Peanut sensitization during the first 5 yr of life is associated with elevated levels of peanut-specific IgG

BACKGROUND

  Allergen-specific IgE antibodies are implicated in allergic diseases while allergen-specific IgG antibodies have been proposed to prevent allergic reactions. The objective for this study was to study whether the immune response (IgG and IgG4) to peanut differs in IgE-sensitized and non-sensitized young children.

METHODS

  A total of 239 children have been followed prospectively from birth to 5 yr of age. The levels of IgG and IgG4 to peanut, Ara h 2, and Ara h 8 were analyzed at 2 and 5 yr of age and related to IgE sensitization and peanut consumption.

RESULTS

  The levels of peanut-specific IgG and IgG4 were significantly higher in peanut-sensitized children at 2 and 5 yr of age when compared with non-sensitized children and children sensitized to other food/inhalant allergens. A strong correlation was seen between levels of peanut-specific IgG/IgG4-ratios and peanut-specific IgE at 5 yr of age. Children avoiding peanuts, a subgroup of the peanut sensitized, had statistically significant higher levels of IgE to peanut and a tendency of higher IgG and IgG4 levels to peanut. In the avoidance group, significant correlations between IgE and IgG/IgG4 to peanut were found compared with children eating peanuts.

CONCLUSION

  Peanut-specific IgG or IgG4 levels were elevated in peanut-sensitized children especially those avoiding peanuts. In our study, IgG and IgG4 do not seem to indicate tolerance or protection from sensitization.

Basophil allergen threshold sensitivity, CD-sens, IgE-sensitization and DBPCFC in peanut-sensitized children

BACKGROUND

Immunoglobulin E (IgE)-sensitization to peanut is common and can indicate an allergy. A positive test needs to be confirmed by a double-blind, placebo-controlled food challenge (DBPCFC), which is regarded as 'the gold standard'. The aim of the study was to evaluate the basophil allergen threshold sensitivity (CD-sens) and antibodies to peanut allergen components in relation to DBPCFC in the diagnoses of peanut allergy in children.

METHODS

Thirty-eight children with suspected peanut allergy underwent a DBPCFC. CD-sens to peanut and Ara h 2 were analysed as well as IgE-antibody to peanut and some of its allergen components (Ara h 1, 2, 3, 8 and 9).

RESULTS

Twenty-five children had a positive DBPCFC, and 92% of these were positive in CD-sens to peanut and Ara h 2. Two children with a positive DBPCFC were classified as 'low-responders' and were not further evaluated. Children positive in DBPCFC had higher CD-sens values to peanut (median 1.3; range 0.4-29, n = 21) compared with children negative in DBPCFC (median 0; range 0-0.5, n = 13) (P < 0.0001). A positive DBPCFC correspond with increased levels of IgE-antibody to Ara h 1, 2 and 3 compared with those with a negative challenge (P < 0.0001 for all). All children with a negative CD-sens were negative in DBPCFC.

CONCLUSION

In this study, a negative CD-sens to peanut excluded peanut allergy. Both tests, CD-sens to peanut and immunoassay for IgE-antibody to the peanut components, appear to be safe, time saving and cost-effective complements to DBPCFC.

P4-19-04: Evaluation of Histopathological Parameters in Male Breast Cancer Reveals Differences Compared with Female Breast Cancer

Purpose: To characterize male breast cancer (MBC) by evaluating established histopathological parameters and their prognostic value.

Methods: 197 male patients with invasive breast cancer and available paraffin-embedded tumor tissue were retrospectively assessed. Patient files were reviewed for clinicopathological data. Tumors were re-evaluated for histologic grading on conventional sections. Immunohistochemical (IHC) stainings for estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2), silver-enhanced in situ hybridization (SISH), Ki-67, CK5/6 and epidermal growth factor receptor (EGFR) were performed on tissue micro arrays. Data on vital status and cause of death were retrieved from the Cause of Death Registry. Cox proportional regression models were used for uni- and multivariate analyses.

Results: ER and PgR positivity was demonstrated in 93 and 78 % of patients, respectively. Nottingham histologic grade III was seen in 41% and HER2 positivity in 11% of all patients. Defining molecular phenotypes using IHC markers revealed luminal (ER+ and/or PgR+, and HER2−) in 83%, luminal/HER2+ (ER+ and/or PgR+, and HER2+) in 11%, basal-like (ER-,PgR-,HER2−,EGFR+ and/or CK5/6 +) in 1%, but no cases of HER2-like or unclassified. Node-positivity (HR 4.6; 95% CI 1.9−11.4), tumor size &gt; 20 mm (HR 2.3; 95% CI 1.1−5.0) and ER-negativity (HR 5.2; 95% CI 1.9−14.2) were significant risk factors for breast cancer death. Grade, HER2 status, Ki-67, or age did not demonstrate independent prognostic information. No difference in breast cancer deaths was demonstrated between luminal and luminal/HER2.

Conclusion: Male breast cancer tumors seem to be of grade III more often than female breast cancer, whereas HER2 expression appears equally common. In our study, the most important predictors for breast cancer death in male breast cancer were lymph nodes, tumor size and ER status. The most common molecular phenotype was luminal.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-19-04.

Social inequality in dynamic balance performance in an early old age Spanish population: the role of health and lifestyle associated factors

This study investigates the association between socioeconomic status (SES) and dynamic balance performance and whether lifestyle factors explained any possible associations. A total of 448 nondisabled individuals, age-range 54-75 years and enrolled in the Active Aging Longitudinal Study of Spain in 2006, constituted the study population. Baseline data of this cross-sectional study were obtained by personal interviews and objective measures of balance performance. The present study shows an educational gradient in poor dynamic balance, where individuals with no formal education had higher risk of poor balance, also after adjustment for age, gender, obesity and physical activity. In addition, obesity and sedentary physical activity were related to poor dynamic balance. The findings suggest an independent effect of both SES and behavioral factors on poor balance performance in the older Spanish population.

An explorative study of low levels of allergen-specific IgE and clinical allergy symptoms during early childhood

BACKGROUND

Early identification of children at risk for later development of allergic disease is essential for early intervention and initiation of proper treatment and management.

OBJECTIVE

To investigate the relationship between low levels (0.1-0.7 kU(A) /l) of IgE sensitization to food and inhalant allergens and symptoms of eczema, rhinitis, and asthma from birth to 5 years of age.

METHODS

Children (268) were followed prospectively from birth to 5 years of age with physical examinations and measurements of s-IgE at 6, 12, 24, and 60 months of age.

RESULTS

Seventy-four percent of the children with low levels of s-IgE to egg and/or milk at the age of 6 months were still sensitized to one or more allergens at age 2 years. Eighty-four percent of the children with low levels of s-IgE to any of the studied allergens at 12 months of age were still sensitized at age 5. The low levels of egg and milk s-IgE also significantly increased the risk for eczema at the same age and also increased the risk for eczema at 2 years of age.

CONCLUSION

Low levels of s-IgE can be detected from the age of 6 months and are related to further IgE sensitization. The low levels seem to be of importance for both the association to present symptoms and for prediction of future allergic symptoms, especially eczema during early infancy. A detectable s-IgE level, albeit low, could be a clear signal that the immune system is alerted and should be followed.

Identification of volatile metabolites from five fungal species cultivated on two media

Five fungal species, Aspergillus versicolor, Penicillium commune, Cladosporium cladosporioides, Paecilomyces variotii, and Phialophora fastigiata, were cultivated on two media, malt extract agar and dichloran glycerol agar. Culture flasks provided with inlet and outlet tubes were used and purified, and humidified air was constantly led through the flasks. Air samples from the cultures were sorbed on Tenax GR and analyzed by thermal desorption-gas chromatography. The produced volatile metabolites were analyzed by mass spectrometry. Various hydrocarbons, alcohols, ketones, ethers, esters, sulfur-containing compounds, and terpenes were identified. The most commonly produced substances were 2-methyl-1-propanol, 2-methyl-1-butanol, 3-methyl-1-butanol, 3-methylfuran, and dimethyl disulfide. The production was highly dependent on both medium and species.

The cag PAI is intact and functional but HP0521 varies significantly in Helicobacter pylori isolates from Malaysia and Singapore

Helicobacter pylori-related disease is at least partially attributable to the genotype of the infecting strain, particularly the presence of specific virulence factors. We investigated the prevalence of a novel combination of H. pylori virulence factors, including the cag pathogenicity island (PAI), and their association with severe disease in isolates from the three major ethnicities in Malaysia and Singapore, and evaluated whether the cag PAI was intact and functional in vitro. Polymerase chain reaction (PCR) was used to detect dupA, cagA, cagE, cagT, cagL and babA, and to type vacA, the EPIYA motifs, HP0521 alleles and oipA ON status in 159 H. pylori clinical isolates. Twenty-two strains were investigated for IL-8 induction and CagA translocation in vitro. The prevalence of cagA, cagE, cagL, cagT, babA, oipA ON and vacA s1 and i1 was >85%, irrespective of the disease state or ethnicity. The prevalence of dupA and the predominant HP0521 allele and EPIYA motif varied significantly with ethnicity (p < 0.05). A high prevalence of an intact cag PAI was found in all ethnic groups; however, no association was observed between any virulence factor and disease state. The novel association between the HP0521 alleles, EPIYA motifs and host ethnicity indicates that further studies to determine the function of this gene are important.

Stage at Diagnosis and Management of Breast Cancer in Men and Women – A Population-Based Study (Sweden)

Background: Male breast cancer is an uncommon disease, representing less than 1% of all breast cancer. Due to the rareness of the disease there is a lack of prospective randomized studies to guide treatment decisions. While current guidelines recommend that male breast cancer should be treated in the same way as female breast cancer, concerns have been raised regarding the quality of management in men. Results from earlier studies indicate that men with breast cancer are not as aggressively treated as women and that outcomes are worse. The aim of this population based study was to assess and compare stage at presentation and management of breast cancer in men and women in Sweden.Material and methods: In a case-control approach, we identified male and female patients with a record of a breast cancer diagnosis in the Breast Cancer Register of Central Sweden between 1993 and 2007. 99 men (cases) with breast cancer were matched on age at and time of diagnosis to four women with breast cancer (controls). Data on tumor characteristics and treatment were retrieved from the Breast Cancer Register.Results: There was no difference in the distribution of stage at diagnosis between men and women; stage I (33% and 36%, respectively), stage II (42% and 41%), stage III (6% and 4%) and stage IV (3% and 4%,). At the time of diagnosis 31% of male patients and 32% of female patients were node positive. Men underwent mastectomy more often than women (95% versus 45%). The proportion of men receiving loco-regional radiotherapy postoperatively was lower compared to women (44% vs. 58%). There were no proportional differences regarding adjuvant chemotherapy (16% vs. 18%) and adjuvant hormonal therapy (60% vs. 55%).Conclusion: At the time of diagnosis, men and women presented with a similar distribution of stage of disease. Our concerns regarding less extensive treatment in male breast cancer patients were not supported by our findings. Additional data including survival analyses will be added and presented at SABCS.Clinical VariablesMale breast cancer patients (cases) N=99Female breast cancer patients (controls) N=396Stage  I33%36%II42%41%III6%4%IV3%4%Missing16%15%N+31%32%M13%4%Mastectomy95%45%Partial mastectomy5%54%No surgery2%4%No axillary surgery11%12%Preoperative radiotherapy1%1%Preoperative chemotherapy5%2%Preoperative hormonal treatment2%3%Chemotherapy16%18%Radiotherapy44%58%Tamoxifen58%45%Aromatase inhibitor2%10%No treatment21%14%    

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2111.

Transthyretin as a potential CSF biomarker for Alzheimer's disease and dementia with Lewy bodies: effects of treatment with cholinesterase inhibitors

BACKGROUND

Previous studies have indicated that transthyretin (TTR) levels in cerebrospinal fluid (CSF) are altered in depression and dementia. The present study aimed to investigate whether CSF TTR can be used to discriminate between patients with Alzheimer's disease (AD) and patients with dementia with Lewy bodies (DLB) with or without medication, as well as to reveal whether CSF TTR correlates with depression in dementia.

METHODS

CSF samples from 59 patients with AD, 13 patients with DLB and 13 healthy controls were collected, and biochemical analysis was performed. Subjects were assessed for the presence of depression.

RESULTS

No significant differences in CSF TTR were found between AD, DLB, and control subjects or between depressed and non-depressed dementia patients. Interestingly, we found a significant reduction in CSF TTR (14%) in AD patients who were medicated with cholinesterase inhibitors compared to those AD patients who were not.

CONCLUSIONS

Significant reductions in CSF TTR were found after cholinesterase inhibitor treatment in patients with AD compared to untreated individuals. CSF TTR was unaltered in patients with DLB and had no relationship to depression in the present cohort with dementias.

Effect of different flooring systems on claw conformation of dairy cows

The effect of different flooring surfaces in walking and standing areas on claw conformation, claw horn growth, and wear was studied in 2 experiments during 2 consecutive housing seasons in a research dairy herd of 170 cows. In experiment 1, the flooring systems tested were solid rubber mats, mastic asphalt with and without rubber-matted feed-stalls, and aged concrete slats. In experiment 2, slatted concrete flooring was compared with slatted rubber flooring. The cows were introduced to the respective flooring systems in early lactation and their claws were trimmed before the exposure period. Toe length, toe angle, sole concavity, and claw width, as well as claw growth and wear rates were recorded for lateral and medial claws of the left hind limb. Claw asymmetry calculations were based on these claw measurements and on differences in sole protrusion between lateral and medial soles. Asphalt floors caused shorter toe length and steeper toe angle. They also increased wear on rear claws (5.30 +/- 0.31 and 5.95 +/- 0.33 mm/mo for lateral and medial claw, respectively; LSM +/- SE) and horn growth rate (5.12 +/- 0.36 and 5.83 +/- 0.31 mm/mo of lateral and medial claws, respectively). Rubber mats instead of asphalt in walking areas reduced wear (1.36 +/- 0.19 and 2.02 +/- 0.20 mm/mo for lateral and medial claw, respectively) and claw growth (3.83 +/- 0.23 and 3.94 +/- 0.17 mm/mo for lateral and medial claw, respectively). Rubber-matted feed-stalls together with asphalt walkways decreased claw wear (3.29 +/- 0.31 and 4.10 +/- 0.32 mm/mo for lateral and medial claw, respectively). The concavity of claw soles was reduced on asphalt, especially in the lateral rear claws. Rubber matting in feed-stalls prevented loss of sole concavity compared with asphalt. Claw asymmetry did not differ between flooring systems. While different access to abrasive flooring affected claw conformation, there was no evidence that flooring system influenced the disproportion between lateral and medial claws.

Evaluation of the effect of TRU-016, an anti-CD37 directed SMIP in combination with other therapeutic drugs in models of non-Hodgkin's lymphoma

8571

Background: TRU-016, a single chain anti-CD37 Fc fusion molecule has been shown to display pro-apoptotic and Fc-dependent cellular cytotoxicity activities against primary CLL cells and NHL cell lines. The pro-apoptotic signal generated by TRU-016 binding to CD37 on CLL cells has been shown to be caspase-independent and distinct from the signal generated by many other therapeutics including rituximab. We have tested drug combinations using the mantle cell lymphoma line Rec-1 and diffuse large B-cell lymphoma line SU-DHL-6 in vitro and extended these results to in vivo settings using the follicular lymphoma cell line DOHH2 treated with the combination of TRU-016 and bendamustine. Methods: To determine TRU-016 interactions with the established therapeutics rituximab, doxorubicin, rapamycin, and bendamustine, drugs were tested alone or in combination with TRU-016 and the anti-proliferative effects on cell lines measured after 96 hours. Combination index analysis was performed for drug combinations over the 20–90% effect levels using the Calcusyn software package. To determine if in vitro synergy could be recapitulated in vivo, SCID mice were implanted with DOHH2 cells and therapeutic treatment was initiated when tumor volumes reached 200 mm3. Treatments consisted of TRU-016, bendamustine, or the combination of TRU-016 and bendamustine. Results: Combination index analyses determined that TRU-016 is synergistic with rituximab, bendamustine, or rapamycin and additive with doxorubicin in NHL models. In vivo results show that treatment with the combination of TRU-016 and bendamustine resulted in increased efficacy compared to the efficacy attained with the individual drugs. This demonstrates that the in vitro synergy results were extendable to a more complex in vivo disease model. Conclusions: TRU-016 in combination with rituximab, rapamycin, or bendamustine increases cell killing of NHL cells. Furthermore, the combination of TRU-016 and bendamustine displayed greater in vivo anti-tumor activity than either agent alone against a follicular lymphoma tumor model.

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Charcoal hemoperfusion for treatment of serious carbamazepine poisoning

A case of severe carbamazepine intoxication (total dose 80 g) is reported. Because of deep coma and cardiovascular symptoms, intensive care and hemoperfusion were employed. The carbamazepine hemoperfusion clearance rate was 80-90 ml/min, but due to a probable ongoing absorption from the gut the effect of hemoperfusion was limited. Long hemoperfusion periods are recommended due to the pharmacokinetic pattern of carbamazepine.

Impaired Toll-like receptor 2 signalling in monocytes from 5-year-old allergic children

The relative composition of the two major monocytic subsets CD14(+)CD16(-) and CD14(+)CD16(+) is altered in some allergic diseases. These two subsets display different patterns of Toll-like receptor levels, which could have implications for activation of innate immunity leading to reduced immunoglobulin E-specific adaptive immune responses. This study aimed to investigate if allergic status at the age of 5 years is linked to differences in monocytic subset composition and their Toll-like receptor levels, and further, to determine if Toll-like receptor regulation and cytokine production upon microbial stimuli is influenced by the allergic phenotype. Peripheral blood mononuclear cells from 5-year-old allergic and non-allergic children were stimulated in vitro with lipopolysaccharide and peptidoglycan. Cells were analysed with flow cytometry for expression of CD14, Toll-like receptors 2 and 4 and p38-mitogen-activated protein kinase (MAPK). The release of cytokines and chemokines [tumour necrosis factor, interleukin (IL)-1 beta, IL-6, IL-8, IL-10, IL-12p70] into culture supernatants was measured with cytometric bead array. For unstimulated cells there were no differences in frequency of the monocytic subsets or their Toll-like receptor levels between allergic and non-allergic children. However, monocytes from allergic children had a significantly lower up-regulation of Toll-like receptor 2 upon peptidoglycan stimulation. Further, monocytes from allergic children had a higher spontaneous production of IL-6, but there were no differences between the two groups regarding p38-MAPK activity or cytokine and chemokine production upon stimulation. The allergic subjects in this study have a monocytic population that seems to display a hyporesponsive state as implicated by impaired regulation of Toll-like receptor 2 upon peptidoglycan stimulation.