Rheumatoid Arthritis: Nagler A

Cohen Y, Nagler A. · Departments of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52621, Israel. · Autoimmun Rev. · Pubmed #15003184 No free full text.

Abstract: Immunological manipulations are the basis of modern therapy for refractory autoimmune diseases (AID). Ablative chemotherapy with stem cell support (autotransplant) as well as targeted immunotherapy using specific monoclonal antibodies, such as rituximab and campath 1-H have become acceptable second line therapy for severe refractory AID. Until now, more than 500 autotransplants have been performed worldwide for various autoimmune disorders, including multiple sclerosis (MS), systemic sclerosis (SSc), systemic lupus erythematosis (SLE) and rheumatoid arthritis (RA) with encouraging results, although transplant related mortality (TRM) in the range between 2 and 17% still remains one of the major limitations of the procedure. Immunotherapy is a relatively safe approach associating with sustained remissions in a considerable proportion of treated patients. Better selection of patients and earlier immunotherapy, preceded an irreversible organ damage might further improve the clinical outcome of patients with AID.

Nagler RM, Nagler A. · Department of Oral and Maxillofacial Surgery, Oral Biochemistry Laboratory and Salivary Clinic, Rambam Medical Center, and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. · J Dent Res. · Pubmed #14742644 No free full text.

Abstract: During the past two decades, the involvement of salivary glands in graft vs. host disease (GVHD) had been intensively researched and published. GVHD occurs in 40-70% of patients treated with bone marrow and peripheral blood stem cell transplantation (PBSCT), and improved survival rates have led to a continuously increasing number of GVHD patients suffering from induced salivary insult. Limited studies suggest that a large percentage of GVHD patients is affected and that the induced salivary dysfunction occurs rapidly following the transplantation. It affects both major and minor salivary glands and reflects the severity of the disease. Moreover, profound sialochemical alterations may be diagnostic of GVHD. An additional reason for this vast research is that GVHD, as an autoimmune-like disease, seemed to be an appropriate model for studying a much more prevalent and well-known and well-studied autoimmune disease involving salivary glands: Sjögren's syndrome. The purpose of the current review-which is, to the best of our knowledge, the first of its kind-is to describe the GVHD-related sialometric and sialochemical data published in the past two decades for both major and minor salivary glands and to discuss the pathogenesis and molecular basis of the disease.

Cohen Y, Polliack A, Nagler A. · Department of Hematology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel. · Curr Pharm Des. · Pubmed #12570832 No free full text.

Abstract: Immunological manipulations are the basis for modern treatments of autoimmune diseases (AID). Targeted immune suppression with lymphopenic based chemotherapy, and monoclonal anti B or T lymphocytic antibodies, are integral part of the conditioning for stem cell transplantation (SCT). Immune manipulation by Cyclophosphamide (Cy), ATG, Campath and recently rituximab (RI), with or without stem cell support are the basis for emerging therapeutic modalities aiming to eradicate the autoreactive clone in various autoimmune disorders. Couple of hundreds of SCTs have been recently performed in various autoimmune disorders, mainly multiple sclerosis (MS), progressive systemic sclerosis (PSS), systemic lupus erythematosis (SLE) and rheumatoid arthritis (RA). Preliminary results are encouraging. Better selection of patients and earlier treatment, before irreversible organ failure develops will probably improve results. Current ongoing multicenter studies are evaluating the role of SCT in MS, RA, SLE, and PSS.