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Expert Review of Clinical Immunology

Rolf Ak Stahl, Linda Reinhard, Elion Hoxha
Membranous nephropathy (MN) is the most common cause of a nephrotic syndrome in Caucasian adults. The identification of target antigens in MN in the last decade has had a major impact on the clinical approach to these patients. Areas covered: Since the discoveries in animal models in the 1980s that circulating autoantibodies induce disease upon in situ binding to glomerular podocytes, many attempts have been undertaken to define the human antigens responsible for disease induction. Only in 2009 was Phospholipase A2 Receptor 1 described as the major antigen responsible for MN onset in about 70% of patients...
November 15, 2018: Expert Review of Clinical Immunology
John P Campbell, James E Turner
No abstract text is available yet for this article.
November 15, 2018: Expert Review of Clinical Immunology
Karl J Lackner, Nadine Müller-Calleja
Even though our understanding of the antiphospholipid syndrome (APS) has improved tremendously over the last decades, we are still not in a position to replace symptomatic anticoagulation by pathogenesis based causal treatments. Areas covered: Recent years have provided further insights into pathogenetically relevant mechanisms. These include a differentiation of pathogenic subtypes of antiphospholipid antibodies (aPL), novel mechanisms modulating disease activity, e.g. extracellular vesicles and microRNA, and novel players in pathogenesis, e...
November 9, 2018: Expert Review of Clinical Immunology
Jennifer J Koplin, Katrina J Allen, Mimi Lk Tang
Food allergy currently affects up to 10% of infants. Identification and implementation of effective food allergy prevention strategies is thus imperative. Areas covered: We focus on five food allergy risk factors/prevention strategies which have been or are currently being tested in randomised controlled trials: (1) timely introduction of allergenic foods into the infant diet; (2) maternal diet and consumption of allergenic foods during pregnancy and breastfeeding; (3) infant skin barrier and the role of moisturisers in early life; (4) infant Vitamin D levels and the role of Vitamin D supplementation; and (5) microbial exposure in early life...
November 9, 2018: Expert Review of Clinical Immunology
Teresa Capriati, Carla Bizzarri, Anna Dilillo, Valerio Nobili, Salvatore Oliva, Antonella Diamanti
Growth failure in children is a frequent feature of childhood-onset Crohn's disease (CD) and stunting can persist into adulthood. Growth is an important outcome by which to judge the effectiveness of therapies in children; currently available studies in CD children have focused on the short-term impact of treatments on growth and there are limited data regarding the long-term effects of treatments upon growth. Areas covered: We designed the present article to review whether the first treatment performed in newly diagnosed CD children may have a role on the future growth course...
November 7, 2018: Expert Review of Clinical Immunology
Giacomo Cafaro, Elena Bartoloni, Alessia Alunno, Roberto Gerli
No abstract text is available yet for this article.
November 5, 2018: Expert Review of Clinical Immunology
Rodney Sinclair, Vetrichevvel Thirthar Palanivelu
Psoriasis is an immune-mediated skin disease amenable to targeted immunotherapy. Tildrakizumab is a humanized IgG1 monoclonal antibody targeting interleukin-23 p19 and is approved for use in moderate to severe psoriasis. Areas covered: This article reviews the mechanism of action, pharmacokinetics, safety, tolerability, and clinical efficacy of tildrakizumab, administered subcutaneously every 12 weeks, in treatment of moderate to severe psoriasis. Expert commentary: In two phase 3 clinical trials, tildrakizumab showed a consistent low occurrence of adverse events, underlining safety and tolerance...
November 3, 2018: Expert Review of Clinical Immunology
Melanie A Ruffner, Katie Kennedy, Antonella Cianferoni
Diagnostic and therapeutic strategies in eosinophilic esophagitis (EoE) are evolving. New knowledge regarding the pathophysiology of EoE has been the foundation for updated diagnostic recommendations and new therapeutic trials. Areas Covered: We performed structured literature searches in Medline and PubMed, Cochrane meta-analyses, and abstracts of international congresses to review therapeutic approaches for EoE in July 2018. Additional articles were obtained by perusing the references of articles identified in the original PubMed search...
November 3, 2018: Expert Review of Clinical Immunology
Lina Serhal, C J Edwards
Tofacitinib and baricitinib have recently been approved as second-line treatments for RA though their maximum expected efficacy may be limited by dose-related toxicities. Upadacitinib selectively inhibits JAK1 which could potentially reduce JAK2 and JAK3-related side effects. Areas covered: In this paper, we review a newly developed oral selective Janus kinase inhibitor (Jakinib), upadacitinib for the treatment of Rheumatoid arthritis (RA). The doses of upadacitinib extended-release 15 and 30 mg daily selected in phase III RA studies have shown a near-maximum efficacy in phase II studies...
November 3, 2018: Expert Review of Clinical Immunology
Masaru Kato, Ryo Hisada, Tatsuya Atsumi
Antiphospholipid syndrome (APS) is an acquired autoimmune thrombophilia associated with the presence of persistent antiphospholipid antibodies. Owing to recent studies, not only APS patients but also incidentally-identified, asymptomatic antiphospholipid antibody (aPL) carriers are able to be stratified in terms of the risk of future thrombotic events, according to the variety and the titer of positive aPL tests and to the non-thrombotic, aPL-associated clinical manifestations. Areas covered: Here, we critically review (a) criteria manifestations of APS, (b) non-criteria manifestations of APS, (c) risk assessment in patients with APS and in aPL carriers, and (d) the potential role of primary thrombosis prophylaxis in aPL carriers...
November 1, 2018: Expert Review of Clinical Immunology
Elena Pezzolo, Luigi Naldi
Smoking is the single most important cause of preventable mortality worldwide. Besides being associated with major cardiovascular and bronchopulmonary diseases, and several cancers, it has been linked with a number of immune-related conditions, including psoriasis and psoriatic arthritis (PsA), with an effect on disease development, which may differ according to the condition considered. We aimed to summarise data on the role of smoking in the development and prognosis of psoriasis and PsA, pointing to the consequences in terms of disease management...
October 31, 2018: Expert Review of Clinical Immunology
Syed-Rehan A Hussain, Asuncion Mejias, Octavio Ramilo, Mark E Peeples, Mitchell H Grayson
In early childhood, wheezing due to lower respiratory tract illness is often associated with infection by commonly known respiratory viruses such as respiratory syncytial virus (RSV) and human rhinovirus (RV). How respiratory viral infections lead to wheeze and/or asthma is an area of active research. Areas covered: This review provides an updated summary of the published information on the development of post-viral induced atopy and asthma and the mechanisms involved. We focus on the contribution of animal models in identifying pathways that may contribute to atopy and asthma following respiratory virus infection, different polymorphisms that have been associated with asthma development, and current options for disease management and potential future interventions...
October 27, 2018: Expert Review of Clinical Immunology
Harsha H Kariyawasam
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complex disease of the upper airway, with long-term morbidity. With detailed mechanistic studies currently lacking, understanding of the immunopathogenesis is still limited. However, outcomes from CRSwNP clinical studies using biologics that block key mediators or cells may provide some insights into how immune signaling pathways potentially integrate and modulate each other and contribute to disease. Current treatments are often ineffective and there is an urgent unmet clinical need for effective therapeutic strategies...
October 27, 2018: Expert Review of Clinical Immunology
Gustavo Guimarães Moreira Balbi, Vinicius Domingues, Gabriela Guimarães Moreira Balbi, Guilherme Ramires De Jesús, Roger Abramino Levy
Since most of the autoimmune diseases (AID) affect mostly women in their fertile years, and fertility is in general preserved, the use of disease-modifying antirheumatic drugs (DMARDs) during conception, pregnancy, and lactation has been a matter of concern in the treatment of women affected by AID. Areas covered: We performed a comprehensive review of the latest and most relevant research papers published in the field and discussed different aspects related to the use of synthetic and biologic DMARDs and immunosuppressants in the preconceptional period, during pregnancy and lactation in AID patients, both in males and females...
October 26, 2018: Expert Review of Clinical Immunology
Darren D O'Rielly, Proton Rahman
Psoriatic arthritis (PsA) is a heterogeneous inflammatory disorder with articular, peri-articular, and extra-articular features along with selected co-morbidities as a sequela to chronic inflammation. There is accumulating evidence that the Th-17 signaling pathway is of critical importance in PsA pathogenesis. Areas covered: Ixekizumab (IXE) is a humanized immunoglobulin G subclass 4 (IgG4) monoclonal antibody directed against IL-17A. Two phase III randomized clinical trials, SPIRIT-P1 and SPIRIT-P2, unequivocally demonstrated superiority of IXE (80 mg every two or 4 weeks) dosing over placebo in moderate-to-severe PsA patients that failed either NSAIDs, conventional disease-modifying anti-rheumatic drugs (csDMARDs), or tumor necrosis factor-α inhibitors (TNFi) for numerous articular and cutaneous parameters...
October 26, 2018: Expert Review of Clinical Immunology
Chiara Borsotti, Antonia Follenzi
Conventional hemophilia treatment is based on repeated infusion of the missing clotting factor. This therapy is lifelong, expensive and can result in the formation of neutralizing antibodies, thus causing failure of the treatment and requiring higher doses of the replacement drug. Areas covered: Gene and cell therapies offer the advantage of providing a definitive and long-lasting correction of the mutated gene, promoting its physiological expression and preventing neutralizing antibody development. This review focuses on the most recent approaches that have been shown to prevent and even eradicate immune response toward the replaced factor...
October 22, 2018: Expert Review of Clinical Immunology
Harold S Nelson
Allergic rhinitis (AR) is among the most common chronic conditions affecting both children and adults. It is the cause of significant morbidity from the symptoms and interference with sleep. It results in major impairment of performance both at school and at work. In the U.S. and certain parts of Europe, ragweed pollen is a major cause of seasonal AR. In 2014, the U.S. Food and Drug Administration (FDA) approved a sublingual ragweed tablet (MK-3641) for use in adults with ragweed-induced AR. Areas covered: This paper will review the impact of ragweed-induced AR and available treatments including subcutaneous immunotherapy and studies with MK-3641...
October 22, 2018: Expert Review of Clinical Immunology
Vanessa Ocampo-Piraquive, Ivana Nieto-Aristizábal, Carlos A Cañas, Gabriel J Tobón
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by organ damage, flare-remission pattern, and increased mortality when compared with the general population. SLE mortality depends on epidemiological, sociodemographic, genetic, and clinical factors. Mortality causes have been mainly grouped in disease activity, infections, and cardiovascular complications. Lupus nephritis and neuropsychiatric lupus are the main manifestations associated to mortality. Bacterial infection remains an important cause of death, and cardiovascular mortality is almost double when compared to age - and sex-matched comparisons...
October 19, 2018: Expert Review of Clinical Immunology
Kassem Sharif, Abdulla Watad, Louis Coplan, Howard Amital, Yehuda Shoenfeld, Arnon Afek
Type 1 diabetes mellitus (T1DM) is a chronic disease characterized by the destruction of insulin-producing β-cells of the pancreas. The current paradigm in this disease's etiopathogenesis points toward the interplay of genetic and environmental factors. Among the environmental variables, dietary factors, intestinal microbiota, toxins, and psychological stress have been implicated in disease onset. Areas covered: This review aims to investigate the relationship between psychological stress and T1DM by presenting evidence from epidemiological studies, animal models, and to provide the mechanism involved in this association...
October 18, 2018: Expert Review of Clinical Immunology
Gailen D Marshall, Matthew T Tull
The global incidence and prevalence of allergic diseases are increasing as is the intensity and duration of excessive psychological stress due to multiple factors associated with living in today's world such as personal, social and political unrest, increased fear and anxiety, and/or depression often leading to hopelessness. Both allergy and chronic psychological stress are characterized by immune imbalances that have similar characteristics. Thus, it is reasonable to posit that the two are interactive and stress may induce as well as complicate at least some allergic diseases...
October 16, 2018: Expert Review of Clinical Immunology
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