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Abel-Fernández E, Fernández-Caldas E. Allergy to fungi: Advances in the understanding of fungal allergens. Mol Immunol 2023; 163:216-223. [PMID: 37864931 DOI: 10.1016/j.molimm.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 10/23/2023]
Abstract
Allergic diseases are a major health problem due to their increasing incidence and high prevalence worldwide. Asthma has several aetiologies, and allergy plays an important role in its development in approximately 60% of adults and 80% of children and adolescents. Although the link between aeroallergen sensitization and asthma exacerbations has been long recognized, the investigations of the triggering allergens may be superficial in many asthma cases. The main allergenic sources related to asthma, and other allergic diseases, are pollens, mites, fungi, and animal epithelia. Fungi are considered the third most frequent cause of respiratory pathologies. Asthma caused by several fungi species may have a bad prognosis in some cases due to its severity and difficulty in avoidance methods. Despite the recognised relevance of fungi in respiratory allergies, the knowledge about fungal allergens seems to be scarce, with few descriptions of new allergens, compared to other allergenic sources. The study of major, minor, and cross-reactive fungal allergens, and their relevance in the allergic disease, might be crucial, not only to accurately diagnose these allergies, but also to predict exacerbations and responses to therapies, as well as for the development of personalized treatment plans in a fast-changing climate scenario.
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Abel-Fernández E, Martínez MJ, Galán T, Pineda F. Going over Fungal Allergy: Alternaria alternata and Its Allergens. J Fungi (Basel) 2023; 9:jof9050582. [PMID: 37233293 DOI: 10.3390/jof9050582] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
Fungal allergy is the third most frequent cause of respiratory pathologies and the most related to a poor prognosis of asthma. The genera Alternaria and Cladosporium are the most frequently associated with allergic respiratory diseases, with Alternaria being the one with the highest prevalence of sensitization. Alternaria alternata is an outdoor fungus whose spores disseminate in warm and dry air, reaching peak levels in temperate summers. Alternaria can also be found in damp and insufficiently ventilated houses, causing what is known as sick building syndrome. Thus, exposure to fungal allergens can occur outdoors and indoors. However, not only spores but also fungal fragments contain detectable amounts of allergens and may function as aeroallergenic sources. Allergenic extracts of Alternaria hyphae and spores are still in use for the diagnosis and treatment of allergic diseases but are variable and insufficiently standardised, as they are often a random mixture of allergenic ingredients and casual impurities. Thus, diagnosis of fungal allergy has been difficult, and knowledge about new fungal allergens is stuck. The number of allergens described in Fungi remains almost constant while new allergens are being found in the Plantae and Animalia kingdoms. Given Alt a 1 is not the unique Alternaria allergen eliciting allergy symptoms, component-resolved diagnosis strategies should be applied to diagnose fungal allergy. To date, twelve A. alternata allergens are accepted in the WHO/IUIS Allergen Nomenclature Subcommittee, many of them are enzymes: Alt a 4 (disulfide isomerase), Alt a 6 (enolase), Alt a 8 (mannitol de-hydrogenase), Alt a 10 (aldehyde dehydrogenase), Alt a 13 (glutathione-S-transferase) and Alt a MnSOD (Mn superoxide dismutase), and others have structural and regulatory functions such as Alt a 5 and Alt a 12, Alt a 3, Alt a 7. The function of Alt a 1 and Alt a 9 remains unknown. Other four allergens are included in other medical databases (e.g., Allergome): Alt a NTF2, Alt a TCTP, and Alt a 70 kDa. Despite Alt a 1 being the A. alternata major allergen, other allergens, such as enolase, Alt a 6 or MnSOD, Alt a 14 have been suggested to be included in the diagnosis panel of fungal allergy.
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Affiliation(s)
- Eva Abel-Fernández
- Applied Science, Inmunotek S.L., Parque Científico Tecnológico Alcalá de Henares, 28805 Madrid, Spain
| | - María José Martínez
- Applied Science, Inmunotek S.L., Parque Científico Tecnológico Alcalá de Henares, 28805 Madrid, Spain
| | - Tania Galán
- Applied Science, Inmunotek S.L., Parque Científico Tecnológico Alcalá de Henares, 28805 Madrid, Spain
| | - Fernando Pineda
- Applied Science, Inmunotek S.L., Parque Científico Tecnológico Alcalá de Henares, 28805 Madrid, Spain
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3
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Vashisht S, Singh N, Sharma A, Saini N, Gaur SN, Arora N. In silico tools to assess the potential allergenicity of shiitake mushrooms (Lentinula edodes). JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2023; 103:877-890. [PMID: 36057923 DOI: 10.1002/jsfa.12199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 08/05/2022] [Accepted: 09/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Computational tools may have an edge over conventional methods for the preliminary evaluation of food allergenicity. In this study, the allergenic potential of Lentinula edodes was evaluated and validated using in silico tools. RESULTS The potential cross-reactivity of mushroom proteins with fungal allergens was determined using sequence alignment - the Fast Alignment (FASTA) and Basic Local Alignment Search Tool (BLAST) algorithm. Eight L. edodes proteins were cross-reactive with allergens from fungal origin, showing 52%-89% sequence identity using FASTA algorithm-based alignment. The BLAST data were corroborated by percentage identity and query coverage. Physico-chemical property-based allergenicity was deciphered by AlgPred, Allermatch, and AllergenFP software, which predicted six out of eight proteins as potential allergens. Sequence alignment showed 66%-86% conservancy between mushroom protein and known fungal allergens. Secondary structure and amino acid composition supported structural affinity between query and fungal proteins. Three-dimensional structures of five mushroom proteins were generated, quality assessed, and superimposed with fungal allergens, suggesting possible allergenicity of mushroom proteins. An enzyme-linked immunosorbent assay (ELISA) demonstrated immunoglobulin E (IgE) binding in 13 out of 21 food-hypersensitive patients' sera. CONCLUSION In silico tools provide preliminary indications about the potential allergenicity and cross-reactivity of mushroom proteins. This approach may be used for the prelusive allergenicity assessment of allergen sources. © 2022 Society of Chemical Industry.
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Affiliation(s)
- Srishti Vashisht
- Allergy and Immunology Section, CSIR-Institute of Genomicsand Integrative Biology, Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Naresh Singh
- Allergy and Immunology Section, CSIR-Institute of Genomicsand Integrative Biology, Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Akansha Sharma
- Allergy and Immunology Section, CSIR-Institute of Genomicsand Integrative Biology, Delhi, India
| | - Neeru Saini
- Allergy and Immunology Section, CSIR-Institute of Genomicsand Integrative Biology, Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Shailendra Nath Gaur
- Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Naveen Arora
- Allergy and Immunology Section, CSIR-Institute of Genomicsand Integrative Biology, Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
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Goshua A, Sampath V, Efobi JA, Nadeau K. The Role of Climate Change in Asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1426:25-41. [PMID: 37464115 DOI: 10.1007/978-3-031-32259-4_2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Human activity and increased use of fossil fuels have led to climate change. These changes are adversely affecting human health, including increasing the risk of developing asthma. Global temperatures are predicted to increase in the future. In 2019, asthma affected an estimated 262 million people and caused 455,000 deaths. These rates are expected to increase. Climate change by intensifying climate events such as drought, flooding, wildfires, sand storms, and thunderstorms has led to increases in air pollution, pollen season length, pollen and mold concentration, and allergenicity of pollen. These effects bear implications for the onset, exacerbation, and management of childhood asthma and are increasing health inequities. Global efforts to mitigate the effects of climate change are urgently needed with the goal of limiting global warming to between 1.5 and 2.0 °C of preindustrial times as per the 2015 Paris Agreement. Clinicians need to take an active role in these efforts in order to prevent further increases in asthma prevalence. There is a role for clinician advocacy in both the clinical setting as well as in local, regional, and national settings to install measures to control and curb the escalating disease burden of childhood asthma in the setting of climate change.
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Affiliation(s)
- Anna Goshua
- Stanford School of Medicine, Stanford, CA, USA
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Palo Alto, CA, USA
| | - Jo Ann Efobi
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Palo Alto, CA, USA
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Palo Alto, CA, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA, USA
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Xu YX, Shen HW, Bao DF, Luo ZL, Su HY, Hao YE. Two new species of Cladosporium from leaf spots of Parispolyphylla in north-western Yunnan Province, China. Biodivers Data J 2021; 9:e77224. [PMID: 34984042 PMCID: PMC8718519 DOI: 10.3897/bdj.9.e77224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND During the survey of pathogenic fungi on medicinal plant leaves in Yunnan Province, China, two Cladosporium-like taxa were isolated from leaf spots of Parispolyphylla. Based on morphological characteristics and phylogenetic analysis of combined ITS, TEF1-α and ACT genes, two new species were discovered. NEW INFORMATION Two new species Cladosporiumyunnanensis and C.paris are introduced, the detailed descriptions and illustrations are provided. Morphology of the two new species is compared with other related Cladosporium species. This study widens the host diversity of the genus Cladosporium.
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Affiliation(s)
- Yue-Xin Xu
- College of Public Health, University of South China, Hengyang, ChinaCollege of Public Health, University of South ChinaHengyangChina
- College of Agriculture and Biological Sciences, Dali University, Dali, ChinaCollege of Agriculture and Biological Sciences, Dali UniversityDaliChina
| | - Hong-Wei Shen
- College of Agriculture and Biological Sciences, Dali University, Dali, ChinaCollege of Agriculture and Biological Sciences, Dali UniversityDaliChina
- Center of Excellence in Fungal Research, Mae Fah Luang University, Chiang Rai, ThailandCenter of Excellence in Fungal Research, Mae Fah Luang UniversityChiang RaiThailand
- School of Science, Mae Fah Luang University, Chiang Rai, ThailandSchool of Science, Mae Fah Luang UniversityChiang RaiThailand
| | - Dan-Feng Bao
- College of Agriculture and Biological Sciences, Dali University, Dali, ChinaCollege of Agriculture and Biological Sciences, Dali UniversityDaliChina
- Center of Excellence in Fungal Research, Mae Fah Luang University, Chiang Rai, ThailandCenter of Excellence in Fungal Research, Mae Fah Luang UniversityChiang RaiThailand
- Department of Entomology and Plant Pathology, Faculty of Agriculture, Chiang Mai University, Chiang Mai, ThailandDepartment of Entomology and Plant Pathology, Faculty of Agriculture, Chiang Mai UniversityChiang MaiThailand
| | - Zong-Long Luo
- College of Agriculture and Biological Sciences, Dali University, Dali, ChinaCollege of Agriculture and Biological Sciences, Dali UniversityDaliChina
| | - Hong-Yan Su
- College of Agriculture and Biological Sciences, Dali University, Dali, ChinaCollege of Agriculture and Biological Sciences, Dali UniversityDaliChina
| | - Yu-E Hao
- College of Public Health, University of South China, Hengyang, ChinaCollege of Public Health, University of South ChinaHengyangChina
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Sánchez Espinosa KC, Rojas Flores TI, Davydenko SR, Venero Fernández SJ, Almaguer M. Fungal populations in the bedroom dust of children in Havana, Cuba, and its relationship with environmental conditions. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:53010-53020. [PMID: 34021890 DOI: 10.1007/s11356-021-14231-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
The study of the fungal community composition in house dust is useful to assess the accumulative exposure to fungi in indoor environments. The objective of this research was to characterize the fungal diversity of house dust and its association with the environmental conditions of bedrooms. For this, the dust was collected from 41 bedrooms of children between the ages of 8 and 9 with a family history of asthma, residents of Havana, Cuba. The fungal content of each sample was determined by two methods: plate culture with malt extract agar and by direct microscopy. An ecological analysis was carried out from the fungal diversity detected. To describe the factors associated with the fungi detected, bivariate logistic regression was used. Through direct microscopy, between 10 and 2311 fragments of hyphae and spores corresponding mainly to Cladosporium, Coprinus, Curvularia, Aspergillus/Penicillium, Xylariaceae, and Periconia were identified. Through the culture, 0-208 CFU were quantified, where Aspergillus, Cladosporium, and Penicillium predominated. The culturability evidenced the differences between the quantification determined by both methods. A positive relationship was found between the type of cleaning of the furniture, the presence of trees in front of the bedroom, indoor relative humidity, indoor temperature, the presence of air conditioning, and natural ventilation with specific spore types and genera. The use of two different identification methods allowed to detect a greater fungal diversity in the residences evaluated. Monitoring the exposure to these fungal allergens in childhood can help to prevent sensitization in the allergic child, the development of asthma, and other respiratory diseases.
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Affiliation(s)
- Kenia C Sánchez Espinosa
- Department of Microbiology and Virology, Faculty of Biology, University of Havana, 25 n. 455 e/I & J, Vedado, 10400, Havana, Cuba
| | - Teresa I Rojas Flores
- Department of Microbiology and Virology, Faculty of Biology, University of Havana, 25 n. 455 e/I & J, Vedado, 10400, Havana, Cuba
| | - Sonia Rodríguez Davydenko
- Department of Microbiology and Virology, Faculty of Biology, University of Havana, 25 n. 455 e/I & J, Vedado, 10400, Havana, Cuba
| | - Silvia J Venero Fernández
- National Institute of Hygiene, Epidemiology and Microbiology, Infanta n. 1158 e/Llinás & Clavel, Cerro, 10300, Havana, Cuba
| | - Michel Almaguer
- Department of Microbiology and Virology, Faculty of Biology, University of Havana, 25 n. 455 e/I & J, Vedado, 10400, Havana, Cuba.
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Wei DJ, Liu WT, Chin HT, Lin CH, Chen IC, Chang YT. An Investigation of Airborne Bioaerosols and Endotoxins Present in Indoor Traditional Wet Markets before and after Operation in Taiwan: A Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062945. [PMID: 33805646 PMCID: PMC7999578 DOI: 10.3390/ijerph18062945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 12/17/2022]
Abstract
Customers in Taiwan prefer to purchase fresh foods and household supplies at indoor traditional wet markets (TWMs). The health risk to indoor TWM staff exposed to bioaerosols needs to be evaluated, since these workers spend long periods of time in the market for stall preparation, selling, and stall cleaning. This study investigated the bioaerosols present in two indoor TWMs. The results showed that the cleaning process at Market A after operations, involving the use of an agitated waterspout, was able to decrease the concentration of bacterial bioaerosols (BBs) by an average of 64%, while at the same time increasing the concentration of fungal bioaerosols (FBs) by about 2.4 fold. The chemical sanitization process at Market B after operations was able to bring about average decreases of 30.8% in BBs and 19.2% in FBs, but the endotoxin concentration increased. Hotspots were found to be associated with vendors of fresh, live poultry and fresh, raw meat/seafood. Pseudomonas spp. and Clostridiumperfringens, both of which can be pathogenic, were found to be the dominant species present in these markets, making up 35.18% to 48.74% and 9.64% to 11.72% of the bacteria present, respectively. Our results provide fundamental information on the distributions of bioaerosols and endotoxins within indoor TWMs both before and after operation.
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Affiliation(s)
- Da-Jiun Wei
- Department of Microbiology, Soochow University, Taipei 11102, Taiwan;
| | - Wen-Te Liu
- Department of Tourism, Tungnan University, New Taipei City 22202, Taiwan;
| | - Huin-Tsung Chin
- The Graduate School of Technology for Hazards Mitigation, Tungnan University, New Taipei City 22202, Taiwan;
| | - Ching-Hsing Lin
- Center of General Education, National Taitung College, Taitung 95045, Taiwan;
| | - I-Chun Chen
- Department of Land Resources, Chinese Culture University, Taipei 11114, Taiwan
- Correspondence: (I-C.C.); (Y.-T.C.); Tel.: +886-2-2861051 (ext. 31431) (I.-C.C.); +886-2-28819471 (ext. 6862) (Y.-T.C.)
| | - Yi-Tang Chang
- Department of Microbiology, Soochow University, Taipei 11102, Taiwan;
- Correspondence: (I-C.C.); (Y.-T.C.); Tel.: +886-2-2861051 (ext. 31431) (I.-C.C.); +886-2-28819471 (ext. 6862) (Y.-T.C.)
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8
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Hegarty B, Pan A, Haverinen-Shaughnessy U, Shaughnessy R, Peccia J. DNA Sequence-Based Approach for Classifying the Mold Status of Buildings. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2020; 54:15968-15975. [PMID: 33258367 DOI: 10.1021/acs.est.0c03904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Dampness or water damage in buildings and human exposure to the resultant mold growth is an ever-present public health concern. This study provides quantitative evidence that the airborne fungal ecology of homes with known mold growth ("moldy") differs from the normal airborne fungal ecology of homes with no history of dampness, water damage, or visible mold ("no mold"). Settled dust from indoor air and outdoor air and direct samples from building materials with mold growth were examined in homes from 11 cities across dry, temperate, and continental climate regions within the United States. Community analysis based on the sequence of the internal transcribed spacer region of fungal ribosomal RNA encoding genes demonstrated consistent and quantifiable differences between the fungal ecology of settled dust in homes with inspector-verified water damage and visible mold versus the settled dust of homes with no history of dampness, water damage, or visible mold. These differences include lower community richness (padj = 0.01) in the settled dust of moldy homes versus no mold homes, as well as distinct community taxonomic structures between moldy and no mold homes (ANOSIM, R = 0.15, p = 0.001). We identified 11 Ascomycota taxa that were more highly enriched in moldy homes and 14 taxa from Ascomycota, Basidiomycota, and Zygomycota that were more highly enriched in no mold homes. The indoor air differences between moldy versus no mold homes were significant for all three climate regions considered. These distinct but complex differences between settled dust samples from moldy and no homes were used to train a machine learning-based model to classify the mold status of a home. The model was able to accurately classify 100% of moldy homes and 90% of no mold homes. The integration of DNA-based fungal ecology with advanced computational approaches can be used to accurately classify the presence of mold growth in homes, assist with inspection and remediation decisions, and potentially lead to reduced exposure to hazardous microbes indoors.
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Affiliation(s)
- Bridget Hegarty
- Department of Chemical and Environmental Engineering, Yale University, P.O. Box 208263 New Haven, Connecticut 06520-8286, United States
| | - Annabelle Pan
- Department of Chemical and Environmental Engineering, Yale University, P.O. Box 208263 New Haven, Connecticut 06520-8286, United States
| | - Ulla Haverinen-Shaughnessy
- Indoor Air Program, The University of Tulsa, 800 South Tucker Drive, Henneke 212, Tulsa, Oklahoma 74101-9700, United States
| | - Richard Shaughnessy
- Indoor Air Program, The University of Tulsa, 800 South Tucker Drive, Henneke 212, Tulsa, Oklahoma 74101-9700, United States
| | - Jordan Peccia
- Department of Chemical and Environmental Engineering, Yale University, P.O. Box 208263 New Haven, Connecticut 06520-8286, United States
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Elmassry MM, Ray N, Sorge S, Webster J, Merry K, Caserio A, Vecellio DJ, Kruczek C, Dowd S, Ardon-Dryer K, Vanos J, San Francisco MJ. Investigating the culturable atmospheric fungal and bacterial microbiome in West Texas: implication of dust storms and origins of the air parcels. FEMS MICROBES 2020; 1:xtaa009. [PMID: 37333960 PMCID: PMC10117434 DOI: 10.1093/femsmc/xtaa009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/21/2020] [Indexed: 11/10/2023] Open
Abstract
Individuals often experience ailments such as allergies, asthma and respiratory tract infections throughout the year. Weather reports often include estimations of common allergens that can affect these individuals. To describe the local 'atmospheric microbiome' in Lubbock, Texas, USA, we examined the culturable fungal and bacterial microbiome present in the air on calm and dust storm days using internal transcribed spacer (ITS)-1 and 16S rRNA amplicon sequencing, respectively. While some types of airborne fungi were frequently present throughout the year, distinct differences were also observed between calm and dust storm days. We also observed the influence of the origin of air parcels and wind elevation of the air trajectory. The most abundant genera of fungi identified during the study period were Cryptococcus, Aureobasidium, Alternaria, Cladosporium and Filobasidium. This observation was not surprising considering the agricultural intensive environment of West Texas. Interestingly, Cladosporium, a common allergenic mold, was increased during days with dust storm events. The predominant bacterial genera observed were Bacillus, Pseudomonas, Psychrobacter, Massilia and Exiguobacterium. The relative abundance of the psychrophiles, Psychrobacter and Exiguobacterium, was surprising, given the semi-aridity of West Texas. Coupling our observations with back trajectories of the wind (Hybrid Single-Particle Lagrangian Integrated Trajectory models) demonstrated that dust storms, regional anthropogenic activity and origin of air parcels are important influences on the diversity and temporal presence of the atmospheric microbiome.
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Affiliation(s)
- Moamen M Elmassry
- Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - Nandini Ray
- Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - Sara Sorge
- Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - Jennifer Webster
- Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - Kyle Merry
- Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - Angelica Caserio
- Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - Daniel J Vecellio
- Department of Geography, Texas A&M University, College Station, TX 77843, USA
| | - Cassandra Kruczek
- Department of Medical Education, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Scot Dowd
- Molecular Research LP, Clovis Road, Shallowater, TX 79363, USA
| | - Karin Ardon-Dryer
- Department of Geosciences, Atmospheric Science Group, Texas Tech University, Lubbock, TX 79409, USA
| | - Jennifer Vanos
- School of Sustainability, Arizona State University, Tempe, AZ 85281, USA
| | - Michael J San Francisco
- Department of Biological Sciences, Texas Tech University, Lubbock, TX 79409, USA
- Honors College, Texas Tech University, Lubbock, TX 79410, USA
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10
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Caraballo L, Valenta R, Puerta L, Pomés A, Zakzuk J, Fernandez-Caldas E, Acevedo N, Sanchez-Borges M, Ansotegui I, Zhang L, van Hage M, Abel-Fernández E, Karla Arruda L, Vrtala S, Curin M, Gronlund H, Karsonova A, Kilimajer J, Riabova K, Trifonova D, Karaulov A. The allergenic activity and clinical impact of individual IgE-antibody binding molecules from indoor allergen sources. World Allergy Organ J 2020; 13:100118. [PMID: 32373267 PMCID: PMC7195550 DOI: 10.1016/j.waojou.2020.100118] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023] Open
Abstract
A large number of allergens have been discovered but we know little about their potential to induce inflammation (allergenic activity) and symptoms. Nowadays, the clinical importance of allergens is determined by the frequency and intensity of their IgE antibody binding (allergenicity). This is a rather limited parameter considering the development of experimental allergology in the last 20 years and the criteria that support personalized medicine. Now it is known that some allergens, in addition to their IgE antibody binding properties, can induce inflammation through non IgE mediated pathways, which can increase their allergenic activity. There are several ways to evaluate the allergenic activity, among them the provocation tests, the demonstration of non-IgE mediated pathways of inflammation, case control studies of IgE-binding frequencies, and animal models of respiratory allergy. In this review we have explored the current status of basic and clinical research on allergenic activity of indoor allergens and confirm that, for most of them, this important property has not been investigated. However, during recent years important advances have been made in the field, and we conclude that for at least the following, allergenic activity has been demonstrated: Der p 1, Der p 2, Der p 5 and Blo t 5 from HDMs; Per a 10 from P. americana; Asp f 1, Asp f 2, Asp f 3, Asp f 4 and Asp f 6 from A. fumigatus; Mala s 8 and Mala s 13 from M. sympodialis; Alt a 1 from A. alternata; Pen c 13 from P. chrysogenum; Fel d 1 from cats; Can f 1, Can f 2, Can f 3, Can f 4 and Can f 5 from dogs; Mus m 1 from mice and Bos d 2 from cows. Defining the allergenic activity of other indoor IgE antibody binding molecules is necessary for a precision-medicine-oriented management of allergic diseases.
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Affiliation(s)
- Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
- Corresponding author. Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia.
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- NRC Institute of Immunology FMBA of Russia, Moscow, Russian Federation
- Department of Clinical Immunology and Allergy, Laboratory of Immunopathology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Leonardo Puerta
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | - Anna Pomés
- Indoor Biotechnologies, Inc. Charlottesville, VA, USA
| | - Josefina Zakzuk
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | | | - Nathalie Acevedo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | - Mario Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela
| | - Ignacio Ansotegui
- Department of Allergy & Immunology Hospital Quironsalud Bizkaia, Bilbao, Spain
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Marianne van Hage
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Eva Abel-Fernández
- Inmunotek, Madrid, Spain and University of South Florida College of Medicine, Tampa, USA
| | - L. Karla Arruda
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Susanne Vrtala
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Mirela Curin
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Hans Gronlund
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Antonina Karsonova
- Department of Clinical Immunology and Allergy, Laboratory of Immunopathology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Jonathan Kilimajer
- Inmunotek, Madrid, Spain and University of South Florida College of Medicine, Tampa, USA
| | - Ksenja Riabova
- Department of Clinical Immunology and Allergy, Laboratory of Immunopathology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Daria Trifonova
- Department of Clinical Immunology and Allergy, Laboratory of Immunopathology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alexander Karaulov
- Department of Clinical Immunology and Allergy, Laboratory of Immunopathology, Sechenov First Moscow State Medical University, Moscow, Russia
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11
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Bozek A, Pyrkosz K. Immunotherapy of mold allergy: A review. Hum Vaccin Immunother 2017; 13:2397-2401. [PMID: 28481693 PMCID: PMC5647975 DOI: 10.1080/21645515.2017.1314404] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 03/22/2017] [Accepted: 03/29/2017] [Indexed: 12/27/2022] Open
Abstract
Mold allergies are common, mainly target the respiratory tract and present as allergic rhinitis and/or bronchial asthma. Molds include a large group of different allergens that induce all types of allergic reactions. Allergen specific immunotherapies (AITs) to molds are common; however, at the present time, they are limited to Alternaria. This review presents not only the benefits but also the problems with such types of AIT based on the literature and our experience.
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Affiliation(s)
- A. Bozek
- Clinical Department of Internal Disease, Dermatology and Allergology, Medical University of Silesia, Katowice, Poland
| | - K. Pyrkosz
- Clinical Department of Internal Disease, Dermatology and Allergology, Medical University of Silesia, Katowice, Poland
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12
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Indirect Immunodetection of Fungal Fragments by Field Emission Scanning Electron Microscopy. Appl Environ Microbiol 2015; 81:5794-803. [PMID: 26092450 DOI: 10.1128/aem.00929-15] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/11/2015] [Indexed: 12/20/2022] Open
Abstract
Submicronic fungal fragments have been observed in in vitro aerosolization experiments. The occurrence of these particles has therefore been suggested to contribute to respiratory health problems observed in mold-contaminated indoor environments. However, the role of submicronic fragments in exacerbating adverse health effects has remained unclear due to limitations associated with detection methods. In the present study, we report the development of an indirect immunodetection assay that utilizes chicken polyclonal antibodies developed against spores from Aspergillus versicolor and high-resolution field emission scanning electron microscopy (FESEM). Immunolabeling was performed with A. versicolor fragments immobilized and fixed onto poly-l-lysine-coated polycarbonate filters. Ninety percent of submicronic fragments and 1- to 2-μm fragments, compared to 100% of >2-μm fragments generated from pure freeze-dried mycelial fragments of A. versicolor, were positively labeled. In proof-of-concept experiments, air samples collected from moldy indoor environments were evaluated using the immunolabeling technique. Our results indicated that 13% of the total collected particles were derived from fungi. This fraction comprises 79% of the fragments that were detected by immunolabeling and 21% of the spore particles that were morphologically identified. The methods reported in this study enable the enumeration of fungal particles, including submicronic fragments, in a complex heterogeneous environmental sample.
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13
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Portnoy JM, Jara D. Mold allergy revisited. Ann Allergy Asthma Immunol 2015; 114:83-9. [PMID: 25624128 DOI: 10.1016/j.anai.2014.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/04/2014] [Accepted: 10/07/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Jay M Portnoy
- Division of Allergy, Asthma & Immunology, Children's Mercy Hospitals & Clinics, Kansas City, Missouri.
| | - David Jara
- Division of Allergy, Asthma & Immunology, Children's Mercy Hospitals & Clinics, Kansas City, Missouri
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14
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Sastre-Ibañez M, Sastre J. Molecular allergy diagnosis for the clinical characterization of asthma. Expert Rev Mol Diagn 2015; 15:789-99. [DOI: 10.1586/14737159.2015.1036745] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Marina Sastre-Ibañez
- 1Allergy Department, Fundación Jiménez Díaz and CIBER de Enfermedades Respiratorias (CIBERES, Institute Carlos III, Ministry of Economy and Competitiveness) Madrid, Universidad Autónoma de Madrid, Madrid, Spain
- 2Hospital Clínico San Carlos, Madrid, Spain
| | - Joaquín Sastre
- 1Allergy Department, Fundación Jiménez Díaz and CIBER de Enfermedades Respiratorias (CIBERES, Institute Carlos III, Ministry of Economy and Competitiveness) Madrid, Universidad Autónoma de Madrid, Madrid, Spain
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15
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Sevinc MS, Kumar V, Abebe M, Lemieux M, Vijay HM. Isolation, expression and characterization of a minor allergen from Penicillium crustosum. Med Mycol 2014; 52:81-9. [PMID: 23902156 DOI: 10.3109/13693786.2013.813086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A ribosomal P1 protein, Pen b 26 from Penicillium brevicompactum, was previously identified as a major allergen. A homolog protein was isolated and characterized from Penicillium crustosum which is not known to be allergenic mold. A cDNA library of P. crustosum was constructed and screened using a probe based on the DNA sequence of Pen b 26. A positive clone was isolated, expressed in Escherichia coli, purified and characterized by comparing its immunological and physical properties to Pen b 26. It was designated as Pen cr 26 and had a 321 nt ORF corresponding to 107 amino acids with a MW of 11 kDa. Pen cr 26 had strong sequence homology to Pen b 26 (92% for nucleotides and 86% for amino acids) and its physical and predicted structural properties were similar to the latter. The level of expression of Pen cr 26 was much lower than that of Pen b 26 in the same expression vector. Both proteins were recognized equally well by the IgG class specific antibodies, but Pen cr 26 was poorly recognized by Penicillium-sensitive atopic sera (IgE), suggesting striking antigenic difference in IgE epitopes, i.e., 87% were positive for Pen b 26 while only 23% were positive for Pen cr 26. The allergenicity of Pen cr 26 seems to be minor in nature and it could be a hypoallergenic variant of Pen b 26.
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Affiliation(s)
- M Serdal Sevinc
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada
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16
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Wolf J, O'Neill NR, Rogers CA, Muilenberg ML, Ziska LH. Elevated atmospheric carbon dioxide concentrations amplify Alternaria alternata sporulation and total antigen production. ENVIRONMENTAL HEALTH PERSPECTIVES 2010; 118:1223-8. [PMID: 20462828 PMCID: PMC2944081 DOI: 10.1289/ehp.0901867] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 04/22/2010] [Indexed: 05/08/2023]
Abstract
BACKGROUND Although the effect of elevated carbon dioxide (CO2) concentration on pollen production has been established in some plant species, impacts on fungal sporulation and antigen production have not been elucidated. OBJECTIVE Our purpose was to examine the effects of rising atmospheric CO2 concentrations on the quantity and quality of fungal spores produced on timothy (Phleum pratense) leaves. METHODS Timothy plants were grown at four CO2 concentrations (300, 400, 500, and 600 micromol/mol). Leaves were used as growth substrate for Alternaria alternata and Cladosporium phlei. The spore abundance produced by both fungi, as well as the size (microscopy) and antigenic protein content (ELISA) of A. alternata, were quantified. RESULTS Leaf carbon-to-nitrogen ratio was greater at 500 and 600 micromol/mol, and leaf biomass was greater at 600 micromol/mol than at the lower CO2 concentrations. Leaf carbon-to-nitrogen ratio was positively correlated with A. alternata spore production per gram of leaf but negatively correlated with antigenic protein content per spore. At 500 and 600 micromol/mol CO2 concentrations, A. alternata produced nearly three times the number of spores and more than twice the total antigenic protein per plant than at lower concentrations. C. phlei spore production was positively correlated with leaf carbon-to-nitrogen ratio, but overall spore production was much lower than in A. alternata, and total per-plant production did not vary among CO2 concentrations. CONCLUSIONS Elevated CO2 concentrations often increase plant leaf biomass and carbon-to-nitrogen ratio. Here we demonstrate for the first time that these leaf changes are associated with increased spore production by A. alternata, a ubiquitous allergenic fungus. This response may contribute to the increasing prevalence of allergies and asthma.
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Affiliation(s)
- Julie Wolf
- Department of Environmental Science and Technology, University of Maryland, College Park, Maryland, USA.
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17
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Abstract
Development and progress made in the field of recombinant allergens have allowed for the development of a new concept in allergy diagnosis, molecular diagnosis (MD), which makes it possible to identify potential disease-eliciting molecules. Microarray-based testing performed with a small amount of serum sample enables clinicians to determine specific-IgE antibodies against multiple recombinants or purified natural allergen components. Performance characteristics of allergens so far tested are comparable with current diagnostic tests, but have to be confirmed in larger studies. The use of allergen components and the successful interpretation of test results in the clinic require some degree of knowledge about the basis of allergen components and their clinical implications. Allergen components can be classified by protein families based on their function and structure. This review provides a brief overview of basic information on allergen components, recombinants or purified, currently available or soon to become commercially available in ImmunoCAP or ISAC systems, including names, protein family and function. Special consideration is given to primary or species-specific sensitization and possible cross-reactivity, because one of the most important clinical utility of MD is its ability to reveal whether the sensitization is genuine in nature (primary, species-specific) or if it is due to cross-reactivity to proteins with similar protein structures, which may help to evaluate the risk of reaction on exposure to different allergen sources. MD can be a support tool for choosing the right treatment for the right patient with the right timing. Such information will eventually give clinicians the possibility to individualize the actions taken, including an advice on targeted allergen exposure reduction, selection of suitable allergens for specific immunotherapy, or the need to perform food challenges. Nevertheless, all in vitro tests should be evaluated together with the clinical history, because allergen sensitization does not necessarily imply clinical responsiveness.
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Affiliation(s)
- J Sastre
- Allergy Department, Fundación Jiménez Díaz, Madrid, Spain.
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18
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Srivastava D, Arora N, Singh BP. Current immunological approaches for management of allergic rhinitis and bronchial asthma. Inflamm Res 2009; 58:523-36. [PMID: 19333724 DOI: 10.1007/s00011-009-0033-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 02/18/2009] [Accepted: 03/12/2009] [Indexed: 01/15/2023] Open
Abstract
A large population world over is affected with allergic diseases and asthma. Pharmacotherapy for allergic diseases and asthma is effective in controlling symptoms but on discontinuation of medication, symptoms reoccur. In contrast, immunotherapy modifies and corrects the underlying pathological immune responses in an antigen-specific manner. Immunotherapy shows an increase in IgG (blocking antibody) that competes with IgE for allergen, inhibiting the release of inflammatory mediators. Recent studies suggest that immunotherapy acts by modifying CD4+ T-cell responses either by immune deviation, T-cell anergy and/or both. Current immunological approaches for management of allergies and asthma involve immunization with native allergen, modified allergen, peptides/cDNA of allergen, anti-IgE, adjuvants coupled allergen, including immunostimulatory DNA sequences, cytokines, and bacterial products. These approaches modulate the immune response and are intended to give long-term benefit.
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Affiliation(s)
- Deepsikha Srivastava
- Allergy and Immunology Section, Institute of Genomics and Integrative Biology (CSIR), Delhi University Campus, Mall Road, Delhi, 110007, India
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19
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Engineered Alt a 13 Fragment of Alternaria alternata Abrogated IgE Binding without Affecting T-cell Stimulation. J Clin Immunol 2008; 29:63-70. [DOI: 10.1007/s10875-008-9224-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 07/15/2008] [Indexed: 11/26/2022]
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Benndorf D, Müller A, Bock K, Manuwald O, Herbarth O, von Bergen M. Identification of spore allergens from the indoor mould Aspergillus versicolor. Allergy 2008; 63:454-60. [PMID: 18315733 DOI: 10.1111/j.1398-9995.2007.01603.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Indoor mould growth and dampness are associated with respiratory health effects and allergies and several studies demonstrated that mainly Aspergillus versicolor and Penicillium expansum are responsible for indoor mould exposure. In contrast, commercialized test systems to diagnose allergic reactions to this mould species are not available. In this study, allergenic proteins from spores of the indoor relevant species A. versicolor and P. expansum should get detected and identified. METHODS We used two-dimensional (2D)-gel electrophoresis of spore proteins and immunoblotting with sera from patients participating in an epidemiologic study about indoor exposure of moulds and their influence on the development of allergies (ESTERSPEGA). Sera were screened for IgE antibodies specific for proteins from A. versicolor, A. fumigatus and P. expansum in one-dimensional blots and in 2D immunoblots. From the 2D gels, the corresponding spots were picked and identified by mass spectrometry. RESULTS More than 20 allergens from A. versicolor were identified; in particular, seven major allergens were selected, which were detected by more than 90% of the positive sera. The most abundant allergen was glyceraldehyde-3-phosphate dehydrogenase, followed by an unnamed protein, which displays a high homology to sobitol/xylose reductase. The other allergens were identified as catalase A, hypothetical protein AN6918.2, enolase, hypothetical protein AN0297.2 and a protein with homology to a fungal malate dehydrogenase. CONCLUSIONS The results indicate an important role of spore proteins from A. versicolor for sensitization against indoor moulds and identification of the major allergens might enable species-specific diagnosis of allergic reactions.
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Affiliation(s)
- D Benndorf
- Department of Proteomics, UFZ - Centre for Environmental Research Leipzig-Halle, Leipzig, Germany
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21
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Tabar AI, Lizaso MT, García BE, Gómez B, Echechipía S, Aldunate MT, Madariaga B, Martínez A. Double-blind, placebo-controlled study of Alternaria alternata immunotherapy: clinical efficacy and safety. Pediatr Allergy Immunol 2008; 19:67-75. [PMID: 17651380 DOI: 10.1111/j.1399-3038.2007.00589.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Allergen-specific immunotherapy (ASIT) with fungal extracts has been beset by safety and efficacy problems, which result mainly from qualitative and quantitative variations. Little has been published on the safety and efficacy of these extracts. The objective was to analyze the safety and efficacy of ASIT with an Alternaria alternata extract. A total of 28 patients were selected with rhinitis and/or bronchial asthma because of Alternaria allergy and monosensitization to molds. The patients were randomized to an active ASIT or placebo group, both groups on a conventional immunotherapy schedule (increasing weekly doses until maintenance dose and then monthly doses). Adverse reactions were classified with the European Academy of Allergology and Clinical Immunology system. Clinical efficacy was analyzed for a year with symptom/medication diary cards, peak expiratory flow (PEF) measures, clinical severity score, severity of symptoms (visual analog scale), subjective evaluation of treatment by the patient and the physician, and a quality of life questionnaire. Twenty-three patients completed the study; all reached the established maintenance dose with only two mild adverse reactions in the whole sample. Significant improvements were found after 6 months in respiratory symptoms in the active treatment group, and in all symptoms in both groups. PEF increased significantly in the active treatment group but not in the placebo group. The severity of asthma decreased in the active treatment group, and the severity of rhinitis decreased in both groups. Visual analog scale scores for severity of symptoms improved in all phases in the active treatment group, but only after 12 months in the placebo group. Physicians judged the disease course as significantly better in the active treatment group. ASIT with the A. alternata extract was safe, with clinical improvements after one year of treatment.
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Affiliation(s)
- Ana I Tabar
- Department of Allergy, Hospital Virgen del Camino, Pamplona, Spain
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22
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Peccia J, Hernandez M. Incorporating polymerase chain reaction-based identification, population characterization, and quantification of microorganisms into aerosol science: A review. ATMOSPHERIC ENVIRONMENT (OXFORD, ENGLAND : 1994) 2006; 40:3941-3961. [PMID: 32288550 PMCID: PMC7108281 DOI: 10.1016/j.atmosenv.2006.02.029] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Revised: 02/18/2006] [Accepted: 02/18/2006] [Indexed: 05/19/2023]
Abstract
The quantity, identity, and distribution of biomass in indoor and outdoor aerosols are poorly described. This is not consistent with the current understanding of atmospheric chemistry or the microbiological characterization of aquatic and terrestrial environments. This knowledge gap is due to both difficulties in applying contemporary microbiological techniques to the low biomass concentrations present in aerosols, and the traditional reliance of aerosol researchers on culture-based techniques-the quantitative limitations and ecological biases of which have been well-documented and are now avoided in other environmental matrices. This article reviews the emergence of the polymerase chain reaction (PCR) as a nonculture-based method to determine the identity, distribution, and abundance of airborne microorganisms. To encourage the use of PCR-based techniques by a broad spectrum of aerosol researchers, emphasis is given to the critical, aerosol specific method issues of sample processing, DNA extraction, and PCR inhibition removal. These methods are synthesized into a generalized procedure for the PCR-based study of microbial aerosols-equally applicable to both indoor and outdoor aerosol environments.
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Affiliation(s)
- Jordan Peccia
- Department of Chemical Engineering, Environmental Engineering Program, Yale University, New Haven, CT 06520, USA
- Corresponding author. Tel.: +1 203 432 4385; fax: +1 203 432 4387.
| | - Mark Hernandez
- Department of Civil, Environmental, and Architectural Engineering, University of Colorado-Boulder, Boulder, CO 80309, USA
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Chung YJ, Coates NH, Viana ME, Copeland L, Vesper SJ, Selgrade MK, Ward MD. Dose-dependent allergic responses to an extract of Penicillium chrysogenum in BALB/c mice. Toxicology 2005. [DOI: 10.1016/j.tox.2005.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Aspergillus fumigatus is a ubiquitous fungus that causes a variety of diseases in man and animals. A number of protein, carbohydrate, and glycoprotein antigens have been identified from A. fumigatus. The diseases are diverse, and therefore are the antigens and their roles in causing or modulating the diseases. The induction and binding of antibodies and the interaction of antigen and various immune cells are of immense significance in the diagnosis and prognosis of the disease. In recent years, over 20 genes encoding A. fumigatus antigens have been cloned and the proteins expressed. Among these allergens, Asp f 1, f 2, f 3, f 4, and f 6 showed strong but diverse IgE binding with sera from different groups of patients. Results currently available suggest that Asp f 2, f 3, and f 6 together reacted with IgE from more patients with asthma and allergic bronchopulmonary aspergillosis (ABPA), although they are only marginally effective in demonstrating specific IgE in patients with cystic fibrosis and ABPA. The molecular structure of allergens also plays a major role in the immunological response in the allergic patients. Antigens can be engineered with less or more binding with IgE, and such antigens may have significant roles as specific reagents or as immunomodulators.
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Affiliation(s)
- V P Kurup
- Department of Pediatrics, Allergy/lmmunology Division, Medical College of Wisconsin, USA.
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25
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Sevinc MS, Kumar V, Abebe M, Casley WL, Vijay HM. Isolation and characterization of a cDNA clone encoding one IgE-binding fragment of Penicillium brevicompactum. Int Arch Allergy Immunol 2005; 138:12-20. [PMID: 16088208 DOI: 10.1159/000087353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Accepted: 04/14/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The abundance of allergenic Penicillium species has been associated with an increased incidence of childhood asthma and pulmonary bleeding. Penicillium brevicompactum has been identified as the most prevalent indoor species of this genus. However, detailed studies on the allergens of the ubiquitous Penicillium species are still lacking. For the characterization of allergens of prevalent Penicillium species, molecular cloning of the allergen genes of P. brevicompactum was performed in the present study. METHODS A phage cDNA library of P. brevicompactum was constructed in Uni-ZAP XR vector using mRNA isolated from the organism. The cDNA library of P. brevicompactum was screened using pooled atopic sera. RESULTS Screening of P. brevicompactum cDNA library resulted in one positive clone encoding an estimated molecular weight of 11 kDa polypeptide, rich in acidic residues (>20%), with a pI of 3.87. This clone was designated as Pen b 26 and found to be reactive only against the atopic sera obtained from individuals sensitive to P. brevicompactum. The amino acid sequence analysis of Pen b 26 revealed that it had strong homology to the 60S acidic ribosomal protein P1 family from different eukaryotic sources, predominantly fungal aero-allergens. Other features of Pen b 26 including having high alpha-helical content (>50%), alanine-rich residues (>20%), and a well-conserved C-terminal epitope region fits well into the common properties of 60S acidic ribosomal proteins. CONCLUSIONS The results obtained suggest that the allergenic clone, Pen b 26 is a 60S acidic ribosomal protein P1 of P. brevicompactum and shows strong similarity to other P1 family proteins.
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Affiliation(s)
- M Serdal Sevinc
- Environmental Health Directorate, F.G. Banting Building, Health Canada, Tunney's Pasture, Ottawa, Ontario K1A 0L2, Postal Locator 2202D2, Canada
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26
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Tournas VH, Katsoudas E. Mould and yeast flora in fresh berries, grapes and citrus fruits. Int J Food Microbiol 2005; 105:11-7. [PMID: 16023239 DOI: 10.1016/j.ijfoodmicro.2005.05.002] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2005] [Revised: 05/09/2005] [Accepted: 05/13/2005] [Indexed: 10/25/2022]
Abstract
Fresh fruits are prone to fungal contamination in the field, during harvest, transport, marketing, and with the consumer. It is important to identify fungal contaminants in fresh fruits because some moulds can grow and produce mycotoxins on these commodities while certain yeasts and moulds can cause infections or allergies. In this study, 251 fresh fruit samples including several varieties of grapes, strawberries, blueberries, raspberries, blackberries, and various citrus fruits were surface-disinfected, incubated at room temperature for up to 14 days without supplemental media, and subsequently examined for mould and yeast growth. The level of contamination (percent of contaminated items/sample) varied depending on the type of fruit. All raspberry and blackberry samples were contaminated at levels ranging from 33% to 100%, whereas 95% of the blueberry samples supported mould growth at levels between 10% and 100% of the tested berries, and 97% of strawberry samples showed fungal growth on 33-100% of tested berries. The most common moulds isolated from these commodities were Botrytis cinerea, Rhizopus (in strawberries), Alternaria, Penicillium, Cladosporium and Fusarium followed by yeasts, Trichoderma and Aureobasidium. Thirty-five percent of the grape samples tested were contaminated and supported fungal growth; the levels of contamination ranged from 9% to 80%. The most common fungi spoiling grapes were Alternaria, B. cinerea and Cladosporium. Eighty-three percent of the citrus fruit samples showed fungal growth at levels ranging from 25% to 100% of tested fruits. The most common fungi in citrus fruits were Alternaria, Cladosporium, Penicillium, Fusarium and yeasts. Less common were Trichoderma, Geotrichum and Rhizopus.
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Affiliation(s)
- V H Tournas
- Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD 20740, USA.
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Ramadan G, Davies B, Kurup VP, Keever-Taylor CA. Generation of cytotoxic T cell responses directed to human leucocyte antigen Class I restricted epitopes from the Aspergillus f16 allergen. Clin Exp Immunol 2005; 140:81-91. [PMID: 15762878 PMCID: PMC1809331 DOI: 10.1111/j.1365-2249.2005.02738.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Invasive aspergillosis (IA) is a major cause of infection-related mortality in patients with haematological malignancies, especially in recipients of haematopoietic stem cell transplants. We have prepared overlapping pentadecapeptides (11-aa overlap with previous peptide) spanning the entire 427-aa coding region of the Aspergillus allergen, Asp f16 shown previously in mice to induce Th1-type cell responses in vivo and in humans to induce proliferative and cytotoxic CD4(+) T cell responses. Mature dendritic cells (DC) pulsed with a complete pool of peptides were used to generate T cell lines. Two lines from HLA-B*3501(+) donors were found to be strongly cytotoxic to autologous Asp f16-peptide pool- and Aspergillus culture extract-pulsed targets after 4-5 weekly primings. Cytotoxic T lymphocyte (CTL) culture supernatant killed Aspergillus conidia, and cells directly killed Aspergillus hyphae. Cytotoxic activity and interferon (IFN)-gamma production were mediated exclusively by CD8(+) T cells in response to pool-pulsed targets. Interleukin (IL)-4 production was not detected. CTL activity was restricted by HLA-B*3501 and based on peptide prediction programmes was most probably directed to YFKYTAAAL (YFK), LPLCSAQTW (LPL) and GTRFPQTPM (GTR) in one donor, while only LPL was recognized by CTL from the second donor. Pool-pulsed B*3503(+) BLCL but not B*3502(+) or B*3508(+) BLCL presented peptide to donor no. 1. B*3503(+) BLCL presented YFK and to a lesser extent GTR, but not peptide LPL. Our data show that in addition to our previously identified Class II restricted peptide response, DC pulsed with a pentadecapeptide pool from Asp f16 are capable of inducing polyclonal, HLA-Class I-restricted, Aspergillus-specific T cells that may be capable of conferring immunity to IA.
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Affiliation(s)
- G Ramadan
- Medical College of Wisconsin, BMT Program, Milwaukee, WI 53226, USA
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Ramadan G, Konings S, Kurup VP, Keever-Taylor CA. Generation of Aspergillus- and CMV- specific T-cell responses using autologous fast DC. Cytotherapy 2005; 6:223-34. [PMID: 15203979 DOI: 10.1080/14653240410006040] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Recent reports have described a new strategy for differentiation and maturation of monocyte (Mo)-derived DCs within only 48 h of in vitro culture (fast-DC). Here we assess the efficacy of the fast-DC to process and present different Aspergillus fumigatus and CMV Ag preparations to autologous T cells, compared with DCs generated in standard 7-day cultures (standard-DC). METHODS Adherent blood Mo were treated with GM-CSF and IL-4 (1 day for fast-DC, 5 days in the standard-DC) to generate immature DCs, and then were matured for either 1-2 days (fast-DC) or 2 days (standard-DC) with inflammatory cytokines. DCs were pulsed with A. fumigatus or CMV Ag preparation immediately prior to maturation, or infected after maturation with adeno-pp65. Mature DCs were then used to prime Ag-specific proliferative and cytotoxic T lymphocytes (CTL) responses. RESULTS Fast-DC were CD14- and expressed mature DC surface markers to the same degree as standard-DC, and maintained this phenotype after withdrawing cytokine from the cultures. Fast-DC and standard-DC were equally capable of inducing A. fumigatus and CMV-specific T-cell proliferation, as well as priming Ag-specific CTL activity. The Aspergillus- and CMV-specific CTL were of mixed CD3+/CD4+ and CD3+/CD8+ phenotype, and specifically killed autologous DC pulsed with A. fumigatus Ag and autologous CMV infected fibroblasts, respectively. DISCUSSION Fast-DC are as effective as standard-DC in the generation of Ag-specific T-cell responses. Moreover, use of fast-DC not only reduces labor and supply cost, as well as workload and time, but also increases the number of DCs derived from adherent Mo, which may facilitate the use of DCs in clinical trials of cellular immunotherapy.
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Affiliation(s)
- G Ramadan
- Medical College of Wisconsin, BMT Program, Milwaukee, WI 53226, USA
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Ramadan G, Davies B, Kurup VP, Keever-Taylor CA. Generation of Th1 T cell responses directed to a HLA Class II restricted epitope from the Aspergillus f16 allergen. Clin Exp Immunol 2005; 139:257-67. [PMID: 15654824 PMCID: PMC1809287 DOI: 10.1111/j.1365-2249.2005.02699.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2004] [Indexed: 11/27/2022] Open
Abstract
The Aspergillus allergen Asp f16 has been shown to confer protective Th1 T cell-mediated immunity against infection with Aspergillus conidia in murine models. Here, we use overlapping (11-aa overlap with preceding peptide) pentadecapeptides spanning the entire 427-aa coding region of Asp f16 presented on autologous dendritic cells (DC) to evaluate the ability of this antigen to induce Th1 responses in humans. Proliferative responses were induced in five out of five donors, and one line with a high frequency of interferon (IFN)-gamma-producing CD4(+) T cells in response to the complete peptide pool was characterized. This line was cytotoxic to autologous pool-pulsed and Aspergillus culture extract-pulsed targets. Limitation of cytotoxicity to the CD4(+) T cell subset was demonstrated by co-expression of the degranulation marker CD107a in response to peptide pool-pulsed targets. Cytotoxic T lymphocytes (CTL) killed Aspergillus hyphae and CTL culture supernatant killed Aspergillus conidia. By screening 21 smaller pools and individual peptides shared by positive pools we identified a single candidate sequence of TWSIDGAVVRT that elicited responses equal to the complete pool. The defined epitope was presented by human leucocyte antigen (HLA)-DRB1-0301. These data identify the first known Aspergillus-specific T cell epitope and support the use of Asp f16 in clinical immunotherapy protocols to prime protective immune responses to prevent or treat Aspergillus infection in immunocompromised patients.
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Affiliation(s)
- G Ramadan
- Medical College of Wisconsin, BMT Program, Milwaukee, WI 53226, USA
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Chung YJ, Coates NH, Viana ME, Copeland L, Vesper SJ, Selgrade MK, Ward MDW. Dose-dependent allergic responses to an extract of Penicillium chrysogenum in BALB/c mice. Toxicology 2005; 209:77-89. [PMID: 15725516 DOI: 10.1016/j.tox.2004.12.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2004] [Revised: 11/23/2004] [Accepted: 12/15/2004] [Indexed: 11/29/2022]
Abstract
Indoor mold has been associated with the development of allergic asthma. Penicillium chrysogenum, a common indoor mold, is known to have several allergens and can induce allergic responses in a mouse model of allergic penicilliosis. Our hypothesis is that soluble components of P. chrysogenum (PCE) can dose-dependently induce responses typical of allergic asthma in BALB/c mice. Mice were exposed to 10, 20, 50, or 70 microg of PCE by involuntary aspiration four times over a 4-week period. Serum and bronchoalveolar lavage fluid (BALF) were collected before (day 0), and at days 1 and 3 following the final exposure. PCE-exposed mice demonstrated dose-dependent increases in: BALF total cell numbers including eosinophil, serum and BALF total IgE levels, BALF IL-5 levels, and increased severity of histopathologic lesions. A single exposure to the highest dose of PCE resulted in edema and cellular damage but not immune responses. Four exposures to Metarhizium anisopliae crude antigen (10 microg, positive control) resulted in equivalent or greater allergic asthma-like responses than those demonstrated by multiple exposures to 50 or 70 microg of PCE. Multiple exposures to 70 microg of PCE showed increased allergen-triggered immediate respiratory responses as well as non-specific airway hyperresponsiveness to methacholine as assessed by barometric whole-body plethysmography. Taken together, repeated pulmonary challenge with P. chrysogenum extract induced dose-dependent allergic asthma-like responses in mice.
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Affiliation(s)
- Yong Joo Chung
- Department of Environmental Sciences and Engineering, School of Public Health, University of North Carolina, Chapel Hill, NC 27599, USA.
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Ibarrola I, Suárez-Cervera M, Arilla MC, Martínez A, Monteseirín J, Conde J, Asturias JA. Production profile of the major allergen Alt a 1 in Alternaria alternata cultures. Ann Allergy Asthma Immunol 2005; 93:589-93. [PMID: 15609770 DOI: 10.1016/s1081-1206(10)61268-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The fungus Alternaria is strongly associated with asthma, but the importance of fungal allergen products is frequently underestimated. The profile of allergen release from fungal material is poorly understood. OBJECTIVE To investigate expression of the major allergen of Alternaria alternata, Alt a 1, during its growth in culture conditions for allergen extract production. METHODS Allergen expression was examined by Alt a 1-specific 2-site monoclonal antibody enzyme-linked immunosorbent assay, immunoblotting, and potency assays. The release of Alt a 1 was studied by transmission electron microscopy in conjunction with immunogold staining by using antibodies with specificity for Alt a 1. RESULTS A maximum amount of Alt a 1 was obtained after 4.5 weeks of growing, and it was found predominantly in the spent culture medium. In the same way, total IgE binding activity showed 15-fold more activity in the spent culture medium than in the buffer-extractable antigen fraction. Immunogold electron microscopy provided evidence that Alt a 1 is released from spores and mycelia. CONCLUSIONS Alternaria alternata allergenic proteins were constantly released into the culture medium, where they accumulated. Alt a 1 was a good marker for checking optimal culture conditions for A alternata extract production intended for clinical use.
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Affiliation(s)
- Ignacio Ibarrola
- Departamento de Investigación y Desarrollo, Bial-Arístegui, Bilbao, Spain
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Schmechel D, Simpson JP, Lewis DM. The production and characterization of monoclonal antibodies to the fungus Aspergillus versicolor. INDOOR AIR 2005; 15 Suppl 9:11-9. [PMID: 15910525 DOI: 10.1111/j.1600-0668.2005.00340.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
UNLABELLED Fungal exposure measurements in indoor environments require accurate and precise monitoring methods. Such techniques may be based on monoclonal antibodies (Mabs) and enzyme-linked immunosorbent assays (ELISA) and here we report the cross-reactivity patterns of Mabs produced against Aspergillus versicolor. Balb/c mice were immunized with the particulate fraction of homogenized spores and 46 Mabs (35 IgM, nine IgG3, two IgG1) were produced and tested for cross-reactivity against 55 fungal species. None of the Mabs was found to be species-specific for A. versicolor. Several Mabs strongly cross-reacted with most Aspergillus, Penicillium and Eurotium species and some Mabs also cross-reacted with Paecilomyces variotii and several Cladosporium and Stachybotrys species. Our results show that antibody responses in mice against spores of A. versicolor are dominated by highly cross-reactive antibodies of the IgM isotype. The widespread cross-reactivity suggests that the specificity of antibodies to be used for the detection of fungi in environmental samples need to be thoroughly characterized in order to avoid ambiguities in the interpretation of monitoring results. Furthermore, accurate estimates of spore concentrations may require the application of species-specific Mabs in order to avoid bias in result interpretation because of the differential reactivity of cross-reactive Mabs with different fungi. PRACTICAL IMPLICATIONS Producers of monoclonal or polyclonal antibodies for the detection of fungi in environmental or clinical samples need to verify antibody reactivity patterns and accurately report that information to potential users. Furthermore, immunoassays based on mouse or human serum or purified immunoglobulin fractions need to consider antibody cross-reactivity as a potential confounding factor during interpretation of results.
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Affiliation(s)
- D Schmechel
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV 26505, USA.
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Schwab CJ, Straus DC. The roles of Penicillium and Aspergillus in sick building syndrome. ADVANCES IN APPLIED MICROBIOLOGY 2004; 55:215-38. [PMID: 15350796 DOI: 10.1016/s0065-2164(04)55008-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Christopher J Schwab
- Department of Microbiology and Immunology Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
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Ebo DG, Hagendorens MM, Bridts CH, Schuerwegh AJ, De Clerck LS, Stevens WJ. In vitro allergy diagnosis: should we follow the flow? Clin Exp Allergy 2004; 34:332-9. [PMID: 15005724 DOI: 10.1111/j.1365-2222.2004.01891.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
During the last 5 years, an increasing number of studies have demonstrated that flow cytometric quantification of in vitro basophil activation can be a quite performant and reliable tool to measure IgE-dependent allergen-specific responses in allergic patients. So far, most assays have used CD63 as a basophil activation marker and native allergen extracts for stimulation. However, other basophil markers and recombinant allergens have recently been introduced. The technique has been applied for the diagnosis of allergy to pollen, house dust mite, food, natural rubber latex, hymenoptera venom and drugs. In addition, the technique has proven to be useful in non-IgE-mediated reactions such as hypersensitivity to drugs as well as detection of auto-antibodies in chronic urticaria. This review will focus on some specific issues: (1) principles of flow cytometric analysis of in vitro-activated basophils, (2) general technical aspects of the technique (including passive sensitization), (3) clinical applications and (4) recommendations for further development and evaluation of the technique.
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Affiliation(s)
- D G Ebo
- Department of Immunology-Allergology-Rheumatology, University of Antwerp, Antwerp, Belgium
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Jovanovic S, Felder-Kennel A, Gabrio T, Kouros B, Link B, Maisner V, Piechotowski I, Schick KH, Schrimpf M, Weidner U, Zöllner I, Schwenk M. Indoor fungi levels in homes of children with and without allergy history. Int J Hyg Environ Health 2004; 207:369-78. [PMID: 15471101 DOI: 10.1078/1438-4639-00302] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A study was performed at the four sentinel health departments of Baden-Württemberg between November 1999 and March 2000 to investigate the indoor levels of fungi at the homes of school children (mean age 10 y) and to describe possible associations with allergy statuses. Three hundred and ninety-seven households of school children with (n = 199) and without (n = 198) allergic history were included in the study. The median of colony forming units (CFU/m3) of fungi, measured in the children's bedrooms' in indoor air, was 105 (range 5 to 15,000), in outdoor air 110 (range 10 to 1500). The median of viable mould spores (CFU/g dust) in floor dust was 28,500 (range 1500 to 1,235,000), in mattresses 16,250 (range 0 to 2,500,000). Neither climatological conditions, nor differences between urban and rural regions showed a systematic influence on fungi counts. There was no difference in concentrations and distribution of fungi species levels between children with and without allergic history. The sensitization rate against molds (IgE) was higher for children with allergic condition (9.2%) than in control children (4.4%), but there was no association with the fungi counts in the rooms. In conclusion, the study defined the mould levels in children's rooms, but did not find an association with allergic history of the children or their sensitization rate.
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Marinkovich VA. Fungal Hypersensitivity: Pathophysiology, Diagnosis, Therapy. ADVANCES IN APPLIED MICROBIOLOGY 2004; 55:289-307. [PMID: 15350799 DOI: 10.1016/s0065-2164(04)55011-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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