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Increased circulating Th17 cells, serum IL-17 and serum IL-23 in Takayasu's Arteritis
i n d i a n j o u r n a l o f r h e u m a t o l o g y 9 ( 2 0 1 4 ) S 1 eS 6
ScienceDirect Available online at www.indianjrheumatol.com and www.sciencedirect.com
IRACON - 2014 Oral Presentation Oral Presentation (November 28, 2014, Friday) b
O1. Increased circulating Th17 cells, serum IL-17 and serum IL-23 in Takayasu's Arteritis Durga Prasanna Misra, Smriti Chaurasia, Ramnath Misra; Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India Introduction: We enumerated Th17, gdT, NK and NKT cells and measured serum levels of IL-17 and IL-23 in peripheral blood of patients with Takayasu’s Arteritis (TA), and looked for their correlation with disease activity. Methods: IL-17 producing cell populations e Th17 (anti-CD3FITC, CD4PECy7, IL-17PE), NKT, NK(anti-CD3APC, CD56FITC) and gdT (anti-CD3FITC, CD4PECy7, CD8APC, gdAPC ) were enumerated by flow cytometry in peripheral blood of 30 patients with TA fulfilling ACR 1990 criteria and 20 healthy controls. Serum IL-17 and IL-23 were measured by ELISA. Their relation with disease activity (ITAS2010 and ITASA) was analyzed. Non-parametric tests were used for analysis (results presented as median with inter-quartile range). This study was approved by the institute ethics committee. Results: Mean age of patients was 33.47±11.78 years (25 females); mean symptom duration was 7.1±5.3 years. 13 were not on immunosuppressive drugs. 12 patients were active (ITAS 4). Compared with normal, the percentage of Th17 cells {patients 2.1 (1.5-3.2), n¼29 vs controls 0.75 (0.32-1.2), n¼20; p<0.0001} was significantly expanded in patients with TA. No differences in other cell populations were found. Serum IL-17 and IL-23 (pg/mL) in patients {6.2(4.6-8.5) and 15 (14.9-26.5) respectively} were significantly higher (p ¼ 0.004 and <0.0001 respectively) than controls {3.9(3.9-7.3) and 14.9(14.9-14.9) respectively}. Subgroup analysis showed that the increased Th17 cells, serum IL-17 and IL-23 did not correlate with ESR, disease activity or medications. Conclusions: There is significant expansion of Th17 cells and elevation of serum IL-17 and IL-23 levels in patients with TA as compared to healthy controls.
O2. Pattern of renal involvement in patients with ANCA associated vasculitis and its correlation with outcomes Aman Sharmaa, Vinay Sagara, Benzeeta Pintoa, Tarun Mittalb, Roopa Rajanc, Varun Dhira, Ritambhra Nadad, Surjit Singha, R.W. Minzd, Manish Rathib; aDepartments of Internal Medicine; http://dx.doi.org/10.1016/j.injr.2014.10.213
Nephrology; cNeurology; India
d
Immunopathology, PGIMER, Chandigarh,
Objective: To describe the pattern of renal involvement in patients with ANCA associated vasculitis and its correlation with outcomes. Methods: Medical records of 92 patients diagnosed to have AAV were analysed. Patients were classified as GPA, MPA, EGPA and undifferentiated AAV. Pattern of renal involvement in the form of RPRF, AKI or isolated urinary abnormality was described and patient outcomes were compared according to renal involvement. Results: 67 (72.8%) patients had GPA, 14 (15.2%) had MPA and 8 (8.7%) had EGPA, 3 (3.3%) had undifferentiated AAV. Renal involvement was seen in 51 (55.4%) patients (46.3% of GPA patients, 78.6% of MPA, 37.5% of EGPA and 33.3% of unclassifiable AAV patients). The type of renal involvement was RPRF in 30 (58.82%), AKI in 6 (11.76%) and isolated urinary abnormality in 15 (29.4%) patients. Of the total AAV patients with renal involvement 11 (21.56%) had advanced renal failure (serum creatinine > 5.7 mg/ dl), 25 (49.02%) had mild to moderate renal insufficiency and 15 (29.4%) had isolated urinary abnormalities without clinically apparent derangement of renal function. Patients with renal involvement had higher mean BVAS scores as compared to patients without renal involvement (p<0.01). 30 patients had good renal outcome with normal creatinine, 21 had persistent renal insufficiency but only 2 remained dialysis dependent, 3 were lost to follow up. Mean survival was lower and numbers of deaths were higher in the patients with renal involvement, however it was not statistically significant. Conclusion: AAV patients with renal involvement had higher BVAS. There was no significant difference in mean survival and deaths in patients with renal involvement suggesting that other organ involvement also contributes to survival and deaths in these patients.
O3. Role and efficacy of platelet rich plasma (PRP) in chronic non healing resistant vasculitic ulcers S. Srirama, M.M. Kavithaa, T.N. Tamilselvama, J. Euphrasia Lathab, S. Rajeswaria; aDepartments of Rheumatology, and bImmunology, Madras Medical College, Chennai, India Aim: To study the role, safety and efficacy of PRP in chronic non healing resistant vasculitic ulcers. Methods: After getting consent 20 patients with chronic nonhealing recalcitrant vasculitic ulcers which were resistant to high
ScienceDirect Available online at www.indianjrheumatol.com and www.sciencedirect.com
IRACON - 2014 Oral Presentation Oral Presentation (November 28, 2014, Friday) b
O1. Increased circulating Th17 cells, serum IL-17 and serum IL-23 in Takayasu's Arteritis Durga Prasanna Misra, Smriti Chaurasia, Ramnath Misra; Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India Introduction: We enumerated Th17, gdT, NK and NKT cells and measured serum levels of IL-17 and IL-23 in peripheral blood of patients with Takayasu’s Arteritis (TA), and looked for their correlation with disease activity. Methods: IL-17 producing cell populations e Th17 (anti-CD3FITC, CD4PECy7, IL-17PE), NKT, NK(anti-CD3APC, CD56FITC) and gdT (anti-CD3FITC, CD4PECy7, CD8APC, gdAPC ) were enumerated by flow cytometry in peripheral blood of 30 patients with TA fulfilling ACR 1990 criteria and 20 healthy controls. Serum IL-17 and IL-23 were measured by ELISA. Their relation with disease activity (ITAS2010 and ITASA) was analyzed. Non-parametric tests were used for analysis (results presented as median with inter-quartile range). This study was approved by the institute ethics committee. Results: Mean age of patients was 33.47±11.78 years (25 females); mean symptom duration was 7.1±5.3 years. 13 were not on immunosuppressive drugs. 12 patients were active (ITAS 4). Compared with normal, the percentage of Th17 cells {patients 2.1 (1.5-3.2), n¼29 vs controls 0.75 (0.32-1.2), n¼20; p<0.0001} was significantly expanded in patients with TA. No differences in other cell populations were found. Serum IL-17 and IL-23 (pg/mL) in patients {6.2(4.6-8.5) and 15 (14.9-26.5) respectively} were significantly higher (p ¼ 0.004 and <0.0001 respectively) than controls {3.9(3.9-7.3) and 14.9(14.9-14.9) respectively}. Subgroup analysis showed that the increased Th17 cells, serum IL-17 and IL-23 did not correlate with ESR, disease activity or medications. Conclusions: There is significant expansion of Th17 cells and elevation of serum IL-17 and IL-23 levels in patients with TA as compared to healthy controls.
O2. Pattern of renal involvement in patients with ANCA associated vasculitis and its correlation with outcomes Aman Sharmaa, Vinay Sagara, Benzeeta Pintoa, Tarun Mittalb, Roopa Rajanc, Varun Dhira, Ritambhra Nadad, Surjit Singha, R.W. Minzd, Manish Rathib; aDepartments of Internal Medicine; http://dx.doi.org/10.1016/j.injr.2014.10.213
Nephrology; cNeurology; India
d
Immunopathology, PGIMER, Chandigarh,
Objective: To describe the pattern of renal involvement in patients with ANCA associated vasculitis and its correlation with outcomes. Methods: Medical records of 92 patients diagnosed to have AAV were analysed. Patients were classified as GPA, MPA, EGPA and undifferentiated AAV. Pattern of renal involvement in the form of RPRF, AKI or isolated urinary abnormality was described and patient outcomes were compared according to renal involvement. Results: 67 (72.8%) patients had GPA, 14 (15.2%) had MPA and 8 (8.7%) had EGPA, 3 (3.3%) had undifferentiated AAV. Renal involvement was seen in 51 (55.4%) patients (46.3% of GPA patients, 78.6% of MPA, 37.5% of EGPA and 33.3% of unclassifiable AAV patients). The type of renal involvement was RPRF in 30 (58.82%), AKI in 6 (11.76%) and isolated urinary abnormality in 15 (29.4%) patients. Of the total AAV patients with renal involvement 11 (21.56%) had advanced renal failure (serum creatinine > 5.7 mg/ dl), 25 (49.02%) had mild to moderate renal insufficiency and 15 (29.4%) had isolated urinary abnormalities without clinically apparent derangement of renal function. Patients with renal involvement had higher mean BVAS scores as compared to patients without renal involvement (p<0.01). 30 patients had good renal outcome with normal creatinine, 21 had persistent renal insufficiency but only 2 remained dialysis dependent, 3 were lost to follow up. Mean survival was lower and numbers of deaths were higher in the patients with renal involvement, however it was not statistically significant. Conclusion: AAV patients with renal involvement had higher BVAS. There was no significant difference in mean survival and deaths in patients with renal involvement suggesting that other organ involvement also contributes to survival and deaths in these patients.
O3. Role and efficacy of platelet rich plasma (PRP) in chronic non healing resistant vasculitic ulcers S. Srirama, M.M. Kavithaa, T.N. Tamilselvama, J. Euphrasia Lathab, S. Rajeswaria; aDepartments of Rheumatology, and bImmunology, Madras Medical College, Chennai, India Aim: To study the role, safety and efficacy of PRP in chronic non healing resistant vasculitic ulcers. Methods: After getting consent 20 patients with chronic nonhealing recalcitrant vasculitic ulcers which were resistant to high