Health-related quality of life and health locus of control beliefs among HIV-infected treated patients

OBJECTIVE

This study examined the relations between health locus of control (HLOC) beliefs and health-related quality of life (HRQL) in 302 HIV-infected patients enrolled in a French cohort, 44 months (M44) after they began highly active antiretroviral therapy (HAART).

METHODS

HLOC beliefs were measured with the Multidimensional Health Locus of Control (MHLOC) scale and HRQL, with the Medical Outcome Study Short-Form Health Survey (MOS-SF-36).

RESULTS

Internal HLOC beliefs at the initiation of treatment were associated with both physical HRQL in multivariate analysis, while chance HLOC beliefs on beginning HAART were associated with mental HRQL at M44.

CONCLUSION

These findings suggest the importance of considering the psychological characteristics and psychosocial beliefs of patients at the initiation of ARV treatment to optimise the long-term HRQL of HIV-infected patient and to develop adaptive intervention on coping strategies.

Association between perceived social support and Th1 dominance

Social support is supposed to have a positive health effect via alteration of immunity. In this study, associations between perceived social support and immune systems were examined. Immunological assessments, e.g. T cell count, Natural Killer cell count, Interferon-gamma, Interleukin-4, and psychological assessments, e.g. Generic Job Stress Questionnaire were conducted on male employees. Two-way (social support x job stressor) analyses of covariance controlling for age, smoking, alcohol consumption, and exercise revealed that there were main effects of perceived social support on NK cell counts, IL-4, and Th1/Th2 balance. On the other hand, interaction effects were observed on T cell counts and INF-gamma production in vitro. Social support affects immune function in a way that is consistent with both the direct and buffering hypotheses depending on the sources of support and the immune parameter.

[Analysis of intracellular cytokines IFN-gamma and IL-4 in peripheral blood T cells in children with bronchospastic reaction]

In the epidemiological study there was suggested that respiratory tract infections--were a strong risk factors for the beginning and development of bronchial asthma. The aim of the study was the evaluation of intracellular cytokine IL-4 and IFN-gamma on peripheral blood T subsets in children with atopic asthma (AA) and recurrent respiratory tract infection with bronchospasm (RRTI).

METHOD

Peripheral blood T cells were stained with fluorescence-labelled antibodies specific for intracellular cytokines IFN-gamma and IL-4 and cell surface markers CD3, CD4 and CD8, and were subjected to flow-cytometric analysis.

RESULTS

Comparing peripheral blood lymphocytes of atopic asthma patients with those of recurrent infections we found significantly more cells positive for IL-4 in asthma patients than in recurrent infection patients, both in the CD3+ subsets (p<0.03) and CD4+ subset (p<0.01). We have also found that percentage of CD4+ was significantly lower (p<0.007) and percentage of CD8+ cells was significantly higher (p<0.05) in RRTI group comparing to atopic asthma patients. In AA group there was a significant increase intracellular expression of IL-4 among the CD3+ (p<0.03) and CD4+ (p<0.01) subsets and no significant differences among CD8+ subset. In AA group there was a significant decrease ratio of IFN-gamma/IL-4 among all of the evaluated subsets.

CONCLUSION

Basing oneself on these results we conclude that markers of atopy are: increased intracellular expression of IL-4 among CD4+ cells and decreased IFN-gamma.

Interleukin-6 and platelet protagonists in T lymphocyte and virological response

The present cross-sectional study evaluated the status and relationship of interleukin-6, a platelet growth factor, with platelet counts, viral load, CD4 counts, and antiretroviral treatment in 75 HIV-infected subjects with thrombocytopenia and 50 gender-, race-, age- and antiretroviral treatment-matched controls without thrombocytopenia. Mean IL-6 production was significantly higher in thrombocytopenic participants (13 432+/-8596) than in non-thrombocytopenic subjects (12 859+/-3538 pg/10(5) Lym). Univariate analyses indicated, however, that thrombocytopenic patients were more likely to have <3000 pg of IL-6 than non-thrombocytopenic patients (OR=7 95% CI 1.3-12; P=0.01). For additional analyses, participants were dichotomized above and below 3000 pg of IL-6. Despite similar age, gender, drug use and antiretroviral treatment, thrombocytopenic participants had lower CD4 counts (186.5+/-149 vs. 401+/-286, P=0.005) than non-thrombocytopenic subjects. Thrombocytopenic participants with elevated IL-6, with or without HAART, were more likely to have higher HIV-replication (496 273+/-210 416; 34 656+/-25 332) than thrombocytopenic individuals with low IL-6 levels (105 332+/-42 699; 19 015+/-14 296 P=0.05). Non-thrombocytopenic patients with high IL-6 levels exhibited the highest CD4s (466.7+/-333) and the lowest viral burden (63 094+/-53 300) of the groups. Two distinct categories of HIV-associated thrombocytopenia exist: one accompanied by low IL-6, and another with compensatory elevations of IL-6. In thrombocytopenic individuals, the latter was associated with the poorest immunological and virological responses.

Modulation of immune response by the acute and chronic exposure to high altitude

PURPOSE

The chronic exposure at high altitude (HA) represents an ideal model for evaluating the in vivo effects of hypobaric hypoxia. Taking advantage of the EV-K2-CNR Pyramid, this study was designed to evaluate whether acute and chronic hypoxia differently modulates the in vivo immune responses.

METHODS

The study includes 13 healthy female moderately active volunteers participating to the Italian HA project EV-K2-CNR. Peripheral blood lymphocytes, collected at sea level and at HA in the Pyramid Laboratory of CNR, Nepal (5050 m), were immunologically characterized by flow cytometry and a series of molecular and functional analyses.

RESULTS

Flow cytometric analyses showed that: a) CD3+ T lymphocytes significantly decreased during both acute and chronic exposure to HA, b) T-cell fall was totally due to CD4+ T-cell reduction, c) B lymphocytes were not influenced by the exposure to HA, and d) natural killer (NK) cells significantly increased during acute and chronic exposure. The evaluation of the Th1/Th2 pattern demonstrated a significant decrease of the expression of the Th1 cytokine interferon-gamma (IFN-gamma) by circulating T cells during acute and chronic exposure to HA. The expression by T cells of CXCR3, a chemokine receptor typically expressed by Th1/Tc1 cells, paralleled the decrease of IFN-gamma. On the contrary, the expression of IL-4 was not conditioned by the exposure to HA. Finally, functional studies showed a significant reduction of the proliferative activity in response to mitogen (PHA) both in acute and chronic HA exposure. Despite the increased number of NK cells, NK cytotoxic activity was not influenced by the HA exposure.

CONCLUSIONS

Our results indicate that the in vivo exposure to HA leads to an impairment of the homeostatic regulation of Th1/Th2 immune balance that potentially could favor long-term immunological alterations and increase the risk of infections.

Dynamic Differentiation of Activated Human Peripheral Blood CD8+ and CD4+ Effector Memory T Cells

Two functionally different memory T cell subsets were originally defined based on their different CCR7 expression profile, but the lineage relationship between these subsets referred to as central memory T cells (T(CM)) and effector memory T cells (T(EM)), is not resolved. A prevalent model proposes a linear progressive differentiation from T(CM) to T(EM). Our results demonstrate that on activation, human CCR7-CD62L- peripheral blood CD8+ and CD4+ T(EM) cells exhibit a dynamic differentiation, involving transient as well as stable changes to T(CM) phenotype and properties. Whereas the larger fraction of T(EM) cells increases expression of effector molecules, such as perforin or IFN-gamma, a smaller fraction first acquires CCR7 expression. We demonstrate that this acquisition of lymph node homing potential is associated with strong proliferation similar to that of activated T(CM) cells. After proliferation, most of these cells lose CCR7 expression again and acquire effector functions (e.g., perforin production). A small proportion (approximately 6%), however, maintain phenotypic and functional T(CM) properties over a long time interval. These results suggest that T(EM) cells provide immediate effector function by a fraction of cells as well as self-renewal by others through up-regulation of CCR7 followed by either secondary peripheral effector function or long term maintenance of T(CM)-like properties.

[Perioperative changes of cellular immune response of patients with esophageal carcinoma evaluated through detecting AgNOR content in peripheral blood T lymphocytes and T cell subsets]

BACKGROUND & OBJECTIVE

Patients with esophageal carcinoma often have immunosuppression. This study was to detect perioperative argyrophil nucleolar orgnizer region (AgNOR) content in peripheral blood T lymphocytes and T cell subsets of patients with esophageal carcinoma, investigate the influences of cellular immune condition and surgery on cellular immune function of these patients.

METHODS

Peripheral blood samples were obtained from 75 healthy adults and 70 patients with esophageal carcinoma before surgery, 3 and 9 days after surgery. AgNOR content in peripheral blood T lymphocytes was measured by tumor immune microphotometry; T cell subsets was measured by flow cytometry.

RESULTS

Before operation, AgNOR content, proportions of CD3(+)CD8(+) and CD8(+)CD25(+) T cells were significantly lower in patients than in healthy controls (P < 0.001); proportions of CD3(+) and CD3(+)CD4(+) T cells of patients were not significantly different from that of healthy controls (P > 0.05); proportions of CD4(+)CD25(+) and CD4(+)/CD8(+) T cells were significantly higher in patients than in healthy controls (P < 0.05). In peripheral blood T lymphocytes of the patients after operation, AgNOR content, CD3(+), CD3(+)CD4+(+), and CD4(+)/CD8(+) T cells were the lowest at the 3rd day, and the highest at the 9th day; CD3(+)CD8(+), CD4(+)CD25(+), and CD8+CD25+ T cells gradually ascended from the 3rd day. At the 9th day after operation, CD3(+) and CD3(+)CD4(+) T cells of patients were not significantly different from that of healthy controls (P> 0.05); AgNOR content, CD3(+)CD8(+) and CD8(+)CD25(+) T cells were still lower in patients than in healthy controls (P<0.05); CD4(+)CD25(+) and CD4(+)/CD8(+) T cells were still higher in patients than in healthy controls (P<0.001).

CONCLUSION

Surgery injure may cause temporary cellular immunosuppression in patients with esophageal carcinoma, which slowly recovers early after operation.

CD4 measurements in patients with HIV: are they feasible for poor settings?

The lack of facilities to measure CD4 counts in poor countries impedes instituting rational and effective antiretroviral therapy in these countries. Can a new microchip counting technique help to solve the problem?

Reduced gravity evaluation of potential spaceflight-compatible flow cytometer technology

BACKGROUND

The presence of a spaceflight-compatible flow cytometer onboard the International Space Station would be extremely beneficial for in-flight medicine and reduced gravity research. In the past, commercially available flow cytometers were not suitable for use during spaceflight due to their size, weight, power, and sheath fluid requirements. Recent advances in cytometer technology have enabled features that now make a spaceflight-compatible cytometer possible. We evaluated a small, robust novel cytometer with design features that minimize or eliminate many incompatibilities with spaceflight. This cytometer is highly miniaturized and lightweight, does not require sheath fluid, and uses a low-energy diode laser. The ability to achieve laminar particle flow without sheath fluid is important because an instrument using large liquid volumes and producing an equivalent amount of hazardous liquid waste would not meet spaceflight constraints.

METHODS

For this study the cytometer was modified so that stained liquid cell samples could be delivered during reduced gravity. The cytometer was then evaluated onboard the NASA KC-135 reduced gravity research aircraft. The KC-135 uses a parabolic flight path to generate essentially zero gravity conditions for 30-s increments. Typically 40 parabolas are flown per mission, resulting in approximately 20 min of reduced gravity during which research may be performed. During this evaluation, bead-based cytometer precision, photomultiplier tube linearity, and leukocyte immunophenotype analysis were performed during reduced gravity. The flight data were then compared with ground-based control data and data generated using a reference cytometer (Beckman-Coulter XL).

RESULTS

This novel cytometer functioned well during reduced gravity and produced data comparable to those of ground-based controls with only minor caveats. The reduced gravity cell immunophenotype data were indistinguishable from ground control data and reference cytometric data. Bead-based instrument precision (coefficient of variation) was slightly increased during reduced gravity operation, but not to a degree that would affect most common flow cytometric applications. The ability of the instrument to collect absolute cell counts was validated.

CONCLUSIONS

This study represents the first generation of real-time flow cytometry data during zero gravity. With modifications, the evaluated cytometer technology could be the basis from which an operational spaceflight-compatible flow cytometer is developed.

Contribución de la captura de híbridos de segunda generación del virus del papiloma humano en el cribado de afección cervical en mujeres con infección por el virus de la inmunodeficiencia humana

BACKGROUND AND OBJECTIVE

The causal relationship between human papillomavirus (HPV) and cervical cancer is well established. The initial diagnosis of HPV-related cervical infection is currently performed by HPV-associated changes in cervical cytology. We aimed to study the accuracy and concordance between HPV ADN detection by second-generation hybrid capture (HC-2) and cervical cytological changes for the diagnosis of HPV cervical infection in human immunodeficiency virus (HIV+) outpatients.

PATIENTS AND METHOD

From March 1999 to August 2002, 139 HIV+ patients were included. HPV infection was determined by cytology and HC-2. The accuracy and level of concordance between both techniques was analyzed.

RESULTS

The applicability of the HC-2 test was 96%. Sixty-eight (49%) patients were diagnosed with HPV infection by HC-2. High-oncogenetic-risk HPV genotypes were detected in 64 (46%) patients. The sensitivity, specificity and positive and negative predictive values of HC-2 in HPV detection were 78%, 69%, 61% and 83%, respectively. The concordance was K = 0.44 (95% confidence interval, 0.29-0.60); p < 0.001.

CONCLUSIONS

The HC-2 diagnostic technique for HPV-related cervical infection in HIV+ patients is a sensitive and specific test. The combined use of both tests might increase the diagnostic efficacy, and hence have positive repercussions on cervical pathology screening on an outpatient basis.

Patterns of anti-tuberculosis drug resistance among HIV-infected patients in Maputo, Mozambique, 2002-2003

SETTING

Two tuberculosis (TB) reference hospitals in Maputo, Mozambique.

OBJECTIVES

To assess the pattern of TB drug resistance and its risk factors in human immunodeficiency virus (HIV) patients.

DESIGN

Adult HIV-positive patients with TB diagnosed by culture of sputum or bronchial washing were enrolled during 2002-2003. Cultures of 111 patients were tested for rifampicin, isoniazid, streptomycin and ethambutol sensitivity. Chest X-ray, haemoglobin (Hb), total lymphocyte and CD4 counts were also performed.

RESULTS

Overall resistance to any drugs was found in 18% and multidrug-resistant TB (MDR-TB) in 9%. New cases of TB accounted for 62% of the studied group. Drug resistance in this subgroup was 13% compared with 26.3% in the previously treated subgroup, and MDR-TB was 5.8% vs. 15.8%. All patients presented Hb levels < 9 g/dl and total lymphocyte counts < 1200/microl. CD4 counts were significantly low in the drug resistance subgroup, with levels mostly < 100/microl. Cavities on X-ray were seen only in drug-sensitive patients. No risk factors for drug resistance were detected.

CONCLUSIONS

Overall observed drug resistance was 18%, and MDR-TB 9%. Previously treated patients had high drug resistance (26.3%) and MDR-TB (15.8%).

Characteristics of CD4+CD25+ regulatory T cells in the peripheral circulation of patients with head and neck cancer

Patients with squamous cell carcinoma of the head and neck (SCCHN) have depressed antitumour immunity. The presence of CD4+CD25+ (T_reg) cells in these patients might be, in part, responsible for downregulation of antitumour immune responses. To evaluate the frequency and characteristics of T_reg in the peripheral circulation of patients with SCCHN, we used multicolour flow cytometry. Expression of CCR7, CD62L, ζ chain and Annexin V binding to T_reg and non-T_reg CD4+ lymphocyte populations were evaluated. T_reg were confirmed to be Foxp3+ and GITR+. The T_reg frequency was significantly elevated in patients with active disease and those with no evidence of disease (NED) following curative therapies. Both T_reg and non-T_reg CD4+ T cells in patients were significantly enriched in CCR7⁻ and CD62L⁻ cell subsets. Although T_reg in patients contained a higher proportion of double negative (CCR7⁻CD62L⁻) cells, the majority of T_regs were CCR7⁻CD62L+. The proportion of Annexin V+CD4+ T cells was higher in patients (P<0.00005) than normal controls (NC), and T_reg were significantly more sensitive to apoptosis than non-T_reg in patients and NC. Expression of ζ was reduced in all subsets of CD4+ T cells obtained from patients vs NC. The data suggest that T_reg in patients with SCCHN largely contain T cells with the ‘effector’ phenotype, which bind Annexin V and have low ζ expression, consistent with their activation state and a rapid turnover in the peripheral circulation.

Seroprevalence of antibodies against varicella-zoster virus and response to the varicella vaccine in pediatric renal transplant patients

The severity of varicella-zoster virus (VZV) in immunocompromised children, especially in those receiving renal transplants, is well known. However, the use of live attenuated virus vaccine in this population is controversial. This study aimed to: (i) assess the immunization status of pediatric renal transplant recipients at our center; (ii) determine the anti-VZV antibody titers in such patients; (iii) evaluate the response to VZV vaccine in seronegative children and in those who present low antibody titers (defined as <500 mAU/mL). Vaccinated children were monitored for adverse effects for 8 wk after vaccination. Fifty patients with a mean age of 13.7 yr (range, 3-17 yr) were enrolled. In 49, blood samples were collected and antibodies were screened using ELISA. Seropositivity to VZV was found in 43 (88%), and antibody titers were >/=500 mAU/mL in 37 (75.5%). Of the 12 children who were eligible for vaccination and had antibody titers <500 mAU/mL, one developed varicella before vaccination, two did not meet the inclusion criteria, and three parents refused the vaccination. In the six vaccinated children, there were no adverse reactions to the vaccine, and four (66.6%) responded with anti-VZV titers >/=500 mAU/mL 6-8 wk after vaccination. In conclusion, after renal transplantation, varicella vaccine is safe with a 66% rate of conversion to high antibody titers.

Psychosocial mediators of antiretroviral nonadherence in HIV-positive adults with substance use and mental health problems

This study used data from 1,889 HIV-positive patients on antiretroviral (ARV) medications who participated in the HIV Cost and Services Utilization Study to investigate whether nonadherence to ARV medications among patients with mental health and substance use problems could be explained by difficulty getting and negative attitudes toward ARV medications, poor fit of the regimen with lifestyle, lack of instruction and cues for remembering the regimen from a health care provider, and poor support from others for taking ARV medications. Difficulty getting ARV medications and poor fit with lifestyle were significant mediators of nonadherence for patients with a probable psychiatric disorder. Difficulty getting medication was a mediator for heavy drinkers, and poor fit with lifestyle was a mediator for drug users who drank heavily. Further research is needed to identify and address the barriers to adherence in these populations.

Polyclonal chemoprotection against temozolomide in a large-animal model of drug resistance gene therapy

Incorporation of drug resistance genes into gene vectors has 2 important roles in stem cell gene therapy: increasing the proportion of gene-corrected cells in vivo (ie, in vivo selection) and marrow protection to permit higher or more tightly spaced doses of chemotherapy in the treatment of malignant diseases. We studied in a clinically relevant canine model of gene therapy the P140K mutant of the drug resistance gene methylguanine methyltransferase (MGMT), which encodes a DNA-repair enzyme that confers resistance to the combination of the MGMT inhibitor O(6)-benzylguanine (O(6)BG) and nitrosourea drugs such as carmustine and methylating agents such as temozolomide. Two dogs received MGMT(P140K)-transduced autologous CD34(+)-selected cells. After stable engraftment, gene marking in granulocytes was between 3% and 16% in the 2 animals, respectively. Repeated administration of O(6)BG and temozolomide resulted in a multilineage increase in gene-modified repopulating cells with marking levels of greater than 98% in granulocytes. MGMT(P140K) overexpression prevented the substantial myelosuppression normally associated with this drug combination. Importantly, hematopoiesis remained polyclonal throughout the course of the study. Extrahematopoietic toxicity was minimal, and no signs of myelodysplasia or leukemia were detected. These large-animal data support the evaluation of MGMT(P140K) in conjunction with O(6)BG and temozolomide in clinical trials.

Lower concentration of serum soluble CD8 in severe Hashimoto's disease

To investigate the roles of soluble CD4 (sCD4) and CD8 (sCD8) in the severity of autoimmune thyroid diseases, we examined serum concentrations of sCD4 and sCD8 in various degrees of severity of Hashimoto's disease (HD) and Graves' disease (GD) by enzyme immunoassay. The serum concentration of sCD8 was lower in euthyroid patients with HD undergoing treatment for hypothyroidism (severe HD) than in untreated, euthyroid patients with HD (mild HD), but the sCD4 concentration did not differ between patients with severe and mild HD. The serum sCD8 concentration was negatively correlated with the proportion of CD25(+) cells in CD8(+) cells in patients with severe HD. Serum sCD4 and sCD8 concentrations did not differ between euthyroid patients with GD in remission and those with intractable GD. These results indicate that serum sCD8 is involved in the severity of HD, possibly by down-regulating the function of cytotoxic T cells.

A phase II multicenter clinical trial of systemic bexarotene in psoriasis

BACKGROUND

Bexarotene, a novel and unique synthetic P, RXR-selective retinoid, is available as a treatment for cutaneous T-cell lymphoma. In psoriasis, a common retinoid-sensitive disease, no data are available on bexarotene treatment.

OBJECTIVE

In this phase II study we investigated the safety, tolerability, and effectiveness of bexarotene in psoriasis at doses of 0.5 to 3.0 mg/kg/day.

METHODS

Fifty patients with moderate to severe plaque-type psoriasis were treated with bexarotene in 4 sequential dose-defined panels of 12-13 patients at doses of 1.0, 2.0, 0.5, and 3.0 mg/kg/day for 12-24 weeks. Patients were monitored for safety and clinical efficacy.

RESULTS

No serious adverse events related to the drug occurred. Bexarotene was well tolerated in most patients. Most frequently observed adverse events related to bexarotene were hypertriglyceridaemia (56%) and a decrease in free T4 serum levels (54%). Significant improvement of psoriasis after bexarotene at all doses was confirmed by a modified psoriasis area and severity index (mPASI), plaque elevation (PEL), and physician's global assessment (PGA). Overall response rates (> or =50% improvement) for mPASI, PEL, and PGA were 22%, 52%, and 36%, respectively. No significant dose-response effect was established for these parameters.

CONCLUSION

The present study indicates an anti-psoriatic effect of bexarotene. Further studies are necessary to assess the optimal dose and the potential for bexarotene as a new therapy for psoriasis.

Expression of the myeloid-associated marker CD33 is not an exclusive factor for leukemic plasmacytoid dendritic cells

A new entity of acute leukemia coexpressing CD4(+)CD56(+) markers without any other lineage-specific markers has been identified recently as arising from lymphoid-related plasmacytoid dendritic cells (pDCs). In our laboratory, cells from a patient with such CD4(+)CD56(+) lineage-negative leukemia were unexpectedly found to also express the myeloid marker CD33. To confirm the diagnosis of pDC leukemia despite the CD33 expression, we demonstrated that the leukemic cells indeed exhibited pDC phenotypic and functional properties. In 7 of 8 other patients with CD4(+)CD56(+) pDC malignancies, we were able to confirm that the tumor cells expressed CD33 although with variable expression levels. CD33 expression was shown by flow cytometry, reverse transcriptase-polymerase chain reaction, and immunoblot analysis. Furthermore, CD33 monoclonal antibody stimulation of purified CD4(+)CD56(+) leukemic cells led to cytokine secretion, thus confirming the presence of a functional CD33 on these leukemic cells. Moreover, we found that circulating pDCs in healthy individuals also weakly express CD33. Overall, our results demonstrate that the expression of CD33 on CD4(+)CD56(+) lineage-negative cells should not exclude the diagnosis of pDC leukemia and underline that pDC-specific markers should be used at diagnosis for CD4(+)CD56(+) malignancies.

Immunologic variables in acute mania of bipolar disorder

Macrophages, lymphocytes and their products, may be involved in the pathophysiology of psychiatric disorders. The cell-mediated immune activation response of manic patients during pre-medication and medication stages remains unclear. The purpose of this case-control study was to investigate the plasma levels of immunologic variables, including interleukin (IL)-1 receptor antagonist (IL-1RA), soluble CD 4 (sCD4) and sCD8, and TH1 (interferon [IFN]-gamma and IL-2) and TH2 (IL-4 and IL-10) cytokines in patients with pre-medicated, medicated bipolar mania. The study subjects, aged 16-44 years, were physically healthy patients with Young Mania Rating Scale (YMRS) scores > or =26, and normal controls, aged 19-40 years, were matched for sex. The immune variables were measured in acute mania and in consequent remission (YMRS scores < or =12) among bipolar patients. The plasma levels of IL-1RA, sCD4, and sCD8 were found significantly increased in pre-medicated acute manic patients as compared to normal controls. But only IL-1RA and sCD8 were found different in remitted bipolar patients as compared to normal controls. For TH1 cytokines, culture supernatant level of IFN-gamma was found significantly lower in manic patients of both acute and remission stages as compared to normal controls. No significant difference was found in IL-2 level in pre-medicated acute manic patients compared to controls. For TH2 cytokines, no significant differences in IL-4 and IL-10 levels were observed. We showed that cell-mediated immune response was activated in patients with bipolar disorder during the pre-medication, medication, and the remission stages. Our study findings suggest that the immune-modulation in patients with bipolar disorder may be abnormal.

C4d-positive acute humoral renal allograft rejection: Rescue therapy by immunoadsorption in combination with tacrolimus and mycophenolate mofetil

OBJECTIVE

We investigated the efficacy of immunoadsorption (IA) in combination with tacrolimus (FK506) and mycophenolate mofetil (MMF) rescue therapy for C4d-positive acute humoral rejection (AHR) of renal transplants.

METHODS

Six of 185 cadaveric renal allograft recipients developed AHR at a mean of 4.8 +/- 0.8 days after the operation. C4d deposits were observed in peritubular capillaries (PTC) with accumulation of granulocytes. IA with staphylococcal protein A and FK506-MMF combination therapy were administered.

RESULTS

After treatment with IA for 6.3 +/- 1.03 sessions combined with FK506 (0.14 to 0.16 mg.kg(-1).d(-1)) and MMF (1.5 g/d) therapy, renal function recovered in all the patients. The mean duration of treatment to a serum creatinine decrease was 14 +/- 2.9 days. The pre-IA panel reactive antibody reactivity (PRA) peaked at 50.2% +/- 6.1%, and was significantly reduced to 8.3% +/- 2.9% after IA. In four of six patients repeat allograft biopsy revealed a remission of AHR. With a mean follow-up of 18.8 +/- 5.46 months, patient and allograft survival are 100% and renal function remains stable with a mean serum creatinine of 1.2 +/- 0.22 mg/dL.

CONCLUSION

The optimal treatment for alloantibody-mediated AHR remains uncertain. Our findings suggest that a therapeutic approach combining IA and FK506-MMF rescue improves the outcome of AHR.

[T cell immunity analysis in children with obstructive sleep apnea syndrome]

OBJECTIVE

To probe into the possible impact on T cell immunity in children with obstructive sleep apnea syndrome (OSAS).

METHOD

Lymphocytes in peripheral blood vessel of children with OSAS vs normal controls were checked by APAAP method and analyzed statistically.

RESULT

The comparison with the controls showed that CD3+ had no significant difference (P>0.05), CD4+, CD4+/CD8+ were significantly lower, CD8+ was significantly higher in children with OSAS (P<0.01), and the analysis of the LSaO2 and period of history showed that the lower the LSaO2, and the longer the period of history, the more effect to CD4+, CD8+, CD3+/CD8+ (P<0.05).

CONCLUSION

T cell immunity are impaired in children with OSAS.

CD25+CD4+ regulatory T cells in patients with Kawasaki disease

OBJECTIVE

To investigate whether the CD25 + CD4 + regulatory T-cell population, which plays important roles not only in maintaining immunologic self-tolerance but also in controlling the magnitude and character of antimicrobial immune responses, is related to the pathophysiology of Kawasaki disease (KD).

STUDY DESIGN

The patient group consisted of 54 patients (median age, 30 months; 27 female and 27 male patients) fulfilling the criteria for KD. Age-matched control subjects included 17 patients with active infections and 24 healthy children. We analyzed CD25 + CD4 + cells and the mRNA expression of Foxp3, cytotoxic T lymphocyte-associated antigen 4 (CTLA4), glucocorticoid-induced tumor necrosis factor receptor (GITR), and transforming growth factor beta in peripheral blood mononuclear cells and purified CD4 + T cells.

RESULTS

The proportions of CD25 + CD4 + cells in patients with acute-phase KD (median, 2.35% of total lymphocytes) were significantly lower than those in healthy control subjects (median, 3.14%) and control subjects with disease (median, 3.15%). The proportions returned to the normal level after intravenous gammaglobulin treatment (median, 3.86%). The mRNA expression of Foxp3, CTLA4, and GITR showed similar tendencies.

CONCLUSIONS

The decrease of CD25 + CD4 + regulatory T cells in the acute phase might have a role in the development of KD.

The expansion of CD4+CD28- T cells in patients with chronic kidney graft rejection

CD4+CD28- T cells are oligoclonal lymphocytes rarely found in healthy subjects, but are present in high frequencies in patients with inflammatory diseases. Contrary to paradigm, they are functionally active and produce interferon gamma and cytolytic proteins, are cytotoxic in vessels and may contribute to tissue damage. The size of the peripheral blood CD4+CD28- T cell compartments was determined in 20 healthy individuals, 20 patients after renal transplantation with stable graft function, and 20 with chronic graft rejection by two-color FACS analysis. In patients with stable graft function, the median frequency of CD4+CD28- T cells was 3.1% and was significantly higher in comparison to the control group (1.4%) (P <.01). The highest subset CD4+CD28- cells was detected in patients with chronic graft rejection (10.65%). The amount of CD4+CD28- cells was significantly higher in this group in comparison to patients with stable graft function (P <.01). The evaluated number of CD4+CD28- cells in patients after renal transplantation, especially in graft recipients with chronic graft rejection, suggests a role of these cells in chronic graft destruction.

Expression of cell surface antigens in diabetic patients and healthy controls after injury

AIMS

Due to the systemic character of Type 2 diabetes, cellular disturbances paralleled by an altered expression of various growth factors constitute the basis for impaired wound healing. Cell-surface antigens are altered in chronic wounds and may also have an effect on the persistance of diabetic foot lesions.

METHODS

We investigated blood samples of diabetic patients with diabetic foot ulcers (n=21) in comparison with those from healthy control patients subsequent to an injury (n=9). A blood sample (EDTA) was taken from each participant (in the trauma control group on the third day after injury) and examined by flow cytometry [fluorescence-activated cell sorter (FACS)]. Typical cell surface antigens involved in wound healing were studied [cluster of differentiation (CD)2, CD3, CD4, CD25 and human leukocyte antigen (HLA)-diabetic retinopathy (DR)].

RESULTS

known to adversely affect wound healing were elevated in diabetic patients (CD2 p<0.001; CD3 p=0.016, CD4 p=0.22, CD25 p<0.001). HLA-DR expression was also decreased in diabetic foot patients (p=0.023).

CONCLUSIONS

Cell-surface antigens appear to be altered in diabetic patients when compared to healthy controls. Thus, due to the systemic character of Type 2 diabetes, cellular disturbances may well constitute the basis for impaired wound healing in diabetes.