Osteoprotegerin in juvenile rheumatoid arthritis: cross talk between the immune and the skeletal systems

Background: Previous studies have linked the decreased local production of osteoprotegerin (OPG), an osteoclastogenesis blocking agent, in the inflamed joints of rheumatoid arthritis patients to the development of bone erosion. Objective: We sought to assess OPG expression in juvenile rheumatoid arthritis (JRA) and to determine its relation to clinical and laboratory markers of disease activity, and radiologic evidence of bone resorption, as well as its relation to the type of onset, duration of illness and different therapeutic modalities. Methods: The study included 40 children and adolescents with JRA, as well as, 20 clinically healthy age- and sex- matched subjects for comparison. The patients underwent clinical evaluation for disease activity by the summed joint index and investigations including assessment of ESR, CRP, antinuclear antibodies and rheumatoid factor. were Serum levels of osteoprotegerin were assayed by ELISA in the patient and control groups. Joints were evaluated radiologically using the modified Larsen index (LI). Results: The serum levels of OPG in the patients [ median (interquartile range): 0.474 (0.4) ng/ml] were comparable to those of the control group [0.495 (0.41) ng/ml] (p=0.29). However, patients with pauciarticular onset JRA had significantly lower OPG levels [0.3 (0.23) ng/ml] than the control group (p= 0.007). The OPG levels were below the 5th percentile of the control value in 60% of pauciarticular and 16.7% of polyarticular JRA cases. Patients with polyarticular JRA had significantly higher values of ESR, activity score and Larsen indices as well as serum OPG levels (p= 0.001, 0.001, 0.002 and 0.02, respectively). OPG levels did not correlate to the ESR or the activity score index values. On the other hand, the duration of illness showed a tendency to be negatively correlated to serum OPG (r= -0.309, p=0.05). LI correlated positively to the activity score index and to the ESR in the JRA patients, whether compiled in one group or classified into subgroups according to disease onset. However, OPG was not significantly correlated to the LI (r= 0.023). The different modalities of therapy did not seem to influence the serum levels of OPG (χ2 = 4.21). Conclusion: Serum OPG expression was low in JRA, especially in the pauciarticular variety. OPG levels were higher in polyarticular JRA, but this does not necessarily have a protective effect since the proinflammatory process is known to promote also the expression of RANKL, an osteoclastogenesis enhancer. While clinical and biochemical parameters of activity, and LI did not correlate to OPG, the latter seemed to be adversely affected by increased disease duration.Keywords: Osteoprotegerin, JRA, osteoclastogenesis, RANKL, bone resorptionEgypt J Pediatr Allergy Immunol 2004; 2(1): 38-4

Plasma Adrenomedullin level in Egyptian children and Adolescents with type 1 diabetes mellitus: relationship to microvascular complications

<p>Abstract</p> <p>Background</p> <p>Adrenomedullin (AM) is known to be elevated in different clinical situations including diabetes mellitus (DM), but its potential role in the pathogenesis of vascular complications in diabetic children and adolescents is to be clarified. Hence, the study aimed at assessment of plasma adrenomedullin levels in children and adolescents with type 1 DM and correlation of these levels with metabolic control and diabetic microvascular complications (MVC).</p> <p>Methods</p> <p>The study was performed in the Diabetes Specialized Clinic, Children's Hospital of Ain Shams University in Cairo, Egypt. It included 55 diabetic children and adolescents (mean age 13.93 ± 3.15 years) who were subdivided into 40 with no MVC and 15 with MVC. Thirty healthy subjects, age-and sex- matched were included as control group (mean age 12.83 ± 2.82 years). Patients and controls were assessed for glycosylated hemoglobin (HbA1c) and plasma adrenomedullin assay using ELISA technique.</p> <p>Results</p> <p>Mean plasma AM levels were significantly increased in patients with and without MVC compared to control group, (110.6 pg/mL, 60.25 pg/mL and 39.2 pg/mL respectively) (P < 0.01) with higher levels in those with MVC (P < 0.05). Plasma AM levels were positively correlated with both duration of diabetes (ρ = 0.703, P < 0.001) and glycemic control (HbA1c) (ρ = 0.453, P < 0.001).</p> <p>Conclusion</p> <p>Higher plasma AM levels in diabetics particularly in those with MVC & its correlation with diabetes duration and metabolic control may reflect the role of AM in diabetic vasculopathy in the pediatric age group.</p

Therapeutic Role of Mobilized Bone Marrow Cells in Children with Nonischemic Dilated Cardiomyopathy

Copyright © 2012 Nevin M. Habeeb et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Dilated cardiomyopathy is an important cause of congestive cardiac failure in infants and children. Mobilizing hematopoietic progenitor cells is a promising intervention to this deadly disease. Aim. Evaluate granulocyte colony stimulating factor (GCSF) as therapeutic modality in children with idiopathic dilated cardiomyopathy (IDCM). Subjects and Methods. This case-control prospective study was conducted on 20 children with IDCM following up at Cardiology Clinic Children’s Hospital, Ain Shams University (group 1) who were compared to another 10 age-, sex-, duration-of-illness-, and systolic-function-matched children with IDCM as control (group 2). They were subjected to history taking, clinical examination, echocardiography, and peripheral blood CD34+ cell assessment before and one week after GCSF intake for 5 consecutive days (by group 1 but not group 2). Results. A significant improvement in echocardiographic data and CD34+-T-cell increase was found in group 1 one week after GCSF intake and for the next 6 months CD34+ T cells percentage of change showed no significant correlation with the that of the left ventricular dimensions and systolic function. Conclusion. Administration of GCSF to children with IDCM resulted in clinical and echocardiographic improvement not correlated to mobilized CD34+ T cells, implying involvement of additional mechanisms over simple stem cell mobilization. 1