A atopia ou dermatite atópica é uma doença inflamatória pruriginosa, crônica e recorrente reconhecida como a segunda alergopatia mais comum, estando aquém apenas da dermatite alérgica à picada de pulgas. Esta doença é caracterizada pela presença exacerbada de prurido corpóreo, infringindo sofrimento ao paciente e desalentando seu proprietário. A busca a uma boa \"qualidade de vida\" está sendo cada vez mais demandada pelos proprietários de animais alergopatas ou portadores de outras doenças crônicas. Por se tratar de uma doença de longo decurso, o tratamento com glicocorticóides pode causar diversos efeitos colaterais, além de doenças mais graves como diabetes melitus e hiperadrenocorticismo iatrogênico. Como alternativa ao tratamento de cães atópicos, a ciclosporina (CsA) acaba tornando-se uma boa opção terapêutica. A CsA inibe as funções das células que iniciam a resposta imunológica (células de Langerhans e linfócitos) e das células que efetuam a resposta alérgica (mastócitos e eosinófilos) e, também, diminui a liberação de histamina e de várias citocinas. Os objetivos do presente estudo incluíram: análise da eficácia da CsA na redução de lesões corpóreas e do prurido com auxílio do CADESI-03 (Olivry et al.,2007) e de duas escalas de prurido corpóreo; detecção de ocorrência de eventuais efeitos adversos (tegumentares ou sistêmicos) decorrentes da terapia imunomodulatória através da realização de hemograma, função renal, função hepática e mensuração da pressão arterial; avaliação e monitoramento da qualidade de vida de 21 animais atópicos tratados com ciclosporina (5 mg/Kg, SID durante 60 dias) com auxílio de uma escala validada para cães. A CsA mostrou-se eficaz no tratamento da dermatite atópica canina pois reduziu as lesões corpóreas em 70% após 60 dias de terapia. Nesse mesmo período ocorreu redução da intensidade do prurido corpóreo em 52,6%, avaliado através da escala numérica verbal; e observou-se redução significativa na escala qualitativa de prurido corpóreo (Hill, 2002; modificada), uma vez que os níveis máximos de prurido (\"três\" e \"quatro\") quase não foram observados após a terapia imunomodulatória. Os efeitos adversos observados foram relacionados a distúrbios gastrintestinais e, ocorreram com maior freqüência nos primeiros 15 dias de tratamento. Alterações laboratoriais não foram observadas. Os animais portadores de dermatite atópica apresentaram melhora no escore de qualidade de vida em 32%. A CsA mostrou-se eficaz no tratamento da dermatite atópica canina. / Atopic dermatitis (AD) is an inflammatory, pruritic and chronic allergic skin disease. It´s recognized as the second most common allergic skin disease of dogs after flea allergy. Pruritus is the predominant sign of canine AD affecting a variety of areas of the body, leading to intense suffering to the animal and its owner. \"Quality of life\" (QL) is being much more requested from owner of animals with allergic skin diseases or with any kind of chronic disease. The long-term use of glucocorticoids therapy can be devastating because of its inumerous adverse effects and secondary diseases like diabetes mellitus and iatrogenic hiperadrenocorticism. Cyclosporine (CsA) has been considered a good therapeutic option in the treatment of canine atopic dermatitis. It inhibits the activation of cells that initiate cutaneous immune response (Langerhans\' cells and lymphocytes) and cells that mediate allergic reactions (mast cell and eosinophils). It also decreases histamine and other citocines release. The objectives of this study included: analysis of the efficacy of CsA in reducing skin lesions and pruritus of 21 atopic dogs using CADESI-03 (Olivry ey al., 2007) and two scales to quantify levels of body itching; detection of any possible adverse effects (dermatologic or systemic) secondary to immunomodulatory therapy, by performing complete blood count, renal and hepatic function and measurement of blood pressure; evaluation and monitoring QL from dogs treated with CsA (5 mg/Kg, SID during 60 days) with a validated scale; This immunomodulatory therapy was considered an effective treatment for atopic dogs because it reduced skin lesions in 70% after 60 days of therapy. During that period there was a reduction of body itching in 52,6% by verbal numeric scale, and there was significant reduction on qualitative scale of body itching (Hill, 2002; modified), since maximum levels of pruritus (\"three\" and \"four\") were hardly observed after immunomodulatory therapy. Gastrointestinal disorders were observed and appeared most often in the first 15 days of therapy. Laboratory abnormalities were not detected. The quality of life of these atopic dogs treated with CsA for 60 days was improved by 32%. CsA was effective and safe in the treatment of canine atopic dermatitis.

Njurtransplantation är det enda botande behandlingsalternativet för patienter som befinner sig i kronisk njursviktsstadium 5. Dagens mest använda immunsuppressiva kombinationsbehandling i klinisk praxis består av calcineurinhämmaren takrolimus, mykofenolatmofetil och kortikosteroider i form av prednisolon. Belatacept (Nulojix®) är ett fusionsprotein som introducerades på marknaden 2011 och ska ses som ett alternativ för primär immunsuppressiv behandling. Verkningsmekanismen för belatacept är att hämma aktiveringen av T-celler genom blockera co-stimulatoriska signaler från antigenpresenterande celler. Teorin bakom belatacept är att man genom en mer specifik immunsuppression ska kunna undvika de nefrotoxiska biverkningar som calcineurinhämmarna takrolimus(Prograf®) och ciklosporin(Sandimmun®) ofta ger. Nefrotoxicitet kan på långsikt leda till en försämring av njurfunktion vilket på sikt kan leda till förlust av transplantatet. Syftet med detta arbete var att undersöka effektiviteten av belatacept jämfört med calcineurinhämmare med avseende på graftöverlevnad, njurfunktion och förekomsten av akuta rejektioner. Detta arbete är en litteraturstudie som gjorts genom att utvärdera fem studier som hittades på sökdatabasen PubMed. Samtliga studier som utvärderades i detta arbete påvisade inga signifikanta skillnader i graftöverlevnad mellan de patienter som behandlades med belatacept och de som behandlades med en calcineurinhämmare. Samtliga studier påvisade en signifikant högre njurfunktion mätt i cGFR, Calculated Glomerular Filtration Rate, hos patienter som behandlades med belatacept. Hos dessa patienter ökade njurfunktionen över tid vilket bekräftar teorin bakom belatacept som säger att man genom att undvika nefrotoxicitet ska kunna behålla en stabil nivå i njurfunktion.  I samtliga studier förutom i studie 2 så har patientgrupperna som mottagit belatacept drabbats av en högre incidens av akuta rejektioner där nästan alla skedde inom de första sex månader efter transplantation vilka oftast ger lindriga komplikationer. Slutsatserna som kan dras är att belatacept ger en högre njurfunktion på lång sikt vilket gör det mycket fördelaktigt framför calcineurinhämmare. Belatacept är förenat med ökad förekomst av akuta rejektioner men fördelen med den höga njurfunktionen kan anses väga tyngre då akuta rejektioner oftast ger lindriga komplikationer. Då belatacept är ett nytt läkemedel så kommer det behövas längre studier framöver för att påvisa en högre graftöverlevnad. / Kidney transplant is the only curing treatment for patients who have chronic kidney disease stage 5. Today’s most used immunosuppressive treatment after kidney transplant in Sweden and worldwide is the combination of the calcineurin inhibitor tacrolimus, mycophenolate mofetil and corticosteroids. Belatacept (Nulojix®) is a fusion protein which was introduced on the pharmaceutical market 2011 and should be viewed as an alternative for primary immunosuppressive treatment after kidney transplant. The mechanism of action for belatacept is to inhibit the activation of T-cells by blocking co-stimulatory signals provided by antigen-presenting cells. The theory behind belatacept is to avoid the nephrotoxic adverse events through a more specific immunosuppression. Nephrotoxicity is often seen with the calcineurin inhibitors tacrolimus (Prograf®) and cyclosporine (Sandimmune®). The consequence of nephrotoxicity is a deterioration in renal function which in a long-term can lead to graft loss. The aim of this study is to evaluate the efficacy of belatacept in comparison to calcineurininhibitors regarding graft survival, renal function and the occurrence of acute rejections. This literature study was conducted by evaluating five studies found in the PubMed database. None of the studies that were evaluated in this study showed any significant differences in graft survival of the patients treated with belatacept compared to calcineurin inhibitors. All studies demonstrated a significantly higher renal function measured in cGFR among patients treated with belatacept. The renal function increased over time which confirms the theory behind belatacept, i.e., that you can keep a more stable renal function over time by avoiding nephrotoxicity. All studies except study 2 demonstrated a higher incidence of acute rejection among patients who received belatacept as treatment. Almost all acute rejections in each study occurred within the first 6 months of the study which most of the time give minor complications.The conclusion that can be drawn from this literature study is that treatment with belatacept results in a higher renal function which makes it favorable to calcineurin inhibitors. Treatment with belatacept also results in a higher incidence of acute rejections but the benefit of a higher renal function can be considered to outweigh the risk of acute rejection.4In order to observe a significant difference in graft survival between patients receiving belatacept and those receiving calcineurin inhibitors several and longer studies, including more patients, need to be conducted.

Drug-induced gingival overgrowth is a disfiguring condition that is a side effect encountered in susceptible responder patients common to three groups of drugs - immunosupressants, calcium channel blockers and anticonvulsant agents. The altered overgrown gingiva can be aesthetically displeasing but in severe cases it can cause functional problems and such patients may eventually require excision of excess tissue. The underlying mechanisms that mediate drug-induced gingival overgrowth is uncertain and the various investigations into the pathogenesis of this disease suggest that it is multifactorial. This study investigated the effects of exogenous addition of cycJosporin and amlodipine on the growth and proliferation of human gingival fibroblasts and the production of collagen by these cells. Results showed that these drugs have a direct stimulatory effect on the gingival fibroblasts of responder patients in vitro and there seems to be a synergistic effect between the two drugs. Findings of this study have important relevance as it suggests that fibroblast proliferation and collagen production must play a significant role in the pathogenesis of drug-induced gingival overgrowth. / Dissertation (MSc (Odontology))--University of Pretoria, 2006. / Dental Management Sciences / unrestricted

No presenta presenta resumen. / Revisión por pares

Erythromelalgia is a neurovascular disorder which causes pain, swelling, erythema, and warmth of the distal extremities. Primary disease is due to a genetic mutation in the gene, but secondary erythromelalgia can be the consequence of a variety of underlying etiologies, including drug and toxin exposures. The disease is rare, occurring in only 1.3 out of every 100,000 in the United States, and symptoms can vary significantly in severity and presentation. Therefore, it can be difficult to recognize the disorder, identify the source, and promptly treat the condition. We report a reversible cause of erythromelalgia induced by the use of oral cyclosporine. This correlation is poorly documented in literature, with limited accounts identifying an association between erythromelalgia and cyclosporine. As drug-induced erythromelalgia represents a reversible cause of disease, physicians should obtain a detailed medication history during the diagnostic workup, specifically inquiring about the use of cyclosporine.

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Kidney transplant recipients must take immunosuppressive medications to prevent the rejection of their transplanted kidney. If female transplant recipients become pregnant, however, very limited data are available about the effects of these medications on their exposed offspring. This study specifically reviews two of the most commonly used immunosuppressive medications prescribed to transplant recipients, cyclosporine and tacrolimus, and evaluates physical and cognitive development of the recipients' children who were exposed to these medications in utero. Participants in this study (n = 71) were female kidney transplant recipients who (a) voluntarily consented to be part of the National Transplantation Pregnancy Registry, (b) took cyclosporine or tacrolimus while pregnant, (c) had a child who is under the age of 6 years at the time of the study, and (d) were reachable via phone. Participants were asked standardized assessment questions related to their child's cognition and physical abilities from the Development Assessment of Young Children (DAYC). Standard scores from the assessment were recorded and analyzed to show that children exposed to cyclosporine or tacrolimus showed higher cognitive scores on the DAYC compared to the normative population. Children exposed to cyclosporine also showed higher physical scores compared to the normative population. Children exposed to tacrolimus did not show significant differences in physical development from the normative population. When cyclosporine or tacrolimus are required during pregnancy, these results help provide reassurance to parents and medical care providers about the cognitive and physical development of their offspring. Practical implications for school psychologists, limitations of this research, and directions for future research were discussed. / School Psychology

Cyclosporine and prednisone are immunosuppressive drugs that are commonly used in combination for the treatment of immune-mediated diseases, and have been shown to individually cause significant suppression of IL-2. Currently, no studies have been performed to determine how a combination of the two drugs would impact suppression of IL-2, and if an additive or synergistic effect on cytokine production could be demonstrated, as in studies of other species. An additive effect of immunosuppression associated with this drug combination could allow clinicians to decrease dosages of drugs, thereby reducing drug costs and minimizing adverse drug side effects. In a cross-over study design using six healthy dogs, the expression of IL-2 was affected with administration of cyclosporine, prednisone, or a combination of each drug. However, there was no significant difference in the level of immunosuppression compared to cyclosporine alone. Small sample size and the dosages of each drug used potentially affected the strength of the results.