Utilizing endogenous molecules as a therapeutic approach is almost unequivocally superior to engineered or synthetic molecules. However, one rarely encounters an anti-inflammatory, cytoprotective, immunomodulatory and wound-healing molecule that has been available for use for decades. α1-antitrypsin (AAT), a circulating protein that rises more than 4-fold during acute-phase responses, has been administered for a rare genetic deficiency at large doses, for life. Aside from advances in insulin therapy, medical research in type 1 diabetes (T1D) has predominantly focused on autoimmunity-controlling the adaptive immune response. However, it is now appreciated that one may need to extend therapeutic targets to incorporate immune responses to cellular injury, as well as promote selective control over excessive inflammation and early tissue repair. Recent data suggest that tissue damage related to lung and renal ischemia-reperfusion injury, stroke, and ischemic heart disease is markedly reduced by AAT. AAT was also shown to protect pancreatic islet β cells at multiple levels. Unlike classic immunosuppressive and anti-inflammatory approaches, AAT exerts some antiviral and antibacterial activities. Based on these and other reports, AAT is under evaluation for treatment of T1D patients in multiple clinical trials. Initial results suggest that AAT therapy could potentially improve insulin production without adverse effects. Up to 50% of individuals displayed improved islet function. It is a rare occurrence in T1D research that a therapy is offered that holds a safety profile equal or superior to that of insulin alone. While placebo-controlled trials are ongoing, the mechanism(s) behind these favorable activities of AAT are still being explored.

BackgroundRAPID3 (Routine Assessment of Patient Index Data 3) is an index for rheumatoid arthritis activity evaluation with no formal joint count or analytical parameters. It was developed by T. Pincus and in its English version included in MDHAQ has demonstrated good correlated with composite indices as CDAI or DAS-28 (1). A spanish version of MDHAQ has been madeObjectivesTo assess whether the Spanish version of RAPID3 included in the spanish version of MDHAQ is useful to monitoring rheumatoid arthritis (RA) patients in our countryMethodsA questionnaire using only the sections of the Spanish version of MDHAQ included in the calculation of RAPID3 was built. All patients attending to the monographic rheumatoid arthritis clinic completed the questionnaire before entering the office. Once in the office a joints count and physician assessment was performed. Acute phase reactants were and DAS28-ESR, DAS28-CRP, SDAI and CDAI indices were calculated. Results were analyzed using the Spearman correlation coefficient.Results154 patients (78.8% women) mean age (SD) of 59 (14) years and disease duration 11 (10) years were included. All patients were treated with DMARDs. 70% received low-dose corticosteroids. 51% were treated with biologic DMARDs, mostly in combination with methotrexate. 312 questionnaires (2.02 per patient) over6 months were analyzed.Correlation between RAPID3 and other indices was not influenced by sex, treatment, age, disease duration, use of corticoids or biologic DMARDs.The Spearman correlation coefficient between RAPID3 and the different indices were:Variableρ-SpearmanpRAPID3DAS28-ESR0,6127<0,0001RAPID3DAS28-CRP0,7180<0,0001RAPID3SDAI0,8368<0,0001RAPID3CDAI0,8556<0,0001ConclusionsRAPID3 may be useful for monitoring RA patients due to its excellent correlation with joint composite indices that use joint counts and acute phase reactants.ReferencesPincus T. et al. RAPID3 (Routine Assessment of Patient Index Data 3), a Rheumatoid Arthritis Index Without Formal Joint Counts for Routine Care: Proposed Severity Categories Compared to Disease Activity Score and Clinical Disease Activity Index Categories. The Journal of Rheumatology 2008; 35:11; doi:10.3899/jrheumDisclosure of InterestNone declared