Alan Tyndall

..The concept of immunological "re-setting" has evolved, and needs to be confirmed by longer follow-up and the multicentre, international phase III randomized studies...

..Despite encouraging small phase 1/2 studies, no positive data from randomized, prospective studies are as yet available in the peer-reviewed literature...

..Experimental strategies to achieve this include pre-emptive (preclinical) treatment before chronification is established, total immune ablation and immune "resetting" and autoantigen immunisation...

..Erectile dysfunction (ED) is common in men with systemic sclerosis (SSc) but the demographics, risk factors and treatment coverage for ED are not well known...

..Despite encouraging small phase I/II studies, no positive data from randomized, prospective studies are as yet available in the peer-reviewed literature...

..In those who relapsed, many responded to agents which pre transplant had been ineffective. The study of immune reconstitution and gene expression pre and post HSCT is being undertaken to further understand the mechanism of autoimmunity...

..Multidisciplinary groups are collaborating to ensure maximal use of available resources to establish the place, if any, of MSC in the treatment of AD...

....

..Basic science programs are also being undertaken to study the immunological mechanisms underlying the clinical events observed...

..This review summarizes the findings of a 1-day meeting devoted to the subject with the aim of coordinating efforts...

....

..Mesenchymal stem cells are in an exploratory phase for the treatment of acute autoimmune disease including SLE. The principle is that they home to inflammed tissue and exert an antiinflammatory paracrine effect...

..We must not forget the aim of improving quality of life for our patients, and not just improvement of immunological laboratory parameters...

..No one regimen was clearly superior to another, with a trend toward more infectious complications with more intense regimens. Prospective, controlled randomized trials are indicated and being planned...

..Randomised, prospective controlled phase III trials are desired, but by consensus, more phase I and II data is required to plan the optimal protocol...

..Further phase I and II data are required in SLE, JIA, and vasculitis. The need for continuing collection of all cases after mobilisation by the standardised EBMT and IBMTR data forms was emphasised...

..Randomized, prospective controlled phase III trials have begun in SSc and will soon commence in RA and multiple sclerosis. More phase I and II data are required for systemic lupus erythematosus and juvenile idiopathic arthritis...

..It is hypothesised that this results in fewer autoinflammatory and unwanted stimulatory signals to other systems such as vascular endothelium and fibroblasts, and these mechanisms are currently under study...

....

..In addition, the newly evolving field of mesenchymal stem cell therapy of autoimmune disease is introduced...

....

..To evaluate the feasibility of haematopoietic stem cell transplantation (HSCT) in vasculitis...

..The study objective was to assess health status of very long-term survivors in comparison with their respective human leukocyte antigen-identical sibling donors...

..We aimed to assess the impact of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) on the management of patients with suspected large vessel vasculitis...

..This year's edition specifically describes and discusses the use of MSC for the treatment of autoimmune diseases, due to the scientific, clinical, and economical implications of this topic...

....

..Such cells are immune privileged and apparently of low toxicity. Further characterization of these cells and consideration of their possible clinical application in AD is underway...

..This year's edition specifically discusses scientific, clinical, regulatory, and commercial aspects related to the use of cell therapy for the repair of cartilage defects...

..Prospective data for a better understanding of autoimmunity and 'altered' immunity after stem-cell transplantation are needed...

..This European multicenter study underlines the need for careful management and follow-up for secondary AD after HSCT...

..Therapies involving mesenchymal stromal cells are currently being explored in clinical settings because of their anti-inflammatory and tissue regenerative properties and their favorable risk/benefit ratio...

..Thus, rheumatic diseases and asymptomatic immune phenomena remain prevalent in HIV-infected persons even after the widespread implementation of highly active anti-retroviral therapy...

..However, allogeneic HSCT can induce remission in patients suffering from refractory AD. These data provide the basis for carefully conducted prospective trials...

....

..When intracavernous injections of prostaglandin E1 (alprostadil) are ineffective, the implantation of a penile prosthesis may be considered. Complex treatment options may require the involvement of urology...

..The aetiology is unknown. Genetic and environmental susceptibility factors have been implicated. It is unknown whether disease presentation varies within Europe...

..In order to better understand the vascular, immunological and fibrotic processes of SSc and to guide its treatment, the EULAR Scleroderma Trials And Research (EUSTAR) group was formed in June 2004...

....

....

..To define the specificity and extent of duplex sonography (DS) findings suggestive of vessel wall inflammation in patients with giant cell arteritis (GCA)...

..Clinical trials are necessary to develop this approach in patients with aggressive disease who have failed conventional treatment including anti-tumor necrosis factor agents...

..81 (0.96-3.42)); low intensity, RR2.34 (1.074-5.11)). These data from the collective EBMT experience support the hypothesis that autologous HSCT can alter disease progression in severe autoimmune disease...

..Autologous and allogeneic HSCT may induce a response in a subset of patients with autoimmune cytopenia of long duration albeit at the price of considerable toxicity...

..This data collection platform is expected to capture and foresee trends for novel cellular therapies in Europe, and warrants further consolidation and extension...

..CONCLUSIONS: A high level of suspicion of infection is necessary in patients under anti-TNF-alpha therapy. We suggest additional strategies for the prevention, rapid identification and pre-emptive therapy of such infections...

..Clear clinical data are still missing. Preliminary data are promising and protocols for prospective studies are being prepared. They should allow a better evaluation of the procedures in a few years from now...

..Our study suggests that IMC measurements, despite the advantages of simplicity, on-line recording of metabolic activity and no use of radioactivity, may be limited to monitoring mitogen-induced lymphocyte proliferation...

..We intended to analyze the effects of autoPBSCT in patients with treatment-resistant systemic vasculitis by analyzing the outcome of 4 patients from our own hospital, and comparing them to cases reported in the literature...

..Prospective studies are needed to elucidate the clinical presentation, evolution and outcome of such patients...

..In this clinical setting, routine PCR for Tropheryma whipplei from vertebral biopsies is recommended...

..Evidence from in vitro and animal experiments suggests that DNA may play a role in the pathogenesis of rheumatoid arthritis (RA)...

..To investigate whether mature human articular chondrocytes (AC) exhibit an antiproliferative effect on activated peripheral blood mononuclear cells (PBMC) and to compare this effect with other cells of mesenchymal origin...

..To describe and analyse the manifestation of sclerosing skin disorders in patients with multiple sclerosis (MS)...

..Early differentiation between septic and non-septic arthritis is difficult. A previous study showed promising diagnostic accuracy of serum Procalcitonin (PCT) in septic arthritis, limited by a low sensitive PCT test kit...

..Awareness is needed to link the typically prolonged onset of clinical symptoms with TDF exposure and then establish the correct diagnosis...

..Focal myositis of the iliopsoas muscle is a rare condition. A case is presented, emphasizing the value of ultrasound for detection, localisation, image-guided biopsy and follow-up in correlation with CT and MRI findings...

..However, the performance of QUS measurements is at least comparable with DXA measurements in identifying subjects with multiple vertebral fractures randomly selected from the population...

..EXAMINATIONS, DIAGNOSIS: In all three patients the MRI of the affected vertebral column was consistent with vertebral osteomyelitis. Microbiological diagnosis was made by bone biopsy in all patients and by blood cultures in two of them...

....

....

..The aim is to optimize cardiac status in order to allow intense immunosuppressive treatments...

..All of these potential resources clearly need to be investigated at the preclinical level but support a great deal of enthusiasm for cell therapy of autoimmune diseases...

..Uncontrolled studies have suggested that these therapies also have an impact on survival, but controlled studies with a long follow-up are needed to corroborate this point...

....

..The safety of this procedure is likely to be improved by patient selection and choice of conditioning regimen. The return of disease activity in one-third of patients might be reduced by long-term immunosuppressive therapy post-ASCT...