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Robert Eisenberg

Publications and source records attributed to Robert Eisenberg.

11 recordsLinked to original sources

Cochlear size variation in a large-scale international multicentre cohort.

AIM: This study aims to (1) review the literature on cochlear size, measured by the A-value, to assess reported variation across studies, and (2) consolidate cochlear parameters-specifically basal turn diameter (A-value) and width (B-value)-measured using the standardized DICOM viewer OTOPLAN®, and compare these with published data. METHODS: A scoping literature review was conducted using the search term "diameter of cochlear basal turn" to identify studies reporting A-value measurements. To complement this, cochlear measurements obtained with OTOPLAN® were collected from clinical collaborators across multiple international centres. The ratio of B- to A-values, which defines the cochlear basal turn shape, was calculated as previously described by Khurayzi et al. (2021). RESULTS: The literature review identified 38 studies comprising 5,206 A-value measurements (average: 9.08 mm; range: 8.01-10.03 mm). Additionally, 5,580 OTOPLAN® measurements were collected from 43 clinics across 25 countries (mean: 9.07 mm; range: 6.67-11.45 mm). Overall, 68.7% of cochleae exhibited an elliptical basal turn shape. CONCLUSION: Using a large, international multicentre dataset and a standardized measurement tool, this study demonstrates substantial variation in cochlear size and shape across clinical cohorts from different regions. The mean A-value (9.07 mm) is consistent with previously published literature, while the wider observed range highlights greater anatomical variability within a multicentre clinical population than previously reported. The majority of cochleae demonstrate an elliptical basal turn configuration.

Humans↗

Targeting B cells in systemic lupus erythematosus: not just déjà vu all over again.

Epratuzumab (anti-CD22) is a humanized monoclonal antibody that recognizes a pan-B-cell marker. It potentially downregulates B cell activity through negative signaling, as well as depleting B cells moderately. The uncontrolled series discussed by Dörner and colleagues in this issue of Arthritis Research & Therapy suggests that epratuzumab may be safe and efficacious for systemic lupus erythematosus. A randomized controlled trial is currently active to test this possibility.

Antibodies, Monoclonal↗

B-cell targeted therapies in rheumatoid arthritis and systemic lupus erythematosus.

B cells appear to have a central role in the immunopathogenesis of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE); both autoantibody production and B-cell anomalies are characteristic of these diseases. With the recent availability of biologic agents that can deplete B cells or block their function in vivo, it has become possible to target B cells therapeutically. Evidence strongly suggests that novel B-cell targeting agents are effective. In addition, the mechanistic specificity of B-cell targeted approaches, combined with the ability to test them in large randomized controlled trials, will provide an unprecedented opportunity to study the precise roles of B cells in the immunopathogenesis of RA and SLE. The largest volume of information is available for rituximab, a chimeric monoclonal antibody that depletes B cells by binding to the CD20 cell-surface antigen. Information from multiple investigator-sponsored trials and from off-label use suggests efficacy of this antibody in RA, SLE, and other autoimmune syndromes. Randomized controlled trials have also provided solid evidence for the efficacy of rituximab in RA and are ongoing in SLE. Other therapeutic agents supported by controlled data include cytotoxic T-lymphocyte-associated protein 4 immunoglobulin and antibodies against the interleukin-6 receptor and the B-cell survival molecule BLyS. Additional agents and targets are in earlier stages of development. The concerns about infectious complications have so far not proven to be justified. We can reasonably expect important advances in the understanding and treatment of RA and SLE in the next 5-10 years, as B-cell targeting methods become more widespread and sophisticated.

Animals↗

Targeting B cells in SLE: the experience with rituximab treatment (anti-CD20).

B cells play a central role in the pathogenesis of SLE. Not only do they make autoantibodies, but they can provide immunoregulatory controls of T cells, dendritic cells, and other B cells, in part through cytokine production. The availability of a chimeric monoclonal antibody that targets B cells has made it possible to treat SLE by B-cell depletion. Rituximab binds to the B-cell specific antigen CD20, and depletes B cells from the peripheral blood and lymphoid tissues. A growing number of anecdotal series and case reports suggest that rituximab may provide clinical benefit in SLE with acceptable toxicity, although the variability in responses of individual patients is not yet fully understood. Two large ongoing randomized controlled trials will determine the efficacy of rituximab in SLE, both renal and extra-renal, and will inform us better about the biology of the B cell in this disease and the effects of B-cell depletion.

Animals↗

The therapeutic potential of anti-CD20 "what do B-cells do?".

B-cells play a major role in the immunopathogenesis of autoimmune diseases. Not only do they produce autoantibodies, but they regulate other cell types, secrete cytokines, and present antigens. They are thus potential targets for therapeutic intervention. CD20 is a B-cell specific cell surface molecule of uncertain function. An anti-CD20 chimeric mAb (rituximab) has been FDA approved for treatment of B-cell lymphomas since 1997. Rituximab also depletes normal B-cells by several mechanisms, including ADCC. Over the past seven years, it has shown promise in a number of autoimmune diseases in phase I trials and anecdotal reports. Efficacy in rheumatoid arthritis has already been demonstrated in randomized control trials (RCTs), and RCTs in SLE, inflammatory myositis, and ANCA associated vasculitis are under way. Safety does not appear to be a major problem, but continued vigilance is warranted. The increased use of rituximab, other anti-CD20 agents, and other B-cell targeting therapies holds great promise for substantial clinical benefits, as well as providing special opportunities to understand better disease pathogenesis.

Animals↗

Do autoantigens define autoimmunity or vice versa?

The basic function of the adaptive immune system is to distinguish self from foreign. The failure of self tolerance can result in autoimmunity, which comes in many forms but still targets a limited selection of the total available autologous determinants. This selectivity must reflect the underlying mechanisms of the autoimmune reaction, as well as the particular features of the autoantigens that are targeted. Here I discuss the overall paradigm of autoimmunity, and what kinds of mechanisms might play a role. It is likely that multiple different pathways are critical in various diseases, and even in a single condition.

Autoantigens↗

The anti-DNA knock-in model of systemic autoimmunity induced by the chronic graft-vs-host reaction.

The injection of spleen cells from bm12 mice into C57BL/6 recipients induces a chronic graft-vs-host reaction characterized by systemic autoimmunity, including anti-double-stranded DNA (anti-dsDNA) autoantibodies and immune complex-type proliferative glomerulonephritis. If the B6 recipient mice express an anti-DNA Vh site-directed transgene, the repertoire is skewed even more toward the anti-DNA response. Over a period of several weeks, high titers of serum anti-DNA antibodies appear and the mice develop renal damage. This permits the examination of the role of somatic immunoglobulin genetics and B-cell tolerance in a model of systemic lupus erythematosus.

Animals↗

SLE - Rituximab in lupus.

B cells are essential to the development of systemic lupus erythematosus (SLE). The chimeric monoclonal antibody rituximab depletes B cells by targeting the pan-B-cell surface marker CD20. Preliminary experience with this agent in SLE and other autoimmune diseases has been encouraging. Controlled trials in SLE will be necessary to determine whether rituximab is useful therapy in this disease, and will teach us more about the roles of B cells in its pathogenesis.

Animals↗

Mechanisms of autoimmunity.

Autoimmunity results from the failure of self-tolerance of the adaptive immune system. The reactivity of antibodies and T cells against endogenous antigens frequently causes organ damage, and consequent autoimmune disease. Systemic lupus erythematosus (SLE) is an extreme example of such a breakdown of tolerance. Our studies with spontaneous genetic mouse models of SLE and an experimentally induced model have elucidated many of the underlying cellular and genetic mechanisms of this immune dysregulation. We find that the B cell plays a key central role in this process and represents an attractive target for therapeutic intervention.

Animals↗