RESUMO
INTRODUCTION AND DEVELOPMENT: Over the last two decades antiphospholipid syndrome (APS) has started to be recognized from the association of apparently anionic phospholipid-specific antibodies with thrombosis, thrombocytopenia and recurrent foetal losses. This syndrome affects patients with systemic lupus erythematosus and is considered to be an important cause of thromboembolic disease. Antiphospholipid antibodies are serum immunoglobulins that react with negatively charged phospholipids, albeit directly or by means of a cofactor, affect the coagulation system, and promote thrombosis. Recent research has been directed towards gaining an understanding of the mechanisms by which these antibodies are able to play a direct role in the pathophysiology of thrombosis, and the extent to which certain risk factors, such as smoking, high blood pressure, lipid disorders and so on, exert an influence over the expression of phospholipids in the cerebral endothelium. CONCLUSION: These antibodies have no single mechanism of action; different authors have described different pathological mechanisms, which help us to understand the heterogeneous clinical manifestations of APS.
Assuntos
Síndrome Antifosfolipídica/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Síndrome Antifosfolipídica/imunologia , Ativação do Complemento , Endotélio Vascular/citologia , Endotélio Vascular/metabolismo , Humanos , Inibidor de Coagulação do Lúpus/metabolismo , Ativação Plaquetária , Prostaglandinas I/imunologia , Prostaglandinas I/metabolismo , Tromboplastina/metabolismoRESUMO
AIMS: In this study we describe the main findings from research into the autoreactive process triggered by activated T lymphocytes, which are generated in the peripheral compartment and then migrate towards the central nervous system (CNS) in multiple sclerosis (MS) and experimental autoimmune encephalomyelitis (EAE) its animal model. METHOD: The different strategies that have been developed to date for the immunological treatment of MS have been designed to intervene in the pathogenic process of the disease by blocking the activation of T cells and B cells with specific antigens, interfering with immunological effector mechanisms and inhibiting the migration of lymphocytes towards the CNS. The cause of the inflammatory response in MS has still not been defined, but the findings from EAE studies and in patients with MS suggest that the disease has an autoimmune aetiology involving autoreactive T cells which are specific for antigens in the myelin membrane. To activate these cells at least two cues are needed during antigen recognition and later the T CD4+ lymphocytes are differentiated in two subpopulations, Th1 and Th2, which differ in the pattern of secretion of cytosines depending on the stage of the disease process. The progressions of EAE and MS give rise to changes in the primary and secondary self reactive responses of the T cells during the progression of the disease. CONCLUSION: The pathological immune mechanisms mediated by activated myelin specific T lymphocytes play a key role in the progression and recuperation, as well as the mediation, of tissue damage during the course of MS and EAE.
Assuntos
Encefalomielite Autoimune Experimental/imunologia , Esclerose Múltipla/imunologia , Linfócitos T/imunologia , Linfócitos T/metabolismo , Animais , Progressão da Doença , Humanos , Ativação LinfocitáriaRESUMO
INTRODUCTION AND METHOD: The study of antiphospholipid antibodies has aroused a great deal of interest among researchers, as some of them are related to neurological diseases and in particular with cerebral ischemia. Cases of strokes in which the aetiology is unknown have been reported in young patients. Until now anticardiolipin antibodies and lupus anticoagulant have received the most attention in studies, but recently descriptions have been published of anticardiolipin antibodies with other particularities that can act as more specific immunity markers for strokes of undetermined origin in young adults. Recent research has been directed towards gaining an understanding of the mechanisms that allow these antibodies to play a direct role in the physiopathology of thrombosis and how certain risk factors smoking, high blood pressure, lipid disorders can exert an influence on the expression of phospholipids in the cerebral endothelium. Several authors have described different pathological mechanisms that help to understand the heterogeneous clinical manifestations of antiphospholipid syndrome. CONCLUSION: There is a need to study the different possible antigens of the antiphospholipid antibodies, as well as their specificities and pathological mechanisms, in greater depth in order to obtain a phospholipid immunity marker that is useful in the diagnosis of young stroke patients who are positive for these antibodies.
Assuntos
Anticorpos Antifosfolipídeos/metabolismo , Acidente Vascular Cerebral/fisiopatologia , Anticorpos Anticardiolipina/imunologia , Anticorpos Anticardiolipina/metabolismo , Anticorpos Antifosfolipídeos/imunologia , Antígenos/imunologia , Antígenos/metabolismo , Biomarcadores , Endotélio Vascular/imunologia , Endotélio Vascular/metabolismo , Humanos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/imunologiaRESUMO
INTRODUCTION: The immunological study of cerebrospinal fluid (CSF) is an essential diagnostic tool for evaluating patients with neurological diseases. The quantitative determination of the albumen and immunoglobulin G (IgG) in blood serum and in CSF by single radial immunodiffusion (SRID), together with the calculation of the IgG index to evaluate the presence of intrathecal synthesis of IgG and of the albumen quotient in order to evaluate the state of functioning of the blood brain barrier are essential elements to be evaluated for diagnosis and research in neurological clinical practice, as well as in the follow up of certain neurological diseases such as multiple sclerosis. Specific antiserums from commercial firms such as Boehring, SIGMA, etc. are used for the quantitative determination of IgG and albumen both in blood serum and in CSF by SRID. The high cost and the difficulty in acquiring these immunodiagnostic kits have had an important effect on the diagnostic and research opportunities throughout the country. MATERIALS AND METHODS: In this work we present the preliminary findings of the evaluation of the human IgG antiserum obtained from a ram, by Labex laboratories, for the quantitative determination of IgG in CSF by SRID, in order to find out whether this antiserum is efficient in the quantitative determination of IgG in CSF. RESULTS AND CONCLUSIONS: The studies conducted so far show that this antiserum may be a good candidate for use in immunological studies of CSF. Further work needs to be carried out on its validation in order to resolve the problems involved in immunological studies of CSF that we highlighted above. This would be achieved with an antiserum that is cheaper than those used up to now.
Assuntos
Soros Imunes/imunologia , Imunoglobulina G/imunologia , Doenças do Sistema Nervoso/líquido cefalorraquidiano , Doenças do Sistema Nervoso/imunologia , Cuba , HumanosRESUMO
A retrospective study was made on 9 cases with pains due to advanced head and neck cancer, attended to at the Pain Clinic of the National Institute of Oncology and Radiobiology between 1988 and 1991. An epidural catheter was implanted to these patients at the CNS level for the administration of a morphine solution. 7 patients (77.8%) showed total pain relief; and 2 cases showed easily-controlled slight pains. The most frequent complications were; fever (3 cases) and alterations of the level of consciousness (2 cases). No infections were reported. The importance of an adequate preparation of the patient and a strict follow up, where oncology nursing personnel play an important role, is pointed out.