Early markers of allergic disease in a primary prevention study using probiotics: 2.5-year follow-up phase

BACKGROUND

We previously reported that a Lactobacillus acidophilus probiotic strain (LAFTI) L10/LAVRI-A1) given for the first 6 months of life increased the risk of allergen sensitization at 1 year of age.

METHODS

To assess the effects on subsequent allergic outcomes, 153 children from the initial prevention cohort (n = 178) were reviewed at 2.5 years of age. Clinical outcomes were assessed in relation to (i) probiotic supplementation; and (ii) immune function previously assessed at 6 months of age.

RESULTS

Supplementation with this probiotic did not reduce the risk of dermatitis at 2.5 years (31/74, 42%) compared with that in placebo group (25/76, 34%). There was no significant reduction in any other allergic disease or allergen sensitization. Inhalant sensitization at 2.5 years (n = 29) was associated with higher proportions of circulating CD4+ CD25+ regulatory T-cell populations (P = 0.005) and higher allergen-induced FOXP3 levels (P = 0.003) at 6 months. This was also seen in children with dermatitis. Children with dermatitis at 2.5 years also had significantly lower toll-like receptor 4 lipopolysaccharide responses at 6 months of age (IL-12 P = 0.04, IL-6 P = 0.039) and lower polyclonal (PHA) responses (IFN-gamma P = 0.005, IL-10 P = 0.001, and IL-6 P = 0.001). Children who had previously received the probiotic had fewer gastrointestinal infections in the preceding 18 months (P = 0.023).

CONCLUSION

The LAFTI L10 probiotic strain did not have any significant effect on allergy outcomes. Allergic children showed a number of early differences in immune function including altered regulatory T-cell markers and innate immune function.

Supplementation with Lactobacillus rhamnosus or Bifidobacterium lactis probiotics in pregnancy increases cord blood interferon-gamma and breast milk transforming growth factor-beta and immunoglobin A detection

BACKGROUND

This study explored the effects of maternal probiotic supplementation on immune markers in cord blood (CB) and breast milk.

METHODS

CB plasma and breast milk samples were collected from a cohort of women who had received daily supplements of either 6 x 10(9) CFU/day Lactobacillus rhamnosus HN001 (n=34), 9 x 10(9) CFU/day Bifidobacterium lactis HN019 (n=35) or a placebo (n=36) beginning 2-5 weeks before delivery and continuing for 6 months in lactating women. CB plasma and breast milk (collected at 3-7 days, 3 months and 6 months postpartum) were assayed for cytokines (IL-13, IFN-gamma, IL-6, TNF-alpha, IL-10, TGF-beta1) and sCD14. Breast milk samples were also assayed for total IgA.

RESULTS

Neonates of mothers who received a probiotic had higher CB IFN-gamma levels (P=0.026), and a higher proportion had detectable blood IFN-gamma levels, compared with the placebo group (P=0.034), although levels were undetectable in many infants. While this pattern was evident for both probiotics, when examined separately only the L. rhamnosus HN001 group showed statistically significant higher IFN-gamma levels (P=0.030) compared with the placebo group. TGF-beta1 levels were higher in early breast milk (week 1) from the probiotic groups (P=0.028). This was evident for the B. lactis HN019 group (P=0.041) with a parallel trend in the L. rhamnosus HN001 group (P=0.075). Similar patterns were seen for breast milk IgA, which was more readily detected in breast milk from both the B. lactis HN019 (P=0.008) and the L. rhamnosus HN001 group (P=0.011). Neonatal plasma sCD14 levels were lower in the B. lactis HN019 group compared with the placebo group (P=0.041).

CONCLUSION

The findings suggest that supplementation with probiotics in pregnancy has the potential to influence fetal immune parameters as well as immunomodulatory factors in breast milk.

[Quantification of extracranial ICA stenoses with vessel ultrasound by CCDS and B-flow in comparison to 64-slice multidector CTA, contrast-enhanced MRA and DSA]

PURPOSE

To evaluate the value of vascular ultrasound determining the pre-interventional degree of distal stenosis in the extracranial internal carotid artery (ICA) by means of color-coded duplex sonography (CCDS) and B-flow. Comparison with contrast-enhanced 64-line CT angiography (CTA), contrast-enhanced MRA (ceMRA) and digital subtraction angiography (DSA).

MATERIALS AND METHODS

Complementary diagnostics and evaluation of the stenosis by means of CCDS, B-flow, CTA, ceMRA and DSA were performed prior to percutaneous stent-assisted PTA in 21 symptomatic ICA stenosis. Ultrasound diagnostics were carried out with high-resolution linear transducers (5-10 MHz and 9-14 MHz). A bolus-triggered contrast-enhanced multislice CTA (collimation 64x0.5 mm) and a ceMRA (1.5 Tesla) as well as selective DSA were performed in every patient. The degree of distal stenosis was established in accordance to NASCET criteria by averaging 5 single measurements per modality and patient. The source images as well as MPR and MIP reconstructions were evaluated in the CTA and ceMRA. Hemodynamic flow parameters were determined with CCDS and B-flow. The images were assessed by two experienced readers in consensus.

RESULTS

The extent of stenosis ranged from 45 to 95%, averaging 73% (+/-13%). There was a high degree of agreement between the B-flow results (r=0.938), the CCDS (r=0.852), the measurements from the source data of the ceMRA (r=0.9117) and reconstructions of the CTA (r=0.8598) compared to quantitative DSA as a reference technique.

CONCLUSION

Compared to selective DSA, vascular ultrasound in combination with CTA and ceMRA increase the reliability of the diagnostic quantification of ICA stenosis.

Self-tolerance of human natural killer cells lacking self-HLA-specific inhibitory receptors

Natural killer (NK) cells identify cells with altered human leucocyte antigen (HLA) expression as targets through lacking engagement of self-HLA-specific inhibitory receptors (e.g. killer cell immunoglobulin-like receptor, KIR). Thus, they eliminate cells with 'missing self' because of viral or malignant transformation. We performed analysis of HLA, KIR genotypes and KIR receptor expression patterns at single cell level in NK cells in 17 donors. The function of NK cell subsets is determined by degranulation assays using target cells expressing self, cognate, control or no HLA class I. Donors could be grouped into three groups: their NK cells possess potential for alloreactivity, autoreactivity based on the presence of NK cells expressing particular KIR only (mono-KIR) in the absence of its ligand or lack alloreactivity. All donors possess NK cells lacking all detectable inhibitory receptors. Both potential autoreactive subpopulations did not respond to HLA class I-positive target cells. They retain partial reactivity against HLA class I-negative tumour target cells. Mono-KIR NK cells without the corresponding ligands in the individuals and NK cells lacking all inhibitory receptors behave self-tolerant. Our results suggest alternative mechanisms than HLA-specific inhibitory receptors to control NK cell activity. But HLA seems to be involved in shaping effector function of the NK cell repertoire.

[A rare cause of exertional dyspnea in a 63-year-old woman]

HISTORY AND CLINICAL FINDINGS

A 63-year-old woman was referred because of excertional dyspnea, pulmonary artery hypertension and right heart dilatation without evidence of pulmonary embolism.

INVESTIGATIONS

Echocardiography, magnetic resonance tomography and right heart catheterisation revealed a left to right shunt through an sinus venosus defect and partial anomalous pulmonary venous return.

DIAGNOSIS, TREATMENT AND COURSE

After surgical repair the hemodynamic changes normalized. The patient is doing well 12 weeks after surgery.

CONCLUSION

Congenital heart disease should be considered as a rare cause of exertional dyspnea in the elderly. Before percutaneous interventional closure of atrial septal defects, concomitant anomalous partial pulmonary venous return should be ruled out.

40-jährige Patientin mit Kopfschmerzen und Infarkt-EKG

Cerebral lesions may contribute to a transient left ventricular ballooning syndrome that can mimic acute myocardial infarction. Fibrinolytic therapy or GP IIb/IIIa antagonists should be withheld in cases of neurologic disorder or unconsciousness even in the presence of ST-elevation.ECG transmission by telemetry and myocardial infarction alarm networks allow correct diagnosis and catheter treatment within required time limits.

[Diagnostics and staging of non-Hodgkin's lymphomas]

Non-Hodgkin's lymphomas represent a clinically and biologically heterogeneous group of diseases. Over the last few years, new treatment approaches such as humoral immunotherapy and high dose therapy with stem cell rescue have improved the chances for a cure in most patients with malignant lymphoma. However, only with the correct diagnosis and staging, including the evaluation of novel prognostic factors, are treating physicians able to choose the optimal treatment for their patients. This review focuses on conventional staging procedures and their role in the management of lymphoma patients, as well as on some new aspects of the molecular classification of lymphomas.

Value of high resolution ultrasound and contrast enhanced US pulse inversion imaging for the evaluation of the vascular integrity of free-flap grafts

OBJECTIVE

The aim of this study was to evaluate the clinical value of color coded Doppler sonography (CCDS) and contrast-enhanced harmonic imaging (CHI) for ultrasound (US) monitoring the integrity of free-flap vascular grafts. Patency of microvascular anastomoses and perfusion as well as microcirculation of the transplanted tissue were analysed.

PATIENTS AND METHODS

Fifteen free parascapular flap grafts performed over a period of three years by a single surgeon were examined with CCDS and CHI. The patients (12 male, 3 female) ranged in age from 16 to 60 years (average age 40+/-12). The follow-up period ranged from two weeks to 2.5 years. CCDS were performed with a multifrequency linear transducer (5-10 MHz, Logiq 9, GE) with 3D flow detection. For detection and characterization, B scan of the flap tissue was compared to tissue harmonic imaging (THI) and Cross Beam with Speckle Reduction Imaging (SRI). US Pulse Inversion Harmonic Imaging (PIHI) after bolus injection of 2.5 ml Sonovue was used for contrast enhancement.

RESULTS

Border and tissue structure of the flaps could be detected best in all 15/15 cases using Cross Beam Technology with SRI and THI. Correlations were found for flow parameters of the common femoral artery, popliteal artery and lower leg artery to the anastomotic vessels. 3D imaging with CCDS facilitated flow detection of elongated and small anastomotic vessels in 4/15 cases. Contrast-enhanced US with PIHI allowed dynamic flow detection of the microcirculation of the transplanted tissue over a depth of up to 3 cm with quantitative perfusion curves of the tissue microcirculation. Reduced US contrast enhancement with modified perfusion curves was seen in 2/15 cases with low anastomic flow in CCDS.

CONCLUSION

Assessment of microvascular perfusion with contrast-enhanced ultrasound can provide valuable information on free flap viability. Contrast-enhanced US enables dynamic and quantitative flow detection of free flap tissue.

Vortex chirality in exchange-biased elliptical magnetic rings

The flux-closed or "vortex" state in thin-film magnetic rings has been proposed as a data storage token, but it has proven difficult to control the vortex chirality in a simple manner. Here, a model is described that predicts the vortex chirality of an elliptical magnetic ring as a function of the direction of the applied field and of the exchange bias, based on the change in energy of the system as the domain walls move. Experimental measurements of chirality in Co and Co/IrMn magnetic rings with 3.2 microm major axis are in excellent agreement with the model. The vortex circulation direction can therefore be tailored with an appropriate combination of applied field direction and exchange bias direction with respect to the major axis.

Significantly improved PCR-based clonality testing in B-cell malignancies by use of multiple immunoglobulin gene targets. Report of the BIOMED-2 Concerted Action BHM4-CT98-3936

Polymerase chain reaction (PCR) assessment of clonal immunoglobulin (Ig) and T-cell receptor (TCR) gene rearrangements is an important diagnostic tool in mature B-cell neoplasms. However, lack of standardized PCR protocols resulting in a high level of false negativity has hampered comparability of data in previous clonality studies. In order to address these problems, 22 European laboratories investigated the Ig/TCR rearrangement patterns as well as t(14;18) and t(11;14) translocations of 369 B-cell malignancies belonging to five WHO-defined entities using the standardized BIOMED-2 multiplex PCR tubes accompanied by international pathology panel review. B-cell clonality was detected by combined use of the IGH and IGK multiplex PCR assays in all 260 definitive cases of B-cell chronic lymphocytic leukemia (n=56), mantle cell lymphoma (n=54), marginal zone lymphoma (n=41) and follicular lymphoma (n=109). Two of 109 cases of diffuse large B-cell lymphoma showed no detectable clonal marker. The use of these techniques to assign cell lineage should be treated with caution as additional clonal TCR gene rearrangements were frequently detected in all disease categories. Our study indicates that the BIOMED-2 multiplex PCR assays provide a powerful strategy for clonality assessment in B-cell malignancies resulting in high Ig clonality detection rates particularly when IGH and IGK strategies are combined.

Resistance Against Natural Killer Cell Cytotoxicity: Analysis of Mechanisms

Target cell resistance against natural killer (NK) cell-mediated cytotoxicity obstructs NK cell-based immunotherapy of leukaemia. Several mechanisms of resistance have been described. Because of lack of simple assays for analysing these mechanisms, their relative impact on a given effector-target pair is mostly unknown. We here analysed the combination of the Granzyme B (GrB) enzyme-linked immunospot assay (ELISPOT) for the assessment of NK cell reactivity and cytotoxicity assays to estimate target cell escape mechanisms. Target cell recognition failure leads to negative GrB ELISPOT results, whereas target cell resistance shows positive GrB ELISPOT results in the absence of cytotoxicity. We confronted NK cells with the sensitive target cell line K562, and with the resistant cell lines ML2, SupB15 and Raji. ML2 cells sufficiently activated GrB-release whilst being resistant against cytotoxic granules of NK cells. Partial resistance of Raji results from the interaction of HLA class I with inhibitory killer immunglobulin-like receptors (KIR) on the NK cells. Failure of target recognition by HLA class I-KIR interaction, lacking ligands to stimulatory NK cell receptors and partial resistance to cytotoxic granules all contributed to resistance of SupB15. In conclusion, revealing the mechanisms of resistance against NK cell-mediated cytotoxicity may allow improving the results of NK-based immunotherapy.

Clinical availability of chemotherapy response assay using adenosine triphosphate in breast cancer patients

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Background: The response to chemotherapeutic agents of breast cancer is heterogeneous from patient to patient. Several methods were developed to decide chemotherapeutic agents which were sensitive to individual patients but so far, there are no ways which is commonly used in the clinic to tailor the treatment. In this study, we performed the chemotherapy response assay using adenosine triphosphate (ATP-CRA) in breast cancer patients and assessed the clinical availability. Methods: From March 2004 to February 2005, 65 breast cancer patients were enrolled in this study. After elimination of normal contaminated cells, cancer cells were evenly divided and treated with commonly used chemotherapeutic drugs in breast cancer(doxorubicin, epirubicin, 5-FU, paclitaxel, docetaxel, vinorelbine, and gemcitabine). 7 Drug-treated cancer cells and untreated cancer cells were cultured for 48 hours and then ATP was measured. To verify in vitro ATP-CRA indirectly, we analyzed the correlation between cell death rate of doxorubicin and epirubicin, and between doxorubicin and paclitaxel. We also analyzed the mean death rate of doxorubicin, epirubicin and paclitaxel by HER-2 status. Results: The ATP-CRA was performed sucessfully in 62 patients. (95.4%) In all cases, we can get the results within 7 days. The range of cell death rate was very wide, from 0 to more than 50%, except gemcitabine. Epirubicin showed the highest mean cell death rate (35.7%) and doxorubicin, paclitaxel in order. According to the chemosensitivity index, paclitaxel is the most frequently first-ranked and doxorubicin, epirubicin in order. Correlation coefficient between the cell death rate of doxorubicin and epirubicin is 0.58 and 0.2 between paclitaxel and epirubicin. In HER-2 positive group, mean cell death rate of epirubicin and paclitaxel was significantly higher than in HER-2 negative group (p = 0.017, p = 0.036) and same trend was seen in doxorubicin but not statistically significant (p = 0.060). Conclusions: ATP-CRA showed heterogeneous results in individual patients. ATP-CRA was successful and can be performed within short time period. With indirect comparison, it showed similar results with in vivo studies but for clinical use, the prospective randomized controlled trial should be preceded.

No significant financial relationships to disclose.