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Manole Cojocaru, Inimioara Cojocaru, Isabela Silosi and Camelia Vrabie

Kidney Damage in Autoimmune Diseases

Renal involvement in autoimmunity has many facets. Glomerular, tubular and vascular structures are targeted and damaged as a consequence of autoimmune processes. Immunologically mediated kidney diseases represent the third most common cause of end-stage renal failure (after diabetic and hypertensive nephropathies). Appropriate evalution of patients with immune-mediated kidney diseases requires a meticulous history and physical examination, with particular attention to the urinalysis, tests of renal function and often renal biopsy. The thorough clinician should personally review microscopic urinalysis in any case in which there is a reasonable index of suspicion of immune-mediated renal disease. In this article we propose to highlight recent developments, with particular reference to renal autoimmunity. Systemic lupus erythe-matosus affects many parts of the body: primarily the skin and joints, but also the kidneys. Goodpasture's syndrome involves an autoantibody that specifically targets the kidneys and the lungs. IgA nephropathy is a form of glomerular disease that results when immunoglobulin A (IgA) forms deposits in the glomeruli, where it creates inflammation. Future research could look for how the disease occurs, and how to easily test for its presence so that early treatment could be started.

Open access

Inimioara Cojocaru, Manole Cojocaru, Isabela Silosi and Camelia Vrabie

Central Nervous System Manifestations in Rheumatic Diseases

Patients with multi-system rheumatic conditions may have a disease affecting the central nervous system (CNS). Central nervous system manifestations vary according to the location of the lesion and range from focal findings (e.g., stroke-like presentations), although serious neurological complications in rheumatic disease appear to be rare. The most prominent features of neurological involvement in rheumatic diseases include cerebral ischaemia and psychiatric symptoms. Little information is available on the prevalence of neurological disease in patients with a rheumatological diagnosis. Involvement of the CNS may be a striking early or presenting feature with a wide variety of manifestations. There is more clarity about the CNS syndromes attributable to systemic lupus erythematosus and new insights into the central mechanisms involved in the manifestations of Sjögren's syndrome and rheumatoid arthritis. Severe CNS involvement is associated with poor prognosis, and high mortality rate. We review the spectrum of neurological diseases in patients with a rheumatological diagnosis.

Open access

Manole Cojocaru, Inimioara Cojocaru, Isabela Silosi and Camelia Vrabie

Autoimmune Lymphoproliferative Syndrome

The autoimmune lymphoproliferative syndrome (ALPS) is a rare disease. ALPS is an inherited condition that affects both sexes. ALPS is not cancer, it is not infectious, and its incidence has not yet been estimated. ALPS generally does not lead to death and most individuals with ALPS are able to live normal lives. ALPS is a disorder associated with abnormal lymphocyte apoptosis, lymphoproliferation, and autoimmunity. Serologic testing is critical in the evaluation of these individuals. Lymphoproliferation in ALPS patients is generally benign, but they are at increased risk for the development of Hodgkin's and non-Hodgkin's lymphoma. It is characterized by massive lymphoadenopathy, splenomegaly, autoimmunity including episodes of immune hemolityc anemia, thrombocytopenia, and neutropenia. ALPS patients have lymphocytosis and a number of lymphocyte abnormalities, including the marked expansion of T lymphocytes that express alpha/beta T-cell receptors, but neither CD4 nor CD8 surface markers (TCR alpha/beta+; CD4-; CD8- cells).

Open access

Simona Alexandra Iacob, Eugenia Panaitescu, Diana G. Iacob and Manole Cojocaru

Abstract

Cathelicidin LL37 is an innate immunity antimicrobial peptide involved in the immune modulation of IFN-Abstract Cathelicidin LL37 is an innate immunity antimicrobial peptide involved in the immune modulation of IFN-γ, the key cytokine of T helper cell type 1 (Th1) response. The role of LL37 in viral hepatitis inflammation is unknown. We assessed the serum variations of LL37 and the Th1 response in hepatitis C virus (HCV), hepatitis B virus (HBV) and hepatitis D virus (HDV) infections. The LL37 level (Elisa detection) and Th1 response (defined by IFN-γ level, CD4+ and CD8+ T cell count) were analyzed in 87 patients: 65 hepatitis patients (34 HCV, 18 HBV, 13 HDV) and 22 healthy controls. The subjects, 33 males/ 54 women aged 20-64 years, were selected at "Matei Bals" Institut, Bucharest, Romania. Hepatitis patients were classified according to viral etiology and viral replication as active cases (detectable viremia) versus negative cases (undetectable viremia). Student T test and Mann Whitney analysis were applied. High levels of LL37 (138.09±88.45ng/ml, p=0.045) and IFN-γ (69.82 pg/ml, p=0.005) were detected in the whole group of hepatitis. Active HCV hepatitis presented a significant increase in LL37 level (155.15±78.84ng/ml, p=0.014) and Th1 response by comparison with inactive HCV hepatitis. Conversely active HBV patients displayed low LL37 levels (76.75ng/ml, p=0.009) and no Th1 dominant response by comparison with inactive B hepatitis. High levels of LL37 up to 171.01±72.08 ng/ml and a moderate Th1 response defined HDV patients. Our results highlights increased levels of the cathelicidin LL37 in all viral hepatitis correlated with a strong and concordant immune response in active HCV hepatitis. , the key cytokine of T helper cell type 1 (Th1) response. The role of LL37 in viral hepatitis inflammation is unknown. We assessed the serum variations of LL37 and the Th1 response in hepatitis C virus (HCV), hepatitis B virus (HBV) and hepatitis D virus (HDV) infections. The LL37 level (Elisa detection) and Th1 response (defined by IFN-γ level, CD4+ and CD8+ T cell count) were analyzed in 87 patients: 65 hepatitis patients (34 HCV, 18 HBV, 13 HDV) and 22 healthy controls. The subjects, 33 males/ 54 women aged 20-64 years, were selected at "Matei Bals" Institut, Bucharest, Romania. Hepatitis patients were classified according to viral etiology and viral replication as active cases (detectable viremia) versus negative cases (undetectable viremia). Student T test and Mann Whitney analysis were applied. High levels of LL37 (138.09±88.45ng/ml, p=0.045) and IFN-γ (69.82 pg/ml, p=0.005) were detected in the whole group of hepatitis. Active HCV hepatitis presented a significant increase in LL37 level (155.15±78.84ng/ml, p=0.014) and Th1 response by comparison with inactive HCV hepatitis. Conversely active HBV patients displayed low LL37 levels (76.75ng/ml, p=0.009) and no Th1 dominant response by comparison with inactive B hepatitis. High levels of LL37 up to 171.01±72.08 ng/ml and a moderate Th1 response defined HDV patients. Our results highlights increased levels of the cathelicidin LL37 in all viral hepatitis correlated with a strong and concordant immune response in active HCV hepatitis.