Neuropeptide Y: a modulator of apoptosis in systemic lupus erythematosus

Systemic lupus erythematosus [SLE] is a multisystem disease characterized by the production of pathological autoantibodies and altered humoral and cellular immune responses. The death receptor Fas is known to induce apoptosis upon interaction with its ligand with consequent activation of caspases and is reported to have an important role in the pathogenesis of SLE. Recently, it has been reported that the nervous system interacts with and directly modulates the immune response through the production of certain neuropeptides as neuropeptide Y [NPY]. To assess the serum level of NPY in SLE patients and to investigate its correlation with the activity of the disease, the level of Fas expression on mononuclear cells and the incidence of apoptosis in SLE patients. The study was conducted on 20 SLE patients and 10 healthy controls. Fas expression was assessed with flow cytometry using mouse antihuman FITC conjugated anti-CD95. The% of apoptotic cells was assessed after cell culture with flow cytometry using propidium iodide staining. NPY was assessed with competitive radioimmunoassay kit for both patients and controls. Both Fas and NPY levels were found to be significantly elevated in SLE as compared with healthy controls [p< 0.01]. Moreover, both levels were found to correlate significantly with the activity score of the disease and with each other. However, despite the elevated Fas expression, the% of apoptotic cells are not significantly increased in SLE compared to healthy controls. Fas expression could be considered a marker of lymphocyte activation in SLE. The presence of high levels of neuropeptides as NPY reflects the link between nervous and immune system. NPY could play an important role as endogenous modulator of the immune response in SLE probably through their inhibiting effect on Fas ligand expression and so switch the lymphocytes to an apoptosis resistant phenotype, which could lead to the activation of autoreactive cells. Thus neuropeptide Y may play an important role in the pathogenesis of SLE

role of laryngeal electromyography in vocal fold immobility

Vocal fold paralysis could be caused by a wide variety of etiological factors that interfere with the nerve supply of the larynx. To assess the utility of laryngeal-EMG as a diagnostic method for patients with immobile vocal folds and to evaluate its possible role as a prognostic indicator in the management of those cases. The study included 35 patients with unilateral vocal fold immobility [VFI] in addition to 10 normal individuals who served as controls. All patients were subjected to full history taking and thorough clinical examination and radiological investigations. Laryngeal EMG was performed for all the patients and controls. None of the control group showed abnormal EMG data while abnormal EMG findings were detected in 23 out of 35 of the patients' group i.e. the specificity of EMG was [100%] while the sensitivity was [65.7%] in detecting VFI. On clinical follow up with indirect laryngoscopy, 6 months later revealed recovery in 10 of the 25 cases [40%]. None of the recovered patients showed abnormal EMG data at presentation while 13 out of 15 cases of non-recovered patients showed abnormal EMG data i.e. the specificity of EMG was 100% while the sensitivity was 86.6% in predicting recovery in patients with VFI. The quantitative analysis of the interference pattern was more sensitive [65.7% and 86.6%] than the conventional methods of analysis [60% and 80%] in detecting and predicting recovery in patients with immobile vocal folds respectively. The clinical use of L-EMG was shown to be an efficient and objective test in the study of patients with immobile vocal folds and in predicting recovery of those cases

High resolution ultrasonography in assessment of rheumatoid knee synovitis: correlation with clinical and laboratory parameters

The formation of synovial pannus is an early event in the course of rheumatoid arthritis [RA] and could be seen before destruction of the cartilage and bone. Thus, its evaluation is of great benefit in the treatment and follow-up of clinical remission. The aim of this study was to investigate the presence of synovial pannus in the knee of RA patients with high-resolution ultrasonography and correlate the finding with the clinical and laboratory parameters of the disease. Thirty patients suffering from RA diagnosed according to the American College of Rheumatology [ACR] criteria together with 10 apparently healthy volunteers were included in the study. Both patients and controls were subjected to proper history taking and clinical examination including disease activity scoring [Mallya and Mace 1981] and functional assessment [Steinbrocker criteria, 1949] together with high resolution ultrasonography of the knee. Soluble adhesion molecules [SICAM-1 and E selectin] in the serum as well as serum and synovial L1F were also done. A high statistical significant difference was found in all laboratory and clinical findings between the patients group and control group including SIC AM-1, SE-selectin, serum and synovial LIF. Serum and synovial LIF correlated significantly with activity scoring [r- 0.8] and, functional status [r= 0.7]. However, SICAM-1 and SE-selectin correlated with activity scoring only [r= 0.48, r= 0.49 respectively]. Ultrasonographic findings were detected in the majority of the patients with statistically significant difference if compared with the control group. Synovial thickening correlated significantly with disease duration [r- 0.49], functional status [r- 0.58] and synovial LIF [r- 0.59]. Effusion showed a significant correlation with activity scoring [r= 0.5], SICAM-1 [r= 0.42] and synovial LIF [r= 0.59] while cartilage destruction correlated with disease duration [r= 0.51] and serum and synovial LIF [r= 0.53 and 0.65 respectively]. Soluble adhesion molecules may be an additional marker for disease activity while LIF may be an indicator of the severity of the disease. HRUS can evaluate the pannus formation in a trial to assess disease activity and the degree of severity to aid in therapeutic intervention and follow-up for clinical remission

Serum interleukin-1 receptor antagonist: clinicopathological correlations with lupus nephritis

To evaluate the relationship between serum interleukin-1 receptor antagonist [IL-1ra] concentrations and renal involvement in SLE and to study its impact on laboratory, immunological and renal histopathological findings in SLE patients as well as its association with disease activity. We studied 26 [23 females, 3 males] SLE patients who had distinct clinical manifestations [22 had vasculitic skin rash, 20 had photosensitivity, 13 had oral ulcerations, 8 had neuropsychiatric manifestations]. They were classified into two subgroups; group Ia included 18 patients who had impaired renal function, 14 of them were proved by renal biopsy and group Ib that included 8 patients without renal affection. Ten healthy subjects matched for age and sex with the patient group were taken as a control group [group II] All patients were subjected to full history taking with stress on clinical manifestations of renal dysfunction, serum samples were tested for interleukin-1 receptor antagonist [IL-1ra] in addition to levels of C3, C4, creatinine levels and for the presence of anti ds-DNA antibodies. Light and electron microscopic examination [LM and EM respectively] of renal biopsy samples were performed for patients of group Ia. The 14 biopsy samples were classified according to the world health organization [WHO] classification as follows: Class I and II [inactive nephritis] n=1, class III and IV [active nephritis], n=11 and class V, n=2. The activity index [AI] and chronicity index [CI] in those 14 renal biopsy specimens were also determined. This study showed that the pattern of IL-1ra in active SLE varies in a manner that is dependent on which organs are involved. Serum IL-1ra concentrations were compared to normal blood donors [t=3.28, p<0.0001 highly significant]. However, significant higher levels of IL-1ra were observed in patients with extra-renal disease group Ib as compared to other patients group Ia [mean +/- SD were 1006.3 +/- 823.9 pg/ml, range 470-3000 and 147.1 +/- 58.5 and range 53-260 pg/ml] for patients without and with renal involvement respectively]. Elevated IL-1ra concentrations in patients with renal manifestations correlated positively with C3 and C4 levels [r=0.56 and 0.36 respectively] and negatively with degree of proteinuria and serum creatinine levels [-0.44 and -0.4 respectively] but not with disease activity index score SLEDAI [r=0.16]. Moreover, there was a high significant difference between the group of patients who were negative for anti ds-DNA [n=4] and those who where positive [n=22] as regards serum IL-1ra levels, being significantly lower in the positive group who were positive for anti ds DNA [t=2.8, p <0.01]. Furthermore, the highermost level of IL-1ra in group Ia [with renal impairment] was 260 pg/ml and the lowermost level of IL-1ra in group Ib was 470 pg/ml so a cut off value was selected at 370 pg/ml and the sensitivity and specificity values for IL-1ra for detection and diagnosis of lupus nephritis were found to be 100% for both. Therefore, a relative decrease of IL-1ra response appears to be a feature characteristic of kidney involvement and IL-1ra elevation clearly correlates with SLE involving other organs. So it may be a useful marker of lupus nephritis