Effectiveness of cyclosporine A in patients with moderate to severe plaque psoriasis in a real-life clinical setting in Italy: the TRANSITION study.

BACKGROUND: Cyclosporine A (CsA) is one of the systemic therapeutic options for moderate-to-severe psoriasis, based on its efficacy and rapidity of action. The current study investigated the response to CsA in patients with moderate-to-severe plaque psoriasis. MATERIALS AND METHODS: TRANSITION was an observational, cross-sectional, multicentre study which evaluated the proportion of partial- and suboptimal-responders among patients with moderate-to-severe plaque psoriasis treated with continuous CsA for ≥12 weeks. Patients demonstrating a Psoriasis Area and Severity Index (PASI) response of ≥90, ≥75 and <90, ≥50 and <75 and <50 were defined as responders, suboptimal-responders, partial-responders, and non-responders, respectively. RESULTS: A total of 196 patients (mean age, 46.6 years; 62.8% males) from 14 sites in Italy were evaluated. At the study visit, the mean (SD) PASI score was 4.2(5.5) compared with 15.3(7.1) prior to the last CsA cycle. For response categories, 39.8%, 22.4%, 16.8%, and 20.9% of patients were responders, suboptimal-responders, partial-responders, and non-responders to CsA treatment. Overall, 28.6% of patients permanently discontinued treatment with CsA (lack of efficacy [10.2%], poor tolerability and voluntary discontinuation [3.6% each], and other [11.7%]). CONCLUSION: Patients were only partially satisfied with CsA treatment, reporting measurable impact on quality of life. Only 40% patients showed a satisfactory response to CsA.

Carbon balance of conifer seedlings at timberline: relative changes in uptake, storage, and utilization.

Low rates of growth for conifers at high elevations may relate to problems in acquiring or utilizing carbon. A traditional hypothesis for growth limits of trees at alpine treeline is that low photosynthesis (A) leads to insufficient supply of carbon for growth. Alternatively, the sink-limitation hypothesis questions the importance of low A, and suggests that trees at treeline have abundant carbon for growth as a result of greater decreases in carbon use [respiration (R) and growth] than A at higher elevations. Concentrations of carbon intermediates (e.g., nonstructural carbohydrates, NSC) have been used to support the sink-limitation hypothesis, with the assumption that NSC reflects the ratio of carbon source to sinks. Our objective was to determine elevation effects on carbon balance (whole-plant uptake, storage, and efflux of carbon) of tree seedlings during their critical establishment phase at timberline. Changes in A and R (of whole crowns), NSC (starches and simple sugars), and growth were measured in seedlings of a treeline (Abies lasiocarpa) and nontreeline species (Pseudotsuga menziesii). Seedlings were outplanted at the lower (2,450 m) and upper (3,000 m) edges of the timberline zone in the Rocky Mountains, USA. At the upper compared with lower elevation, both species had 10-20% less root and needle growth, 13-15% less A, 35-39% less R, and up to 50% greater NSC. A. lasiocarpa allocated more biomass to needles and had greater A but less NSC than P. menziesii. The greater effects of elevation on R compared with A led to a 1.3-fold increase in A:R at the upper elevation, and a corresponding increase in starch (r2 = 0.42)-a pattern consistent with the predictions of the sink-limitation hypothesis. Nevertheless, A and dry mass gain were positively correlated (r2 = 0.42), indicating that variation in photosynthesis was related to growth of seedlings at timberline.

Prevalence and characteristics of anti-single-stranded DNA antibodies in localized scleroderma. Comparison with systemic lupus erythematosus.

Prevalence, levels, and immunoglobulin classes of anti-single-stranded DNA antibodies were determined by an enzyme-linked immunosorbent assay in 52 patients with localized scleroderma (33 with morphea, four with generalized morphea, and 15 with linear scleroderma), in 60 healthy controls, and, for comparison, in 31 patients with systemic lupus erythematosus. Localized scleroderma revealed a significant prevalence of anti-single-stranded DNA antibodies, mainly characterized by high levels and IgM and IgA isotypes. Comparison of antibody characteristics in different clinical forms of localized scleroderma showed some significant differences (levels and immunoglobulin isotypes). Comparison with systemic lupus erythematosus showed that frequency, high levels, and IgG isotype of anti-single-stranded DNA antibodies significantly prevailed in systemic lupus erythematosus, while the IgM isotype significantly prevailed in localized scleroderma. However, generalized morphea and linear scleroderma did not significantly differ from systemic lupus erythematosus as regards antibody frequency and prevalence of high antibody levels.