Yalcin Arzu Didem, Yalcin Ata Nevzat
Department of Internal Medicine, Allergy and Clinical Immunology, Academia Sinica, Genomics Research Center, Taipei, Taiwan.
Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Akdeniz University, Antalya, Turkey.
Immunopharmacol Immunotoxicol. 2020 Aug;42(4):379-382. doi: 10.1080/08923973.2020.1789656. Epub 2020 Jul 7.
Monoclonal antibody therapies have revolutionized the treatment of autoinflammatory-immune/genetic disease including spondylarthritis, asthma and rheumatoid arthritis. Behcet's disease (BD) is a multi-systemic vasculitis, which is generally recurrent aphthous lesions (RAL) as well as ocular and skin lesions. Today, the immunohistopathogenesis of BD is mostly unknown.
Omalizumab (Anti-IgE humanized monoclonal antibody) therapy is given for severe persistent allergic asthma, and unintentionally it had effect on RAL. Our patient has received omalizumab treatment for 3 years. The steroid treatment was completely discontinued a month later and the systemic-steroid dependent diabetes mellitus was healed. The IL-1 β, IL-6, IL-8, IL-33, IL-25, IL-10, IL-23, and IL-17A levels were measured using an Enzyme-Linked Immunosorbent Assay (ELISA) kit.
After a long-term omalizumab treatment administered, the levels of WBC, d-dimer, IL-33, IL-6, IL-25 and IL-1 β decreased. The patient's hsCRP decreased from 3 to 0.1 and Eosinophil Cationic Protein (ECP) levels decreased from 78 to 21. A significant improvement was noticed in the RAL, the asthma symptoms (cough, shortness of breath), the number of emergency admissions, and the average length of stay of the patient within the days following the initiation of the omalizumab treatment.
Here, for the first time, we introduce omalizumab treatment of a patient diagnosed with BD and the examination of the treatment for the clinical manifestations and the cytokines/coagulant protein levels. A significant improvement is observed in the patient's RAL following the initiation of omalizumab. There is strong evidence that the serum proinflammatory cytokines/coagulant factors could also play an important role in the relationship between RAL and IgE-dependent vascular autoinflammation.
单克隆抗体疗法彻底改变了包括脊柱关节炎、哮喘和类风湿关节炎在内的自身炎症性免疫/遗传性疾病的治疗方法。白塞病（BD）是一种多系统血管炎，通常表现为复发性口腔溃疡（RAL）以及眼部和皮肤病变。如今，BD的免疫组织发病机制大多尚不明确。
奥马珠单抗（抗IgE人源化单克隆抗体）用于治疗严重持续性过敏性哮喘，无意中它对复发性口腔溃疡产生了作用。我们的患者接受奥马珠单抗治疗3年。一个月后完全停用类固醇治疗，系统性类固醇依赖型糖尿病得以治愈。使用酶联免疫吸附测定（ELISA）试剂盒测量白细胞介素-1β、白细胞介素-6、白细胞介素-8、白细胞介素-33、白细胞介素-25、白细胞介素-10、白细胞介素-23和白细胞介素-17A水平。
经过长期奥马珠单抗治疗后，白细胞、D-二聚体、白细胞介素-33、白细胞介素-6、白细胞介素-25和白细胞介素-1β水平下降。患者的高敏C反应蛋白从3降至0.1，嗜酸性粒细胞阳离子蛋白（ECP）水平从78降至21。在开始奥马珠单抗治疗后的几天内，复发性口腔溃疡、哮喘症状（咳嗽、呼吸急促）、急诊入院次数以及患者的平均住院天数均有显著改善。
在此，我们首次介绍奥马珠单抗治疗一名诊断为BD的患者，并对该治疗的临床表现以及细胞因子/凝血蛋白水平进行检查。开始奥马珠单抗治疗后，患者的复发性口腔溃疡有显著改善。有强有力的证据表明，血清促炎细胞因子/凝血因子在复发性口腔溃疡与IgE依赖的血管自身炎症之间的关系中也可能起重要作用。
