Clinical and Immunological Factors Associated with Recommended Trough Levels of Adalimumab and Infliximab in Patients with Crohn’s Disease

Introduction: Up to 40% of patients with Crohn’s disease do not respond to treatment with anti-TNF or lose response after the initial benefit. Low drug concentrations have been proposed as the main predictor of treatment failure. Our aim was to study the immunological profile and clinical evolution of patients with Crohn’s disease according to the anti-TNF dose and serum trough levels.Methods: Crohn’s disease patients in remission treated with infliximab or adalimumab at stable doses for at least for 3 months were included. Serum levels of anti-TNF, TNF-α, interferon-γ, and interleukin IL-12, IL-10, and IL-26 were determined in blood samples taken just before drug administration. Patients were classified according to anti-TNF levels below, within, or above the target level range and the use of intensified doses. Clinical evolution at 6 months was analyzed.Results: A total of 62 patients treated with infliximab (8 on intensified schedule) and 49 treated with adalimumab (7 on intensified schedule) were included. All infliximab-treated patients showed levels within the recommended range, but half of adalimumab-treated patients were below the recommended range. A significant negative relationship between body weight and adalimumab levels was observed, especially in patients treated with intensified doses. Patients with infliximab levels over 8 µg/ml presented higher median IL-10 than patients with in-range levels (84.0 pg/ml, interquartile range [IQR] 77.0–84.8 vs. 26.2 pg/mL, IQR 22.6–38.0; p < 0.001), along with lower values of interferon-γ (312.9 pg/ml, IQR 282.7–350.4 vs. 405.6 pg/ml, IQR 352.2–526.6; p = 0.005). Patients receiving intensified versus non-intensified doses of infliximab showed significantly higher IL-26 levels (91.8 pg/ml, IQR 75.6–109.5 vs. 20.5 pg/ml, IQR 16.2–32.2; p = 0.012), irrespective of serum drug levels. Patients with in-range levels of adalimumab showed higher values of IL-10 than patients with below-range levels (43.3 pg/ml, IQR 35.3–54.0 vs. 26.3 pg/ml, IQR 21.6–33.2; p = 0.001). Patients treated with intensified vs regular doses of adalimumab had increased levels of IL-12 (612.3 pg/ml, IQR 570.2–1353.7 vs. 516.4 pg/mL, IQR 474.5–591.2; p = 0.023). Four patients with low adalimumab levels (19%) and four treated with intensified doses were admitted to a hospital during a follow-up compared to none of the patients with levels within the range.Conclusion: Patients with Crohn’s disease treated with infliximab and adalimumab exhibit differences in serum levels of cytokines depending on the drug, dose intensification, and steady state trough serum levels.

Clinical aspects, food management, and clinical evolution of a cat with hypertrophic muscular dystrophy

ABSTRACT: Hypertrophic feline muscular dystrophy (HFMD), rarely reported in the literature, is a disease caused by a hereditary recessive dystrophin deficiency linked to the X chromosome, mainly affecting young male cats. Here, we presented the clinical aspects, food management, and clinical evolution of a seven-year-old mixed-breed cat diagnosed with HFMD, having a primary history of progressive tongue protrusion.

Flu pandemics: homeopathic prophylaxis and definition of the epidemic genius

Recent studies on viral genetics establish swine-H1N1 – responsible for the ongoing pandemics – as a remainder or continuation of the agent causing the flu epidemics of 1918. This study aimed at analyzing whether this common etiology also result in significant correlations of clinical manifestations. To do so, data were collected to compare the clinical evolution of cases in the 1918 and 2009 epidemics. This historical revision was the ground for evaluating the response to treatment including homeopathy in the former epidemics. It is discussed the convenience of including homeopathic prophylaxis grounded on the diagnosis of the epidemic genius among public health actions.

Biotherapic T. cruzi 17DH when continuously used clinically improves mice infected with T. cruzi.

Introduction: In Trypanosoma cruzi infection, the pathogenesis is the result of a rupture in the host - parasite relationship [1]. This rupture is related to the imbalance of the vital force of the host, expressed through signs and symptoms, defined by Hahnemann (1995)[2] as being the source of the disease. There is no research in the literature about the clinical evolution of mice experimentally infected with T. cruzi and treated in different ways using biotherapic. Therefore, this is an area to be studied in the future. Aim: To evaluate the effect of different ways of treatment using biotherapic T. cruzi 17 DH on clinical evolution of mice experimentally infected with T. cruzi. Materials and methods: A blind randomized controlled trial was performed, using 30 swiss male mice, aged 28 days, divided into groups according to the treatment: CONTROL - animals treated with 7% water-alcohol solution diluted in water given ad libitum in an amber bottle; GAVAGE – animals treated with medication highly diluted T. cruzi 17 DH from 4th to 9th day of infection by gavage; WATER -animals treated with highly diluted T. cruzi 17 DH in water ad libitum offered in an amber bottle until the end of the study period. The groups were infected with the Y strain of T. cruzi, intraperitoneal, 1400 blood trypomastigotes. The medicine was handled according to the Brazilian Homeopathic Pharmacopoeia [3] with microbiological test according to RDC n° 67 and in vivo biological risk. Parasitemic curve was determined by daily counting of the parasites [4]. Were measured temperature, weight, intake of water and feed, the ruffle fur and survival of mice. Statistical analysis was performed using the tests Fisher Exact and Log-Rank, with a significance of 5%. The experiment was approved under the protocol n° 030/2008 - Ethics in Animal Experimentation of the Universidade Estadual de Maringá. Results: The mice under different treatment ways using biotherapic T. cruzi 17DH showed differences in the clinical evolution. The treatment using biotherapic diluted in water initially shows hypothermia, with subsequent recovery of normal temperature (p=0.05) (Fig1). The weight curve shows a better evolution in mice treated with water compared to control groups (p=0.055) and the groups treated by gavage (p=0.0064). Feed and water intake did not differ among the groups. While the mice that were treated with biotherapic diluted in water showed a slight level of ruffled fur, the mice in control groups and the ones treated by gavage showed a more intense level of ruffled fur (p=0.00001). The difference in the evolution of mortality among the groups was significant (p=0.034), while in the group treated with biotherapic diluted with water, the mortality rate started later, reaching the maximum of 90%. This group showed a better clinical result, expressed by the smaller extent of ruffled fur, a better evolution of the temperature curve and higher gain of weight. This is an important result because the Y strain of T. cruzi has a mortality rate of 100% in mice, showing once again the good performance of biotherapic in this model of infection. Conclusion: The use of biotherapic T. cruzi 17DH for a long period causes clinical improvement of the infected mice with Trypanosoma cruzi. The clinical use of these results in human beings should consider the allometric medicine dosage which takes into account the metabolic rate of each organism.

Comprehensive Analysis of the Effects of Genetic Ancestry and Genetic Characteristics on the Clinical Evolution of Oral Squamous Cell Carcinoma

Oral squamous cell carcinoma (OSCC), a kind of malignant cancer, is associated with increasing morbidity and mortality. Patients with different genetic ancestries may respond differently to clinical treatment. The limited understanding of the influence of genetic ancestry and genetic characteristics on OSCC impedes the development of precision medicine. To provide a reference for clinical treatment, this study comprehensively analyzed multigenomic differences in OSCC patients with different genetic ancestries and their impact on prognosis. An analysis of data from OSCC patients with different genetic ancestries in The Cancer Genome Atlas (TCGA) showed that the overall survival (OS) of African (AFR) patients was lower than that of primarily European (EUR) patients, and differences were also observed in the tumor–stroma ratio (TSR) and tumor-infiltrating lymphocytes (TILs), which are associated with prognosis. FAT1 is a key mutant gene in OSCC, and it has inconsistent effects on clinical evolution for patients with diverse genetic characteristics. PIKfyve and CAPN9 showed a significant difference in mutation frequency between EUR and AFR; PIKfyve was related to Ki-67 expression, suggesting that it could promote tumor proliferation, and CAPN9 was related to the expression of Bcl-2, promoting tumor cell apoptosis. A variant methylation locus, cg20469139, was correlated with the levels of PD-L1 and Caspase-7 and modulated tumor cell apoptosis. A novel ceRNA model was constructed based on genetic ancestries, and it could accurately evaluate patient prognosis. More importantly, although T cell dysfunction scores could determine the potential of tumor immune escape, the efficacy was obviously affected by patients’ genetic ancestries. To provide patients with more precise, personalized therapy and to further improve their quality of life and 5-year survival rate, the influence of genetic ancestry should be fully considered when selecting treatments.

Regulatory T Cells as Predictors of Clinical Course in Hospitalised COVID-19 Patients

BackgroundThe host immune response has a prominent role in the progression and outcome of SARS-CoV-2 infection. Lymphopenia has been described as an important feature of SARS-CoV-2 infection and has been associated with severe disease manifestation. Lymphocyte dysregulation and hyper-inflammation have been shown to be associated with a more severe clinical course; however, a T cell subpopulation whose dysfunction correlate with disease progression has yet to be identify.MethodsWe performed an immuno-phenotypic analysis of T cell sub-populations in peripheral blood from patients affected by different severity of COVID-19 (n=60) and undergoing a different clinical evolution. Clinical severity was established based on a modified WHO score considering both ventilation support and respiratory capacity (PaO2/FiO2 ratio). The ability of circulating cells at baseline to predict the probability of clinical aggravation was explored through multivariate regression analyses.ResultsThe immuno-phenotypic analysis performed by multi-colour flow cytometry confirmed that patients suffering from severe COVID-19 harboured significantly reduced circulating T cell subsets, especially for CD4+ T, Th1, and regulatory T cells. Peripheral T cells also correlated with parameters associated with disease severity, i.e., PaO2/FiO2 ratio and inflammation markers. CD4+ T cell subsets showed an important significant association with clinical evolution, with patients presenting markedly decreased regulatory T cells at baseline having a significantly higher risk of aggravation. Importantly, the combination of gender and regulatory T cells allowed distinguishing between improved and worsened patients with an area under the ROC curve (AUC) of 82%.ConclusionsThe present study demonstrates the association between CD4+ T cell dysregulation and COVID-19 severity and progression. Our results support the importance of analysing baseline regulatory T cell levels, since they were revealed able to predict the clinical worsening during hospitalization. Regulatory T cells assessment soon after hospital admission could thus allow a better clinical stratification and patient management.

Nlrp3 Inflammasome Genetic Variants Are Associated With Risk And/Or Protection To Hospitalization Among Covid-19 Patients From Rio De Janeiro, Brazil

Background COVID-19 has a broad spectrum of clinical manifestations, from asymptomatic to mild or moderate symptoms, reaching the most severe forms and death. The mechanisms underlying the SARS-CoV-2 infection and its clinical evolution are still unclear. Once SARS-CoV-2 infects individuals, host factors are activated by the presence of the virus inside the cells, such as the inflammasome system. The search of risk factors for COVID-19 is of relevance for clinical management. In this study, we investigated the impact of 11 single-base polymorphisms (SNPs) in the NLRP3, CARD8, AIM2, CASP-1, IFI16, and IL-1β inflammasome genes in SARS-CoV-2 infected individuals with distinct disease outcomes. Methods Patients were divided into two groups: (1) inpatients, with severe/critical disease (Hospitalized group, n=451), and (2) convalescent volunteers with prior SARS-CoV-2 infection and a history of asymptomatic to mild symptoms (Mild group, n=43). Patients hospitalized were followed up at a Hospital Center for COVID-19 Pandemic – National Institute of Infectology (INI)/FIOCRUZ, Rio de Janeiro, Brazil, from June 2020 to March 2021. The Mild group was recruited at Oswaldo Cruz Institute (IOC)/FIOCRUZ, Rio de Janeiro, Brazil, in 2020. Genotyping of the SNPs was determined by Real-Time PCR. Protection and risk estimations were performed by unconditional logistic regression models. Results Among the genotyped SNPs, significant differences in the NLRP3 rs1539019 and rs10754558 frequencies were observed between the groups. The C/C genotype (ORadj=6.31; Padj=0.026) or allele C (ORadj=1.05; Padj=0.002) in rs1539019 polymorphism were associated with the risk for hospitalization, while the C/G genotype (ORadj=0.16; Padj=0.016) or carrier-G (ORadj=0.2; Padj=0.028) in rs10754558 polymorphism were associated with protection for hospitalization. Regarding the NLRP3 genetic variants, the A-C-G-C-G haplotype (ORadj=0.14; Padj= 0.030) was associated with protection for hospitalization. No significant association was observed for the other polymorphisms. Conclusions As of our knowledge, this is the first study demonstrating the association of inflammasome NLRP3 variants with risk and/or protection for hospitalization in COVID-19. Studies linking the NLRP3 inflammasome and SARS-CoV-2 infection are still scarce due to the recent emergence of this pathogen. Our results contribute to the discussion of the impact of inflammasomes in the clinical evolution of COVID-19.

TO STUDY THE COMPLICATIONS IN DENGUE LIKE ILLNESSES IN CHILDREN

Background: Dengue has a wide spectrum of clinical presentations, often with unpredictable clinical evolution and outcome. To study the complication of dengue like illness in children Methods: The hospital based study was conducted on patients presenting to paediatric hospital, who fulfilled inclusion and exclusion criteria. Results: According to complications, in dengue positive cases, bleeding was the most common complication seen in 51.00% cases while shock, myocarditis, and convulsion were present in 34.00%, 3.00% and 1.00% of cases respectively. Conclusion: It concluded that dengue hemorrhagic shock was most common complication. Keywords: Dengue Like Illness, Complication, Shock.