[Hepatitis C in kidney transplantation: comparative study between two Maghrebin centers: Casablanca and Tunis]. / L'hépatite virale C au cours de la transplantation rénale: étude comparative entre deux centres Maghrébins: Casablanca et Tunis.

BACKGROUND: Hepatitis viral C (HVC) is relatively frequent among kidney transplants. It is responsible for a morbid-mortality that compromises the results of transplantation in the medium and long term. AIM: To evaluate and to compare the prevalence of HVC, 172 kidney transplant adult patients were investigated in two Maghrebian centers at Casablanca (G1): 57 Moroccan patients and Tunisia (G2):.115 Tunisian patients. The impact of the HVC infection for a morbid-mortality was concerned only the Tunisian recipient patients: 20 kidney recipients having antibodies anti-VHC and positive HVC-RNA (Cases) which were matched in age, sex and date of the kidney graft, to 20 kidney transplant patients anti-HVC and VHCRNA negative (Controls). METHODS: The anti-VHC antibodies were detected by ELISA: Innogenetics and their positivity were confirmed by RIBAII. The ARN-VHC was analyzed by RT-PCR INNO-LiPA HCV II amplification of Innogenetics. RESULTS: The prevalence of hepatitis C is similar for the two groups: 19.3% among Moroccan kidney transplants and 20.9% among Tunisians. The infection by the HVC was often active and the detection of viral RNA was found in 91.7% of the G2 patients against 50% among G1 patients. The genotype 1b is the most prevalent; it is found in 59% of the patients. The frequency of HVC among our kidney transplant patients is particularly determined by the duration and the mode of dialysis. In fact, 22.1% of the patients treated by hemodialysis are VHC (+) against 5,6% patients treated by peritoneal dialysis. Also, the average duration of the dialysis is 58,8 months for HVC (+) patients against 33.5 months for HVC (-) (p<0.0001) patients. The frequency of the chronic rejection of the graft is higher in the G2, but it is similar in Tunisian patients with or without antibodies anti-HVC. In the G1, this frequency is statistically higher among positive HVC transplant patients compared to the negative HVC grafted patients (p<0.05). The case-control study emphasizes the frequency of the proteinuria, the renal insufficiency, the mellitensis diabetes and the polyglobulinemia among patients HCV (+); however the differences between the two groups remain statistically non significant. The total rate of the hospitalizations is 26 per 100 patients per year in the HCV (+) group against 17 for the HCV (-). The average duration of hospitalizations is 72 days among HCV (+) patients against 30.2 days for the controls (p<0.05). The averages of survival of the patients and of the controls were similar 11.6±5.6 years for transplant patient HCV (+) against 11.2±5.5 years for the controls. The actuarial curves of the patients were not different for the patients having antibodies anti-HCV positive or negative. CONCLUSION: The blood and nosocomial modes of contamination of HVC infection explain their higher frequency in this population at risk. The mortality and the morbidity of the renal transplant patients infected by the HCV seem to be higher compared to the uninfected patients. A further study by large population should be carried out to confirm these results.

[IL1/IL1 Ra, CTLA-4 and Apo1/Fas genes polymorphisms and susceptibility to IgA nephropathy in Tunisian patients]. / Polymorphismes des gènes de l'IL1/IL1 Ra, CTLA-4 et Apo1/Fas et susceptibilité à la néphropathie à IgA chez des patients Tunisiens.

BACKGROUND: The IgA nephropathy (IgA-N) is considered the most common form of primary glomerulonephritis and its pathogenic mechanisms are very complex. The study of several genes which encode for immunoregulator molecules in inflammatory and immunological responses during the disease, allowed to describe some number of polymorphisms would be involved in the molecular expression, the road marking, the synthesis and\or the binding to the receptors. So an abnormality of the molecular function associated with its polymorphism would be suggested in the genetic predisposition to the disease. AIM: To determine interleukin 1 (IL1), interleukin1 receptor antagonist (IL1 Ra), CTLA-4 and Apo1/Fas genes polymorphisms frequencies in IgA-N in order to estimate the impact of these polymorphisms in the disease susceptibility. METHODS: The polymorphism of a single nucleotide (SNP) at (-889) IL1 a of 21 IgA-N patients and 100 healthy blood donors, as controls, was studied by PCRSSP. The SNPs of the IL1 ß (+3954), CTLA-4 (+49) and l'Apo1/Fas were analyzed by PCR RFLP and finally the polymorphism of the IL1 Ra gene was determined by a PCR VNTR (variable number tandem repeat). RESULTS: Investigation of IL1a/ß and Apo1/Fas polymorphisms showed no differences in genotypes and alleles frequencies between IgA-N patients and controls. However, genotype AA of CTLA-4 exon1 (+49) was significantly higher in patients (47.62%) than in controls (9.1%) p<0.001. Nevertheless, the clinical, histological and biological characteristics of IgA-N were similar in AA CTLA-4 genotype patients compared to AG or GG genotype patients. We fund also, a significant increased frequency of 1/1 IL1 Ra genotype in IgA-N patients (95.24%) compared to controls (54%) (p<0.001) (p<0.001). CONCLUSION: We conclude that the susceptibility to IgA-N seems to be associated with the presence of CTLA-4 AA and IL1 Ra 1/1 genotypes in Tunisian population. However, the lack of association between IL1 a/ß and Apo1/fas genes polymorphisms should be further investigated by large population based studies.

[Association Budd Chiari syndrome, antiphospholipid syndrome and Grave's disease]. / Association syndrome de Budd Chiari, syndrome des antiphospholipides et maladie de Basedow.

BACKGROUND: Antiphospholipid syndrome is revealed by Budd Chiari syndrome in 5% of the cases. Antiphospholipid syndrome is characterized by venous or arterial thrombosis, foetal loss and positivity of antiphospholipid antibodies, namely lupus anticoagulant, anticardiolipin antibodies and anti-beta2-glycoprotein I. Anticardiolipin antibodies was reported in auto-immune thyroid disorders, particularly in Grave's disease. Antiphospholipid syndrome associated to Grave's disease was reported in only three cases. AIM: To describe a case report of association of Grave's disease and antiphospholipid syndrome. OBSERVATION: We report the first case of Grave's disease associated with antiphospholipid syndrome, revealed by Budd Chiari syndrome. CONCLUSION: Our observation is particular by the fact that it is about a patient presenting a Grave's disease associated with antiphospholipid syndrome revealed by Budd Chiari syndrome. This triple association has never been reported in literature. Although association between antiphospholipid syndrome and Grave's disease was previously described, further studies evaluating the coexistence of these two affections in the same patient would be useful.

Distribution of HLA-B*27 subtypes in Tunisians and their association with ankylosing spondylitis.

OBJECTIVE: The human leukocyte antigen HLA-B27 is a class I antigen of the major histocompatibility complex strongly associated with ankylosing spondylitis (AS) and other related spondyloarthropathies (SpAs). The mechanism of this association remains unknown. HLA-B27 is a serologic specificity that represents a family of at least 25 different HLA-B27 alleles (2701-2725). These alleles are closely related by nucleotide sequence homology, but differ in ethnic distribution. The purpose of the present study is to investigate the distribution of HLA-B27 alleles in healthy controls and in patients with ankylosing spondylitis (AS). METHODS: We selected 160 HLA-B27-positive individuals (39 controls and 121 patients with ankylosing spondylitis). Typing of HLA-B27, and Cw alleles were performed by polymerase chain reaction amplification with sequence specific primers (PCR-SSP), and by serological typing (microlymphocytotoxicity). RESULTS: Seven B27 subtypes were identified: B*2702, 03, 04, 05, 07, 09 and B*2714. The distribution of these alleles in the population of patients was B*2702 (47.1%) and B*2705 (47.1%). These subtypes were also detected in 16 (41%) and 16 (41%), respectively of the 39 control subjects. HLA-B*2707 was detected in 4 (3.31%) patients and in 3 (7.6%) controls. B*2704, 09 and B*2714 were relatively rare and were detected in one subject each. No significant differences were noticed in the frequencies and distribution of HLA-B27 alleles between patients and controls. CONCLUSIONS: Our results show a restricted number of HLA B27 subtypes associated with AS. B*2702 and B*2705 were equally common in patients and controls. The most prominent B27/Cw haplotypes in the patient groups and controls were B*2702/Cw02022 and B*2705/Cw02022.

[Auto-immune serological disorders in chronic viral C hepatitis: prevalence and clinical significance]. / Anomalies serologiques auto-immunes au cours de l'hepatite chronique virale C: prevalence et signification clinique.

BACKGROUND: Hepatitis C viral (HCV) infection has been shown to lead to auto-immune phenomena. AIMS: We review the prevalence of serological auto-immune disorders associated to HCV infection and to clarify their clinical significance. METHODS: Literature review. RESULTS: The serological immune response to HCV infection may include the development of cryoglobulinemia, rheumatoid factor, anticardiolipin, antinuclear, anti-liver-kidney-microsome 1 and anti-smooth muscle antibodies. Serological auto-immune manifestations were explained by the lymphotropism of HCV and the polyclonal activation of B cells. Interferon-based treatment of HCV infection may precipitate or exacerbate the associated auto-immune disease. CONCLUSION: In patients with serological auto-immune disorders associated with HCV infection, a very careful analysis of clinical and biological features is needed. Application of classification criteria of systemic auto-immune diseases and testing more specific antibodies can resolve this point.