In this very interactive and highly scientific environment key opinion leaders were asked to present their experiences in how to predict, diagnose and treat complex clinical cases.
The scientific organizers, Prof J. Isgaard from Sweden and Dr. G. Aimaretti from Italy, articulated the program in a very dynamic format. After each session a different discussion approach stimulated the faculty and attendees in exchanging additional experiences as well as approaches on each presented topic.
The first session covered the cardiovascular manifestations in endocrine disorders. Prof Biondi exposed the effect of reduced or increased action of the thyroid hormone on the cardiovascular system highlighting that not only overt hypo and hyper-thyroidism have a relevant cardiovascular effect, but also the Subclinical Thyroid Dysfunctions (STD), in particular the fact that the cut-off that determines the adverse effect related to this conditions still remains to be established. Also mentioned was that a recent consensus panel assessment recommended to treat patients presenting serum levels of TSH >10mU/L to prevent the progression to overt disease. Moreover, mild hypothyroidism (TSH<10mU/L) can negatively affect the cardiovascular system and the treatment of these patients was advised. In conclusion Prof Biondi presented an elegant algorithm for the diagnosis and treatment of STD.
The second presentation held by Prof Danchin presented epidemiological research on cases of cardiovascular complications in Type 2 diabetes. In these studies cardiovascular mortality represented more than 50% of deaths in the diabetic population. The treatment of Type 2 diabetes is not efficient to prevent and keep under control cardiovascular complications therefore there is a need for a global approach for type 2 diabetes patients.
Prof Marzullo’s presentation on “Cardiovascular manifestations in pituitary disorders” was really appreciated. He covered the effect of altered GH/IGF axis on cardiomyocytes trophism and impacts on the vascular system.
This first session was concluded by Prof. L. Saccà presenting a complete lecture on “Heart Failure: a Syndrome of multiple hormonal deficiency”. He covered the interrelation between Heart failure and Growth Hormone deficiency and resistance, diabetes and “low T3 syndrome”.
The second session addressed the various Metabolic Complications in Endocrine Disorders. Pierre Chatelain presented data on SGA and the Turner Syndrome and explained why Growth Hormone (GH) should rather be named “growth and metabolic” hormone since its growth promoting action, illustrated by the impressive dwarfism of untreated severe GH Deficiency in children, does not emphasize enough its metabolic effects which instead are illustrated by adult GHD or acromegaly. He also presented all the possible cellular paths of GH and its metabolic targets: Glucose metabolism, lipid metabolism, bone metabolism and others.
Prof. Rudling showed recent data confirming that the impact of plasma cholesterol for the development of arteriosclerosis cannot be overestimated. In a series of papers he has shown the importance of the pituitary in body cholesterol homeostasis and particularly the role of GH for the normal expression of Low Density Lipoprotein (LDL) receptors in the liver. The results implicate that the age-dependent increase in plasma LDL-cholesterol could in part be due to the progressively reduced secretion of GH that occurs with aging.
Prof. Golay’s lecture on “Adipose tissue as an endocrine organ” presented the white adipose tissue (WAT) as an important endocrine organ. In WAT, mature adipocytes account for no more than half of the total cells. The tissue contains a large number of preadipocytes and other cell types (such as fibroblasts, endothelial cells and macrophages). These cells secrete a heterogeneous group of proteins and factors – adipokines. It has been recognized that adipokines are involved in control and regulation of appetite and energy balance, glucose and lipid metabolism, neuroendocrine function, reproduction, immunity, and cardiovascular function.
Prof. Brabant closed this second session by showing how thyroid hormones have a profound effect on glucose metabolism. This is mediated by several interlinked processes: Hypothyroidism results in profound changes in energy homeostasis which in turn results, with some variations, in a shift to more fat in hypothyroid states. This is linked to increased levels of triglycerides and free fatty acids inducing insulin resistance. In addition there appears to be direct interaction with glucose uptake, which may be governed by local blood flow. Hypothyroidism leads to a profound decrease in peripheral blood flow, which is only in part counteracted by the vasodilatory effects of high TSH levels.
Prof. Clayton’s lecture was about the pharmacogenomic approach to tailored GH therapy in addition to biomarkers of response such as insulin-like and growth factor-I (IGF-I), anthropometric and biochemical parameters.
Models based on pre-treatment variables can predict up to 61% of the variability in first year growth response in GHD. However a significant percentage of response is unexplained by these models. There is therefore a need to explore other factors that may influence growth response. One avenue that is presently being explored is the examination of genetic backgrounds making it possible to combine established auxology-based prediction models and well-characterized biomarkers such as IGF-I with key gene polymorphisms (DNA), baseline and changes in gene expression (mRNA) in response to GH to identify those children who will derive the greatest benefit from GH treatment with the lowest risk of adverse effects.
Prof. Jørgensen covered the history of the GH drug development and its use. A number of placebo-controlled trials, a few of which with a duration of two years, documented potentially beneficial effects on body composition, physical fitness, cardiac function, lipoproteins and also general well-being. At the same time it became evident that hypopituitarism in the adult was associated with excess morbidity and mortality from cardiovascular diseases, and it was speculated that this in part could relate to GH-deficiency. Indeed, recent data from observational (i.e. uncontrolled) surveillance studies suggest that mortality is declining, but this may reflect a general increased awareness and thus include treatment modalities in addition to GH, such as improved substitution of additional pituitary deficits, less use of radiation therapy, lipid lowering drugs, more rigorous treatment of hypertension and diabetes. He finally listed the side effects of GH replacement, which rarely causes significant clinical problems if the GH dosage is tailored appropriately to the individual patient
Prof. Aimairetti presented data on Traumatic Brain Injury (TBI) in the last lecture. This is very often cause of hypopituitarism and GH deficiency both in children and adult patients. Nevertheless, TBI-related hypopituitarism remains largely under-diagnosed, mostly due to lack of awareness among physicians who are likely to treat patients who may be suffering from it. Due to high number of pituitary deficits after TBI and its un-relationship with the severity of the trauma itself, the first approach would be to test any patient with a history of head trauma. But this approach would exhaust the health economics resources of any National Health Organization. From a practical point of view, on a population basis, more severe is the trauma higher is the likelihood of hypopituitarism. So, from a cost-effective approach, it is now better to focus on patients with moderate to severe head traumas (GCS < 13) based on the consideration that most of the studies in scientific literature were performed in more severe TBI patients.
In conclusion this event was very appreciated by participants who asked to have this symposium every year in order to build an interactive scientific environment in which to discuss possible integrated approaches to various diseases.
Monica Lispi
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I am Marilia Martins Guimarães (MD, PHD), graduated at the Federal University of Minas Gerais in 1968. I received a Master’s degree and a PHD degree from the Federal University of Rio de Janeiro in 1976 and 1987 respectively. I became a specialist in Endocrinology in 1974 and in Pediatric Endocrinology in 2001, both by the Associação Médica Brasileira (Brazilian Medical Society). I am a member of the following medical societies: Sociedade Brasileira de Endocrinologia e Metabologia (the Brazilian Society of Endocrinology), Sociedade Brasileira de Pediatria (the Brazilian Society of Pediatrics) and of the Sociedade Latino-Americana de Endocrinologia Pediátrica (the Latin American Pediatric Endocrinology Society). Currently I am the President of the Pediatric Endocrinology Department of the Brazilian Society of Endocrinology.
What are your main research and clinical activities?
I am an Associate Professor at the Federal University of Rio de Janeiro. My main research interest is the clinical aspects of the endocrine system in genetic diseases, especially Turner Syndrome.
What of the most recent findings of GH effects on the cardiovascular system and metabolic mechanisms are relevant for clinical practice?
Growth hormone has several metabolic effects. In the metabolism of carbohydrates, growth hormone decreases insulin sensitivity and consequently the peripheral glucose uptake stimulated by insulin. It also increases glycogen breakdown and the release of glucose into the circulation by the liver. In the metabolism of lipids, growth hormone stimulates lipolysis and lipid oxidation, decreasing serum cholesterol, LDL cholesterol and triglycerides while increasing serum levels of HDL cholesterol and free fatty acids. In protein metabolism it stimulates protein synthesis and inhibits proteolysis, causing positive nitrogen balance. GH deficiency is associated with a gain in fat mass and loss of muscle mass. It is also associated with an increase in the serum fasting glucose, insulin, LDL cholesterol and triglycerides levels. These changes correlate with an increase in the cardiovascular risk and are better observed in adults. Treatment with rhGH improves these abnormalities.
How do chronic diseases in children and adolescents impact on GH/IGF secretion and on the activity of these hormones?
Chronic diseases may affect growth through many mechanisms. Depending on the disease there may be a change in oxygen delivery to the different organs, a change in the availability of nutrients due to diminished appetite and impaired intestinal absorption, accumulation of unwanted metabolites, increase in caloric expenditure, inappropriate hormonal synthesis, change in the metabolic “set-up” from a state of anabolism, typical of children, to a state of catabolism and the presence of inflammatory agents with local and systemic effects, like the cytokines.
The majors cytokines increased during chronic inflammation are the interleukins (IL-6 and IL-1b) and the tumor necrosis factor (TNF-alpha). They interfere with the pituitary synthesis of growth hormone and its action in the liver and at the growth plate. This decreases serum IGF-I levels and reduces the effect of IGF-1 at the growth plate. Cytokines also increase the secretion of cortisol, which further interferes with expression, and activity of the GH/IGF-I axis.
What improvements are expected, on the basis of these findings, in the management of pediatric patients with chronic diseases?
The most important aspect in the management of the growth in children with chronic diseases is to treat the underlying disease. IGF-I partially prevents cytokine-induced growth retardation and the use of rhGH in chronic diseases associated with a growth deficit is under investigation. Presently investigators are also focusing in the synthesis and function of the many inflammatory agents that are expressed in chronic diseases. For example, recent studies have investigated the employment of substances that inhibit cytokines with the improvement of the underlying disease followed by an improvement in the growth of children with chronic disease. One of these promising agents used in rheumatoid arthritis is Etarnecept, a drug that inhibits TNF-alpha.
Thank you very much.
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LITERATURE REVIEW
Human Immune System is now available on the Serono Symposia International Foundation website. |
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NEW ONLINE COURSE IN IMMUNOLOGY
An Introduction to Immunology is now available on the Serono Symposia International Foundation website |
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GLOSSARY IN IMMUNOLOGY
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The symposium started with a basic science session on genetic screening of oocytes and clinical results particularly focused on the use of comparative genomic hybridization (CGH) and blastomere Fluorescence in-situ Hybridization (FISH) analysis. It was followed the analysis of oocyte quality in Poly-Cistosis Ovary Syndrome cases together with possible treatments such as the use of metformin and androgen stimulation. The third session stimulated an excellent and extensive discussion on the possible parameters to be used in ovarian reserve tests like the Antral Follicular Count, the Anti Mulleran Hormone and basal FSH. A talk on the use of oocyte morphology to predict embryo quality was also presented.
In the IV session Prof. Olivennes gave a very interesting lecture on the possible approach to select a starting dose of gonadotrophins in the IVF protocols and very much appreciated was the Keynote lecture of Prof. Te Velde on the future of motherhood.
The conference closed with sessions covering the interest of LH addition in ovarian stimulation, the indication and results of mild stimulation regimen, prevention technique of Ovary Hyper Stimulation Syndrome (OHSS) and recent progress on oocytes freezing results.
The attendees valued the conference as a unique opportunity to meet the world leading experts and learn about the latest scientific approaches in a fascinating place like Beaune.
Monica Lispi
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Brilliantly put together by the Scientific Organizer Carl Laskin, “Just because we can” was an attempt to gather professional stakeholders who deal on a daily basis with some of the most daunting ethical dilemmas faced in medicine today particularly following the technological advances in the field of infertility treatment that have seen the light in recent decades. Participants, Canadian physicians, nurses, embryologists, counsellors, lawyers, ethicists and administrative staff who work in infertility, all strongly felt the need to discuss ethics in such a delicate topic such as Assisted Reproduction.
Shawn Winsor opened the meeting with an excellent presentation on ethical thinking in ART which was followed by a breakout session where participants were divided into groups based on their professional experience to discuss two case studies.
The second keynote lecture was particularly eye opening. Barry Stevens, a documentarist, was conceived through sperm donation and he felt compelled to discover everything he could about the sperm donor. A documentary, Offspring, was made on his progress and it starts with this statement: "About a year ago, I found out that I might have one or even two hundred half brothers and sisters. I don't know who they are, nor do I know the man from whose body we were all made”. His talk on his experience, personal search and the ethical issues raised touched many of the people present at the workshop.
The meeting closed with another breakout session – with mixed professional groups this time – on two more case studies.
The participants particularly appreciated the structure of the event. The breakout sessions gave them the chance to interact with colleagues first and people from different professions later over real cases. The latter plus the two keynote lectures translated into a format that will certainly be reproposed by SSIF.
Simon Basten
I am a medical director of LifeQuest Centre for Reproductive Medicine which is one of the largest reproductive biology units in Canada. I am an Associate Professor of Medicine, Obstetrics & Gynecology and Immunology at the University of Toronto. In addition, I am the incoming Vice President of the Canadian Fertility and Andrology Society. LifeQuest established the first in-house Ethics Committee among Canadian reproductive medicine clinics. The Ethics Committee is very active contributing to policy development in the daily operation of the Clinic.
You have recently chaired an SSIF workshop on Ethics in ART "Just because we can", a complex matter. What have been, in your opinion, the main take home messages of this meeting?
The recent ethics workshop, "Just Because We Can..." was the first of its kind in Canada dealing with ethics in ART. The workshop was restricted to professionals dealing with reproductive medicine. Perhaps the take-home message from this meeting was facing the complexity of ethical issues presenting themselves to all professions involved in the care of patients with reproductive problems. The first issue may be to determine if a particular problem meets ethical standards but the second issue, which may be the over-riding one, is the comfort level of the clinic and whether or not all are willing to take on this particular problem. The separation of ethics and personal perspective may be difficult but that was one of the objectives of the workshop. Again, just because we can does it mean we should.
On what aspects of ART procedures ethical principles are mainly focused (PGD, embryo freezing, gametes donation, etc.)?
The ethical issues that generated the most discussion were: gamete donation and the "saviour child". The former dealt with scenarios such as inter-generational gamete donation particularly when an older woman found herself in a new relationship and she and her partner were hoping to have a child. The woman sought the assistance of her 25 year old daughter from a previous relationship as an ovum donor. Other related issues were payment of donors versus altruistic gamete donation and embryo adoption. The "saviour child" scenario involved creating a pregnancy using PGD which was an acceptable genetic match for the production of stem cells or bone marrow to save a sibling with a terminal illness. There were no definite conclusions reached on any of these issues but the discussion in the break-out groups brought out perspectives that simply were not considered initially by many participants.
Which role have scientists nowadays in the discussion on ethical principles applied to medicine and science?
Scientists have a major role to play in any discussion of ethical principles applied to medicine. There is no doubt that the excitement of discovery has the potential to create "near sightedness" amongst the scientific community but this is also a community that has the ability to see beyond the immediate horizon. The long term application of a discovery is best appreciated by the scientific community. Any discussion or evaluation of the ethical implications of a discovery requires the background input from the scientists before considering the input of clinical professionals and concerned citizens. Too often there is an immediate response by the public before there is an understanding of the science. The issues must be developed based upon accurate information and not emotion. Similarly, the scientific community must always be prepared to answer to themselves if the benefits of a discovery outweigh the liabilities and costs. Again, just because we can does it mean we should.
What improvements are to be expected, in the future, to solve problems involving science, politics and ethics?
As technology moves forward at an ever increasing pace, we will find ourselves in an increased number of complex ethical dilemmas. The solution to these problems might best be solved by open discussions with all stake holders including the scientific community. Legislation by governments based upon that particular government's emotional response is inappropriate. In addition, the creation of government committees that are simply stacked with one particular attitude is simply wrong. An open discussion before a mixed and therefore unbiased committee will be more productive. There are no simple solutions but all stakeholders must ask themselves how their personal values impact their decision to support or reject the application of a scientific/medical discovery. In contrast, those who are so excited by a discovery and blindly move quickly towards implementation must ask themselves "just because we can, does it mean we should". Perhaps no field in medicine will face these ethical dilemmas more frequently than reproductive medicine.
Thank you.
During this one day conference some of the most important actors in the field of reproductive medicine gave lectures on factors influencing fertility and Assisted Reproduction Technology outcomes, how to personalize ovarian stimulation and which procedures could be used to improve cycle outcomes.
Participants appreciated the high level of the faculty, the possibility to meet them in such a dynamic and interactive environment as well as to get very professional answers to all their questions.
The presentations on the Genetic markers of reproductive function and Future perspectives in ART were really appreciated for the innovative contents they showed.
The Scientific Organizer and the entire faculty auspicate to have this Academia repeated next year with more participants to stimulate discussion and disseminate scientific knowledge in reproductive medicine.
Monica Lispi
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Giancarlo Comi, chairman of the event, opened the Symposium introducing SSIF and explaining the rationale of the Symposium. Serge Rombouts illustrated some of the techniques implemented in his center, mainly based on the BOLD (Blood Oxigen Dependent signal). He described how these techniques are employed in patients affected by Alzheimer and why the results obtained are offering new relevant insights in the study of this disease. Franz Fazekas’s lecture was focused on the methods used to measure brain atrophy in patients with dementia and on the studies that evaluated relationships between dementia and brain damages in several diseases. Marco Onofri addressed the topic of electrophysiological evaluations in patients with cognitive impairment and dementia induced by Alzheimer and other neurodegenerative diseases. It was a comprehensive review rich of experimental findings and suggestions for the use of such tests in clinical practice.
Tommaso Sacco
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The first day, after the introductions of SSIF and the Unit of Clinical Neuroimmunology, Alan Thompson had a keynote speech that addressed the interesting topic of relationships between MRI findings and MS progression monitoring. Mireia Sospedra and Pablo Villoslada focused their lectures on factors involved in etiology of MS, environmental and genetics respectively. He also addressed the novel topic of systems biology that is supposed to contribute, in a near future, in clarifying some of the pathogenetic mechanisms of the disease. The session entered in the clinical aspects with Oscar Fernandez who dealt with the different patterns of MS: he concluded his presentation hypothesizing that paraclinical or biological markers are expected to reduce the actual variability in the classification of MS, allowing to tailor treatment according each phase of the disease. The last two speeches of the session were dedicated to clinical issues, such as juvenile MS and MS treatment in pregnancy, which may be difficult to manage in practice. The visits to the UNIC’s premises allowed participants to collect information of logistic and organizing aspects of the activity of the Clinic. Thanks to the coordination of the personnel that has been involved, these sessions were successful and fruitful. Three lectures, on diagnosis by Mar Tintore’, on MRI by Alex Rovira and on therapeutic targets in pathogenesis of MS by Roland Martin, followed the visits and, despite the intensity of the first day of the course and the late hour, the participants asked several questions to all these speakers.
Management of relapses and symptomatic treatment were the topic addressed, respectively, by Carlos Nos and Jaume Sastre-Garriga in the first lectures of the second day. Three working group were then engaged in a case study session. The Scientific Organizers had offered participants to present interesting clinical cases to be discussed during this session and Marcela Fiol agreed to show his case with Nieves Téllez, one of the chairs of the session, to one working group. Maria Pia Amato later gave a comprehensive overview on cognition disorders in MS and María Jesús Arévalo reviewed the emotional disturbances associated with the disease. A second round of visits allowed all participants to see all UNIC’s premises, then Jordi Rio and Manuel Comabella addressed two critical points in MS management: definition of response to treatment and pharmacogenetics, respectively.
The third day of the Preceptorship was opened by a series of several outstanding lectures. Giancarlo Comi addressed two main topics, the optimization of use of available DMDs and the treatments that, in the near future, will widen therapeutic options in MS practice. Xavier Montalban focused his lecture on one of the “hot” topics of actual management: early treatment. Maria Trojano elegantly showed how outcomes of observational trials can contribute to the knowledge of MS experts and provide useful suggestions for a patient tailored approach. A panel discussion offered participants the opportunity to clear doubts and debate different point of view on MS treatment.
The subsequent role playing session was very well prepared and managed by María Jesús Arévalo and Jaume Sastre-Garriga. A physician and a patient played several sketches, simulating the most problematic interaction that can happen in a MS ambulatory setting. After each sketch, the psychologist, María Jesús Arévalo, discussed with the audience what is right and wrong in the interaction played and how it can be improved. This session offered to participants a unique chance to find, together with experienced colleagues and speakers operating in a top-level center, the best solutions. After another case study session focused on MS treatment, chaired by Lluis Ramió, Ester Moral and Karolina Hankiewicz, Xavier Montalban closed the meeting reviewing the highlights of lectures presented in the three days of the course. The lively participation of the audience and the satisfaction of participants confirmed that the MS Preceptorship is one of the most efficacious SSIF meeting and the best stimulus to further improve its program.
Tommaso Sacco
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In the second session of the Symposium, after a comprehensive lecture on immunological mechanisms of pathophysiology of psoriasis delivered by Nilgun Atakan, Carlo Pincelli and Andreas Katsambas presented the two classes of biologics indicated in psoriasis treatment: TNF-blockers and T-cells modulators. Nahide Onsun opened the last session of the Symposium addressing the real problems of psoriasis patients including those related to comorbidities and psychologic distress. Christopher Griffiths’s lecture “designed” the ideal therapy for psoriasis. The pillars of management should be personalization and long-term treatment. Long-term administration requires drugs with favourable safety profiles and the last speaker, Kim Papp reviewed available data on tolerability of drugs indicated in psoriasis showing that some biologics are suitable for this approach.
In conclusion, this Symposium was successful offering participants a comprehensive “preview” of the hottest topics that were subsequently developed during the EADV Congress.
Tommaso Sacco
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I am Professor and Chairman at the University of Athens-School of Medicine-Dermatology Department at A. Sygros Hospital of Athens, Greece.
How important is psoriasis within dermatology?
Psoriasis is very important within dermatology, due to the large number of patients requiring dermatological care for this disease. It is a chronic inflammatory, autoimmune disorder affecting primarily the skin, nails and mucous membranes. 5-40% of patients suffering from psoriasis also suffer from psoriatic arthritis. The disease has a profound psychological impact on patients’ everyday life and results in a substantial decrease in quality of life. The treatment of psoriasis is always a challenge for the dermatologist not only because of the chronic character of the disease but also because of the new therapeutic options given with the biologic drugs.
Do you think that dermatologists perceive psoriasis as a systemic disease?
Psoriasis has been traditionally viewed as an inflammatory skin disorder of unknown origin. Recent advances in the immunopathogenesis and genetics of psoriasis have broadened our understanding of the disease. Psoriasis is now considered a systemic inflammatory condition analogous to other inflammatory immune disorders. Patients with other immune disorders, such as systemic lupus erythematosus or rheumatoid arthritis are known to be in increased risk of heart disease. Similarly, patients with psoriasis may carry an excess risk of heart disease, which would represent an important previously unrecognized cause of morbidity and mortality. Obesity, history of diabetes mellitus, heart failure and hypertension and also habits as smoking and alcohol consumption are taken always under consideration for a psoriatic patient.
What can be done to educate dermatologists to cope with the metabolic and cardiovascular comorbidities of psoriasis?
Through seminars, workshops, publications and personal contact, dermatologists could be educated to realize that the psoriatic patient needs a more general approach. The metabolic syndrome and its comorbidities should always be kept in mind when examining a patient with psoriasis.
Do you think that the availability of new treatments will improve that management of the disease and the QoL of patients and if so how?
Given the chronic nature of the disease and its frequent early onset, there is a substantial need for therapies that can be administered safely on a continuous long-term basis. The increasing number of treatment options also allows for rotational approaches. The new biological therapies that alter the immune function via the T-cell pathways and TNF-a, contribute strongly in the management of the disease. Maintaining a constant remission and by avoiding side effects also improves the QoL.
Thank you.
Recent findings have provided new insights on the pathophysiology of Multiple Sclerosis and on the role of the immune system in this disease. The aim of this annual edition of the Serono Symposia International Foundation conference in MS is to provide an update on these topics and to review the effects of available as well as future therapies on these mechanisms which offer the opportunity to individualize treatment. An overview on the neuroprotection approach will also be covered.
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NEW ONLINE COURSE IN NEUROLOGY
Progressive forms of MS is now available on the Serono Symposia International Foundation website |
The aim of the Symposium is to create an interdisciplinary forum for discussing present and future developments in the field of phenylketonuria (PKU). PKU was formerly one of the most frequent definable causes of mental retardation. Thanks to newborn screening and early dietary therapy, mental retardation is now rarely seen in PKU. As a consequence of this remarkable and dramatic development, PKU has become the flagship for treatable genetic disease. Despite this wonderful advance, however, there remains a number of very troubling problems in long term outcome. Included among these is disagreement on how long the diet should be continued. Thus, new approaches such as enzyme replacement therapy, gene therapy, large neutral amino acids (LNAA), and tetrahydrobiopterin are of interest.
The aim of this congress is to provide a forum where researchers and/or clinicians who address the problematics involved in the treatment of autoimmune diseases affecting different systems and tissues, may gather to review their respective experiences and acquire new knowledge that can assist in the identification of common aspects, as well as pathologic differences, to assist reaching optimal and innovative therapeutic approaches.
