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Neff C, Price M, Cioffi G, Liu Z, Walsh R, Barnholtz-Sloan JS, Walsh KM, Salama AKS, Anders CK, Fecci PE, Ostrom QT. Atopy improves survival and decreases risk of brain metastasis in cutaneous melanoma. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.15.24307061. [PMID: 38798534 PMCID: PMC11118623 DOI: 10.1101/2024.05.15.24307061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Importance Development of new therapies in melanoma has increased survival, and as a result more patients are living to develop brain metastasis (BrM). Identifying patients at increased risk of BrM is therefore of significant public health importance. Objective To determine whether history of atopy is associated with improved survival or reduced incidence of BrM in cutaneous melanoma. Design A retrospective cohort study conducted from June 2022 to March 2024. Setting Population-based in states with Surveillance, Epidemiology and End Results (SEER) supported cancer registries. Participants Individuals (≥65 years) diagnosed with cutaneous melanoma between January 1, 2008 and December 31, 2017 that are participants in traditional Medicare. Exposures Individuals were compared that had history of atopy (allergic rhinitis, atopic dermatitis, asthma, and/or allergic/atopic conjunctivitis) diagnosed prior to melanoma diagnosis, ascertained using ICD-9 or ICD-10 codes in Medicare claims. Main Outcomes and Measures Primary endpoints were diagnosis with a BrM or death during the follow-up period. Associations between atopy and endpoints were assessed using cox proportional hazards models to estimate hazard ratios (HR) and p-values. Results A total of 29,956 cutaneous melanoma cases were identified (median age 76, 60% male and 97% non-Hispanic White). Overall, 7.1% developed BrM during follow up. Among the 35% that had history of atopy, the most common condition was atopic dermatitis (19%). After adjustment for demographic and prognostic factors, atopy was associated with a 16% decrease in death (HR=0.84 [95%CI:0.80-0.87], pFDR<0.001). Among those with non-metastatic disease at time of diagnosis, atopy conferred a 15% decrease in cumulative incidence BrM (HR=0.85 [95%CI: 0.76-0.94], pFDR=0.006), with a 25% decrease associated with atopic dermatitis (HR=0.75 [95%CI:0.65-0.86], pFDR<0.001). Among those with metastatic disease at diagnosis (any metastatic site), only those who received immune checkpoint inhibitors had a survival benefit associated with atopy (HR=0.31, [95%CI:0.15-0.64], p=0.001 vs HR=1.41, [95%CI:0.87-2.27], p=0.165). Conclusions and Relevance Atopy, particularly atopic dermatitis, was significantly associated with improved survival and decreased incidence of BrM. The improved survival associated with these conditions in the context of immunotherapy suggests that these conditions in the elderly may identify those with more robust immune function that may be more responsive to treatment.
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Affiliation(s)
- Corey Neff
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Mackenzie Price
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Gino Cioffi
- Trans Divisional Research Program (TDRP) Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, MD, USA
| | - Zhen Liu
- Department of Biostatistics, Duke University School of Medicine, Durham, NC, USA
| | - Rabina Walsh
- Department of Dermatology, Duke University School of Medicine, Durham, NC, USA
| | - Jill S. Barnholtz-Sloan
- Department of Biostatistics, Duke University School of Medicine, Durham, NC, USA
- Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, MD, USA
| | - Kyle M. Walsh
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - April K. S. Salama
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Carey K. Anders
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Peter E. Fecci
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Quinn T. Ostrom
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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Huang Q, Huang Y, Xu S, Yuan X, Liu X, Chen Z. Association of asthma and lung cancer risk: A pool of cohort studies and Mendelian randomization analysis. Medicine (Baltimore) 2024; 103:e35060. [PMID: 38306564 PMCID: PMC10843492 DOI: 10.1097/md.0000000000035060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/11/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Over the past 2 decades, population-based studies have shown an increased association between asthma and the risk of lung cancer. However, the causal links between these 2 conditions remain poorly understood. METHODS We conducted a comprehensive search of various databases, including PubMed, Embase, Web of Science, and Cochrane Library, up until May 04, 2023. Only articles published in English were included in our study. We performed a meta-analysis using random-effects models to calculate the odds ratio (OR) and corresponding 95% confidence interval (CI). Subgroup analyses were conducted based on study design, gender, and histologic types. We also conducted a 2-sample Mendelian randomization (MR) using the genome-wide association study pooled data (408,422 people) published by the UK Biobank to explore further the potential causal relationship between asthma and lung cancer. RESULTS Our meta-analysis reviewed 24 population-based cohort studies involving 1072,502 patients, revealing that asthma is significantly associated with an increased risk of lung cancer (OR = 1.29, 95% CI 1.19-1.38) in all individuals. Subgroup analysis showed a significantly higher risk of lung cancer in females with asthma (OR = 1.23, 95% CI 1.01-1.49). We found no significant association between asthma and lung adenocarcinoma (LUAD) (OR = 0.76, 95% CI 0.54-1.05), lung squamous carcinomas (LUSC) (OR = 1.09, 95% CI 0.79-1.50), or small-cell lung cancer (SCLC) (OR = 1.00, 95% CI 0.68-1.49). Interestingly, our MR analysis supported an increasing causality between asthma and lung cancer (OR = 1.11, 95% CI 1.04-1.17, P = .0008), specifically in those who ever smoker (OR = 1.09, 95% CI 1.01-1.16, P = .0173) and LUSC pathological type (OR = 1.15, 95% CI 1.05-1.26, P = .0038). CONCLUSION Through meta-analysis, our study confirms that patients with asthma have a higher risk of developing lung cancer. Our MR study further support an increasing causal relationship between asthma and the risk of lung cancer, particularly in smokers and LUSC. Future studies examining the link between asthma and the risk of developing lung cancer should consider the bias of controlled and uncontrolled asthma.
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Affiliation(s)
- Qinyao Huang
- Department of Respiratory and Critical Care Medicine, the Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan, China
- The Sixth Clinical College, Guangzhou Medical University, Guangzhou, China
| | - Yunxia Huang
- Department of Respiratory and Critical Care Medicine, the Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan, China
- The Sixth Clinical College, Guangzhou Medical University, Guangzhou, China
| | - Senkai Xu
- Department of Respiratory and Critical Care Medicine, the Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan, China
- The Sixth Clinical College, Guangzhou Medical University, Guangzhou, China
| | - Xiaojun Yuan
- Department of Respiratory and Critical Care Medicine, the Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan, China
- The Sixth Clinical College, Guangzhou Medical University, Guangzhou, China
| | - Xinqi Liu
- Department of Respiratory and Critical Care Medicine, the Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan, China
- The Sixth Clinical College, Guangzhou Medical University, Guangzhou, China
| | - Zisheng Chen
- Department of Respiratory and Critical Care Medicine, the Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan, China
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Morello S, Cicala C. Ecto-5'-nucleotidase (CD73): an emerging role as prognostic factor in allergic sensitization. Inflamm Res 2024; 73:111-115. [PMID: 38087076 DOI: 10.1007/s00011-023-01820-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 01/10/2024] Open
Abstract
Over the years, the importance of the epithelium in the assessment of allergic sensitization and development of allergic diseases has increased. Sensitization to allergens appears to be influenced by genetic and external environmental factors. However, not all subjects exposed to environmental factors that damage epithelial cells suffer from allergic diseases. On this basis, identifying the signaling pathways that characterize the different phenotypes and endotypes of allergy is of high priority for a successful personalized therapy. Ecto-5'-nucleotidase/CD73 is a membrane-bound enzyme responsible for extracellular adenosine accumulation from AMP derived, in turn, from the hydrolysis of extracellular ATP. Current knowledge suggests that CD73 expression and enzymatic activity at epithelial barriers would be of fundamental importance to control the first defense against allergens, by preserving both physical and immunological epithelial barrier functions. Here, we highlight evidence for a crucial role of CD73 in features of allergic sensitization and the potential of this enzyme as prognostic marker and target of therapeutic intervention.
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Affiliation(s)
- Silvana Morello
- Department of Pharmacy, University of Salerno, 84084, Fisciano, Italy.
| | - Carla Cicala
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, 80131, Naples, Italy.
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Patients with a history of atopy have fewer cutaneous melanomas than those without atopy: a cross-sectional study in 496 patients at risk of skin cancers. Melanoma Res 2023; 33:218-229. [PMID: 36847301 DOI: 10.1097/cmr.0000000000000887] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The connection between atopy and skin cancers may be related to the stimulation of protective immune response, for example, through autoreactive immunoglobulin-E (IgE), or to the predisposition to carcinogenesis through chronic inflammation. The aim of this study was to investigate whether a past or present atopic disorder is associated with cutaneous photodamage, pigment cell nevi and skin cancers. For this, adult subjects at risk of any type of skin cancer (aged 21-79 years, 250 males, 246 females, 94 with immunosuppression) were examined for past or present malignancies in skin and extracutaneous site (ECS), photodamage, nevi, past or present atopic disorder in skin or mucus membranes, and possible other cancer-related factors. No association between atopy and photodamage, keratinocyte carcinomas or nevus count was found. Instead, there were fewer subjects with melanoma in 171 atopic (14.6%) than in 325 nonatopic subjects (22.2%) (P = 0.044), and the investigator-estimated risk class of skin cancers was lower in atopic than nonatopic subjects. In all subjects, the multivariate odds ratio (OR) for melanoma was 0.583 (P = 0.046; 95% confidence interval, 0.343-0.990) in atopic subjects, but in immunocompetent subjects, the reduced risk was confined to mucus membrane atopy (OR, 0.417; P = 0.020). Also, there were fewer subjects with malignancy in ECS in atopic (8.8%) than nonatopic subjects (15.7%) (P = 0.031). No association between serum total IgE and skin cancers, photodamage, nevi or malignancies in ECS was found. In conclusion, the atopy, especially mucus membrane atopy, is associated with lower percentages of subjects with a history of melanoma.
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CD73 + Epithelial Progenitor Cells That Contribute to Homeostasis and Renewal Are Depleted in Eosinophilic Esophagitis. Cell Mol Gastroenterol Hepatol 2022; 13:1449-1467. [PMID: 35108658 PMCID: PMC8957025 DOI: 10.1016/j.jcmgh.2022.01.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND & AIMS Although basal cell hyperplasia is a histologic hallmark of eosinophilic esophagitis (EoE), little is known about the capabilities of epithelial renewal and differentiation in the EoE inflammatory milieu. In murine esophageal epithelium, there are self-renewing and slowly proliferating basal stem-like cells characterized by concurrent expression of CD73 (5'-nucleotidase ecto) and CD104 (integrin β4). Here, we investigated CD73+CD104+ cells within the basal population of human esophageal epithelium and clarified the biological significance of these cells in the EoE epithelium. METHODS We performed flow cytometry on esophageal biopsy samples from EoE and non-EoE patients to determine the quantity of CD73+CD104+ cells in the epithelium. Simulating the EoE milieu we stimulated primary patient-derived and immortalized cell line-derived esophageal organoids with interleukin (IL)4 and IL13 and analyzed by flow cytometry, immunohistochemistry, and quantitative reverse-transcription polymerase chain reaction. We performed single-cell RNA sequencing on primary organoids in the setting of IL13 stimulation and evaluated the CD73+CD104+ population. We performed fluorescent-activated cell sorting to purify CD73+CD104+ and CD73- CD104+ populations and seeded these groups in organoid culture to evaluate the organoid formation rate and organoid size. We used RNA interference to knock down CD73 in esophageal organoids to evaluate organoid formation rates and size. We evaluated the effects of signal transducer and activator of transcription 6 (STAT6) signaling inhibition by RNA interference, a STAT6 inhibitor, AS1517499, as well as the proton pump inhibitor omeprazole. RESULTS EoE patients showed decreased epithelial CD73+CD104+ cell content. IL4 and IL13 stimulation depleted this population in 3-dimensional organoids with a recapitulation of basal cell hyperplasia as corroborated by single-cell RNA sequencing of the organoids, which suggests depletion of CD73+CD104+ cells. The CD73+CD104+ population had enhanced organoid formation compared with the CD73-CD104+ population. Similarly, knock-down of CD73 resulted in decreased organoid formation rate. Genetic and pharmacologic inhibition of STAT6 prevented T helper 2 cytokine-induced depletion of CD73+CD104+ cells. Lastly, omeprazole treatment prevented the effects of IL4 and IL13 on the CD73+CD104+ population. CONCLUSIONS This study addressed the role of CD73+CD104+ cells in epithelial renewal and homeostasis in the context of EoE. The depletion of the CD73+CD104+ self-renewal population by helper T cell 2 cytokines in EoE milieu may be perpetuating epithelial injury. Future therapies targeting epithelial restitution in EoE could decrease the need for immune modulation and steroid therapy.
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Boyle RJ, Shamji MH. Developments in the field of allergy in 2020 through the eyes of Clinical and Experimental Allergy. Clin Exp Allergy 2021; 51:1531-1537. [PMID: 34750898 DOI: 10.1111/cea.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
While 2020 will be remembered for the global coronavirus pandemic, there were also important advances in the field of allergy. In this review article, we summarize key findings reported in Clinical and Experimental Allergy during 2020. We hope this provides readers with an accessible snapshot of the work published in our journal during this time.
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Affiliation(s)
- Robert J Boyle
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Mohamed H Shamji
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Imperial Biomedical Research Centre, London, UK
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Renke J, Wasilewska E, Kędzierska-Mieszkowska S, Zorena K, Barańska S, Wenta T, Liberek A, Siluk D, Żurawa-Janicka D, Szczepankiewicz A, Renke M, Lipińska B. Tumor Suppressors-HTRA Proteases and Interleukin-12-in Pediatric Asthma and Allergic Rhinitis Patients. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E298. [PMID: 32560402 PMCID: PMC7353852 DOI: 10.3390/medicina56060298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022]
Abstract
Background and objective: Allergy belongs to a group of mast cell-related disorders and is one of the most common diseases of childhood. It was shown that asthma and allergic rhinitis diminish the risk of various cancers, including colon cancer and acute lymphoblastic leukemia. On the other hand, asthma augments the risk of lung cancer and an increased risk of breast cancer in patients with allergy has been observed. Thus, the relation between allergy and cancer is not straightforward and furthermore, its biological mechanism is unknown. The HTRA (high temperature requirement A) proteases promote apoptosis, may function as tumor suppressors and HTRA1 is known to be released by mast cells. Interleukin-12 (Il-12) is an important cytokine that induces antitumor immune responses and is produced mainly by dendritic cells that co-localize with mast cells in superficial organs. Material and methods: In the present study we have assessed with ELISA plasma levels of the HTRA proteins, Il-12, and of the anti-HTRA autoantibodies in children with allergy (40) and in age matched controls (39). Children are a special population, since they usually do not have comorbidities and take not many drugs the processes we want to observe are not influenced by many other factors. Results: We have found a significant increase of HTRA1, 2 and 3, and of the Il-12 levels in the children with atopy (asthma and allergic rhinitis) compared to controls. Conclusion: Our results suggest that the HTRA1-3 and Il-12 levels might be useful in analyzing the pro- and antioncogenic potential in young atopic patients.
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Affiliation(s)
- Joanna Renke
- Department of General and Medical Biochemistry, University of Gdańsk, Wita Stwosza 59 80-308 Gdańsk, Poland; (S.K.-M.); (T.W.); (D.Ż.-J.); (B.L.)
| | - Eliza Wasilewska
- Department of Allergology, Medical University of Gdańsk, Dębinki 7, 80-210 Gdańsk, Poland;
| | - Sabina Kędzierska-Mieszkowska
- Department of General and Medical Biochemistry, University of Gdańsk, Wita Stwosza 59 80-308 Gdańsk, Poland; (S.K.-M.); (T.W.); (D.Ż.-J.); (B.L.)
| | - Katarzyna Zorena
- Department of Immunobiology and Environmental Microbiology Medical University of Gdańsk, Dębinki 7, 80-210 Gdańsk, Poland;
| | - Sylwia Barańska
- Department of Bacterial Molecular Genetics University of Gdańsk Wita Stwosza 59, 80-308 Gdańsk, Poland;
| | - Tomasz Wenta
- Department of General and Medical Biochemistry, University of Gdańsk, Wita Stwosza 59 80-308 Gdańsk, Poland; (S.K.-M.); (T.W.); (D.Ż.-J.); (B.L.)
| | - Anna Liberek
- Faculty of Health Sciences with Subfaculty of Nursing, Medical University of Gdańsk, Tuwima 15, 80-210 Gdańsk, Poland;
| | - Danuta Siluk
- Department of Biopharmaceutics and Pharmacodynamics, Medical University of Gdańsk, Hallera 107, 80-416 Gdańsk, Poland;
| | - Dorota Żurawa-Janicka
- Department of General and Medical Biochemistry, University of Gdańsk, Wita Stwosza 59 80-308 Gdańsk, Poland; (S.K.-M.); (T.W.); (D.Ż.-J.); (B.L.)
| | - Aleksandra Szczepankiewicz
- Laboratory of Molecular and Cell Biology, Department of Pediatric Pulmonology, Allergy and Clinical Immunology, Poznan University of Medical Sciences, 60-512 Poznan, Poland;
| | - Marcin Renke
- Department of Occupational, Metabolic and Internal Diseases, Medical University of Gdańsk, Powstania Styczniowego 9B, 81-519 Gdynia, Poland;
| | - Barbara Lipińska
- Department of General and Medical Biochemistry, University of Gdańsk, Wita Stwosza 59 80-308 Gdańsk, Poland; (S.K.-M.); (T.W.); (D.Ż.-J.); (B.L.)
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Hetland G, Tangen JM, Mahmood F, Mirlashari MR, Nissen-Meyer LSH, Nentwich I, Therkelsen SP, Tjønnfjord GE, Johnson E. Antitumor, Anti-Inflammatory and Antiallergic Effects of Agaricus blazei Mushroom Extract and the Related Medicinal Basidiomycetes Mushrooms, Hericium erinaceus and Grifola frondosa: A Review of Preclinical and Clinical Studies. Nutrients 2020; 12:nu12051339. [PMID: 32397163 PMCID: PMC7285126 DOI: 10.3390/nu12051339] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/23/2020] [Accepted: 05/04/2020] [Indexed: 02/07/2023] Open
Abstract
Since the 1980s, medicinal effects have been documented in scientific studies with the related Basidiomycota mushrooms Agaricus blazei Murill (AbM), Hericium erinaceus (HE) and Grifola frondosa (GF) from Brazilian and Eastern traditional medicine. Special focus has been on their antitumor effects, but the mushrooms' anti-inflammatory and antiallergic properties have also been investigated. The antitumor mechanisms were either direct tumor attack, e.g., apoptosis and metastatic suppression, or indirect defense, e.g., inhibited tumor neovascularization and T helper cell (Th) 1 immune response. The anti-inflammatory mechanisms were a reduction in proinflammatory cytokines, oxidative stress and changed gut microbiota, and the antiallergic mechanism was amelioration of a skewed Th1/Th2 balance. Since a predominant Th2 milieu is also found in cancer, which quite often is caused by a local chronic inflammation, the three conditions-tumor, inflammation and allergy-seem to be linked. Further mechanisms for HE were increased nerve and beneficial gut microbiota growth, and oxidative stress regulation. The medicinal mushrooms AbM, HE and GF appear to be safe, and can, in fact, increase longevity in animal models, possibly due to reduced tumorigenesis and oxidation. This article reviews preclinical and clinical findings with these mushrooms and the mechanisms behind them.
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Affiliation(s)
- Geir Hetland
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, 0407 Oslo, Norway; (M.R.M.); (L.S.H.N.-M.); (I.N.)
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; (G.E.T.); (E.J.)
- Correspondence:
| | - Jon-Magnus Tangen
- National CBRNE Medical Advisory Centre, Oslo University Hospital, 0407 Oslo, Norway;
| | - Faiza Mahmood
- Department of Immunology and Transfusion Medicine, Akershus University Hospital, 1478 Lørenskog, Norway;
| | - Mohammad Reza Mirlashari
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, 0407 Oslo, Norway; (M.R.M.); (L.S.H.N.-M.); (I.N.)
| | - Lise Sofie Haug Nissen-Meyer
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, 0407 Oslo, Norway; (M.R.M.); (L.S.H.N.-M.); (I.N.)
| | - Ivo Nentwich
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, 0407 Oslo, Norway; (M.R.M.); (L.S.H.N.-M.); (I.N.)
| | | | - Geir Erland Tjønnfjord
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; (G.E.T.); (E.J.)
- Department of Haematology, Oslo University Hospital, 0424 Oslo, Norway
- KG Jebsen Centre for B-cell Malignancies, Institute of Clinical Medicine, University of Oslo, 0315 Oslo, Norway
| | - Egil Johnson
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway; (G.E.T.); (E.J.)
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, 0407 Oslo, Norway
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