The Medical clinics of North America
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Histocompatibility typing has assumed an increasingly important role as a clinical and research tool in rheumatic diseases. The HLA antigens which are serologically defined (A and B series) are being used most extensively for clinical work, but the role of other immunologic determinants in the HLA complex is being evaluated. These include D-locus (MLC) determinants, several complement components, and immune response genes which have been well characterized in the mouse, but not in man. ⋯ Its value as an indicator of prognosis, and its value in counselling family members is not well established. There are many interesting hypotheses regarding pathogenetic mechanisms of these rheumatic diseases based on susceptibility factors related to the major histocompatibility complex. An abnormal immune response gene within the complex is probably a key feature of the mechanism, but the exact details are little more than speculative at this point.
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Med. Clin. North Am. · Sep 1976
ReviewImmunosuppressive therapy of idiopathic thrombocytopenic purpura.
The autoimmune nature of idiopathic thrombocytopenic purpura, as currently defined, is well established. Manipulations of the immune apparatus aimed at abating this deviant immunologic state may be one mode of approach to the therapy of this disease. Several cytotoxic compounds are capable of inhibiting the primary and secondary immune response to experimentally injected antigens in animals and man. ⋯ The mechanisms by which immunosuppressive agents effect therapeutic response, and, in particular, whether this action is linked to suppression of immune reactivity needs clarification. Although preliminary analysis of the efficacy of immunosuppressive drugs in idiopathic thrombocytopenic purpura is encouraging, their therapeutic role has not superseded that of conventional management with steroids and splenectomy. Carefully controlled randomized clinical trials are now necessary so that more rational use of these agents can be recommended in future reports.