BackgroundGroup 2 innate lymphoid cells (ILC2s) were closely associated with asthma. However, there were no perspective studies about the effects of glucocorticoid on ILC2s in asthma patients. Our objective was to perform a perspective study and evaluate the ILC2 activity after glucocorticoid therapy in asthma patients.MethodsThe asthma and asthma with allergic rhinitis patients were treated with glucocorticoid for 3 months. The circulating ILC2 levels were evaluated. The effects of glucocorticoid on ILC2s and possible signalling pathways were investigated in vitro.ResultsThe patients were well‐controlled, and the high ILC2 levels were significantly decreased at 1 and 3 months after treatment. Peripheral blood monocytes from allergic patients produced dramatic IL‐5, IL‐13 and IL‐9 in response to IL‐25, IL‐33 plus IL‐2, and glucocorticoid significantly decreased their levels. Moreover, ILC2s were identified to be the predominant source of IL‐5, IL‐13 and IL‐9, and glucocorticoid treatment was able to reverse their high levels. STAT3, STAT5, STAT6, JAK3 and MEK signalling pathways were proved to be involved in regulating ILC2 activity under the glucocorticoid treatment.ConclusionThe data suggested that glucocorticoid administration could be effective in treating asthma by regulating ILC2s via MEK/JAK‐STAT signalling pathways. This provides a new understanding of glucocorticoid application in regard to allergic diseases.

Background: Treatment of chronic wounds using traditional surgical procedures is challenging because of the low graft take rates. This study investigated the combination approach of split-thickness autografts with harvested skin cell suspension for chronic wound treatment. Click here to watch video footage recorded by the author about the contents of this paper.

Background Mycophenolate mofetil (MMF) and azathioprine (Aza) has long been used as maintenance immunosuppressive treatment for lupus nephritis. However, the benefits of MMF was limited by its high cost in China. Unpredictable severe pancytopenia induced by Aza is not common but may be fetal. Optimal therapeutic modalities with more cost-effectiveness and safety were required to be identified and thus modify the immunotherapeutic strategies. Tripterygium wilfordii multiglycoside (GTW), an authorized Chinese patent drug, has been used for the treatment of autoimmune diseases for decades in China[1]. We retrospectively reviewed 326 patients with proliferative lupus nephritis who received MMF, Aza or GTW as long-term maintenance agents in this study, compared the efficacy among these three groups and observed side effects of the medication. Objectives To evaluate the outcome and side effects of Tripterygium wilfordii multiglycoside as long-term maintenance therapy in the treatment of systemic lupus erythematosus. Methods We retrospectively reviewed 326 patients with proliferative lupus nephritis between 2000 and 2006 in south China who received MMF, Aza or Tripterygium wilfordii multiglycoside as maintenance regimen. After a short course of intravenous cyclophophamide as induction therapy according to the NIH protocol, MMF (target dose: 2 g/day), AZA (target dose: 2 mg/kg/day) or GTW (target dose: 1.8 g/day) was administrated. Steroids and antimalarial drugs were continued if necessary. The patients were followed up till October 2011. Details of the clinical presentation (renal remission, disease remission, the occurrence of renal relapse, chronic renal failure and death, etc), serological, immunological variables and side effects were collected. Results No significance of demographic variables was found among MMF group (115 cases), Aza group (91 cases) and GTW group (120 cases). Significant renal parameter improvements were observed in all patients after induction therapy. GTW group had a similar probability of remaining remission and renal function improvement or stabilization in five years to AZA group (77% in GTW group and 74% in AZA group). Time to severe systemic flare, benign flare and glucosteroid withdrawal were similar between the two groups. MMF was superior to GTW and AZA (87% in MMF group). Skin and joint involvements were best controlled in GTW group. Drug related toxicities were similar except that cytopenias were more common in AZA group. Conclusions GTW was as effective as AZA in the long-term maintenance treatment of proliferative lupus nephritis. Fewer renal flares were identified in the patients received MMF. GTW was a reasonable consideration for patients unwilling to take MMF. Promising toxicity profile was observed in GTW. References Comparison of toxic reaction of Tripterygium wilfordii multiglycoside in normal and adjuvant arthritic rats. J Ethnopharmacol. 2011; 135 (2): 270-7. Disclosure of Interest None Declared

Objectives Infections commonly complicate the course of systemic lupus erythematosus (SLE). Our aim is to investigate the clinical features and potential clinical predictors of infections in patients with SLE. Methods A retrospective cohort study was performed among patients admitted to the First Affiliated Hospital of Sun Yet-sen University from January 2007 to June 2012. Demographic information, clinical and laboratory data and pathogen were collected. Univariate analysis and logistic regression models were used for the analysis of data. Results Among 2568 patients included, 1321 (51.44%) were diagnosed with infection, with the average age of 34.97±13.22 years old and the mean duration of SLE was 44.65±65.19 months (range 1-480 months). 1452 infections involving various microorganisms were recorded. Bacterial infection was predominant (49.66%), followed by viral infection (39.12%), fungal infection (7.30%) and Mycobacterium (3.93%) infections. The pulmonary was most commonly affected (37.81%). Less common sites of infection included upper respiratory tract, genitourinary tract, skin/soft tissue and so on. The most frequently found bacteria were Escherichia coli (26.63%), followed by Acinetobacter baumannii (13.43%) and Staphylococcus aureus (11.19%). 32.84% of the isolated bacteria were multi-drug resistant. Herpes zoster was the most common viral infection. The most common fungus was Candida albicans (74 episodes), followed by Candida tropicalis (8 episodes) and Candida glabrata (8 episodes). The mortality (1.74% vs. 0.80%, respectively) and average length of stay (19.88±14.84 days vs. 15.54±9.33 days, respectively) in patients with infection were both significantly higher than those in the patients without infection. The logistic regression multivariate analysis indicated that higher SLEDAI (OR=1.02, 95% CI: 1.00-1.03), lung disease (OR=1.80, 95%CI: 1.16-2.79),nephritis (OR=1.71, 95%CI: 1.45-2.21), anemia (OR=1.38, 95%: 1.13-1.69), elevated CRP (OR=1.04, 95% CI: 1.04-1.05) and treatment with higher dose cyclophosphamide (CYC) (≥1.0 g/m2/month) (OR=2.94,95%CI: 2.24-3.87) were positively associated with the occurrence of infections. Conclusions Infections were common in SLE patients, which increased both the mortality and average length of stay. The current study demonstrated that higher SLEDAI, lung disease, nephritis, anemia, elevated CRP and treatment with higher dose CYC were associated with the infection. It is concluded that a high level of suspicion and close monitoring of SLE patients with risk factors may ensure an optimal outcome. The judicious use of CYC is critical in limiting infections in SLE patients. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.3052

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