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Optic Neuropathies Associated with Systemic Disorders And Radiation-Induced Optic Neuropathy
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
In cases of proven, presumed or suspected sarcoidosis presenting with optic nerve involvement, it is recommended that patients receive high-dose corticosteroids, with a slow taper (2). Relapses should be managed with the addition of an immunosuppressive agent. Patients who experience an inflammatory version of sarcoid optic neuropathy often respond to treatment, whereas those with infiltrative or progressive optic nerve involvement may recover less robustly (2). Methotrexate, azathioprine, hydroxychloroquine, mycophenolate mofetil and cyclosporine A represent second-line therapy considerations (4, 6). Third-line therapies include cyclophosphamide and tumor necrosis factor (TNF)-alpha antagonists (4, 6). Treatment responses include total remission (27%), incomplete remission (32%), stable disease (24%) and deterioration (6%) (4).
Immunoregulatory Factors Secreted by Human or Murine Placenta or Gestational Tumors
Published in Gérard Chaouat, The Immunology of the Fetus, 2020
The first obvious immunosuppressive agent that has to be considered is HCG. It has two dissimilar subunits, alpha and beta, and is glycosylated (with abnormally high mannose intermediate products in the JAR and BeWo choriocarcinoma cell lines). After trimming, the fully glycosylated units are assembled via a disulfide bridge (alpha is 22,000 Da on SDS PAGE; beta, 34,000 Da). The final apparent mol wt is 45,000. It has been reported to be immunosuppressive in vitro in a variety of tests, including PHA, PWM, ConA, MLR, PPD, LPS, and dextran sulfate.6 It was later shown by Stimson that the immunosuppressive factor was not HCG, but a contaminant exhibiting a 24,000 and 49,000 mol wt on SDS PAGE gels.6In vivo, however, a convincing report by Bartocci et al. described suppression by highly purified HCG of delayed type hypersensitivity in the mouse.
Pharmacological considerations for lymphatic malformation management
Published in Byung-Boong Lee, Peter Gloviczki, Francine Blei, Jovan N. Markovic, Vascular Malformations, 2019
One hypothetical consideration in the context of the therapeutic use of sirolimus, a potent immunosuppressive agent, is the risk of new neoplastic events. Overgrowth syndromes are known, in general, to predispose to embryonal cancers and therefore merit surveillance.16 However, based on a recent evaluation of self-reports from affected families, along with review of the extant literature, the risk of embryonal cancer, other than Wilms tumor, in children with KTS does not appear to be higher than in the general population.17
Effect of Anti-TNF Treatment on Mooren’s Ulcer: A Case Series and Review of the Literature
Published in Ocular Immunology and Inflammation, 2023
Annie Xia, Tina Dietrich-Ntoukas, Uwe Pleyer
Based on the positive experience with different bDMARDs, we were interested to summarize the current literature on this rare disorder. Since the pathogenesis of Mooren’s ulcer is complex involving multiple immune cells and a cascade of different cytokines, several potential candidates can be considered for targeted treatment. These can be directed, e.g., against CD20, CD52 or interleukin-6 receptor as summarized in Table 3. One case series described an effective treatment with rituximab, a chimeric humanized monoclonal antibody against CD20, in severe and refractory Mooren’s ulcers.30 Rituximab was also successful in peripheral ulcerative keratitis associated with granulomatosis with polyangiitis, formerly called M. Wegener.40 However, careful use of this immunosuppressive agent is indicated due to its long-term depletion of B-cells. This has been a limitation in our case series because it hindered vaccination during the ongoing SARS-CoV-2 pandemic. Van der Hoeck et al. considered Campath-1 H as another therapeutic option in a refractory case of Mooren’s ulcer.39 Campath-1 H is a humanized monoclonal antibody against CD52 on T-cells administered intravenously but shows side effects including transient anaemia, reduction in T- and B-cells and possible early development of cataract. Table 3 provides an overview of the literature on different bDMARDs as treatment options for Mooren’s ulceration.
Evaluation of maternal serum progesterone-induced blocking factor levels in pregnancies complicated with early- and late-onset preeclampsia
Published in Journal of Obstetrics and Gynaecology, 2022
Erdem Sahin, Yusuf Madendag, Mefkure Eraslan Sahin, Ilknur Col Madendag, Mehmet Mete Kirlangic, Sabahattin Muhtaroglu
Pregnancy triggers an immunological response that maintains chemicals that enable the maternal immunity to carry her semi-allogeneic foetus. Until the 1990s, it was not known how the maternal immune system did not reject her semi-allogeneic baby; however, studies have shown that progesterone could act as a ‘natural’ immunosuppressive agent. It has been suggested that this hormone is critical for regulating the immune system to carry a foetus in the womb (Szekeres-Bartho and Schindler 2019). Maternal lymphocytes secrete a protein called progesterone-induced blocking factor (PIBF) that provides the immunological effects of progesterone during pregnancy by activating T-helper type 2 (Th2) cells and inhibiting any activated uterine natural killer (uNK) cells (Szekeres-Bartho et al. 1985). Further studies showed that this process is initiated after PIBF induces the generation of interleukin (IL)-10, IL-4 and IL-3 and suppresses interferon-γ cytokines and IL-12 (Szekeres-Bartho et al. 1996). These immunologic effects allow the pregnant woman’s immune system to carry her semi-allogeneic foetus.
The emerging role of mycophenolate mofetil in interstitial lung diseases
Published in Expert Review of Respiratory Medicine, 2021
Kevin K Brown, Sujeet K Rajan, Padmanabha Shenoy, Monali Mehta, Meena Lopez, Rashmi S Hegde, Jaideep Gogtay
ILDs are often complex with more than 200 entities that often present with similar symptoms clinically but have different disease courses and prognosis. However, decades of research have been marked by changes in the understanding of ILDs to a large extent. The approvals of pirfenidone and nintedanib changed the paradigm of IPF treatment. Nonetheless, many challenges and unmet needs remain in the management of other progressive ILDs. A range of immunosuppressants are available for the treatment of ILDs, including cyclosporine, tacrolimus and cyclophosphamide. These drugs are reported to be associated with a variety of serious side effects that often limit and reduce tolerability. Therefore, there is a clear need for a therapy that is well tolerated and with fewer side effects. MMF, which is primarily used to suppress acute and chronic allograft rejection in post-transplant patients, has emerged as a wise choice of ILD therapy. It is an anti-proliferative, immunosuppressive agent with a relatively favorable safety profile. Observational data and clinical experience support the use of MMF in non-IPF ILDs, especially cHP and CTD-ILD. Leucopaenia, bone marrow suppression and gastrointestinal symptoms (such as nausea, diarrhea and abdominal cramping) are frequent and mild to moderate in severity, but may improve with divided dosing (e.g. three to four times a day) or a decrease in the total daily dose.