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Jiang Y, Bao C, Zhao X, Chen Y, Song Y, Xiao Z. Intestinal bacteria flora changes in patients with Mycoplasma pneumoniae pneumonia with or without wheezing. Sci Rep 2022; 12:5683. [PMID: 35383237 PMCID: PMC8981890 DOI: 10.1038/s41598-022-09700-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 03/28/2022] [Indexed: 12/05/2022] Open
Abstract
Mycoplasma pneumoniae (MP) infection is a common cause of community-acquired pneumonia in children. Furthermore, many children with Mycoplasma pneumoniae pneumonia (MPP) have recurrent wheezing and reduced small airway function after their clinical symptoms have resolved, eventually leading to asthma. MPP can trigger immune disorders and systemic inflammatory responses. Hence, the intestine is the largest immune organ of the body. Therefore, we sought to investigate whether the alteration of intestinal flora is correlated with the development of wheezing in children with MPP. We collected 30 healthy children as group A, 50 children with nonwheezing MPP as group B, and 50 children with wheezing MPP as group C. We found that the percentage of eosinophil cells (EC) was significantly higher in group C than that in group B for routine blood tests and serum inflammatory factors. The serum cytokines, including IL-4, IL-17, TNF-α, and TGF-β, were significantly higher in group C than in group B. In addition, the level of IL-10 was significantly lower in group C than in group B. The distribution characteristics of intestinal flora strains in children with MPP were detected by sequencing of 16S rRNA gene amplicon sequencing. There were differences in the abundance of intestinal flora between children with MPP and healthy children, with lower abundance of Ruminococcus flavefaciens, Clostridium butyricum, Lactobacillus, and Bifidobacterium in the intestine of children with MPP compared to healthy children. The abundance of Ruminococcus flavefaciens and Clostridium butyricum was significantly lower in the intestine of children with wheezing MPP compared to children without wheezing MPP. In the correlation analysis between children with MPP and inflammatory factors, Ruminococcus flavefaciens was found to be negatively correlated with IL-17. Clostridium butyricum was negatively correlated with L-4, IL-17, TNF-α, and TGF-β; however, it positively correlated with IL-10. Thus, it was concluded that alterations in intestinal flora play a crucial role in the immune response to MPP, where a significant decline in intestinal Ruminococcus flavefaciens and Clostridium butyricum leads to an exacerbation of the inflammatory responses, which may promote the development of children with wheezing MPP.
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Affiliation(s)
- Yonghong Jiang
- Department of Paediatrics, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Xuhui District, Shanghai, 200032, China.
| | - Chunxiu Bao
- Department of Paediatrics, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Xuhui District, Shanghai, 200032, China
| | - Xiaoyang Zhao
- Department of Paediatrics, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Xuhui District, Shanghai, 200032, China
| | - Yiliu Chen
- Department of Paediatrics, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Xuhui District, Shanghai, 200032, China
| | - Yao Song
- Department of Paediatrics, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Xuhui District, Shanghai, 200032, China
| | - Zhen Xiao
- Department of Paediatrics, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Xuhui District, Shanghai, 200032, China.
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Jiang Y, Wang W, Zhang Z, Ma X, Sang Y, Wang J, Xu G, Feng Q, Zhao S. Serum amyloid a, C-reactive protein, and procalcitonin levels in children with Mycoplasma pneumoniae infection. J Clin Lab Anal 2022; 36:e24265. [PMID: 35148010 PMCID: PMC8906050 DOI: 10.1002/jcla.24265] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/12/2022] [Accepted: 01/15/2022] [Indexed: 12/16/2022] Open
Abstract
Background Mycoplasma pneumoniae (MP) is a common pathogen of community‐acquired pneumonia in children. In the present study, serum amyloid A (SAA), C‐reactive protein (CRP), and procalcitonin (PCT) levels in children with MP infection were analyzed and the differential diagnoses of MP evaluated. Methods The study included 152 children with MP infection hospitalized in Tai’an Central Hospital in Shandong Province and 50 healthy children as controls. SAA, CRP, and PCT, as well as serum immunoglobulins and T lymphocyte subsets were analyzed during the acute and convalescent phases. Among the MP‐infected children, 30 cases were selected to monitor the SAA, immunoglobulins, and T lymphocyte subset levels for a week. Results The SAA, CRP, PCT, IgA, and IgM levels were significantly higher in the MP‐infected group than in the control group (F(SAA) = 83.91, p < 0.05; F(CRP) = 40.79, p < 0.05; F(PCT) = 60.58, p < 0.05; F(IgA) = 43.45, p < 0.05; F(IgM) = 233.88, p < 0.05). In addition, the levels of these factors were significantly higher in the acute phase than in the convalescent phase (p < 0.05). However, significant difference was not observed in the IgG level between these two groups (p > 0.05). The CD3+ and CD4+ levels in the MP‐infected group were lower than in the control group ( F(CD3+)= 60.58, P < 0.05; F(CD4+) = 89.05, p < 0.05), and the CD8+ level was higher than in the control group ( F(CD8+)= 96.96, p < 0.05). The CD3+, CD4+, and CD8+ levels were significantly different between the acute phase and the convalescent phase (CD3+: acute phase vs. convalescent phase, q = 2.79, p < 0.05; CD4+: acute phase vs. convalescent phase, q = 2.83, p < 0.05; CD8+: acute phase vs. convalescent phase, q = 3.15, p < 0.05). The changes in serum SAA levels in the MP‐infected group positively correlated with the changes in IgA, IgM, and CD8+ levels and negatively correlated with CD3+, CD4+, and CD4+/CD8+. Conclusion SAA, CRP, and PCT were specific markers for diagnosing early MP infection in children. These findings are important in the differential diagnosis of MP infection and clinical guidance for MP treatment.
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Affiliation(s)
- Yuanyuan Jiang
- Department of Clinical Laboratory, Taian City Central Hospital, Shandong, China
| | - Wenyang Wang
- Department of Clinical Laboratory, Taian City Central Hospital, Shandong, China
| | - Zhijun Zhang
- Department of Clinical Laboratory, Taian City Central Hospital, Shandong, China
| | - Xianfen Ma
- Department of Clinical Laboratory, Taian City Central Hospital, Shandong, China
| | - Yanyan Sang
- Department of Clinical Laboratory, Taian City Central Hospital, Shandong, China
| | - Jin Wang
- Department of Clinical Laboratory, Taian City Central Hospital, Shandong, China
| | - Guoxiang Xu
- Shanghai Upper Bio Tech Pharma Co., Ltd, Shanghai, China.,Shanghai Engineering Research Center of iPOCT Medicine, Shanghai, China
| | - Qiang Feng
- Department of Clinical Laboratory, Taian City Central Hospital, Shandong, China
| | - Shuping Zhao
- Department of Clinical Laboratory, Taian City Central Hospital, Shandong, China
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Liu J, Shen R, Feng L, Cheng S, Chen J, Xiao T, Zhao S. Proteomics study of Mycoplasma pneumoniae pneumonia reveals the Fc fragment of the IgG-binding protein as a serum biomarker and implicates potential therapeutic targets. Front Med 2021; 16:378-388. [PMID: 34241785 DOI: 10.1007/s11684-021-0840-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/24/2020] [Indexed: 10/20/2022]
Abstract
Macrolide and corticosteroid resistance has been reported in patients with Mycoplasma pneumoniae (MP) pneumonia (MPP). MP clearance is difficult to achieve through antibiotic treatment in sensitive patients with severe MPP (SMPP). SMPP in children might progress to airway remodeling and even bronchiolitis/bronchitis obliterans. Therefore, identifying serum biomarkers that indicate MPP progression and exploring new targeted drugs for SMPP treatment require urgency. In this study, serum samples were collected from patients with general MPP (GMPP) and SMPP to conduct proteomics profiling. The Fc fragment of the IgG-binding protein (FCGBP) was identified as the most promising indicator of SMPP. Biological enrichment analysis indicated uncontrolled inflammation in SMPP. ELISA results proved that the FCGBP level in patients with SMPP was substantially higher than that in patients with GMPP. Furthermore, the FCGBP levels showed a decreasing trend in patients with GMPP but the opposite trend in patients with SMPP during disease progression. Connectivity map analyses identified 25 possible targeted drugs for SMPP treatment. Among them, a mechanistic target of rapamycin kinase (mTOR) inhibitor, which is a macrolide compound and a cell proliferation inhibitor, was the most promising candidate for targeting SMPP. To our knowledge, this study was the first proteomics-based characterization of patients with SMPP and GMPP.
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Affiliation(s)
- Jinrong Liu
- Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Rongfang Shen
- State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lin Feng
- State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shujun Cheng
- State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jun Chen
- Beijing Engineering Research Center of Pediatric Surgery, Engineering and Transformation Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| | - Ting Xiao
- State Key Laboratory of Molecular Oncology, Department of Etiology and Carcinogenesis, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Shunying Zhao
- Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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Kong K, Ding Y, Wu B, Lu M, Gu H. Clinical Predictors of Wheezing Among Children Infected With Mycoplasma Pneumoniae. Front Pediatr 2021; 9:693658. [PMID: 34631611 PMCID: PMC8492963 DOI: 10.3389/fped.2021.693658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Mycoplasma pneumoniae (MP) not only was a common pathogen of respiratory tract infections, but also could trigger the exacerbation of asthmatic symptoms in children with or without asthma. Objective: This study aimed to identify possible risk factors associated with wheezing among children diagnosed with MP infection. Methods: A retrospective analysis of medical records of children aged 28 days to 18 years old who visited the Shanghai Children's Hospital between January 2019 and January 2020 was carried out, and all children were then classified into three groups: two wheezing groups (with or without MP infection) and a non-wheezing group with MP infection. Information including patient's demographics, clinical features, laboratory data, and radiography findings was extracted from the electronic medical record system. Chest radiographs were reviewed independently by two board-certified, blinded pediatric radiologists. Results: A total of 1,512 patients were included in our study, and 21.9% of them belonged to the wheezing group without MP infection. Among 1,181 patients with MP infection, 295 people (25.0%) suffered from wheezing, and males accounted for 61%. Through the multivariable logistic regression analyses, we found that six variables were positively associated with wheezing attacks in children with MP infection: male gender (likelihood ratio [LR] = 2.124, 95% confidence interval [CI]: 1.478-3.053), history of allergy (LR= 3.301, 95% CI: 2.206-4.941), history of wheezing (LR = 7.808, 95% CI: 5.276-11.557), autumn in reference to summer (LR = 2.414, 95% CI: 1.500-3.885), non-end-point infiltration in reference to consolidation or pleural effusion (LR = 1.982, 95% CI: 1.348-2.914), and infiltration scope (LR = 1.773, 95% CI: 1.293-2.432). However, the model showed that the probability of wheezing after MP infection decreased as age increased (LR = 0.257, 95% CI: 0.196-0.337). Moreover, the area under the curve (AUC) of the regression model was as high as 0.901 (0.847-0.955). Conclusion: The model integrated with factors including gender, age, season, radiological patterns, infiltration scope, and history of allergy performed well in predicting wheezing attack after MP infection in children.
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Affiliation(s)
- Kaimeng Kong
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Ding
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Beirong Wu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Min Lu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Haoxiang Gu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Cytokine signatures associate with disease severity in children with Mycoplasma pneumoniae pneumonia. Sci Rep 2019; 9:17853. [PMID: 31780733 PMCID: PMC6882793 DOI: 10.1038/s41598-019-54313-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 11/01/2019] [Indexed: 02/08/2023] Open
Abstract
Host immune response may be involved in the pathogenesis of children Mycoplasma pneumoniae pneumonia (MPP). In the current study, we investigated the alterations of cytokines levels among control, mild MPP and severe MPP children to determine whether cytokine signatures associate with MPP and correlate with disease severity. We measured 13 cytokines in bronchoalveolar lavage fluid (BALF) of 88 children with MPP and 26 children with foreign body aspiration (FB) using a Luminex system. Linear discriminant analyses were performed to develop predictive models of mild MPP and severe MPP on these children. We observed nearly complete separations of severe MPP group, mild MPP group and control group in linear discriminant analyses. Eleven cytokines significantly increased in children with MPP, and seven cytokines had statistically significant upward linear trends correlated with MPP severity. In addition, compared to control group, both IFNγ/IL4 ratio and IFNγ/IL13 ratio increased in mild MPP and severe MPP groups. Our results suggest that children MPP can alter BALF cytokines signatures which associate with disease severity and can be characterized by a distinct airway molecular phenotype that has elevated Th1/Th2 ratios.
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Abstract
The airways are under continuous assault from aerosolized bacteria and oral flora. The bacteria present in the airways and gastrointestinal tract of neonates promote immune maturation and protect against asthma pathogenesis. Later bacterial infections and perturbations to the microbiome can contribute to asthma pathogenesis, persistence, and severity.
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Affiliation(s)
- Michael Insel
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of Arizona Health Sciences, University of Arizona College of Medicine - Tucson, 1501 North Campbell Avenue, PO Box 245017, Tucson, AZ 85724, USA
| | - Monica Kraft
- Department of Medicine, College of Medicine Tucson, Asthma and Airway Disease Research Center, University of Arizona Health Sciences, University of Arizona College of Medicine - Tucson, 1501 North Campbell Avenue, PO Box 245017, Tucson, AZ 85724, USA.
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7
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The influence of etiological factors on immunoreactivity in patients with community-acquired pneumonia. КЛИНИЧЕСКАЯ ПРАКТИКА 2018. [DOI: 10.17816/clinpract9447-54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to uncover the characteristics of immunoreactivity in patients with community-acquired pneumonia, depending on the pathogen. The inflammatory process caused by various pathogens, has its own characteristics and affects the course of the disease. The study of the mechanisms of these complex interactions can improve the understanding of the processes occurring in community-acquired pneumonia, and, therefore, develop individual approaches to the therapy depending on the etiological factor.
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8
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Pihan M, Keddie S, D'Sa S, Church AJ, Yong KL, Reilly MM, Lunn MP. Raised VEGF: High sensitivity and specificity in the diagnosis of POEMS syndrome. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 5:e486. [PMID: 30175160 PMCID: PMC6117193 DOI: 10.1212/nxi.0000000000000486] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/29/2018] [Indexed: 12/24/2022]
Abstract
Objective To investigate the sensitivity and the specificity of serum vascular endothelial growth factor (sVEGF) for the diagnosis of polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome in patients with a neuropathy (NP) and to identify confounding causes of raised vascular endothelial growth factor (VEGF) in this context to improve accuracy. Methods We studied the specificity and sensitivity of sVEGF for the diagnosis of POEMS syndrome in a cohort of 195 consecutive patients with an NP in serum samples from June 2009 to November 2013, including 27 untreated patients with POEMS syndrome. We then studied VEGF in other neuropathies and analyzed causes of elevated VEGF in a multiple logistic regression analysis in a larger cohort of 236 patients including 168 with a non-POEMS NP and 68 without NP. Results The sensitivity of elevated sVEGF for the diagnosis of POEMS was 100%. Its specificity was 91% in patients with an NP and 92% in patients with an NP and a paraproteinemia. sVEGF was much higher in POEMS before treatment. sVEGF was not significantly elevated in any non-POEMS NP or hematologic disease group. Multiple logistic regression showed that anemia with low iron was a significant predictor for elevated sVEGF and that chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea-hypopnoea syndrome were significant predictors for very elevated sVEGF. Interpretation We confirmed the high sensitivity and specificity of an elevated VEGF for the diagnosis of POEMS. However, VEGF testing should be repeated, particularly after acute illnesses. Raised sVEGF should be interpreted with caution unless anemias with low iron, sleep apnea, COPD, cancers, vasculitis, and chronic inflammatory diseases are excluded. Classification of evidence This study provides class IV evidence that elevated sVEGF levels accurately identifies patients with POEMS syndrome.
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Affiliation(s)
- Morgane Pihan
- MRC Centre for Neuromuscular Diseases (M.P., S.K., M.M.R., M.P.L.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Cancer Division (S.D., K.L.Y.), University College London Hospitals NHS Foundation Trust, London, UK; and Department of Neuroimmunology (A.J.C., M.P.L.), Institute of Neurology, Queen Square, London, UK
| | - Stephen Keddie
- MRC Centre for Neuromuscular Diseases (M.P., S.K., M.M.R., M.P.L.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Cancer Division (S.D., K.L.Y.), University College London Hospitals NHS Foundation Trust, London, UK; and Department of Neuroimmunology (A.J.C., M.P.L.), Institute of Neurology, Queen Square, London, UK
| | - Shirley D'Sa
- MRC Centre for Neuromuscular Diseases (M.P., S.K., M.M.R., M.P.L.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Cancer Division (S.D., K.L.Y.), University College London Hospitals NHS Foundation Trust, London, UK; and Department of Neuroimmunology (A.J.C., M.P.L.), Institute of Neurology, Queen Square, London, UK
| | - Andrew J Church
- MRC Centre for Neuromuscular Diseases (M.P., S.K., M.M.R., M.P.L.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Cancer Division (S.D., K.L.Y.), University College London Hospitals NHS Foundation Trust, London, UK; and Department of Neuroimmunology (A.J.C., M.P.L.), Institute of Neurology, Queen Square, London, UK
| | - Kwee L Yong
- MRC Centre for Neuromuscular Diseases (M.P., S.K., M.M.R., M.P.L.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Cancer Division (S.D., K.L.Y.), University College London Hospitals NHS Foundation Trust, London, UK; and Department of Neuroimmunology (A.J.C., M.P.L.), Institute of Neurology, Queen Square, London, UK
| | - Mary M Reilly
- MRC Centre for Neuromuscular Diseases (M.P., S.K., M.M.R., M.P.L.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Cancer Division (S.D., K.L.Y.), University College London Hospitals NHS Foundation Trust, London, UK; and Department of Neuroimmunology (A.J.C., M.P.L.), Institute of Neurology, Queen Square, London, UK
| | - Michael P Lunn
- MRC Centre for Neuromuscular Diseases (M.P., S.K., M.M.R., M.P.L.), National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Cancer Division (S.D., K.L.Y.), University College London Hospitals NHS Foundation Trust, London, UK; and Department of Neuroimmunology (A.J.C., M.P.L.), Institute of Neurology, Queen Square, London, UK
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Ye Q, Mao JH, Shu Q, Shang SQ. Mycoplasma pneumoniae induces allergy by producing P1-specific immunoglobulin E. Ann Allergy Asthma Immunol 2018; 121:90-97. [PMID: 29555351 DOI: 10.1016/j.anai.2018.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/01/2018] [Accepted: 03/12/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Our previous study found that most Mycoplasma pneumoniae (MP) pneumonia (MPP)patients had elevated serum total immunoglobulin E (IgE) levels. OBJECTIVE To determine components of MP that can cause an IgE increase in children, and to clarify its specific mechanism. METHODS The components of MP cells were isolated by serum IgE from patients with MP pneumonia. These components obtained through the prokaryotic expression were used as allergens to detect the proportion of allergen-specific IgE produced in MPP patients, and the clinical characteristics and related immune parameters of these patients who produced this allergen-specific IgE were also analyzed. In addition, a cell experiment was used to verify the biological effect of these components in vitro. RESULTS P1-specific IgE was detected in serum of MPP children. An approximately 24-kDa polypeptide of P1 protein was obtained through prokaryotic expression purified by nickel agarose affinity chromatography. Approximately 9.2% of MPP patients produced IgE against this polypeptide of P1 protein, which was more likely to be produced in MPP patients with no history of allergies or family history of allergy-related diseases. P1-specific IgE-positive MPP patients had more severe clinical symptoms, with excessive secretion of interleukin (IL)-4 and IL-5 and overdifferentiation of Th0 cells into Th2 cells. Tests also demonstrated that the P1 protein stimulated excessive secretion of IL-4 and IL-5 in peripheral blood mononuclear cells from the peripheral blood of healthy donors. CONCLUSION Mycoplasma pneumoniae is not only an infectious agent but also an allergen for certain individuals. The P1 protein of MP can induce the production of P1-specific IgE.
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Affiliation(s)
- Qing Ye
- Zhejiang Key Laboratory for Neonatal Diseases, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
| | - Jian-Hua Mao
- Zhejiang Key Laboratory for Neonatal Diseases, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Qiang Shu
- Zhejiang Key Laboratory for Neonatal Diseases, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Shi-Qiang Shang
- Zhejiang Key Laboratory for Neonatal Diseases, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
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10
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Medjo B, Atanaskovic-Markovic M, Nikolic D, Radic S, Lazarevic I, Cirkovic I, Djukic S. Increased Serum Interleukin-10 but not Interleukin-4 Level in Children with Mycoplasma pneumoniae Pneumonia. J Trop Pediatr 2017; 63:294-300. [PMID: 28057814 DOI: 10.1093/tropej/fmw091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mycoplasma pneumoniae (MP) is a common cause of community-acquired pneumonia in children, and it has been associated with wheezing. The aim of this study was to examine the serum level of interleukin (IL)-4 and IL-10 in children with Mycoplasma pneumoniae pneumonia (MPP) and to analyse them in relation to the presence of wheezing. METHODS The study included 166 children with radiologically confirmed pneumonia. MP infection was confirmed by enzyme-linked immunosorbent assay (ELISA) serum MP-IgM and MP-IgG test and throat swab MP DNA with real-time polymerase chain reaction. Serum levels of IL-4 and IL-10 were measured using ELISA. RESULTS There was no significant difference in serum level of IL-4 between children with MPP and those with non-MPP. Among children with MPP, we found similar level of IL-4 regardless of the personal and family history of allergy and asthma or the presence of wheezing. A significantly higher level of IL-10 was found in children with MPP than in children with non-MPP (32.92±18.582 vs. 27.01±14.100 pg/ml, p =0.022). Furthermore, wheezing children with MPP had a significantly higher level of IL-10 than children with MPP without wheezing (43.75±26.644 vs. 27.50±10.211 pg/ml, p=0.027). CONCLUSION Our results show significantly increased serum level of IL-10 in children with MPP, which was significantly higher in children with wheezing. These findings may suggest a role of IL-10 in the pathogenesis of MPP and in the occurrence of wheezing during acute MP infection.
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Affiliation(s)
- Biljana Medjo
- Pediatric Intensive Care Unit, University Children's Hospital, Belgrade 11 000, Serbia.,Medical Faculty, University of Belgrade, Belgrade 11 000, Serbia
| | - Marina Atanaskovic-Markovic
- Medical Faculty, University of Belgrade, Belgrade 11 000, Serbia.,Department of Pulmonology and Allergology, University Children's Hospital, Belgrade 11 000, Serbia
| | - Dimitrije Nikolic
- Medical Faculty, University of Belgrade, Belgrade 11 000, Serbia.,Department of Neurology, University Children's Hospital, Belgrade 11 000, Serbia
| | - Snezana Radic
- Children's Hospital for Respiratory Diseases and TB, Clinical Health Center 'Dr Dragisa Misovic-Dedinje', Belgrade 11 000, Serbia
| | - Ivana Lazarevic
- Institute of Microbiology, Medical Faculty, University of Belgrade, Belgrade 11 000, Serbia
| | - Ivana Cirkovic
- Institute of Microbiology, Medical Faculty, University of Belgrade, Belgrade 11 000, Serbia
| | - Slobodanka Djukic
- Institute of Microbiology, Medical Faculty, University of Belgrade, Belgrade 11 000, Serbia
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11
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Serum cytokine profile contributes to discriminating M. pneumoniae pneumonia in children. Cytokine 2016; 86:73-78. [DOI: 10.1016/j.cyto.2016.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 07/14/2016] [Accepted: 07/24/2016] [Indexed: 01/18/2023]
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12
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Host-directed therapies for antimicrobial resistant respiratory tract infections. Curr Opin Pulm Med 2016; 22:203-11. [DOI: 10.1097/mcp.0000000000000271] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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13
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Wu SH, Chen XQ, Kong X, Yin PL, Dong L, Liao PY, Wu JM. Characteristics of respiratory syncytial virus-induced bronchiolitis co-infection with Mycoplasma pneumoniae and add-on therapy with montelukast. World J Pediatr 2016; 12:88-95. [PMID: 25846070 DOI: 10.1007/s12519-015-0024-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/26/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND The influence of Mycoplasma pneumoniae (MP) infection on bronchiolitis remains unclear. Additionally, reports on the efficacies of leukotriene receptor antagonists in the treatment of bronchiolitis have been inconclusive. METHODS Children with respiratory syncytial virus (RSV)-induced bronchiolitis were divided into two groups: RSV+MP group and RSV group. Each group was randomly divided into two subgroups: one received routine and placebo treatment, while the other received routine and montelukast treatment for 9 months. The cumulative numbers of wheezing episodes and recurrent respiratory tract infections were recorded. Blood parameters were determined. RESULTS Patients in the RSV+MP group exhibited an older average age, fever, more frequent flaky and patchy shadows in chest X-rays, more frequent extrapulmonary manifestations, and longer hospital stays compared with patients in the RSV group. Additionally, higher baseline blood eosinophil counts, eosinophil cationic protein (ECP), total immunoglobulin E (IgE), interleukin (IL)-4, IL-5, IL-4/interferon-γ ratios, leukotriene (LT) B4, and LTC4, and lower baseline lipoxin A4 (LXA4)/LTB4 ratios were observed in the RSV+MP group compared with the RSV group. Montelukast treatment decreased the cumulative numbers of recurrent wheezing episodes and recurrent respiratory tract infections at 9 and 12 months. This efficacy may be related to the montelukast-induced reductions in peripheral eosinophil counts, ECP and total IgE, as well as the montelukast-dependent recovery in T helper (Th) 1/Th2 balance and LXA4/LTB4 ratios in children with bronchiolitis. CONCLUSIONS RSV bronchiolitis with MP infection was associated with clinical and laboratory features that differed from those of RSV bronchiolitis without MP infection. Add-on therapy with montelukast for 9 months was beneficial for children with bronchiolitis at 9 and 12 months after the initiation of treatment.
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Affiliation(s)
- Sheng-Hua Wu
- Department of Pediatrics, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| | - Xiao-Qing Chen
- Department of Pediatrics, Jiangsu Maternity and Children Healthcare Hospital, Nanjing, 210036, China
| | - Xia Kong
- Department of Pediatrics, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, 210006, China
| | - Pei-Ling Yin
- Department of Pediatrics, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, 210006, China
| | - Ling Dong
- Department of Pediatrics, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Pei-Yuan Liao
- Department of Pediatrics, Central Hospital of Tengzhou, Tengzhou, 277500, China
| | - Jia-Ming Wu
- Department of Pediatrics, Qidong People's Hospital, 753 Central Jianghai Road, Qidong, 226200, China
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14
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Esposito S, Patria MF, Spena S, Codecà C, Tagliabue C, Zampiero A, Lelii M, Montinaro V, Pelucchi C, Principi N. Impact of genetic polymorphisms on paediatric atopic dermatitis. Int J Immunopathol Pharmacol 2015; 28:286-95. [DOI: 10.1177/0394632015591997] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In order to investigate whether polymorphisms of genes encoding some factors of innate and adaptive immunity play a role in the development of, or protection against atopic dermatitis (AD) and condition its severity, we genotyped 33 candidate genes and 47 single nucleotide polymorphisms (SNPs) using Custom TaqMan Array Microfluidic Cards and an ABI 7900HT analyser (Applied Biosystems, Foster City, CA, USA). The study involved 104 children with AD (29 with mild-to-moderate and 75 with severe disease; 42 girls; mean age ± SD, 5.8 ± 3.3 years) and 119 healthy controls (49 girls; mean age, 4.8 ± 3.0 years). IL10-rs1800872T, TG and MBL2-rs500737AG were all significantly more frequent among the children with AD ( P = 0.015, P = 0.004 and P = 0.030), whereas IL10-rs1800896C and TC were more frequent in those without AD ( P = 0.028 and P = 0.032). The VEGFA-rs2146326A and CTLA4-rs3087243AG SNPs were significantly more frequent in the children with mild/moderate AD than in those with severe AD ( P = 0.048 and P = 0.036). IL10-rs1800872T and TG were significantly more frequent in the children with AD and other allergic diseases than in the controls ( P = 0.014 and P = 0.007), whereas IL10-rs1800896TC and C were more frequent in the controls than in the children with AD and other allergic diseases ( P = 0.0055 and P = 0.0034). These findings show that some of the polymorphisms involved in the immune response are also involved in some aspects of the development and course of AD and, although not conclusive, support the immunological hypothesis of the origin of the inflammatory lesions.
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Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Francesca Patria
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Spena
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudio Codecà
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Tagliabue
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Zampiero
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mara Lelii
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Montinaro
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudio Pelucchi
- Department of Epidemiology, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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15
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Esposito S, Ierardi V, Daleno C, Scala A, Terranova L, Tagliabue C, Rios WP, Pelucchi C, Principi N. Genetic polymorphisms and risk of recurrent wheezing in pediatric age. BMC Pulm Med 2014; 14:162. [PMID: 25326706 PMCID: PMC4210469 DOI: 10.1186/1471-2466-14-162] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 09/22/2014] [Indexed: 12/30/2022] Open
Abstract
Background Wheezing during early life is a very common disorder, but the reasons underlying the different wheezing phenotypes are still unclear. The aims of this study were to analyse the potential correlations between the risk of developing recurrent wheezing and the presence of specific polymorphisms of some genes regulating immune system function, and to study the relative importance of the associations of different viruses and genetic polymorphisms in causing recurrent episodes. Methods The study involved 119 otherwise healthy infants admitted to hospital for a first episode of wheezing (74 of whom subsequently experienced recurrent episodes) and 119 age- and sex-matched subjects without any history of respiratory problem randomly selected from those attending our outpatient clinic during the study period. All of the study subjects were followed up for two years, and 47 single nucleotide polymorphisms (SNPs) in 33 candidate genes were genotyped on whole blood using an ABI PRISM 7900 HT Fast Real-time instrument. Results IL8-rs4073AT, VEGFA-rs833058CT, MBL2-rs1800450CT and IKBKB-rs3747811AT were associated with a significantly increased risk of developing wheezing (p = 0.02, p = 0.03, p = 0.05 and p = 0.0018), whereas CTLA4-rs3087243AG and NFKBIB-rs3136641TT were associated with a significantly reduced risk (p = 0.05 and p = 0.04). IL8-rs4073AT, VEGFA-rs2146323AA and NFKBIA-rs2233419AG were associated with a significantly increased risk of developing recurrent wheezing (p = 0.04, p = 0.04 and p = 0.03), whereas TLR3-rs3775291TC was associated with a significantly reduced risk (p = 0.03). Interestingly, the study of gene-environment interactions showed that rhinovirus was significantly associated with recurrent wheezing in the presence of IL4Ra-rs1801275GG and G (odds ratio [OR] 6.03, 95% confidence interval [CI]: 1.21-30.10, p = 0.03) and MAP3K1-rs702689AA (OR 4.09, 95% CI: 1.14-14.61, p = 0.03). Conclusions This study shows a clear relationship between the risk of wheezing and polymorphisms of some genes involved in the immune response. Although further studies are needed to confirm the results, these findings may be useful for the early identification of children at the highest risk of developing recurrent episodes and possibly subsequent asthma.
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Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy.
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16
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Kim JH, Cho TS, Moon JH, Kim CR, Oh JW. Serial Changes in Serum Eosinophil-associated Mediators between Atopic and Non-atopic Children after Mycoplasma pneumoniae pneumonia. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2014; 6:428-33. [PMID: 25229000 PMCID: PMC4161684 DOI: 10.4168/aair.2014.6.5.428] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 11/27/2013] [Accepted: 01/06/2014] [Indexed: 01/22/2023]
Abstract
Purpose Mycoplasma pneumoniae pneumonia (MP) is associated with the exacerbation, timing, and onset of asthma. The goal of this study was to elucidate the impact of MP on eosinophil-related hyper-reactive amplification in atopic children. Methods We studied 48 patients with MP (26 atopic, 22 non-atopic), between 3 and 12 years of age. Serial changes in blood eosinophil counts, serum interleukin-5 (IL-5), and serum eosinophil cationic protein (ECP) levels were measured in atopic and non-atopic children with MP upon admission, recovery, and at 2 months post-recovery. Serum IL-5 and ECP levels were measured by enzyme-linked immunosorbent assays; eosinophil counts were measured using an autoanalyzer. Results Serial changes in serum IL-5, ECP, and total eosinophil counts were significantly higher in atopic patients, relative to non-atopic controls (P≤0.001). Serum IL-5 and ECP levels were significantly higher in atopic patients at all three time points tested, while eosinophil counts were higher in the clinical recovery and follow-up phases, but not in the acute phase. Furthermore, among atopic patients, serum ECP levels were significantly higher in the recovery and follow-up phases than in the acute phase. Conclusions The present study demonstrated significant differences in eosinophil counts, serum IL-5, and serum ECP levels between atopic and non-atopic children with MP at admission, recovery, and 2 months after clinical recovery. These outcomes are suggestive of eosinophil-related hyperreactivity in atopic children, with this status maintained for at least 2 months after MP.
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Affiliation(s)
- Joo-Hwa Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Tae-Shik Cho
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Jin-Hwa Moon
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Chang-Ryul Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Jae-Won Oh
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
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17
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van de Kant KDG, Klaassen EMM, van Aerde KJ, Damoiseaux J, Bruggeman CA, Stelma FF, Stobberingh EE, Muris JWM, Jöbsis Q, van Schayck OCP, Dompeling E. Impact of bacterial colonization on exhaled inflammatory markers in wheezing preschool children. J Breath Res 2012; 6:046001. [PMID: 22990010 DOI: 10.1088/1752-7155/6/4/046001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Wheeze is a common symptom in preschool children. The role of bacteria, regulatory T (T(reg)) cells and their association with airway inflammation in preschool wheeze is largely unknown. We evaluated inflammatory markers in exhaled breath condensate (EBC), bacterial colonization and circulating T(reg) cells in preschool children with and without recurrent wheeze. We recruited 252 children (aged two to four years) with (N = 202) and without (N = 50) recurrent wheeze. EBC was collected using an efficient closed glass condenser. Inflammatory markers in EBC (Interleukin(IL)-2, IL-4, IL-8, IL-10, IL-13) were assessed using multiplex immunoassay. Nasal and throat swabs were analysed for presence of Streptococcus pneumoniae, Haemophilus (para)influenzae and Staphylococcus aureus. Proportions of T(reg) cells (CD4(+)CD25(high)CD127(-)) were quantified by flow cytometry. Recurrent wheezing children had elevated EBC levels of IL-2, IL-4, IL-10 and IL-13 compared to non-wheezers (odds ratio (95% confidence interval): 1.67 (1.23-2.27): 1.58 (1.15-2.18): 1.47 (1.14-1.90): 1.55 (1.16-2.06), p <0.05, respectively). Bacteria were frequently present in children with and without wheeze, with no difference in prevalence (16-52% versus 16-50%, respectively). Moreover, the proportion of T(reg) cells did not differ between both groups. Wheezing children with bacterial colonization did not significantly differ in exhaled levels of inflammatory markers or proportion of T(reg) cells compared to wheezing children without colonization. The analysis of EBC might serve as a helpful non-invasive tool to early assess airway inflammation in wheezing children. The various elevated exhaled inflammatory markers indicate increased airway inflammation in wheezing preschool children. In the presence of wheeze, we found no evidence for bacterial induced airway inflammation.
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Affiliation(s)
- Kim D G van de Kant
- Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC), PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
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18
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Jeong YC, Yeo MS, Kim JH, Lee HB, Oh JW. Mycoplasma pneumoniae Infection Affects the Serum Levels of Vascular Endothelial Growth Factor and Interleukin-5 in Atopic Children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2011; 4:92-7. [PMID: 22379604 PMCID: PMC3283799 DOI: 10.4168/aair.2012.4.2.92] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 10/11/2011] [Accepted: 10/25/2011] [Indexed: 12/16/2022]
Abstract
PURPOSE Previous studies have outlined mechanisms by which Mycoplasma pneumonia (M. pneumonia) infection may promote allergic lung inflammation and airway remodeling, and increasing evidence from human studies suggests that atypical bacterial infections contribute to asthma exacerbation, chronic asthma, and disease severity with changes in cytokine expression. The present study evaluated changes in serum levels of vascular endothelial growth factor (VEGF) and interleukin (IL)-5 in atopic children with Mycoplasma pneumoniae pneumonia. METHODS We recruited a total of 72 children with pneumonia. The patients were divided into 4 groups: atopic children with M. pneumonia pneumonia (group I, n=24), non-atopic children with M. pneumonia pneumonia (group II, n=23), atopic children with viral pneumonia (group III, n=13), and non-atopic children with viral pneumonia (group IV, n=12). Serum levels of IL-5, IL-13, VEGF, and tumor necrosis factor-α were measured at admission and at recovery using enzyme-linked immunosorbent assays. RESULTS Serum levels of VEGF and IL-5 were elevated in group I compared with the other groups at both admission phase and clinical recovery phase. In group I, serum levels of VEGF and IL-5 were higher at recovery phase than at admission phase (VEGF: 1,102.2±569.4 vs. 874.9±589.9 pg/mL, respectively; IL-5: 150.5±63.9 vs. 120.2±46.7 pg/mL, respectively). CONCLUSIONS The serum levels of VEGF and IL-5 were more increased in atopic children with M. pneumonia pneumonia than in the other groups. In this group, the serum levels of VEGF and IL-5 were more increased at recovery phase than at admission phase. The results of this study suggest that increases in VEGF and IL-5 may contribute to the development of hypersensitivity during M. pneumonia infection. These cytokines may act through their respective pro-inflammatory pathways to aggravate the allergic status and induce airway hypersensitivity during M. pneumonia pneumonia in atopic children.
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Affiliation(s)
- You-Cheol Jeong
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
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Soto-Martinez ME, Hoepker A, Soto-Quiros M. Wheezing and pneumonia: a complex relationship. Allergol Immunopathol (Madr) 2010; 38:1-3. [PMID: 20022158 DOI: 10.1016/j.aller.2009.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 10/30/2009] [Indexed: 11/19/2022]
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