Regulatory T cells expressing granzyme B play a critical role in controlling lung inflammation during acute viral infection

The inflammatory response to lung infections must be tightly regulated, enabling pathogen elimination while maintaining crucial gas exchange. Using recently described "depletion of regulatory T cell" (DEREG) mice, we found that selective depletion of regulatory T cells (Tregs) during acute respiratory syncytial virus (RSV) infection enhanced viral clearance but increased weight loss, local cytokine and chemokine release, and T-cell activation and cellular influx into the lungs. Conversely, inflammation was decreased when Treg numbers and activity were boosted using interleukin-2 immune complexes. Unexpectedly, lung (but not draining lymph node) Tregs from RSV-infected mice expressed granzyme B (GzmB), and bone marrow chimeric mice with selective loss of GzmB in the Treg compartment displayed markedly enhanced cellular infiltration into the lung after infection. A crucial role for GzmB-expressing Tregs has not hitherto been described in the lung or during acute infections, but may explain the inability of children with perforin/GzmB defects to regulate immune responses to infection. The effects of RSV infection in mice with defective immune regulation closely parallel the observed effects of RSV in children with bronchiolitis, suggesting that the pathogenesis of bronchiolitis may involve an inability to regulate virus-induced inflammation.

P4-10-01: Tumor Markers Predicting Recurrence Type after a Primary Ductal Carcinoma In Situ

Background: The risk for recurrence after a primary ductal carcinoma in situ (DCIS) is approximately 8% after ten years. If a recurrence occurs, the risk of the recurrence being invasive is approximately 50%. However, the knowledge of determinants for type of recurrence is limited. The purpose of this study was to investigate the predictable effect of specific biologic markers on the type recurrence after a primary DCIS.

Material and Methods: All women diagnosed with a primary DCIS between 1986 and 2004 in Uppsala and Västerås, Sweden were included (n=458). We also included all women from the SweDCIS Trial with a known recurrence (n= 166). TMA blocks were constructed and immunohistochemistry (IHC) was used to evaluate the status of estrogen receptor (ER), HER2, epidermal growth factor receptor (EGFR/HER1), cytokeratin 5/6 (CK 5/6), forkhead box A1 (FOXA1), forkhead box C1 (FOXC1), Ki 67, CD 10 and transacting T-cell-specific transcription factor GATA-3 (GATA-3) in the primary DCIS tumors. Logistic regression was employed to calculate the difference of expression status of biological markers between groups. Odds ratios (ORs) and 95% confidence interval (CI) were calculated, with adjustment for age, free margins, surgical type and molecular subtype by IHC.

Results: Of the 624 patients, 358 without recurrence were grouped as controls. Of the 266 with recurrence, 130 developed an in situ recurrence, while the remaining 136 developed invasive recurrence. Mastectomy compared to breast conserving surgery (BCS) and free margins were associated with less recurrences (OR 0.07, 95% CI 0.03 — 0.15) and (OR 0.39, 95% CI 0.26 — 0.58). As compared with the most common molecular subtype Luminal A, the subtype Luminal B had statistically significant higher risk of recurrence (OR 2.01, 95% CI 1.12 — 3.59). Higher risk of all recurrences was also observed for FOXA1 (OR 3.16, 95% CI 1.48 — 4.74) and FOXC1 (OR 2.39, 95% CI 1.39 — 4.09). In the analyses of type of recurrence, ER-negative, HER2−positive and EGFR-positive tumors recurred more often as in situ; (OR 2.34, 95% CI 1.17 — 4.71), (OR 2.08, 95% CI 1.11 — 3.88) and (OR 2.20, 95% CI 1.11 — 4.36). The molecular subtype HER2+ was also associated with a lower risk of invasive recurrence (OR 0.27, 95% CI 0.11 — 0.67).

Conclusion: As expected, mastectomy and free margins were associated with a lower risk of recurrence. Molecular subtype Luminal B and tumor markers FOXA1 and FOXC1 had a higher risk of recurrence. Recurrences after molecular subtype HER2+, ER-negative and EGFR-positive DCIS were more often of the in situ type.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-10-01.

Description of macrolide-resistant and potential virulent clones of Streptococcus pyogenes causing asymptomatic colonization during 2000-2006 in the Lisbon area

The asymptomatic oropharyngeal colonization rate by Streptococcus pyogenes was 10.7% in children (901 among 8,405 children 0-16 years old) and 3.3% in adults (37 among 1,126 households of children) in the Lisbon area during 2000-2006. Macrolide-resistant S. pyogenes from children (n = 149) was variable with time: 9.8-10.7% in 2000-2002, 28.1% in 2003, 19.6-2.7% in 2004-2005 and 14.6% in 2006. Eight lineages (97.3% of isolates) were identified based on at least 80% similarity of PFGE patterns, T types, emm types and multilocus sequence types (ST). The elevated frequency of macrolide resistance was associated with M phenotype lineages I (emm12/ST36) and V (emm4, emm75/ST39 and a novel emmstMrp6 type) and with one cMLS(B) lineage IV (emm28/ST52) known to be associated with upper respiratory tract and invasive infections. Significant associations (p < 0.05) between emm type/virulence genotype were found, such as emm1/speA (+) ssa (-), emm4/ssa (+) prtF1 (+), emm12/speA (-) ssa (-). The high prevalence (>20%) of speC, prtF1 or ssa was probably caused either by clonal dissemination (speC), or to horizontal gene transfer events (prtF1 and ssa). This report contributes to a better understanding of the molecular epidemiology and evolution of macrolide-resistant S. pyogenes causing symptom-free oropharyngeal colonization. These colonizing strains carry macrolide resistance and virulence genes capable of being transferred to other bacterial species sharing the same niche.

Piglet model for studying esophageal regrowth after resection and interposition of a silicone stented small intestinal submucosa tube

PURPOSE

To investigate the use and subsequent healing of a silicone stented small intestinal submucosa (SIS) tube as a full-circumference replacement following surgical resection of the esophagus in piglets.

MATERIAL AND METHODS

Three centimeters of the intrathoracic esophagus was replaced with a silicone stented SIS tube (Cook Medical) in 6 growing piglets. The esophageal stent was retained for 4 weeks. Esophageal dilations were performed, if needed, after stent removal.

RESULTS

The piglets were sacrificed 1-17 weeks after surgery. Recurrent dilations were needed after stent removal. Histology showed that the gap between the resection margins was filled with new loose connective tissue consisting of fibroblasts and few inflammatory cells. In this tissue, intense angiogenesis was seen at the early time points, which then gave way to the proliferation of immature-looking smooth-muscle-like cells in the submucosa, which appeared to stem from the pericytes of the ingrowing capillaries.

CONCLUSIONS

Through using a stented SIS tube as a circumferential esophageal replacement in a piglet model, this study suggests that pericytes from ingrowing capillaries may play a role in the remodeling of the SIS mesh. It remains to be seen if this process gives a favorable end result because stricture formation after stent removal remains a problem.

Dysphagia in adults operated on for esophageal atresia--use of a symptom score to evaluate correlated factors

INTRODUCTION

Dysphagia is not unusual following repair of esophageal atresia (EA). The lack of a uniform definition has led to a variance when it comes to reporting the prevalence of dysphagia among patients operated on for EA. Our aim is to estimate the occurrence and degree of dysphagia, using a numerical score with its statistical versatility independent of a specific definition. The results are used to find early risk factors of dysphagia within this patient group. The results are also used to see whether we can find a correlation between dysphagia and symptoms of gastroesophageal reflux (GER) and quality of life (QoL).

METHODS

79 consecutive survivors operated on for EA in Gothenburg between 1968 and 1983 were located. Hospital charts were reviewed and patients received questionnaires on dysphagia, symptoms of GER and QoL. Dysphagia was measured by a numerical score, symptoms of GER were extracted using a predetermined questionnaire (GerdQ), and QoL was determined using the generic questionnaire SF-36.

RESULTS

73 patients (92.4%) returned the questionnaires. In order to make the study group as homogeneous as possible with regard to the malformation we choose to study the 63 patients representing the vast majority: those with Gross type C. 36 patients (57%) had symptoms of dysphagia to varying degrees. We did not find any aggravating factors in their hospital charts nor did we find any correlation to the most recent demographics. There was a significant difference in dysphagia scores when we compared Gross type C to the often more complex type A (p<0.05). We did not find any correlation to heartburn but a strong correlation to regurgitation with an OR of 2.8 (95% CI: 1.2-6.6). The QoL was good for this patient group, and we did not find any correlation between QoL and the dysphagia score.

CONCLUSIONS

The dysphagia score provides easy-to-use results when it comes to evaluating the potential influence of dysphagia. Dysphagia is common within this patient group. Patients operated on for EA Gross type A seem to do worse when it comes to dysphagia. Regurgitation is associated with dysphagia, which could imply that GER is an aggravating factor. Further studies to support this finding will show whether there is a correlation between the dysphagia score and the results of 24-h pH-monitoring. If so, this could mean that treating GER might decrease dysphagia, at least in this patient group.

Efficacy of memantine in PDD and DLB: an extension study including washout and open-label treatment

OBJECTIVE

This 30-week extension trial was a continuation of the first double-blind randomized controlled trial (RCT) to study memantine in dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD). The objective was to evaluate the presence of recurrence of symptoms upon drug withdrawal. Furthermore, the aim was to explore washout dynamics in order to inform clinical practice.

METHODS

Patients were enrolled from psychiatric, memory and neurological outpatient clinics in Norway, Sweden and the UK. The trial comprised a 4-week washout period and a 26-week open-label treatment period. Outcome measures were presence of recurrence of symptom upon drug withdrawal, Clinical Global Impression of Change (CGIC) and modified motor Unified Parkinson's Disease Rating Scale (UPDRS).

RESULTS

recurrence of symptoms occurred more frequently (p=0.04) in patients receiving memantine (58%) than in patients receiving placebo (25%). There was a significant global deterioration (p=0.0003) during washout within the memantine group as measured by CGIC. The patients seemed to recover during the open-label treatment, however these findings were non-significant.

CONCLUSIONS

The findings inform clinical practice that any possible memantine-associated benefits might be rapidly lost after drug withdrawal. The magnitude of deterioration suggests a symptomatic rather than a disease-modifying effect of the drug. Open-label results should merely be considered inspiration for future trials.

Hepatic venous Doppler in the evaluation of fetal extrasystoles

OBJECTIVES

To evaluate the use of fetal hepatic venous Doppler in the diagnosis of fetal extrasystoles, to estimate the prevalence and persistence of extra atrial and ventricular heart beats throughout pregnancy, labor and delivery, and to estimate the frequency of coexisting congenital heart disease.

METHODS

This was a retrospective study of 256 singleton pregnancies attending our hospital as outpatients due to fetal extrasystoles. Hepatic venous Doppler and detailed fetal echocardiography were performed. Information on fetal heart rate patterns during labor and neonatal conditions was collected. Congenital heart malformations and the frequency and persistence of fetal extrasystoles were noted.

RESULTS

On venous Doppler examination, 228 (89%) of the fetuses showed signs of supraventricular extrasystoles (SVES) and 28 (11%) had ventricular extrasystoles (VES). One fetus with SVES developed atrial flutter during pregnancy and another case developed supraventricular tachycardia postnatally. SVES persisted until labor and delivery in 28 (12.3%) fetuses and VES persisted in six (21.4%). In 31 of 34 (91.2%) fetuses with extrasystoles during labor and delivery, the conduction pattern normalized within 3 days. Five neonates were referred for evaluation by a pediatric cardiologist. Two cases had congenital heart disease. Extrasystoles persisted until labor and delivery more frequently in male fetuses (P < 0.0001).

CONCLUSION

Hepatic venous Doppler can differentiate between SVES and VES. Despite being the more uncommon of the two, VES persists throughout pregnancy more often. Our results strongly support the suggestion that extrasystoles are a benign finding, with very few cases developing tachycardia or having a coexisting congenital heart malformation.

Mast cells generated from patients with atopic eczema have enhanced levels of granule mediators and an impaired Dectin-1 expression

BACKGROUND

The disrupted skin barrier of patients with atopic eczema (AE) might facilitate contact between mast cells (MCs) in the skin and environmental triggers of the disease. One such trigger is the skin-colonizing yeast Malassezia sympodialis (M. sympodialis). In this study, we investigated the interaction of MC with M. sympodialis.

METHODS

Mast cells were generated from peripheral blood CD34(+) progenitor cells of healthy controls (HC) and M. sympodialis-sensitized AE patients. Biopsy specimens were taken from HC and lesional AE skin for immunohistological stainings.

RESULTS

The progenitor-derived MCs expressed the macrophage-inducible C-type lectin receptor Mincle, and exposure of these cells to M. sympodialis induced up-regulation of the mRNA expression of Mincle. Furthermore, we demonstrate that, when compared to HC, the progenitor-derived MCs from AE patients (i) contain more intrinsic granule mediators such as histamine, (ii) exhibit enhanced IL-6 release in response to M. sympodialis exposure, and (iii) have an impaired up-regulation of the fungal recognition receptor Dectin-1. In addition, analysis of skin sections from HC and AE patients revealed MCs as the predominant Dectin-1-expressing cell type in the skin.

CONCLUSION

Our data indicate that progenitor-derived MCs from AE patients differ from those from HC. Further investigations with skin-derived MCs are necessary to confirm the observed differences which could provide new insights into the pathogenic mechanisms underlying AE.

A review on the effectiveness of street sweeping, washing and dust suppressants as urban PM control methods

Given the absence of a definitive threshold for atmospheric particulate matter (PM)-induced adverse health effects and the evidence of road traffic as a main contributor to PM-urban levels, there is a general agreement in reducing PM-associated health risks by firstly focusing on vehicle traffic sector. Beside the reduction of primary exhaust emissions, recent potential measures are challenging to reduce emissions of particulate matter from abrasion and resuspension processes given the high potential health burden of heavy metals and metalloids sourced by vehicle-wear particles (brakes, tires, rotor, discs and catalysts) and of coarse particles (PM(2.5-10)). Some mitigating measures can be adopted in order to reduce road dust emissions from paved roads by removing or binding those particles already deposited and easy to be resuspended by traffic-generated turbulence. Sweeping, water flushing and use of chemical suppressants are usually more commonly employed to try to diminish emissions, but evaluating the effectiveness of preventive measures on improving air quality is a difficult task, consequently there is a general dearth of information about their effectiveness in reducing ambient PM concentrations. In particular, the scientific bibliography seems to be particularly scarce, whilst most of the information comes from local authorities committees. Consequently the existing reports are often aimed only to the municipalities and in the native language, with an objective difficulty for the international scientific community to access to them. For this review we have gathered contributions from some of major experts in this field, with the purpose of taking advantage of their background and personal awareness about any kind of related reports even not in English. Furthermore, the results we have gathered are often dissimilar, probably due to the different local conditions (weather, road pavement conditions etc.), therefore another objective of the review is to make a balance of actual knowledge and create a useful reference for future research studies and air quality management.

Maternal allergic disease does not affect the phenotype of T and B cells or the immune response to allergens in neonates

BACKGROUND

It is hypothesized that the in utero environment in allergic mothers can affect the neonatal immune responses. The aim of this study was to analyse the effect of maternal allergic disease on cord blood mononuclear cell (CBMC) phenotype and proliferative responses upon allergen stimulation.

METHODS

Peripheral blood mononuclear cells (PBMC) from 12 allergic and 14 nonallergic mothers and CBMC from their children were analysed. In the mothers, we determined cell proliferation, production of IL-4 and expression of FOXP3 in response to allergen stimulation. In the children, we evaluated cell proliferation and FOXP3 expression following allergen stimulation. Furthermore, expression of different homing markers on T cells and regulatory T cells and maturity of the T cells and B cell subsets were evaluated directly ex vivo.

RESULTS

The timothy- and birch-allergic mothers responded with increased proliferation and/or IL-4 production towards timothy and birch extract, respectively, when compared to nonallergic mothers. This could not be explained by impairment of FOXP3(+) regulatory T cells in the allergic mothers. CBMC proliferation and FOXP3 expression in response to allergens were not affected by the allergic status of the mother. Also, phenotype of T cells, FOXP3(+) regulatory T cells and B cells was not affected by the allergic status of the mother.

CONCLUSION

Our results suggest that maternal allergic disease has no effect on the neonatal response to allergens or the phenotype of neonatal lymphocytes. The factors studied here could, however, still affect later development of allergy.

Production of nitric oxide in loam under aerobic and anaerobic conditions

Measurements of gas flow through soil columns of loam from Kjettslinge, Uppland, Sweden, gave average NO production rates of 0.06 +/- 0.01 ng of NO N g of soil min in aerobic conditions and 3.7 +/- 0.6 ng of NO N g of soil min in anaerobic conditions at 25 degrees C. Approximately 30% of the NO(3) loss in anaerobic conditions was as NO. In aerobic conditions an equilibrium concentration for NO was found. Above this concentration there was uptake of NO. Autoclaved samples indicated that less than 10% of the NO production was abiological, and there was no abiological NO uptake. The NO production reached anaerobic rates at soil O(2) levels between 0.5 and 0.05%.

S-tryptophan concentrations after intestinal bypass in extreme obesity

Treatment of extreme obesity with jejunoileostomy was followed by a decreased level of S-tryptophan; permanently low concentrations were recorded postoperatively in 29 out of 52 patients. Patients in the low tryptophan group had a higher rate of weight loss and a hgiehr incidecnce of electrolyte disturbances and signs of liver injury. Symptoms of depression and anxiety were slightly more common in patients with low S-tryptophan. The influence of a decreased S-albumin and a deranged amino acid pattern on the non-protein-bound fraction of S-tryptophan needs further investigation. Serum levels of tryptophan rose significantly after rwo weeks' oral supplementation with 1.2 g L-tryptophan daily; this dosage was insufficient to normalize a low S-tryptophan level in patients who have undergone jejunoileostomy.

Effect of an H2-receptor blocking agent on diarrhoeas after extensive small bowel resection in Crohn's disease

The effect of an H2-receptor blocking agent, cimetidine, on faecal losses of fluid, electrolytes and fat was examined in 10 patients with Crohn's disease, who had diarrhoeas after extensive small bowel resection. A randomized, double-blind and cross-over design was applied, and patients were hospitalized and on a defined diet during the study. Cimetidine, 4 x 400 mg, significantly reduced diarrhoeal volumes by an average of 22% (p less than 0.05) and faecal sodium by 27% (p less than 0.05). Patients with severe diarrhoeas responded better to treatment. No side-effects were recorded. The reported data suggest that cimetidine may be useful in symptomatic treatment of patients with severe diarrhoeas after extensive ileal resection. Due to deficient drug absorption, higher doses may be needed for optimal effect.

Interaction by cholestyramine on the uptake of hydrocortisone in the gastrointestinal tract

An absolute reduction of the plasma cortisol levels and a delay of the peak concentrations were recorded in 10 healthy subjects, when a bile-sequestering anionic exchange resin, cholestyramine, was given prior to a single oral hydrocortisone dose, indicating that the resin interferes with the uptake of a neutral sterol in the human gastrointestinal tract. The possibility of a direct binding of drug to resin is supported by the affinity of hydrocortisone to cholestyramine in vitro, which was uninfluenced by the presence of sodium taurocholate. Cholestyramine significantly delayed the gastric emptying of a glucose solution, indicating that the resin not only decreases but also delays hydrocortisone absorption. Careful supervision is recommended when treatment with cholestyramine is given concomitant to neutral sterol drugs.

Acid instillation increases gastric luminal prostaglandin E2 output in man

The capacity of the gastroduodenal mucosa to maintain integrity when exposed to acid and pepsin may require formation of endogenous prostaglandins (PG). The gastric mucosa is capable of PG biosynthesis, and PGE2 is present in the gastric contents of man. The purpose of this study was to examine if acidification of the human stomach affects the output of PGE2. Gastric perfusion was made with 150 mM HCl in seven healthy subjects pretreated with a histamine-2-receptor blocker (ranitidine). Gastric luminal PGE2 was measured by gas chromatography-mass spectrometry. Basal output of PGE2 was 1.42 +/- 0.24 pmol/min (mean + SEM), which increased to 5.37 +/- 0.91 pmol/min (p less than 0.02) during acid perfusion. Gastric acidification did not cause mucosal damage as judged by luminal DNA. We conclude that PGE2 is synthesized in the gastric mucosa even during nearly complete inhibition of parietal cell secretion. Luminal acid, a likely physiological stimulator of mucosal defense, induces a fivefold increase in PGE2 output from the intact mucosa.