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Salmani A, Mohammadi M, Farid Hosseini R, Tavakol Afshari J, Fouladvand A, Dehnavi S, Khoshkhooi M, Jabbari Azad F. A significant increase in expression of FOXP3 and IL-17 genes in patients with allergic rhinitis underwent accelerated rush immunotherapy. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2019; 22:989-996. [PMID: 31807241 PMCID: PMC6880522 DOI: 10.22038/ijbms.2019.32979.7878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective(s): Allergic rhinitis (AR) is a common hypersensitivity disease worldwide. Immunotherapy has been performed as the best treatment for years. This study aimed to study the gene expression pattern of immune system cells following an accelerated rush immunotherapy protocol (ARIT) in patients with AR. Materials and Methods: Fifteen patients with AR (15–55 years old) resident in Mashhad, Iran, with positive prick test to regional aeroallergens (weed mix, grass mix, tree mix, and Salsola) enrolled in this study. All patients were treated for three months with 3-day ARIT protocol between July 2015 and August 2016. Clinical symptoms and quality of life were recorded by two questioners. The expression levels of FOXP3, TGF-β, IL-10, IL-17, IL-4, and IFN-γ genes in patient’s peripheral blood mononuclear cells were evaluated by SYBR Green real-time RT-PCR technique. Results: The severity of disease and quality of life showed significant improvement following ARIT (P-value<0.05). Gene expression of IFN-γ and IL-10 was increased whereas TGF-β and IL-4 down-regulated, following ARIT, but these changes were not significant. However, gene expression of FOXP3 and IL-17 was significantly increased after intervention when compared with the baseline (P-value< 0.002). Conclusion: Significant up-regulation of FOXP3 and IL-17 genes, additionally, a significant improvement in the clinical signs following ARIT might be related to increases in HLA-DR- and FOXP3+ Treg population at the initiation phase of ARIT. Employing the flow cytometry technique to study the phenotype of these cells is suggested for future studies.
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Affiliation(s)
- Amirabbas Salmani
- Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojgan Mohammadi
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Farid Hosseini
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Ali Fouladvand
- Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sajad Dehnavi
- Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Khoshkhooi
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Ciprandi G, Incorvaia C, Tosca MA. The behavior of Italian allergists in prescribing allergen immunotherapy for house dust mites allergy. Immunotherapy 2019; 10:1343-1348. [PMID: 30474482 DOI: 10.2217/imt-2018-0066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The meeting 'Clinical Evidence, Extracts Quality and Biotechnology Innovation in Allergen Immunotherapy' held in Trieste (Italy) on 1 October 2017 concerned the outcomes of a real-world survey conducted on a group of Italian allergists about allergen immunotherapy (AIT) for house dust mites allergy. It pointed out: allergist's confidence that AIT should be prescribed continuously; tablets seem to be well accepted by patients and effective in most subjects with a fast onset of action (3-6 months); combined score for symptom severity and medication use is universally assessed; there is disagreement about the diagnosis of house dust mites allergy, the quote of AIT prescription, the choice for AIT route of administration, assessment of serum IgE and perception of patient's adherence.
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3
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Marteles D, Verde MT, Conde T, Pereboom D, Casanova Á, Villanueva-Saz S, Ortín A, Fernández A. Effects of allergen-specific immunotherapy on peripheral blood regulatory T cells and serum concentrations of cytokines and immunoglobulins in horses with allergic dermatitis. Int Immunopharmacol 2019; 74:105674. [PMID: 31195188 DOI: 10.1016/j.intimp.2019.105674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/20/2019] [Accepted: 05/29/2019] [Indexed: 12/30/2022]
Abstract
The aim of this study was to assess the effect of allergen-specific immunotherapy (ASIT) on the immunological responses of horses. Blood samples were taken from thirty-two horses with allergic dermatitis treated with ASIT and 10 healthy control horses at 0, 3, 6, 9 and 12 months to investigate the evolution of the percentage of regulatory T cells (Treg) in the peripheral blood and the serum levels of cytokines and immunoglobulins. Clinical improvement was appreciated by the majority of the horses' owners (56.6%). No effect of ASIT on CD4+CD25High Treg cells was found during the one year treatment period. No differences in the percentage of CD4+ T cells were observed between the groups, and no effects of ASIT over time were observed. The percentage of CD25+ T cells was always higher in the ASIT group (17.9 ± 11.3%) than in the control group (7.3 ± 4.4%, p < 0.001). We did not detect any effect of ASIT on the serum levels of TGF-β, IL-10 and IFN-γ or on the serum concentrations of IgA and IgG4. A reduction in the serum levels of total IgE in the horses with allergic dermatitis was observed at the 6th month (p < 0.05), but increased again at the end of the study. The results indicate that immunotherapy was insufficient to induce significant changes that could indicate T cell tolerance, a shift in cytokine production to more protective Th1 cells. More studies are needed with new vaccine compositions and administration protocols to improve the immunological responses of the horses with allergic dermatitis.
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Affiliation(s)
- Diana Marteles
- Animal Pathology Department, Veterinary Faculty, Zaragoza University, 50013 Zaragoza, Spain
| | - María Teresa Verde
- Animal Pathology Department, Veterinary Faculty, Zaragoza University, 50013 Zaragoza, Spain; Clinical Immunology Laboratory, Veterinary Faculty, Zaragoza University, 50013 Zaragoza, Spain
| | - Tomás Conde
- Animal Pathology Department, Veterinary Faculty, Zaragoza University, 50013 Zaragoza, Spain
| | - Desirée Pereboom
- Pharmacology and Physiology Department, Medicine Faculty, Zaragoza University, SAI de Citomica 50009 Zaragoza, Spain
| | - Álvaro Casanova
- Pharmacology and Physiology Department, Medicine Faculty, Zaragoza University, SAI de Citomica 50009 Zaragoza, Spain
| | - Sergio Villanueva-Saz
- Clinical Immunology Laboratory, Veterinary Faculty, Zaragoza University, 50013 Zaragoza, Spain; Pharmacology and Physiology Department, Medicine Faculty, Zaragoza University, SAI de Citomica 50009 Zaragoza, Spain
| | - Aurora Ortín
- Animal Pathology Department, Veterinary Faculty, Zaragoza University, 50013 Zaragoza, Spain
| | - Antonio Fernández
- Animal Pathology Department, Veterinary Faculty, Zaragoza University, 50013 Zaragoza, Spain; Clinical Immunology Laboratory, Veterinary Faculty, Zaragoza University, 50013 Zaragoza, Spain.
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4
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Shin JU, Kim SH, Noh JY, Kim JH, Kim HR, Jeong KY, Park KH, Lee J, Chu H, Lee JH, Yong TS, Park JW, Lee KH. Allergen-specific immunotherapy induces regulatory T cells in an atopic dermatitis mouse model. Allergy 2018; 73:1801-1811. [PMID: 29679487 DOI: 10.1111/all.13465] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several studies have demonstrated that allergen-specific immunotherapy (SIT) can be an effective treatment for atopic dermatitis (AD). However, there is no relevant mouse model to investigate the mechanism and validate the novel modality of SIT in AD. METHODS NC/Nga mice with induced AD-like skin lesions received a subcutaneous injection of SIT (an extract of the house dust mite Dermatophagoides farinae [DfE]) or placebo for 5 weeks). Clinical and histological improvements of AD-like skin lesions were examined. The responses of local and systemic regulatory T (Treg) cells, natural killer (NK) cells, B cells, serum immunoglobulin, and T-cell cytokine response to DfE were evaluated to determine the underlying mechanism of the observed results. RESULTS Specific immunotherapy significantly improved AD-like skin lesions. Histologically, SIT decreased epidermal thickness and reduced inflammatory cell infiltration, especially that of eosinophils. Concomitantly, SIT suppressed Th2 responses and induced local infiltration of Treg cells into the skin. Also, SIT induced the immunoglobulin G4 and attenuated allergen-specific immunoglobulin E. Furthermore, SIT induced local and systemic IL-10-producing Treg cells and regulatory NK cells. CONCLUSION We established a SIT model on AD mice and showed that our model correlates well with previous reports about SIT-treated patients. Also, we revealed NK cells as another possible resource of IL-10 in SIT. Based on our results, we suggest our SIT model as a useful tool to investigate mechanism of action of SIT and to validate the efficacy of new SIT modalities for the treatment of AD.
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Affiliation(s)
- J. U. Shin
- Department of Dermatology & Cutaneous Biology Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - S. H. Kim
- Department of Dermatology & Cutaneous Biology Research Institute; Yonsei University College of Medicine; Seoul Korea
- Brain Korea 21 PLUS Project for Medical Science; Yonsei University College of Medicine; Seoul Korea
| | - J. Y. Noh
- Department of Dermatology & Cutaneous Biology Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - J. H. Kim
- Department of Dermatology & Cutaneous Biology Research Institute; Yonsei University College of Medicine; Seoul Korea
- Brain Korea 21 PLUS Project for Medical Science; Yonsei University College of Medicine; Seoul Korea
| | - H. R. Kim
- Department of Dermatology & Cutaneous Biology Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - K. Y. Jeong
- Department of Internal Medicine; Institute of Allergy; Yonsei University College of Medicine; Seoul Korea
| | - K. H. Park
- Department of Internal Medicine; Institute of Allergy; Yonsei University College of Medicine; Seoul Korea
| | - J. Lee
- Department of Dermatology & Cutaneous Biology Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - H. Chu
- Department of Dermatology & Cutaneous Biology Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - J.-H. Lee
- Department of Internal Medicine; Institute of Allergy; Yonsei University College of Medicine; Seoul Korea
| | - T.-S. Yong
- Department of Environmental Medical Biology; Arthropds of Medical Importance Resource Bank; Institute of Tropical Medicine; Yonsei University College of Medicine; Seoul Korea
| | - J.-W. Park
- Department of Internal Medicine; Institute of Allergy; Yonsei University College of Medicine; Seoul Korea
| | - K. H. Lee
- Department of Dermatology & Cutaneous Biology Research Institute; Yonsei University College of Medicine; Seoul Korea
- Brain Korea 21 PLUS Project for Medical Science; Yonsei University College of Medicine; Seoul Korea
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Hrdý J, Kocourková I, Lodinová-Žádníková R, Kolářová L, Prokešová L. The effect of a probiotic Escherichia coli strain on regulatory T-cells in six year-old children. Benef Microbes 2016; 7:639-648. [PMID: 27633175 DOI: 10.3920/bm2016.0030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Probiotics are believed to prevent or reduce allergy development but the mechanism of their beneficial effect is still poorly understood. Immune characteristics of regulatory T cells (Tregs) in peripheral blood of perinatally probiotic-supplemented children of allergic mothers (51 children), non-supplemented children of allergic mothers (42 children), and non-supplemented children of healthy mothers (28 children) were compared at the age of 6-7 years. A first dose of a probiotic Escherichia coli strain (E. coli O83:K24:H31) was administered within 2 days after the birth and then 12 times during the first months of life and children were followed longitudinally. Proportion and functional properties of Tregs were estimated by flow cytometry in relation to the children's allergy status. Proportion of Tregs in the peripheral blood of children suffering from allergy tends to be higher whereas median of fluorescence intensity (MFI) of FoxP3 was significantly decreased in allergic group. Intracellular presence of regulatory cytokine interleukin (IL)-10 was also lower in allergic children. Immune functions of Tregs reflected by both MFI of FoxP3 and IL-10 in the group of probiotic-supplemented children of allergic mothers were nearly comparable with children of healthy mothers while probiotic non-supplemented children of allergic mothers have decreased immune function of Tregs. Supplementation by probiotic E. coli strain decreases allergy incidence in high-risk children. In contrast to our expectation, proportion of Tregs has not been increased in probiotic supplemented children. Beneficial effect of probiotics on newborn immature immune system could be, at least partially, explained by the modulating immune function of Tregs. In summary, we detected increased proportion of Tregs in peripheral blood of allergic children, their functional properties were decreased in comparison with the Tregs of healthy children. A unifying hypothesis for these findings is that Treg numbers in allergic children are increased in order to compensate for decreased function.
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Affiliation(s)
- J Hrdý
- 1 Institute of immunology and microbiology, First faculty of medicine, Charles University in Prague, Studnickova 7, 128 00 Prague, Czech Republic
| | - I Kocourková
- 2 Institute for the care of mother and child, Podolské nábřeží 157/4, 147 00 Prague 4, Czech Republic
| | - R Lodinová-Žádníková
- 2 Institute for the care of mother and child, Podolské nábřeží 157/4, 147 00 Prague 4, Czech Republic
| | - L Kolářová
- 1 Institute of immunology and microbiology, First faculty of medicine, Charles University in Prague, Studnickova 7, 128 00 Prague, Czech Republic
| | - L Prokešová
- 1 Institute of immunology and microbiology, First faculty of medicine, Charles University in Prague, Studnickova 7, 128 00 Prague, Czech Republic
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Ozdemir C, Kucuksezer UC, Akdis M, Akdis CA. Mechanisms of Aeroallergen Immunotherapy: Subcutaneous Immunotherapy and Sublingual Immunotherapy. Immunol Allergy Clin North Am 2016; 36:71-86. [PMID: 26617228 DOI: 10.1016/j.iac.2015.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Allergen immunotherapy (AIT) is an effective way to treat allergic disorders, targeting the underlying mechanisms and altering the disease course by inducing a long-lasting clinical and immune tolerance to allergens. Although sublingual and subcutaneous routes are used in daily practice, many novel ways to decrease side effects and duration and increase efficacy have been pursued. Further studies are needed to develop biomarkers for the identification of AIT responder patients and also to use the developed knowledge in allergy prevention studies. Future directions in AIT include treatments for autoimmune diseases, chronic infections, organ transplantation, and breaking immune tolerance to cancer cells.
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Affiliation(s)
- Cevdet Ozdemir
- Department of Pediatric Allergy, Memorial Atasehir Hospital, Memorial Health Group, Vedat Gunyol Cad. 28-30, Istanbul 34758, Turkey
| | - Umut Can Kucuksezer
- Department of Immunology, Institute of Experimental Medicine (DETAE), Vakif Gureba Cad, Istanbul University, Istanbul 34093, Turkey
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Obere Strasse, CH-7270, Davos, Switzerland
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Obere Strasse, CH-7270, Davos, Switzerland.
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7
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Pratesi S, Nencini F, Filì L, Occhiato EG, Romagnani S, Parronchi P, Maggi E, Vultaggio A. Dermatophagoides pteronyssinus group 2 allergen bound to 8-OH modified adenine reduces the Th2-mediated airway inflammation without inducing a Th17 response and autoimmunity. Mol Immunol 2016; 77:60-70. [DOI: 10.1016/j.molimm.2016.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
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8
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Bonnet B, Vigneron J, Levacher B, Vazquez T, Pitoiset F, Brimaud F, Churlaud G, Klatzmann D, Bellier B. Low-Dose IL-2 Induces Regulatory T Cell-Mediated Control of Experimental Food Allergy. THE JOURNAL OF IMMUNOLOGY 2016; 197:188-98. [PMID: 27259854 DOI: 10.4049/jimmunol.1501271] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 04/29/2016] [Indexed: 11/19/2022]
Abstract
Regulatory T cells (Tregs) are pivotal for maintenance of immune self-tolerance and also regulate immune responses to exogenous Ags, including allergens. Both decreased Treg number and function have been reported in allergic patients, offering new therapeutic perspectives. We previously demonstrated that Tregs can be selectively expanded and activated by low doses of IL-2 (ld-IL-2) inducing immunoregulation without immunosuppression and established its protective effect in autoimmune diseases. In this study, we evaluated the ability of ld-IL-2 to control allergy in an experimental model of food allergy. Ld-IL-2 induced Treg expansion and activation that elicited protection against clinical manifestations of food allergy in two mouse models with OVA and peanut. This clinical effect was lost in Treg-depleted mice, demonstrating the major contribution of Tregs in ld-IL-2 efficacy. Mechanistic studies further indicated that protection from allergy could be explained by a Treg-dependent local modification of the Th1/Th2 balance and an inhibition of mast cell recruitment and activation. Preventive and therapeutic effects of ld-IL-2 were observed over a 7-mo-period, highlighting its long-term efficacy. This study demonstrated that ld-IL-2 is efficient to prevent and to treat allergic immune responses, and thus represents a promising therapeutic strategy for managing allergic diseases.
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Affiliation(s)
- Benjamin Bonnet
- Sorbonne Universités, Université Pierre et Marie Curie, Université Paris 6, UMRS 959, I, F-75013 Paris, France; INSERM, UMRS 959, I, F-75013 Paris, France; and Service de Biothérapies et Centre d'Investigation Clinique en Biothérapie, Groupe Hospitalier Pitié Salpêtrière, Assistance Publique - Hôpitaux de Paris, 75013 Paris, France
| | - James Vigneron
- Sorbonne Universités, Université Pierre et Marie Curie, Université Paris 6, UMRS 959, I, F-75013 Paris, France; INSERM, UMRS 959, I, F-75013 Paris, France; and
| | - Béatrice Levacher
- Sorbonne Universités, Université Pierre et Marie Curie, Université Paris 6, UMRS 959, I, F-75013 Paris, France; INSERM, UMRS 959, I, F-75013 Paris, France; and
| | - Thomas Vazquez
- Sorbonne Universités, Université Pierre et Marie Curie, Université Paris 6, UMRS 959, I, F-75013 Paris, France; INSERM, UMRS 959, I, F-75013 Paris, France; and
| | - Fabien Pitoiset
- Sorbonne Universités, Université Pierre et Marie Curie, Université Paris 6, UMRS 959, I, F-75013 Paris, France; INSERM, UMRS 959, I, F-75013 Paris, France; and
| | - Faustine Brimaud
- Sorbonne Universités, Université Pierre et Marie Curie, Université Paris 6, UMRS 959, I, F-75013 Paris, France; INSERM, UMRS 959, I, F-75013 Paris, France; and
| | - Guillaume Churlaud
- Sorbonne Universités, Université Pierre et Marie Curie, Université Paris 6, UMRS 959, I, F-75013 Paris, France; INSERM, UMRS 959, I, F-75013 Paris, France; and Service de Biothérapies et Centre d'Investigation Clinique en Biothérapie, Groupe Hospitalier Pitié Salpêtrière, Assistance Publique - Hôpitaux de Paris, 75013 Paris, France
| | - David Klatzmann
- Sorbonne Universités, Université Pierre et Marie Curie, Université Paris 6, UMRS 959, I, F-75013 Paris, France; INSERM, UMRS 959, I, F-75013 Paris, France; and Service de Biothérapies et Centre d'Investigation Clinique en Biothérapie, Groupe Hospitalier Pitié Salpêtrière, Assistance Publique - Hôpitaux de Paris, 75013 Paris, France
| | - Bertrand Bellier
- Sorbonne Universités, Université Pierre et Marie Curie, Université Paris 6, UMRS 959, I, F-75013 Paris, France; INSERM, UMRS 959, I, F-75013 Paris, France; and Service de Biothérapies et Centre d'Investigation Clinique en Biothérapie, Groupe Hospitalier Pitié Salpêtrière, Assistance Publique - Hôpitaux de Paris, 75013 Paris, France
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Yu SJ, Liao EC, Tsai JJ. Effects of local nasal immunotherapy in allergic airway inflammation: Using urea denatured Dermatophagoides pteronyssinus. Hum Vaccin Immunother 2016; 11:915-21. [PMID: 25933184 DOI: 10.1080/21645515.2015.1012029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Despite improvements in anti-allergy medication, the prevalence of allergic airway inflammation remains high, affecting up to 40% of the population worldwide. Allergen immunotherapy is effective for inducing tolerance but has the adverse effect of severe allergic reaction. This can be avoided by denaturing with urea. In this study, we demonstrated that the serum level of allergen-specific IgE in mice sensitized with native Dermatophagoides pteronyssinus (Der p) crude extract after receiving local nasal immunotherapy (LNIT) with urea-denatured Der p crude extract (DN-Dp) significantly decreased compared to that in the normal saline (NS) treatment group. Expressions of IL-4 were significantly reduced in lung tissues after treatment. Inflammation around the bronchial epithelium improved and airway hypersensitivity was down-regulated. LNIT with DN-Dp can down-regulate IL-1b, IL-6 and TNF-a expression and then decrease Der p-induced allergic airway inflammation. This therapeutic modality may be used as an alternative treatment for airway allergic diseases.
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Affiliation(s)
- Sheng-Jie Yu
- a Institute of Biomedical Sciences; National Chung Hsing University ; Taichung , Taiwan
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10
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Differential Plasma-cell evolution is linked with Dermatophagoides pteronyssinus immunotherapy response. Sci Rep 2015; 5:14482. [PMID: 26416023 PMCID: PMC4586444 DOI: 10.1038/srep14482] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 09/01/2015] [Indexed: 11/08/2022] Open
Abstract
Allergic rhinitis is highly prevalent worldwide. Immunotherapy has been shown to control its symptoms, however, up to 30% of patients may not respond. Previous studies of the immunological mechanisms involved in allergen-immunotherapy (AIT) have focused on the humoral and T-cell response and several studies have evaluated some B-cell subpopulations during AIT and their role in immunological tolerance. However, although B and plasma-cell subpopulations are two of the most important cellular subtypes involved in allergic reactions, their relation with AIT efficacy remains unelucidated. The objective was to analyze the effects of immunotherapy on different B and plasma-cell subpopulations and whether these changes correlate with the clinical response to the treatment. Although no changes are found in B-cell subpopulations, responder patients show increased levels of memory B-cells even before the beginning of treatment. Changes in plasma-cell subpopulations are found, mainly in circulating inflammatory plasma-cells that could affect the response to the allergen. Moreover, an early increase of specific-IgG4 and IgG4 secreting-cells was found. All these suggest that the determination of the memory B-cells before the initiation of the treatment, and the quantification of IgG4 and IgG4-secreting-cells in the first months of immunotherapy, could serve as markers for the clinical response to treatment.
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Ciprandi G, Marseglia GL, Castagnoli R, Valsecchi C, Tagliacarne C, Caimmi S, Licari A. From IgE to clinical trials of allergic rhinitis. Expert Rev Clin Immunol 2015; 11:1321-33. [PMID: 26358006 DOI: 10.1586/1744666x.2015.1086645] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The current scientific research is continuously aiming at identifying new therapeutic targets with the purpose of modifying the immune response to allergens. The evolution in immunological methods has led to the identification of immunoglobulin E (IgE) as both a diagnostic biomarker and potential therapeutic target in allergic diseases, such as allergic rhinitis. Allergen immunotherapy has been used for more than 100 years to treat allergic diseases and it is today considered the only disease-modifying treatment capable of inducing a long-lasting immunological and clinical tolerance toward the causal allergen. During the past 20 years, major advances have been made in understanding the molecular and cellular mechanisms of allergen tolerance in humans. Moreover, there has been considerable progress in allergen extract modifications and additions to standard extracts. The recognition that IgE plays a pivotal role in basic regulatory mechanisms of allergic inflammation has recently stimulated research into the therapeutic potential of directly targeting this antibody. Omalizumab, the most advanced humanized anti-IgE monoclonal antibody, is currently approved for the treatment of uncontrolled allergic asthma and chronic spontaneous urticaria. Interesting results also arise from studies in which omalizumab was administered in patients with allergic rhinitis. The aim of this review is to provide an update on current findings on immunological and clinical effects of allergen immunotherapy and anti-IgE therapy, which have been shown to have synergistic modes of action for the treatment of allergic rhinitis.
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Affiliation(s)
- Giorgio Ciprandi
- a 1 Department of Medicine, IRCCS-A.O.U. San Martino di Genova, Genoa, Italy
| | - Gian Luigi Marseglia
- b 2 Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Riccardo Castagnoli
- b 2 Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Chiara Valsecchi
- b 2 Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Carlotta Tagliacarne
- b 2 Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Silvia Caimmi
- b 2 Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Amelia Licari
- b 2 Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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Nencini F, Pratesi S, Petroni G, Filì L, Cardilicchia E, Casini A, Occhiato EG, Calosi L, Bani D, Romagnani S, Maggi E, Parronchi P, Vultaggio A. Treatment with 8-OH-modified adenine (TLR7 ligand)-allergen conjugates decreases T helper type 2-oriented murine airway inflammation. Immunology 2015; 145:570-82. [PMID: 25930741 PMCID: PMC4515136 DOI: 10.1111/imm.12475] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 04/09/2015] [Accepted: 04/27/2015] [Indexed: 01/16/2023] Open
Abstract
A strategy to improve allergen-specific immunotherapy is to employ new adjuvants stably linked to allergens. The study is addressed to evaluate the in vivo and in vitro effects of allergens [natural Dermatophagoides pteronyssinus 2 (nDer p 2) and ovalbumin (OVA)] chemically bound to an 8-OH-modified adenine. Humoral and cellular responses were analysed in allergen-sensitized and challenged mice by using conjugates (Conj) in a therapeutic setting. The in vitro activity of the conjugates on cytokine production induced by bone marrow dendritic cells and the co-culture system was also investigated. The nDer p 2-Conj treatment in nDer p 2-primed and challenged BALB/c mice reduced the numbers of eosinophils in bronchoalveolar lavage fluid and lung, airway allergen-driven interleukin-13 (IL-13) production in lung mononuclear cells and IgE, in comparison with nDer p 2-treated mice. The increase of IgG2a paralleled that of interferon-γ (IFN-γ) and IL-10 in allergen-stimulated spleen cells. Similar effects were elicited by treatment with OVA-Conj in an OVA-driven BALB/c model. The nDer p 2-Conj or OVA-Conj redirected memory T helper type 2 cells towards the production of IL-10 and IFN-γ also in C57BL/6 mice and when subcutaneously administered. Interleukin-10, IL-12 and IL-27 were produced in vitro by Conj-stimulated bone marrow dendritic cells, whereas IL-10 and IFN-γ were up-regulated in co-cultures of CD11c+ and CD4+ T cells from Conj-treated mice stimulated with allergen. Cytofluorometric analysis indicated that the Conj expanded IFN-γ- and IL-10- producing memory T cells. The Conj effects on IL-10−/− and IL-12−/− mice confirmed the role of IL-10 and IFN-γ in inducing a protective and balanced redirection the T helper type 2-mediated airway inflammation.
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Affiliation(s)
- Francesca Nencini
- Department of Experimental and Clinical Medicine, Centre for Research, Transfer and High Education DENOTHE, Florence, Italy
| | - Sara Pratesi
- Department of Experimental and Clinical Medicine, Centre for Research, Transfer and High Education DENOTHE, Florence, Italy
| | - Giulia Petroni
- Department of Experimental and Clinical Medicine, Centre for Research, Transfer and High Education DENOTHE, Florence, Italy
| | - Lucia Filì
- Department of Experimental and Clinical Medicine, Centre for Research, Transfer and High Education DENOTHE, Florence, Italy
| | - Elisa Cardilicchia
- Department of Experimental and Clinical Medicine, Centre for Research, Transfer and High Education DENOTHE, Florence, Italy
| | - Andrea Casini
- Department of Chemistry 'Ugo Schiff', University of Florence, Florence, Italy
| | | | - Laura Calosi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniele Bani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sergio Romagnani
- Department of Experimental and Clinical Medicine, Centre for Research, Transfer and High Education DENOTHE, Florence, Italy
| | - Enrico Maggi
- Department of Experimental and Clinical Medicine, Centre for Research, Transfer and High Education DENOTHE, Florence, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, Centre for Research, Transfer and High Education DENOTHE, Florence, Italy
| | - Alessandra Vultaggio
- Immunoallergology Unit, Department of Biomedicine, Careggi Hospital, Florence, Italy
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13
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Orally inhaled fixed-dose combination products for the treatment of asthma and chronic obstructive pulmonary disease: not simple math. Ther Deliv 2014; 5:297-317. [PMID: 24592955 DOI: 10.4155/tde.14.4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Over the past decade, orally inhaled fixed-dose combination products (FDCs) have emerged as an important therapeutic class for the treatment of asthma and chronic obstructive pulmonary disease. However, the conceptual simplicity of inhaled FDCs belies both the complexity of their development, and the profound advantages they offer patients. The benefits of combining agents are not merely additive, and range from increased compliance via simple convenience to complex receptor-level synergies. Similarly, though, the development challenges often exceed the sum of their parts. FDC formulation and analytical method development is generally more complex than for two monotherapy products. Likewise, FDC clinical programs can easily eclipse those of their monotherapy peers and their inherent complexity is often furthered by the diverse regulatory requirements for worldwide approval. As such, the proposition of developing an orally inhaled FDC for global registration often represents a significant increase in both the potential rewards and assumed risks of drug development.
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14
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Canonica GW, Cox L, Pawankar R, Baena-Cagnani CE, Blaiss M, Bonini S, Bousquet J, Calderón M, Compalati E, Durham SR, van Wijk RG, Larenas-Linnemann D, Nelson H, Passalacqua G, Pfaar O, Rosário N, Ryan D, Rosenwasser L, Schmid-Grendelmeier P, Senna G, Valovirta E, Van Bever H, Vichyanond P, Wahn U, Yusuf O. Sublingual immunotherapy: World Allergy Organization position paper 2013 update. World Allergy Organ J 2014; 7:6. [PMID: 24679069 PMCID: PMC3983904 DOI: 10.1186/1939-4551-7-6] [Citation(s) in RCA: 328] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 02/07/2014] [Indexed: 02/07/2023] Open
Abstract
We have prepared this document, "Sublingual Immunotherapy: World Allergy Organization Position Paper 2013 Update", according to the evidence-based criteria, revising and updating chapters of the originally published paper, "Sublingual Immunotherapy: World Allergy Organization Position Paper 2009", available at http://www.waojournal.org. Namely, these comprise: "Mechanisms of sublingual immunotherapy;" "Clinical efficacy of sublingual immunotherapy" - reporting all the data of all controlled trials published after 2009; "Safety of sublingual immunotherapy" - with the recently published Grading System for adverse reactions; "Impact of sublingual immunotherapy on the natural history of respiratory allergy" - with the relevant evidences published since 2009; "Efficacy of SLIT in children" - with detailed analysis of all the studies; "Definition of SLIT patient selection" - reporting the criteria for eligibility to sublingual immunotherapy; "The future of immunotherapy in the community care setting"; "Methodology of clinical trials according to the current scientific and regulatory standards"; and "Guideline development: from evidence-based medicine to patients' views" - including the evolution of the methods to make clinical recommendations.Additionally, we have added new chapters to cover a few emerging crucial topics: "Practical aspects of schedules and dosages and counseling for adherence" - which is crucial in clinical practice for all treatments; "Perspectives and new approaches" - including recombinant allergens, adjuvants, modified allergens, and the concept of validity of the single products. Furthermore, "Raising public awareness about sublingual immunotherapy", as a need for our patients, and strategies to increase awareness of allergen immunotherapy (AIT) among patients, the medical community, all healthcare stakeholders, and public opinion, are also reported in detail.
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Affiliation(s)
- Giorgio Walter Canonica
- Respiratory and Allergy Clinic, DIMI—Department of Internal Medicine, University of Genoa, IRCCS Aou San Martino, Largo Rosanna Benzi 10, Genoa 1-16132, Italy
| | - Linda Cox
- Department of Medicine, Nova Southeastern University, College of Osteopathic Medicine, Davie Florida, USA
| | - Ruby Pawankar
- Division of Allergy, Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Carlos E Baena-Cagnani
- Research Center for Respiratory Medicine (CIMER), Catholic University, Fundación LIBRA, Córdoba, Argentina
| | - Michael Blaiss
- Department of Pediatrics and Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sergio Bonini
- Department of Medicine, Second University of Naples, Institute of Translational Pharmacology, Italian National Research Council, Rome, Italy
| | - Jean Bousquet
- Centre Hospitalier Regional Universitaire de Montpellier, Université de Montpellier, Montpellier, France
| | - Moises Calderón
- Section of Allergy and Clinical Immunology, Imperial College of London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK
| | - Enrico Compalati
- Allergy and Respiratory Diseases Clinic, Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Stephen R Durham
- Allergy and Clinical Immunology, National Heart and Lung Institute, Imperial College of London, London, UK
| | - Roy Gerth van Wijk
- Department of Allergology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Harold Nelson
- National Jewish Health, University of Colorado – Denver School of Medicine, Denver, Colorado, USA
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino IST, University of Genoa, Genova, Italy
| | - Oliver Pfaar
- Center for Rhinology and Allergology Wiesbaden, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Mannheim, Germany
| | - Nelson Rosário
- Pediatric Allergy and Immunology Division, Hospital de Clínicas, Federal University of Parana, Curitiba, Brazil
| | - Dermot Ryan
- Academic Centre of Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Lanny Rosenwasser
- Children’s Mercy Hospital, University of Missouri – Kansas City School of Medicine, Kansas City, Missouri
| | | | | | - Erkka Valovirta
- Department of Clinical Allergology and Pulmonary Diseases, University of Turku, Finland, and Allergy Clinic, Terveystalo, Turku, Finland
| | - Hugo Van Bever
- Department of Paediatrics, University Children’s Medical Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Pakit Vichyanond
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ulrich Wahn
- Department of Pediatric Pneumology and Immunology, Charité, Humboldt University, Berlin, Germany
| | - Osman Yusuf
- The Allergy and Asthma Institute, Islamabad, Pakistan
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15
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Ciepiela O, Zawadzka-Krajewska A, Kotuła I, van Overveld F, Kulus M, Demkow U. Sublingual Immunotherapy for Asthma: Affects T-Cells but Does not Impact Basophil Activation. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2014; 27:17-23. [PMID: 24669352 DOI: 10.1089/ped.2014.0328] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/03/2014] [Indexed: 01/04/2023]
Abstract
Objective: Allergen-specific immunotherapy (SIT) is the unique modifying treatment of atopic diseases. Dysregulation of T-cell apoptosis plays a crucial role in the in the development of asthma. Nevertheless, the effect of sublingual immunotherapy (SLIT) on T-cell apoptosis has not been elucidated. The aim of the study was to evaluate the influence of 1 year of SIT in atopic children on the frequency of Th1 and Th2 cells in peripheral blood, on T-cell apoptosis, and on the response of basophils to allergen challenge. Methods: Children suffering from bronchial asthma were treated with SLIT for 12 months (Staloral 300). Basophil activation was evaluated by measurement of CD203c antigen expression. Th1 and Th2 cells frequencies and their associated frequencies of apoptosis by the expression of Bcl-2 were evaluated with flow cytometry. Results: Basophil activation showed no difference in response before and after therapy. The frequency of Th1 cells increased (p=0.01, n=19), whereas the frequency of Th2 cells remained stable. Additionally, a significant increase of Bcl-2 positive Th1 cells was found (p=0.0465, n=19). Conclusions: We conclude that the increase in frequency of Th1 cells secondary to SLIT might be associated with increased resistance to apoptotic signals. The basophil activation is not useful in evaluation of patient desensitization.
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Affiliation(s)
- Olga Ciepiela
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw , Poland
| | | | - Iwona Kotuła
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw , Poland
| | | | - Marek Kulus
- Department of Pediatric Pneumonology and Allergology, Medical University of Warsaw , Poland
| | - Urszula Demkow
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw , Poland
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16
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The use of single versus multiple antigens in specific allergen immunotherapy for allergic rhinitis. Curr Opin Allergy Clin Immunol 2014; 14:20-4. [DOI: 10.1097/aci.0000000000000018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Tools and methods for identification and analysis of rare antigen-specific T lymphocytes. EXPERIENTIA SUPPLEMENTUM (2012) 2014; 104:73-88. [PMID: 24214619 DOI: 10.1007/978-3-0348-0726-5_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
T lymphocytes are essential as effector and memory cells for immune defense against infections and as regulatory T cells in the establishment and maintenance of immune tolerance. However, they are also involved in immune pathology being effectors in autoimmune and allergic diseases or suppressors of immunity in cancer, and they often cause problems in transplantation. Therefore, strategies are being developed that allow the in vivo amplification or isolation, in vitro expansion and genetic manipulation of beneficial T cells for adoptive cell therapies or for the tolerization, or elimination of pathogenic T cells. The major goal is to make use of the exquisite antigen specificity of T cells to develop targeted strategies and to develop techniques that allow for the identification and depletion or enrichment of very often rare antigen-specific naïve as well as effector and memory T cells. Such techniques are very useful for immune monitoring of T cell responses in diagnostics and vaccination and for the development of T cell-based assays for the replacement of animal testing in immunotoxicology to identify contact allergens and drugs that cause adverse reactions.
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18
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Kimura's disease or IgG4-related disease? A case-based review. Clin Rheumatol 2013; 34:385-9. [PMID: 24352754 DOI: 10.1007/s10067-013-2462-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 12/08/2013] [Indexed: 12/18/2022]
Abstract
Kimura's disease usually presents with benign painless soft tissue swelling around the head and neck areas with eosinophilia and high immunoglobulin E (IgE) levels. IgG4-related disease is characterized by fibrosis and sclerosis of the involved organs, with infiltration of IgG4-positive plasma cells. There are some similar clinical manifestations of these two diseases, with eosinophilia or high IgE levels often found in patients with IgG4-related disease. However, the relation between these two diseases is not well known. We report a 23-year-old man who had multiple neck lumps for longer than 1 year. He had remarkable eosinophilia and elevated serum IgE levels. Biopsy of his lymph nodes suggested the diagnosis of both Kimura's disease and IgG4-related disease. In this article, we discuss the relationship between Kimura's disease and IgG4-related disease. We also suggest a possible model ("allergen-specific immunotherapy") to illustrate our view that an increase in IgG4-positive plasma cells is an epiphenomenon of Kimura's disease.
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19
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Perspectives in vaccine adjuvants for allergen-specific immunotherapy. Immunol Lett 2013; 161:207-10. [PMID: 24361819 DOI: 10.1016/j.imlet.2013.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/13/2013] [Indexed: 12/22/2022]
Abstract
The design of more powerful adjuvants is a tool of crucial interest to ameliorate vaccination strategies to reduce injections and/or dose of antigen, induce local immunity and obtain better protection. Effective anti-infectious vaccines should elicit protective TH1 responses, cytotoxic CD8+ cells and antibody-forming cells. However, cytokine microenvironment is a key point also in targeted therapeutic vaccinations, such as allergen-specific immunotherapy, where the interference with an already-existing but inappropriate immunity is required. In this case, safe, appropriately conditioning and potentially orally available adjuvants together with delivery to appropriate subsets of dendritic cells would be highly appreciated to properly boost innate immune cells. In fact, aluminium hydroxide, although safe, has been classically associated with the induction of a TH2 response to co-formulated antigens. Thus, detoxified lipopolysaccaride (MPL-A), CpG oligonucleotides, imidazoquinolines and adenine derivatives acting via innate sensors may represent improvements in therapeutic vaccinations for allergy as able to interfere with pathogenic TH2 cells with eventual induction of TH1 differentiation.
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20
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Aryan Z, Compalati E, Comapalati E, Canonica GW, Rezaei N. Allergen-specific immunotherapy in asthmatic children: from the basis to clinical applications. Expert Rev Vaccines 2013; 12:639-59. [PMID: 23750794 DOI: 10.1586/erv.13.45] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Atopic asthma in childhood with the tendency to persist into adult life is an important issue in pediatrics. Allergen-specific immunotherapy (SIT) is the only curative treatment option for these children, being directed to the causes of the disease. The Th2 phenotype is a predominant immunological pattern in atopic asthma and SIT leads to apoptosis/anergy of T cells and induces immune-regulatory responses and immune deviation towards Th1. Many factors can affect the safety and efficacy of SIT, such as pattern of sensitization, allergy vaccine (allergen extracts, adjuvants and conjugated molecules), route of administration (subcutaneous or sublingual) and different treatment schedules. Overall, asthma symptoms and medication scores usually decrease following a SIT course and the most common observed side effects are restricted to local swelling, erythema and pruritus. Compared with conventional pharmacotherapy, SIT may be more cost effective, providing a benefit after discontinuation and a steroid-sparing effect. In addition, it can prevent new sensitizations in monosensitized asthmatic children. Microbial supplements such as probiotics, immunomodulatory substances like anti-IgE/leukotrienes, antibodies and newer allergen preparations such as recombinant forms have been tested to improve the efficacy and safety of SIT with inconclusive results. In conclusion, SIT provides an appropriate solution for childhood asthma that should be employed more often in clinical practice. Further studies are awaited to improve current knowledge regarding the mechanisms behind SIT and determine the most appropriate materials and schedule of immunotherapy for children with asthma.
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Affiliation(s)
- Zahra Aryan
- Molecular Immunology Research Center, Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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21
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The management of paediatric allergy: not everybody's cup of tea--10-11th February 2012. Curr Opin Allergy Clin Immunol 2013; 13 Suppl 1:S1-50. [PMID: 23377496 DOI: 10.1097/aci.0b013e32835e8b94] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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22
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Filì L, Vultaggio A, Cardilicchia E, Manuelli C, Casini A, Nencini F, Maggi L, Pratesi S, Petroni G, Boscaro F, Guarna A, Occhiato EG, Romagnani S, Maggi E, Parronchi P. A novel allergen-adjuvant conjugate suitable for specific immunotherapy of respiratory allergy. J Allergy Clin Immunol 2013; 132:84-92. [PMID: 23498597 DOI: 10.1016/j.jaci.2013.01.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/09/2013] [Accepted: 01/24/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Several approaches to find a better adjuvant, focus immunomodulation, and reduce allergenicity are under investigation to improve the efficacy and safety of specific immunotherapy. OBJECTIVE We performed an investigation of the in vitro and in vivo effects of a purified allergen chemically conjugated to a novel 8-OH modified adenine as an adjuvant. METHODS Purified group 2 major allergen from house dust mite chemically conjugated to 4-(6-amino-9-benzyl-8-hydroxy-9H-purin-2-ylsulfanyl)-butyric acid succinimidyl ester was analyzed by using mass spectrometry. The adduct (nDer p 2-Conj) was assayed for Toll-like receptor activation on transfected HEK293 cells, stimulation of innate cells, and effects on the functional phenotype of specific T-cell lines and clones by means of flow cytometry, real-time PCR, and expression of TH-related transcription factors. Lung cells and sera of nDer p 2-Conj-sensitized C57Bl/6 mice were studied by means of cytology, histology, real-time PCR, and ELISA. RESULTS nDer p 2-Conj stimulated IL-12 and IFN-α production from monocytes and plasmacytoid dendritic cells, respectively, retaining the ability to trigger Toll-like receptor 7 exclusively, and expanded human allergen-specific lymphocytes with reduced ability to produce T(H)2-related cytokines and increased IFN-γ levels, as based on GATA-3/T-bet expression. In vivo adduct-sensitized mice exhibited reduced eosinophil infiltration and IL-13 expression in the airways, IFN-γ upregulation together with IgE downregulation, and an increase in allergen-specific IgG(2a) levels in sera. The conjugate exhibited reduced ability to activate human FcεRI(+) cells without inducing T(H)17 cells or autoantibodies. CONCLUSIONS The codelivery of an allergen with a modified adenine as a conjugate inducing modulatory cytokines from innate cells redirects in vitro and in vivo pathogenic TH2 responses without eliciting harmful effects.
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Affiliation(s)
- Lucia Filì
- Department of Experimental and Clinical Medicine, Centre for Research, Transfer and High Education DENOTHE, University of Florence, Florence, Italy
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23
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Hessenberger M, Weiss R, Weinberger EE, Boehler C, Thalhamer J, Scheiblhofer S. Transcutaneous delivery of CpG-adjuvanted allergen via laser-generated micropores. Vaccine 2012; 31:3427-34. [PMID: 23273971 PMCID: PMC3724055 DOI: 10.1016/j.vaccine.2012.09.086] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 08/06/2012] [Accepted: 09/19/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Two main shortcomings of classical allergen-specific immunotherapy are long treatment duration and low patient compliance. Utilizing the unique immunological features of the skin by transcutaneous application of antigen opens new approaches not only for painless vaccine delivery, but also for allergen-specific immunotherapy. Under certain conditions, however, barrier disruption of the skin favors T helper 2-biased immune responses, which may lead to new sensitizations. METHODS In a prophylactic approach, an infra-red laser device was employed, producing an array of micropores of user-defined number, density, and depth on dorsal mouse skin. The grass pollen allergen Phl p 5 was administered by patch with or without the T helper 1-promoting CpG oligodeoxynucleotide 1826 as adjuvant, or was subcutaneously injected. Protection from allergic immune responses was tested by sensitization via injection of allergen adjuvanted with alum, followed by intranasal instillation. In a therapeutic setting, pre-sensitized mice were treated either by the standard method using subcutaneous injection or via laser-generated micropores. Sera were analyzed for IgG antibody subclass distribution by ELISA and for IgE antibodies by a basophil mediator release assay. Cytokine profiles from supernatants of re-stimulated lymphocytes and from bronchoalveolar lavage fluids were assessed by flow cytometry using a bead-based assay. The cellular composition of lavage fluids was determined by flow cytometry. RESULTS Application of antigen via micropores induced T helper 2-biased immune responses. Addition of CpG balanced the response and prevented from allergic sensitization, i.e. IgE induction, airway inflammation, and expression of T helper 2 cytokines. Therapeutic efficacy of transcutaneous immunotherapy was equal compared to subcutaneous injection, but was superior with respect to suppression of already established IgE responses. CONCLUSIONS Transcutaneous immunotherapy via laser-generated micropores provides an efficient novel platform for treatment of type I allergic diseases. Furthermore, immunomodulation with T helper 1-promoting adjuvants can prevent the risk for new sensitization.
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Affiliation(s)
- Michael Hessenberger
- Department of Molecular Biology, Division of Allergy & Immunology, University of Salzburg, Hellbrunnerstrasse 34, 5020 Salzburg, Austria
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24
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Valenta R, Campana R, Marth K, van Hage M. Allergen-specific immunotherapy: from therapeutic vaccines to prophylactic approaches. J Intern Med 2012; 272:144-57. [PMID: 22640224 PMCID: PMC4573524 DOI: 10.1111/j.1365-2796.2012.02556.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Immunoglobulin E-mediated allergies affect more than 25% of the population. Allergen exposure induces a variety of symptoms in allergic patients, which include rhinitis, conjunctivitis, asthma, dermatitis, food allergy and life-threatening systemic anaphylaxis. At present, allergen-specific immunotherapy (SIT), which is based on the administration of the disease-causing allergens, is the only disease-modifying treatment for allergy. Current therapeutic allergy vaccines are still prepared from relatively poorly defined allergen extracts. However, with the availability of the structures of the most common allergen molecules, it has become possible to produce well-defined recombinant and synthetic allergy vaccines that allow specific targeting of the mechanisms of allergic disease. Here we provide a summary of the development and mechanisms of SIT, and then review new forms of therapeutic vaccines that are based on recombinant and synthetic molecules. Finally, we discuss possible allergen-specific strategies for prevention of allergic disease.
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Affiliation(s)
- R Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria.
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