Study of the Hemodialysis on Immunomodulation of TH1/TH2 balance

Patients on chronic intermittent haemodialysis [HD] show an impaired cellular and humoral immune response that clinically appears with frequent infectious complications and low vaccination responses. This immune defect strongly correlates with reduced in vitro proliferative responses of T cells. The defect is localized in antigen presenting cells, which show a decreased co-stimulatory activity. Furthermore, the impaired immune response correlates with an increased production of pro-inflammatory cytokines. In response to primary, activation, CD4 positive T helper [Th] cells mainly differentiate into either Th1 or Th2 cells. Th1 cells support cell mediated immunity whereas Th2 cells enhance humoral immune responses. Since both types of responses mutually inhibit each other, the impaired humoral immune response seen in HD patients could either be due to a reduced number of Th2 cells or to a predominant Th1 response. The current study was to analyze the outcome of the Th1 or Th2 cell responses in HD patients compared with healthy controls and to place them in the context of the altered cellular characteristics and impaired immune status seen in HD patients. The study protocol was approved in 50 Patients in Damnhour National Medical Institute. In HD patients, a significantly higher percentage of CD4 cells are characterized by a Th1-type cytokine secretion pattern compared with healthy controls. Our findings contribute to a better understanding of the pathogenesis of impaired cellular immune functions in dialysis patients. They provide a link between overproduction of pro-inflammatory cytokines [IL-12] and imbalanced T-cell activation

Evaluation of different Rheumatoid factors in patients with rheumatoid arthritis: correlation with disease activity and response to therapy

Antibodies to citrullinated proteins have been described in patients with rheumatoid arthritis [RA] and these appear to be the most specific markers of the disease. Our objective was to determine the frequency of antibodies to cyclic citrullinated [CCPs] in patients with RA and investigate that. Comparison of available serologic rheumatoid markers in patient with rheumatoid arthritis [anti-CCP and rheumatoid factor]and correlation of the relevance of these markers to disease activity and their sensitivity to anti rheumatoid drugs. Patients divide into two groups 1[st] group contain 30 patients with RA [Newly diagnosed], 2[nd] group contain 30 patients with RA [Receiving different therapies] and 10 consider as healthy control group, median age of patient 25 years, range [10-35 years]. This study was conducted in the outpatient rheumatology unit of Damanhour Medical Institute. There was no significant difference between the anti-CCP positive and negative patients with RA. There was also no significant correlation between anti-CCP antibody and ESR, CRP. A small but significant correlation was found between RF and anti-CCP antibody. Anti-CCP antibodies had a better diagnostic value than RF for RA. However the moderate sensitivity and high specificity of anti CCP antibodies for RA, along with the appearance of anti-CCP antibodies before disease onset, suggest that anti-CCP antibodies be included in the classification criteria for RA