Tsvetelina Velikova | Medical University of Sofia (original) (raw)
Papers by Tsvetelina Velikova
A number of childhood lung diseases have immunological mechanisms of development, such as bronchi... more A number of childhood lung diseases have immunological mechanisms of development, such as bronchial asthma, allergic rhinitis, and cystic fibrosis. Asthma is one of the most common lung diseases in children with a prevalence of 8-10% of all children. It is characterized by chronic inflammation of the airways, in the pathogenesis of which play inflammatory cells: T-lymphocytes, immunoglobulin E (IgE)-producing plasmocytes, eosinophils, mast cells, macrophages, epithelial cells, fibroblasts, as well as pro-inflammatory cytokines (i.e., interleukin `[IL]-6, IL-8, IL-12, IL-4, IL-10, IL-13, interferon-g, and IL-17). [1] Thus, bronchial asthma is a complex and heterogeneous disease characterized by intermittent and reversible airway obstruction, chronic airway inflammation, bronchial hyperresponsiveness, and cell infiltration in the airway submucosa. Obstruction of the airways is variable and reversible, either spontaneously or under treatment. There is also an increase in the bronchial response to a variety of specific and nonspecific stimuli. About 80% of asthmatics are diagnosed before the 6 th year of age, proving the early onset of the disease, whose natural course is manifested by a progressive decline in the respiratory function such as forced expiratory volume in one second. [1] Management of the asthma is also influenced by the inflammatory and structural changes in the airways.
American journal of clinical and experimental immunology, 2020
Bladder carcinoma (BC) is one of the most common malignancies of the urinary system in developed ... more Bladder carcinoma (BC) is one of the most common malignancies of the urinary system in developed countries, with a high number of recurrences. The secondary lymphoid organs (SLO) are crucial for initiating the adaptive immune response. They are developed as a part of a genetically preprogrammed process during embryogenesis. However, SLO's organogenesis can be reduplicated de novo in other tissues by a process termed lymphoid neo-genesis, giving rise to tertiary lymphoid structures (TLS). These well-organized lymphoid structures in cancer are essential modulators of cancer immunologic response, and the histological examination of TLS gave a new strategy for cancer immunotherapy. This review explores the biological and histological characteristics of TLS in muscle non-invasive and invasive BC.
Autoimmune diseases of the liver often lead to organ failure which raises the issue of allogeneic... more Autoimmune diseases of the liver often lead to organ failure which raises the issue of allogeneic transplantation as definitive therapy. Immunological mechanisms of the underlying autoimmune diseases, however, and the immune-mediated processes occurring after transplantation despite the administration of immunosuppressive therapy, define a number of problems in these patients. In addition to the risks associated with the transplantation itself, consideration should also be given to the possibility of recurrence or de novo origin of the autoimmune liver disease [1].Table 1 presents the main liver diseases that require liver transplantation, as well as the prognosis after transplantation [1].
World Journal of Transplantation, 2021
Lung transplantation (LT) is a life-saving therapeutic procedure that prolongs survival in patien... more Lung transplantation (LT) is a life-saving therapeutic procedure that prolongs survival in patients with end-stage lung disease. Furthermore, as a therapeutic option for high-risk candidates, single LT (SLT) can be feasible because the immediate morbidity and mortality after transplantation are lower compared to sequential single (double) LT (SSLTx). Still, the long-term overall survival is, in general, better for SSLTx. Despite the great success over the years, the early post-SLT period remains a perilous time for these patients. Patients who undergo SLT are predisposed to evolving early or late postoperative complications. This review emphasizes factors leading to post-SLT complications in the early and late periods including primary graft dysfunction and chronic lung allograft dysfunction, native lung complications, anastomosis complications, infections, cardiovascular, gastrointestinal, renal, and metabolite complications, and their association with morbidity and mortality in th...
Bronchial asthma (BA) in childhood is the most common chronic disease estimated to affect up to 1... more Bronchial asthma (BA) in childhood is the most common chronic disease estimated to affect up to 10% of all children. Moreover, the observed increase in the incidence of asthma relies mainly on the rise in childhood BA. It is well-established that BA is an immune -mediated complex and heterogeneous disease, characterised clinically by bronchial reactivity, intermittent but reversible obstruction, and chronic airway inflammation due to the infiltration with various immune cells (T lymphocytes, mast cells, basophils, IgE -producing plasmocytes) [1]. Intensively investigated for the last years was IL-17-driven inflammation in BA. After pathogen or allergen irritation, a subsequent differentiation of naive T lymphocytes into IL17 producing cells was also observed. Th17 lymphocytes secrete various cytokines, such as IL-17A, IL17F, and IL-22, which contribute to the well-establish broad range of cytokines (IL-4, IL-5, IL-6, IL-8, IL12, IL-10, IL-13, IFN-y) described to be involved in the B...
In some cases, spontaneous inhibition of immunological reactivity in transplantation, which is re... more In some cases, spontaneous inhibition of immunological reactivity in transplantation, which is responsible for the graft rejection, has been observed, a phenomenon mediated by a specific T cell population defined as regulatory T cells (Tregs). This mini-review discusses the impact of Treg cells on the in initiation and maintenance of operational tolerance after liver transplantation, the Treg cells as a biomarker for post-transplantation tolerance assessment, and the novel approach of adoptive transfer of Treg cells after liver transplantation. Currently, the data are limited and do not allow for extensive comments. However, by virtue of the immunological background, Tregs are promising as diagnosing and therapeutic application that gives hope for successful liver transplantation.
Gluten enteropathy, a.k.a. celiac or non-tropical sprue is an autoimmune disease of the small int... more Gluten enteropathy, a.k.a. celiac or non-tropical sprue is an autoimmune disease of the small intestines which arise in genetically predisposed children and adults [1]. It is thought to be caused by immunological hypersensitivity to gluten-containing food [2]. The key aspects of the pathogenesis of the disease include the enzyme tissue transglutaminase (tTG). Intestinal tTG is a calcium-dependent enzyme that catalyzes hydrolysis (i.e., deamidation, conversion of the amino acid glutamine into glutamate) of glutamine residues. Gliadin, a protein rich in glutamine, is a specific substrate for this enzyme. tTG selectively deamidates the gliadin molecules trapped in lamina propria so that deamidated gliadin peptides are formed [3].
OBJECTIVE To evaluate serum matrix metalloproteinase (MMP)-3 levels as a prognostic marker for th... more OBJECTIVE To evaluate serum matrix metalloproteinase (MMP)-3 levels as a prognostic marker for the progression of cartilage damage in patients with knee osteoarthritis (KOA). METHODS Fifty-six patients, aged 40 to 80 years (62.59 ± 10.11 years) who met the ACR criteria for KOA, were included in a one-year observational prospective clinical study. Complete baseline and follow-up data were collected from 50 out of 56 patients. X-ray and magnetic-resonance images were carried out at baseline and after 12 months. They were evaluated according to the Kellgren-Lawrence and Whole-Organ magnetic Resonance iMaging Score (WORMS) semi-quantitative scales, respectively. Progression of cartilage damage in the medial tibiofemoral compartment was registered at the end of the follow-up using the change in WORMS. Serum levels of MMP-3 were measured during the baseline visit, using enzyme-linked immunosorbent assay. RESULTS Significantly higher values of baseline MMP-3 levels were observed in patient...
In liver transplant patients, solid tumors and post-transplant lymphoproliferative disorders (PTL... more In liver transplant patients, solid tumors and post-transplant lymphoproliferative disorders (PTLD) have emerged as significant long-term mortality causes. Additionally, it is assumed that de novo malignancy (DNM) after liver transplantation (LT) is the second-leading cause of death after cardiovascular complications. Well-established risk factors for PTLD and solid tumors are calcineurin inhibitors (CNIs), tacrolimus (TAC), and cyclosporine, the cornerstones of all immunosuppressive (IS) therapies used after LT. The loss of immunocompetence facilitated by the host immune system due to prolonged IS therapy leads to cancer development, including in LT patients. Hindering DNA repair mechanisms, promoting tumor cell invasiveness, and hampering apoptosis are critical events in tumorigenesis and tumor growth in LT patients resulting from IS administration. This paper aims to overview the refined mechanisms of IS-induced tumorigenesis after LT and the loss of immunocompetence facilitated ...
Celiac disease (CD) is a condition with a strong genetic predisposition that may affect people of... more Celiac disease (CD) is a condition with a strong genetic predisposition that may affect people of all ages and gender. The established prevalence of the disease varies from 1:70 (in Australia) to 1:120 in Europe [1]. However, about 80% of the affected people remain undiagnosed. The main features of the disease are inflamed and flattened intestinal mucosa leading to small bowel damage [1]. Although CD is considered as an autoimmune disease characterized by sensitiveness to gluten throughout the whole life, thus, in this sense patients are never cured, even though a strict gluten-free diet (GFD) allows CD to be managed effectively [2]. The pathophysiology of CD remains elusive, although a substantial progress in the knowledge of gluten sensitization and the role of some environmental factors was made.
The case report presented here describes the culturing and characterization of mesenchymal stem c... more The case report presented here describes the culturing and characterization of mesenchymal stem cells (MSCs) isolated from a primary indolent B-cell lymphoma, located in the CNS of an immunocompetent patient. The presence of such cells in the tumor mass can further elucidate the pathogenesis of the disease and reveal possible future approaches for its treatment. We present a case report of a 61-year-old immunocompetent woman who had an episode of confusion with numbness in the right leg and the right arm, slurred and dysarthric speech and urine incontinence. The peripheral blood tests were normal. The neurological examination demonstrated a latent hemi-paresis of the right side, aphasia, discrete hypertension and bradypsychia. The ophthalmologic examination revealed left quadranopsia. Computed tomography and magnetic resonance imaging of the brain showed a 3.5 × 2.9 cm infiltrative neoplastic lesion involving the left temporal parenchyma. The morphological features and the immunophe...
Laboratory tests are an integral part of both the diagnostic and follow-up algorithm of patients ... more Laboratory tests are an integral part of both the diagnostic and follow-up algorithm of patients with inflammatory bowel disease (IBD). Their advantages over other non-invasive methods for assessing disease activity are greater objectivity than clinical activity indices and imaging studies. This review aims to analyze shortly the most common laboratory tests used to assess disease activity in pediatric patients with IBD. In addition to the conventional blood and serum markers that are not specific for gut inflammation, although routinely used, we also reviewed the established fecal markers such as calprotectin, lactoferrin, M2-pyruvate kinase, osteoprotegerin, HMGB1, chitinase 3-like 1, and the promising non-coding microRNA. In conclusion, neither marker is unique to the pediatric IBD. More clinical data are required to assess biomarkers’ full potential for diagnosis, management, and follow-up of pediatric IBD patients.
Rheumatology International
The coronavirus disease-2019 (COVID-19) pandemic continues to be a cause of unprecedented global ... more The coronavirus disease-2019 (COVID-19) pandemic continues to be a cause of unprecedented global morbidity and mortality. Whilst COVID-19 vaccination has emerged as the only tangible solution to reducing poor clinical outcomes, vaccine hesitancy continues to be an obstacle to achieving high levels of vaccine uptake. This represents particular risk to patients with autoimmune diseases, a group already at increased risk of hospitalization and poor clinical outcomes related to COVID-19 infection. Whilst there is a paucity of long-term safety and efficacy data of COVID-19 vaccination in patients with autoimmune diseases, the current evidence strongly suggests that the benefits of vaccination outweigh the risks of adverse effects and disease flares. Herein, we report the protocol of the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study, an ongoing international collaborative study involving 29 countries and over 110 investigators.
World Journal of Gastrointestinal Oncology
Digestive Diseases
Patients with irritable bowel syndrome (IBS) usually suffer from non-specific and overlapping sig... more Patients with irritable bowel syndrome (IBS) usually suffer from non-specific and overlapping signs that hamper the diagnostic process. In line with this, biomarkers specific for IBS could be of great benefit for diagnosing and managing patients. In IBS, the need is for apparent distinguishing features linked to the disease that improve diagnosis, differentiate from other organic diseases, and discriminate between IBS subtypes. Some biomarkers are associated with a possible pathophysiologic mechanism of IBS; others are used for differentiating IBS from non-IBS patients. Implementation of IBS biomarkers in everyday clinical practice is critical for early diagnosis and treatment. However, our knowledge about their efficient use is still scarce. This review discusses the biomarkers implemented for IBS diagnosis and management, such as blood (serum), fecal, immunological, related to the microbiome, microRNAs, and some promising novel biomarkers associated with imaging and psychological ...
Metabolic Syndrome and Related Disorders
Background: Neopterin, marker of cellular immunity and oxidative stress, is mainly produced by ac... more Background: Neopterin, marker of cellular immunity and oxidative stress, is mainly produced by activated macrophages. It could play a crucial role in the development of insulin resistance (IR) and type 2 diabetes (T2D). The aim of this study was to investigate the circulating levels of neopterin in different stages of glucose dysregulation from obesity through prediabetes to newly diagnosed diabetes. Methods: Neopterin levels were determined using a commercially available human enzyme-linked immunosorbent assay kit. The homeostasis model assessment of IR was used as an index to assess IR. Results: The sample consisted of 163 subjects with mean age 52.5 ± 11.3 years, divided in three age- and body mass index (BMI)-matched groups-obesity, prediabetes, and diabetes. The control group consisted of 42 healthy individuals. Neopterin levels were significantly higher in patients with obesity and/or prediabetes and newly diagnosed diabetes than those in the control group, respectively (4.14 ± 2.51; 4.04 ± 2.80 and 2.17 ± 1.93 vs. 0.87 ± 0.84; P < 0.05). Correlation analysis showed that the level of neopterin positively correlated with BMI, waist, waist-to-stature ratio, waist-to-hip ratio, fasting glucose, and triglycerides. Receiver operating characteristic analysis established neopterin suitable for distinguishing subjects with obesity [area under the curve (AUC) = 0.83; P < 0.001] and carbohydrate disturbances (AUC = 0.59; P < 0.05) from those without these conditions. Neopterin ≥0.47 ng/mL have an odds ratio (OR) of 2.71 for development of dysglycemia, whereas threshold value of neopterin ≥0.56 ng/mL shows an OR of 5.94 for development of obesity. Conclusion: The levels of neopterin were increased in patients with obesity and carbohydrate disturbances. Further studies will elucidate the role of the biomarker in development of T2D and its complications.
World Journal of Immunology
A number of childhood lung diseases have immunological mechanisms of development, such as bronchi... more A number of childhood lung diseases have immunological mechanisms of development, such as bronchial asthma, allergic rhinitis, and cystic fibrosis. Asthma is one of the most common lung diseases in children with a prevalence of 8-10% of all children. It is characterized by chronic inflammation of the airways, in the pathogenesis of which play inflammatory cells: T-lymphocytes, immunoglobulin E (IgE)-producing plasmocytes, eosinophils, mast cells, macrophages, epithelial cells, fibroblasts, as well as pro-inflammatory cytokines (i.e., interleukin `[IL]-6, IL-8, IL-12, IL-4, IL-10, IL-13, interferon-g, and IL-17). [1] Thus, bronchial asthma is a complex and heterogeneous disease characterized by intermittent and reversible airway obstruction, chronic airway inflammation, bronchial hyperresponsiveness, and cell infiltration in the airway submucosa. Obstruction of the airways is variable and reversible, either spontaneously or under treatment. There is also an increase in the bronchial response to a variety of specific and nonspecific stimuli. About 80% of asthmatics are diagnosed before the 6 th year of age, proving the early onset of the disease, whose natural course is manifested by a progressive decline in the respiratory function such as forced expiratory volume in one second. [1] Management of the asthma is also influenced by the inflammatory and structural changes in the airways.
American journal of clinical and experimental immunology, 2020
Bladder carcinoma (BC) is one of the most common malignancies of the urinary system in developed ... more Bladder carcinoma (BC) is one of the most common malignancies of the urinary system in developed countries, with a high number of recurrences. The secondary lymphoid organs (SLO) are crucial for initiating the adaptive immune response. They are developed as a part of a genetically preprogrammed process during embryogenesis. However, SLO's organogenesis can be reduplicated de novo in other tissues by a process termed lymphoid neo-genesis, giving rise to tertiary lymphoid structures (TLS). These well-organized lymphoid structures in cancer are essential modulators of cancer immunologic response, and the histological examination of TLS gave a new strategy for cancer immunotherapy. This review explores the biological and histological characteristics of TLS in muscle non-invasive and invasive BC.
Autoimmune diseases of the liver often lead to organ failure which raises the issue of allogeneic... more Autoimmune diseases of the liver often lead to organ failure which raises the issue of allogeneic transplantation as definitive therapy. Immunological mechanisms of the underlying autoimmune diseases, however, and the immune-mediated processes occurring after transplantation despite the administration of immunosuppressive therapy, define a number of problems in these patients. In addition to the risks associated with the transplantation itself, consideration should also be given to the possibility of recurrence or de novo origin of the autoimmune liver disease [1].Table 1 presents the main liver diseases that require liver transplantation, as well as the prognosis after transplantation [1].
World Journal of Transplantation, 2021
Lung transplantation (LT) is a life-saving therapeutic procedure that prolongs survival in patien... more Lung transplantation (LT) is a life-saving therapeutic procedure that prolongs survival in patients with end-stage lung disease. Furthermore, as a therapeutic option for high-risk candidates, single LT (SLT) can be feasible because the immediate morbidity and mortality after transplantation are lower compared to sequential single (double) LT (SSLTx). Still, the long-term overall survival is, in general, better for SSLTx. Despite the great success over the years, the early post-SLT period remains a perilous time for these patients. Patients who undergo SLT are predisposed to evolving early or late postoperative complications. This review emphasizes factors leading to post-SLT complications in the early and late periods including primary graft dysfunction and chronic lung allograft dysfunction, native lung complications, anastomosis complications, infections, cardiovascular, gastrointestinal, renal, and metabolite complications, and their association with morbidity and mortality in th...
Bronchial asthma (BA) in childhood is the most common chronic disease estimated to affect up to 1... more Bronchial asthma (BA) in childhood is the most common chronic disease estimated to affect up to 10% of all children. Moreover, the observed increase in the incidence of asthma relies mainly on the rise in childhood BA. It is well-established that BA is an immune -mediated complex and heterogeneous disease, characterised clinically by bronchial reactivity, intermittent but reversible obstruction, and chronic airway inflammation due to the infiltration with various immune cells (T lymphocytes, mast cells, basophils, IgE -producing plasmocytes) [1]. Intensively investigated for the last years was IL-17-driven inflammation in BA. After pathogen or allergen irritation, a subsequent differentiation of naive T lymphocytes into IL17 producing cells was also observed. Th17 lymphocytes secrete various cytokines, such as IL-17A, IL17F, and IL-22, which contribute to the well-establish broad range of cytokines (IL-4, IL-5, IL-6, IL-8, IL12, IL-10, IL-13, IFN-y) described to be involved in the B...
In some cases, spontaneous inhibition of immunological reactivity in transplantation, which is re... more In some cases, spontaneous inhibition of immunological reactivity in transplantation, which is responsible for the graft rejection, has been observed, a phenomenon mediated by a specific T cell population defined as regulatory T cells (Tregs). This mini-review discusses the impact of Treg cells on the in initiation and maintenance of operational tolerance after liver transplantation, the Treg cells as a biomarker for post-transplantation tolerance assessment, and the novel approach of adoptive transfer of Treg cells after liver transplantation. Currently, the data are limited and do not allow for extensive comments. However, by virtue of the immunological background, Tregs are promising as diagnosing and therapeutic application that gives hope for successful liver transplantation.
Gluten enteropathy, a.k.a. celiac or non-tropical sprue is an autoimmune disease of the small int... more Gluten enteropathy, a.k.a. celiac or non-tropical sprue is an autoimmune disease of the small intestines which arise in genetically predisposed children and adults [1]. It is thought to be caused by immunological hypersensitivity to gluten-containing food [2]. The key aspects of the pathogenesis of the disease include the enzyme tissue transglutaminase (tTG). Intestinal tTG is a calcium-dependent enzyme that catalyzes hydrolysis (i.e., deamidation, conversion of the amino acid glutamine into glutamate) of glutamine residues. Gliadin, a protein rich in glutamine, is a specific substrate for this enzyme. tTG selectively deamidates the gliadin molecules trapped in lamina propria so that deamidated gliadin peptides are formed [3].
OBJECTIVE To evaluate serum matrix metalloproteinase (MMP)-3 levels as a prognostic marker for th... more OBJECTIVE To evaluate serum matrix metalloproteinase (MMP)-3 levels as a prognostic marker for the progression of cartilage damage in patients with knee osteoarthritis (KOA). METHODS Fifty-six patients, aged 40 to 80 years (62.59 ± 10.11 years) who met the ACR criteria for KOA, were included in a one-year observational prospective clinical study. Complete baseline and follow-up data were collected from 50 out of 56 patients. X-ray and magnetic-resonance images were carried out at baseline and after 12 months. They were evaluated according to the Kellgren-Lawrence and Whole-Organ magnetic Resonance iMaging Score (WORMS) semi-quantitative scales, respectively. Progression of cartilage damage in the medial tibiofemoral compartment was registered at the end of the follow-up using the change in WORMS. Serum levels of MMP-3 were measured during the baseline visit, using enzyme-linked immunosorbent assay. RESULTS Significantly higher values of baseline MMP-3 levels were observed in patient...
In liver transplant patients, solid tumors and post-transplant lymphoproliferative disorders (PTL... more In liver transplant patients, solid tumors and post-transplant lymphoproliferative disorders (PTLD) have emerged as significant long-term mortality causes. Additionally, it is assumed that de novo malignancy (DNM) after liver transplantation (LT) is the second-leading cause of death after cardiovascular complications. Well-established risk factors for PTLD and solid tumors are calcineurin inhibitors (CNIs), tacrolimus (TAC), and cyclosporine, the cornerstones of all immunosuppressive (IS) therapies used after LT. The loss of immunocompetence facilitated by the host immune system due to prolonged IS therapy leads to cancer development, including in LT patients. Hindering DNA repair mechanisms, promoting tumor cell invasiveness, and hampering apoptosis are critical events in tumorigenesis and tumor growth in LT patients resulting from IS administration. This paper aims to overview the refined mechanisms of IS-induced tumorigenesis after LT and the loss of immunocompetence facilitated ...
Celiac disease (CD) is a condition with a strong genetic predisposition that may affect people of... more Celiac disease (CD) is a condition with a strong genetic predisposition that may affect people of all ages and gender. The established prevalence of the disease varies from 1:70 (in Australia) to 1:120 in Europe [1]. However, about 80% of the affected people remain undiagnosed. The main features of the disease are inflamed and flattened intestinal mucosa leading to small bowel damage [1]. Although CD is considered as an autoimmune disease characterized by sensitiveness to gluten throughout the whole life, thus, in this sense patients are never cured, even though a strict gluten-free diet (GFD) allows CD to be managed effectively [2]. The pathophysiology of CD remains elusive, although a substantial progress in the knowledge of gluten sensitization and the role of some environmental factors was made.
The case report presented here describes the culturing and characterization of mesenchymal stem c... more The case report presented here describes the culturing and characterization of mesenchymal stem cells (MSCs) isolated from a primary indolent B-cell lymphoma, located in the CNS of an immunocompetent patient. The presence of such cells in the tumor mass can further elucidate the pathogenesis of the disease and reveal possible future approaches for its treatment. We present a case report of a 61-year-old immunocompetent woman who had an episode of confusion with numbness in the right leg and the right arm, slurred and dysarthric speech and urine incontinence. The peripheral blood tests were normal. The neurological examination demonstrated a latent hemi-paresis of the right side, aphasia, discrete hypertension and bradypsychia. The ophthalmologic examination revealed left quadranopsia. Computed tomography and magnetic resonance imaging of the brain showed a 3.5 × 2.9 cm infiltrative neoplastic lesion involving the left temporal parenchyma. The morphological features and the immunophe...
Laboratory tests are an integral part of both the diagnostic and follow-up algorithm of patients ... more Laboratory tests are an integral part of both the diagnostic and follow-up algorithm of patients with inflammatory bowel disease (IBD). Their advantages over other non-invasive methods for assessing disease activity are greater objectivity than clinical activity indices and imaging studies. This review aims to analyze shortly the most common laboratory tests used to assess disease activity in pediatric patients with IBD. In addition to the conventional blood and serum markers that are not specific for gut inflammation, although routinely used, we also reviewed the established fecal markers such as calprotectin, lactoferrin, M2-pyruvate kinase, osteoprotegerin, HMGB1, chitinase 3-like 1, and the promising non-coding microRNA. In conclusion, neither marker is unique to the pediatric IBD. More clinical data are required to assess biomarkers’ full potential for diagnosis, management, and follow-up of pediatric IBD patients.
Rheumatology International
The coronavirus disease-2019 (COVID-19) pandemic continues to be a cause of unprecedented global ... more The coronavirus disease-2019 (COVID-19) pandemic continues to be a cause of unprecedented global morbidity and mortality. Whilst COVID-19 vaccination has emerged as the only tangible solution to reducing poor clinical outcomes, vaccine hesitancy continues to be an obstacle to achieving high levels of vaccine uptake. This represents particular risk to patients with autoimmune diseases, a group already at increased risk of hospitalization and poor clinical outcomes related to COVID-19 infection. Whilst there is a paucity of long-term safety and efficacy data of COVID-19 vaccination in patients with autoimmune diseases, the current evidence strongly suggests that the benefits of vaccination outweigh the risks of adverse effects and disease flares. Herein, we report the protocol of the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study, an ongoing international collaborative study involving 29 countries and over 110 investigators.
World Journal of Gastrointestinal Oncology
Digestive Diseases
Patients with irritable bowel syndrome (IBS) usually suffer from non-specific and overlapping sig... more Patients with irritable bowel syndrome (IBS) usually suffer from non-specific and overlapping signs that hamper the diagnostic process. In line with this, biomarkers specific for IBS could be of great benefit for diagnosing and managing patients. In IBS, the need is for apparent distinguishing features linked to the disease that improve diagnosis, differentiate from other organic diseases, and discriminate between IBS subtypes. Some biomarkers are associated with a possible pathophysiologic mechanism of IBS; others are used for differentiating IBS from non-IBS patients. Implementation of IBS biomarkers in everyday clinical practice is critical for early diagnosis and treatment. However, our knowledge about their efficient use is still scarce. This review discusses the biomarkers implemented for IBS diagnosis and management, such as blood (serum), fecal, immunological, related to the microbiome, microRNAs, and some promising novel biomarkers associated with imaging and psychological ...
Metabolic Syndrome and Related Disorders
Background: Neopterin, marker of cellular immunity and oxidative stress, is mainly produced by ac... more Background: Neopterin, marker of cellular immunity and oxidative stress, is mainly produced by activated macrophages. It could play a crucial role in the development of insulin resistance (IR) and type 2 diabetes (T2D). The aim of this study was to investigate the circulating levels of neopterin in different stages of glucose dysregulation from obesity through prediabetes to newly diagnosed diabetes. Methods: Neopterin levels were determined using a commercially available human enzyme-linked immunosorbent assay kit. The homeostasis model assessment of IR was used as an index to assess IR. Results: The sample consisted of 163 subjects with mean age 52.5 ± 11.3 years, divided in three age- and body mass index (BMI)-matched groups-obesity, prediabetes, and diabetes. The control group consisted of 42 healthy individuals. Neopterin levels were significantly higher in patients with obesity and/or prediabetes and newly diagnosed diabetes than those in the control group, respectively (4.14 ± 2.51; 4.04 ± 2.80 and 2.17 ± 1.93 vs. 0.87 ± 0.84; P < 0.05). Correlation analysis showed that the level of neopterin positively correlated with BMI, waist, waist-to-stature ratio, waist-to-hip ratio, fasting glucose, and triglycerides. Receiver operating characteristic analysis established neopterin suitable for distinguishing subjects with obesity [area under the curve (AUC) = 0.83; P < 0.001] and carbohydrate disturbances (AUC = 0.59; P < 0.05) from those without these conditions. Neopterin ≥0.47 ng/mL have an odds ratio (OR) of 2.71 for development of dysglycemia, whereas threshold value of neopterin ≥0.56 ng/mL shows an OR of 5.94 for development of obesity. Conclusion: The levels of neopterin were increased in patients with obesity and carbohydrate disturbances. Further studies will elucidate the role of the biomarker in development of T2D and its complications.
World Journal of Immunology