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Kim JH, Yi YY, Ha EK, Cha HR, Han MY, Baek HS. Neurodevelopment at 6 years of age in children with atopic dermatitis. Allergol Int 2023; 72:116-127. [PMID: 36058807 DOI: 10.1016/j.alit.2022.08.002] [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: 12/09/2021] [Revised: 07/17/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Few studies have reported an association between atopic dermatitis and cognitive impairment in children. Therefore, we evaluated the association between atopic dermatitis (AD) and neurodevelopmental dysfunction in children. METHODS We analyzed 2,395,966 children born between 2008 and 2012 in Korea. All data were acquired from the databases of the Korean National Health Insurance System. AD was defined as five or more diagnoses before age 24 months. The outcome was suspected neurodevelopmental dysfunction in the gross motor skill, fine motor skill, cognition, language, sociality, and self-care domains of the Korean Developmental Screening Test for Infants and Children at age 6 years. The positive control outcome was defined as attention deficit hyperactive disorder (ADHD). The associations were assessed using ordinal logistic regression, adjusting for asthma and allergic rhinitis. RESULTS Among the eligible children, 89,452 and 30,557 were allocated to the control and AD groups, respectively. In the weighted data, the AD group showed a higher risk of suspected neurodevelopmental dysfunction in the total score (weighted adjusted odds ratio [95% CI] 1.10 [1.05-1.16]), gross motor skills (1.14 [1.04-1.25]), and fine motor skills (1.15 [1.06-1.25]) than the control group. The AD with steroids or hospitalization groups showed an increased risk of suspected neurodevelopmental dysfunction. In addition, the AD group showed a significant association with mental retardation, psychological development disorder, and behavioral and emotional disorders as well as ADHD. CONCLUSIONS AD before age 2 years may be associated with an increased risk of neurodevelopmental dysfunction including gross and fine motor skills in the young childhood period.
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Affiliation(s)
- Ju Hee Kim
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Yoon Young Yi
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea
| | - Hey Ryung Cha
- Department of Data Science, Sejong University College of Software Convergence, Seoul, South Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea.
| | - Hey-Sung Baek
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
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Jackson-Cowan L, Cole EF, Silverberg JI, Lawley LP. Childhood atopic dermatitis is associated with cognitive dysfunction: A National Health Interview Survey study from 2008 to 2018. Ann Allergy Asthma Immunol 2020; 126:661-665. [PMID: 33189871 DOI: 10.1016/j.anai.2020.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a common inflammatory skin disease in children and adults. Little is known regarding the association of childhood AD with cognitive dysfunction. OBJECTIVE To evaluate the association of AD and cognitive dysfunction, including memory impairment, developmental delays and attention deficit (hyperactivity) disorder in US children (age <18 years). METHODS Data was analyzed from the National Health Interview Survey 2008 to 2018, which used a multistage, clustered, cross-sectional design. RESULTS The prevalences of cognitive dysfunction, such as memory impairment (0.87% vs 0.42%), developmental delays (6.96% vs 3.87%), and attention deficit (hyperactivity) disorder (10.78% vs 8.10%), were higher in children with vs without AD. In multivariable logistic regression models adjusting for age, sex, race, region, socioeconomic factors, allergic conditions, and mental health, childhood AD was associated with higher odds of memory impairment (adjusted odds ratio [95% confidence interval]: 1.84 [1.34-2.51]), developmental delays (1.54 [1.40-1.70]), and attention deficit (hyperactivity) disorder (1.31 [1.20-1.42]) compared with children without AD. Childhood atopic disease (defined as comorbid AD, asthma, allergic rhinitis, and food allergies) further increased the prevalence of developmental delays to 13.44% (2.10 [1.20-3.70]) in boys but not in girls. CONCLUSION In a nationally representative sample of the US population, a statistically significant and positive association between childhood AD and atopic disease with cognitive dysfunction was identified (P < .001). Furthermore, a dimorphic relationship with developmental delays was identified between sexes.
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Affiliation(s)
- LaDonya Jackson-Cowan
- The Medical College of Georgia at Augusta University, Augusta University/University of Georgia Medical Partnership, Athens, Georgia.
| | - Emily F Cole
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Leslie P Lawley
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
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3
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Guseva D, Rüdrich U, Kotnik N, Gehring M, Patsinakidis N, Agelopoulos K, Ständer S, Homey B, Kapp A, Gibbs BF, Ponimaskin E, Raap U. Neuronal branching of sensory neurons is associated with BDNF-positive eosinophils in atopic dermatitis. Clin Exp Allergy 2020; 50:577-584. [PMID: 31925827 DOI: 10.1111/cea.13560] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 12/20/2019] [Accepted: 01/03/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Pruritus is a major symptom of atopic dermatitis (AD) and is transmitted by a subpopulation of non-myelinated C-type free nerve endings in the epidermis and upper dermis. Stimulation of these nerve terminals is affected by histamine, neurotrophins and physical factors. Eosinophils of patients with AD are a source of neurotrophins, including brain-derived neurotrophic factor (BDNF), levels of which correlate with disease severity. OBJECTIVE The purpose of this study was to determine the anatomical localization of eosinophils in the skin of patients with AD with regard to peripheral nerves and to investigate whether eosinophils induce sprouting and neurite outgrowth in murine sensory neurons. METHODS Cryosections of skin derived from AD and control (NA) patients were subjected to immunofluorescence analysis with markers for eosinophils, BDNF and neuronal cells. Stimulated eosinophil supernatants were used for the treatment of cultured peripheral mouse dorsal root ganglia (DRG) neurons followed by morphometric analysis. RESULTS Dermal axon density and the proximity of eosinophils to nerve fibres were significantly higher in AD patients vs NA. Both neuronal projections and eosinophils expressed BDNF. Furthermore, activated eosinophil supernatants induced BDNF-dependent mouse DRG neuron branching. CONCLUSIONS AND CLINICAL RELEVANCE Our results indicate that BDNF-positive eosinophils are also localized in close proximity with nerve fibres in AD, suggesting a functional relationship between BDNF-expressing eosinophils and neuronal projections. These observations suggest that eosinophils may have considerable impact on pruritus by supporting sensory nerve branching.
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Affiliation(s)
- Daria Guseva
- Department of Cellular Neurophysiology, Hannover Medical School, Hannover, Germany.,Department of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Urda Rüdrich
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Nika Kotnik
- Division of Experimental Allergology and Immunodermatology, University of Oldenburg, Oldenburg, Germany
| | - Manuela Gehring
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Nikolaos Patsinakidis
- University Clinic of Dermatology and Allergy, University of Oldenburg, Oldenburg, Germany
| | - Konstantin Agelopoulos
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Bernhard Homey
- Department of Dermatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Alexander Kapp
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Bernhard F Gibbs
- Division of Experimental Allergology and Immunodermatology, University of Oldenburg, Oldenburg, Germany
| | - Evgeni Ponimaskin
- Department of Cellular Neurophysiology, Hannover Medical School, Hannover, Germany.,Institute of Cytology and Genetics, Novosibirsk, Russia
| | - Ulrike Raap
- Division of Experimental Allergology and Immunodermatology, University of Oldenburg, Oldenburg, Germany.,University Clinic of Dermatology and Allergy, University of Oldenburg, Oldenburg, Germany
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Britt RD, Thompson MA, Wicher SA, Manlove LJ, Roesler A, Fang YH, Roos C, Smith L, Miller JD, Pabelick CM, Prakash YS. Smooth muscle brain-derived neurotrophic factor contributes to airway hyperreactivity in a mouse model of allergic asthma. FASEB J 2019; 33:3024-3034. [PMID: 30351991 PMCID: PMC6338659 DOI: 10.1096/fj.201801002r] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 10/01/2018] [Indexed: 01/14/2023]
Abstract
Recent studies have demonstrated an effect of neurotrophins, particularly brain-derived neurotrophic factor (BDNF), on airway contractility [ via increased airway smooth muscle (ASM) intracellular calcium [Ca2+]i] and remodeling (ASM proliferation and extracellular matrix formation) in the context of airway disease. In the present study, we examined the role of BDNF in allergen-induced airway inflammation using 2 transgenic models: 1) tropomyosin-related kinase B (TrkB) conditional knockin (TrkBKI) mice allowing for inducible, reversible disruption of BDNF receptor kinase activity by administration of 1NMPP1, a PP1 derivative, and 2) smooth muscle-specific BDNF knockout (BDNFfl/fl/SMMHC11Cre/0) mice. Adult mice were intranasally challenged with PBS or mixed allergen ( Alternaria alternata, Aspergillus fumigatus, house dust mite, and ovalbumin) for 4 wk. Our data show that administration of 1NMPP1 in TrkBKI mice during the 4-wk allergen challenge blunted airway hyperresponsiveness (AHR) and reduced fibronectin mRNA expression in ASM layers but did not reduce inflammation per se. Smooth muscle-specific deletion of BDNF reduced AHR and blunted airway fibrosis but did not significantly alter airway inflammation. Together, our novel data indicate that TrkB signaling is a key modulator of AHR and that smooth muscle-derived BDNF mediates these effects during allergic airway inflammation.-Britt, R. D., Jr., Thompson, M. A., Wicher, S. A., Manlove, L. J., Roesler, A., Fang, Y.-H., Roos, C., Smith, L., Miller, J. D., Pabelick, C. M., Prakash, Y. S. Smooth muscle brain-derived neurotrophic factor contributes to airway hyperreactivity in a mouse model of allergic asthma.
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Affiliation(s)
- Rodney D. Britt
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Michael A. Thompson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA; and
| | - Sarah A. Wicher
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA; and
| | - Logan J. Manlove
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA; and
| | - Anne Roesler
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA; and
| | - Yun-Hua Fang
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Carolyn Roos
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Leslie Smith
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Christina M. Pabelick
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA; and
| | - Y. S. Prakash
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA; and
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Sridhar S, Liu H, Pham TH, Damera G, Newbold P. Modulation of blood inflammatory markers by benralizumab in patients with eosinophilic airway diseases. Respir Res 2019; 20:14. [PMID: 30658649 PMCID: PMC6339432 DOI: 10.1186/s12931-018-0968-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/19/2018] [Indexed: 01/01/2023] Open
Abstract
Background Benralizumab, a humanized, afucosylated, monoclonal antibody that targets interleukin-5 receptor α, depletes eosinophils and basophils by enhanced antibody-dependent cell-mediated cytotoxicity. It demonstrated efficacy for patients with moderate to severe asthma and, in a Phase IIa trial, for chronic obstructive pulmonary disease (COPD) with eosinophilic inflammation. We investigated effects of benralizumab 100 mg every 8 weeks (first three doses every 4 weeks) subcutaneous on blood inflammatory markers through proteomic and gene-expression analyses collected during two Phase II studies of patients with eosinophilic asthma and eosinophilic COPD. Methods Serum samples for proteomic analysis and whole blood for gene expression analysis were collected at baseline and 52 weeks (asthma study) or 32 weeks (COPD study) post-treatment. Proteomic analyses were conducted on a custom set of 90 and 147 Rules-Based Medicine analytes for asthma and COPD, respectively. Gene expression was profiled by Affymetrix Human Genome U133 plus 2 arrays (~ 54 K probes). Gene set variation analysis (GSVA) was used to determine transcriptomic activity of immune signatures. Treatment-related differences between analytes, genes, and gene signatures were analyzed for the overall population and for patient subgroups stratified by baseline blood eosinophil count (eosinophil-high [≥300 cells/μL] and eosinophil-low [< 300 cells/μL]) via t-test and repeated measures analysis of variance. Results Eosinophil chemokines eotaxin-1 and eotaxin-2 were significantly upregulated (false discovery rate [FDR] < 0.05) by approximately 2.1- and 1.4-fold in the asthma study and by 2.3- and 1.7-fold in the COPD study following benralizumab treatment. Magnitude of upregulation of these two chemokines was greater for eosinophil-high patients than eosinophil-low patients in both studies. Benralizumab was associated with significant reductions (FDR < 0.05) in expression of genes associated with eosinophils and basophils, such as CLC, IL-5Rα, and PRSS33; immune-signaling complex genes (FCER1A); G-protein–coupled receptor genes (HRH4, ADORA3, P2RY14); and further immune-related genes (ALOX15 and OLIG2). The magnitude of downregulation of gene expression was greater for eosinophil-high than eosinophil-low patients. GSVA on immune signatures indicated significant treatment reductions (FDR < 0.05) in eosinophil-associated signatures. Conclusions Benralizumab is highly selective, modulating blood proteins or genes associated with eosinophils or basophils. Modulated protein and gene expression patterns are most prominently altered in eosinophil-high vs. eosinophil-low patients. Trial registration NCT01227278 and NCT01238861. Electronic supplementary material The online version of this article (10.1186/s12931-018-0968-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sriram Sridhar
- MedImmune LLC, One MedImmune Way, #4552B, Gaithersburg, MD, USA
| | - Hao Liu
- MedImmune LLC, One MedImmune Way, #4552B, Gaithersburg, MD, USA
| | - Tuyet-Hang Pham
- MedImmune LLC, One MedImmune Way, #4552B, Gaithersburg, MD, USA
| | - Gautam Damera
- MedImmune LLC, One MedImmune Way, #4552B, Gaithersburg, MD, USA
| | - Paul Newbold
- MedImmune LLC, One MedImmune Way, #4552B, Gaithersburg, MD, USA.
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Vinnik T, Kirby M, Bairachnaya M, Koman I, Tarkina T, Sadykova G, Abildinova G, Batpenova G, Pinhasov A. Seasonality and BDNF polymorphism influences depression outcome in patients with atopic dermatitis and psoriasis. World J Biol Psychiatry 2017; 18:604-614. [PMID: 27409526 DOI: 10.1080/15622975.2016.1212171] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine the effect of seasonality and rs6265 genotype on depression outcome and brain-derived neurotrophic factor (BDNF) level with dermatitis patients from onset through remission. METHODS Atopic dermatitis (AD, 56) and psoriasis (PS, 33) patients and healthy controls (HC, 49) were recruited over the 2014 calendar year. Patients were subdivided by immunoglobulin E (IgE) sensitivity (AD only), season and rs6265 genotype. Assessments were performed at onset and week 10 (Hamilton Depression Rating Scale [HAM-D], SCORAD/PASI, IgE, BDNF). Patients received standard corticosteroid and antihistamine interventions. RESULTS All patients responded to corticosteroid treatment. Seasonally differential outcomes were observed in all groups. HAM-D was elevated at onset and improved over 10 weeks: AD cohort 1 (autumn/winter, AD-1) patients improved and AD cohort 2 (spring/summer, AD-2) patients remained elevated. BDNF levels were elevated in AD and seasonal differential: AD-2 declined at 10 weeks, whereas AD-1 remained high (intrinsic AD) or elevated further (extrinsic AD). PS cohort 2 declined to below control at 10 weeks. AD Val/Val had persistently elevated HAM-D and AD Val/Met were either normal (AD-1) or persistently elevated (AD-2). CONCLUSIONS Findings presented here suggest a strong influence of seasonality on depression outcome and BDNF expression in AD and PS and likely reflect separate patient populations which differentially respond to environment-based stressors.
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Affiliation(s)
- Tatyana Vinnik
- a Department of Dermatovenereology , Astana Medical University , Astana , Kazakhstan
| | - Michael Kirby
- b Department of Molecular Biology , Ariel University , Ariel , Israel
| | | | - Igor Koman
- b Department of Molecular Biology , Ariel University , Ariel , Israel
| | - Tatyana Tarkina
- a Department of Dermatovenereology , Astana Medical University , Astana , Kazakhstan
| | - Gulnaz Sadykova
- a Department of Dermatovenereology , Astana Medical University , Astana , Kazakhstan
| | - Gulshara Abildinova
- c National Research Centre of Maternal and Child Health , Astana , Kazakhstan
| | - Gulnara Batpenova
- a Department of Dermatovenereology , Astana Medical University , Astana , Kazakhstan
| | - Albert Pinhasov
- b Department of Molecular Biology , Ariel University , Ariel , Israel
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Brain-derived neurotrophic factor is increased in serum levels of patients with symptomatic dermographism. Postepy Dermatol Alergol 2017; 34:346-349. [PMID: 28951710 PMCID: PMC5560183 DOI: 10.5114/ada.2017.69315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 06/01/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction Symptomatic dermographism (SD) is the most common form of physical urticaria. However, the role of neuroimmune mechanisms in SD is unclear. Aim To investigate circulating levels of brain-derived neurotrophic factor (BDNF) in symptomatic dermographism. Material and methods Thirty-two patients suffering from SD and 33 healthy subjects were included in the study. Serum BDNF levels were determined by a human enzyme-linked immunoassay (ELISA) kit. The serum C-reactive protein concentration and eosinophil counts in peripheral blood were evaluated. Results The BDNF serum levels were detectable in both SD patients and healthy controls. The BDNF serum levels were significantly higher in patients with SD compared with healthy controls (p = 0.004). There was a positive but weak correlation between serum BDNF and CRP levels; it was not statistically significant (r = 0.211, p = 0.255). There was also a positive but weak correlation between serum BDNF and eosinophil counts; it was not statistically significant (r = 0.271, p = 0.141). Conclusions The present study shows that BDNF is increased in the serum levels of patients with SD, suggesting a role for BDNF in the pathophysiology of this disorder.
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Lee J, Park CO, Lee KH. Specific immunotherapy in atopic dermatitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2014; 7:221-9. [PMID: 25749758 PMCID: PMC4397361 DOI: 10.4168/aair.2015.7.3.221] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/30/2014] [Accepted: 06/30/2014] [Indexed: 11/20/2022]
Abstract
Allergen specific immunotherapy (SIT) using house dust mite (HDM) extracts has been performed mainly with patients of asthma and allergic rhinitis. In the meanwhile, there has been a long debate on the efficacy of SIT in atopic dermatitis (AD) with only a few double-blind placebo-controlled trials. However, several randomized controlled trials of SIT in AD revealed significant improvement of clinical symptoms and also, positive result was shown by a following meta-analysis study of these trials. In order to predict and evaluate the treatment outcome, finding a biomarker that can predict treatment responses and treatment end-points is critical but it is very challenging at the same time due to the complexity of causes and mechanisms of AD. Other considerations including standardization of the easiest and safest treatment protocol and optimizing the treatment preparations should be studied as well. This review summarizes the basics of SIT in AD including the brief mechanisms, treatment methods and schedules, and also highlights the clinical efficacy of SIT in AD along with mild, controllable adverse reactions. Immunologic effects and studies of various biomarkers are also introduced and finally, future considerations with upcoming studies on SIT were discussed.
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Affiliation(s)
- Jungsoo Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Ook Park
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang Hoon Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
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Peters EM, Liezmann C, Klapp BF, Kruse J. The neuroimmune connection interferes with tissue regeneration and chronic inflammatory disease in the skin. Ann N Y Acad Sci 2012; 1262:118-26. [DOI: 10.1111/j.1749-6632.2012.06647.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Chimienti G, Mezzapesa A, Rotelli MT, Lupo L, Pepe G. Plasma concentrations but not serum concentrations of brain-derived neurotrophic factor are related to pro-inflammatory cytokines in patients undergoing major abdominal surgery. Clin Biochem 2012; 45:631-6. [PMID: 22425604 DOI: 10.1016/j.clinbiochem.2012.02.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 02/24/2012] [Accepted: 02/26/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To investigate peripheral brain-derived neurotrophic factor (BDNF) concentrations in the perioperative period, their relationship with transforming growth factor-β1 (TGF-β1 tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6) and IL-6 genetics. DESIGN AND METHODS Prospective, observational study. BDNF, TGF-β1, IL-6 and TNF-α were analysed at baseline (T0), 5 h (T1), 24 h (T2) and 5 days (T3) after surgery, in 21 patients. The IL-6 -174 G/C polymorphism was genotyped. RESULTS Serum BDNF concentrations decreased (P=0.048), correlated with TGF-β1 (r=0.610 at T1, r=0.493 at T2, r=0.554 at T3). Plasma BDNF concentrations raised (P=0.049), correlated with IL-6 and TNF-α at T1 (r=0.495 and r=0.441, respectively). BDNF response was predictable from TNF-α and IL-6 concentrations and the IL-6 -174 G/C genotype. CONCLUSION Serum and plasma BDNF concentrations could relate to platelet activation and inflammatory response, respectively. IL-6 genetics played a role in the BDNF acute response.
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Affiliation(s)
- G Chimienti
- Department of Biosciences, Biotechnologies and Pharmacological Sciences, Italy
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11
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Rössing K, Novak N, Mommert S, Pfab F, Gehring M, Wedi B, Kapp A, Raap U. Brain-derived neurotrophic factor is increased in serum and skin levels of patients with chronic spontaneous urticaria. Clin Exp Allergy 2011; 41:1392-9. [DOI: 10.1111/j.1365-2222.2011.03795.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Forsgren S, Grimsholm O, Dalén T, Rantapää-Dahlqvist S. Measurements in the Blood of BDNF for RA Patients and in Response to Anti-TNF Treatment Help Us to Clarify the Magnitude of Centrally Related Pain and to Explain the Relief of This Pain upon Treatment. Int J Inflam 2011; 2011:650685. [PMID: 21755028 PMCID: PMC3132632 DOI: 10.4061/2011/650685] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 04/19/2011] [Indexed: 12/31/2022] Open
Abstract
Brain-derived neurotrophic factor (BDNF) is a neurotrophin with functions related to neuronal survival/proliferation processes and inflammation. BDNF is also an important central pain mediator. The levels of BDNF have been found to be high for RA patients with severe disease and to become lowered in response to anti-TNF treatment. New information says that the levels of BDNF in the blood parallel the BDNF concentrations in the brain and that BDNF can pass the blood-brain barrier. Furthermore, most of the circulating BDNF is produced in the brain. Habitual and regular exercise, in contrast to temporary exercise, does also lead to a lowering of BDNF blood levels. Both anti-TNF treatment and habitual and regular exercise do have pain-relieving effects. It might be that the pain-relieving effect of anti-TNF treatment is related to an affection of central neuronal regions, hereby influencing BDNF production. Measurements of BDNF in the blood help us to clarify the magnitude of centrally related pain for RA patients and help us to explain the relief of this pain in response to anti-TNF treatment.
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Affiliation(s)
- Sture Forsgren
- Anatomy Section, Department of Integrative Medical Biology, Umeå University, 901 87 Umeå, Sweden
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Phillips TM, Wellner EF. Chip-based immunoaffinity CE: application to the measurement of brain-derived neurotrophic factor in skin biopsies. Electrophoresis 2009; 30:2307-12. [PMID: 19569127 DOI: 10.1002/elps.200900095] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A chip-based immunoaffinity CE system has been employed to measure the concentrations of brain-derived neurotrophic factor in human skin biopsies, taken during atopic inflammatory events. The device employs a replaceable immunoaffinity disk to which capture antibodies have been chemically immobilized. Homogenates obtained from micro-dissected human skin samples were injected into the system, where the analyte of interest was captured in the immunoextraction port, thus allowing non-reactive materials to be removed prior to analysis. The captured analyte was labeled in situ with a red-emitting laser dye before being released from the capture antibody, separated by electrophoresis, and the resolved peaks detected by online LIF. Comparison of this chip-based system with conventional immunoassay demonstrated good correlation when analyzing both standards and patient samples. The system was semi-automated resulting in a CE analysis within 1.5 min and a total of circa 5 min. Intra- and inter-assay CV's of 3.85 and 4.19 were achieved with circa 98.8% recovery of brain-derived neurotrophic factor at a concentration of 100 pg/mL. The assay demonstrated clear differences between clinical stages of atopic dermatitis in human patients and could run 10-15 samples per hour. This system holds the potential for being modified to be a portable unit that could be used in clinics and other biomedical screening studies.
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Affiliation(s)
- Terry M Phillips
- Ultramicro Immunodiagnostics Section, Laboratory of Bioengineering and Physical Science, National Institute of Biomedical Imaging and Bioengineering, NIH, Bethesda, MD 20892, USA.
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Ma L, Gao XH, Zhao LP, Di ZH, Mchepange UO, Zhang L, Chen HD, Wei HC. Brain-derived neurotrophic factor gene polymorphisms and serum levels in Chinese atopic dermatitis patients. J Eur Acad Dermatol Venereol 2009; 23:1277-81. [PMID: 19522715 DOI: 10.1111/j.1468-3083.2009.03308.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) plays an important role in the pathogenesis of atopic dermatitis (AD). Whether BDNF gene polymorphisms are associated with Chinese AD remains totally unknown. OBJECTIVE The aim is to determine if BDNF gene C270T and G196A polymorphisms are associated with Chinese AD, and analyse the clinical relevance of BDNF gene polymorphisms and BDNF serum levels. Methods We conducted a case-control association analysis (160 patients and 169 controls) in Northern Chinese subjects. Genotyping was performed by restriction fragment length polymorphism, and serum levels of BDNF were measured using enzyme-linked immunosorbent assay. RESULTS For C270T, there were significant differences in C/T genotype distribution (P = 0.003) and T allele frequencies (P = 0.004) between AD patients and controls in the whole dataset. Higher C/T genotype frequencies were found in male AD (10.6% vs. 1.1%, P = 0.018) and in intrinsic AD (IAD; 15.79% vs. 2.91%, P = 0.008). No association between G196A polymorphism and AD was observed in the whole cohort, while A allele was much more frequent in AD patients with atopy in first-degree relatives (65.8% vs. 34.2%, P = 0.038). Serum BDNF levels were correlated with IAD severity as measured by Scoring Atopic Dermatitis index (r = 0.576, P < 0.001). CONCLUSION T allele in C270T may be a risk factor for AD, especially in IAD and male AD. A allele in G196A may be a risk factor in AD patients with atopy in first-degree relatives. Serum BDNF levels were correlated with the severity of IAD.
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Affiliation(s)
- L Ma
- State Key Department of Dermatology, No.1 Hospital of China Medical University, Shenyang, China
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15
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Fauchais AL, Boumediene A, Lalloue F, Gondran G, Loustaud-Ratti V, Vidal E, Jauberteau MO. Brain-derived neurotrophic factor and nerve growth factor correlate with T-cell activation in primary Sjogren's syndrome. Scand J Rheumatol 2009; 38:50-7. [PMID: 18830907 DOI: 10.1080/03009740802378832] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Identification of factors associated with disease activity and B and T cell activation is a challenge in primary Sjogren's syndrome (pSS). Neurotrophins (NTs), recently reported as B cell antiapoptotic, and T-cell activation factors seem to be implicated in autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). METHODS Samples from 18 pSS patients and 12 control subjects were studied to determine serum levels of nerve-growth factor (NGF) and brain-derived neurotrophic factor (BDNF), and their relationships with T- and B-cell activation and disease activity. Peripheral blood mononuclear cells (PBMCs) from patients with pSS and controls were examined by flow cytometry for HLA-DR expression by activated T cells. B cell activation was evaluated by B cell activating factor (BAFF) serum levels measured by enzyme-linked immunosorbent assay (ELISA) and immunoglobulin (Ig) and free light chain (FLC) levels. RESULTS Mean serum levels of BDNF in pSS patients were significantly higher than in healthy controls and correlated directly with disease activity. NGF levels were associated with the subgroup of patients with hypergammaglobulinaemia. The pSS group was characterized by peripheral CD4+ and CD8+ T cell activation that correlated positively with BDNF and NGF levels, respectively. CONCLUSION NT levels are potential biomarkers for lymphocyte activation in pSS patients.
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Affiliation(s)
- A L Fauchais
- EA 3842 (IFR 145), University of Limoges, France
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Hoffjan S, Parwez Q, Petrasch-Parwez E, Stemmler S. Variation in the BDNF and NGFB genes in German atopic dermatitis patients. Mol Cell Probes 2009; 23:35-8. [DOI: 10.1016/j.mcp.2008.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 10/28/2008] [Accepted: 10/28/2008] [Indexed: 11/30/2022]
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Oyoshi MK, He R, Kumar L, Yoon J, Geha RS. Cellular and molecular mechanisms in atopic dermatitis. Adv Immunol 2009; 102:135-226. [PMID: 19477321 DOI: 10.1016/s0065-2776(09)01203-6] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Atopic dermatitis (AD) is a pruritic inflammatory skin disease associated with a personal or family history of allergy. The prevalence of AD is on the rise and estimated at approximately 17% in the USA. The fundamental lesion in AD is a defective skin barrier that results in dry itchy skin, and is aggravated by mechanical injury inflicted by scratching. This allows entry of antigens via the skin and creates a milieu that shapes the immune response to these antigens. This review discusses recent advances in our understanding of the abnormal skin barrier in AD, namely abnormalities in epidermal structural proteins, such as filaggrin, mutated in approximately 15% of patients with AD, epidermal lipids, and epidermal proteases and protease inhibitors. The review also dissects, based on information from mouse models of AD, the contributions of the innate and adaptive immune system to the pathogenesis of AD, including the effect of mechanical skin injury on the polarization of skin dendritic cells, mediated by keratinocyte-derived cytokines such as thymic stromal lymphopoietin (TSLP), IL-6, and IL-1, that results in a Th2-dominated immune response with a Th17 component in acute AD skin lesions and the progressive conversion to a Th1-dominated response in chronic AD skin lesions. Finally, we discuss the mechanisms of susceptibility of AD skin lesions to microbial infections and the role of microbial products in exacerbating skin inflammation in AD. Based on this information, we discuss current and future therapy of this common disease.
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Affiliation(s)
- Michiko K Oyoshi
- Division of Immunology, Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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18
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Johansson M, Jönsson M, Norrgård O, Forsgren S. New aspects concerning ulcerative colitis and colonic carcinoma: analysis of levels of neuropeptides, neurotrophins, and TNFalpha/TNF receptor in plasma and mucosa in parallel with histological evaluation of the intestine. Inflamm Bowel Dis 2008; 14:1331-40. [PMID: 18452198 DOI: 10.1002/ibd.20487] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The levels of neuropeptides, neurotrophins, and TNFalpha (TNFalpha)/TNF receptor in plasma and mucosa for patients with ulcerative colitis (UC) and colonic carcinoma, and concerning plasma also for healthy controls, were examined. Moreover, the relationships between the different substances and the influence of mucosal derangement on the levels were analyzed. METHODS The levels of VIP, SP, CGRP, BDNF, NGF, and TNFalpha/TNF receptor 1 were measured using ELISA/EIA. RESULTS Patients with UC demonstrated the highest levels of all analyzed substances in plasma, with the exception of BDNF. However, there were differences within the UC group, patients treated with corticosteroids, and/or nonsteroid antiinflammatory/immunosuppressive treatment having higher plasma levels than those not given these treatments. Patients with colonic carcinoma showed higher SP and TNF receptor 1 levels in plasma compared to healthy controls. Concerning mucosa, the levels of almost all analyzed substances were elevated for patients with UC compared to noncancerous mucosa of colonic carcinoma patients. There were correlations between many of the substances in both plasma and mucosa, especially concerning the 3 neuropeptides examined. There were also marked associations with mucosa derangement. CONCLUSIONS Via analysis of correlations for the respective patients and via comparisons between the different patient groups, new and original information was obtained. Interestingly, the degree of mucosal affection was markedly correlated with tissue levels of the substances and the treatments were found to be of importance concerning plasma but not tissue levels of these. Combined plasma analysis of neuropeptides, neurotrophins, and TNF receptor 1 may help to distinguish UC and colonic carcinoma patients.
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Affiliation(s)
- Malin Johansson
- Department of Integrative Medical Biology, Anatomy, Umeå University, SE-901 87 Umeå, Sweden.
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19
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Raap U, Wardlaw AJ. A new paradigm of eosinophil granulocytes: neuroimmune interactions. Exp Dermatol 2008; 17:731-8. [PMID: 18505411 DOI: 10.1111/j.1600-0625.2008.00741.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Eosinophil granulocytes have long been regarded as potent effector cells with the potential to release an array of inflammatory mediators involved in cytotoxicity to helminths and tissue destruction in chronic inflammatory diseases such as asthma. However, it has become evident that eosinophils are also involved in regulatory mechanisms modulating local tissue immune responses. Eosinophils take part in remodelling and repair mechanisms and contribute to the localized innate and acquired immune response as well as systemic adaptive immunity. In addition, eosinophils are involved in neuroimmune interactions modulating the functional activity of peripheral nerves. Neuromediators can also modulate the functional activity of eosinophils, revealing bidirectional interactions between the two cell types. Eosinophils are tissue-resident cells and have been found in close vicinity of peripheral nerves. This review describes neuroimmune interactions between eosinophil granulocytes and peripheral nerves and highlights why eosinophils are important in allergic diseases such as asthma.
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Affiliation(s)
- Ulrike Raap
- Department of Dermatology and Allergology, Hannover Medical School, Hannover, Germany.
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20
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Ikeda Y, Yahata N, Ito I, Nagano M, Toyota T, Yoshikawa T, Okubo Y, Suzuki H. Low serum levels of brain-derived neurotrophic factor and epidermal growth factor in patients with chronic schizophrenia. Schizophr Res 2008; 101:58-66. [PMID: 18289832 DOI: 10.1016/j.schres.2008.01.017] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Revised: 01/07/2008] [Accepted: 01/16/2008] [Indexed: 12/22/2022]
Abstract
Neurotrophic factors (NFs) play a pivotal role in the development of the central nervous system. They are thus also suspected of being involved in the etiology of schizophrenia. Previous studies reported a decreased level of serum brain-derived neurotrophic factor (BDNF) in schizophrenia, whereas the association of epidermal growth factor (EGF) with this illness remains controversial. Using a two-site enzyme immunoassay, we conducted the simultaneous measurement of serum BDNF and EGF levels in a group of patients with chronic schizophrenia (N=74) and a group of normal controls matched in age, body mass index, smoking habit and sex (N=87). We found that, compared to normal controls, patients with chronic schizophrenia exhibited lower serum levels of both BDNF and EGF across all ages examined (21-59 years). The serum levels of BDNF and EGF were negatively correlated in the controls (r=-0.387, P=0.0002) but not in the patients. Clinical parameters such as duration of illness and psychiatric rating scale also showed no robust correlations with the NF levels. Collectively, these results suggest that pervasive, abnormal signaling of NFs underlies the pathophysiology of chronic schizophrenia.
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Affiliation(s)
- Yumiko Ikeda
- Department of Pharmacology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan.
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Cevikbas F, Steinhoff A, Homey B, Steinhoff M. Neuroimmune interactions in allergic skin diseases. Curr Opin Allergy Clin Immunol 2007; 7:365-73. [PMID: 17873574 DOI: 10.1097/aci.0b013e3282a644d2] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Recent studies have advanced our understanding that allergic inflammation triggers neuronal dysfunction, thereby modulating inflammation-related changes in affected tissues including the skin. Vice versa, evidence has emerged that inflammatory responses are controlled by neurons. Moreover, structural cells and invading immune cells express neuronal receptors and release mediators which directly communicate with nerve endings in the skin. RECENT FINDINGS During the allergic response, skin cells do not only represent a significant source of neuromediators but also represent targets for neuropeptides or neurotrophins as well as neurotransmitters in the inflamed tissue. During the last decade, it has become obvious that a large variety of molecules influence the adaptive as well as the innate immune response. Beside neuropeptide receptors, proteinase-activated receptors, novel histamine receptors, different cytokine or chemokine receptors play a role in the pathophysiology of atopic and allergic diseases. SUMMARY Peripheral sensory and autonomic nerves are critically involved in many pathways of the innate and adoptive immune system during allergic and atopic skin diseases. Further dissection of receptor-mediated and intracellular signal pathways will help to develop more effective therapeutic approaches for allergic and inflammatory skin diseases.
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Affiliation(s)
- Ferda Cevikbas
- Department of Dermatology, IZKF Moenster and Boltzmann-Institute for Cell and Immunobiology of the Skin, University of Münster, Germany
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22
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Current World Literature. Curr Opin Allergy Clin Immunol 2007; 7:454-5. [PMID: 17873589 DOI: 10.1097/aci.0b013e3282f0cf23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Glenister KM, Payne KA, Sparrow RL. Proteomic analysis of supernatant from pooled buffy-coat platelet concentrates throughout 7-day storage. Transfusion 2007; 48:99-107. [PMID: 17894789 DOI: 10.1111/j.1537-2995.2007.01487.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The platelet (PLT) storage lesion remains incompletely understood. To gain a greater insight into the PLT storage lesion, a proteomic analysis of supernatant from leukofiltered pooled buffy-coat PLT concentrates (PCs) was undertaken. STUDY DESIGN AND METHODS PCs were prepared in PLT additive solution and stored according to standard blood bank procedures. Supernatant samples were collected throughout 7 days of storage. Maps of supernatant proteins were generated by two-dimensional (2D) gel electrophoresis and mass spectrometry. Cytokine antibody microarrays and enzyme-linked immunosorbent assay were used to investigate bioactive molecules. RESULTS The 2D gel maps of PC supernatant proteins displayed many features of plasma protein maps. Several storage-induced protein changes were identified including modifications to major plasma proteins. PLT-derived proteins were also identified, including tremlike transcript 1 and integrin-linked kinase, which may influence PLT-endothelium interactions. Cytokine antibody microarrays revealed a number of bioactive proteins that have not been previously associated with PCs produced for transfusion, such as brain-derived neurotrophic factor (BDNF). The concentration of PLT-derived cytokines including BDNF, CXCL7, epidermal growth factor, PLT-derived growth factor (PDGF), and CCL5 significantly increased during storage of PCs. Extended storage from Day 5 to Day 7 caused significantly increased levels of BDNF, PDGF, and CCL5 in PC supernatant. CONCLUSION Proteomic techniques provide valuable new insight into the effects of storage on PCs and the contribution of soluble proteins to the development of the PLT storage lesion and recipient responses to PLT transfusion.
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Affiliation(s)
- Kristen M Glenister
- Research Unit, Australian Red Cross Blood Service, Melbourne, Victoria, Australia
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Schulte-Herbrüggen O, Fölster-Holst R, von Elstermann M, Augustin M, Hellweg R. Clinical relevance of nerve growth factor serum levels in patients with atopic dermatitis and psoriasis. Int Arch Allergy Immunol 2007; 144:211-6. [PMID: 17579279 DOI: 10.1159/000103994] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 04/02/2007] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Nerve growth factor (NGF) is known to act as a potent mediator in neuroinflammatory processes. Recent studies point to a role of NGF in the skin pathophysiology of atopic dermatitis (AD) and psoriasis. Hereby, NGF was found to interact with the major cellular components (mast cells and eosinophils) of both skin diseases. OBJECTIVES In order to investigate NGF serum levels as a possible clinical marker of disease activity and immunological status, we determined serum NGF, eosinophil cationic protein (ECP), total IgE and score of AD (SCORAD) in 57 patients with AD as well as NGF and the psoriasis area and severity index (PASI) in 17 patients with psoriasis. Fifty healthy subjects served as controls. METHODS We used a highly sensitive improved fluorometric two-site ELISA system for serum NGF detection. IgE and ECP were measured by CAP-FEIA and radioimmunoassay. RESULTS We did not find a significant correlation between NGF and either ECP, total IgE, or severity of disease assessed by SCORAD. Also in patients with psoriasis, there was no significant correlation with disease activity determined by PASI. CONCLUSION Even though there is increasing evidence showing NGF to be involved in the local inflammatory pathophysiology of AD within skin lesions, our findings suggest that NGF systemic serum concentration is not a suitable parameter to estimate the clinical or immunological status of AD or psoriasis patients. This result is inconsistent with some previous studies showing a positive correlation of serum NGF with AD severity, which might be, for example, due to the fact that the present results are corrected for unspecific binding.
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Affiliation(s)
- O Schulte-Herbrüggen
- Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
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