Kimura's disease associated with IgA nephropathy: A case report

Kimura's disease (KD) is a rare chronic inflammatory disorder of unknown etiology that manifests as painless subcutaneous lesions in the head and neck. It primarily affects young Asian males and is characterized by peripheral eosinophilia and elevated levels of serum Immunoglobulin (Ig)E. Histologically, a variety of renal lesions have been observed in patients with KD, although IgA nephropathy is rarely reported. In the current study, a case of KD with an atypical manifestation accompanied with IgA nephropathy was reported in a middle-aged Chinese man. The subcutaneous lesion was located on the elbow of the patient. Although the recurrence rate of KD-associated nephrotic syndrome is high, the patient has not experienced relapse following 6 months of pulse treatment with methylprednisone and cyclophosphamide. In conclusion, methylprednisone combined with cyclophosphamide is effective in the treatment of KD-associated IgA nephropathy, and long-term administration of methylprednisone may achieve the effect of preventing KD recurrence.

Expressions and roles of periostin in otolaryngological diseases

Periostin is a 90-kDa member of the fasciclin-containing family; it functions as part of matricellular proteins, and its production by airway epithelial cells is induced by IL-4 and IL-13. Periostin is secreted by fibroblasts and upregulated in the airway epithelia of patients with bronchial asthma; it is considered to contribute to remodeling under this pathological condition. However, despite many studies in diverse research areas, our overall understanding of this intriguing molecule is still inadequate. Here, we integrate the available evidence on periostin expression and its roles in otolaryngological diseases, including allergic rhinitis, chronic rhinosinusitis with nasal polyps, aspirin-induced asthma, organized hematoma, eosinophilic otitis media, and IgG4-related disease. Periostin might be involved as an important structural mediator in pathological processes such as insult and injury, Th2-driven inflammation, extracellular matrix restructuring, fibrosclerosis, tumor angiogenesis, and tissue remodeling.

Expression of pendrin and periostin in allergic rhinitis and chronic rhinosinusitis

BACKGROUND

Pendrin and periostin are newly identified mediators of the inflammatory process. The expression of these proteins in human sinonasal tissue and their roles in allergic rhinitis and chronic rhinosinusitis remain to be elucidated. This study investigated the expression of pendrin and periostin in sinonasal tissue of patients with allergic rhinitis, chronic rhinosinusitis, and aspirin-induced asthma. Prospective control study conducted at Yamagata University, Japan.

METHODS

Surgical samples were investigated by means of real-time reverse transcription-polymerase chain reaction to evaluate the expression of pendrin and periostin mRNA. The presence and location of pendrin and periostin were determined by immunohistochemistry and Western blotting.

RESULTS

Pendrin and periostin production was significantly higher in patients with nasal disorders than in controls. Further significant increases in periostin expression were noted in patients with chronic rhinosinusitis with nasal polyps and in those with aspirin-induced asthma. Immunohistochemistry revealed positive staining for pendrin in epithelial cells and submucosal glands and for periostin in the basement membrane in all three disorders, and additionally for periostin in nasal polyp tissue in chronic rhinosinusitis and aspirin-induced asthma.

CONCLUSIONS

Production of pendrin and periostin is upregulated in allergic rhinitis, chronic rhinosinusitis with nasal polyps, and aspirin-induced asthma. These findings suggest that pendrin can induce mucus production and that periostin can induce tissue fibrosis and remodeling in the nasal mucosa. Therefore, these mediators may be therapeutic target candidates for allergic rhinitis, chronic rhinosinusitis with nasal polyps, and aspirin-induced asthma.

Roles of IL-17, Th1, and Tc1 cells in patients with IgG4-related sclerosing sialadenitis

OBJECTIVES/HYPOTHESIS

Immunoglobulin G4 (IgG4)-related sclerosing sialadenitis is a recently recognized disease entity characterized by high serum IgG4 concentration and IgG4-producing plasma cell expansion in affected organs, which show fibrotic or sclerotic changes. However, little is known about the roles of CD4+ and CD8+ T cells or interleukin (IL)-17 in this disease. The purpose of this study was to evaluate the characteristics of CD4+ and CD8+ T cells and IL-17 in patients with IgG4-related sclerosing sialadenitis.

STUDY DESIGN

A retrospective clinical study at the Yamagata University School of Medicine.

METHODS

The patient group consisted of six males and four females with an average age of 57.9 years (range, 38 to 73 years). Subsets of T helper (Th)1, Th2, T cytotoxic type (Tc)1, and Tc2 cells from patients with IgG4-related sclerosing sialadenitis were examined by using intracellular cytokine flow cytometry. Expression of IL-17 in the patients' lesions was also investigated immunohistochemically.

RESULTS

Six patients with IgG4-related sclerosing sialadenitis with high ratios of IgG4/IgG and prominent infiltration of IgG4-positive plasmacytes in the involved salivary glands had systemic complications, including pancreatitis, retroperitoneal fibrosis, and/or inflammatory pseudotumor of the lung after the initial swelling of the salivary glands. Populations of Th1 and Tc1 cells were significantly greater in IgG4-related sclerosing sialadenitis than in the controls (P < .05), but Th2 and Tc2 cell populations were not significantly increased. Expression of IL-17 was observed in the lesions of affected patients.

CONCLUSIONS

Increases in Th1 and Tc1 cell populations and IL-17 expression might be involved in the mechanism of pathogenesis of IgG4-related sclerosing sialadenitis.

Increase of Th2 and Tc1 cells in patients with Kimura's disease

OBJECTIVE

A Th1/Th2 cytokine imbalance with a predominance of Th2 cytokines has been suggested to be of pathogenic importance in Kimura's disease.

METHODS

To evaluate the role of Th1/Th2 cytokines in Kimura's disease, the subsets of Th1, Th2, Tc1 and Tc2 cells from patients with Kimura's disease were examined by intracellular cytokine flow cytometry. The expressions of IL-5, eotaxin and RANTES in the lesions were investigated by RT-PCR.

RESULTS

The population of Th2 and Tc1 cells in Kimura's disease was significantly increased compared with these cells in control (p<0.05). Th1 and Tc2 cells in Kimura's disease were not significantly increased compared with control subjects. The titers of IgE and the number of Th2 cells were correlated. The expression of IL-5 and RANES was observed in the lesions of patients with Kimura's disease.

CONCLUSION

These results indicate that the predominance of Th2 and Tc1 cells might contribute to the mechanism in pathogenesis of Kimura's disease.

Patulin influences the expression of Th1/Th2 cytokines by activated peripheral blood mononuclear cells and T cells through depletion of intracellular glutathione

Patulin is a mold toxin secreted mainly by fungi of the Penicillium species. Exposure generally results from consumption of moldy fruits and fruit products. Since recent studies identified mold exposure as a risk factor for allergic diseases, we examined the effects of patulin on human peripheral blood mononuclear cells (PBMC) prepared from buffy coats of healthy donors. Cells were stimulated with CD3- and CD28-specific antibodies in the presence or absence of patulin. Effects of patulin on PBMCs were evaluated by proliferation, viability assays, and cytokine ELISAs. The presence of 50 ng/mL patulin strongly decreased the amounts of several cytokines in the supernatant of stimulated PBMCs. This decrease in cytokine secretion was not due to cytotoxic effects of patulin. Moreover, the extent of the reduction of cytokine amounts was cytokine specific, affecting some (IL-4, IL-13, IFNgamma, and IL-10), but not others (IL-8, IL-5). We show that all effects could be abolished by adding thiol containing compounds. A depletion of intracellular GSH could be measured after incubation of cells with patulin. Taken together, our data indicate that patulin modulates the functional activation of PBMCs with respect to proliferation and cytokine secretion patterns by depletion of intracellular GSH. The depletion of intracellular glutathione may influence the balance between Th1 and Th2 cells and have implications for allergic diseases.

Allergen immunotherapy in intermittent allergic rhinitis reduces the intracellular expression of IL-4 by CD8+ T cells

BACKGROUND

T helper subset dysregulation is evident in allergic disorders. The role of T cytotoxic subsets is less understood. We investigated whether allergen immunotherapy in intermittent allergic rhinitis influences the intracellular expression of IL-4 and IFN-gamma by CD3+CD8(-) and CD3+CD8+ cells.

METHODS

Nineteen adult patients with intermittent allergic rhinitis were evaluated before the pollen season, and then after one preseasonal course of subcutaneous allergen immunotherapy. Twelve healthy nonatopic patients matched for age and sex served as controls. Intracellular expression of IFN-gamma and IL-4 by CD3+CD8(-) (Th1 and Th2, respectively) and CD3+CD8+ (Tc1 and Tc2, respectively) was estimated by flow cytometry in peripheral blood cells after stimulation with PMA and ionomycin.

RESULTS

Before immunotherapy the percentages of Th1, Th2, Tc1 and Tc2 did not significantly differ between the patients and the controls. After immunotherapy the percentage of Tc2 was lower in the rhinitic patients than in the controls (0.38% vs. 0.45%, p=0.04). The percentage of Tc2 cells decreased significantly after immunotherapy in the intermittent allergic rhinitis group (0.64% vs. 0.38%, p=0.02) with tendency to decrease in ratios of Tc2/Tc1 (p=0.059) and with no changes in ratios of Th2/Th1. The percentages of Th1, Th2 and Tc1 were comparable before and after immunotherapy within the rhinitic patient group.

CONCLUSIONS

The preseasonal allergen subcutaneous immunotherapy applied to intermittent allergic rhinitis patients suppressed the percentage of IL-4 producing CD3+CD8+ cells. Decreased number of CD3+CD8+IL-4+ cells may participate in the regulatory mechanisms of immunotherapy.