#05#
Revisiones-Clínica-Diagnóstico
*** Reviews-Clinical-Diagnostics
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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Only articles written in Spanish and/or English are included.
[1]
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.
----------------------------------------------------
[2]
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
----------------------------------------------------
[3]
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
----------------------------------------------------
[4]
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
----------------------------------------------------
[5]
TÍTULO / TITLE: - ACC/AHA Guidelines for
the Evaluation and Management of Chronic Heart Failure in the Adult: Executive
Summary A Report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines (Committee to Revise the 1995
Guidelines for the Evaluation and Management of Heart Failure): Developed in
Collaboration With the International Society for Heart and Lung
Transplantation; Endorsed by the Heart Failure Society of America.
REVISTA
/ JOURNAL: - Circulation. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://circ.ahajournals.org/
●●
Cita: Circulation: <> 2001 Dec 11;104(24):2996-3007.
AUTORES
/ AUTHORS: - Hunt SA; Baker DW; Chin MH; Cinquegrani
MP; Feldmanmd AM; Francis GS; Ganiats TG; Goldstein S; Gregoratos G; Jessup ML;
Noble RJ; Packer M; Silver MA; Stevenson LW; Gibbons RJ; Antman EM; Alpert JS;
Faxon DP; Fuster V; Gregoratos G; Jacobs AK; Hiratzka LF; Russell RO; Smith SC
Jr
----------------------------------------------------
[6]
TÍTULO / TITLE: - HLA DNA typing and
transplantation.
REVISTA
/ JOURNAL: - Immunity 2001 Apr;14(4):347-56.
AUTORES
/ AUTHORS: - Erlich HA; Opelz G; Hansen J
INSTITUCIÓN
/ INSTITUTION: - Roche Molecular Systems, Alameda, CA
94501, USA. henry.erlich@roche.com N. Ref:: 26
----------------------------------------------------
[7]
TÍTULO / TITLE: - Fulminant hepatic
failure secondary to acetaminophen poisoning: a systematic review and meta-analysis
of prognostic criteria determining the need for liver transplantation.
REVISTA
/ JOURNAL: - Crit Care Med 2003 Jan;31(1):299-305.
●●
Enlace al texto completo (gratuito o de pago) 1097/01.CCM.0000034674.51554.4C
AUTORES
/ AUTHORS: - Bailey B; Amre DK; Gaudreault P
INSTITUCIÓN
/ INSTITUTION: - Division of Emergency Medicine, Department
of Pediatrics, Hopital Ste-Justine, Universite de Montreal, Quebec, Canada. baileyb@med.umontreal.ca
RESUMEN
/ SUMMARY: - OBJECTIVES: To summarize and compare
different prognostic criteria used to determine need for liver transplantation
in patients with fulminant hepatic failure secondary to acetaminophen
poisoning. DATA SOURCES: Studies published in the literature that investigated
criteria for hepatic transplantation secondary to acetaminophen-induced liver
failure as identified by a preestablished MEDLINE strategy (1966 through
October 2001). STUDY SELECTION: Studies were included if 2 x 2 tables could be
reconstructed and if they did not assume that patients undergoing transplantation
would have eventually died had they not received the transplant. DATA
EXTRACTION: Relevant articles were reviewed by two authors independently.
Discrepancies or disagreements, if any, on the inclusion or exclusion of
studies were resolved by consulting the third author. DATA SYNTHESIS: King’s
criteria (pH < 7.30 or prothrombin time of >100 secs plus creatinine of
>300 micromol/L plus encephalopathy grade of > or =3) were evaluated in
nine studies, pH < 7.30 in four, prothrombin time of >100 secs in three,
prothrombin time of >100 secs plus creatinine of >300 micromol/L plus
encephalopathy grade of > or =3 in three, creatinine of >300 micromol/L
in two, and one each for increase in prothrombin time day 4, factor V of
<10%, Acute Physiology and Chronic Health Evaluation (APACHE) II score of
>15, and Gc-globulin of <100 mg/L. King’s criteria were more sensitive
than pH: 69% (95% confidence interval, 63-75) vs. 57% (95% confidence interval,
44-68). Their specificities were, however, comparable: 92% (95% confidence
interval, 81-97) vs. 89% (95% confidence interval, 62-97). APACHE II score of
>15 had the highest positive likelihood ratio (16.4) and the lowest negative
likelihood ratio (0.19) but was evaluated in only one study. The accuracy
measures of all other criteria were lower than that of King’s criteria or pH
< 7.30. CONCLUSIONS: Presently, available criteria are not very sensitive
and may miss patients requiring transplantation. Future studies should further
evaluate the efficacy of the APACHE II criteria. N. Ref:: 33
----------------------------------------------------
[8]
TÍTULO / TITLE: - Preliminary guidelines
for diagnosing and treating tuberculosis in patients with rheumatoid arthritis
in immunosuppressive trials or being treated with biological agents.
REVISTA
/ JOURNAL: - Ann Rheum Dis 2002 Nov;61 Suppl 2:ii62-3.
AUTORES
/ AUTHORS: - Furst DE; Cush J; Kaufmann S; Siegel J;
Kurth R
INSTITUCIÓN
/ INSTITUTION: - UCLA Medical School, Los Angeles, USA
Presbyterian Hospital, Dallas, USA.
----------------------------------------------------
[9]
TÍTULO / TITLE: - Insulin/IGF and target
of rapamycin signaling: a TOR de force in growth control.
REVISTA
/ JOURNAL: - Trends Cell Biol 2003 Feb;13(2):79-85.
AUTORES
/ AUTHORS: - Oldham S; Hafen E
INSTITUCIÓN
/ INSTITUTION: - The Burnham Institute, La Jolla, CA 92037,
USA.
RESUMEN
/ SUMMARY: - ‘They come in all sizes.’ Apart from its
origin and use in the clothing industry, this saying reflects the fact that the
size of organisms spans an enormous range. Whether destined to be large or
small, species grow in an organized fashion to reach their final specified
size. For growth to proceed, food must be metabolized to liberate energy in the
form of adenosine triphosphate (ATP) and protein building blocks in the form of
amino acids. One major orchestrator of this complex growth process in diverse
metazoan species is the insulin/insulin-like growth factor (IGF) system. This
review summarizes current studies primarily from Drosophila regarding the
function of the insulin/IGF system in the control of growth. N. Ref:: 75
----------------------------------------------------
[10]
TÍTULO / TITLE: - Diagnosis and therapy
of coronary artery disease in renal failure, end-stage renal disease, and renal
transplant populations.
REVISTA
/ JOURNAL: - Am J Med Sci 2003 Apr;325(4):214-27.
AUTORES
/ AUTHORS: - Logar CM; Herzog CA; Beddhu S
INSTITUCIÓN
/ INSTITUTION: - Renal Section, Salt Lake VA Healthcare
System, Department of Medicine, University of Utah School of Medicine, Salt
Lake City, USA.
RESUMEN
/ SUMMARY: - Even though cardiovascular disease is the
leading cause of death in patients with CRF and end-stage renal disease (ESRD),
ill-conceived notions have led to therapeutic nihilism as the predominant
strategy in the management of cardiovascular disease in these populations. The
recent data clearly support the application of proven interventions in the
general population, such as angiotensin-converting enzyme inhibitors and
statins to patients with CRF and ESRD. The advances in coronary stents and
intracoronary irradiation have decreased the restenosis rates in renal failure
patients. Coronary artery bypass with internal mammary graft might be the
procedure of choice for coronary revascularization in these patients. The role
of screening for asymptomatic coronary disease is established as a
pretransplant procedure, but it is unclear whether this will be applicable to
all patients with ESRD. Future studies need to focus on unraveling the
mechanisms by which uremia leads to increased cardiovascular events to design
optimal therapies targeted toward these mechanisms and improve cardiovascular
outcomes. N. Ref:: 125
----------------------------------------------------
[11]
TÍTULO / TITLE: - Individuality: the
barrier to optimal immunosuppression.
REVISTA
/ JOURNAL: - Nat Rev Immunol 2003 Oct;3(10):831-8.
●●
Enlace al texto completo (gratuito o de pago) 1038/nri1204
AUTORES
/ AUTHORS: - Kahan BD
INSTITUCIÓN
/ INSTITUTION: - Division of Immunology and Organ
Transplantation, Department of Surgery, University of Texas Medical School at
Houston, Suite 6.240, 6431 Fannin, Houston, Texas 77030, USA. Barry.D.Kahan@uth.tmc.edu.
RESUMEN
/ SUMMARY: - Immunosuppressive therapy aims to protect
transplanted organs from host responses. Individuals have unique repertoires of
responses to foreign antigens and toxic reactions to immunosuppressants; the
former determining the type or intensity of rejection reactions and the latter
influencing the severity of iatrogenic effects. Because existing agents target
molecules that are widely distributed in tissues, new strategies must
selectively block lymphoid cells only, disrupt alloresponses but not innate
immune responses, interact synergistically with other agents, facilitate the
homeostatic process that naturally leads to graft acceptance and ideally only
interrupt donor-specific responses. Approaches presently under investigation
aim to alter cell trafficking, or selectively deviate the maturation of
antigen-presenting cells or inhibit lymphocyte-activation cascades - events
that are crucial to rejection responses.
N. Ref:: 92
----------------------------------------------------
[12]
TÍTULO / TITLE: - Effect of dexamethasone
on beta2-adrenergic desensitization in airway smooth muscle: role of the ARG19
polymorphism.
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):368S-9S.
AUTORES
/ AUTHORS: - Moore PE; Calder MM; Silverman ES;
Panettieri RA Jr; Shore SA
INSTITUCIÓN
/ INSTITUTION: - Departments of Pediatrics and Pharmacology
(Dr. Moore and Mr. Calder), Vanderbilt University School of Medicine,
Nashville, TN 37232-2586, USA. N.
Ref:: 1
----------------------------------------------------
[13]
TÍTULO / TITLE: - Overcoming restenosis
with sirolimus: from alphabet soup to clinical reality.
REVISTA
/ JOURNAL: - Lancet 2002 Feb 16;359(9306):619-22.
AUTORES
/ AUTHORS: - Poon M; Badimon JJ; Fuster V
INSTITUCIÓN
/ INSTITUTION: - Mount Sinai School of Medicine, 1 Gustav L
Levy Place, Box 1030, New York, NY 10029, USA.
N. Ref:: 34
----------------------------------------------------
[14]
TÍTULO / TITLE: - Effects of glatiramer
acetate on relapse rate and accumulated disability in multiple sclerosis:
meta-analysis of three double-blind, randomized, placebo-controlled clinical
trials.
REVISTA
/ JOURNAL: - Mult Scler 2003 Aug;9(4):349-55.
AUTORES
/ AUTHORS: - Boneschi FM; Rovaris M; Johnson KP; Miller
A; Wolinsky JS; Ladkani D; Shifroni G; Comi G; Filippi M
INSTITUCIÓN
/ INSTITUTION: - Department of Neuroscience, Scientific
Institute, University H San Raffaele, Milan, Italy.
RESUMEN
/ SUMMARY: - Three randomized, double-blind,
placebo-controlled trials have shown that glatiramer acetate (GA) is effective
in reducing relapse rate in patients with relapsing-remitting (RR) multiple
sclerosis (MS). Using raw data pooled from 540 patients, we performed a
meta-analysis of these three trials, to investigate whether the extent of GA
efficacy varies according to disease-related variables at study entry. Three
regression models were developed to assess the efficacy of GA on the annualized
relapse rate (primary outcome measure), on the total number of on-trial
relapses and on the time to first relapse. We also explored the efficacy of GA
on accumulated disability and the potential role of baseline clinical variables
as predictors of relapse-rate variables and treatment efficacy. The mean
adjusted annualized relapse rate on study was 1.14 in the pooled
placebo-treated subjects and 0.82 in the pooled GA group (P = 0.004),
indicating an average reduction in annualized relapse rate of 28%. About a one
third reduction of the total number of on-trial relapses was also observed in
patients receiving GA (P < 0.0001), who had a median time to the first
relapse of 322 days versus a median time to the first relapse of 219 days seen
in those receiving placebo (P = 0.01). A beneficial effect on accumulated
disability was also found (risk ratio of 0.6; 95%; CI = 0.4-0.9; P = 0.02). The
drug assignment (P = 0.004), baseline EDSS score (P = 0.02) and number of
relapses during the two years prior to study entry (P = 0.002) were significant
predictors of on-trial annualized relapse rate. No other demographic or
clinical variable at baseline significantly influenced the treatment effect.
This meta-analysis reaffirms the effectiveness of GA in reducing relapse rate
and disability accumulation in RRMS, at a magnitude comparable to that of other
available immunomodulating treatments. It also suggests that GA efficacy is not
significantly influenced by the patients’ clinical characteristics at the time
of treatment initiation.
----------------------------------------------------
[15]
TÍTULO / TITLE: - Treatment of chronic
granulomatous disease with myeloablative conditioning and an unmodified
hemopoietic allograft: a survey of the European experience, 1985-2000.
REVISTA
/ JOURNAL: - Blood. Acceso gratuito al texto completo a
partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.bloodjournal.org/
●●
Cita: Blood: <> 2002 Dec 15;100(13):4344-50. Epub 2002 Aug 8.
●●
Enlace al texto completo (gratuito o de pago) 1182/blood-2002-02-0583
AUTORES
/ AUTHORS: - Seger RA; Gungor T; Belohradsky BH;
Blanche S; Bordigoni P; Di Bartolomeo P; Flood T; Landais P; Muller S; Ozsahin
H; Passwell JH; Porta F; Slavin S; Wulffraat N; Zintl F; Nagler A; Cant A;
Fischer A
INSTITUCIÓN
/ INSTITUTION: - European Group for Blood and Marrow
Transplantation (EBMT) and the European Society for Immunodeficiencies (ESID),
Division of Immunology/Hematology, University Children’s Hospital, Zurich,
Switzerland. reinhard.seger@kispi.unizh.ch
RESUMEN
/ SUMMARY: - Treatment of chronic granulomatous disease
(CGD) with myeloablative bone marrow transplantation is considered risky. This
study investigated complications and survival according to different risk
factors present at transplantation. The outcomes of 27 transplantations for
CGD, from 1985 to 2000, reported to the European Bone Marrow Transplant
Registry for primary immunodeficiencies were assessed. Most transplant
recipients were children (n = 25), received a myeloablative busulphan-based
regimen (n = 23), and had unmodified marrow allografts (n = 23) from human
leukocyte antigen (HLA)-identical sibling donors (n = 25). After myeloablative
conditioning, all patients fully engrafted with donor cells; after
myelosuppressive regimens, 2 of 4 patients fully engrafted. Severe (grade 3 or
4) graft-versus-host disease (GVHD) disease developed in 4 patients: 3 of 9
with pre-existing overt infection, 1 of 2 with acute inflammatory disease.
Exacerbation of infection during aplasia was observed in 3 patients;
inflammatory flare at the infection site during neutrophil engraftment in 2:
all 5 patients belonged to the subgroup of 9 with pre-existing infection.
Overall survival was 23 of 27, with 22 of 23 cured of CGD (median follow-up, 2
years). Survival was especially good in patients without infection at the
moment of transplantation (18 of 18). Pre-existing infections and inflammatory
lesions have cleared in all survivors (except in one with autologous
reconstitution). Myeloablative conditioning followed by transplantation of
unmodified hemopoietic stem cells, if performed at the first signs of a severe
course of the disease, is a valid therapeutic option for children with CGD
having an HLA-identical donor. N.
Ref:: 30
----------------------------------------------------
[16]
TÍTULO / TITLE: - Sublingual
immunotherapy for allergic rhinitis.
REVISTA
/ JOURNAL: - Cochrane Database Syst Rev
2003;(2):CD002893.
AUTORES
/ AUTHORS: - Wilson DR; Torres LI; Durham SR
INSTITUCIÓN
/ INSTITUTION: - Upper Respiratory Medicine, Imperial
College School of Medicine at the National Heart & Lung Institute,
Dovehouse Street, London, UK, SW3 6LR. duncw 99@yahoo.co.uk
RESUMEN
/ SUMMARY: - BACKGROUND: Allergic rhinitis is a common
condition which, at its most severe, can significantly impair quality of life
despite optimal treatment with antihistamines and topical nasal
corticosteroids. Allergen injection immunotherapy significantly reduces
symptoms and medication requirements in allergic rhinitis but its use is
limited by the possibility of severe systemic reactions. There has therefore
been considerable interest in alternative routes for delivery of allergen
immunotherapy, particularly the sublingual route. OBJECTIVES: To evaluate the
efficacy of sublingual immunotherapy (SLIT), compared with placebo, for
reductions in symptoms and medication requirements. SEARCH STRATEGY: The
Cochrane Controlled Trials Register, MEDLINE (1966-2002), EMBASE (1974-2002)
and Scisearch were searched, up to September 2002, using the terms (Rhin* OR
hay fever) AND (immunotherap* OR desensiti*ation) AND (sublingual). SELECTION
CRITERIA: All studies identified by the searches were assessed by the reviewers
to identify randomised controlled trials involving participants with symptoms
of allergic rhinitis and proven allergen sensitivity, treated with SLIT or
corresponding placebo. DATA COLLECTION AND ANALYSIS: Data from identified
studies were abstracted onto a standard extraction sheet and subsequently
entered into RevMan 4.1. Analysis was performed by the method of Standardised
Mean Differences (SMD) using a random effects model. P values <0.05 were
considered statistically significant. Subgroup analyses were performed
according to the type of allergen administered, the age of participants and the
duration of treatment. MAIN RESULTS: Twenty two trials involving 979 patients
were included. There were 6 trials of SLIT for House Dust Mite allergy, 5 for
Grass Pollen, 5 for Parietaria, 2 for Olive and one each for, Ragweed, Cat,
Tree and Cupressus. Four studies enrolled exclusively children. Seventeen
studies administered the allergen by sublingual drops subsequently swallowed, 3
by drops subsequently spat out and 2 by sublingual tablets. Eight studies
involved treatment for less than 6 months, 10 studies for 6-12 months and 4
studies for greater than 12 months. All included studies were double-blind
placebo-controlled trials of parallel group design. Concealment of treatment
allocation was considered adequate in all studies and the use of identical
placebo preparations was almost universal. There was significant heterogeneity,
most likely due to widely differing scoring systems between studies, for most
comparisons. Overall there was a significant reduction in both symptoms (SMD
-0.34, 95% confidence interval -0.69 to -0.15; p=0.002) and medication
requirements (SMD -0.43 [-0.63, -0.23]; p=0.00003) following immunotherapy.
Subgroup analyses failed to identify a disproportionate benefit of treatment
according to the allergen administered. There was no significant reduction in
symptoms and medication scores in those studies involving only children but
total numbers of participants were small, casting doubt on the validity of the
conclusion. Increasing duration of treatment does not clearly increase
efficacy. The total dose of allergen administered may be important but
insufficient data were available to analyse this factor. REVIEWER’S CONCLUSIONS:
SLIT is a safe treatment which significantly reduces symptoms and medication
requirements in allergic rhinitis. The size of this benefit compared to that of
other available therapies, particularly injection immunotherapy, is not clear,
having been assessed directly in very few studies. Further research is required
concentrating on optimising allergen dosage and patient selection. N. Ref:: 41
----------------------------------------------------
[17]
TÍTULO / TITLE: - Drug immunosuppression
therapy for adult heart transplantation. Part 2: clinical applications and
results.
REVISTA
/ JOURNAL: - Ann Thorac Surg 2004 Jan;77(1):363-71.
AUTORES
/ AUTHORS: - Mueller XM
INSTITUCIÓN
/ INSTITUTION: - Department of Cardiovascular Surgery,
Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada. xavier.mueller@usherbrooke.ca
RESUMEN
/ SUMMARY: - This review describes the clinical
application of classical immunosuppressive drugs as well as that of more recent
drugs. All current immunosuppressive drugs target T-cell activation, and
cytokine production and clonal expansion, or both. Immunosuppressive protocols
can be broadly divided into induction therapy, maintenance immunosuppression,
and treatment of acute rejection episodes.
N. Ref:: 82
----------------------------------------------------
[18]
TÍTULO / TITLE: - B cell-ablative therapy
for the treatment of autoimmune diseases.
REVISTA
/ JOURNAL: - Arthritis Rheum 2002 Aug;46(8):1984-5.
●●
Enlace al texto completo (gratuito o de pago) 1002/art.10476
AUTORES
/ AUTHORS: - Patel DD
N. Ref:: 18
----------------------------------------------------
[19]
TÍTULO / TITLE: - The future of
antigen-specific immunotherapy of allergy.
REVISTA
/ JOURNAL: - Nat Rev Immunol 2002 Jun;2(6):446-53.
●●
Enlace al texto completo (gratuito o de pago) 1038/nri824
AUTORES
/ AUTHORS: - Valenta R
INSTITUCIÓN
/ INSTITUTION: - Department of Pathophysiology, University
of Vienna Medical School, Vienna General Hospital-AKH, Australia. Rudolf.valenta@akh-wein.ac.at
RESUMEN
/ SUMMARY: - More than 25% of the population in
industrialized countries suffers from immunoglobulin-E-mediated allergies. The
antigen-specific immunotherapy that is in use at present involves the
administration of allergen extracts to patients with the aim to cure allergic
symptoms. However, the risk of therapy-induced side effects limits its broad
application. Recent work indicates that the epitope complexity of natural
allergen extracts can be recreated using recombinant allergens, and
hypoallergenic derivatives of these can be engineered to increase treatment
safety. It is proposed that these modified molecules will improve the current
practice of specific immunotherapy and form a basis for prophylactic
vaccination. N.
Ref:: 120
----------------------------------------------------
[20]
TÍTULO / TITLE: - How I treat chronic
graft-versus-host disease.
REVISTA
/ JOURNAL: - Blood. Acceso gratuito al texto completo a
partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.bloodjournal.org/
●●
Cita: Blood: <> 2001 Mar 1;97(5):1196-201.
AUTORES
/ AUTHORS: - Vogelsang GB
INSTITUCIÓN
/ INSTITUTION: - Oncology Center, Johns Hopkins University
School of Medicine, Baltimore, MD 21231-1000, USA. vogelge@jhmi.edu
RESUMEN
/ SUMMARY: - Allogeneic stem cell transplantation (SCT)
is now a commonplace procedure. Clinicians who care for patients with
hematologic malignancies and aplastic anemia are almost certain to follow up
patients after SCT. This review is intended to help clinicians observe patients
for probably the most important late complication of SCT, chronic
graft-versus-host disease (GVHD). It reviews the pathophysiology, risk factors,
clinical manifestations, evaluation, treatment, and supportive care of chronic
GVHD. N. Ref:: 34
----------------------------------------------------
[21]
TÍTULO / TITLE: - Renal transplantation:
can we reduce calcineurin inhibitor/stop steroids? Evidence based on protocol
biopsy findings.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Mar;14(3):755-66.
AUTORES
/ AUTHORS: - Gotti E; Perico N; Perna A; Gaspari F;
Cattaneo D; Caruso R; Ferrari S; Stucchi N; Marchetti G; Abbate M; Remuzzi G
INSTITUCIÓN
/ INSTITUTION: - Department of Medicine and
Transplantation, Ospedali Riuniti di Bergamo, Mario Negri Institute for
Pharmacological Research, Italy.
RESUMEN
/ SUMMARY: - How to combine antirejection drugs and
which is the optimal dose of steroids and calcineurin inhibitors beyond the
first year after kidney transplantation to maintain adequate immunosuppression
without major side effects are far from clear. Kidney transplant patients on
steroid, cyclosporine (CsA), and azathioprine were randomized to per-protocol
biopsy (n = 30) or no-biopsy (n = 29) 1 to 2 yr posttransplant. Steroid or CsA
were discontinued or reduced on the basis of biopsy to establish effects on
drug-related complications, acute rejection, and graft function over 3 yr of
follow-up. Serum creatinine, GFR (plasma clearance of iohexol), RPF (renal
clearance of p-aminohippurate), CsA pharmacokinetics, and adverse events were
monitored yearly. At the end, patients underwent a second biopsy. Per-protocol
biopsy histology revealed no lesions (n = 5, steroid withdrawal), CsA
nephropathy (n = 13, CsA discontinuation/reduction), or chronic rejection (n =
12, standard therapy). Reducing the drug regimen led to overall fewer side
effects related to immunosuppression as compared with standard therapy or
no-biopsy. Steroids were safely stopped with no acute rejection or graft loss.
Complete CsA discontinuation was associated with acute rejection in the first
four patients. Lowering CsA to low target CsA trough (30 to 70 ng/ml) never led
to acute rejection or major renal function deterioration. Biopsy patients on
conventional regimen had no acute rejection, one graft loss, no significant
change in GFR, and significant RPF decline. No-biopsy controls: no acute
rejection, one graft loss, significant decline of GFR and RPF. By serial biopsy
analysis, severe lesions did not develop in patients with steroid
discontinuation in contrast to patients on standard therapy over follow-up. CsA
reduction did not adversely affect histology. Per-protocol biopsy more than 1
yr after kidney transplantation is a safe procedure to guide change of drug
regimen and to lower the risk of major side effects.
----------------------------------------------------
[22]
TÍTULO / TITLE: - Clinical protocol.
Purging of autologous stem cell sources with bcl-x(s) adenovirus for women
undergoing high-dose chemotherapy for stage IV breast carcinoma.
REVISTA
/ JOURNAL: - Hum Gene Ther 2001 Nov 1;12(16):2023-5.
AUTORES
/ AUTHORS: - Ayash LJ; Clarke M; Adams P; Ferrara J;
Ratanatharathorn V; Reynolds C; Roessler B; Silver S; Strawderman M; Uberti J;
Wicha M
RESUMEN
/ SUMMARY: - High-dose chemotherapy (HDCT) and
autologous bone marrow transplantation (BMT) is frequently used to treat
patients with metastatic cancer including breast cancer and neuroblastoma.
However, the bone marrow of such patients is often contaminated with tumor
cells. Recently, we have found that a recombinant adenovirus vector that
contains a bcl-x, minigene (a dominant negative inhibitor of the bcl-2 family),
called the bcl-x(s) adenovirus, is lethal to cancer cells derived from
epithelial tissues, but not to normal human hematopoietic cells. To determine
the mechanism, by which this virus spares normal hematopoietic cells, we
isolated normal mouse hematopoietic stem cells and infected them with an
adenovirus that contains a beta-galactosidase minigene. Such cells do not
express beta-galactosidase, indicating that hematopoietic stem cells do not express
transgene encoded by adenovirus vectors based upon the RSV-AD5 vector system.
When breast cancer cells mixed with hematopoietic cells were infected with the
bcl-x(s) adenovirus, cancer cells were selectively killed by the suicide
adenoviruses. Hematopoietic cells exposed to the suicide vectors were able to
reconstitute the bone marrow of mice exposed to lethal doses of y-irradiation.
These studies suggest that adenovirus suicide vectors may provide a simple and
effective method to selectively eliminate cancer cells derived from epithelial
tissue that contaminate bone marrow to be used for autologous BMT. We therefore
propose to initiate a phase I clinical trial to test the safety of this virus
in women with breast cancer undergoing high does chemotherapy and autologous
BMT.
----------------------------------------------------
[23]
TÍTULO / TITLE: - Drug immunosuppression
therapy for adult heart transplantation. Part 1: immune response to allograft
and mechanism of action of immunosuppressants.
REVISTA
/ JOURNAL: - Ann Thorac Surg 2004 Jan;77(1):354-62.
AUTORES
/ AUTHORS: - Mueller XM
INSTITUCIÓN
/ INSTITUTION: - Department of Cardiovascular Surgery,
Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada. xavier.mueller@usherbrooke.ca
RESUMEN
/ SUMMARY: - In the early days of transplantation,
immunosuppression therapy was rather broad and nonspecific, mainly using
high-dose corticosteroids and azathioprine. Thereafter we progressively
narrowed the target of immunosuppressive strategy starting with polyclonal
antibodies. The introduction of cyclosporine, OKT3, and tacrolimus further
narrowed the target on the T-cell pathways. More recently mycophenolate mofetil
progressively took the place of azathioprine with its higher lymphocyte
specificity and sirolimus and interleukin-2 receptor antibodies were
introduced. In this field in constant movement the aim is to find a drug or a
regimen that provides optimal immunosuppression therapy with minimal side
effects, in other words to find the right balance between overimmunosuppression
and underimmunosuppression therapy. This review is divided into two parts. The
first part will provide a basic understanding of the immunologic response to allograft
and explain how conventional and recently introduced immunosuppressive agents
work. The second part will describe the clinical application of
immunosuppressive drugs to provide practical information for those in charge of
heart transplant recipients. N.
Ref:: 68
----------------------------------------------------
[24]
TÍTULO / TITLE: - Regulatory T cells in
kidney transplant recipients: active players but to what extent?
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Jun;14(6):1706-8.
AUTORES
/ AUTHORS: - Zhai Y; Kupiec-Weglinski JW N. Ref:: 20
----------------------------------------------------
[25]
TÍTULO / TITLE: - IL-10 and its related
cytokines for treatment of inflammatory bowel disease.
REVISTA
/ JOURNAL: - World J Gastroenterol. Acceso gratuito al
texto completo.
●●
Enlace a la Editora de la Revista http://www.wjgnet.com/1007-9327/wj.htm
●●
Cita: World Journal of Gastroenterology: <> 2004 Mar 1;10(5):620-5.
AUTORES
/ AUTHORS: - Li MC; He SH
INSTITUCIÓN
/ INSTITUTION: - Allergy and Inflammation Research
Institute, Shantou University Medical College, 22 Xin Ling Road, Shantou
515041, Guangdong Province, China.
RESUMEN
/ SUMMARY: - Inflammatory bowel diseases (IBDs),
including Crohn’s disease and ulcerative colitis are chronic inflammatory
disorders of gastrointestinal tract. Although the etiology is incompletely
understood, initiation and aggravation of the inflammatory process seem to be
due to a massive local mucosal immune response. Interleukin-10 (IL-10) is a
regulatory cytokine which inhibits both antigen presentation and subsequent
pro-inflammatory cytokine release, and it is proposed as a potent
anti-inflammatory biological therapy in chronic IBD. Many methods of IL-10 as a
treatment for IBD have been published. The new strategies of IL-10 treatment,
including recombinant IL-10, the use of genetically modified bacteria, gelatine
microsphere containing IL-10, adenoviral vectors encoding IL-10 and combining
regulatory T cells are discussed in this review. The advantages and disadvantages
of these IL-10 therapies are summarized. Although most results of recombinant
IL-10 therapies are disappointing in clinical testing because of lacking
efficacy or side effects, therapeutic strategies utilizing gene therapy may
enhance mucosal delivery and increase therapeutic response. Novel IL-10-related
cytokines, including IL-19, IL-20, IL-22, IL-24, IL-26, IL-28 and IL-29, are
involved in regulation of inflammatory and immune responses. The use of IL-10
and IL-10-related cytokines will provide new insights into cell-based and
gene-based treatment against IBD in near future. N. Ref:: 54
----------------------------------------------------
[26]
TÍTULO / TITLE: - Immunosuppression and
xenotransplantation of cells for cardiac repair.
REVISTA
/ JOURNAL: - Ann Thorac Surg 2004 Feb;77(2):737-44.
●●
Enlace al texto completo (gratuito o de pago) 1016/j.athoracsur.2003.08.036
AUTORES
/ AUTHORS: - Xiao YF; Min JY; Morgan JP
INSTITUCIÓN
/ INSTITUTION: - Stem Cell Research Laboratory, The Charles
A. Dana Research Institute, Department of Medicine, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, Massachusetts, USA. yxiao@bidmc.harvard.edu
RESUMEN
/ SUMMARY: - The death of highly vulnerable
cardiomyocytes during ischemia leads to cardiac dysfunction, including heart
failure. Due to limited proliferation of adult mammalian cardiomyocytes, the
dead myocardium is replaced by noncontractile fibrotic tissue. Introducing exogenous
cells to participate in the regeneration of infarcted myocardium has thus been
proposed as a novel therapeutic approach. In view of the availability of
various xenogeneic cells and fewer ethical and political concerns that surround
human embryonic stem cells and fetal cardiomyocytes, cellular
xenotransplantation may be a potential alternative approach for cardiac repair
in humans. However, one of the most daunting challenges of xenotransplantation
is immunorejection. This article summarizes the progress in cellular
xenotransplantation for cardiac repair in experimental settings and the current
understanding of possible immune responses following the engraftment of
xenogeneic cells. The public attitude towards xenotransplantation is reportedly
more favorable to receiving cells or tissues than a whole organ, but many
scientific obstacles need to be overcome before the utilization of xenogeneic
cells for cardiac repair in patients with heart disease becomes applicable to
clinical practice. N.
Ref:: 82
----------------------------------------------------
[27]
TÍTULO / TITLE: - Cytokine-based
immunointervention in the treatment of autoimmune diseases.
REVISTA
/ JOURNAL: - Clin Exp Immunol 2003 May;132(2):185-92.
AUTORES
/ AUTHORS: - Adorini L
INSTITUCIÓN
/ INSTITUTION: - BioXell, Via Olgettina 58, 20132 Milan,
Italy. luciano.adorini@bioxell.com N. Ref:: 99
----------------------------------------------------
[28]
TÍTULO / TITLE: - Protocol core needle
biopsy and histologic Chronic Allograft Damage Index (CADI) as surrogate end
point for long-term graft survival in multicenter studies.
REVISTA
/ JOURNAL: - J Am Soc Nephrol. Acceso gratuito al texto
completo a partir de 1 año de la fecha de publicación.
●●
Enlace a la Editora de la Revista http://www.jasn.org/
●●
Cita: Journal of the American Society of Nephrology: <> 2003
Mar;14(3):773-9.
AUTORES
/ AUTHORS: - Yilmaz S; Tomlanovich S; Mathew T;
Taskinen E; Paavonen T; Navarro M; Ramos E; Hooftman L; Hayry P
INSTITUCIÓN
/ INSTITUTION: - Data Analysis Center, Division of
Transplantation, Department of Surgery, University of Calgary, Alberta, Canada.
RESUMEN
/ SUMMARY: - This study is an investigation of whether
a protocol biopsy may be used as surrogate to late graft survival in
multicenter renal transplantation trials. During two mycophenolate mofetil
trials, 621 representative protocol biopsies were obtained at baseline, 1 yr,
and 3 yr. The samples were coded and evaluated blindly by two pathologists, and
Chronic Allograft Damage Index (CADI) score was constructed. At 1 yr, only 20%
of patients had elevated (>l.5 mg/100 ml) serum creatinine, whereas 60% of
the biopsies demonstrated an elevated (>2.0) CADI score. The mean CADI score
at baseline, 1.3 +/- 1.1, increased to 3.3 +/- 1.8 at 1 yr and to 4.1 +/- 2.2
at 3 yr. The patients at 1 yr were divided into three groups, those with CADI
<2, between 2 and 3.9, and >4.0, the first two groups having normal (1.4 +/-
0.3 and 1.5 +/- 0.6 mg/dl) and the third group pathologic (1.9 +/- 0.8 mg/dl)
serum creatinine. At 3 yr, there were no lost grafts in the low CADI group, six
lost grafts (4.6%) in the in the elevated CADI group, and 17 lost grafts
(16.7%) in the high CADI group (P < 0.001). One-year histologic CADI score
predicts graft survival even when the graft function is still normal. This
observation makes it possible to use CADI as a surrogate end point in
prevention trials and to identify the patients at risk for intervention trials.
----------------------------------------------------
[29]
TÍTULO / TITLE: - Pulmonary infiltrates
in the non-HIV-infected immunocompromised patient: etiologies, diagnostic
strategies, and outcomes.
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: <> 2004 Jan;125(1):260-71.