Activation of cytokines corroborate with development of inflammation and autoimmunity in thromboangiitis obliterans patients.

Thromboangiitis obliterans (TAO) is a segmental inflammatory occlusive disorder that affects the arm and leg arteries of young smokers. The immune system seems to play a critical role in the aetiology of TAO; however, knowledge of the aspects involved in the progression of vascular tissue inflammation and, consequently, the evolution of this disease is still limited. This study was carried out to investigate the cytokine levels of tumour necrosis factor (TNF)-α, interleukin (IL)-1ß, IL-4, IL-17 and IL-23 in the plasma of TAO patients presenting with acute clinical manifestations. The study included 20 TAO patients (n = 10 women; n = 10 men) aged 38-59 years under clinical follow-up, classified into two groups: (i) TAO former smokers (n = 11) and (ii) TAO active smokers (n = 9); the control groups included normal volunteer non-smokers (n = 10, active smokers (n = 10) and former smokers (n = 10). Patients' plasma samples were measured using the sandwich enzyme-linked immunosorbent assay. Statistical analyses were performed using the non-parametric Mann-Whitney U-test, with parameters significant at P < 0·05. The activities of all cytokines were different in groups of TAO patients when compared with normal controls, and decreased for control smokers. Increased levels of TNF-α, IL-1ß, IL-4, IL-17 and IL-23 were significant in patients with TAO when compared to the controls (P < 0·005, all parameters). The results presented here indicate an increased production of cytokines in TAO, possibly contributing to the inflammatory response observed in the patients' vascular levels. In addition, the increased levels of IL-17 and IL-23 suggest that the disturbance of TAO is involved with mechanisms of autoimmunity. Thus, the discovery of IL-17 and its association with inflammation and autoimmune pathology has reshaped our viewpoint regarding the pathogenesis of TAO, which was based previously on the T helper type 1 (Th1)-Th2 paradigm.

Determination of kininogens levels and kallikrein/kininase II activities in patients with thromboangiitis obliterans.

Some components of the kinin system such as plasma kallikrein levels, the activities of tissue kallikrein (including saliva) and kininase II and the concentrations of kininogen fractions (low-molecular weight/LKg and high-molecular weight/HKg) were evaluated in the plasma of patients with thromboangiitis obliterans (TAO) presenting clinical symptoms of the condition. Twenty TAO were diagnosed by means of the traditional Shionoya and Olin criteria and later classified into non-smokers (n = 11) and active smokers (n = 9). Fifty-three normal, non-smoking/smoking individuals (control) were also studied. Kininogen levels were determined by ELISA; the activities of kallikreins and kininase II were determined using selective substrates. The levels of enzymes (kallikreins and kininase II) and protein (kininogens) were significantly higher in patients with TAO who were active smokers compared to the control groups (no matter whether control individuals were active smokers or non-smokers, P < 0.001 for all comparisons). Interestingly, regardless of the time of disease onset, a significant increase in the levels of these components of the kinin system was also observed in patients when TAO active smokers were compared with TAO ex-smokers (P < 0.01 for all analysed parameters). Activation of the kinin system in patients with TAO may indicate the involvement of vasodilatation in an attempt to control vascular changes, thereby favouring the deposition of immune complexes at the vascular level because of nicotine stimulation. Moreover, our results corroborate the idea that TAO can be an autoimmune disorder with specific mechanisms.

Buerger's disease and anticardiolipin antibodies.

Thromboangiitis obliterans or Buerger's disease is an occlusive, inflammatory, nonatherosclerotic vascular disease of unknown etiology, which affects mainly the small and medium arteries, veins and nerves. Anticardiolipin antibodies are associated with arterial and venous thrombosis, repetitive miscarriages and thrombocytopenia. The aim of this study is to bring to attention the diagnosis of Buerger's disease when found in conjunction with anticardiolipin antibodies. Three clinical cases that satisfy Shionoya's criteria for Buerger's disease (except the lack of smoking in one of the cases) are documented in this work. The following examinations were performed: hemogram, creatinine, glycemia, cholesterol, anticardiolipin antibodies, echocardiogram and angiogram. Shionoya's criteria for Buerger's disease were compatible with the two diseases: anticardiolipin antibody syndrome and Buerger's disease, both of which can occur in isolation or associated, thereby complicating the diagnosis. It is concluded that anticardiolipin can be associated with Buerger's disease and may worsen the thrombotic event of the disease but the two entities are separate. The diagnosis is not complicated.

Alteraciones de la ultraestructura del músculo esquelético en la enfermedad de Buerger: reporte de un caso / Ultrastructure alterations of skeletal muscle in Buerger's disease

La tromboangeitis obliterante (TAO) o enfermedad de Buerger ha sido considerada una forma de vasculitis relacionada etiológicamente con el hábito tabáquico. De acuerdo a la revisión de la literatura, no existen estudios previos acerca del compromiso muscular en esta enfermedad, esto nos estimuló a reportar el caso de un paciente afectado de la mencionada patología y con signos clínicos evidentes de alteración muscular. Por ese motivo, se realizó biopsia muscular por punción percutánea, con aguja tipo Bergstrom, del músculo cuadriceps femoris. Se procesaron las muestras por métodos convencionales para microscopía electrónica de transmisión. De acuerdo a los resultados ultraestructurales, las alteraciones que se producen en los capilares intramusculares son de tipo isquémico. Igualmente, la presencia de atrofia nos señala un posible daño neural en esta enfermedad. Algunas de las alteraciones observadas en los capilares y en relación con el infiltrado presente podrían sugerir un componente autoinmune en la etiología de la enfermedad