Prognosis and future developments in vasculitis

Basu, Neil; Karabayas, Maira; Pusey, Charles D.

doi:10.1016/j.berh.2018.08.011

Cited by 19 publications

(17 citation statements)

References 119 publications

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“…The most plausible explanation for this difference is that a higher baseline SII was associated with lower levels of serum creatinine in the present study. The severity of renal dysfunction at presentation has been demonstrated to be a key negative prognostic factor for renal survival ( 28 ). Another explanation may be that the SII is a potential index for reflecting the inflammatory response in MPO-AAV, as mentioned above.…”

Section: Discussionmentioning

confidence: 99%

Systemic immune‑inflammation index predicts a reduced risk of end‑stage renal disease in Chinese patients with myeloperoxidase‑anti‑neutrophil cytoplasmic antibody‑associated vasculitis: A retrospective observational study

et al. 2021

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Chronic inflammation has been indicated to be important in the pathogenesis of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). The systemic immune-inflammation index (SII) is a novel marker of inflammation. The present study was thus performed to explore the association between the SII at diagnosis and inflammatory response and disease activity in Chinese patients with myeloperoxidase (MPO)-AAV. Furthermore, it was evaluated whether the SII is able to predict the progression to end-stage renal disease (ESRD) and patient survival. A total of 190 patients with MPO-AAV were included in the present study. The baseline SII was positively correlated with C-reactive protein (CRP; r=0.274, P<0.0001) and the erythrocyte sedimentation rate (ESR; r=0.481, P<0.0001). However, the SII had no obvious correlation with the Birmingham vasculitis activity score. Patients with SII≥2,136.45 exhibited better cumulative renal survival rates than those with SII<2,136.45 (P=0.001). However, no significant difference in patient survival was indicated between patients with SII≥2,136.45 and those with SII<2,136.45 at diagnosis. In conclusion, the SII was positively correlated with CRP and ESR in Chinese patients with MPO-AAV. Furthermore, the SII may be an independent factor associated with a reduced risk of ESRD.

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Section: Discussionmentioning

confidence: 99%

Systemic immune‑inflammation index predicts a reduced risk of end‑stage renal disease in Chinese patients with myeloperoxidase‑anti‑neutrophil cytoplasmic antibody‑associated vasculitis: A retrospective observational study

et al. 2021

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“…In other disease settings where ANCA positivity is prominent, such as granulomatosis with polyangiitis, therapy with corticosteroids and rituximab are common, and reduce immune exertion and circulating B cell numbers, respectively. Indeed, a number of biologics targeting immune cells or their secreted components continue to be trialed in such conditions with some success ( Basu et al., 2018 ). However, these ANCA-associated conditions do not co-present with chronic infection, and immunosuppressive therapy in chronically infected PWCF may not be advisable ( King and Harper, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Targeting IgG Autoantibodies for Improved Cytotoxicity of Bactericidal Permeability Increasing Protein in Cystic Fibrosis

et al. 2020

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In people with cystic fibrosis (PWCF), inflammation with concurrent infection occurs from a young age and significantly influences lung disease progression. Studies indicate that neutrophils are important effector cells in the pathogenesis of CF and in the development of anti-neutrophil cytoplasmic autoantibodies (ANCA). ANCA specific for bactericidal permeability increasing protein (BPI-ANCA) are detected in people with CF, and correlate with infection with Pseudomonas aeruginosa. The aim of this study was to determine the signaling mechanism leading to increased BPI release by CF neutrophils, while identifying IgG class BPI-ANCA in CF airways samples as the cause for impaired antimicrobial activity of BPI against P. aeruginosa. Plasma and/or bronchoalveolar lavage fluid (BAL) was collected from PWCF (n = 40), CF receiving ivacaftor therapy (n = 10), non-CF patient cohorts (n = 7) and healthy controls (n = 38). Plasma and BAL BPI and BPI-ANCA were measured by ELISA and GTP-bound Rac2 detected using an in vitro assay. The antibacterial effect of all treatments tested was determined by colony forming units enumeration. Levels of BPI are significantly increased in plasma (p = 0.007) and BALF (p < 0.0001) of PWCF. The signaling mechanism leading to increased degranulation and exocytosis of BPI by CF neutrophils (p = 0.02) involved enhancement of Rac2 GTPloading (p = 0.03). The full-length BPI protein was detectable in all CF BAL samples and patients displayed ANCA with BPI specificity. IgG class autoantibodies were purified from CF BAL complexed to BPI (n=5), with IgG autoantibody cross-linking of antigen preventing BPI induced P. aeruginosa killing (p < 0.0001). Results indicate that the immune-mediated diminished antimicrobial defense, attributed to anti-BPI-IgG, necessitates the formation of a drug/immune complex intermediate that can maintain cytotoxic effects of BPI towards Gram-negative pathogens, with the potential to transform the current treatment of CF airways disease.

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“…Despite medical advances, patients' quality of life remains severely poor. Similar to our recipient's complex clinical vignette, patients frequently accrue significant damage, stemming from the vasculitis process itself (e.g., lung fibrosis, ESKD), side effects of administered treatment (e.g., infections, osteoporosis), and worsening of preexisting comorbidities (e.g., hypertension, obesity) [40]. In addition, the burden of immunosuppression is further augmented by the frequent relapses experienced as part of the disease's natural course, a characteristic commonly observed in PR3-ANCA positive AAV [41].…”

Section: Disease Process In Aavmentioning

confidence: 99%

Evaluating a Living Donor With Rheumatoid Arthritis for a Recipient With End-Stage Renal Disease From Antineutrophil Cytoplasmic Antibodies Associated Vasculitis

Souza

Ghahramani

Abendroth

et al. 2021

Cureus

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A 60-year-old Caucasian female with sero-positive rheumatoid arthritis (RA) was evaluated as a potential kidney donor for her brother-in-law with end-stage kidney disease (ESKD) secondary to c-antineutrophil cytoplasmic antibody (c-ANCA) associated vasculitis (AAV) and membranous nephropathy (MN). With little to no data supporting or contradicting this unique scenario, in addition to the varying viewpoints expressed by the different specialists, our multidisciplinary transplant committee encountered a difficult decision of whether to approve a candidate with RA for a living kidney donation or not. As a result, we carried out a careful literature review addressing aspects of recipients' outcomes following kidney transplants from a living donor with RA, especially when the recipient has AAV, living donor's short-and long-term outcomes post kidney donation, renal disease in AAV and RA, and maintenance of disease remission.

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Prognosis and future developments in vasculitis

Cited by 19 publications

References 119 publications

Systemic immune‑inflammation index predicts a reduced risk of end‑stage renal disease in Chinese patients with myeloperoxidase‑anti‑neutrophil cytoplasmic antibody‑associated vasculitis: A retrospective observational study

Systemic immune‑inflammation index predicts a reduced risk of end‑stage renal disease in Chinese patients with myeloperoxidase‑anti‑neutrophil cytoplasmic antibody‑associated vasculitis: A retrospective observational study

Targeting IgG Autoantibodies for Improved Cytotoxicity of Bactericidal Permeability Increasing Protein in Cystic Fibrosis

Evaluating a Living Donor With Rheumatoid Arthritis for a Recipient With End-Stage Renal Disease From Antineutrophil Cytoplasmic Antibodies Associated Vasculitis

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