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Revisiones-Clínica-Etiología & Patología *** Reviews-Clinical-Etiology & Pathology

 

INMUNOSUPRESIÓN *** IMMUNOSUPPRESSION

(Conceptos / Keywords: Immunosuppression; Immunosuppressive ag.; Transpl. immunol.; GVH; Antirejection therapy; Lymphocyte depletion; Transpl. conditioning; etc).

 

Enero / January 2001 --- Marzo / March 2004

 

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Enlace / Link

 

[1]

TÍTULO / TITLE:  - Hepcidin: a putative iron-regulatory hormone relevant to hereditary hemochromatosis and the anemia of chronic disease.

REVISTA / JOURNAL:  - Proc Natl Acad Sci U S A. Acceso gratuito al texto completo a partir de los 6 meses de la fecha de publicación.

      ●● Enlace a la Editora de la Revista http://www.pnas.org/ 

      ●● Cita: Proc Natl Acad Sci USA (PNAS): <> 2001 Jul 17;98(15):8160-2.

      ●● Enlace al texto completo (gratuito o de pago) 1073/pnas.161296298

AUTORES / AUTHORS:  - Fleming RE; Sly WS

INSTITUCIÓN / INSTITUTION:  - Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO 63014, USA.  N. Ref:: 30

 

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[2]

TÍTULO / TITLE:  - Beta lactam monotherapy versus beta lactam-aminoglycoside combination therapy for sepsis in immunocompetent patients: systematic review and meta-analysis of randomised trials.

REVISTA / JOURNAL:  - British Medical J (BMJ). Acceso gratuito al texto completo.

      ●● Enlace a la Editora de la Revista http://bmj.com/search.dtl 

      ●● Cita: British Medical J. (BMJ): <> 2004 Mar 20;328(7441):668. Epub 2004 Mar 2.

      ●● Enlace al texto completo (gratuito o de pago) 1136/bmj.38028.520995.63

AUTORES / AUTHORS:  - Paul M; Benuri-Silbiger I; Soares-Weiser K; Leibovici L

INSTITUCIÓN / INSTITUTION:  - Department of Medicine E and Infectious Diseases Unit, Rabin Medical Centre, Beilinson Campus, Petah-Tikva 49100, Israel. mica@zahav.net.il

RESUMEN / SUMMARY:  - OBJECTIVE: To compare beta lactam monotherapy with beta lactam-aminoglycoside combination therapy for severe infections. DATA SOURCES: Medline, Embase, Lilacs, Cochrane Library, and conference proceedings, to 2003; references of included studies; contact with all authors. No restrictions, such as language, year of publication, or publication status. STUDY SELECTION: All randomised trials of beta lactam monotherapy compared with beta lactam-aminoglycoside combination therapy for patients without neutropenia who fulfilled criteria for sepsis. DATA SELECTION: Two reviewers independently applied selection criteria, performed quality assessment, and extracted the data. The primary outcome assessed was all cause fatality by intention to treat. Relative risks were pooled with the random effect model (relative risk < 1 favours monotherapy). RESULTS: 64 trials with 7586 patients were included. There was no difference in all cause fatality (relative risk 0.90, 95% confidence interval 0.77 to 1.06). 12 studies compared the same beta lactam (1.02, 0.76 to 1.38), and 31 studies compared different beta lactams (0.85, 0.69 to 1.05). Clinical failure was more common with combination treatment overall (0.87, 0.78 to 0.97) and among studies comparing different beta lactams (0.76, 0.68 to 0.86). There was no advantage to combination therapy among patients with Gram negative infections (1835 patients) or Pseudomonas aeruginosa infections (426 patients). There was no difference in the rate of development of resistance. Nephrotoxicity was significantly more common with combination therapy (0.36, 0.28 to 0.47). Heterogeneity was not significant for these comparisons. CONCLUSIONS: In the treatment of sepsis the addition of an aminoglycoside to beta lactams should be discouraged. Fatality remains unchanged, while the risk for adverse events is increased.  N. Ref:: 26

 

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[3]

TÍTULO / TITLE:  - Immunopathogenesis and immunotherapy in AIDS virus infections.

REVISTA / JOURNAL:  - Nat Med 2003 Jul;9(7):861-6.

      ●● Enlace al texto completo (gratuito o de pago) 1038/nm0703-861

AUTORES / AUTHORS:  - Letvin NL; Walker BD

INSTITUCIÓN / INSTITUTION:  - Division of Viral Pathogenesis, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.

RESUMEN / SUMMARY:  - The heterogeneity of HIV and the different human leukocyte antigen (HLA) backgrounds of infected individuals have posed challenges to understanding the pathogenesis of HIV infection. But continuing advances in our knowledge of the role of immune responses in controlling HIV viremia should help to define goals for immune-based therapies and vaccine strategies against AIDS.  N. Ref:: 106

 

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[4]

TÍTULO / TITLE:  - Integration of growth factor and nutrient signaling: implications for cancer biology.

REVISTA / JOURNAL:  - Mol Cell 2003 Aug;12(2):271-80.

AUTORES / AUTHORS:  - Shamji AF; Nghiem P; Schreiber SL

INSTITUCIÓN / INSTITUTION:  - Harvard Biophysics Program, Harvard University, 12 Oxford Street, Cambridge, MA 02138, USA.

RESUMEN / SUMMARY:  - Signaling networks that promote cell growth are frequently dysregulated in cancer. One regulatory network, which converges on effectors such as 4EBP1 and S6K1, leads to growth by promoting protein synthesis. Here, we discuss how this network is regulated by both extracellular signals, such as growth factors, and intracellular signals, such as nutrients. We discuss how mutations amplifying either type of signal can lead to tumor formation. In particular, we focus on the recent discovery that a tumor suppressor complex whose function is lost in tuberous sclerosis patients regulates the nutrient signal carried by the critical signaling protein TOR to the effectors 4EBP1 and S6K1. Finally, we describe how the small molecule rapamycin, which inhibits TOR and thereby the activation of these effectors, could be useful to treat tumors that have become dependent upon this pathway for growth.  N. Ref:: 80

 

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[5]

TÍTULO / TITLE:  - Defying death—HIV mutation to evade cytotoxic T lymphocytes.

REVISTA / JOURNAL:  - N Engl J Med. Acceso gratuito al texto completo a partir de los 6 meses de la fecha de publicación.

      ●● Enlace a la Editora de la Revista http://content.nejm.org/ 

      ●● Cita: New England J Medicine (NEJM): <> 2002 Oct 10;347(15):1203-4.

      ●● Enlace al texto completo (gratuito o de pago) 1056/NEJMcibr022067

AUTORES / AUTHORS:  - Lieberman J

INSTITUCIÓN / INSTITUTION:  - Center for Blood Research, Boston, MA 02115, USA.  N. Ref:: 5

 

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[6]

TÍTULO / TITLE:  - Dendritic cells: emerging pharmacological targets of immunosuppressive drugs.

REVISTA / JOURNAL:  - Nat Rev Immunol 2004 Jan;4(1):24-34.

      ●● Enlace al texto completo (gratuito o de pago) 1038/nri1256

AUTORES / AUTHORS:  - Hackstein H; Thomson AW

INSTITUCIÓN / INSTITUTION:  - Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig University Giessen, Langhansstr. 7, D-35392 Giessen, Germany. holger.hackstein@immunologie.med.uni-giessen.de

RESUMEN / SUMMARY:  - Immunosuppressive drugs have revolutionized organ transplantation and improved the therapeutic management of autoimmune diseases. The development of immunosuppressive drugs and understanding of their action traditionally has been focused on lymphocytes, but recent evidence indicates that these agents interfere with immune responses at the earliest stage, targeting key functions of dendritic cells (DCs). Here, we review our present understanding of how classical and new immunosuppressive agents interfere with DC development and function. This knowledge might provide a rational basis for the selection of immunosuppressive drugs in different clinical settings and for the generation of tolerogenic DCs in the laboratory.  N. Ref:: 116

 

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[7]

TÍTULO / TITLE:  - Impact of shared epitope genotype and ethnicity on erosive disease: a meta-analysis of 3,240 rheumatoid arthritis patients.

REVISTA / JOURNAL:  - Arthritis Rheum 2004 Feb;50(2):400-12.

      ●● Enlace al texto completo (gratuito o de pago) 1002/art.20006

AUTORES / AUTHORS:  - Gorman JD; Lum RF; Chen JJ; Suarez-Almazor ME; Thomson G; Criswell LA

INSTITUCIÓN / INSTITUTION:  - University of California, San Francisco, CA 94143-0500, USA. lac@itsa.ucsf.edu

RESUMEN / SUMMARY:  - OBJECTIVE: The strongest known genetic association in rheumatoid arthritis (RA) is with HLA-DRB1 alleles that share a similar amino acid sequence, termed the shared epitope (SE). Although many studies have examined the association of the SE with disease severity, the results have been inconsistent, which may reflect the relatively small sample sizes or ethnic differences. The aim of this study was to assess the association of HLA-DRB1 SE alleles and genotype with the development of bony erosions in RA by meta-analysis. METHODS: We identified English-language articles published between January 1, 1987 and June 1, 1999 through Medline, EMBase, and manual searches of 6 relevant journals. Included were studies in which molecular typing of HLA-DRB1 alleles was performed and in which the presence or absence of bony erosions was reported. Data were extracted from the studies, and erosions were coded as present or absent. Authors were contacted for missing information and data on individual patients. RESULTS: A total of 29 studies and 3,240 patients were available for analysis. The summary odds ratios (ORs), when all patients were evaluated as a single group, demonstrated a significant association of the presence of the SE (2 or 1 versus 0 SE alleles) with erosions (OR 2.0; 95% confidence interval [95% CI] 1.8-2.2), although significant heterogeneity was present (P = 0.002). Subgroup analyses demonstrated the important influence of ethnic background. For example, no association of the SE with erosions was demonstrated in Greeks (OR 0.8 [95% CI 0.2-1.5]). In contrast, there was a striking dose-dependent relationship in southern European Caucasians and Asians, with ORs as high as 6.2 and 5.4, respectively, in patients with 2 SE alleles. Although our ability to assess the relationship between SE genotype and erosions was limited, particular importance of the DRB1*0401 SE allele was suggested in an analysis restricted to northern European Caucasians. CONCLUSION: The SE is associated with the development of erosive disease in many ethnic groups; however, striking exceptions exist. These variations may be due to allele differences between populations, such as the frequency of DRB1*0401 among different ethnic groups. Further study to better understand the genetic and environmental differences between these populations may provide insight into mechanisms that influence the clinical expression of RA.

 

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[8]

TÍTULO / TITLE:  - Routes to transplant tolerance versus rejection; the role of cytokines.

REVISTA / JOURNAL:  - Immunity 2004 Feb;20(2):121-31.

AUTORES / AUTHORS:  - Walsh PT; Strom TB; Turka LA

INSTITUCIÓN / INSTITUTION:  - University of Pennsylvania, 700 Clinical Research Building, 415 Curie Boulevard, Philadelphia, PA 19104, USA.

RESUMEN / SUMMARY:  - The alloimmune response can be divided into specific junctures where critical decisions between tolerance and immunity are made which define the outcome of the transplant. At these “decision nodes” various cytokines direct alloresponsive T cells to develop either a proinflammatory response aimed at graft destruction or an immunoregulatory response facilitating graft acceptance. This review will focus on the role of these cytokines in influencing the progression of an alloimmune response leading ultimately to either allograft survival or rejection.  N. Ref:: 97

 

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[9]

TÍTULO / TITLE:  - Microchimerism: an investigative frontier in autoimmunity and transplantation.

REVISTA / JOURNAL:  - JAMA. Acceso gratuito al texto completo.

      ●● Enlace a la Editora de la Revista http://jama.ama-assn.org/search.dtl 

      ●● Cita: JAMA: <> 2004 Mar 3;291(9):1127-31.

      ●● Enlace al texto completo (gratuito o de pago) 1001/jama.291.9.1127

AUTORES / AUTHORS:  - Adams KM; Nelson JL

INSTITUCIÓN / INSTITUTION:  - Program in Human Immunogenetics, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.

RESUMEN / SUMMARY:  - Recent studies indicate cells transfer between fetus and mother during pregnancy and can persist in both decades later. The presence within one individual of a small population of cells from another genetically distinct individual is referred to as microchimerism. Naturally acquired microchimerism has recently been investigated in autoimmune diseases, including scleroderma, thyroiditis, primary biliary cirrhosis, Sjogren syndrome, systemic lupus, dermatomyositis, and neonatal lupus. Iatrogenic chimerism has been investigated in transplantation and following blood transfusion. Considering findings of naturally acquired microchimerism along with iatrogenic microchimerism suggests microchimerism can have detrimental and/or beneficial effects in both settings. Recent identification of tissue-specific microchimerism either from naturally acquired or iatrogenic microchimerism (eg, cardiac myocytes) raises the possibility that microchimerism can be a target of autoimmunity or alternatively contribute to tissue repair. Advances in this new frontier of research with varied and numerous implications for human health are summarized.  N. Ref:: 26

 

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[10]

TÍTULO / TITLE:  - The allogeneic response and tumor immunity.

REVISTA / JOURNAL:  - Nat Med 2001 Jun;7(6):649-52.

      ●● Enlace al texto completo (gratuito o de pago) 1038/89008

AUTORES / AUTHORS:  - Fabre JW

INSTITUCIÓN / INSTITUTION:  - Department of Clinical Sciences, Institute of Liver Studies Guy’s, King’s and St Thomas’ School of Medicine, London, UK. john.fabre@kcl.ac.uk

RESUMEN / SUMMARY:  - The strong allogeneic response to donor MHC molecules in transplantation and the weak response to tumor antigens represent two important and divergent but potentially interactive immune responses. A patient’s response to allogeneic MHC molecules might promote an effective T-cell response to self MHC-restricted tumor peptides and the possibilities for this are discussed here. These allogeneic responses might successfully be harnessed to promote the immune eradication of metastatic cancer.  N. Ref:: 45

 

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[11]

TÍTULO / TITLE:  - Skin cancers after organ transplantation.

REVISTA / JOURNAL:  - N Engl J Med. Acceso gratuito al texto completo a partir de los 6 meses de la fecha de publicación.

      ●● Enlace a la Editora de la Revista http://content.nejm.org/ 

      ●● Cita: New England J Medicine (NEJM): <> 2003 Apr 24;348(17):1681-91.

      ●● Enlace al texto completo (gratuito o de pago) 1056/NEJMra022137

AUTORES / AUTHORS:  - Euvrard S; Kanitakis J; Claudy A

INSTITUCIÓN / INSTITUTION:  - Department of Dermatology, Edouard Herriot Hospital, Lyons, France. sylvie.euvrard@numericable.fr  N. Ref:: 100

 

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[12]

TÍTULO / TITLE:  - Haematopoietic cell transplantation as immunotherapy.

REVISTA / JOURNAL:  - Nature 2001 May 17;411(6835):385-9.

      ●● Enlace al texto completo (gratuito o de pago) 1038/35077251

AUTORES / AUTHORS:  - Appelbaum FR

INSTITUCIÓN / INSTITUTION:  - Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D5-310, PO Box 19024, Seattle, Washington 98109-1024, USA.

RESUMEN / SUMMARY:  - The graft-versus-tumour effect seen after allogeneic (genetically different) haematopoietic cell transplantation for human malignancies represents the clearest example of the power of the human immune system to eradicate cancer. Recent advances in our understanding of the immunobiology of stem-cell engraftment, tolerance and tumour eradication are allowing clinicians to better harness this powerful effect.  N. Ref:: 60

 

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[13]

TÍTULO / TITLE:  - Lack of association of the HLA-DRB1 shared epitope with rheumatoid nodules: an individual patient data meta-analysis of 3,272 Caucasian patients with rheumatoid arthritis.

REVISTA / JOURNAL:  - Arthritis Rheum 2004 Mar;50(3):753-62.

      ●● Enlace al texto completo (gratuito o de pago) 1002/art.20119

AUTORES / AUTHORS:  - Gorman JD; David-Vaudey E; Pai M; Lum RF; Criswell LA

INSTITUCIÓN / INSTITUTION:  - University of California, San Francisco, and School of Public Health, University of California, Berkeley.

RESUMEN / SUMMARY:  - OBJECTIVE: The objective of this individual patient data (IPD) meta-analysis was to examine the relationship of rheumatoid nodules to the HLA-DRB1 shared epitope (SE) and to individual SE genotypes. METHODS: English-language studies that enrolled adult non-Hispanic Caucasian patients with rheumatoid arthritis (RA) were identified by searches of Medline and Embase, and by manual searches of medical journals. All authors were contacted for IPD. Meta-analysis was performed to assess the association of SE presence, dose, and genotype with rheumatoid nodules. Meta-analyses adjusted for disease duration and cumulative meta-analyses were also performed to assess the influence of RA duration and year of study publication on the results. RESULTS: A total of 24 studies and 3,272 patients were available for analysis. IPD were obtained for 22 of the studies. There was a nonsignificant association between the presence of the SE (i.e., 1 or 2 alleles versus 0 alleles) and rheumatoid nodules (summary odds ratio [OR] 1.3, 95% confidence interval [95% CI] 0.97-1.6). Analysis by SE genotype, however, demonstrated a weak relationship with inheritance of a single DRB1*0401 SE allele (OR 1.4, 95% CI 1.1-1.8). No other genotypes achieved statistical significance in the adjusted or unadjusted analyses. CONCLUSION: The presence of the HLA-DRB1 SE does not appear to significantly increase the risk of rheumatoid nodules among Caucasian patients with RA. Analysis by DRB1 SE genotype was uninformative, suggesting only a potential (and at most modest) role of the DRB1*0401 SE allele. Results from this IPD meta-analysis implicate other genetic, stochastic, and/or environmental factors in the susceptibility to rheumatoid nodules.

 

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[14]

TÍTULO / TITLE:  - Chronic graft-vs-host disease.

REVISTA / JOURNAL:  - JAMA. Acceso gratuito al texto completo.

      ●● Enlace a la Editora de la Revista http://jama.ama-assn.org/search.dtl 

      ●● Cita: JAMA: <> 2003 Nov 19;290(19):2599-603.

      ●● Enlace al texto completo (gratuito o de pago) 1001/jama.290.19.2599

AUTORES / AUTHORS:  - Bhushan V; Collins RH Jr

INSTITUCIÓN / INSTITUTION:  - Hematopoietic Cell Transplantation Program, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75390-8852, USA.  N. Ref:: 26

 

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[15]

TÍTULO / TITLE:  - Interferon-gamma reduces interleukin-4- and interleukin-13-augmented transforming growth factor-beta2 production in human bronchial epithelial cells by targeting Smads.

REVISTA / JOURNAL:  - Chest. Acceso gratuito al texto completo a partir de 1 año de la fecha de publicación.

      ●● Enlace a la Editora de la Revista http://www.chestjournal.org/ 

      ●● Cita: Chest: <> 2003 Mar;123(3 Suppl):372S-3S.

AUTORES / AUTHORS:  - Wen FQ; Liu XD; Terasaki Y; Fang QH; Kobayashi T; Abe S; Rennard SI

INSTITUCIÓN / INSTITUTION:  - Pulmonary and Critical Care Medicine Section, University of Nebraska Medical Center, Omaha, NE 68198-5125, USA.  N. Ref:: 0

 

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[16]

TÍTULO / TITLE:  - When the lymphocyte loses its clothes.

REVISTA / JOURNAL:  - Immunity 2003 Apr;18(4):453-7.

AUTORES / AUTHORS:  - Nekrep N; Fontes JD; Geyer M; Peterlin BM

INSTITUCIÓN / INSTITUTION:  - Institute of Biochemistry, Medical Faculty of the University of Ljubljana, Slovenia.

RESUMEN / SUMMARY:  - The type II bare lymphocyte syndrome (BLS) or major histocompatibility complex class II (MHCII) deficiency is a severe combined immunodeficiency (SCID) that is characterized by the absence of constitutive and inducible expression of MHCII determinants on immune cells. Four complementation groups of BLS have been defined, and they result from mutations in DNA-bound activators and the coactivator for MHCII transcription. Recently, all complementation groups of BLS patients have been accounted for. Studies of the syndrome and specific mutations reveal important lessons for the genetics of the immune response.  N. Ref:: 35

 

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[17]

TÍTULO / TITLE:  - Ex vivo selection of recipient-type alloantigen-specific CD4(+)CD25(+) immunoregulatory T cells for the control of graft-versus-host disease after allogeneic hematopoietic stem-cell transplantation.

REVISTA / JOURNAL:  - Transplantation 2004 Jan 15;77(1 Suppl):S32-4.

      ●● Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000106470.07410.CA

AUTORES / AUTHORS:  - Trenado A; Fisson S; Braunberger E; Klatzmann D; Salomon BL; Cohen JL

INSTITUCIÓN / INSTITUTION:  - Biologie et Therapeutique des Pathologies Immunitaires, Hopital Pitie-Salpetriere, Paris, France.

RESUMEN / SUMMARY:  - Allogeneic hematopoietic stem-cell transplantation (HSCT) is the treatment of choice for many malignant and nonmalignant hematologic disorders. Donor T cells present in the hematopoietic stem-cell transplant improve engraftment and immune reconstitution and contribute to the graft-versus-leukemia effect, but are also responsible for the life-threatening graft-versus-host disease (GVHD). CD4(+)CD25(+) immunoregulatory T cells, which play a pivotal role in preventing organ-specific diseases, can also modulate GVHD if administered in equal numbers of T cells at the time of grafting. In this article, the authors describe a procedure of ex vivo selection and expansion of regulatory T cells specific for recipient-type alloantigens. These expanded regulatory T cells controlled GVHD. Their therapeutic use in HSCT should allow specific suppression of the activation of donor alloreactive T cells involved in GVHD while preserving the beneficial effects of other T cells.  N. Ref:: 27

 

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[18]

TÍTULO / TITLE:  - Hemochromatosis gene modifies course of hepatitis C viral infection.

REVISTA / JOURNAL:  - Gastroenterology 2003 May;124(5):1509-23.

AUTORES / AUTHORS:  - Pietrangelo A

INSTITUCIÓN / INSTITUTION:  - Department of Internal Medicine, Centre for Hemochromatosis and Metabolic Liver Diseases, University of Modena and Reggio Emilia, Modeno, Italy. antonello@unimore.it  N. Ref:: 161

 

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[19]

- Castellano -

TÍTULO / TITLE:La ruta de senalizacion CA++/calcineurina/NFAT en activacion endotelial y angiogenesis: efectos de la ciclosporina A. CA++/ calcineurin/NFAT signaling in endothelial activation and angiogenesis: effects od cyclosporin A .

REVISTA / JOURNAL:  - Nefrologia. Acceso gratuito al texto completo.

      ●● Enlace a la Editora de la Revista http://www.aulamedica.es/nefrologia/ 

      ●● Cita: Nefrologia: <> 2003;23 Suppl 3:44-8.

AUTORES / AUTHORS:  - Quesada AJ; Redondo JM

INSTITUCIÓN / INSTITUTION:  - Centro de Biologia Molecular Severo Ochoa, Consejo Superior de Investigaciones Cientificas, Universidad Autonoma de Madrid y Centro Nacional de Investigaciones Cardiovasculares (CNIC), Sinesio Delgado, 4 28049 Cantoblanco, Madrid. jmredondo@cbm.uam.es  N. Ref:: 31

 

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[20]

TÍTULO / TITLE:  - Regulating the immune response to transplants. a role for CD4+ regulatory cells?

REVISTA / JOURNAL:  - Immunity 2001 Apr;14(4):399-406.

AUTORES / AUTHORS:  - Waldmann H; Cobbold S

INSTITUCIÓN / INSTITUTION:  - Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford OX1 3RE, United Kingdom. herman.waldmann@path.ox.ac.uk  N. Ref:: 50

 

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[21]

TÍTULO / TITLE:  - Dendritic cells in transplantation—friend or foe?

REVISTA / JOURNAL:  - Immunity 2001 Apr;14(4):357-68.

AUTORES / AUTHORS:  - Lechler R; Ng WF; Steinman RM

INSTITUCIÓN / INSTITUTION:  - Department of Immunology, Division of Medicine, Hammersmith Hospital, Imperial College School of Medicine, Du Cane Road, London W12 ONN, United Kingdom. r.lechler@ic.ac.uk  N. Ref:: 80

 

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[22]

TÍTULO / TITLE:  - Nystatin prophylaxis and treatment in severely immunodepressed patients.

REVISTA / JOURNAL:  - Cochrane Database Syst Rev 2002;(4):CD002033.

AUTORES / AUTHORS:  - Gotzsche PC; Johansen HK

INSTITUCIÓN / INSTITUTION:  - The Nordic Cochrane Centre, Rigshospitalet, Dept. 7112, Blegdamsvej 9, Copenhagen O, Denmark, 2100. p.c.gotzsche@cochrane.dk

RESUMEN / SUMMARY:  - BACKGROUND: Nystatin is sometimes used prophylactically in patients with severe immunodeficiency or in the treatment of fungal infection in such patients, although the effect seems to be equivocal. OBJECTIVES: To study whether nystatin decreases morbidity and mortality when given prophylactically or therapeutically to patients with severe immunodeficiency. SEARCH STRATEGY: MEDLINE and The Cochrane Library using a comprehensive search strategy, date of last search November 2001. Contacted industry and scanned reference lists. SELECTION CRITERIA: Randomised trials comparing nystatin with placebo, an untreated control group, fluconazole or amphotericin B. DATA COLLECTION AND ANALYSIS: Data on mortality, invasive fungal infection and colonisation were extracted by both authors independently. A random effects model was used unless p>0.10 for the test of heterogeneity. MAIN RESULTS: We included 12 trials (1,464 patients). The drugs were given prophylactically in ten trials and as treatment in two. Seven trials were in acute leukaemia, two in cancer, one in liver transplant patients, one in critically ill surgical and trauma patients, and one in AIDS patients. Nystatin had been compared with placebo in three trials and with fluconazole in nine; the dose varied from 1.5 MIE to 72 MIE daily. The effect of nystatin was similar to that of placebo on fungal colonisation (relative risk 0.85, 95% confidence interval 0.65 to 1.13). There was no statistically significant difference between fluconazole and nystatin on mortality (relative risk 0.76, 0.49 to 1.18) whereas fluconazole was more effective in preventing invasive fungal infection (relative risk 0.37, 0.15 to 0.91) and colonisation (relative risk 0.49, 0.34 to 0.70). The results were very similar if the three studies which were not performed in cancer patients were excluded. REVIEWER’S CONCLUSIONS: Nystatin cannot be recommended for prophylaxis or treatment of Candida infections in immunodepressed patients.  N. Ref:: 22

 

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[23]

TÍTULO / TITLE:  - Immune tolerance after long-term enzyme-replacement therapy among patients who have mucopolysaccharidosis I.

REVISTA / JOURNAL:  - Lancet 2003 May 10;361(9369):1608-13.

AUTORES / AUTHORS:  - Kakavanos R; Turner CT; Hopwood JJ; Kakkis ED; Brooks DA

INSTITUCIÓN / INSTITUTION:  - Lysosomal Diseases Research Unit, Department of Chemical Pathology, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia

RESUMEN / SUMMARY:  - BACKGROUND: Enzyme-replacement therapy has been assessed as a treatment for patients who have mucopolysaccharidosis I (alpha-L-iduronidase deficiency). We aimed to investigate the humoral immune response to recombinant human alpha-L-iduronidase among these patients. METHODS: We characterised the antibody titres and specific linear sequence epitope reactivity of serum antibodies to alpha-L-iduronidase for ten patients with mucopolysaccharidosis I, at the start of treatment and after 6, 12, 26, 52, and 104 weeks. We compared the values for patients’ samples with those for samples from normal human controls. FINDINGS: Before enzyme-replacement therapy, all patients had low serum antibody titres to recombinant human alpha-L-iduronidase that were within the control range. Five of the ten patients produced higher-than-normal titres of antibody to the replacement protein during the treatment course (serum antibody titres 130000-500000 and high-affinity epitope reactivity). However, by week 26, antibody reactivity was reduced, and by week 104 all patients had low antibody titres and only low-affinity epitope reactivity. Patients who had mucopolysaccharidosis I with antibody titres within the normal range at 6-12 weeks did not subsequently develop immune responses. INTERPRETATION: After 2 years of treatment, patients who initially had an immune reaction developed immune tolerance to alpha-L-iduronidase. This finding has positive implications for long-term enzyme-replacement therapy in patients who have mucopolysaccharidosis I.  N. Ref:: 32

 

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[24]

TÍTULO / TITLE:  - Interleukin-2 receptor monoclonal antibodies in renal transplantation: meta-analysis of randomised trials.

REVISTA / JOURNAL:  - British Medical J (BMJ). Acceso gratuito al texto completo.

      ●● Enlace a la Editora de la Revista http://bmj.com/search.dtl 

      ●● Cita: British Medical J. (BMJ): <> 2003 Apr 12;326(7393):789.

      ●● Enlace al texto completo (gratuito o de pago) 1136/bmj.326.7393.789

AUTORES / AUTHORS:  - Adu D; Cockwell P; Ives NJ; Shaw J; Wheatley K

INSTITUCIÓN / INSTITUTION:  - Department of Nephrology, Queen Elizabeth Hospital, Birmingham, B15 2TH. dwomoa.adu@uhb.nhs.uk

RESUMEN / SUMMARY:  - OBJECTIVE: To study the effect of interleukin-2 receptor monoclonal antibodies on acute rejection episodes, graft loss, deaths, and rate of infection and malignancy in patients with renal transplants. DESIGN: Meta-analysis of published data. DATA SOURCES: Medline, Embase, and Cochrane library for years 1996-2003 plus search of medical editors’ trial amnesty and contact with manufacturers of the antibodies. SELECTION OF STUDIES: Randomised controlled trials comparing interleukin-2 receptor antibodies with placebo or no additional treatment in patients with renal transplants receiving ciclosporin based immunosuppression. RESULTS: Eight randomised controlled trials involving 1871 patients met the selection criteria (although only 1858 patients were analysed). Interleukin-2 receptor antibodies significantly reduced the risk of acute rejection (odds ratio 0.51, 95% confidence interval 0.42 to 0.63). There were no significant differences in the rate of graft loss (0.78, 0.58 to 1.04), mortality (0.75, 0.46 to 1.23), overall incidence of infections (0.97, 0.77 to 1.24), incidence of cytomegalovirus infections (0.81, 0.62 to 1.04), or risk of malignancies at one year (0.82, 0.39 to 1.70). The different antibodies had a similar sized effect on acute rejection (test for heterogeneity P=0.7): anti-Tac (0.37, 0.16 to 0.89), BT563 (0.37, 0.1 to 1.38), basiliximab (0.56, 0.44 to 0.72), and daclizumab (0.46, 0.32 to 0.67). The reduction in acute rejections was similar for all ciclosporin based immunosuppression regimens (test for heterogeneity P=1.0). CONCLUSIONS: Adding interleukin-2 receptor antibodies to ciclosporin based immunosuppression reduces episodes of acute rejection at six months by 49%. There is no evidence of an increased risk of infective complications. Longer follow up studies are needed to confirm whether interleukin-2 receptor antibodies improve long term graft and patient survival.

 

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[25]

TÍTULO / TITLE:  - Regulatory T cells in transplantation tolerance.

REVISTA / JOURNAL:  - Nat Rev Immunol 2003 Mar;3(3):199-210.

      ●● Enlace al texto completo (gratuito o de pago) 1038/nri1027

AUTORES / AUTHORS:  - Wood KJ; Sakaguchi S

INSTITUCIÓN / INSTITUTION:  - Nuffield Department of Surgery, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK. kathryn.wood@nds.ox.ac.uk

RESUMEN / SUMMARY:  - The identification and characterization of regulatory T (T(Reg)) cells that can control immune responsiveness to alloantigens have opened up exciting opportunities for new therapies in transplantation. After exposure to alloantigens in vivo, alloantigen-specific immunoregulatory activity is enriched in a population of CD4+ T cells that express high levels of CD25. In vivo, common mechanisms seem to underpin the activity of CD4+CD25+ T(Reg) cells in both naive and manipulated hosts. However, the origin, allorecognition properties and molecular basis for the suppressive activity of CD4+CD25+ T(Reg) cells, as well as their relationship to other populations of regulatory cells that exist after transplantation, remain a matter of debate.  N. Ref:: 138

 

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[26]

TÍTULO / TITLE:  - Interleukin 2 receptor antagonists for renal transplant recipients: a meta-analysis of randomized trials.

REVISTA / JOURNAL:  - Transplantation 2004 Jan 27;77(2):166-76.

      ●● Enlace al texto completo (gratuito o de pago) 1097/01.TP.0000109643.32659.C4

AUTORES / AUTHORS:  - Webster AC; Playford EG; Higgins G; Chapman JR; Craig JC

INSTITUCIÓN / INSTITUTION:  - Cochrane Renal Group, Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, NSW, Australia.

RESUMEN / SUMMARY:  - BACKGROUND: Interleukin 2 receptor antagonists (IL-2Ra) are increasingly used to treat renal transplant recipients. This study aims to systematically identify and summarize the effects of using IL-2Ra as induction immunosuppression, as an addition to standard therapy, or as an alternative to other antibody therapy. METHODS: Databases, reference lists, and abstracts of conference proceedings were searched extensively to identify relevant randomized controlled trials in all languages. Data were synthesized using the random effects model. Results are expressed as relative risk (RR), with 95% confidence intervals (CI). RESULTS: A total of 117 reports from 38 trials involving 4,893 participants were included. When IL-2Ra were compared with placebo (17 trials; 2,786 patients), graft loss was not significantly different at 1 year (14 trials: RR 0.84; CI 0.64-1.10) or 3 years (4 trials: RR 1.08; CI 0.71-1.64). Acute rejection was significantly reduced at 6 months (12 trials: RR 0.66; CI 0.59-0.74) and at 1 year (10 trials: RR 0.67; CI 0.60-0.75). At 1 year, cytomegalovirus infection (7 trials: RR 0.82; CI 0.65-1.03) and malignancy (9 trials: RR 0.67; CI 0.33-1.36) were not significantly different. When IL-2Ra were compared with other antibody therapy, no significant differences in treatment effects were demonstrated, but IL-2Ra had significantly fewer side effects. CONCLUSIONS: Given a 40% risk of rejection, seven patients would need treatment with IL-2Ra in addition to standard therapy, to prevent one patient from undergoing rejection, with no definite improvement in graft or patient survival. There is no apparent difference between basiliximab and daclizumab.

 

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[27]

TÍTULO / TITLE:  - Tolerance and autoimmunity.

REVISTA / JOURNAL:  - N Engl J Med. Acceso gratuito al texto completo a partir de los 6 meses de la fecha de publicación.

      ●● Enlace a la Editora de la Revista http://content.nejm.org/ 

      ●● Cita: New England J Medicine (NEJM): <> 2001 Mar 1;344(9):655-64.

AUTORES / AUTHORS:  - Kamradt T; Mitchison NA

INSTITUCIÓN / INSTITUTION:  - Deutsches Rheumaforschungszentrum Berlin and Universitatsklinikum Charite, Medizinische Klinik mit Schwerpunkt Rheumatologie and Klinische Immunologie, Germany. kamradt@drfz.de  N. Ref:: 151

 

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[28]

TÍTULO / TITLE:  - Organ-specific autoimmune disease: a deficiency of tolerogenic stimulation.

REVISTA / JOURNAL:  - J Exp Med. Acceso gratuito al texto completo a partir de los 2 años de la fecha de publicación.

      ●● Enlace a la Editora de la Revista http://www.jem.org/ 

      ●● Cita: J. Exp Med: <> 2001 Sep 3;194(5):F31-6.

AUTORES / AUTHORS:  - Lesage S; Goodnow CC

INSTITUCIÓN / INSTITUTION:  - Australian Cancer Research Foundation Genetics Lab, Medical Genome Centre, John Curtin School of Medical Research, Canberra, ACT 2601, Australia.  N. Ref:: 35

 

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[29]

TÍTULO / TITLE:  - Genetic interaction of CTLA-4 with HLA-DR15 in multiple sclerosis patients.

REVISTA / JOURNAL:  - Ann Neurol 2003 Jul;54(1):119-22.

      ●● Enlace al texto completo (gratuito o de pago) 1002/ana.10617

AUTORES / AUTHORS:  - Alizadeh M; Babron MC; Birebent B; Matsuda F; Quelvennec E; Liblau R; Cournu-Rebeix I; Momigliano-Richiardi P; Sequeiros J; Yaouanq J; Genin E; Vasilescu A; Bougerie H; Trojano M; Martins Silva B; Maciel P; Clerget-Darpoux F; Clanet M; Edan G; Fontaine B; Semana G

INSTITUCIÓN / INSTITUTION:  - Laboratoire Universitaire d’Immunologie (UPRES EA 1257, IFR 97) and Etablissement Francais du Sang Bretagne, Faculte de Medecine, Rennes, France.

RESUMEN / SUMMARY:  - Multiple sclerosis is a chronic inflammatory disease of the central nervous system with a genetic component. Until now, the more consistent association with the disease is found with the major histocompatibility complex, especially HLA-DRB1*1501-DQB1*0602 haplotype. In this report, we demonstrate the interaction of Cytotoxic T Lymphocyte-associated antigen 4 (CTLA-4 [CD152]) gene with DRB1*15 haplotype in multiple sclerosis genetic susceptibility. Our data were obtained from two European independent family-based studies including 610 multiple sclerosis family trios. Ann Neurol 2003;54:119-122