The endothelial-specific Angiopoietin-Tie2 ligand-receptor system is an important regulator of endothelial activation. Binding of angiopoietin-2 (Ang-2) to Tie2 receptor renders the endothelial barrier responsive to pro-inflammatory cytokines. We previously showed that circulating Ang-2 correlated with disease severity in a small cohort of critically ill patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis. The current study reassessed Ang-2 as a biomarker of disease activity and relapse in AAV. Circulating Ang-2 was measured in 162 patients with severe AAV (BVAS/WG≥3, with or without glomerulonephritis) in a clinical trial. Ang-2 levels during active AAV were compared to levels in the same patients during remission (BVAS/WG = 0). Levels in clinical subsets of AAV were compared, and association with future disease course was assessed. Ang-2 levels were elevated in severe disease (median 3.0 ng/ml, interquartile range 1.9-4.4) compared to healthy controls (1.2, 0.9-1.5). However, they did not reliably decline with successful treatment (median 2.6 ng/ml, interquartile range 1.9-3.8, median change -0.1). Ang-2 correlated weakly with BVAS/WG score (r = 0.17), moderately with markers of systemic inflammation (r = 0.25-0.41), and inversely with renal function (r = -0.36). Levels were higher in patients with glomerulonephritis, but levels adjusted for renal dysfunction were no different in patients with or without glomerulonephritis. Levels were higher in patients with newly diagnosed AAV and lower in patients in whom treatment had recently been started. Ang-2 levels during active disease did not predict response to treatment, and Ang-2 levels in remission did not predict time to flare. Thus, Ang-2 appears to have limited practical value in AAV as a biomarker of disease activity at time of measurement or for predicting future activity.
17%) and 13 only symptomatic treatment (dermal, ocular, analgesics, psychoactive drugs, etc.).Conclusion: BD is a disease of difficult diagnosis by the numerous and varied clinical manifestations and the absence of pathognomonic laboratory tests.The delay in diagnosis, is common in countries of low prevalence such as Spain, so it mean san increased in morbidity and mortality in these patients.Implementation of units of systemic autoimmune diseases and multidisciplinary units of Uveitis has facilitated the diagnosis of this disease.RD registries, based on multiple sources of information, are fundamental for the study and quantification of such diseases.The realization of BD and RD registries is necessary to quantify its prevalence.
Abstract Background We previously reported a transient increased risk of hospitalization after mRNA vaccination among patients with prior SARS-CoV-2, absolute risk ~ 1:1000. Here, we extend and expand this analysis to evaluate the impact of prior infection on hospitalization after a third (booster) dose. Methods Nationwide, retrospective cohort study of hospitalization among US Veterans who received a third dose of mRNA vaccine between 7/1/2021-2/28/2022. Daily rates of incident hospitalization were compared before and after booster doses, stratified by history of SARS-CoV-2. Results 1,632,806 patients received a third dose, including 90,174 with a history of SARS-CoV-2 infection. Hospitalization rates were unchanged before and after the booster dose among patients with (112.3/100,000 post-dose versus 100.2/100,000 pre-dose, p = 0.24) or without previous infection (32.1/100,000 post-dose versus 31.3/100,000 pre-dose, p = 0.71). Among 241 patients hospitalized after receipt of the initial vaccination, 90 received a booster, and none of these 90 patients were hospitalized. Conclusions There was not convincing evidence for increased hospitalizations shortly after booster vaccines, including in patients with a history of SARS-CoV-2 infection who required hospitalization after their initial vaccine. The size and design of the study prevent strong conclusions about absence of risk.
To identify circulating proteins that distinguish between active anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and remission in a manner complementary to markers of systemic inflammation.
Methods
Twenty-eight serum proteins representing diverse aspects of the biology of AAV were measured before and 6 months after treatment in a large clinical trial of AAV. Subjects (n=186) enrolled in the Rituximab in ANCA-Associated Vasculitis (RAVE) trial were studied. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were available for comparison. The primary outcome was the ability of markers to distinguish severe AAV (Birmingham Vasculitis Activity Score for Wegener9s granulomatosis (BVAS/WG)≥3 at screening) from remission (BVAS/WG=0 at month 6), using areas under receiver operating characteristic (ROC) curve (AUC).
Results
All subjects had severe active vasculitis (median BVAS/WG=8) at screening. In the 137 subjects in remission at month 6, 24 of the 28 markers showed significant declines. ROC analysis indicated that levels of CXCL13 (BCA-1), matrix metalloproteinase-3 (MMP-3) and tissue inhibitor of metalloproteinases-1 (TIMP-1) best discriminated active AAV from remission (AUC>0.8) and from healthy controls (AUC>0.9). Correlations among these markers and with ESR or CRP were low.
Conclusions
Many markers are elevated in severe active AAV and decline with treatment, but CXCL13, MMP-3 and TIMP-1 distinguish active AAV from remission better than the other markers studied, including ESR and CRP. These proteins are particularly promising candidates for future studies to address unmet needs in the assessment of patients with AAV.
Variant cancer cells which arise from the parent tumor during tumor progression can escape immunity but retain antigens. We have mixed highly immunogenic (A + B + ) murine parental cancer cells with less immunogenic (A ‐ B + ) variant cancer cells to construct a model of a cancer containing escape variants. When such mixtures of cancer cells were injected into normal mice, the variant cells grew out because immune responsiveness to the B antigen on the variant was hindered by dominance of the A antigen on the surrounding parental tumor cells. However, A ‐ B + variant cells inoculated alone at a separate site induced B specific cytolytic T cells and were rejected. Moreover, mice immunized with A ‐ B + cells rejected a challenge which contained a mixture of variant and parental cancer cells, while immunization with A + B + cells was ineffective. Thus, variant tumor cells selected from parental tumor cells by cytolytic T cells in vitro can be used to induce protective immunity against variants expected to escape tumor immunity in vivo. The immunodominance of the A antigen may be related to its ability to induce a much more rapid CTL response than the B antigen, since we show in another model that the preexistence of a CTL response to one antigen prevented the subsequent induction of CTL to another antigen injected at the same site, even if both antigens were equally efficient at inducing CTL. These results indicate that immunodominance can affect strong as well as weak antigens. Vaccination with individual antigens at separate sites rather than with multiple antigens at one site may, therefore, be needed to prevent tumor escape and tumor recurrence or to counteract infectious diseases.
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