Glomerulonefritis rápidamente progresiva mediada por inmunocomplejos (tipo II). Revisión de la literatura / Immune complex-mediated rapidly progressive glomerulonephritis (type II). Literature review

La glomerulonefritis rápidamente progresiva mediada por complejos inmunes (GMNRP II) es un síndrome clínico caracterizado por el rápido deterioro de la función renal asociado a hematuria, edemas y oliguria. Histológicamente se manifiesta como una glomerulonefritis crescéntica, con la presencia de depósitos granulares en la inmunofluorescencia. Aunque es una enfermedad rara, es grave y puede evolucionar a una enfermedad renal crónica, por lo cual es fundamental su identificación temprana. A continuación, se presenta una revisión sobre este tipo de glomerulonefritis, con énfasis en su etiología y en las opciones terapéuticas existentes en la actualidad

Rapidly progressive immune complex-mediated glomerulonephritis (RPGNMN II) is a clinical syndrome characterized by severe deterioration of renal function associated with hematuria, edema, and oliguria. It is histologically characterized as a crescentic glomerulonephritis, with the presence of granular deposits on immunofluorescence. Although it is a rare condition, it is a potentially serious disease that may progress to chronic renal disease, therefore its early identification is essential. Here we present a review of this form of glomerulonephritis, with emphasis on its etiology and the currently available therapeutic options

Inmunocomplejos circulantes en el lupus eritematoso sistémico / Circulating immunocomplexes in systemic erythematous lupus

Introducción: Los biomarcadores son claves en el diagnóstico y pronóstico del lupus eritematoso sistémico en el cual las manifestaciones clínicas son extremadamente complejas y heterogéneas. Objetivo: Determinar el valor clínico de los inmunocomplejos circulantes en pacientes con lupus eritematosos sistémico. Métodos: Se determinaron los niveles séricos de inmunocomplejos fijadores del C1q y de los anticuerpos anti-ácido desoxirribonucleico de doble cadena (anti-ADNdc), anti-nucleosoma (anti-Nuc) y anti-proteínas ribosomales (anti-RibP) por el ensayo inmuno-adsorbente ligado a enzima (ELISA) en 93 pacientes con diagnóstico de lupus eritematosos sistémico. Se utilizaron exámenes no paramétricos para probar la asociación entre los inmunocomplejos y los auto-anticuerpos. La frecuencia de nefritis lupica en los grupos de pacientes positivos y negativos de inmunocomplejos circulantes se comparó mediante Chi cuadrado. Resultados: Los inmunocomplejos se encontraron en 24 (25,8 por ciento) pacientes con lupus eritematosos sistémico. Los pacientes que presentaron los títulos más altos de inmunocomplejos fueron los positivos a los tres auto-anticuerpos usados (p=0,044). Se encontró correlación directa entre los niveles de anti-RibP y los inmunocomplejos (Rho=0,303, p=0,003) y entre los anti-ADNdc y anti-Nuc (Rho=0,449, p=0,001). La nefritis lúpica se presentó en 58,3 por ciento de pacientes con inmunocomplejos, y 31,9 por ciento pacientes negativos de inmunocomplejos (p=0,213). Conclusiones: Los inmunocomplejos circulantes caracterizaron una fracción menor de pacientes con lupus eritematosos sistémico. La presencia de estos no se asoció a los anticuerpos anti-ADNdc ni a la nefritis lupica(AU)

Introduction: Biomarkers are essential in the diagnosis and prognosis of systemic erythematous lupus in which clinical manifestations are extremely complex and heterogeneous. Objective: To determine the clinical value of circulating immunocomplexes in patients with systemic erythematous lupus. Methods: Serum levels of C1q-binding immunocomplexes and anti-double-stranded deoxyribonucleic acid (anti-dsDNA), anti-nucleosome (anti-Nuc) and anti-ribosomal proteins (anti-RibP) were determined by enzyme-linked immunosorbent assay (ELISA) in 93 patients diagnosed with systemic lupus erythematosus. Nonparametric tests were used to test the association between immunocomplexes and auto-antibodies. The frequency of lupus nephritis in the circulating immunocomplex positive and negative patient groups was compared using Chi square. Results: Immunocomplexes were found in 24 (25.8 percent) patients with systemic lupus erythematosus. The patients with the highest immunocomplex titers were positive for the three autoantibodies used (p = 0.044). A direct correlation was found between the levels of anti-RibP and immunocomplexes (Rho = 0.303, p = 0.003) and between anti-dsDNA and anti-Nuc (Rho = 0.449, p = 0.001). Lupus nephritis occurred in 58.3 percent of immunocomplex patients, and 31.9 percent immunocomplex negative patients (p = 0.213). Conclusions: Circulating immunocomplexes characterized a smaller fraction of patients with systemic lupus erythematosus. Their presence was not associated with anti-dsDNA antibodies or lupus nephritis(AU)

Adjuvant effects of saponins on animal immune responses / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Vaccines require optimal adjuvants including immunopotentiator and delivery systems to offer long term protection from infectious diseases in animals and man. Initially it was believed that adjuvants are responsible for promoting strong and sustainable antibody responses. Now it has been shown that adjuvants influence the isotype and avidity of antibody and also affect the properties of cell-mediated immunity. Mostly oil emulsions, lipopolysaccharides, polymers, saponins, liposomes, cytokines, ISCOMs (immunostimulating complexes), Freund's complete adjuvant, Freund's incomplete adjuvant, alums, bacterial toxins etc., are common adjuvants under investigation. Saponin based adjuvants have the ability to stimulate the cell mediated immune system as well as to enhance antibody production and have the advantage that only a low dose is needed for adjuvant activity. In the present study the importance of adjuvants, their role and the effect of saponin in immune system is reviewed.

Immune responses of a liposome/ISCOM vaccine adjuvant against streptococcal fibronectin binding protein 1 (Sfb1) in mice.

BACKGROUND & OBJECTIVES: The fibronectin binding protein Sfb1 of Streptococcus pyogenes is a well characterised antigen which induces protection against lethal challenge with group A streptococcus (GAS) when adjuvanted with cholera toxin B-subunit (CTB). As an alternative to CTB adjuvanted intranasal immunisations we investigated the immune responses generated in mice using Sfb1 incorporated in to the skin and mucosal adjuvant SAMA4. METHODS: Mice (BALB/c) were vaccinated intradermally with 100 microl of either SAMA4 (adjuvant only group) or SAMA4/Sfb1 and were boosted 7 days later. Mice vaccinated with CTB based vaccines were immunised by intranasal inoculation with a mixture containing 30 microg Sfb1 and 10 microg CTB on days 1, 3, 5 and 15. At 14 days after the last booster immunisation the immune response was characterised and mice were challenged with 10(8) CFU of S. pyogenes. RESULTS: Mice vaccinated with SAMA4/Sfb1 elicited a Sfb1-specific IgG response in the sera that was significantly higher than that seen in control mice and mice immunised with the adjuvant only (P<0.05). No significant differences were seen for specific IgA antibodies in the sera in all groups examined. Compared with non-immunised and adjuvant only immunised controls, mice immunised with the Sfb1/SAMA4 vaccine exhibited a significant increase (P<0.05) in the number of Sfb1 reactive spleen cells in lymphoproliferation assays which were three fold higher than those seen for mice vaccinated with the Sfb1/CTB vaccine. Mice vaccinated with CTB/Sfb1 had the highest level of protection (80%) as where mice vaccinated with SAMA4 and SAMA4/Sfb1 displayed no protection (20% and 40%). INTERPRETATION & CONCLUSION: These data suggest that the SAMA4 adjuvant used in this study fails to elicit protective immunity in BALB/c mice when used to adjuvant the known protective antigen Sfb1.

A Current Research Insight into Function and Development of Adjuvants

In recent years, adjuvants have received much attention because of the development of purified subunit and synthetic vaccines which are poor immunogens and require adjuvants to evoke the immune response. Therefore, immunologic adjuvants have been developed and testing for most of this century. During the last years much progress has been made on development, isolation and chemical synthesis of alternative adjuvants such as derivatives of muramyl dipeptide, monophosphoryl lipid A, liposomes, QS-21, MF-59 and immunostimulating complexes (ISCOMS). Biodegradable polymer microspheres are being evaluated for targeting antigens on mucosal surfaces and for controlled release of vaccines with an aim to reduce the number of doses required for primary immunization. The most common adjuvants for human use today are aluminum hydroxide and aluminum phosphate. Calcium phosphate and oil emulsions have been also used in human vaccination. The biggest issue with the use of adjuvants for human vaccines is the toxicity and adverse side effects of most of the adjuvant formulations. Other problems with the development of adjuvants include restricted adjuvanticity of certain formulations to a few antigens, use of aluminum adjuvants as reference adjuvant preparations under suboptimal conditions, non-availability of reliable animal models, use of non-standard assays and biological differences between animal models and humans leading to the failure of promising formulations to show adjuvanticity in clinical trials. The availability of hundreds of different adjuvants has prompted a need for identifying rational standards for selection of adjuvant formulations based on safety and sound immunological principles for human vaccines. The aim of the present review is to put the recent findings into a broader perspective to facilitate the application of these adjuvants in general and experimental vaccinology.

Estudo aberto multicêntrico do uso de Broncho-Vaxom® no auxílio do tratamento e prevenção de infecções comunitárias do trato respiratório em crianças / An Open Multicenter Study Using Broncho-Vaxom® as an Adjunt Therapy for the Treatment a Prevention of Respiratory Community Aquired Infections in Children

Vários estudos controlados na Europa têm mostrado a eficácia do Broncho-Vaxom® (imunoestimulante oral contendo frações bacterianas) no auxílio ao tratamento e prevenção de infecções respiratórias em crianças. Entretanto, até o momento, não é do nosso conhecimento nenhuma publicação referente à sua utilização no tratamento destas afecções na população infantil em nosso meio. Objetivo: No presente estudo, os autores avaliam a eficácia e segurança do Broncho-Vaxom® no tratamento e prevenção de doenças respiratórias de 792 crianças com idade entre 6 meses e 12 anos, atendidas em vários centros médicos do Brasil com diagnóstico de otite média, sinusite, bronquite/pneumonia e faringotonsilites recorrentes. Material e método: Os pacientes foram avaliados através de critérios objetivos e subjetivos. O diagnóstico foi baseado em critérios pré-estabelecidos da história clínica e exame físico, e radiografia simples. Broncho-Vaxom® foi prescrito por 10 dias (3,5 mg/dia em uma tomada), e os pacientes foram reavaliados no 30°, 60° e 90° dias após o primeiro dia de medicação. Resultados: De forma geral, na maioria os pacientes apresentaram uma melhora acentuada dos quadros de infecção, com ausência de infecção neste período, e/ou aumentando o intervalo entre as infecções e/ou com diminuição da gravidade dos sintomas e/ou com redução do período de sintomatologia. Conclusão: Os efeitos adversos observados foram leves, na maioria relacionados com o sistema gastrointestinal (vômitos, náusea e diarréia) em 6% das crianças, sendo que em nenhuma uma delas o tratamento foi interrompido.

Controlled clinical studies in Europe have already shown-the efficacy of Broncho-Vaxom® (an oral immunomodulating Material lysate) for the treatment and prevention of bronchitis, sinusitis, pharyngitis and otitis media in children. However, it is not of our knowledge any studies of Broncho-Vaxom® in children with respiratory infections in our population. Aim: In order to validate, the efficacy and safety of Broncho-Vaxom® the authors evaluated the treatment of 792 children assisted in several medical centers in Brasil, ages 6 months to 12 years, referred for recurrent otitis media, recurrent sinusitis, recurrent bronchitis/pneumonia and recurrent pharyngitis/tonsilitis. Material and methods: The patients were evaluated both by subjetive and objective criteria. The diagnosis was based on a standardized history and physical examination and roentgenograms. Broncho-Vaxom® was prescribed for 10 days (3,5 mg/day once a day), for 3 consecutive months. They were reevaluated at 30, 60 and 90 days after the first day of medication. Results: Overall, most of the patients presented excellent and good results, with absence of infections in 90 days, and/or increasing the period between infections and/or reducing the gravity or the time lasting of infections. Conclusion: Overall, minor adverse reactions were observed in 6% dos patients (vomit, diarrhea, nausea). There was no report of interruption of the treatment.