Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Natural Killer Cell Cytotoxicity in Rheumatoid Arthritis Patients Treated with TNF Inhibitors
TNF İnhibitörleri ile Tedavi Edilen Romatoid Artrit Hastalarında Doğal Öldürücü Hücre Toksisitesi
Ali Berkant AVCIa, Veli YAZISIZb, Münevver KAHRAMAN, PhDc, Funda ERBASANd, Mehtap DEMİRELe, Arzu Didem YALÇINf, Reginald M. GORCZYNSKIg, Ender TERZİOĞLUa
aDepartment of Internal Medicine, Division of Rheumatology, Akdeniz University Faculty of Medicine,
cAkdeniz University Faculty of Medicine, Health Sciences Research Centre,
Clinics of
dRheumatology,
fImmunology and Allergy, Antalya Education and Research Hospital,
eMedical Park Hospital, Antalya
bClinic of Rheumatology, Şişli Etfal Education and Research Hospital, İstanbul
gDivision of Cellular & Molecular Biology, Toronto General Research Institute (TGRI), Toronto
Turkiye Klinikleri J Med Sci. 2012;32(2):485-93
doi: 10.5336/medsci.2011-26488
Article Language: EN
Full Text
ABSTRACT
 Objective: Patients with low natural killer (NK) cell activity were shown to have a higher risk of cancer development. Increased cancer risk in rheumatoid arthritis (RA) patients treated with anti-tumor necrosis factor (anti-TNF) agents is still being debated. Therefore, we think it is important to show whether anti-TNF therapy has any effects on the NK cell cytotoxicity in these patients. Material and Methods: We included 60 rheumatoid arthritis patients, 31 treated with anti-TNF therapy, 29 treated with other disease modifying antirheumatic drugs (DMARDs), and 51 ankylosing spondylitis (AS) patients, 35 treated with anti-TNF therapy and 16 treated with nonsteroidal anti-inflammatory drugs or conventional DMARDs as a disease control into the study. The results of two healthy control groups each consisting of 32 age- and sex- matched healthy individuals were also included. Results: Median values of NK cytoxicity in patients with RA who were being treated with anti-TNF and patients treated with other DMARDs were 29% and 43%, respectively (p=0.203). When we reanalyzed the results independent of clinical diagnosis, patients using anti-TNF medications and patients treated with other medicine had NK cytotoxicity median values of 32% and 43%, respectively (p=0.277). Conclusion: We suppose that NK cell cytotoxicity may decrease in patients with RA when they use anti-TNF agents, and this may help partly to explain why these patients are more prone to development of cancer and severe infections. We think that this study will encourage new studies with higher number of patients to better clarify effects of anti-TNF treatment on NK cell functions.

Keywords: Arthritis, rheumatoid; tumor necrosis factor-alpha; natural killer T-cells
ÖZET
 Amaç: Düşük doğal öldürücü (NK) hücre aktivitesi olan hastalarda kanser gelişme riskinin daha yüksek olduğu gösterilmiştir. Anti-tümör nekrozis faktör (anti-TNF) ile tedavi edilen romatoid artrit (RA) hastalarında artmış kanser riski literatürdeki farklı sonuçlarla halen bir tartışma konusudur. Bu nedenle biz RA tanılı hastalarda anti-TNF tedavinin NK hücre toksisitesi üzerine etkisi olup olmadığını göstermenin önemli olduğunu düşündük. Gereç ve Yöntemler: Çalışmaya 31'i anti-TNF tedavi alan, 29'u diğer hastalık modifiye edici ilaçlarla (DMARD) tedavi edilen 60 RA hastası alındı. Ayrıca hasta kontrol grubu olarak 35'i anti-TNF tedavi, 16'sı nonsteroid antiinflamatuar ilaçlar veya konvansiyonel DMARD'larla tedavi edilen 51 ankilozan spondilit (AS) hastası dâhil edildi. Hem RA hem de AS grubu için her biri yaş ve cinsiyet açısından eşleştirilmiş 32'şer hastadan oluşan iki sağlıklı kontrol grubunun sonuçları da çalışmaya dâhil edildi. Bulgular: Anti-TNF ilaçlarla tedavi edilen RA hastaları ile diğer DMARD'larla tedavi edilen hastaların NK sitotoksisitesi median değerleri sırasıyla, %29 ve %43'tü (p=0,203). Tanıdan bağımsız olarak sonuçlar tekrar analiz edildiğinde, anti-TNF ilaçlarla tedavi edilen hastalarla diğer ilaçlarla tedavi edilen hastaların NK sitotoksisitesi median değerleri sırasıyla %32 ve %43 olarak hesaplandı (p=0,277). Sonuç: Biz anti-TNF tedavi alan RA hastalarında NK hücre toksisitesinin düşebileceğini ve bunun kısmen de olsa bu hastaların malign hastalıklara ve ciddi enfeksiyonlara duyarlı olmasında etkisi olabileceğini öngörmekteyiz. Bu ilişkinin daha net ortaya konabilmesi için, bu çalışmanın daha çok sayıda hasta ile yapılacak yeni çalışmalara cesaretlendireceğini düşünmekteyiz.

Anahtar Kelimeler: Artrit, romatoid; tümör nekroze edici faktör-alfa; doğal öldürücü T- hücreleri

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30.03.2014

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