Introdução: O infliximabe é um anticorpo monoclonal quimérico que inibe o fator de necrose tumoral, sendo usado em doenças autoimunes e/ou inflamatórias, tais como a artrite reumatóide (AR), a espondilite anquilosante (EA), a psoríase e a artrite psoriásica (AP) e as doenças inflamatórias intestinais (DII). Objetivos: Avaliar se o infliximabe induz à formação de autoanticorpos e verificar a ocorrência de eventos adversos, sobretudo o lúpus induzido por este medicamento. Metodologia: Trata-se de um estudo aberto, prospectivo, de fase IV, onde dosamos os autoanticorpos antes e depois do tratamento (das doenças citadas anteriormente), o qual teve duração mínima de 6 meses (5 infusões). Resultados: No total, 286 pacientes foram avaliados para o fator anti-nuclear (FAN) por imunofluorescência indireta em células Hep2, sendo significativo o aumento de número de indivíduos (p = 0,0001), antes e depois da medicação. Além do FAN, foram dosados, em 146 pacientes, 17 outros autoanticorpos pelo método multiplex, sendo que o anti-DNA de dupla hélice (anti-dsDNA) e o anticardiolipina IgM (aCL IgM) tiveram um aumento significativo (p = 0,003 e 0,0024, respectivamente). Pacientes com AR tiveram uma variação significativa nos títulos do anticorpo anti-proteína citrulinada (ACPA) (antes e depois do tratamento) (p = 0,012). De todos os pacientes avaliados (n = 286), somente 1 (0,35%) apresentou sinais clínicos e laboratoriais de lúpus induzido pelo infliximabe. Conclusão: O estudo demonstrou que o infliximabe interferiu na formação de autoanticorpos (FAN, anti-dsDNA, aCL IgM e ACPA), sendo rara a indução de lúpus pelo medicamento. / Background: Infliximab is a chimeric monoclonal antibody that inhibits tumor necrosis factor, and is thus used in the treatment of autoimmune and/or inflammatory diseases, such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriasis and psoriatic arthritis (PA), and inflammatory bowel diseases (IBD). Objective: To determine whether infliximab induces the formation of autoantibodies and assess the occurrence of adverse effects, mainly drug-induced lupus. Method: The study consisted of a phase IV, prospective, open-label trial, in which autoantibody levels were determined before and after treatment (of the above mentioned diseases) with a minimum duration of 6 months (5 infusions). Results: A total of 286 patients were assessed for the presence of antinuclear antibodies (ANA) by means of indirect immunofluorescence on human epithelial (HEp-2) cells, with a significant increase in the number of individuals observed after treatment (p = 0.0001). In addition to ANA, 17 other autoantibodies were assessed in 146 patients using multiplex technology, and a significant increase was observed in anti-double stranded DNA (anti-dsDNA) and anticardiolipin IgM (aCL IgM) antibody titers (p = 0.003 and 0.0024, respectively). Patients with RA showed significant variations in anti-citrullinated protein antibody (ACPA) titers (before and after treatment) (p = 0.012). Among the 286 patients assessed, only 1 (0.35%) presented clinical and laboratory signs of infliximab-induced lupus. Conclusion: The present study showed that infliximab did affect the formation of autoantibodies (ANA, anti-dsDNA, aCL IgM and ACPA), with a rare occurrence of drug-induced lupus.

LEITE, C. A. V. G. Bloqueio do receptor da interleucina-1 com Anakinra Inibe a cistite hemorrágica induzida por ifosfamida. 2014. 117 f. Faculdade de Medicina, Departamento de Fisiologia e Farmacologia, Universidade Federal do Ceará, 2014. / Submitted by Erika Fernandes (erikaleitefernandes@gmail.com) on 2016-03-28T13:12:59Z No. of bitstreams: 1 2014_dis_cavgleite.pdf: 15500726 bytes, checksum: 5778b5236486c0be61c59f733cd9532e (MD5) / Approved for entry into archive by Erika Fernandes(erikaleitefernandes@gmail.com) on 2016-03-28T13:13:10Z (GMT) No. of bitstreams: 1 2014_dis_cavgleite.pdf: 15500726 bytes, checksum: 5778b5236486c0be61c59f733cd9532e (MD5) / Made available in DSpace on 2016-03-28T13:13:10Z (GMT). No. of bitstreams: 1 2014_dis_cavgleite.pdf: 15500726 bytes, checksum: 5778b5236486c0be61c59f733cd9532e (MD5) Previous issue date: 2014-04-11 / Hemorrhagic cystitis (HC) induced by ifosfamide (IFO) is an important clinical complication in patients with cancer. Despite prophylaxis, HC is observed. The role of interleukin-1 (IL-1) and tumor necrosis factor (TNF) in the pathogenesis of HC provides targets for treatment. Thus, this study aimed to evaluate the protective effect of the IL-1 receptor antagonist (anakinra) and anti-TNF-alpha antibody (infliximab) in experimental HC-induced by IFO in mice. Swiss , C57BL6 , IL -1R-/-, CASP1-/-, TNFR1-/-, TNFR1/R2-/- mice were used. Animals were submitted to pre- treatment with anakinra 100 mg/ kg, ip or infliximab 5 mg/ Kg, ip, or saline ip, 1h after, they were treated with IFO 400 mg/ kg ip, and 12 h after IFO injection they were killed. Then, it was performed resection of the bladder for macroscopic and histopathological evaluation, vascular permeability assay, myeloperoxidase assay, muscle contractility, cistometrogram and flow cytometry to neutrophils and macrophages. Some animals prior to death, were subjected to evaluation of visceral nociception. Anakinra was able to attenuate hemorrhage, edema, neutrophil infiltration, visceral hypernociception and bladder dysfunction. In addition, it was observed reduction of inflammatory parameters and bladder infiltration of neutrophils and macrophages in IL -1R-/- mice, when compared to wild type animals. In contrast, caspase-1-/- mice did not change the inflammatory pattern when compared to wild type animals. Conversely, infliximab inhibited bladder edema and visceral hypernociception, but did not inhibit hemorrhage, infiltration of neutrophils and macrophages and bladder dysfunction. A reduction in bladder edema was also observed in TNFR1-/- mice, when compared with wild type animals, although TNFR1-/- mice did not block infiltration of neutrophils and macrophages. In other hand, TNFR1/R2-/- mice treated with IFO showed a deterioration of HC. Thus, this study shows the efficacy of anakinra in preventing the HC syndrome induced by IFO, and efficacy of infliximab in inhibiting hypernociception. In addition, the pathogenesis of HC appears to be independent of IL- 1β produced by caspase-1 or IL-1α dependent. Furthermore, HC appears to be partially dependent of TNFR1, but possibly arising from a physiological protection TNFR2. / Cistite hemorrágica (CH) induzida por ifosfamida (IFO) é uma importante complicação clínica em pacientes com câncer. Atualmente, mesna e hiper- hidratação são utilizadas como profilaxia, a despeito de ainda ser observada CH através de cistoscopia e histopatologia mesmo com essas medidas. A participação de interleucina-1 (IL-1) e fator de necrose tumoral (TNF) na patogênese da CH provê alvos para o tratamento dessa doença. Assim, esse trabalho objetivou avaliar o efeito protetor do antagonista do receptor da IL-1 (anakinra) e do anticorpo anti-TNF- alfa (infliximabe) nas respostas inflamatórias, nociceptivas e funcionais da CH experimental induzida por IFO em camundongos. Foram utilizados camundongos Swiss, C57BL6, IL-1R-/-, CASP1-/-, TNFR1-/-, TNFR1/R2-/-. Os animais WT foram submetidos ao tratamento com anakinra 100 mg/kg i.p. ou infliximabe 5 mg/kgi.p. ou salina i.p., foram tratados 1h após com IFO 400 mg/kg i.p., e 12 h após a IFO foi realizado o sacrifício, com excisão das bexigas para avaliação macroscópica, histopatológica, permeabilidade vascular, mieloperoxidase, contratilidade, cistometrografia e citometria de fluxo para neutrófilos e macrófagos. Alguns animais, antes do sacrifício, foram submetidos a avaliação de nocicepção visceral. Anakinra foi capaz de atenuar hemorragia, edema, infiltrado neutrofílico, hipernocicepção visceral e disfunção vesical. Além disso, foi observada redução dos parâmetros inflamatórios e no infiltrado vesical de neutrófilos e macrófagos em animais IL-1R-/-em comparação a animais selvagens. Por outro lado, com animais caspase-1-/-, não houve mudança no padrão inflamatório. O infliximabe, por sua vez, inibiu o edema vesical e a hipernocicepção visceral, sem interferir na hemorragia, no infiltrado de neutrófilos e macrófagos e na disfunção vesical. Foi observada também uma melhora do edema vesical em animais TNFR1-/-, sem melhora no infiltrado de neutrófilos e macrófagos, e observou-se uma piora da CH em animais TNFR1/R2-/-. Com isso, o presente trabalho demonstra a eficácia de anakinra em prevenir a síndrome da CH induzida por IFO, e a eficácia do infliximabe em inibir a hipernocicepção. Adicionalmente, a patogênese da CH parece ser independente de IL-1β produzido por caspase-1, ou dependente de IL-1α. Além disso, a CH parece ser dependente parcialmente do receptor TNFR1, e possivelmente possui uma proteção fisiológica advinda do receptor TNFR2.

Introdução: O infliximabe é um anticorpo monoclonal quimérico que inibe o fator de necrose tumoral, sendo usado em doenças autoimunes e/ou inflamatórias, tais como a artrite reumatóide (AR), a espondilite anquilosante (EA), a psoríase e a artrite psoriásica (AP) e as doenças inflamatórias intestinais (DII). Objetivos: Avaliar se o infliximabe induz à formação de autoanticorpos e verificar a ocorrência de eventos adversos, sobretudo o lúpus induzido por este medicamento. Metodologia: Trata-se de um estudo aberto, prospectivo, de fase IV, onde dosamos os autoanticorpos antes e depois do tratamento (das doenças citadas anteriormente), o qual teve duração mínima de 6 meses (5 infusões). Resultados: No total, 286 pacientes foram avaliados para o fator anti-nuclear (FAN) por imunofluorescência indireta em células Hep2, sendo significativo o aumento de número de indivíduos (p = 0,0001), antes e depois da medicação. Além do FAN, foram dosados, em 146 pacientes, 17 outros autoanticorpos pelo método multiplex, sendo que o anti-DNA de dupla hélice (anti-dsDNA) e o anticardiolipina IgM (aCL IgM) tiveram um aumento significativo (p = 0,003 e 0,0024, respectivamente). Pacientes com AR tiveram uma variação significativa nos títulos do anticorpo anti-proteína citrulinada (ACPA) (antes e depois do tratamento) (p = 0,012). De todos os pacientes avaliados (n = 286), somente 1 (0,35%) apresentou sinais clínicos e laboratoriais de lúpus induzido pelo infliximabe. Conclusão: O estudo demonstrou que o infliximabe interferiu na formação de autoanticorpos (FAN, anti-dsDNA, aCL IgM e ACPA), sendo rara a indução de lúpus pelo medicamento. / Background: Infliximab is a chimeric monoclonal antibody that inhibits tumor necrosis factor, and is thus used in the treatment of autoimmune and/or inflammatory diseases, such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriasis and psoriatic arthritis (PA), and inflammatory bowel diseases (IBD). Objective: To determine whether infliximab induces the formation of autoantibodies and assess the occurrence of adverse effects, mainly drug-induced lupus. Method: The study consisted of a phase IV, prospective, open-label trial, in which autoantibody levels were determined before and after treatment (of the above mentioned diseases) with a minimum duration of 6 months (5 infusions). Results: A total of 286 patients were assessed for the presence of antinuclear antibodies (ANA) by means of indirect immunofluorescence on human epithelial (HEp-2) cells, with a significant increase in the number of individuals observed after treatment (p = 0.0001). In addition to ANA, 17 other autoantibodies were assessed in 146 patients using multiplex technology, and a significant increase was observed in anti-double stranded DNA (anti-dsDNA) and anticardiolipin IgM (aCL IgM) antibody titers (p = 0.003 and 0.0024, respectively). Patients with RA showed significant variations in anti-citrullinated protein antibody (ACPA) titers (before and after treatment) (p = 0.012). Among the 286 patients assessed, only 1 (0.35%) presented clinical and laboratory signs of infliximab-induced lupus. Conclusion: The present study showed that infliximab did affect the formation of autoantibodies (ANA, anti-dsDNA, aCL IgM and ACPA), with a rare occurrence of drug-induced lupus.

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / A periodontite à uma doenÃa inflamatÃria crÃnica caracterizada pela destruiÃÃo em vÃrios nÃveis do osso alveolar, fibras colÃgenas e do cemento, à considerada importante causa de perda dentÃria em adultos. O infliximabe (RemicadeÂ) à um medicamento composto de anticorpo quimÃrico monoclonal do fator de necrose tumoral-alfa (TNF-α), sendo utilizada atualmente no tratamento da artrite reumatÃide, doenÃa de Crohn, artrite psoriÃsica, espondilite anquilosante e colite ulcerativa. O objetivo do presente estudo foi investigar o efeito osteoprotetor do infliximabe na doenÃa periodontal experimental (DPE). A DPE foi induzida passando-se um fio de nÃilon 3.0 em torno do segundo molar superior esquerdo de ratos Wistar machos. Os animais foram tratados com infliximabe (1, 5 e 10mg/kg), ou soluÃÃo salina por via endovenosa 30 minutos antes da induÃÃo da periodontite e acompanhados atà o dia do sacrifÃcio no dÃcimo primeiro dia. Alguns animais foram sacrificados no terceiro dia para anÃlise de mieloperoxidase (MPO) gengival e Ãndice de MPO neutrofÃlica no sangue perifÃrico. Foram analisados os seguintes parÃmetros: marcadores de reabsorÃÃo Ãssea, incluindo Ãndice de perda Ãssea (IPO) por morfometria e autofluorescÃncia do colÃgeno no tecido periodontal a partir de microscopia confocal e imunohistoquÃmica para metaloproteinase-1/-8 (MMP-1/-8) no tecido maxilar; marcadores inflamatÃrios, MPO e citocinas prÃ-inflamatÃrias (IL-1β e TNF-α) do tecido gengival detectados por western blot e ELISA, leucometria (e hemograma completo) e Ãndice de MPO leucocitÃrio no sangue perifÃrico; sinalizaÃÃo imunoinflamatÃria, a partir de imunohistoquÃmica para RANK, RANK-L e osteoprotegerina (OPG) no tecido Ãsseo maxilar. A periodontite experimental causou leucocitose, aumento significativo de IPO, aumento dos nÃveis de citocinas inflamatÃrias e aumento do infiltrado inflamatÃrio no tecido gengival e alteraÃÃo da disposiÃÃo do colÃgeno no aparelho periodontal. Ainda nos grupos desafiados, identificamos a presenÃa de vÃrias figuras do resto epitelial de Malassez (REM) na proximidade do cemento e osso alveolar. O infliximabe na dose de 5mg/kg foi capaz de reduzir a quantidade de granulÃcitos no sangue perifÃrico, melhorar o IPO e a integridade do colÃgeno no complexo do tecido periodontal e reduzir o infiltrado inflamatÃrio em relaÃÃo ao grupo desafiado recebendo salina. O fÃrmaco proporcionou ainda uma reduÃÃo dos nÃveis de IL-1β, TNF-α e MPO gengivais (apenas no terceiro dia para MPO) em comparaÃÃo ao grupo salina. AlÃm disso, o tratamento com infliximabe diminuiu a imunomarcaÃÃo para MMP-1/-8, RANK e RANK-L quando comparado ao grupo salina. Interessantemente, uma forte imunomarcaÃÃo para RANK-L foi identificada no REM no processo de periodontite experimental, achado esse que foi reduzido pelo tratamento com inflimixabe. Estes resultados confirmam a participaÃÃo da via OPG-RANK-RANK-L na osteÃlise inflamatÃria e o envolvimento do REM na fisiopatologia da periodontite experimental e ainda sugerem que uma resposta inflamatÃria local e sistÃmica precede a ativaÃÃo dessa via e o processo de reabsorÃÃo Ãssea. ConcluÃmos que o infliximabe na dose de 5,0 mg/Kg possui efeito antinflamatÃrio e osteoprotetor na doenÃa periodontal experimental em ratos Wistar. / Periodontitis is a chronic inflammatory disease characterized by different levels of collagen, cementum, and alveolar bone destruction. Peridontitis is considered an important cause of tooth loss in adults. Infliximab (RemicadeÂ) is a quimeric monoclonal antibody against the tumoral necrosis factor-alpha (TNF-α) and is currently prescribed in the treatment of the rheumatoid arthritis, Crohnâs disease, psoriasis arthritis, ankylosing spondylitis, and ulcerative colitis. The aim of the current study was to investigate the bone protective effect of infliximab on the experimental periodontal disease (EPD). EPD was induced by passing a 3.0 nylon thread around the upper left second molar in Wistar male rats. Animals were either treated with infliximab (1, 5 e 10mg/kg) or saline solution by endovenous route 30 minutes before the periodontitis induction and were followed until they were sacrificed in the tenth first day. A subset of rats was euthanized in the third day for gingival myeloperoxidase (MPO) and for the neutrophilic MPO index from peripheral blood analyses. We analyzed the following parameters: bone reabsorption markers, including the bone loss index (BLI) by morphometry and periodontal collagen autofluorescence using confocal microscopy, and immunohistochemistry for metalloproteinase-1/-8 (MMP-1/-8) in the maxillary tissue; inflammatory markers, gingival MPO and pro-inflammatory cytokines (IL-1β e TNF-α) detected by western blot and ELISA, leukometry (and complete blood count) and the MPO leukocyte index in the peripheral blood; immune-inflammatory signaling, including immunohistochemistry for RANK, RANK-L and osteoprotegerin (OPG) in the maxillary bone tissue. Experimental periodontitis caused leukocytosis, significant increases in BLI and in pro-inflammatory cytokines with inflammatory cell infiltrate in the gingival tissue and periodontal collagen disarrangement. In the challenged group we also identify various figures of the epithelial cell rests of Malassez (ERM) in the proximity of the cementum and alveolar bone. Infliximab in the dose of 5mg/kg was able to reduce granulocyte numbers in the peripheral blood, improve the BLI and the periodontal tissue collagen integrity and to reduce the inflammatory infiltrate in comparison with the challenged group receiving saline. The compound could lead to reductions in the gingival levels of IL-1β, TNF-α, and MPO (the latter only in the third day) as opposed to the saline control. Furthermore, infliximab treatment reduced the MMP-1/-8, RANK, and RANK-L immunolabeling. Interestingly, a strong RANK-L immunolabeling was found in the ERM during the experimental periodontitis, finding that was diminished by infliximab treatment. Altogether our findings confirm the involvement of the OPG-RANK-RANK-L signaling during the inflammatory osteolytis and the ERM involvement in the experimental periodontitis pathophysiology. In addition, these findings suggest that a local and systemic inflammatory response precedes the activation of that signaling pathway and the bone reabsorption. We conclude that infliximab in the dose of 5.0 mg/Kg had anti-inflammatory and bone protective effect in our experimental periodontal disease in Wistar rats.

No description available.

INTRODUCTION: Acute severe ulcerative colitis (ASUC) is a severe complication of ulcerative colitis (UC) that is associated with significant morbidity, treatment refractoriness and need for colectomy. Patients who do not adequately respond to the initial intravenous steroid therapy receive medical rescue therapy with infliximab or cyclosporine or undergo surgery for their refractory disease. However, there is limited guidance on management of steroid responders in this setting. While it is well established that Crohn’s disease (CD) is progressive and benefits from early institution of immunosuppressive therapy, such a paradigm is less well established in UC and thresholds for therapy escalation remain poorly defined. In immunosuppression-naïve patients, whether a single hospitalization for ASUC is a sufficient threshold to escalate to immunomodulator or biologic therapy is unknown. METHODS: From a single tertiary referral center, we identified all patients with ASUC hospitalized for intravenous steroids who were immunosuppression naïve (new UC diagnosis, no therapy, or 5-aminosalicylate (5-ASA) therapy) at their index hospitalization. We excluded patients who were refractory to steroids and initiated medical rescue therapy or required surgery during the index hospitalization. Our primary exposure of interest was initiation of biologic therapy within 1 month of hospital discharge or immunomodulator therapy (thiopurine, methotrexate) within 3 months. Our primary outcomes were need for colectomy within 12 months following hospitalization. Secondary outcomes include re-hospitalization rate within 12 months and late colectomy ( between 91-365 days). RESULTS: Our study included a total of 133 immunosuppressive-naïve ASUC patients among whom 56 (42%) escalated therapy to thiopurine (93%) or biologic (7%) post-hospitalization. The median age of the cohort was 29 years (range 16 – 88 years) and 46% were male. 82 patients (62%) had pancolitis on disease distribution. 38% and 58% were noted to have moderate to severe disease on sigmoidoscopic evaluation. Thirteen patients (10%) underwent surgery by 1 year. At 12 months, there was no difference in the rate of colectomy among those with therapy escalation (13%) compared to those who did not undergo such escalation (8%, unadjusted OR= 1.69 p=0.53). This lack of difference remained robust on multivariable regression analysis and propensity score adjusted models (OR 0.90, 95% confidence interval (CI) 0.18 – 4.45). There was no difference in the rates of hospitalization within 1 year (OR 2.24 95% CI 0.16 – 4.22) or in the time to colectomy between the two groups (log-rank p=0.27). CONCLUSION: Immunosuppression-naïve ASUC patients who respond to intravenous steroids remain at high risk for colectomy with 10% (13/133) receiving such surgery within 1 year. Therapy escalation was not associated with a reduction in this risk. There is an important need for larger prospective studies defining the benefit of early therapy escalation in UC, and appropriate thresholds for the same.

Introdução: recentemente, foi descrita a ação do abatacepte (ABA) na redução nos níveis de imunoglobulinas (Ig) plasmáticas em pacientes com artrite reumatoide (AR). No entanto, a possível associação destes resultados com infecções não foi avaliada até o presente momento. Objetivos: comparar os níveis totais de Igs, suas frações (IgG, IgM, IgA) e das cadeias leves (kappa e lambda) em pacientes com AR em uso de ABA vs. agentes anti-TNF semestralmente, durante 24 meses de uso, e correlacioná-los com a presença de infecções. Método: dezoito pacientes consecutivos com AR tratados abatacepte (ABA-AR) foram comparados com 18 pacientes com AR tratados com anti-TNF (aTNF-AR). Dados clínicos, laboratoriais e dosagens de imunoglobulinas total, suas frações (IgG, IgM, IgA) e das cadeias leves (kappa e lambda) foram obtidos a cada seis meses até o tempo total de 24 meses. Foi feito screening sistemático para presença de infecções. Os critérios de exclusão foram: uso prévio de abatacepte/rituximabe e hipogamablobulinemia basal (< 0,7 g/dL). Resultados: no baseline, as medianas da idade (55 vs. 53 anos, P = 0,92), porcentagem de gênero feminino (78 vs. 78%, P = 1,0), comorbidades (28 vs. 28%, P = 1,0), DAS-28 (5,73 vs. 5,67, P = 0,93), HAQ (1,5 vs. 1,13, P = 0,1), VHS (21,5 vs. 22 mm/1ahora, P = 0,49), PCR (15,5 vs. 12 mg/dL, P = 0,43) e contagem de linfócitos (2.200 vs. 1.800/mm3, P = 0,18) foram semelhantes entre os grupos ABA-AR e aTNF-AR, assim como as medianas da gamaglobulina total (1,4 vs. 1,35 g/dL, P = 0,74), IgG (1.168 vs. 1.079 mg/dL, P = 0,46), IgM (107 vs. 113mg/dL, P = 0,38), IgA (333 vs. 322 mg/dL, P = 0,71), kappa (342 vs. 249 mg/dL, P = 0,39) e lambda (170 vs. 150 mg/dL, P = 0,20). No grupo ABA-AR, após seis meses de uso, houve uma queda dos níveis séricos de gamaglobulina total (1,4 vs. 1,05 g/dL, P < 0,001), IgG (1.168 vs. 997 mg/dL, P < 0,001), IgA (333 vs. 278 mg/dL, P < 0,001), kappa (342 vs. 257 mg/dL, P < 0,001) e lambda (170 vs. 144 mg/dL, P < 0,001). Esses níveis permaneceram estáveis dos seis meses até os 24 meses de tratamento (P > 0,05). Em contraste, no grupo aTNF-AR, não houve alteração nos níveis séricos da gamaglobulina total, suas frações e cadeias leves (P > 0,05) em nenhum momento. A variação negativa da gamaglobulina total, IgG, IgM, IgA, kappa e lambda no grupo ABA-AR foi diferente do grupo aTNF-AR (P < 0,05) em todas as avaliações. No entanto, a frequência de infecções foi semelhante entre os grupos (77,8 vs. 88,9%, P = 0,66) e não se associou às variações da gamaglobulina total, de suas frações ou das cadeias leves em nenhum dos dois grupos. Não houve infecções graves durante o período do estudo. Conclusão: o presente estudo demonstra que o abatacepte, mas não os aTNFs, induz uma queda nos níveis de imunoglobulina total, suas frações e cadeias leves nos primeiros seis meses de uso, com estabilidade nos níveis até 24 meses. No entanto, essa queda não está relacionada ao aumento da frequência de infecções nesse grupo de pacientes / Objective: to evaluate the influence of abatacept on gamma-globulin levels in comparison to anti-TNF treatment and correlate these effects with infections frequency in rheumatoid arthritis (RA) patients. Methods: eighteen consecutive RA patients undergoing abatacept (ABA-RA) were compared to 18 patients treated with anti-TNF (aTNF-RA) agents with similar ages. Clinical and laboratory data, total, specific (IgG, IgM, IgA) gamma-globulin and free light chains (FLC) levels were assessed before and every six months during biologic treatment, up to 24 months. Systematic clinical screening protocol for infection was performed. Exclusion criteria were previous abatacept/rituximab treatments and low gamma-globulin level ( < 0.7 g/dL). Results: at baseline, median age (55 vs. 53 years, P = 0.92), female gender (78 vs. 78%, P = 1.0), co morbities (28 vs. 28%, P = 1), DAS-28 (5.73 vs. 5.67, P = 0.93), HAQ (1.5 vs. 1.13, P = 0.1), ESR (21.5 vs. 22mm/1sth, P = 0.49), CRP (15.5 vs. 12mg/dL, P = 0.43) and lymphocyte count (2,200 vs. 1,800/mm3, P = 0.18) were comparable in ABA-RA and aTNF-RA. Medians of gamma-globulin (1.4 vs. 1.35g/dL, P = 0.74), IgG (1,168 vs. 1,079mg/dL, P = 0.46), IgM (107 vs. 113mg/dL, P = 0.38), IgA (333 vs. 322mg/dL, P = 0.71), kappa (342 vs. 249mg/dL, P = 0.39), lambda (170 vs. 150mg/dL, P = 0.20) were also alike. In ABA-RA, total gamma-globulin (1.4 vs. 1.05 g/dL, P < 0.001), IgG (1,168 vs. 997 mg/dL, P < 0.001), IgA (333 vs. 278 mg/dL, P < 0.001), kappa (341.5 vs. 257 mg/dL, P < 0.001), lambda (169.5 vs. 144.3 mg/dL, P < 0.001) levels decreased after six months in comparison to baseline values and persisted stable up to 24 months (P > 0.05). In contrast, in aTNF-RA no decrease in total, specific gamma-globulin levels or FLC was seen (P > 0.05). The negative variation of gamma-globulin, IgG, IgM, IgA, kappa and lambda levels in ABA-RA was different from aTNF-RA (P < 0.05) at all evaluations. However, the infection rates (77.8 vs. 88.9%, P = 0.66) were similar and not associated to variations in total or specific gamma-globulin levels in any group. No severe infection was observed. Conclusion: these comparative data demonstrate that ABA, but not the aTNF, induces a non-progressive and mild, but significant reduction in gamma-globulin levels. We further demonstrated that this alteration is not clinically relevant since it is not associated with increased infection rate

The main forms of inflammatory bowel diseases (IBD) are Crohns disease and ulcerative colitis. These are chronic diseases, with periods of progression and remission. They are mostly characterized by digestive symptoms such as diarrhea, abdominal pain and weight loss. They affect young individuals and their frequencies have increased for the last decades. The etiology of these pathologies is not well understood, however genetic and environmental factors are involved. The treatment of IBD aims to control the inflammation and to extend periods of clinical remission. Infliximab is an anti-TNF-α antibody, leading to a clear improvement of the symptomatology. However, about 30 % of the patients do not response to this treatment. Genetic factors are certainly involved in these inter-individual differences. The purpose of our work was to find: 1- genetic factors implicated in the response to Infliximab in Crohns disease and 2- genetic factors predisposing to IBD. First we could show that both genes LTA and TNF, which are closely related, are not associated with the answer to Infliximab in Crohns disease. However, different polymorphisms of the ADAM17 gene were associated with a response to the treatment in our Belgian cohort. Second, we could demonstrate an association between an insertion/deletion in the IRF5 gene and IBD. The insertion allele, predisposing to IBD, is expected to create a new binding site for the SP1 transcription factor.

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Introdução: recentemente, foi descrita a ação do abatacepte (ABA) na redução nos níveis de imunoglobulinas (Ig) plasmáticas em pacientes com artrite reumatoide (AR). No entanto, a possível associação destes resultados com infecções não foi avaliada até o presente momento. Objetivos: comparar os níveis totais de Igs, suas frações (IgG, IgM, IgA) e das cadeias leves (kappa e lambda) em pacientes com AR em uso de ABA vs. agentes anti-TNF semestralmente, durante 24 meses de uso, e correlacioná-los com a presença de infecções. Método: dezoito pacientes consecutivos com AR tratados abatacepte (ABA-AR) foram comparados com 18 pacientes com AR tratados com anti-TNF (aTNF-AR). Dados clínicos, laboratoriais e dosagens de imunoglobulinas total, suas frações (IgG, IgM, IgA) e das cadeias leves (kappa e lambda) foram obtidos a cada seis meses até o tempo total de 24 meses. Foi feito screening sistemático para presença de infecções. Os critérios de exclusão foram: uso prévio de abatacepte/rituximabe e hipogamablobulinemia basal (< 0,7 g/dL). Resultados: no baseline, as medianas da idade (55 vs. 53 anos, P = 0,92), porcentagem de gênero feminino (78 vs. 78%, P = 1,0), comorbidades (28 vs. 28%, P = 1,0), DAS-28 (5,73 vs. 5,67, P = 0,93), HAQ (1,5 vs. 1,13, P = 0,1), VHS (21,5 vs. 22 mm/1ahora, P = 0,49), PCR (15,5 vs. 12 mg/dL, P = 0,43) e contagem de linfócitos (2.200 vs. 1.800/mm3, P = 0,18) foram semelhantes entre os grupos ABA-AR e aTNF-AR, assim como as medianas da gamaglobulina total (1,4 vs. 1,35 g/dL, P = 0,74), IgG (1.168 vs. 1.079 mg/dL, P = 0,46), IgM (107 vs. 113mg/dL, P = 0,38), IgA (333 vs. 322 mg/dL, P = 0,71), kappa (342 vs. 249 mg/dL, P = 0,39) e lambda (170 vs. 150 mg/dL, P = 0,20). No grupo ABA-AR, após seis meses de uso, houve uma queda dos níveis séricos de gamaglobulina total (1,4 vs. 1,05 g/dL, P < 0,001), IgG (1.168 vs. 997 mg/dL, P < 0,001), IgA (333 vs. 278 mg/dL, P < 0,001), kappa (342 vs. 257 mg/dL, P < 0,001) e lambda (170 vs. 144 mg/dL, P < 0,001). Esses níveis permaneceram estáveis dos seis meses até os 24 meses de tratamento (P > 0,05). Em contraste, no grupo aTNF-AR, não houve alteração nos níveis séricos da gamaglobulina total, suas frações e cadeias leves (P > 0,05) em nenhum momento. A variação negativa da gamaglobulina total, IgG, IgM, IgA, kappa e lambda no grupo ABA-AR foi diferente do grupo aTNF-AR (P < 0,05) em todas as avaliações. No entanto, a frequência de infecções foi semelhante entre os grupos (77,8 vs. 88,9%, P = 0,66) e não se associou às variações da gamaglobulina total, de suas frações ou das cadeias leves em nenhum dos dois grupos. Não houve infecções graves durante o período do estudo. Conclusão: o presente estudo demonstra que o abatacepte, mas não os aTNFs, induz uma queda nos níveis de imunoglobulina total, suas frações e cadeias leves nos primeiros seis meses de uso, com estabilidade nos níveis até 24 meses. No entanto, essa queda não está relacionada ao aumento da frequência de infecções nesse grupo de pacientes / Objective: to evaluate the influence of abatacept on gamma-globulin levels in comparison to anti-TNF treatment and correlate these effects with infections frequency in rheumatoid arthritis (RA) patients. Methods: eighteen consecutive RA patients undergoing abatacept (ABA-RA) were compared to 18 patients treated with anti-TNF (aTNF-RA) agents with similar ages. Clinical and laboratory data, total, specific (IgG, IgM, IgA) gamma-globulin and free light chains (FLC) levels were assessed before and every six months during biologic treatment, up to 24 months. Systematic clinical screening protocol for infection was performed. Exclusion criteria were previous abatacept/rituximab treatments and low gamma-globulin level ( < 0.7 g/dL). Results: at baseline, median age (55 vs. 53 years, P = 0.92), female gender (78 vs. 78%, P = 1.0), co morbities (28 vs. 28%, P = 1), DAS-28 (5.73 vs. 5.67, P = 0.93), HAQ (1.5 vs. 1.13, P = 0.1), ESR (21.5 vs. 22mm/1sth, P = 0.49), CRP (15.5 vs. 12mg/dL, P = 0.43) and lymphocyte count (2,200 vs. 1,800/mm3, P = 0.18) were comparable in ABA-RA and aTNF-RA. Medians of gamma-globulin (1.4 vs. 1.35g/dL, P = 0.74), IgG (1,168 vs. 1,079mg/dL, P = 0.46), IgM (107 vs. 113mg/dL, P = 0.38), IgA (333 vs. 322mg/dL, P = 0.71), kappa (342 vs. 249mg/dL, P = 0.39), lambda (170 vs. 150mg/dL, P = 0.20) were also alike. In ABA-RA, total gamma-globulin (1.4 vs. 1.05 g/dL, P < 0.001), IgG (1,168 vs. 997 mg/dL, P < 0.001), IgA (333 vs. 278 mg/dL, P < 0.001), kappa (341.5 vs. 257 mg/dL, P < 0.001), lambda (169.5 vs. 144.3 mg/dL, P < 0.001) levels decreased after six months in comparison to baseline values and persisted stable up to 24 months (P > 0.05). In contrast, in aTNF-RA no decrease in total, specific gamma-globulin levels or FLC was seen (P > 0.05). The negative variation of gamma-globulin, IgG, IgM, IgA, kappa and lambda levels in ABA-RA was different from aTNF-RA (P < 0.05) at all evaluations. However, the infection rates (77.8 vs. 88.9%, P = 0.66) were similar and not associated to variations in total or specific gamma-globulin levels in any group. No severe infection was observed. Conclusion: these comparative data demonstrate that ABA, but not the aTNF, induces a non-progressive and mild, but significant reduction in gamma-globulin levels. We further demonstrated that this alteration is not clinically relevant since it is not associated with increased infection rate