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Efeitos do micofenolato de sódio no aparelho mucociliar: estudo experimental em ratos / Effects of mycophenolate on mucociliary clearance: experimental study in ratsJesus, Viviane Ferreira Paes e Silva de 15 December 2010 (has links)
O transplante pulmonar tem se tornado a opção de tratamento para os pacientes com doença pulmonar terminal. Maiores problemas associados são a rejeição e a infecção; por isso, a importância de se estudar os mecanismos de defesa do aparelho respiratório e o efeito de drogas imunossupressoras sobre o mesmo. O micofenolato de sódio é uma droga imunossupressora que inibe a proliferação dos linfócitos, envolvidos no mecanismo de defesa celular. Objetivo: Avaliar os efeitos do micofenolato de sódio versus solução salina no aparelho mucociliar de ratos. Métodos: Foram utilizados 60 ratos machos Wistar. Todos foram submetidos à cirurgia de secção e anastomose brônquica esquerda. Distribuídos aleatoriamente em dois grupos, um grupo de 30 ratos que recebeu solução salina, pulmão direito controle (S) e pulmão esquerdo operado (SC); enquanto que o segundo grupo recebeu, também por gavagem, micofenolato, pulmão direito controle (M) e pulmão esquerdo operado (MC); até o sacrifício no 7º, 15º e 30º dia de tratamento. Avaliados a frequência do batimento ciliar (FBC), velocidade do transporte mucociliar in vivo (VTMC); e a velocidade de transporte mucociliar in vitro (PLT). Resultados: A FBC é menor no grupo MC em relação ao grupo M, no período de 30 dias (p= 0, 003); e dentro do grupo MC, ao compararmos o 7º e o 30º (p=0, 0001) dia e o 15º e o 30º dia (p=0, 026) de tratamento notamos uma piora da FBC. Em relação à VTMC houve uma melhora no grupo SC no 7º e 30º dia (p=0, 003) e 15º e 30 º dia (p= 0, 005) de tratamento. Comparando o grupo SC e MC no período de 30 dias, verificamos que esta VTMC é menor no segundo grupo (p= 0, 0001). No PLT não houve diferença estatística entre os grupos. Conclusões: O micofenolato associado à secção brônquica diminui a FBC no decorrer do tempo; a VTMC no grupo que recebeu solução salina associado ao procedimento cirúrgico apresentou uma recuperação no decorrer do tempo, o mesmo não foi observado quando associado ao procedimento cirúrgico foi administrado micofenolato; e não houve alteração na qualidade do muco na amostra estudada / The lung transplantation has become the treatment option for the patients with terminal lung illness. Major problems associated are rejection and infection; that´s the reason the importance of studying the mechanism of respiratory system defense and the immunosuppressive drugs effects about itself. The sodium Mycophenolate is an immunosuppressive drug that inhibits the proliferation of lymphocytes, involved in cellular defense mechanism. Purpose: evaluating the sodium Mycophenolate effects versus salt solution in the mucociliary system of rats. Methods: sixty male Wistar rats were used. Every rat was submitted to section surgery and left bronchial anastomosis. The rats were randomly divided: a group of 30 rats which received saline solution; Right lung control (S) and operated Left lung (SC); meanwhile the second group received also by gavage Mycophenolate, Right lung control (M) and Left operated lung (MC); until the sacrifice at the seventh, fifteenth and thirtieth day of treatment. Ciliary beat frequency (CBF) has been evaluated, mucociliary transport speed in vivo (MCTS); and the Velocity of Transport of the Mucociliary in vitro (PLT). Results: the CBF is smaller in the MC group than M group, in thirty days (p=0,003), and inside MC group, when comparing with the seventh and the thirtieth (p=0, 0001) day and the fifteenth and the thirtieth day (p= 0,026) of the treatment we noticed a worsening of CBF. About the MCTS there was an improvement in the SC group in the seventh and the thirtieth day (p=0,003) and the seventh and the thirtieth day (p=0,005) of treatment. The comparing the SC and the MC groups in thirty days we noticed that this MCTS is smaller in the second group (p=0, 0001). In the PLT there were no statistic differences between those groups. Conclusions: the Mycophenolate associated to bronchial section reduces the CBF over time; the MCTS in the group that received salt solution associated to surgical procedure showed recovery, the same was not observed when associated to surgical procedure when submitted to Mycophenolate; and there was not any change in the quality of mucus in the studied sample
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Der Einfluss von Mycophenolat-Mofetil (MMF) auf die renale Fibrogenese: Bedeutung für neue therapeutische Ansätze / The influence of mycophenolate mofetil on renal fibrogenesis: Relevance for new therapeutic approachesBrehmer, Franziska 15 February 2011 (has links)
No description available.
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Nouveaux outils de pharmacodynamie des immunosuppresseurs chez des receveurs pédiatriques de greffe d’organeLapeyraque, Anne-Laure 08 1900 (has links)
L’immunosuppression optimale après greffe d’organe solide est une balance délicate et propre à chaque individu entre le risque de rejet et les risques liés à une surexposition au traitement immunosuppresseur. L’évaluation de la fonction résiduelle des lymphocytes T après stimulation par un mitogène (pharmacodynamie effective) devrait permettre de mesurer l’effet direct des médicaments immunosuppresseurs sur leur cible.
Nous avons étudié différents paramètres de pharmacodynamie effective chez 34 receveurs pédiatriques de greffe d’organes solides traités par tacrolimus et mycophénolate. Les tests proposés dans ce travail sont adaptés au milieu pédiatrique et à une réalisation en temps réel.
La quantification du CD25 parmi les CD4 activés par l’OKT3 permet de distinguer deux groupes de patients selon leur degré d’immunosuppression. L’âge médian est plus bas et la concentration plasmatique médiane en MPA plus élevée dans le groupe de patients plus fortement immunosupprimés.
L’étude des paramètres immunologiques pouvant influencer la réponse (sécrétion des interleukines, proportion des sous-populations lymphocytaires CD4, CD8, T naïfs et Trég) ainsi que l’étude du pouvoir de restauration de la fonction lymphocytaire par l’Il-2, la guanosine ou la xanthosine, ne permettent pas de mieux comprendre les variabilités interindividuelles observées.
Ces résultats devront être confirmés sur une cohorte plus grande de patients afin de juger de leur intérêt en pratique clinique. / Optimal immunosuppression following solid organ transplantation is unique to each individual and requires a balance between risks of rejection and overexposure to immunosuppressive therapy. The evaluation of residual function of T lymphocytes after mitogen stimulation (effective pharmacodynamic monitoring) should allow measurement of the direct effect of immunosuppressive drugs on their target.
We studied various parameters of effective pharmacodynamic monitoring in 34 paediatric patients receiving solid organ transplants and treated with tacrolimus and mycophenolate (MPA). The tests proposed in this work are adapted to the paediatric setting in real time.
Quantification of CD25 among CD4 cells activated by OKT3 can differentiate two groups of patients according to their degree of immunosuppression. Median values for age and MPA plasma concentration are lower and higher, respectively, in the patient group most heavily immunosuppressed.
Neither study of the parameters that may influence the response (secretion of interleukins, proportion of lymphocyte subpopulations CD4, CD8, naive and regulatory T cells) nor study of the restoration of basal cell function brought about by Il2, guanosine or xanthosine, helped to explain the observed inter-individual variability.
These results should be confirmed in a larger cohort of patients in order to test their relevance in clinical practice.
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Einfluss von unterschiedlichen immunsuppressiven Strategien auf Proliferation, Stoffwechsel und Differenzierung humaner fetaler neuraler Progenitorzellen in vitroGlien, Anja 26 February 2015 (has links) (PDF)
The influence of immunosuppressive drugs on neural stem/progenitor cell fate in vitro.
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Efeito de uma disfunção da barreira glomerular sobre a imunidade inata de células tubulares proximais / Effect of dysfunction acute barrier glomerular on the innate immunity of proximal tubular cellsViviane Dias Faustino 27 March 2018 (has links)
A sobrecarga de proteínas nas células tubulares proximais pode levar a lesão intersticial por mecanismos não claros que podem envolver a ativação da imunidade inata. Nós investigamos a hipótese de que a exposição prolongada de células tubulares a altas concentrações de proteínas estimula a imunidade inata, desencadeando inflamação intersticial progressiva e lesão renal. Além disso, investigamos se a inibição específica da imunidade inata ou adaptativa proporcionaria renoproteção em um modelo estabelecido de proteinúria maciça, nefropatia por adriamicina (ADR). Os ratos adultos Munich-Wistar receberam uma dose única de ADR (5 mg / kg iv), sendo acompanhados por 2, 4 e 20 semanas. A albuminúria maciça foi associada à ativação precoce das vias da imunidade inata NF-?B e NLRP3, cuja intensidade correlacionou-se fortemente com a densidade da infiltração de linfócitos. Além disso, os ratos ADR exibiram sinais claros de estresse oxidativo renal. Vinte semanas após a administração de ADR, observaram-se fibrose intersticial intensa, glomerulosclerose e perda da função renal. A administração de micofenolato de mofetil (MMF), 10 mg / Kg / dia, impediu a ativação da imunidade inata e adaptativa, bem como do estresse oxidativo renal e fibrose renal. Além disso, o tratamento MMF foi associado com a mudança de MØ do tipo M1 para o fenótipo M2. Nas células cultivadas de NRK52-E, o excesso de albumina aumentou o teor de proteína de TLR4, NLRP3, Caspase-1, IL6, IL1-beta, MCP-1, alfa-SMA e COLL-1. O silenciamento do TLR4 e / ou NLRP3 mRNA atenuou esse comportamento proinflamatório / profibrótico. A ativação simultânea de imunidade inata e adaptativa podem ser fundamentais para o desenvolvimento de lesão renal em doenças altamente proteinúricas. A inibição da imunidade inata e/ou adaptativa podem constituir uma estratégia para prevenir a DRC nesse contexto / Protein overload of proximal tubular cells can promote interstitial injury by unclear mechanisms that may involve activation of innate immunity. We investigated the hypothesis that prolonged exposure of tubular cells to high protein concentrations stimulates innate immunity, triggering progressive interstitial inflammation and renal injury. In addition, we investigated whether specific inhibition of innate or adaptive immunity would provide renoprotection in an established model of massive proteinuria, adriamycin (ADR) nephropathy. Adult male Munich-Wistar rats received a single dose of ADR (5 mg/kg iv), being followed for 2, 4 or 20 weeks. Massive albuminuria was associated with early activation of both the NF-kB and NLRP3 innate immunity pathways, whose intensity correlated strongly with the density of lymphocyte infiltration. In addition, ADR rats exhibited clear signs of renal oxidative stress. Twenty weeks after ADR administration, marked interstitial fibrosis, glomerulosclerosis and renal functional loss were observed. Administration of mycophenolate mofetil (MMF), 10 mg/Kg/day, prevented activation of both innate and adaptive immunity, as well as renal oxidative stress and renal fibrosis. Moreover, MMF treatment was associated with shifting of M0 from the M1 to the M2 phenotype. In cultivated NRK52-E cells, excess albumin increased the protein content of TLR4, NLRP3, Caspase-1, IL6, IL- 1beta, MCP-1, alpha-actin and collagen-1. Silencing of TLR4 and/or NLRP3 mRNA abrogated this proinflammatory/profibrotic behavior. Simultaneous activation of innate and adaptive immunity may be key to the development of renal injury in heavily proteinuric disease. Inhibition of innate and/or adaptive immunity may constitute a strategy to prevent CKD in this setting
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Efeitos do micofenolato de sódio no aparelho mucociliar: estudo experimental em ratos / Effects of mycophenolate on mucociliary clearance: experimental study in ratsViviane Ferreira Paes e Silva de Jesus 15 December 2010 (has links)
O transplante pulmonar tem se tornado a opção de tratamento para os pacientes com doença pulmonar terminal. Maiores problemas associados são a rejeição e a infecção; por isso, a importância de se estudar os mecanismos de defesa do aparelho respiratório e o efeito de drogas imunossupressoras sobre o mesmo. O micofenolato de sódio é uma droga imunossupressora que inibe a proliferação dos linfócitos, envolvidos no mecanismo de defesa celular. Objetivo: Avaliar os efeitos do micofenolato de sódio versus solução salina no aparelho mucociliar de ratos. Métodos: Foram utilizados 60 ratos machos Wistar. Todos foram submetidos à cirurgia de secção e anastomose brônquica esquerda. Distribuídos aleatoriamente em dois grupos, um grupo de 30 ratos que recebeu solução salina, pulmão direito controle (S) e pulmão esquerdo operado (SC); enquanto que o segundo grupo recebeu, também por gavagem, micofenolato, pulmão direito controle (M) e pulmão esquerdo operado (MC); até o sacrifício no 7º, 15º e 30º dia de tratamento. Avaliados a frequência do batimento ciliar (FBC), velocidade do transporte mucociliar in vivo (VTMC); e a velocidade de transporte mucociliar in vitro (PLT). Resultados: A FBC é menor no grupo MC em relação ao grupo M, no período de 30 dias (p= 0, 003); e dentro do grupo MC, ao compararmos o 7º e o 30º (p=0, 0001) dia e o 15º e o 30º dia (p=0, 026) de tratamento notamos uma piora da FBC. Em relação à VTMC houve uma melhora no grupo SC no 7º e 30º dia (p=0, 003) e 15º e 30 º dia (p= 0, 005) de tratamento. Comparando o grupo SC e MC no período de 30 dias, verificamos que esta VTMC é menor no segundo grupo (p= 0, 0001). No PLT não houve diferença estatística entre os grupos. Conclusões: O micofenolato associado à secção brônquica diminui a FBC no decorrer do tempo; a VTMC no grupo que recebeu solução salina associado ao procedimento cirúrgico apresentou uma recuperação no decorrer do tempo, o mesmo não foi observado quando associado ao procedimento cirúrgico foi administrado micofenolato; e não houve alteração na qualidade do muco na amostra estudada / The lung transplantation has become the treatment option for the patients with terminal lung illness. Major problems associated are rejection and infection; that´s the reason the importance of studying the mechanism of respiratory system defense and the immunosuppressive drugs effects about itself. The sodium Mycophenolate is an immunosuppressive drug that inhibits the proliferation of lymphocytes, involved in cellular defense mechanism. Purpose: evaluating the sodium Mycophenolate effects versus salt solution in the mucociliary system of rats. Methods: sixty male Wistar rats were used. Every rat was submitted to section surgery and left bronchial anastomosis. The rats were randomly divided: a group of 30 rats which received saline solution; Right lung control (S) and operated Left lung (SC); meanwhile the second group received also by gavage Mycophenolate, Right lung control (M) and Left operated lung (MC); until the sacrifice at the seventh, fifteenth and thirtieth day of treatment. Ciliary beat frequency (CBF) has been evaluated, mucociliary transport speed in vivo (MCTS); and the Velocity of Transport of the Mucociliary in vitro (PLT). Results: the CBF is smaller in the MC group than M group, in thirty days (p=0,003), and inside MC group, when comparing with the seventh and the thirtieth (p=0, 0001) day and the fifteenth and the thirtieth day (p= 0,026) of the treatment we noticed a worsening of CBF. About the MCTS there was an improvement in the SC group in the seventh and the thirtieth day (p=0,003) and the seventh and the thirtieth day (p=0,005) of treatment. The comparing the SC and the MC groups in thirty days we noticed that this MCTS is smaller in the second group (p=0, 0001). In the PLT there were no statistic differences between those groups. Conclusions: the Mycophenolate associated to bronchial section reduces the CBF over time; the MCTS in the group that received salt solution associated to surgical procedure showed recovery, the same was not observed when associated to surgical procedure when submitted to Mycophenolate; and there was not any change in the quality of mucus in the studied sample
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Einfluss von unterschiedlichen immunsuppressiven Strategien auf Proliferation, Stoffwechsel und Differenzierung humaner fetaler neuraler Progenitorzellen in vitro: Einfluss von unterschiedlichen immunsuppressiven Strategien aufProliferation, Stoffwechsel und Differenzierung humaner fetalerneuraler Progenitorzellen in vitroGlien, Anja 15 January 2015 (has links)
The influence of immunosuppressive drugs on neural stem/progenitor cell fate in vitro.
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Einfluss von Cyclodextrinen auf die okulare Verfügbarkeit von Antiglaukomatosa und Immunsuppressiva in vitro / in vivoKnapp-Ulrich, Sigrid Ursula 27 October 2004 (has links)
Die Verwendung von Cyclodextrinen (CDen) als Hilfsstoffe zur topischen Anwendung in der Ophthalmologie hat in den letzten Jahren zunehmend an Bedeutung gewonnen. Hierbei steht die Verbesserung der Wasserlöslichkeit schwerlöslicher Arzneistoffe, die Modifizierung der Bioverfügbarkeit sowie die Verminderung okularer Reizungen im Vordergrund. Diese Arbeit untersuchte die corneale In-vitro-Permeation von Betarezeptorenblockern (partiell mit Pilocarpin kombiniert) im Zusammenhang mit alpha-CD und den hydroxypropylierten (HP) alpha-, beta- bzw. gamma-CD-Derivaten. Der Zusatz von CDen führte teilweise zu einer signifikanten Veränderung der Permeationsparameter, verglichen mit denjenigen der CDfreien Lösungen. Weiterhin wurden das schwerlösliche Prodrug Mycophenolatmofetil (MMF) und die aktive Wirksubstanz Mycophenolsäure (MPA) mit HP-beta-CD in Lösung gebracht und anschließend die Wirkstoffverteilung im Kaninchenauge in vivo bestimmt. Im Vergleich zu einer MMF-Suspension waren die MPA-Spiegel in Cornea und Kammerwasser nach 60 min für die HP-beta-CD-haltige MMF-Lösung deutlich erhöht. Ferner wurden für die neuen, extrem schwer wasserlöslichen Selektiven Glucocorticoid-rezeptoragonisten (SEGRA) - ZK 216771 und ZK 247756 - innovative Augentropfen-formulierungen entwickelt. So wurde ZK 216771 mit Ethanol und HP-gamma-CD in Lösung gebracht und für ZK 247756 eine HP-gamma-CDhaltige Mikroemulsion entwickelt. In beiden Fällen war ein spezielles Herstellungsverfahren erforderlich. ZK 247756 konnte auf diese Weise nach Keratoplastik bei Ratten erfolgreich angewendet werden (signifikante Verlängerung der Transplantatüberlebenszeit im Vergleich zu einer unbehandelten Kontrollgruppe bzw. Vehikelgruppe). / In the past years, cyclodextrins (CDs) became more and more an important excipient for drug formulations. The main use of CDs in ophthalmic drug delivery is to increase the water solubility of lipophilic drugs, to modify drug bioavailability and to reduce ocular irritation. In the present study, the corneal permeability of different betablockers (in part combined with pilocarpine) in the presence of alpha-CD and hydroxypropylated (HP) alpha-, beta- and gamma-CD was examined. Addition of CDs often led to significant changes in permeation parameters, compared to CD-free solutions. The prodrug mycophenolate mofetil and its active drug mycophenolic acid (MPA) were solubilized by HP-beta-CD. The intraocular availability of these solutions was studied in the rabbit eye in vivo in comparison to a MMF-suspension. Applying MMF/HP-beta-CD-solution, the MPA level in cornea and aqueous humour (after 60 min) turned out to be significant higher than those of the MMF-suspension. In addition, for the extremely low soluble selective glucocorticoidreceptor agonists (SEGRA) - ZK 216771 and ZK 247756 - innovative drug formulations were developed. ZK 216771 was solubilized with ethanol and HP-gamma-CD in buffer. A microemulsion, containing also HP-gamma-CD, served as vehicle for ZK 247756. For both formulations, a special manufacturing process was required. In this way, ZK 247756 could be applied in rabbits after corneal transplantation. Topical application of this formulation was highly effective in prolonging the mean survival time of corneal grafts as compared to untreated controls or animals that received the vehicle only.
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Θεραπευτικές παρεμβάσεις στη μεμβρανώδη σπειραματονεφρίτιδα και εκτίμηση της αποτελεσματικότητάς τους με βάση δείκτες εξέλιξης της νόσου / Treatment regimens for membranous glomerulonephritis and evaluation of their effectiveness according to disease progression indicatorsΚουτρούλια, Ελένη 30 March 2015 (has links)
Η Ιδιοπαθής Μεμβρανώδης Σπειραματονεφρίτιδα (ΙΜΣ) ή νεφροπάθεια, η πιο συχνή αιτία νεφρωσικού συνδρόμου στους ενήλικες, συνήθως αντιμετωπίζεται με τη χορήγηση κορτικοειδών και κυτταροτοξικών φαρμάκων ή κυκλοσπορίνης (cyclosporine-A, CsA). Σκοπός της μελέτης ήταν η εκτίμηση της αποτελεσματικότητας της μακροχρόνιας χορήγησης CsA στην πρόκληση ύφεσης του νεφρωσικού συνδρόμου και των ιστολογικών αλλοιώσεων σε επαναληπτικές βιοψίες νεφρού μετά τη χορήγηση του δυνητικά νεφροτοξικού αυτού φαρμάκου. Επιπλέον, εκτιμήθηκε η αποτελεσματικότητα του Mycophenolate Mofetil (MMF) ως σχήματος θεραπείας της ΙΜΣ σε μικρό αριθμό ασθενών και η προγνωστική αξία των επιπέδων του αυξητικού παράγοντα TGF-β1 στα ούρα και στο πλάσμα ως δεικτών εξέλιξης της νόσου.
Μελετήθηκαν 32 ασθενείς με ΙΜΣ οι οποίοι εμφάνιζαν νεφρωσικό σύνδρομο και είχαν ικανοποιητική νεφρική λειτουργία κατά τη διάγνωση της νόσου και στους οποίους χορηγήθηκε συνδυασμός πρεδνιζολόνης και CsA. Παρατηρήθηκε πλήρης ύφεση του νεφρωσικού συνδρόμου σε 18 (56%) και μερική ύφεση σε 10 ασθενείς (31%) μετά από 12 μήνες θεραπείας (συνολικά στο 87% των ασθενών). Επεισόδια υποτροπών παρατηρήθηκαν στο 39% και 60% των ασθενών με πλήρη ή μερική ύφεση αντίστοιχα, και πολλαπλές υποτροπές στο 25% των ασθενών, οι οποίοι παρουσίασαν βαθμιαία μείωση της απαντητικότητας στη CsA και επιδείνωση της νεφρικής λειτουργίας. Επαναληπτική βιοψία νεφρού έγινε σε 18 ασθενείς με ύφεση του νεφρωσικού συνδρόμου μετά από 24 μήνες θεραπείας για να εκτιμηθεί η δραστηριότητα της νόσου και οι πιθανές ιστολογικές αλλοιώσεις σε πλαίσια τοξικότητας από κυκλοσπορίνη. Στις επαναληπτικές βιοψίες παρατηρήθηκαν: εξέλιξη του σταδίου της νόσου, επιδείνωση της σπειραματοσκλήρυνσης και της διαμεσοσωληναριακής βλάβης στο 60% των ασθενών. Δεν παρατηρήθηκαν χαρακτηριστικές αλλοιώσεις νεφροτοξικότητας από την κυκλοσπορίνη. Η βαρύτητα των ιστολογικών αλλαγών συσχετίστηκε με το χρονικό διάστημα που είχε παρέλθει από την πρώτη βιοψία νεφρού (r = 0.452, p < 0.05) και θεωρήθηκε ως φυσική εξέλιξη της νόσου.
Ικανοποιητικά αποτελέσματα διαπιστώθηκαν από τη χορήγηση Mycophenolate Mofetil σε 6 ασθενείς με ΙΜΣ, στους οποίους το MMF χρησιμοποιήθηκε σε συνδυασμό με μικρή δόση πρεδνιζολόνης, είτε λόγω ανθεκτικότητας του νεφρωσικού συνδρόμου στην CsA, είτε ως αρχική θεραπεία σε περιπτώσεις αντένδειξης στην χορήγηση CsA. Ύφεση του νεφρωσικού συνδρόμου παρατηρήθηκε σε 4 από τους 6 ασθενείς.
Τα επίπεδα του TGF-β1 στα ούρα ασθενών με ΙΜΣ και λευκωματουρία ήταν σημαντικά υψηλότερα συγκριτικά με αυτά υγιών εθελοντών και ασθενών με άλλες σπειραματοπάθειες που δεν παρουσίαζαν λευκωματουρία και μειώθηκαν σημαντικά μετά από χορήγηση κορτικοειδών και κυκλοσπορίνης. Η συγκέντρωση του TGF-β1 στο πλάσμα δε διέφερε σημαντικά μεταξύ υγιών εθελοντών και ασθενών με ΙΜΣ και νεφρωσικό σύνδρομο, καθώς και μεταξύ ασθενών με ή χωρίς ύφεση της λευκωματουρίας μετά από τη θεραπευτική αγωγή. / Idiopathic membranous nephropathy (IMN), the most common cause of nephrotic syndrome in adults, is usually treated with a combination of corticosteroids with cytotoxic drugs or cyclosporin A (CsA). The aim of this study was the estimation of the effectiveness of long-term use of CsA in the remission and relapse rate of nephrotic syndrome along with histological changes in repeat renal biopsies after treatment with this potentially nephrotoxic drug, and the evaluation of Mycophenolate Mofetil (MMF) as a treatment regimen for IMN. In addition, urinary and plasma TGF-β1 levels were evaluated as markers of progression of kidney disease.
Thirty-two nephrotic patients with well-preserved renal function treated by prednisolone and CsA were studied. Complete remission of nephrotic syndrome was observed in 18 (56%) and partial remission in 10 patients (31%) after 12 months of treatment (total 87%). Relapses were observed in 39% and 60% of patients with complete and partial remission, respectively, and multiple relapses in 25% of patients, who showed gradual unresponsiveness to CsA and decline of renal function. A repeat biopsy was performed in 18 patients with remission of nephrotic syndrome, after 24 months of treatment, to estimate the activity of the disease and features of CsA toxicity. Progression of the stage of the disease, more severe glomerulosclerosis and tubulointerstitial injury were recognized in 60% of patients in repeat renal biopsies. Features of CsA nephrotoxicity were not observed. The severity of histological changes was related to the time elapsed from the first biopsy (r = 0.452, P < 0.05).
MMF was proved effective in a small number of nephrotic patients with IMN and well-preserved renal function. MMF in combination with small dose of prednisolone was given in 6 patients with either persistent nephrotic syndrome to CsA or as initial therapy because of contraindication to CsA administration. Remission of nephrotic syndrome was observed in 4 out of 6 MMF treated patients.
Urinary and plasma TGF-β1 levels were examined as markers of progression of the disease. TGF-β1 levels in the urine of patients with proteinuria were significantly higher compared with those of healthy individuals and patients with other types of nephropathy without proteinuria. Furthermore, urinary TGF-β1 of nephrotic patients with membranous nephropathy significantly reduced after treatment with CsA and corticosteroids. Plasma TGF-β1 levels showed no difference between patients and healthy subjects as well as between patients with and without remission of proteinuria after treatment.
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Mechanismy patogeneze experimentální autoimunitní uveitidy a možnosti jejich ovlivnění. / The Mechanism of Pathogenesis of Experimental Autoimmune Uveitis and Possilbilities of Their RegulationKlímová, Aneta January 2016 (has links)
Introduction:Uveitis in an ocular inflammation affecting mostly people of working age. Uveitis is responsible for severe visual impairment despite of expanding new therapeutics. The animal models of uveitis were established, because the wide clinical variability of uveitis limits the studies in human medicine. The goal our project was to establish a reproducible model of experimental autoimmune uveitis in Czech Republic, and further on this model to observe the frequency of CD3+ and F4/80+ cells in retina, to assess the influence of microbial environment on intensity of intraocular inflammation and to test the therapeutical possibilities. Material and methods: The C57BL/6J mice were immunized by retinal antigen (IRBP 1-20, interphotoreceptor retinoid binding protein), enhanced by complete Freund's adjuvant and pertussis toxin and mild posterior autoimmune uveitis was induced. The mice were bred in conventional and germ-free (gnotobiotic) conditions. The uveitis intensity was evaluated in vivo biomicroscopically and post mortem histologically on hematoxylin eosin stained sections according to the standard protocol. The histological eye specimen were analyzed also by imunohistochemisty and by flow cytometry. Each experiment was performed for 35 days. The conventional mice with uveitis were treated...
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