Clinical spectrum time course in non-Asian patients positive for anti-MDA5 antibodies

Objectives: To define the clinical spectrum time-course and prognosis of non-Asian patients positive for anti-MDA5 antibodies. Methods: We conducted a multicentre, international, retrospective cohort study. Results: 149 anti-MDA5 positive patients (median onset age 53 years, median disease duration 18 months), mainly females (100, 67%), were included. Dermatomyositis (64, 43%) and amyopathic dermatomyositis (47, 31%), were the main diagnosis; 15 patients (10%) were classified as interstitial pneumonia with autoimmune features (IPAF) and 7 (5%) as rheumatoid arthritis. The main clinical findings observed were myositis (84, 56%), interstitial lung disease (ILD) (108, 78%), skin lesions (111, 74%), and arthritis (76, 51%). The onset of these manifestations was not concomitant in 74 cases (50%). Of note, 32 (21.5%) patients were admitted to the intensive care unit for rapidly progressive-ILD, which occurred in median 2 months from lung involvement detection, in the majority of cases (28, 19%) despite previous immunosuppressive treatment. One-third of patients (47, 32% each) was ANA and anti-ENA antibodies negative and a similar percentage was anti-Ro52 kDa antibodies positive. Non-specific interstitial pneumonia (65, 60%), organising pneumonia (23, 21%), and usual interstitial pneumonia-like pattern (14, 13%) were the main ILD patterns observed. Twenty-six patients died (17%), 19 (13%) had a rapidly progressive-ILD. Conclusions: The clinical spectrum of the anti-MDA5 antibodies-related disease is heterogeneous. Rapidly-progressive ILD deeply impacts the prognosis also in non-Asian patients, occurring early during the disease course. Anti-MDA5 antibody positivity should be considered even when baseline autoimmune screening is negative, anti-Ro52 kDa antibodies are positive, and radiology findings show a NSIP pattern

Immunosuppressive activity of proteases in cervical carcinoma

Objective. The host immune response is essential for restraining both HPV infections and HPV-related cervical cancer. We previously reported a direct correlation between proteolytic activity and malignant progression from precursor lesions to invasive cervical carcinoma. The present study was undertaken to investigate whether proteinases from cervical carcinoma extracts and representative purified proteinases involved in tumor progression could regulate lymphocyte proliferation to phytohemagglutinin (PHA) mitogen. Methods. Extracts were prepared from tissue samples obtained from patients with invasive cervical squamous carcinoma, squamous intra-epithelial lesions or women with normal cervix. Lymphocytes obtained from a single healthy donor were pre-incubated with one of these extracts in the presence or absence of proteinase inhibitors, and stimulated with PHA during 72 h. The proliferative response was measured using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl- tetrazolium bromide (MTT) method (re-validated with thymidine uptake). Results. Lymphocyte proliferation was significantly decreased by cervical carcinoma extracts, while only slightly decreased by squamous intra-epithelial lesions or normal extracts. Inhibitor assays indicated that proteinases from cervical carcinoma were responsible for 53.30% of total suppressive activity. We found that purified enzymes such as trypsin, cathepsin B, uPA and type IV collagenase suppressed the proliferative response in a dose-dependent fashion. Conclusions. Our data suggest that in addition to the classic role in tumor invasion, proteases could represent an immune evasion mechanism in cervical carcinoma. © 2005 Elsevier Inc. All rights reserved

Urokinase-type plasminogen activator and plasminogen activator inhibitors (PAI-1 and PAI-2) in extracts of invasive cervical carcinoma and precursor lesions

In a previous study we reported a direct correlation between the degree of total proteolytic activity and the natural history of cervical carcinoma. The present work examined whether an increase in the urokinase-type plasminogen activator (uPA) and the plasminogen activator inhibitors (PAIs) is correlated with the natural history of cervical carcinoma. We measured uPA and PAI-1 activities and uPA, PAI-1 and PAI-2 antigen concentrations in cervical extracts from normal, squamous intraepithelial lesions (SIL) or invasive carcinoma patients. The uPA activity in invasive carcinoma extracts was 8.46 times that of normal extracts and 4.9 times that of SIL extracts. The PAI-1 activity in invasive carcinoma extracts was 1.3 times that of normal extracts and 1.24 times that of SIL extracts. uPA, PAI-1 and PAI-2 amounts were 25.7-, 12.1- and 7.9-fold higher, respectively, in invasive carcinoma than in SIL, and 39.1-, 21.38- and 27.3-fold higher, respectively, than in normal extracts. uPA and PAI-1 activities were 2.02- and 1.42-fold higher in extracts from patients with stages II-IV than those from stage I extracts, respectively. uPA, PAI-1 and PAI-2 amounts were 3.06-, 4.2-and 1.4- fold higher in extracts from patients with stages II-IV than those from stage I extracts, respectively. The increase in uPA activity and the antigen levels of uPA and PAIs (PAI-1 and PAI-2) in stages II-IV of invasive carcinoma of the cervix suggests that these components play an important role in invasion and metastasis in advanced stages of this tumour