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Medell&#237;n&#44; Colombia&#44; we analyzed the presence of Anti C1q antibodies&#44; including antineutrophil cytoplasmic antibody &#40;ANCA&#41;-associated vasculitis&#44; &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&#44; polyarteritis nodosa &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; LIVEN &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41; and Takayasu arteritis &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#46; Serum Anti-C1q were measured by ELISA techniques &#40;QUANTA Lite&#44; Inova&#44; USA&#41;&#46; This study was approved by the institutional review board at our institution&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">From this small pilot study&#44; we found that anti C1q antibodies were more prevalent in LIVEN patients in comparison with other vasculitis &#40;75&#37; vs&#46; 5&#46;3&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Mean anti C1q titers were significantly higher in patients with LIVEN than in other vasculitis &#40;51&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#46;3 vs&#46; 10&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;1<span class="elsevierStyleHsp" style=""></span>IU&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46; Main clinical and serological characteristics including serum complement levels are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">It is well known that levamisole induces circulating autoantibodies&#46; Patients commonly have high levels of perinuclear ANCA &#40;p-ANCA&#41; but not always against myeloperoxidase &#40;MPO&#41;&#46; p-ANCA titers are often directed against atypical p-ANCA-associated antigens within the neutrophil granules such as&#58; human neutrophil elastase&#44; lactoferrin&#44; and cathepsin G&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Recently&#44; our group described a series of 11 patients with LIVEN&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> ANCA &#40;91&#37;&#41;&#44; lupus anticoagulant &#40;73&#37;&#41;&#44; ANAS &#40;45&#37;&#41;&#44; anti dsDNA &#40;29&#37;&#41;&#44; anti Ro &#40;29&#37;&#41; were most common autoantibodies&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> Given the social difficulties for clinical follow-up in cocaine users&#44; anti C1q antibodies are not measured yet in all patients with LIVEN attending our center&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Anti C1q antibodies have been described in many conditions including hypocomplementic urticarial vasculitis&#44; systemic lupus erythematosus and membranoproliferative glomerulonephritis&#44; among others&#46; To our knowledge&#44; this study is the first on anti C1q antibodies in patients suffering LIVEN&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">C1q is a molecule important for the clearance of apoptotic cells&#46; Apoptotic cells express autoantigens in their surface and may induce autoimmunity&#46; Cocaine&#47;levamisole generates repeated release of neutrophil antigens that might act as autoantigens and leads to decreasing tolerance&#46; Neutrophils secrete complement proteins upon activation with PMA&#44; fMLP and C5a&#46; Neutrophil extracellular traps &#40;NETs&#41; have been implied as a potential source of autoantigens&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> Leffler et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> demonstrated that <span class="elsevierStyleItalic">in vitro</span> complement interaction with NETs and that C1q bound well and C3b deposited on NETs&#46; The authors argue that decreased degradation of NETs led to deposition of complement and autoantibodies&#44; recruitment of more complement&#44; perpetuating the inflammatory cycle&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Finally&#44; metabolic products of cocaine promote complement synthesis and lead to the deposition of C5b-9&#46; LIVEN is proposed as a membrane attack complex &#40;C5b-9&#41; disease with enhanced apoptosis and prominent vascular expression of ICAM-1&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Increasing reports signal that LIVEN is a contemporary public health problem&#46; Recent reports from different authorities in the U&#46;S&#46; and the U&#46;K&#46; suggest that cocaine samples are contaminated with levamisole in 50&#8211;80&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> According to local authorities in Colombia&#44; levamisole contaminates 40&#37; of the market&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> Indeed&#44; preventing cocaine use is crucial for mitigating additional cases of LIVEN&#46; Despite awareness of its toxicity by clinicians&#44; identifying new biomarkers is necessary for practitioners that interface with these patients&#46; Given our small sample size&#44; further research is needed to confirm our findings that suggest anti C1q antibodies are useful markers in patients with LIVEN&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anti C1q antibodies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#47;male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ear necrosis&#44; retiform purpura on legs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anti MPO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C3&#58; NormalC4&#58; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive &#40;20&#46;3<span class="elsevierStyleHsp" style=""></span>IU&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PDN 30<span class="elsevierStyleHsp" style=""></span>mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#47;male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rapidly progressive glomerulonephritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anti MPO&#44; aCL IgG&#44; aCL IgM&#44; lupus anticoagulant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C3&#58; LowC4&#58; Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive &#40;116&#46;4<span class="elsevierStyleHsp" style=""></span>IU&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PDN 60<span class="elsevierStyleHsp" style=""></span>mg&#47;dayCyclo 1<span class="elsevierStyleHsp" style=""></span>g &#40;pulses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#47;female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ear necrosis&#44; retiform purpura on legs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anti MPO&#44; aCL IgG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C3&#58; NormalC4&#58; Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive &#40;64&#46;4<span class="elsevierStyleHsp" style=""></span>IU&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PDN 20<span class="elsevierStyleHsp" style=""></span>mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#47;male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ear necrosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANAs&#44; Anti dsDNAAnti MPO&#44; Anti Ro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C3&#58; NormalC4&#58; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Negative &#40;3&#46;1<span class="elsevierStyleHsp" style=""></span>IU&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MPDN 500<span class="elsevierStyleHsp" style=""></span>mg pulses plus PDN 40<span class="elsevierStyleHsp" style=""></span>m&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "texto" => "<p id="par0060" class="elsevierStylePara elsevierViewall">J&#46;A&#46; G&#243;mez-Puerta was supported by <span class="elsevierStyleGrantSponsor" id="gs1">Colciencias</span> &#40;convocatoria 656 de 2014&#41;&#46; We would like to thank Catalina Perez Koller and Liliana Marcela Pe&#241;aranda &#40;Inova&#47;Wefen&#41; for assisting with sample management and analysis of antibodies&#46;</p>"
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Letter to the Editor
Anti C1q antibodies. A promising biomarker for cocaine-levamisole induced vasculitis
Anticuerpos anti C1q. Un biomarcador prometedor para la vasculitis inducida por cocaína-levamisol
José A. Gómez-Puertaa,b,
Autor para correspondencia
jagomez@clinic.cat

Corresponding author at: Servicio de Reumatología, Hospital Clínic, Villarroel 170, Escala 11-2 Planta, 08036 Barcelona, Spain.
, Carlos H. Muñoza,c, Adriana L. Vanegas-Garcíaa,c, Tomás Urregod, Gloria Vásqueza,d, Luis A. Gonzáleza
a Grupo de Reumatología, Universidad de Antioquia, Medellín, Colombia
b Servicio de Reumatología, Hospital Clínic, Barcelona, Spain
c Hospital Universitario San Vicente Fundación, Medellín, Colombia
d Grupo de Inmunología Celular e Inmunogenética, GICIG, Universidad de Antioquia, Medellín, Colombia
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">During the 1960s&#44; Levamisole was used as an anthelmintic agent&#46; It was subsequently found to have immunomodulatory effects and was used to treat several inflammatory disorders&#46; During the last decade&#44; attention has been focused on the use of levamisole as a cutting agent for cocaine and on several cases of severe agranulocytosis associated with cocaine use&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Cocaine&#47;levamisole-induced vasculitis &#8211; LIVEN &#8211; is a heterogeneous vasculopathy characterized by skin necrosis concentrated in acral areas &#91;ears&#44; cheeks&#44; genitals and digital necrosis&#93;&#44; retiform purpura&#44; general symptoms and cytopenias&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> Histopathological samples reveal pauci-inflammatory thrombotic diathesis accompanied with intravascular monocytes and evidence of complement activation&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In 23 consecutive patients with systemic vasculitis from Hospital Universitario San Vicente Fundaci&#243;n&#44; Medell&#237;n&#44; Colombia&#44; we analyzed the presence of Anti C1q antibodies&#44; including antineutrophil cytoplasmic antibody &#40;ANCA&#41;-associated vasculitis&#44; &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&#44; polyarteritis nodosa &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; LIVEN &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41; and Takayasu arteritis &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#46; Serum Anti-C1q were measured by ELISA techniques &#40;QUANTA Lite&#44; Inova&#44; USA&#41;&#46; This study was approved by the institutional review board at our institution&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">From this small pilot study&#44; we found that anti C1q antibodies were more prevalent in LIVEN patients in comparison with other vasculitis &#40;75&#37; vs&#46; 5&#46;3&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Mean anti C1q titers were significantly higher in patients with LIVEN than in other vasculitis &#40;51&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#46;3 vs&#46; 10&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;1<span class="elsevierStyleHsp" style=""></span>IU&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46; Main clinical and serological characteristics including serum complement levels are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">It is well known that levamisole induces circulating autoantibodies&#46; Patients commonly have high levels of perinuclear ANCA &#40;p-ANCA&#41; but not always against myeloperoxidase &#40;MPO&#41;&#46; p-ANCA titers are often directed against atypical p-ANCA-associated antigens within the neutrophil granules such as&#58; human neutrophil elastase&#44; lactoferrin&#44; and cathepsin G&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Recently&#44; our group described a series of 11 patients with LIVEN&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> ANCA &#40;91&#37;&#41;&#44; lupus anticoagulant &#40;73&#37;&#41;&#44; ANAS &#40;45&#37;&#41;&#44; anti dsDNA &#40;29&#37;&#41;&#44; anti Ro &#40;29&#37;&#41; were most common autoantibodies&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> Given the social difficulties for clinical follow-up in cocaine users&#44; anti C1q antibodies are not measured yet in all patients with LIVEN attending our center&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Anti C1q antibodies have been described in many conditions including hypocomplementic urticarial vasculitis&#44; systemic lupus erythematosus and membranoproliferative glomerulonephritis&#44; among others&#46; To our knowledge&#44; this study is the first on anti C1q antibodies in patients suffering LIVEN&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">C1q is a molecule important for the clearance of apoptotic cells&#46; Apoptotic cells express autoantigens in their surface and may induce autoimmunity&#46; Cocaine&#47;levamisole generates repeated release of neutrophil antigens that might act as autoantigens and leads to decreasing tolerance&#46; Neutrophils secrete complement proteins upon activation with PMA&#44; fMLP and C5a&#46; Neutrophil extracellular traps &#40;NETs&#41; have been implied as a potential source of autoantigens&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> Leffler et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> demonstrated that <span class="elsevierStyleItalic">in vitro</span> complement interaction with NETs and that C1q bound well and C3b deposited on NETs&#46; The authors argue that decreased degradation of NETs led to deposition of complement and autoantibodies&#44; recruitment of more complement&#44; perpetuating the inflammatory cycle&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Finally&#44; metabolic products of cocaine promote complement synthesis and lead to the deposition of C5b-9&#46; LIVEN is proposed as a membrane attack complex &#40;C5b-9&#41; disease with enhanced apoptosis and prominent vascular expression of ICAM-1&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Increasing reports signal that LIVEN is a contemporary public health problem&#46; Recent reports from different authorities in the U&#46;S&#46; and the U&#46;K&#46; suggest that cocaine samples are contaminated with levamisole in 50&#8211;80&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> According to local authorities in Colombia&#44; levamisole contaminates 40&#37; of the market&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> Indeed&#44; preventing cocaine use is crucial for mitigating additional cases of LIVEN&#46; Despite awareness of its toxicity by clinicians&#44; identifying new biomarkers is necessary for practitioners that interface with these patients&#46; Given our small sample size&#44; further research is needed to confirm our findings that suggest anti C1q antibodies are useful markers in patients with LIVEN&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Autoantibodies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Serum complement<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anti C1q antibodies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#47;male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ear necrosis&#44; retiform purpura on legs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anti MPO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C3&#58; NormalC4&#58; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive &#40;20&#46;3<span class="elsevierStyleHsp" style=""></span>IU&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PDN 30<span class="elsevierStyleHsp" style=""></span>mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#47;male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rapidly progressive glomerulonephritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anti MPO&#44; aCL IgG&#44; aCL IgM&#44; lupus anticoagulant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C3&#58; LowC4&#58; Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive &#40;116&#46;4<span class="elsevierStyleHsp" style=""></span>IU&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PDN 60<span class="elsevierStyleHsp" style=""></span>mg&#47;dayCyclo 1<span class="elsevierStyleHsp" style=""></span>g &#40;pulses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#47;female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ear necrosis&#44; retiform purpura on legs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Anti MPO&#44; aCL IgG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C3&#58; NormalC4&#58; Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Positive &#40;64&#46;4<span class="elsevierStyleHsp" style=""></span>IU&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PDN 20<span class="elsevierStyleHsp" style=""></span>mg&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#47;male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ear necrosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ANAs&#44; Anti dsDNAAnti MPO&#44; Anti Ro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C3&#58; NormalC4&#58; Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Negative &#40;3&#46;1<span class="elsevierStyleHsp" style=""></span>IU&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MPDN 500<span class="elsevierStyleHsp" style=""></span>mg pulses plus PDN 40<span class="elsevierStyleHsp" style=""></span>m&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical and serological characteristics of LIVEN patients&#46;</p>"
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      "titulo" => "References"
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          "identificador" => "bibs0015"
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                      "autores" => array:1 [
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                  "host" => array:1 [
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                      "autores" => array:1 [
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            2 => array:3 [
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                      ]
                    ]
                  ]
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                            1 => "D&#46; Inaebnit"
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                          ]
                        ]
                      ]
                    ]
                  ]
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                        ]
                      ]
                    ]
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            4 => array:3 [
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              "etiqueta" => "5"
              "referencia" => array:1 [
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cocaine-levamisole induced vasculitis&#58; a series of 11 cases"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;H&#46; Mu&#241;oz"
                            1 => "A&#46;L&#46; Vanegas"
                            2 => "A&#46; Arbelaez"
                            3 => "M&#46; Restrepo"
                            4 => "G&#46; V&#225;squez"
                            5 => "L&#46;A&#46; Correa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Rheum Dis"
                        "fecha" => "2016"
                        "volumen" => "75"
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                      ]
                    ]
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            5 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neutrophil extracellular traps as a potential source of autoantigen in cocaine-associated autoimmunity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "C&#46; Lood"
                            1 => "G&#46;C&#46; Hughes"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Rheumatology &#40;Oxford&#41;"
                        "fecha" => "2016"
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            6 => array:3 [
              "identificador" => "bib0080"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neutrophil extracellular traps that are not degraded in systemic lupus erythematosus activate complement exacerbating the disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Leffler"
                            1 => "M&#46; Martin"
                            2 => "B&#46; Gullstrand"
                            3 => "H&#46; Tyd&#233;n"
                            4 => "C&#46; Lood"
                            5 => "L&#46; Truedsson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4049/jimmunol.1102404"
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                        "tituloSerie" => "J Immunol"
                        "fecha" => "2012"
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                      "titulo" => "Identification of levamisole impurities found in illicit cocaine exhibits"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;F&#46; Casale"
                            1 => "E&#46;M&#46; Corbeil"
                            2 => "A&#46;H&#46; Patrick"
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                        ]
                      ]
                    ]
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                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Microgram J"
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              "identificador" => "bib0090"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "<a target="_blank" href="https://www.unodc.org/documents/colombia/2014/Julio/Estudio_de_Consumo_UNOD.C.pdf">https&#58;&#47;&#47;www&#46;unodc&#46;org&#47;documents&#47;colombia&#47;2014&#47;Julio&#47;Estudio&#95;de&#95;Consumo&#95;UNOD&#46;C&#46;pdf</a> &#91;accessed 24&#46;07&#46;16&#93;&#46;"
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      0 => array:4 [
        "identificador" => "xack430965"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0060" class="elsevierStylePara elsevierViewall">J&#46;A&#46; G&#243;mez-Puerta was supported by <span class="elsevierStyleGrantSponsor" id="gs1">Colciencias</span> &#40;convocatoria 656 de 2014&#41;&#46; We would like to thank Catalina Perez Koller and Liliana Marcela Pe&#241;aranda &#40;Inova&#47;Wefen&#41; for assisting with sample management and analysis of antibodies&#46;</p>"
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Información del artículo
ISSN: 1699258X
Idioma original: Inglés
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