Vol 52, No 8 (2024)

Objective: To analyze literature data and compare the common pathways of inflammation in inflammatory bowel diseases (IBD) and atherosclerosis with focus on the effects of proinflammatory cytokines on both pathologies, as well as from the perspective of potential role of gene polymorphism of proinflammatory cytokines in the pathophysiology of atherosclerosis in IBD patients.

Main provisions: In IBD, a serum cytokine profile initiates and supports the chronic inflammation. The main immunological mechanisms in both IBD and atherosclerosis are mediated by hyperproduction of proinflammatory cytokines, such as tumor necrosis factor α (TNF-α), interleukins (IL) IL-1β, IL-6, IL-8, IL-12, IL-23, IL-17, and relative insufficiency of anti-inflammatory IL-4 and IL-10, with significant increase in pro-inflammatory cytokines. An association has been established between the polymorphisms of TNF-α (rs1800629), IL-8 (rs117518778, rs8057084), IL-10 (rs3024505, rs1800896), IL-12 (rs6887695, rs10045431), IL-23 (rs11209026A) candidate genes and the development of ulcerative colitis (UC). The polymorphisms of the TNF-α (rs1800629), IL-8 (rs117518778, rs8057084), IL-1β (rs16944), IL-17A (rs2275913), IL-4 (rs2243250), IL-23 (rs6682925T/C) genes are associated with a high risk of atherosclerosis. Protein tyrosine phosphatase, receptor type, C (PTPRC) was identified as the hub crosstalk gene for the comorbidity of UC and atherosclerosis. The effects of cytokine genes polymorphisms as key targets of the pathogenetically oriented IBD therapy on the development of atherosclerosis in these patients remain a poorly investigated question.

Conclusion: IBD and atherosclerosis are mediated by the shared mechanisms of enhanced synthesis of proinflammatory cytokines, as well as polymorphisms of the candidate genes. Studies on the polymorphism of proinflammatory cytokines genes and small molecules in patients with UC, as well as the association of these polymorphisms with the development of atherosclerosis would open up new possibilities for prediction of cardiovascular diseases in these patients, development of preventive measures, and for repositioning of biological therapy for the prevention and treatment of atherosclerosis.

Background: Myocardial remodeling facilitates the development and maintenance of atrial fibrillation (AF). Trans-thoracic echocardiography (TTE) is an available and easily reproducible method for assessment of patients with cardiovascular disorders. The evaluation of TTE parameters with a neural network-based program (NN) could be used for early detection of AF in asymptomatic patients.

Aim: To establish the potential of a previously developed NN to predict the incident AF in the patients with no past history of heart arrhythmias.

Methods: The study was based on the electrocardiographic data from electronic case record forms of 256 patients (mean age 63.47 ± 16.21 years, 151 (58.98%) women) with no past history of AF, who were treated in the in-patient Department of Cardiology in 2022. The TTE parameters (ascending aorta and left atrium diameters, left ventricular end-diastolic size, pulmonary artery diameter, maximal thickness of the anterior and posterior left ventricular walls in the diastole, transverse diameter of the right atrium, aortal, mitral and tricuspid valve regurgitation grade, left ventricular ejection fraction) were processed by the NN “Prediction of atrial fibrillation based on the trans-thoracic echocardiography data” (Russian state registration certificate for the computer software #2023662423 from 07.06.2023). Depending on the NN output values, the patients were divided into three groups: with a high probability of incident AF (n = 48; NN output value ≤ 0.33), with an intermediate probability of incident AF (n = 185, NN output value 0.34 to 0.66), and with a low probability (n = 23, NN output values ≥ 0.67). The patients were followed up to March 1, 2024 based on their electronic medical records (endpoints: referrals due to AF, AF mentioned as a complication of the underlying disease or as a concomitant disorder, cardiovascular death).

Results: The median time of the follow-up was 16 [14; 21] months. During the study period, AF developed in 8/48 (16%) patients with the NN values ≤ 0.33 and in 4/185 (2.16%) patients with the NN values of 0.34 to 0.66, whereas no AF cases were registered in those with the NN values ≥ 0.67 (0/23). The cardiovascular death rate in the study groups was 17/48 (31.25%), 13/185 (3.78%), and 0/23 (0%), respectively (р < 0.05). The area under the ROC curve (AUC) for incident AF was 0.85, for death 0.84, and for the combination endpoint of incident AF + death 0.86.

Conclusion: The NN used in the study meets the goal of the binary differentiation, i. e. it allows to differentiate the heart structure and function typical for AF from those not typical for AF. Heart chamber dilatation, left ventricular systolic function and valvular regurgitation grade are associated with an increased risk of AF and death. The analysis of TTE parameters by the NN can be used for identification of patients at risk of incident AF with the goal of their additional work-up and monitoring.

Background: The SARS-CoV-2 pandemic can be considered a multifactorial event involving both the direct impact of the virus on the human body and a complex impact (through social, psychological, occupational, and behavioral changes) on the pathomorphosis of many diseases, including skin disorders. The analysis of the incidence, severity, and effectiveness of standard treatments for dermatoses in the new environmental model could be of value for the understanding of the mechanisms of skin disorders, improvement of the approaches to their treatment, development of rehabilitation and preventive tools.

Aim: To asses an impact of the new coronavirus infection (SARS-CoV-2) on the severity and progression of non‐communicable inflammatory skin diseases depending on their immune response pattern.

Methods: Adult patients with moderate to severe non‐communicable inflammatory skin diseases hospitalized to the Department of Dermatology of a multidisciplinary hospital from March 30, 2020, to March 15, 2023 were included into the study. All patients had SARS-CoV-2 infection in their history confirmed by polymerase chain reaction for SARS-CoV-2 RNA or computed tomography of the lungs. We retrospectively analyzed changes in clinical parameters on the Investigator's Global Assessment (IGA) scale and the number of exacerbations (mean value of each parameter over the year before SARS-CoV-2 infection and after its convalescent period). Also, the changes over time of the Dermatology Life Quality Index (DLQI) before and after SARS-CoV-2 infection were assessed. The patients were divided into the groups based on the dominant immune response pattern: lichenoid (group 1), eczematous (group 2), bullous (group 3), psoriatic (group 4), fibrogenic (group 5), granulomatous (group 6).

Results: A total of 845 patients (518 (61,4%) women) aged 19 to 76 years (mean age, 53.8 ± 17.7 years) with the verified diagnosis of non‐communicable inflammatory skin disease and past history of SARS-CoV-2 infection participated in the study. Mean duration of the skin disease was 119.5 ± 103.1 months. Group 1 was represented by 59 patients with lichen ruber planus, discoid lupus erythematoides, and large plaque parapsoriasis; group 2, by 181 patients with atopic dermatitis, chronic eczema, and prurigo; group 3, by 41 patients with pemphigus vulgaris and bullous pemphigoid; group 4, by 366 patients with pustulous psoriasis, psoriasis and small plaque parapsoriasis; group 5, by 177 patients with localized sclerodermia, and group 6, by 21 patients with annular granuloma and rosacea. In all groups, there was a significant increase in the IGA, DLQI and the number of exacerbations of the non‐communicable inflammatory skin disease after SARS-CoV-2 infection. The assessment of the effectiveness of previously used treatment regimens and methods for the non‐communicable inflammatory skin disease showed the necessity to modify the therapeutic protocols in more than 45% of the cases in each group.

Conclusion: The SARS-CoV-2 pandemic has contributed to significant worsening of the course of non‐communicable inflammatory skin diseases and deterioration of the patients’ quality of life, regardless of the immunopathogenesis of the dermatoses.

Despite the available novel drug treatments for inflammatory bowel diseases, the number of patients with treatment resistance has been growing. These patients might need more aggressive treatment strategies, as the lack of control over the persistent active inflammation results in the progression of Crohn's disease and development of complications. By now, two randomized controlled studies of high-dose immunosuppressive therapy with autologous hematopoietic stem cell transplantation (HDIT-AHSCT) for the treatment of refractory Crohn's disease (ASTIC and ASTIC-lite) have been completed: their results are quite equivocal. The paper presents the description of a clinical case illustrating the possibility of HDIT-AHSCT as an alternative strategy to achieve remission in a patient with refractory Crohn's disease. This was a young patient with a difficult-to-treat inflammatory Crohn's disease (terminal ileitis and colitis with perianal lesion – A2L3B1p) with high disease activity (frequent loose stools, severe fatigue, abdominal pain, weight loss; C-reactive protein 13 mg/l, erythrocyte sedimentation rate 40 mm/h, fecal calprotectin 1500 mcg/g, SES-CD 8 points). He underwent an HDIT-AHSCT procedure resulting in clinical, laboratory and endoscopic remission at 24 weeks. Up to 24 months, he did not require any resumption of the immunosuppressive and biological therapy. At present, the patient's follow up and monitoring is ongoing. Further accumulation of clinical data is needed for the evaluation of the efficacy and safety of HDIT-AHSCT, profiling of the patient candidates for the use of the procedure, choice of optimal conditioning regimens, time and algorithms of anti-relapse therapy.