Discover and read the best of Twitter Threads about #immunosuppression
Most recents (13)
Human #intestinal #spirochetosis:
✔️#sexual #transmitted infections
✔️of the large intestine by anaerobic spirochetes of the genus Brachyspira spp.
1/10
🖊️A De Gea, @alfredomaldo ,@clarapath, @MarianaDazAlmi1, @alirri, Raquel Escudero, et al.
👇
sciencedirect.com/science/articl…
✔️#sexual #transmitted infections
✔️of the large intestine by anaerobic spirochetes of the genus Brachyspira spp.
1/10
🖊️A De Gea, @alfredomaldo ,@clarapath, @MarianaDazAlmi1, @alirri, Raquel Escudero, et al.
👇
sciencedirect.com/science/articl…
@alfredomaldo @clarapath @MarianaDazAlmi1 @alirri Gastrointestinal symptoms such as abdominal pain, proctitis, or chronic diarrhea are the most common manifestations.
Most cases with accompanying symptoms show improvement with metronidazole antibiotic therapy.
2/10
#IntestinalSpirochetosis
Most cases with accompanying symptoms show improvement with metronidazole antibiotic therapy.
2/10
#IntestinalSpirochetosis
Routine staining methods (haematoxylin & eosin & Warthin-Starry) can identify spirochetes on the surface of enterocytes.
Histologically, characteristic findings include a decrease in microvilli &a predominantly eosinophilic inflammatory infiltrate.
3/10
#Pathologists #pathology
Histologically, characteristic findings include a decrease in microvilli &a predominantly eosinophilic inflammatory infiltrate.
3/10
#Pathologists #pathology
*FDA did not find #LYMErix increased arthritis.
They only reviewed arthritis complaints b/c the crooks running the trials had redefined #LymeDisease & rigged testing to only DX arthritis-susceptible cases.
Not gonna find dangerous AEs only looking for swollen knees.
They only reviewed arthritis complaints b/c the crooks running the trials had redefined #LymeDisease & rigged testing to only DX arthritis-susceptible cases.
Not gonna find dangerous AEs only looking for swollen knees.
Do these AEs look like arthritis? (Thanks for the link, @danaparish.)
Oct 2021 I told FDA investigators, in person, that current #LymeDisease #vaccine trials must be halted.
There is no valid diagnostic so there is no way to determine efficacy.
Plus, it’s not a vaccine.
There is no valid diagnostic so there is no way to determine efficacy.
Plus, it’s not a vaccine.
#Immunosuppressive therapy in virus-negative inflammatory CMP : 20-year follow-up of the #TIMIC trial
Immunosuppressive Tx of virus-negative inflammatory #CMP is associated to a persistent improvement of LV
function and better outcomes during long-term follow-up
#HeartFailure
Immunosuppressive Tx of virus-negative inflammatory #CMP is associated to a persistent improvement of LV
function and better outcomes during long-term follow-up
#HeartFailure
#Immunosuppressive Tx promoted an improvement in cardiac function in 88% of the cases compared the placebo group
A persistent ⤴️ in the #LVEF is seen in long -term (up to 20 years) clinical outcomes of the whole cohort of 85 patients originally enrolled in the #TIMIC trial
A persistent ⤴️ in the #LVEF is seen in long -term (up to 20 years) clinical outcomes of the whole cohort of 85 patients originally enrolled in the #TIMIC trial
Recurring virus-negative myocarditis responding to #immunosuppressive therapy
EKG showing LBBB (A) resolving after therapy (B)
(C and D) Echo apical view showing recovery of LV dysfunction from EF -28% ➡️ up to 51%
#HeartFailure #EchoFirst @ESC_Journals academic.oup.com/eurheartj/adva…
EKG showing LBBB (A) resolving after therapy (B)
(C and D) Echo apical view showing recovery of LV dysfunction from EF -28% ➡️ up to 51%
#HeartFailure #EchoFirst @ESC_Journals academic.oup.com/eurheartj/adva…
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 2/ 📸 Faculty disclosures & CME certification ℹ
Want a #CME certificate? → ℹ️ bit.ly/3IbTRdB
#MondayNightIBD
Want a #CME certificate? → ℹ️ bit.ly/3IbTRdB
#MondayNightIBD
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 3/ 😭 most pts are NOT getting safe 💉 like flu, pneumonia & HepB.
🤷♀️ Why?
🚫Many GIs won't/can't give 💉
❓Many PCPs don't know what to give
📞 Better communication is needed
#MondayNightIBD
Who do you think should make vaccine recs & where should pts w/ #IBD get 💉?
🤷♀️ Why?
🚫Many GIs won't/can't give 💉
❓Many PCPs don't know what to give
📞 Better communication is needed
#MondayNightIBD
Who do you think should make vaccine recs & where should pts w/ #IBD get 💉?
@MondayNightIBD @DCharabaty @janssen @pfizer @TakedaPharma 4/ pts w #IBD , esp if on ⚠️immunosuppressants (IS), at ⬆risk of (preventable) infections, so #vaccination is 🗝️
Infection in IBD = ⬆hospitalization ⬆ 🏥 stays ⬆costs & ⬆mortality.
Despite their benefits, vaccination rates remain LOW.
#MondayNightIBD
Infection in IBD = ⬆hospitalization ⬆ 🏥 stays ⬆costs & ⬆mortality.
Despite their benefits, vaccination rates remain LOW.
#MondayNightIBD
1) Welcome to a new #accredited #tweetorial on the #goKDIGO guidance regarding evaluation and management of focal segmental glomerulosclerosis (#FSGS)--one of the most common causes of primary glomerular disease in adults. Leading us through this material is @edgarvlermamd.
2) Dr. Lerma is core faculty at both @ckd_ce & @cardiomet_CE and is an expert #nephrologist and #educator. This tweetorial is accredited for 0.5h CE/#CME for #physicians #nurses #NPs #PAs #pharmacists. Please follow along!
3) This educational program is supported by grants from Travere, Bayer, & Otsuka, and is intended for healthcare providers. Faculty disclosures can be found at ckd-ce.com/disclosures/. Past programs, still available for CE/#CME credit, are at ckd-ce.com.
#immunosuppression
IMMUNE CONTROL POINTS AND COVID-19
✅IMMUNOLOGIC CONTROL POINT MOLECULES ARE #INHIBITOR RECEPTORS EXPRESSED IN IMMUNE CELLS THAT TRIGGER IMMUNOSUPPRESSOR SIGNALING PATHWAYS.
IMMUNE CONTROL POINTS AND COVID-19
✅IMMUNOLOGIC CONTROL POINT MOLECULES ARE #INHIBITOR RECEPTORS EXPRESSED IN IMMUNE CELLS THAT TRIGGER IMMUNOSUPPRESSOR SIGNALING PATHWAYS.
These molecules are crucial to maintaining self-tolerance. 👉SIGNALING THROUGH THESE MOLECULES MAY TAKE IMMUNE EFFECT CELLS (ESPECIALLY T CELLS) TO A STATE KNOWN AS "DEPLETION". T cell depletion is defined by reduced effector function, poor memory responses
👉 due to sustained expression of immune checkpoint molecules (such as PD1, # CTLA4, # LAG3 ...). There are numerous types of activating and inhibitory interactions that occur between antigen presenting cells (APC) and T cells and thus regulate the nature of immunity.
1/
Another #immunosuppression #tweetorial...spotlight today on #belatacept today
How do you say it? @Babybel @MedTweetorials
Another #immunosuppression #tweetorial...spotlight today on #belatacept today
How do you say it? @Babybel @MedTweetorials
2/
Belatacept is the FUSION protein that has been the @NKOTB in #kidneytransplant - having been approved for use in 2011.
What's fused?
1. Human IgG1 Fc fragment
2. Extracellular domain of cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4)
pubmed.ncbi.nlm.nih.gov/25416857/
Belatacept is the FUSION protein that has been the @NKOTB in #kidneytransplant - having been approved for use in 2011.
What's fused?
1. Human IgG1 Fc fragment
2. Extracellular domain of cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4)
pubmed.ncbi.nlm.nih.gov/25416857/
3/
The goal of this fusion protein? Disrupt Signal 2⃣ of the 3⃣-Signal T-cell activation pathway
Signal 2 = Binding of CD28 (on T-cell) to B7-1/B7-2 (on APC)
This important step is called co-stimulation and is necessary for T-cell activation
nejm.org/doi/full/10.10…
The goal of this fusion protein? Disrupt Signal 2⃣ of the 3⃣-Signal T-cell activation pathway
Signal 2 = Binding of CD28 (on T-cell) to B7-1/B7-2 (on APC)
This important step is called co-stimulation and is necessary for T-cell activation
nejm.org/doi/full/10.10…
Tabulated the topline results released by the #recoverytrial team on #hydroxychloroquine & #dexamethasone, and went over their protocol (recoverytrial.net/results) to better digest them.
Basic stuff:
- hospitalized patients @ 175 NHS centres
- open label, 5 initial arms
- thread—
Basic stuff:
- hospitalized patients @ 175 NHS centres
- open label, 5 initial arms
- thread—
Important point from #RECOVERYTrial protocol
- if a patient had a #contraindication to one of the intervention arms, according to the clinical care team at the site, that particular arm was not available to that patient at the time of #randomization
- if a patient had a #contraindication to one of the intervention arms, according to the clinical care team at the site, that particular arm was not available to that patient at the time of #randomization
So if a patient enrolled in #recoverytrial had a contraindication to #dexamethasone, that patient was not allowed to be randomized to that arm. So the results need to be interpreted in the context of no contraindication to steroids: already on steroids, #immunosuppression, etc.
Recent @CellCellPress #COVID19 study on #immunity helps explain why these 2pts with X-linked agammaglobulinemia (genetic immunodeficiency where pts have complete abscence of Bcells: inability to produce antibodies) developed COVID19 pneumonia—but RECOVERED
onlinelibrary.wiley.com/doi/abs/10.111…
onlinelibrary.wiley.com/doi/abs/10.111…
2/In another recently published case #COVID19 study in @AnnalsAllergy—pt with another genetic immunodeficiency (common variable immunodeficiency on monthly IVIG w/stable bronchiectasis) had #COVID19 but fully recovered after ICU care despite increased risk
annallergy.org/article/S1081-…
annallergy.org/article/S1081-…
3/ Of note, CVID pt with #COVID19 also had breast cancer in remission on tamoxifen OD, hypothyroidism & Sjögren’s on #hydroxychloroquine 200mg BID. She presented to ER on D7 of symptoms. Her home dose of hydroxychloroquine was incr to TID w/IVIG. No azithromycin d/t known allergy
All right #dermtwitter & #medtwitter, it's time for the...
@MedDermSoc & @DermHospitalist Mini-Symposium on #COVID19 & #dermatology!!
I will be attempting to #livetweet the Zoom meeting!
Join along if you'd like. I will be using the h/t #COVIDDerm!
@RoxanaDaneshjou @dschless
@MedDermSoc & @DermHospitalist Mini-Symposium on #COVID19 & #dermatology!!
I will be attempting to #livetweet the Zoom meeting!
Join along if you'd like. I will be using the h/t #COVIDDerm!
@RoxanaDaneshjou @dschless
Let's get started!!!!
Your cohosts are super excited to have you join. To give a little background, this meeting was planned in ~1 week, and we have over 500 RSVPs!
@MishaRosenbach now kicking us off with #COVIDDerm!
Your cohosts are super excited to have you join. To give a little background, this meeting was planned in ~1 week, and we have over 500 RSVPs!
@MishaRosenbach now kicking us off with #COVIDDerm!
.@DrEstherFreeman is speaking and reminding us all to register our #COVID19 #dermatology cases in the @AADskin #COVID registry!
Reminder to do so here:
aad.org/covidregistry
#COVIDDerm
Reminder to do so here:
aad.org/covidregistry
#COVIDDerm
1/ Continuing the #immunosuppression #tweetorial series...@MedTweetorials
Today's player: #mTORi, mammalian/mechanistic target of rapamcyin inhibitors
Rapamcyin was @US_FDA approved for #kidneytransplant in 2003.
It was isolated from a soil sample from which island in 1975?
Today's player: #mTORi, mammalian/mechanistic target of rapamcyin inhibitors
Rapamcyin was @US_FDA approved for #kidneytransplant in 2003.
It was isolated from a soil sample from which island in 1975?
2/ Meet mTOR, a phosphatidylinositol 3-kinase (PI3)-related kinase (adds a phos). mTOR adds a phosphoryl group to serine/threonine residues.
It is a key component of the complexes mTORC1 and mTORC 2 - which regulate processes including cell growth, proliferation, and survival.
It is a key component of the complexes mTORC1 and mTORC 2 - which regulate processes including cell growth, proliferation, and survival.
3/ mTOR inhibition blocks "Signal 3" of #TCell activation - reducing cytokine dependent cell proliferation and activation.
Take a look at all 3 signals below 👇🏽
nejm.org/doi/full/10.10…
Take a look at all 3 signals below 👇🏽
nejm.org/doi/full/10.10…
1/
Here's another #immunosuppression #tweetorial. This time, a focus on mycophenolic acid (MPA). #MMF #Mycophenolate
The main mechanism of action of MPA is inhibition of which of the following:
Here's another #immunosuppression #tweetorial. This time, a focus on mycophenolic acid (MPA). #MMF #Mycophenolate
The main mechanism of action of MPA is inhibition of which of the following:
2/ Let's meet the players. Mycophenolate mofetil (MMF, left) is a prodrug of MPA while mycophenolate sodium (MPS, right) is an enteric-coated salt of MPA.
MMF administration releases MPA in the stomach, while mycophenolate sodium (MPS) releases it in the small intestine.
MMF administration releases MPA in the stomach, while mycophenolate sodium (MPS) releases it in the small intestine.
3/ MPA is often referred to as an "anti-metabolite", which means a substance that interrupts a metabolic process within cells.
The process that MPA interrupts here: PURINE SYNTHESIS
The process that MPA interrupts here: PURINE SYNTHESIS
This! The activity of the host #immune response largely determines whether #pathobionts acquired from an #FMT donor might become capable of virulence 👉 So including immune status in the study of FMT outcomes would be extremely informative
IMO immune status should be included in the general study of #antibiotic resistant infection 👉 It’s no coincidence that most “superbug” infections occur in immunocompromised patients, often in hospitals (w/ patients on cocktails of steroids for procedures like organ transplants)
Because extrapolate that trend and consider that the immunosuppressive biologics used to palliate “#autoimmune” disease symptoms are the top selling medications in the world 👉 With top side effects of such drugs being “serious #infection by viruses, fungi or bacteria”(see below)
