COPD is associated with increased pro-inflammatory CD28null CD8 T and NKT-like cells in the small airways

We previously showed increased steroid resistant CD28null CD8+ senescent lymphocyte subsets in peripheral blood from COPD patients. These cells expressed decreased levels of the glucocorticoid receptor (GCR), suggesting their contribution to the steroid resistant property of these cells. COPD is a disease of the small airways. We therefore hypothesized that there would be a further increase in these steroid resistant lymphocytes in the lung, particularly in the small airways. We further hypothesized that the pro-inflammatory/cytotoxic potential of these cells could be negated using prednisolone with low-dose cyclosporin A. Blood, bronchoalveolar lavage, large proximal and small distal airway brushings were collected from 11 COPD patients and 10 healthy aged-matched controls. The cytotoxic mediator granzyme b, pro-inflammatory cytokines IFNγ/TNFα, and GCR were determined in lymphocytes subsets before and after their exposure to 1µM prednisolone and/or 2.5ng/mL cyclosporin A. Particularly in the small airways, COPD subjects showed an increased percentage of CD28null CD8 T-cells and NKT-like cells, with increased expression of granzyme b, IFNγ and TNFα and a loss of GCR, compared with controls. Significant negative correlations between small airway GCR expression and IFNγ/TNFα production by T and NKT-like cells (eg, T-cell IFNγ R= -.834, p=.031) and with FEV1 (R= -890) were shown. Cyclosporine A and prednisolone synergistically increased GCR expression and inhibited pro-inflammatory cytokine production by CD28null CD8- T and NKT-like cells. COPD is associated with increased pro-inflammatory CD28null CD8+ T and NKT-like cells in the small airways. Treatments that increase GCR in these lymphocyte subsets may improve efficacy of clinical treatment.

Cyclosporine A nephropathy, its pathogenesis and management

CsA, obtained from a fungus called Tolypocladium inflatum came into medical use in 1983. Organ transplants have shown great success after the use of Cyclosporine, especially in 3- and 5-year graft survival. However, nephrotoxicity seen in the early and late periods complicates its use. It is very important to distinguish especially early toxicity from rejection attacks; because the treatments of both processes are completely different. While vasocostriction in the renal artery system is prominent in the early period, the underlying factor for late toxicity is the thickening of the arteriolar intima and the consequent decrease in tissue oxygenation. The article discusses the variants of toxicity caused by the use of cyclosporin A. Morphological changes with the use of cyclosporin A are shown in rat models. The results of our own observations on the use of prostaglandin, which demonstrated the effect of vasodilation, are also presented, which can probably be used for further studies in order to reduce the nephrotoxicity of cyclosporin A. In particular, we found that PGE2 significantly reduced vasoconstriction and reduced the toxic effect due to CsA. The limitations was the usage of these agents once, so we couldn’t continue and only gave them intravenously. However, the results obtained were found to be significant.

Cyclophilin A regulates A549 cells apoptosis via stabilizing Twist1 protein

Cyclophilin A (CypA) is an essential member of the immunophilin family. As an intracellular target of immunosuppressive drug cyclosporin A (CsA) or a peptidyl-prolyl cis/trans isomerase (PPIase), it catalyzes the cis-trans isomerization of proline amidic peptide bonds, through which, it regulates a variety of biological processes, such as intracellular signaling, transcription, and apoptosis. In this study, we found that intracellular CypA enhanced Twist1 phosphorylation at Ser68 and inhibited apoptosis in A549 cells. Mechanistically, CypA could mediate the phosphorylation of Twist1 at Ser68 via p38 MAPK, which inhibited its ubiquitination-mediated degradation. In addition, CypA increased Twist–p65 interaction and nuclear accumulation, which regulated Twist1-dependent expression of CDH1 and CDH2. Our findings collectively indicated the role of CypA in Twist1-mediated A549 cells apoptosis through stabilizing Twist1 protein.

Seronegative polyartikuläre juvenile idiopathische Arthritis mit Lungenbeteiligung – oder wohl doch nicht?

ZusammenfassungEs wird ein Patient vorgestellt, der im Alter von 9 Jahren eine polyartikuläre Arthritis entwickelte, die auf eine Therapie mit Methotrexat zunächst ansprach. Aufgrund deutlicher Transaminasenerhöhungen wurde die Methotrexat-Therapie nach 4 Monaten beendet und Etanercept gegeben. Darunter entwickelte der Patient eine Pneumonitis und es kam es zur Entwicklung eines systemischen Lupus erythematodes, der nach Absetzen des Etanercept wieder verschwand. Wir vermuteten dann eine Mischkollagenose und therapierten mit Steroiden und Mycophenolat-Mofetil sowie später mit Tocilizumab. Im Verlauf kam es zur Entwicklung einer Kalzinose und erst auswärts nach Nachweis von MDA-5-Antikörpern zur Diagnose eines dermatopulmonalen Syndroms und einer weitgehend amyopathischen juvenilen Dermatomyositis. Unter einer Therapie mit Cyclosporin A persistieren Bewegungseinschränkungen an der Schulter, ansonsten ist der Patient weitgehend beschwerdefrei, treibt Sport und wird von Erwachsenenrheumatologen weiter betreut.

The Effect of Particle Size on the Absorption of Cyclosporin A Nanosuspension Through the Gastrointestinal Barrier

Background: The particle size is one of great important properties of nanoparticles which affects the dissolution rate in vitro and pharmacokinetics in vivo. This study aimed to design an oral cyclosporin A nanosuspension (CsA-NS) and investigate the effect of particle size of cyclosporin A nanosuspension (CsA-NS) on absorption through the gastrointestinal barrier.Results: CsA-NSs with different particle sizes were prepared. Dissolution rate in vitro, transmembrane permeation, gastrointestinal transport properties and the oral absorption of CsA-NSs were promoted by reducing size, except cellular uptake. Specially the particle size of CsA-NSs was nanoscale, their bioavailability was bioequivalent with marked soft capsules (Sandimmun Neoral®) which is self-microemulsion. Conclusions: This study proposed the potential of developing CsA oral multi dosage form, taken the advantage of nanosuspensions.