title: Serum levels of soluble TNFalpha receptors (sTNFR1 and sTNFR2) during corticosteroid treatment in patients with Graves' ophthalmopathy.
abstract: TNFalpha was shown to play an important role in the autoimmune inflammatory process of Graves' ophthalmopathy (GO). In our previous study we found no significant changes in serum TNFalpha levels in GO patients. The aim of the present study was to estimate an influence of corticosteroids on serum levels of TNFalpha receptors (sTNFR1 and sTNFR2) in GO patients and to assess their potential as a guideline of immunosuppressive therapy. We detected serum sTNFRI and sTNFR2 in three groups of subjects: 18 patients with clinical symptoms of ophthalmopathy [Clinical Activity Score (CAS) > or = 4, anamnesis of GO > or = 1 yr], 16 patients with Graves' disease without ophthalmopathy (Gd) and 14 healthy volunteers. Corticosteroid therapy consisted of intravenous infusions of methylprednisolone (MP) and subsequent treatment with oral prednisone (P). The serum samples were collected 24 hours before MP, 24 hours after MP, 14 days of treatment with prednisone and after the end of the corticosteroid therapy. The levels of serum sTNFR1 and sTNFR2 were determined by ELISA. Serum levels of sTNFR1 were significantly higher in GO individuals as compared to the control group (p < 0.01). We have found a significant decrease in sTNFR1 concentration in corticosteroid-respondent patients (satisfactory clinical effect, decrease of CAS > or = 1) as compared to the pretreatment values after MP treatment (p < 0.05) and after 14 days of prednisone (p < 0.01). There were significant differences in sTNFR2 level after MP treatment (p < 0.02) and after corticosteroid administration (p < 0.05) between responders and non-responders. Baseline values of sTNFRI in GO individuals were positively correlated with CAS (r = 0.6, p < 0.02).
  
  
  CONCLUSIONS
  TNFalpha acting through its receptors plays an important role in the pathogenesis of Graves' ophthalmopathy. Moreover, the beneficial influence of corticosteroids on the course of GO may be explained, at least in part, by an inhibition of sTNFR1 and sTNFR2. Measurement of soluble TNFalpha receptors might potentially serve as an indicator in prognostic estimation of corticosteroids' efficacy.
authors.affiliation: Department of Endocrinology, Diabetology and Internal Diseases, Medical Academy of Białystok, Białystok, Poland. mysjan@poczta.onet.pl
authors.forename: Janusz
authors.initials: J
authors.lastname: Myśliwiec
authors.forename: Adam
authors.initials: A
authors.lastname: Kretowski
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Stepień
authors.forename: Ida
authors.initials: I
authors.lastname: Kinalska
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000276:immunology / Q000627:therapeutic use*; D016022:Case-Control Studies; D005260:Female; D006111:Graves Disease / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D008775:Methylprednisolone / Q000276:immunology / Q000627:therapeutic use*; D008875:Middle Aged; D011241:Prednisone / Q000276:immunology / Q000627:therapeutic use*; D018124:Receptors, Tumor Necrosis Factor / Q000097:blood*
chemical_list: D000893:Anti-Inflammatory Agents; D018124:Receptors, Tumor Necrosis Factor; D011241:Prednisone; D008775:Methylprednisolone