OX40/OX40L in systemic lupus erythematosus: association with disease activity and lupus nephritis

OX40-OX40L interaction is implicated in the pathogenesis of systemic lupus erythematosus [SLE]. We evaluated the role of OX40/OX40L as markers of disease activity and nephritis in SLE patients. Case-control study conducted in 2009 on SLE patients attending the outpatient clinics of Ain Shams University Hospital, Egypt. We assessed the percentage of CD4+ T-lymphocytes expressing OX40 by flowcytometry, and serum OX40 ligand [OX40L] levels in 40 patients with SLE [20 with lupus nephritis and 20 without] and in 20 healthy controls. Disease activity was assessed by the University of Toronto SLE disease activity index [SLEDAI]. The percentage of CD4+ T-lymphocytes expressing OX40 was significantly higher in SLE patients than in controls, and in patients with lupus nephritis than in those without. OX40 expression correlated positively with both serum creatinine levels and SLEDAI. OX40 expression was the highest in patients with class V lupus nephritis and lowest in class II. Serum OX40L levels were significantly higher in SLE patients than in controls, and in patients with nephritis than in those without. Serum OX40L levels correlated with serum creatinine levels but not with SLEDAI. OX40 expression on CD4+ T-cells had a higher sensitivity and specificity in diagnosing lupus nephritis than both OX40L and anti-double-stranded DNA levels. OX40-OX40L interaction plays a role in the pathogenesis of SLE. The expression of OX40 on CD4+ T-lymphocytes and the serum level of OX40L may act as markers of lupus nephritis. Measurements of percentages of CD4+ T-lymphocytes expressing OX40 may serve as an indicator of disease activity in SLE

Study of natural killer and natural killer T cells in chronic hepatitis C infection

Natural killer [NK] and natural killer T [NKT] cells are components of the innate immune system, and participate in the inflammatory processes during hepatic diseases. Impaired activity of these cells is suggested to contribute to viral persistence and chronic infection in hepatitis C virus [HCV] infection. However, the exact mechanisms are not yet fully understood. To investigate the frequency of peripheral NK and NKT cells in patients with chronic HCV infection, as compared to healthy controls. 30 patients with chronic hepatitis due to HCV infection were included. Patients with liver cirrhosis, HCV and HBV co-infection, diabetes mellitus, or who received interferon therapy were excluded. In addition, 20 normal healthy subjects were included as controls. Assessment of the frequency of peripheral NK and NKT cells by flow cytometry was carried out for all subjects. Compared to controls, HCV patients had significantly lower percentages of NK and NKT cells in peripheral blood. Among HCV patients, NK and NKT cell percentages did not correlate significantly with serum transaminase levels. Defective innate immunity, as evidenced by reduced peripheral NK and NKT cell frequency, is observed in patients with chronic hepatitis C infection

Subcutaneous and sublingual immunotherapy versus conventional therapy in atopic dermatitis

Subcutaneous immunotherapy [SCIT] has been shown to improve eczema in patients with atopic dermatitis [AD]. Recently, a sublingual route with a more satisfactory safety profile has emerged, as an effective alternative to SCIT. To date, there are only a few studies regarding the efficacy and safety of sublingual immunotherapy [SLIT] in patients with AD. The aim of the study was to compare the clinical efficacy of SCIT and SLIT in patients with AD, as compared to conventional therapy. In addition, the efficacy of SLIT using food allergens was assessed. This study was conducted on 60 AD patients with a positive skin prick test [SPT] reaction to inhalant allergens. Immunotherapy using inhalant allergens was given subcutaneously in 20 patients [group A], and sublingually in 20 patients [group B]. In group B, patients who also showed a positive SPT reaction to a food allergen received additional SLIT using that food allergen. 20 patients received conventional therapy only for AD [group C]. All groups received therapy for six months. We assessed the following outcomes: severity of atopic dermatitis by SCOR.AD, SPT reactivity, and total serum IgE levels at baseline, and after 6 months of therapy. After 6 months, the mean SCORAD decreased significantly in all 3 groups. Both immunotherapy groups showed a comparable percent of change in SCORAD, which was significantly higher than in group C. A marked reduction in the use of topical corticosteroids and oral antthistamines was detected among groups A and B. A negativization of skin tests, as well as a decreased reactivity to inhalant allergens occurred almost only among groups A and B. 58% of patients in group B, who were given SLIT for food allergens showed a negativization or a decreased reactivity of SPT reactions to food allergens. A substantially higher proportion of patients receiving SCIT reported side effects as compared to those receiving SLIT, Total serum IgE levels did not change significantly among any of the 3 groups. Both SCIT and SLIT are effective in AD, but the ease of administration and the lower incidence of side effects with SLIT encourage its use. SLIT with food allergens was effective in a substantial proportion of patients, and its clinical usefulness deserves additional studies