Case report of COVID-19 in an elderly patient: could SARS-CoV2 trigger myositis?

Though the exact etiology of autoimmune diseases still remains not completely known, there are various factors which are known to contribute to be trigger of autoimmune diseases. Viral infection is known to be among the other. It is known as the infection from severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) can be an autoimmune trigger, so, we suppose that SARS-Coronavirus (SARS-CoV-2) could be as well. Several authors have highlighted the temporal consequence between SARS-CoV-2 and autoimmune diseases. In this case report we described a patient admitted for COVID-19 pneumonia with completely negative autoimmunity at admission who developed major pulmonary interstitial disease. During the hospitalization the weaning difficulties from oxygen led us to the repetition of autoimmunity pattern which became positive (both during hospitalization then after two months from dismission) with marked positivity for specific antibodies for myositis even after the patient's infectious healing. In the follow-up, the patient continued to have asthenia and muscle weakness despite steroid therapy. She is still in follow-up and will be further evaluated over time. Can we therefore think that in this case the development of autoimmunity can persist beyond the infectious phase and determine over time the development of a real autoimmune myositis?

Atractylenolide III reduces NLRP3 inflammasome activation and Th1/Th2 imbalances in both in vitro and in vivo models of asthma.

Paediatric asthma is a common inflammatory disease in children. Atractylenolide III is an active component of the Atractylodes rhizome, an herbal medicine that has been used as an asthma treatment. This study aimed to explore the effects and underlying mechanisms of atractylenolide III in IL-4-induced 16HBE cells and ovalbumin-induced asthmatic mice. The results showed that IL-4 stimulation significantly decreased, and atractylenolide III treatment increased, growth and apoptosis of 16HBE cells. In 16HBE cells, administration of atractylenolide III also significantly suppressed the IL-4-induced increases in the expression of cleaved caspase-1; apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC); and nucleotide-binding domain and leucine-rich repeat protein 3 (NLRP3). Moreover, the numbers of total leukocytes, neutrophils, eosinophils, and macrophages significantly increased in ovalbumin-induced mice, and then decreased after atractylenolide III treatment. In ovalbumin-induced asthmatic mice, atractylenolide III treatment also significantly inhibited NLRP3 inflammasome activation and restored the Th1/Th2 balance. These results indicate that atractylenolide III reduced NLRP3 inflammasome activation and regulated the Th1/Th2 balance in IL-4 induced 16HBE cells and ovalbumin-induced asthmatic mice, suggesting it has a protective effect that may be useful in the treatment of paediatric asthma.

[Influence of Adamantilbromphenylamine on Parameters of Immunity and Symptoms of Asthenia in Patients with Non-Psychotic Mental Disorders].

OBJECTIVE: Our aim was to assess effect of antiasthenic drug adamantilbromphenylamine on the immune system and symptoms of asthenia in patients with non-psychotic mental disorders and to reveal possible criteria for prediction of treatment efficiency. METHODS: Uncontrolled study with interrupted time series was carried out. According to efficiency of treatment patients were divided into two groups (group 1 (n=21)--very much improved and much improved; group 2 (n=9)--minimally improved). Adamantilbromphenylamine was administered to patients as a monotherapy 100 mg a day for 28 days. Examination was conducted before and after therapy. Severity of asthenic symptoms according to MFI-20 scale was identified; cellular and humoral immunity parameters, mitogen-induced production of interleukins (IL) 1ß and IL 4 by immunocompetent cells of patients were assessed. RESULTS: 30 patients with non-psychotic mental disorders with predominance of asthenic symptomatology in clinical picture of the disease were examined. Before therapy every proband had over 60 points across 5 items of MFI-20 scale. As compared with control decrease of number of lymphocytes of CD3+-, HLA-DR+, CD16+-phenotypes; increase in the ratio of CD4+/CD8+; concentration of serum IgM; phagocytic activity of neutrophils were revealed. In the end of therapy in group 1, sum total of points of asthenia decreased up to 26(23-37) (p<0.001); in group 2--up to 57(47-61). Only in group 1 positive dynamic of immune parameters was revealed. It was shown that baseline level of proinflammatory cytokine IL 1ß in group with apparent therapeutic effect of the drug was reliably lower, than in group with minimal improvement (p=0.005). These differences remained also after course of therapy (p=0.042). CONCLUSION: Interrelationship of clinical-immunological effect of adamantilbromphenylamine has been revealed; intensity of production of IL 1ß may be considered as a criterion of prognosis of efficiency of treatment with adamantilbromphenylamine in patients with non-psychotic mental disorders.

[Immunomodulatory effects of selank in patients with anxiety-asthenic disorders].

The purpose of this article was to study the immunotropic effects of the new neurotrophic heptapeptide selank. The experiments in vitro revealed that the drug in concentration 10-7 M completely suppressed gene expression by peripheral blood IL-6 of patients with depression but not of the healthy controls. At the same time, the significant increase (p<0,05) of IL-6 concentration was observed in the cell culture of peripheral blood of patients in the presence of selank. The changes of the Th1/Th2 cytokine balance in vivo were found in the serum of patients with generalized anxiety disorder and neurasthenia who received Selank during 14 days. The dynamics of these changes had the significant inverse correlation dependence. The cytokine regulating effects revealed in the study suggest that selank can be used as a novel immunomodulator in patients with anxiety-asthenic disorders. Additionally, the adaptogenic properties of selank may be beneficial to its use in elderly people and people exposed to environmental stressors for the prevention of infectious diseases.

An attempt to predict anergy in tuberculosis suspect cynomolgus monkeys.

Acid-fast microorganisms were identified from the tuberculous lesions of a male cynomolgus monkey (Macaca fascicularis). Twenty-two other cynomolgus monkeys housed in the same room were presumed exposed to tuberculosis (Mycobacterium spp.). In addition to standard intradermal (ID) tuberculin testing, clinicians attempted to evaluate the immune status of these monkeys in order to identify animals exhibiting false negative (anergy) ID tuberculin tests. Twenty-one of the potentially exposed monkeys were immunized with tetanus toxoid (TT). Tetanus antitoxin (TAT) titers were measured before and after immunization. The delayed cutaneous hypersensitivity (DCH) reaction to TT was evaluated using a commercially available human test panel. Some animals did not exhibit a DCH reaction to TT. At necropsy 1 of the 21 animals exhibited tuberculous lesions, and acid-fast microorganisms were identified on direct smears of lymphatic tissue of a second animal. Although reported to be of value in assessing the cellular immune status of rhesus monkeys (Macaca mulatta), the delayed cutaneous hypersensitivity response to tetanus toxoid was not helpful during this outbreak in identifying cynomolgus monkeys infected with M. tuberculosis, or in interpreting suspect ID tuberculin tests.