Welcome to the Autoimmunity 2021 Congress Calendar
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THE TECHNOLOGY OF ULTRA-HIGH DILUTION AS AN APPROACH TO THE TREATMENT OF AUTOIMMUNE DISEASES
Abstract
Background and Aims
Application of low-dose agents is one of the treatment approaches used in autoimmunology. Subcutaneous injections of low-dose allergens (10-6 to 10-17 g) are able to eliminate the development of an allergic reaction by stimulating the production of Treg. Due to the oral tolerance phenomenon, oral administration of antigens can reduce the activity of antigen-specific T cells. Thus, low-dose substances can act specifically on the immune system by suppressing excessive activation of the cellular response and reduce the severity of autoimmune disease. Recently, it has been shown that therapeutic effects can be obtained by applying ultra-high dilutions of antibodies; their activity can be realized through the influence on natural autoantibodies.
Methods
The mechanism of action of several ultra-high dilutions of antibodies to various targets was investigated in standard experimental models. Their efficacy and safety in humans were assessed in multicenter, double-blind, placebo-controlled, randomized clinical trials for the treatment of various diseases including autoimmune ones (type I diabetes mellitus, rheumatoid arthritis).
Results
The mechanism of action of ultra-high dilutions of antibodies is based on conformational changes in their targets, which are involved in the pathogenesis of the diseases, shown by structural biology methods (i.e. Nuclear Magnetic Resonance spectroscopy). These modifications affect the signaling pathways and form the basis of the drugs’ therapeutic activity. The efficacy as well as high safety including the absence of immunotoxicity have been confirmed in clinical trials.
Conclusions
Ultra-high dilutions of antibodies have shown promising results in the treatment of various diseases including autoimmune ones.
THE MEDICALIZATION OF CANNABIS FOR CLINICAL USE AND RESEARCH
CANNABIS AND AUTOIMMUNITY: POSSIBLE MECHANISMS OF ACTION
CANNABIS THERAPY; ARE THERE SIDE EFFECTS?
IMMUNOLOGICAL CONSEQUENCES OF IMMUNE ‘RECONSTITUTION’ THERAPY IN MULTIPLE SCLEROSIS: A SYSTEMATIC REVIEW
Abstract
Background and Aims
Background: Immune reconstitution therapy (IRT) is an emerging concept for the treatment of multiple sclerosis (MS).
Aim: To summarize knowledge regarding the short- and long-term immunological consequences of different IRTs in patients with MS.
Methods
Methods: A systematic literature review was performed. A total of 586 articles published between January 2010 and September 2019 were identified and screened; 44 studies met inclusion criteria for the review.
Results
Results: Autologous hematopoietic stem cell transplantation produced the longest-lasting and greatest effects on a wide range of immune cells. A proportion of patients treated with alemtuzumab and cladribine tablets required retreatment to maintain these effects. Alemtuzumab may produce greater depletion of both CD4+ and CD8+ T cells than cladribine tablets, although both treatments similarly deplete B cells. Recovery of B cells before T cell recovery and hyperpopulation of B cells after alemtuzumab may contribute to secondary autoimmunity. Cladribine tablets had a greater effect on B cells than T cells, and no hyperpopulation of B cells was observed after treatment with cladribine tablets. Effects of the drug treatments on the innate immune system were minor compared with those on the adaptive immune system.
Conclusions
Conclusion: Additional characterization of the cellular changes occurring during IRT may lead to further improvement in the understanding of the pathogenesis of MS and the future development of therapies with even longer lasting effects. Although the treatments considered in this review improve quality of life and outcomes for patients with MS, a cure for this debilitating disease is not yet in sight.
THE ROLE OF CANNABINOID OIL IN FIBROMYALGIA: CLINICAL EXPERIENCE
Abstract
Background and Aims
Introduction:Cannabidiol (CBD), a major substance of cannabis sativa, has been considered beneficial for the relief of pain and insomnia in patients with fibromyalgia and an increasing number of patients receive it, even without physician’s guidance.
Aim: To assess the efficacy of CBD in patients with fibromyalgia in terms of safety, pain relief, depression and sleepiness
Methods
Material and Methods: Twenty nine patients with fibromyalgia (26 women, median age 46, range 35-72) received CBD (10% oil, sublingual), 1000 mg) in addition to their pre-scribed medication.
Results
Results:Upon questioning, 25/29 (86.2%) initially perceived CDD as medical cannabis and further explanation was needed to clarify its nature; 23/29 (79.3%) received CBD oil for 2-24 weeks, 6 (20.7%) for less than 2 weeks (including 3 without any clinical improvement). Three stopped because of adverse reactions, 1 because of allergic reaction, two because of nausea/bloating). Of the 23 who received it for more than 2 weeks, 20 (69%) showed an improvement in pain, sleep and/or mood. Of those 5/20 (25%) receive CBD alone, as they were able to stop medication pre-scribed for their symptomatology.
Conclusions
Conclusions: CBD intake appears safe without significant adverse reactions. Patients with fibromyalgia appear to exert a benefit in terms of symptomatology relief. Randomized clinical trials are urgently needed to assess the efficacy of CBD in patients with fibromyalgia.
AUTOLOGOUS HEMATOLOGICAL STEM CELL TRANSPLANTATION FOR SYSTEMIC SCLEROSIS IN ISRAEL.
Abstract
Background and Aims
Autologous Hematological stem cell transplantation (AHSCT) is a novel therapy for systemic sclerosis (SSc) that has been validated in three randomized controlled trials. We report herein the first Israeli experience of 5 patients with SSc treated successfully with HSCT and review the current literature.
Methods
Demographic and clinical data of all SSc patiients who underwent AHSCT in our institutes between 2016- 2019 was collected from medical records. Data included age, sex, length of disease, modified Rodnan Skin Score (mRSS), pulmoanry function tests, echocardiography, chest CT scans, cardiac MRI, laboratory tests, medical therapies before and after HASCT.
Results
Four adult SSc women and one girl underwent AHSCT at a mean age of 44±21 years. AHSCT has been done 1.4±0.8 years since diagnosis. Two patients were RNA POLIII positive, two were anti topoisomerase 1 positive and one only ANA positive. All patients had skin and lung involvement. The mRSS improved from 29±4.7 to 10.4±9.6 after AHSCT. The FVC improved from 68±13% predicted to 90±28% predicted. DLCO increased by 7%. Among severe adverse events were cyclophosphamide related congestive heart failure, ATG related capillary leak syndrome and scleroderma renal crisis, all completely resolved without sequela. No treatment related mortality was recorded.
Conclusions
AHSCT is an important step forward in the treatment of progressive SSc in Israel. Careful patient selection has reduced treatment related morbidity and mortality. This work is the product of a warm collaboration between three centers, Hopital Saint Louis in Paris, rheumatology unit Bnai Zion medical center and Stem cell transplantation center Rambam, Israel.
Development of Raynaud's phenomenon following use of medical cannabis
Abstract
Background and Aims
Across the globe, use of medical cannabis is rising. Extensive research has illustrated that its components harbor both euphoric effects as well as anti-inflammatory properties. At the same time, multiple case reports have been published illustrating features of cannabis arteritis. Manifestations mostly involve signs of distal extremity ischemia and necrosis that resolve following cannabis cessation.
Methods
Case report below.
Results
A 56 year old woman with a longstanding history of ankylosing spondylitis presented to the hospital with blackening and numbness of the left second finger. She had been refractory to treatment with DMARDs and 5 different biologic treatments. Therefore, she was prescribed 10 mg of cannabis oil to be applied sublingually twice daily. Two months after beginning this treatment, the patient noticed the darkening of the distal third of her left second finger, unrelated to environmental stimuli, with loss of sensation along the affected distribution. Over the course of the next several weeks, she developed progressive color changes in the rest of her fingers and toes, encompassing the entirety of the digits. Comprehensive labwork was absent for any other prothrombic factors. Two weeks following the discontinuation of cannabis, symptoms had improved dramatically, with return of color and sensation to the left second finger and only mild Raynaud's upon severe cold exposure.
Conclusions
This patient’s medical course illustrates the onset of Raynaud’s phenomenon following the use of cannabis oil. As rheumatologists turn to cannabis as a treatment, they must be aware of the potential adverse events in order to better monitor for their emergence.