Collagen-binding integrin alpha11beta1 contributes to joint destruction in arthritic hTNFtg mice

Background: In rheumatoid arthritis (RA), fibroblast-like synoviocytes (FLS) undergo a tumor-like transformation, wherein they develop an aggressive phenotype that is characterized by increased adhesion to components of cartilage extracellular matrix (ECM) and that contributes extensively to joint destruction. The collagen-binding integrin alpha11beta1 was previously shown to be involved in similar processes in cancer-associated fibroblasts mediating tumorigenicity and metastasis in certain tumors. Therefore, this study aimed to study the role of integrin alpha11beta1 in RA and to characterize the effects of alpha11beta1 deficiency on the disease course and severity in arthritic hTNFtg mice. Methods: The expression levels of integrin alpha11beta1 were analyzed by immunohistochemistry, immunofluorescence, and western blot analysis in synovial samples and FLS of patients with RA and osteoarthritis (OA) as well as in samples from wild type (wt) and arthritic hTNFtg mice. Furthermore, the subcellular expression of integrin alpha11beta1 was investigated in co-culture experiments with cartilage explants and analyzed by transmission electron microscopy. To investigate the effects of integrin alpha11beta1 deficiency, itga11-/- mice were interbred with hTNFtg mice and disease severity was assessed by clinical scoring of grip strength and paw swelling over the disease course. Hind paws of 12-weeks-old mice of all genotypes were analyzed by uCT imaging followed by stainings of paraffin-embedded tissue sections with Toluidine-blue and tartrate-resistant acid phosphatase (TRAP) to evaluate established parameters of joint destruction such as inflammation area, cartilage destaining, FLS attachment to the cartilage surface, and bone damage. Results: Expression levels of integrin alpha11beta1 were clearly elevated in synovial tissues and FLS from RA patients and hTNFtg mice, compared to the controls derived from OA patients and wt mice. Interestingly, this expression was shown to be particularly localized in focal adhesions of the FLS. As revealed by transmission electron microscopy, integrin alpha11beta1 expression was particularly evident in areas of direct cellular contact with the ECM of cartilage. Evaluations of clinical scorings and histomorphological analyses demonstrated that itga11-/-hTNFtg displayed alleviated clinical symptoms, higher bone volume, less cartilage destruction, and reduced FLS attachment to the cartilage in comparison to hTNFtg mice. Conclusions: The collagen-binding integrin alpha11beta1 is upregulated in the context of RA and its deficiency in mice with an inflammatory hTNFtg background leads to a significant reduction in the arthritic phenotype which makes integrin alpha11beta1 an interesting target for therapeutical intervention.

Pain in Multiple Sclerosis: Understanding Pathophysiology, Diagnosis, and Management Through Clinical Vignettes

Neuropathic pain and other pain syndromes occur in the vast majority of patients with multiple sclerosis at some time during their disease course. Pain can become chronic and paroxysmal. In this review, we will utilize clinical vignettes to describe various pain syndromes associated with multiple sclerosis and their pathophysiology. These syndromes vary from central neuropathic pain or Lhermitte's phenomenon associated with central nervous system lesions to trigeminal neuralgia and optic neuritis pain associated with nerve lesions. Muscular pain can also arise due to spasticity. In addition, we will discuss strategies utilized to help patients manage these symptoms.

Case Report: Variety of Target Antigens During 1 Year Follow-Up of a Patient Initially Diagnosed With Bullous Pemphigoid

Autoimmune bullous diseases (AIBDs), presenting cutaneous and/or mucosal bullous lesions, are classified into pemphigus and pemphigoid diseases. A longtime observation for complicated AIBD cases is rarely reported. In this study, serum samples of one AIBD patient were collected at seven different time points during the disease course including a relapse, which were examined by our conventional and newly developed methods for the detection of autoantibodies. Interestingly, we found changes of both the presence and the titers of various autoantibodies in accordance with the changes of clinical features during the whole disease course, which indicated that the patient started as bullous pemphigoid and relapsed as concurrence of bullous pemphigoid and mucosal-dominant-type pemphigus vulgaris.

The dark and light sides of extra-tumor environment

The paradox in the pathobiological processes driving the incidence and progression across carcinomas unveil new opportunities for effective cancer treatment. The scattered evidence across the literature indicates that the insufficiencies/alterations in mesothelial cell migration, development, or function dramatically change the clinical disease course. We succinctly report in-general phenomena extensible across carcinomas predisposing to desmoplasia/reactive stroma, with due understanding of the limitations associated with such broader extrapolation. We further highlight the need for a comprehensive understanding of these purported pathways with an emphasis towards determining the tradeoffs between the risks associated with cancer susceptibility and disease progression.

Nanotechnology in Drug Delivery for Liver Fibrosis

Liver fibrosis is a reversible disease course caused by various liver injury etiologies, and it can lead to severe complications, such as liver cirrhosis, liver failure, and even liver cancer. Traditional pharmacotherapy has several limitations, such as inadequate therapeutic effect and side effects. Nanotechnology in drug delivery for liver fibrosis has exhibited great potential. Nanomedicine improves the internalization and penetration, which facilitates targeted drug delivery, combination therapy, and theranostics. Here, we focus on new targets and new mechanisms in liver fibrosis, as well as recent designs and development work of nanotechnology in delivery systems for liver fibrosis treatment.

Anti-NMDAr Encephalitis and COVID-19 in a Patient With Systemic pANCA-Vasculitis and Recurrent Varicella Zoster Infection

Introduction There is a complex interplay between systemic autoimmunity, immunosuppression, and infections. Any or all of these can result in neurologic manifestations, requiring diligence on the part of neurologists. Case report We herein report a case of a patient on immunosuppressive treatment for a vasculitis that resulted in zoster meningoencephalitis. This was further complicated by the development of anti-NMDAr encephalitis, the etiology of which is undetermined and further discussed in this paper. The patient eventually developed COVID-19 during hospitalization, succumbing to the respiratory infection. Conclusion This case emphasizes that post-infectious autoimmune disorders are becoming increasingly recognized and that they should still be considered in patients who are on immunosuppression. Practitioners should be aware of the complex relationship between autoimmunity and immunosuppression and consider both throughout the disease course.

LESSONS AND NEW PERSPECTIVES: IS CONVALESCENT PLASMA THERAPY EFFECTIVE ON COVID-19 PATIENTS?

Objective: Recently, convalescent plasma (CP) therapy has shown promising evidence in the treatment of several serious contagious diseases, including SARS-CoV, Influenza and Ebola. We conducted a systematic review to extract data about using CP treatment for COVID-19 patients and it’s effectively. Methods: The retrieval of studies was conducted according to Cochrane Collaboration and from electronic databases including PubMed, Medline, and others (medRxiv and BioRxiv). Searching of the available evidence concerning CP treatment of COVID-19 patients was conducted in journal articles published between December 2019 and October 2020. The articles were further screened based on inclusion and exclusion criteria to identify the high-quality studies for analysis. Results: A total of 18 CP studies were included in this review. We found variance regarding the effectiveness of CP in the reduction of mortality rate, length of stay, and increased discharging rate. Several findings show CP therapy is effective in increasing viral negativity, neutralizing antibodies to recipients, does not cause harmful adverse reactions and in some cases can improve clinical symptoms. This therapy is presently considered effective for generating good clinical outcomes when given early in the course of the disease. Conclusion: The effectiveness of CP in terms of mortality, length of stay, and increased discharging patients is still debatable. However, CP therapy is effective in increasing the negativity of SARS-CoV-2 test, neutralizing antibody titer and is safe so it can be considered for COVID-19 patients. CP should not be given in the initial disease course but is recommended for the early disease course.