Mechanism of intravenous immunoglobulin and its application in renal transplantation / 器官移植

Intravenous immunoglobulin (IVIG) is an immunoglobulin (Ig) isolated from the plasma of healthy human, and its main component is IgG. The mechanism of IVIG is complex, which may play a role via multiple pathways. For example, the combination of Fc fragment of IgG with various Fc gamma receptor (FcγR) regulates inflammatory response and autoantibody metabolism, and Fab fragment of IgG neutralizes multiple antigens and other molecules. IVIG may also inhibit complement activation and affect the balance of anti-inflammation and proinflammation among immune cells. In the treatment of diseases, IVIG constantly plays a role through multiple mechanisms simultaneously, primarily via one certain mechanism in different diseases. IVIG is commonly applied in the desensitization treatment of sensitized patients, ABO incompatible renal transplantation, antibody-mediated rejection and several infectious diseases. In this article, the mechanism of IVIG and its application in renal transplantation were reviewed.

A study of clinicopathological features and outcomes of crescentic glomerulonephritis

Background: Crescentic Glomerulonephritis (CrGN) is characterized by rapidly progressive renal failure. Most of the literatures have defined >50% crescents in biopsy as CrGN. Only very few studies have included the presence of <50% crescents as CrGN.Methods: To assess the clinico-pathological features and outcome of CrGN with >10% crescents on renal biopsy and comparing them splitting our diagnosis into Immune Complex Mediated CrGN (ICCGN) and non-immune complex mediated CrGN (NICCGN) groups.Results: ICCGN was the commonest group. When compared to ICCGN group, NICCGN patients were older, anuric, had more glomerular necrosis and severe IFTA in biopsy at presentation, more became dialysis dependent at index visit discharge. When patients with >50% crescents in both the groups were compared similar results were seen except that infective complications and proliferative lesions were more in ICCGN. When patients with <50% crescents in both the groups were compared similar findings were seen except that no difference was seen in clinical features and dialysis dependency between them.Conclusions: Oliguria at presentation, Hb <9 g/dl, index visit eGFR<15 ml/min, crescents >60%, moderate to severe IFTA are the independent risk factors for dialysis dependency at index visit discharge.

Rituximab Therapy for Post-Liver Transplant Membranoprolifertive Glomerulonephritis Associated with Hepatitis C Viral Infection

Post-transplant membranoprolifertive glomerulonephritis(MPGN), due to hepatitis C virus, is a serious immunecomplex disease with potential for both kidney and liver loss.Treatment with corticosteroids and immunosuppressive canactivate viral infection and the use of interferon alpha caninduce acute rejection of the transplanted liver. In this casereport; a lady, with hepatitis C genotype 4, had developedsevere nephrotic syndrome with progressive renal failure dueto MBGN following liver transplant. Initially, she had receivedHarvoni (Ledipasvir/sofosbuvir) 90/400 mg daily for 12 weeks.Despite, clearance of hepatitis C viremia, she did not improve.Hence, Rituximab was started. Fortunately, her renal failureand nephrotic state improved without activation of hepatitis Cinfection or induction of rejection.

Fibrillary glomerulonephritis in a human immunodeficiency virus-positive, hepatitis C-negative Indian patient: Expanding the profile of renal involvement in human immunodeficiency virus infection

Highly active anti retroviral therapy (HAART) has dramatically improved life expectancy of human immunodeficiency virus (HIV) infected patients, converting HIV infection into a chronic illness with associated changes in its attendant renal complications. The past two decades have witnessed a decrease in the prevalence of HIV associated nephropathy (HIVAN), traditionally considered to be the hall mark of renal involvement in HIV infection. Simultaneously a host of other glomerular and tubulo-interstitial diseases have emerged, expanding the spectrum of HIV associated renal diseases, predominant among which is HIV associated immune complex mediated kidney diseases (HIVICK). Of the diverse glomerular diseases constituting HIVICK, fibrillary glomerulonephritis (FGN) remains a rarity, with only two existing reports to date, confined to patients co-infected with Hepatitis C virus (HCV). The pathogenetic role of HIV in these patients remains under a cloud because of previously well established association of HCV infection and FGN. We report a case of FGN in a HIV seropositive, HCV negative Indian patient, highlighting the diagnostic electron microscopy (EM) findings of FGN and strengthening the causal association of HIV with FGN. In view of increasing heterogeneity of renal complications in HIV infection, the diagnostic utility of a comprehensive renal biopsy evaluation inclusive of EM is emphasized for appropriate selection of treatment modalities.

Pathogenesis of galactose-deficient immunoglobulin A1 in children with Henoch-Sch?nlein purpura nephri-tis / 国际儿科学杂志

Henoch-Sch?nlein purpura ( HSP ) is a well-known systemic vasculitis disease mediated by IgA1 immune complex in children, and the pathogenesis remains unclear. Henoch-Sch?nlein purpura nephritis ( HSPN) is the most serious complication when the kidneys are damaged. It is also the key to determine the prog-nosis of the disease. Due to a combination of genetic,environmental,and infectious factors,IgA1 is abnormally glycosylated during the immune response. Galactose-deficient immunoglobulin A1(Gd-IgA1)is easy to self-ag-gregate and recognized by the antibody to form an immune complex deposited in the glomerular mesangial, which lead to kidney damage. This article reviews the progress of a series of pathogenic mechanisms of IgA1 glycosylation abnormality in HSPN.

Immune complex inhibits toll-like receptor 9-activated JNK and p38 pathways in B lymphocytes / 第二军医大学学报

Objective To explore the inhibitory effect of immune complex (IC) on the signal pathways of high-expressed CD40 and CD80 induced by Toll-like receptor (TLR9) agonist CpG oligodeoxynucleotide (ODN) in B lymphocytes. Methods The mice were intraperitoneally injected with CpG ODN or IC plus CpG ODN, and the spleen CD19+ B lymphocytes were sorted by magnetic-activated cell sorting (MACS). The expressions of CD40 and CD80 on the B lymphocytes were detected by flow cytometry. The spleen B lymphocytes were isolated from wild type and immunoglobulin G Fcγ receptor Ⅱb (FcγRⅡb) knockout mice by MACS. After the isolated cells were stimulated with CpG ODN or IC plus CpG ODN in vitro, the phosphorylation levels of related protein kinases were detected in the B lymphocytes by Western blotting. Following CpG ODN stimulation, the B lymphocytes were treated with JNK p38 inhibitor SP600125 (50 μmol/L) or p38 inhibitor SB203580 (20 mg/L), and then the CD40 and CD80 expression levels on the CpG ODN-activated B lymphocytes were detected by flow cytometry. Results IC inhibited CD40 and CD80 expressions on the CpG ODN-activated B lymphocytes in vivo (both P0.05). IC inhibited the phosphorylation levels of JNK and p38 induced by CpG ODN in B lymphocytes, but did not inhibit them in the B lymphocytes from FcγRⅡb－/－ mice. The CD40 and CD80 expressions on the CpG ODN-activated B lymphocytes were significantly decreased after treated with SP600125 and SB203580 (both P0.01). Conclusion IC can inhibit the CD40 and CD80 expressions induced by TLR9 agonist CpG ODN through inhibiting the JNK and p38 pathways in B lymphocytes.

Complejos inmunes IgM-ApoB100 modificadas / Immune complexes IgM-modified ApoB100 / Complexos Imunes IgM-ApoB100 modificadas

La aterosclerosis es la patología vascular de mayor prevalencia, lo cual motiva numerosas investigaciones sobre su fisiopatogenia. Las lipoproteínas pueden ser modificadas por mecanismos de oxidación y acetilación entre otros, a nivel de sus componentes lipídicos como proteicos, tornándose aterogénicas. Las Apolipoproteínas B100 modificadas (ApoB100m), desempeñan un rol activo en el desarrollo de las lesiones ateroscleróticas conjuntamente con otros factores de riesgo. Éstas tienen la capacidad de producir respuesta inmune llevando a la producción de anticuerpos y la subsecuente formación de complejos inmunes. La importancia de los anticuerpos contra las ApoB100m en la aterogénesis todavía no está clara, existiendo datos contradictorios respecto a si su rol es protectivo o aterogénico. Se establecieron dos objetivos: Determinar los niveles de complejos inmunes circulantes IgM-ApoB100m por enzimoinmunoanálisis, en sujetos normales (sin riesgo aterogénico) y pacientes con alto riesgo y establecer su correlación con los factores de riesgo aterogénico ya establecidos, mediante un estudio observacional transversal. Se obtuvieron valores medios más elevados de IgM-ApoB100m en el grupo de sujetos normales. Los complejos inmunes IgM-ApoB100m correlacionan negativamente con los factores de riesgo aterogénicos clásicos (sexo masculino, avanzada edad, dislipemia, LDL-C aumentado y HDL-C disminuido).

Atherosclerosis is the most prevalent vascular disease, which motivates extensive research on its pathogenesis. Lipoproteins can be modified by acetylation and oxidation mechanisms, at the level of lipid components as protein, becoming atherogenic. Modified Apolipoprotein B100 (ApoB100m), play an active role in the development of atherosclerotic lesions in conjunction with other risk factors. These have the ability to produce immune response leading to antibody production and subsequent formation of immune complexes. The importance of antibodies against ApoB100m in atherogenesis is still unclear since, contradictory data exist on whether their role is protective or atherogenic. Two objectives were established: to determine the levels of circulating immune complexes IgM-ApoB100m by enzyme immunoassay, in normal subjects (without atherogenic risk) and high-risk patients and to establish its correlation with atherogenic risk factors established by a cross-sectional study. Higher mean values of IgM-ApoB100m were obtained in the group of normal subjects. Immune complexes IgM-ApoB100 negatively correlated with classic atherogenic risk factors (male, older, dyslipidemia, increased LDL-C and decreased HDL-C).

A aterosclerose é a doença vascular mais prevalente, o que motiva numerosas pesquisas sobre sua patogênese. As lipoproteínas podem ser modificadas por meio de mecanismos de oxidação e de acetilação entre outros, em nível de seus componentes lipídicos como proteicos, tornando-se aterogênicas. As apolipoproteínas B100 modificadas (ApoB100m), desempenham um papel ativo no desenvolvimento de lesões ateroscleróticas em conjunto com outros fatores de risco. Elas têm a capacidade de produzir resposta imune que conduz à produção de anticorpos e subsequente formação de complexos imunes. A importância de anticorpos contra a ApoB100m na aterogênese ainda não é clara, existindo dados contraditórios sobre se seu papel é de proteção ou aterogênico. Foram estabelecidos dois objetivos. Determinar os níveis de complexos imunes circulantes IgM-ApoB100m por enzimoimunoanálise em indivíduos normais (sem risco aterogênico) e pacientes de alto risco e, estabelecer sua correlação com os fatores de risco aterogênico já estabelecidos por um estudo Observacional Transversal. Foram obtidos valores médios mais elevados de IgM-ApoB100m no grupo de indivíduos normais. Os complexos imunes IgM-ApoB100 correlacionam negativamente com os fatores de risco aterogênicos clássicos (sexo masculino, idosos, dislipidemia, LDL-C aumentado e HDL-C diminuído).

Differentially expressed proteins in serum immune complexes of rheumatoid arthritis: Analysis by mass spectrometry / 医学研究生学报

Objective Rheumatoid arthritis (RA) is a typical type Ⅲ hypersensitivity with a large number of immune complexes (IC) and complement deposits in the synovial tissue , but its specific pathogenesis is not yet clear.This article was to explore the expression of the antigenic profile of serum ICs in RA.Methods ICs were isolated from the serum of 55 patients with RA (41 cases of anti-CCP antibody [+] and 14 cases of anti-CCP antibody [-]), 41 with systemic lupus erythematosus (SLE), and another 41 healthy controls by polyethylene glycol (PEG) precipitation, separated by immunoprecipitation, digested with trypsin in gel, and then subjected to mass spectrometry for identification.The levels of total proteins were compared among different groups using Vennny 2.1.0.The protein expression was considered to be up-regulated when the total protein level of the RA group was >2 times and down-regulated when it was <0.5 times that of the control.Further functional analysis was performed on the differential proteins in RA using the STRING software.Results Totally, 277 proteins were identified in the serum ICs of the RA patients, including 162 in the anti-CCP (+) and 248 in the anti-CCP (-) RA group.Compared with the SLE and healthy control groups, only 129 proteins were found in the RA patients, including 38 in the anti-CCP (+), 109 in the anti-CCP (-) RA group, and 18 in both the two groups.Among the proteins identified in the RA patients and healthy controls, 2 and 11 were up-regulated while 17 and 21 down-regulated in the anti-CCP (+) and anti-CCP (-) RA group, respectively.Conclusion More differentially expressed proteins were identified in the anti-CCP (-) than in the anti-CCP (+) RA patients.The identification of differentially expressed proteins provides a new idea and direction for the investigation of the pathogenesis and new biomarkers of RA.

Interleukin 17-expressing Innate Synovial Cells Drive K/Bxn Serum-induced Arthritis

K/BxN serum can induce arthritis in normal mice because of abundant autoantibodies that trigger an innate inflammatory response in joints. To determine whether IL-17 is involved in the pathogenesis of serum-induced arthritis, we injected wild-type and IL-17(−/−) mice with K/BxN serum and evaluated them for signs of arthritis. Unlike wild-type mice, IL-17(−/−) mice did not show any signs of arthritis. IL-17 was produced predominantly by CD3⁻ CD4⁻γδTCR⁻ NK1.1⁻ Sca1(int) Thy1(hi) cells residing in the inflamed synovial tissue. When synovial cells extracted from normal joints were stimulated with IL-23 or autoantibody-containing immune complexes, a substantial fraction of Sca1(int) Thy1(hi) cells produced IL-17. Thus, we have identified a novel population of IL-17-producing innate synovial cells that play a crucial role in the development of K/BxN serum-induced arthritis.

A Case of Polyarthritis Associated with Reactivation of Chronic Hepatitis B Virus Infection

Hepatitis viruses (hepatitis B virus (HBV) and hepatitis C virus) have been associated with development of inflammatory arthritis. Approximately 400 million people worldwide have chronic HBV infection. HBV infection is the one of the most common causes of liver disease, and the prevalence of HBV infection in Korea is almost 6%. Arthritis in patients with HBV can be encountered in two settings: as a rheumatoid arthritis (RA)-like, acute, self-limited polyarthritis during the pre-symptomatic phase of acute hepatitis B, or, more rarely, as arthritis occurring in the context of HBV-associated polyarteritis nodosa (PAN). In both cases, the pathogenesis of arthritis is attributed to the deposition of immune complexes containing viral antigens (HBsAg or HBeAg) and their respective antibodies (anti-HBs and anti-HBe) in synovial tissues. Here we report on a case of polyarthritis associated with reactivation of chronic hepatitis B virus infection with a review of the literature.

Red Blood Cell Immune Complex Binding Capacity in Children with Sickle Cell Trait (HbAS) Living in P. falciparum Malaria Holoendemic Region of Western Kenya.

Aims: Malaria infection leads to the formation of circulating immune complexes (CICs) which have been implicated in the pathogenesis of complicated malaria which includes severe malarial anemia. Children with sickle cell trait (HbAS) are less predisposed to getting severe manifestations of malaria. We carried out a study to determine the competence of the red blood cells (RBCs) of children with HbAS to bind immune complexes (ICs) and compared this with normal hemoglobin (HbAA). Methods: Children (aged 0-192 months) were enrolled in a nested case controlled study conducted in Kombewa Division, Kisumu West District, Kenya. Based on hemoglobin (Hb) type, children were stratified into those with HbAS (n=47) and HbAA (n=69). The 47 HbAS individuals were matched to 69 HbAA of similar age. The children were further categorized into three cohorts (0-12, 13-48 and 49-192 months). Immune complex binding capacity (ICBC) was quantified using a FACScan flow cytometer under normal and reduced oxygen saturation. Results: The mean immune complex binding capacity for the HbAS cells was significantly higher than that of HbAA cells (P=0.0191) under normal oxygen saturation or under reduced oxygen saturation (P=0.0050). When a matching variable (UNIANOVA) was done to control for age, gender, the presence or absence of malaria parasitaemia, the binding capacity was again significantly higher for the HbAS than for HbAA under normal oxygen saturation (P=0.025) and under reduced oxygen saturation (P=0.003). The binding capacity was lowest in the 7-12 months age group for both HbAS and HbAA; however, the overall picture showed that HbAS individuals had higher immune complex binding capacity than HbAA in all the age cohorts. Conclusion: These results demonstrate that the protection afforded by HbAS against severe manifestations of malaria may be partly due to higher immune complex binding capacity of the HbAS compared to the HbAA cells. This high binding capacity may lead to the mopping up of ICs formed during malaria attacks and therefore protect these cells from deposition and subsequent destruction.

Crescentic glomerulonephritis: A clinical and histomorphological analysis of 46 cases.

Background: Crescentic glomerulonephritis (CrGN), defined as crescents involving more than 50% of the glomeruli, includes pauci-immune, immune complex-mediated and anti-glomerular basement membrane disease. Objectives: The present study was aimed at evaluating the various clinical, biochemical and histological parameters in CrGN with respect to these categories and clinical outcome. Materials and Methods: Renal biopsies diagnosed as CrGN between Jan 2008 and Feb 2010 were included. Clinical and laboratory parameters were retrieved along with the therapeutic approach and clinical outcome, wherever available. Renal biopsy slides were evaluated for various glomerular, tubulo-interstitial and arteriolar features. Appropriate statistical tests were applied for significance. Results: A total of 46 cases of CrGN were included; majority (71.7%) of cases were pauci-immune (PI) while 28.3% were immune complex-mediated (IC). Among clinical features, gender ratio was significantly different between PI and IC groups (P = 0.006). The various histological parameters, including proportion of cellular crescents, tuft necrosis and Bowman's capsule rupture, were similar in both the groups. Four unusual associations, including idiopathic membranoproliferative glomerulonephritis (MPGN), multibacillary leprosy, acute lymphoblastic leukemia and C1q nephropathy were detected. Adequate follow-up information was available in 21 (46%) of the patients. Of these, 11 (52.4%) were dialysis-dependent at the last follow-up. Adult patients required renal replacement therapy more frequently than pediatric cases (P = 0.05). Presence of arteriolar fibrinoid necrosis also showed association with poor clinical outcome (P = 0.05). Conclusions: Crescentic glomerulonephritis remains one of the main causes of acute renal failure with histological diagnosis. Immunohistologic examination is essential for accurate classification into one of the three categories. This condition should be considered in rare causal associations like leprosy or MPGN with renal failure, to allow for timely performed renal biopsy and appropriate aggressive therapy.

Resultados preliminares del perfeccionamiento del DAVIH-AgP24 con el empleo del sistema de amplificación biotina-tiramina/estreptavidina-peroxidasa / Preliminary results of DAVIH-AgP24 with the biotin-tiramyne/streptavidine-peroxidase amplification system

Se modificó el ELISA DAVIH-Ag P24 con la introducción de la disociación por calor de las muestras de plasma y el empleo de un sistema de amplificación biotina-tiramina/estreptavidina-peroxidasa, para incrementar su sensibilidad. Se determinó la repetibilidad interensayo en el DAVIH-Ag P24 amplificado. Se evaluaron 32 muestras de plasma de individuos infectados por el VIH-1 en 3 categorías clínicas (caso SIDA, asintomßticos y con infecciones oportunistas menores). En la determinación de la repetibilidad interensayo se obtuvo un coeficiente de variación entre 4 y 10,3 por ciento. Con el DAVIH-Ag P24 amplificado se incrementó el nivel de detección de P 24 hasta 0,5 pg/mL. El DAVIH-Ag P24 amplificado alcanzó 66 por ciento de sensibilidad, mientras que el DAVIH-Ag P24 obtuvo 31 por ciento. Este estudio preliminar permitió demostrar que la incorporación de las nuevas modificaciones al sistema DAVIH-Ag P24 amplificado logró aumentar los niveles de detección de P24 y ganar en sensibilidad.

ELISA DAVIH-Ag p24 was modified by introducing heat dissociation of plasma samples and a tyramine/streptavidine-peroxidase amplification system, with the objective of increasing sensitivity. Between-assay repeatability was determined in amplified DAVIH-Ag p24. Thirty two plasma samples from HIV-1-infected individuals classified in three clinical categories (AIDS case, asymptomatic and minor opportunistic infections) were evaluated. The variation coefficient ranged 4-10.3 percent in between-assay repeatability. With the amplified DAVIH-p24 Ag, the p24 antigen detection level increased to 0.5 pg/mL. Amplified DAVIH-p24 Ag reached 66 percent sensitivity whereas standard DAVIH-p24 Ag sensitivity rate was 31 percent. This preliminary study proved that the introduction of new modifications in amplified DAVIH-p24 Ag managed to increase the p24 antigen detection levels and to gain sensitivity.

Whole Body Imaging Using 18-Fluorine Fluorodeoxyglucose (18F-FDG) Positron Emission Tomography/Computed Tomography (PET/CT) with or without Contrast Enhanced Computed Tomography (CT) in Dignosing Arteritis

Introduction: Takayasu's Arteritis and Horton's Arteritis are two rare cases of auto-immune complex diseases resulting in sterile inflammatory reactions affecting the wall of large and medium sized arteries. Various radiological and interventional methods employed are inconclusive and become diagnostic only when complications begin to set in. The new non-invasive hybrid Positron Emission Tomography Computed Tomography (PET/CT) using 18Florine-Fluorodeoxyglucose (18F-FDG) imaging technique could detect arteritis in an early clinical stage when routine conventional cross-sectional imaging was inconclusive. Method: Two cases from Klagenfurt Hospital, Austria and Milan General Hospital, Italy were compared with image acquisition being done in the respective hospitals. In Klagenfurt, PET/CT image acquisition was performed using intravenous contrast administration and in Milan, CT parameters were used as attenuation correction and anatomical correlation of PET images. Results: CT performed using both methods, with or without iodinated contrast media, were useful in detecting arteritis. Conclusion: It is concluded that PET/CT aside from being a useful tool in cancer imaging, is also useful for pyrexia of unknown origin. PET/CT should be employed early in managing this clinical condition where arteritis is a possible diagnosis.

Effect of Dexarmthasome of Jianlishu Powder on the Release of Tumor Necrosis Factor-? in Rats of Adjuvant-induced Arthritis Model / 中国药房

OBJECTIVE: To study of effects of dexarmethasome of Jianlishu Powder on the release of tumor necrosis factor-? in rats of adjuvant arthritis model. METHODS: Adjuvant-induced arthritis (AIA) was induced by injection of frenndi's complete adjuvant in rats' plantar to observe the effects of Jianlishu Powder on rice' hypersensitivity reaction, thickness of inflamed plantar of both feet, and levels of tumor necrosis factor-?(TNF-?), Interleukin-2 (IL-2) and circulating immune complex (CIC) in AIA rats. RESULTS:rats' right posterior metatarsus which was injected with adjuvant was swollen from the second day for 15 days (primary lesion). Jianlishu Powder significantly inhibited feet swelling induced by collagen dose-dependently and down-regulate the contents of TNF-?,IL-2 and CIC thus resulting in an anti-inflammatory action in AIA rats(P

Clinical characteristics of rapidly progressive glomerulonephritis / 대한내과학회지

BACKGROUND: Rapidly progressive glomerulonephritis (RPGN) is microscopically characterized by formation of crescents in more than 50% of glomeruli observed. The patients usually move on rapidly to renal failure and the prognosis is not favorable. But there was only a few study because of the rarity in incidence. METHODS: We reviewed and analyzed the records of 15 patients diagnosed as crescentic glomerulonephritis (CrGN) by renal biopsy from March 1990 to December 2003. RESULTS: Fifteen out of 1055 biopsy cases were CrGN including 6 (40%) of pauci-immune glomerulonephritis (PIGN) and 9 (60%) of immune complex glomerulonephritis (ICGN). Underlying diseases of PIGN were: unknown 2, Wegener's granulomatosis 2, focal segmental glomerulosclerosis 1, and rectal cancer 1. For ICGN were: IgA nephropathy 3, lupus nephritis class IV 3, Henoch-Schonlein purpura 2, and HBV-associtated membranoproliferative glomerulonephritis type I. The incidence of major manifestation in PIGN vs. ICGN was respectively: hypertension 50% vs. 22.2%, nephrotic syndrome 50% vs. 88.9%, percents of crescents 73.9% vs. 57.3%. The levels of BUN (mg/dL) and serum creatinine (mg/dL) were higher in PIGN as 76.8 +/- 14.3 and 6.6 +/- 1.2 vs. 26.9 +/- 8.9 and 1.6 +/- 0.3 in ICGN. With methylprednisolone pulse, 5 out of 7 patients showed some improvement in their renal function. A case of Wegener's granulomatosis taken oral prednisolone and another case of lupus nephritis given cyclophosphamide pulse also had relatively favorable course. At the end of follow-up, the more crescents they had the higher creatinine level (r=0.711, p<0.01). CONCLUSION: RPGN manifested nephrotic syndrome commonly and many of them progressed to the chronic kidney disease or even developed end stage renal disease. But appropriate immunosuppre- ssive treatment could help to preserve renal function. When considering the proportion of crescentic glomeruli, it was related to the worse prognosis. It is necessary to make an effort to diagnose early and treat vigorously.

Abnormal characteristics of plasma lipid levels in patients with rheumatoid arthritis / 医学研究生学报

Objective: To explore the mechanism of high incidence of cardiovascular diseases and the levels of plasma lipids and oxidized lowdensity lipoprotein(Ox-LDL) in patients with rheumatoid arthritis(RA).Methods: Fifty-five patients with RA(24 case of active type,31 non-active) and 60 healthy controls were randomly chosen.Plasma lipids and Ox-LDL levels were studied.All the data were subjected to statistical analysis.Results: Compared with the control,total cholesterol(TC),LDL cholesterol(LDL-C) and apolipoprotein B(apoB) levels were increased in patients with active RA,while TC,triglyceride(TG),LDL-C,apoAⅠ,B and Ox-LDL levels were elevated in those with non-active RA.Furthermore,plasma lipids and Ox-LDL level decreased in the active patients as compared with the non-active ones,while only the change of apoAⅠhad statistical significance.The erythrocyte sedimentation rate was found negatively related with TC,LDL-C,high-density lipoprotein cholesterol(HDL-C) and apoAⅠ,while C-reacting protein was found negatively related with LDL-C and HDL-C.Conclusion: Ox-LDL and plasma lipid levels were changed in RA patients.Inflammation may induce changes of lipoprotein and play an important role in atherosclerosis.

Influence of Simvastatin on immune complexes in the plaque lesion of atherosclerosis / 医学研究生学报

Objective: to study the relationship between immune complex(IC)and the origin of atherosclerosis(AS),and to evaluate the simvastatin's potential effect on immunomodulation. Methods: Thirty eight truebred New Zealand rabbits were randomly divided into four groups: control group,high-cholesterol fed group,simvastatin-protecting group and simvastatin-treatment group.the structural change of artery and the deposit of IC(and their classes)in plaque lesions of AS were analyzed with hematoxylin and eosin stain and immunohistochemistry. Results: plaque lesions of AS were obvious after 8-weeks high-cholesterol feeding.With the development of AS,the IC of IgG accumulated in plaque lesions,while the IC of IgM did not.The immunohistochemical stain was stronger in high-cholesterol feed group than that in the simvastain-intervening groups.The distribution of immune complexes was under the endothelium in the early plaque while mainly localized in the core or the shoulder of mature plaque lesions. Conclusion: The IC of IgG exists in the plaque lesions of AS.The IC is close related to the origin and the progress of AS.Simvastatin can inhibit the formation of IC as well as lowering the lipid levels and regressing the plaque,which maybe related to it's effect on the immunomodulation.

A case of membranous nephropathy in a patient with Graves' disease / 대한내과학회지

Membranous nephropathy is one of the most common causes of the nephrotic syndrome in adults. Membranous nephropathy is known as a disease associated with many other disorders and the presumed etiology of the disease is a deposition of circulating immune complexes. But, it has rarely been reported in association with autoimmune thyroiditis. We report a case of membranous nephropathy associated with Graves' disease and review the literature regarding this disease entity.

One Year result of Dermatophagoides farinae antigen - speciffic autologous antibody complex immunotherapy in respiratory allergic patients sensitized to house dust mite / 천식및알레르기

BACKGROUND: Although good clinical effects have been reported, immunotherapy with house dust mite ( HDM ) antigen - autologous specific antibody complex ( IC - IT ) is not yet accepted as an effective immunomodulating tool in HDM allergic diseases. We aimed to prove the clinical effect of IC - IT in HDM sensitized respiratory allergic subjects. Method : Six HDM sensitized respiratory allergic subjects were enrolled. Autologous D. farinae specific IgG was purified with DEAE ion exchange and affinity chromatography. After one year of IC - IT treatment the clinical effects were analyzed with symptom scores, methacholine PC20, ELISA assay of D. farinae specific antibodies and intradermal skin reactivity. Result : The rhinitis symptom score significantly improved after a one - year administration of IC - IT ( 1.23 +/- 0.30 vs. 0.37 +/- 0.15, p< 0.05), but no significant differences were found in asthma symptom score, intradermal skin reactivity to D. farinae and ELISA optic absorbances of D. farinae specific IgE, IgG, and IgG subclasses. Methacholine PC20 values improved in all 6 patients who were administered with IC - IT ( 0.35 vs. 1.66 mg/ml, p< 0.05 ). CONCLUSION: IC - IT may be efficient for management of HDM atopic asthma. Further studies are needed before clinical application of IC - IT in house dust mite atopic subjects.