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Jan 2022 DOI 10.14302/issn.2692-1537.ijcv-21-4051
Background As COVID-19 immunomodulation has been a part of interest for studies, it has been found that severe coronavirus disease 2019 (COVID-19) is associated with hyper-inflammatory response and increased levels of interleukin-6 (IL-6) and interleukin-10 (IL-10). This can progress to cytokine storm syndrome and eventually development of acute respiratory distress syndrome (ARDS). Interleukin-1 receptor antagonist (IL-1RA) is a protein that is a member of the interleukin 1 cytokine family. Monocyte chemoattractant protein 1 (MCP1) is a small cytokine that belongs to the CC chemokine family. Interferon gamma-induced protein 10 (IP-10) is a protein secreted by several cell types in response to Interferon-Gamma (IFN-γ). All of these have roles in the immune response and eventually development of a cytokine storm. Methods Serum levels of IL-1RA, MCP-1 and IP-10 were measured in a cohort of 21 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on admission to a tertiary care hospital in Riyadh, Saudi Arabia, as well as in an approximately age-sex matched group of 4 uninfected controls. The study population was classified into severe, moderate, mild and controls. Results Serum levels of IL-1RA, MCP-1 and IP-10 were found to be elevated before the clinical deterioration. Conclusion These cytokines may play a role in early detection of disease severity especially in the pre-storm phase. Medications that target cytokines may prevent the development of an overt cytokine storm.
Aug 2019 DOI 10.14302/issn.2470-5020.jnrt-19-2797
Background There is substantial evidence, from well-conducted epidemiological studies, that low vitamin D levels are correlated with increased risk for MS, and multiple case control studies have implicated the involvement of vitamin D deficiency in MS etiology. Narrow-band Ultraviolet B (NB-UVB; 300nm - 311 nm) induced vitamin D production has not previously been studied in a multiple sclerosis (MS) randomized placebo-controlled trial (RCT). Objectives To investigate NB-UVB induced vitamin D production, immunomodulation and MS symptomology following NB-UVB phototherapy in a MS cohort. Methods Using a blinded RCT study design, twelve individuals 18 years or older with MS were enrolled and assigned (1:1) into individualized NB-UVB dose (10-30kJ/m) phototherapy, or into placebo treatment, delivered 3 times per week, for 8-weeks. Serum vitamin D levels, walking performance, strength, cognitive function, mood and circulating progenitor cells (CPCs: CD34+CD45dim), monocyte populations (Intermediate CD14+CD16+, Classical CD14+CD16-), and T regulatory cell (CD4+/CD25+/FoxP3+Tregs) count were assesed. The data were analyzed by 2 x 3 mixed factor ANOVA. Results A statistically significant condition by time interaction on vitamin D levels (F=7.14, p<.005, partial η2=.42) was identified. NB-UVB phototherapy may provide immunomodulation in a select group of MS individuals. Conclusion UVB phototherapy corrects vitamin D deficiency. This study adds to the growing research investigating UVB treatment in MS.
Jun 2017 DOI 10.14302/issn.2474-7785.jarh-17-1578
Frailty describes a medical syndrome that confers increased vulnerability to disproportionate changes in health status following minor stressors. With loss of homeostatic reserve in multiple physiological systems, frailty conveys an increased risk of adverse health outcomes. Despite the lack of a clear universal definition, the utilisation of two landmark operational models has allowed a rapid expansion in frailty-centred research. The pathophysiology of frailty is yet to be elucidated in the literature, but a critical role for a heightened inflammatory state is hypothesised. Raised levels of pro-inflammatory cytokines are associated with frailty, with emerging evidence relating their biochemical action with development of the frailty phenotype. Dysregulation of both the innate and adaptive immune system are key components of the frailty syndrome. Remodelling of the T cell compartment and upregulated inflammatory pathways are theorised to propagate the heightened inflammatory state critical in the frailty syndrome. Increased neutrophil counts, in conjunction with ineffective neutrophil migration associated with age, is theorised to produce tissue damage and secondary inflammation conducive of the inflammatory picture in frailty. Beyond the gold standard of the comprehensive geriatric assessment, management of frailty is a fast-evolving area of research. Exercise interventions have shown promising results, improving functional ability and showing beneficial immunomodulation. Vitamin D supplementation, with proposed anti-inflammatory effects, nutritional support and pharmacological treatments all provide promising areas for future therapeutic intervention.