de hipersensibilidad por Clopidogrel. El primer caso se trata de una reacción inmediata tras la administración de Clopidogrel, en él demostramos hipersensibilidad de tipo I mediante pruebas cutáneas. El segundo caso se trata de una reacción tardía por sensibilización tipo IV al Clopidogrel, confirmada con prueba de provocación oral en el cual además demostramos buena tolerancia a otros antiagregantes plaquetarios como la Ticlopidina