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Vempati R, Bijlani RL, Deepak KK. The efficacy of a comprehensive lifestyle modification programme based on yoga in the management of bronchial asthma: a randomized controlled trial. BMC Pulm Med 2009; 9:37. [PMID: 19643002 PMCID: PMC2734746 DOI: 10.1186/1471-2466-9-37] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Accepted: 07/30/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a substantial body of evidence on the efficacy of yoga in the management of bronchial asthma. Many studies have reported, as the effects of yoga on bronchial asthma, significant improvements in pulmonary functions, quality of life and reduction in airway hyper-reactivity, frequency of attacks and medication use. In addition, a few studies have attempted to understand the effects of yoga on exercise-induced bronchoconstriction (EIB) or exercise tolerance capacity. However, none of these studies has investigated any immunological mechanisms by which yoga improves these variables in bronchial asthma. METHODS The present randomized controlled trial (RCT) was conducted on 57 adult subjects with mild or moderate bronchial asthma who were allocated randomly to either the yoga (intervention) group (n = 29) or the wait-listed control group (n = 28). The control group received only conventional care and the yoga group received an intervention based on yoga, in addition to the conventional care. The intervention consisted of 2-wk supervised training in lifestyle modification and stress management based on yoga followed by closely monitored continuation of the practices at home for 6-wk. The outcome measures were assessed in both the groups at 0 wk (baseline), 2, 4 and 8 wk by using Generalized Linear Model (GLM) repeated measures followed by post-hoc analysis. RESULTS In the yoga group, there was a steady and progressive improvement in pulmonary function, the change being statistically significant in case of the first second of forced expiratory volume (FEV1) at 8 wk, and peak expiratory flow rate (PEFR) at 2, 4 and 8 wk as compared to the corresponding baseline values. There was a significant reduction in EIB in the yoga group. However, there was no corresponding reduction in the urinary prostaglandin D2 metabolite (11beta prostaglandin F2alpha) levels in response to the exercise challenge. There was also no significant change in serum eosinophilic cationic protein levels during the 8-wk study period in either group. There was a significant improvement in Asthma Quality of Life (AQOL) scores in both groups over the 8-wk study period. But the improvement was achieved earlier and was more complete in the yoga group. The number-needed-to-treat worked out to be 1.82 for the total AQOL score. An improvement in total AQOL score was greater than the minimal important difference and the same outcome was achieved for the sub-domains of the AQOL. The frequency of rescue medication use showed a significant decrease over the study period in both the groups. However, the decrease was achieved relatively earlier and was more marked in the yoga group than in the control group. CONCLUSION The present RCT has demonstrated that adding the mind-body approach of yoga to the predominantly physical approach of conventional care results in measurable improvement in subjective as well as objective outcomes in bronchial asthma. The trial supports the efficacy of yoga in the management of bronchial asthma. However, the preliminary efforts made towards working out the mechanism of action of the intervention have not thrown much light on how yoga works in bronchial asthma. TRIAL REGISTRATION Current Controlled Trials ISRCTN00815962.
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Affiliation(s)
- Ramaprabhu Vempati
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Lal Bijlani
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
- Sri Aurobindo Ashram, New Delhi, India
| | - Kishore Kumar Deepak
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Al Obaidi AHA, Al Samarai AGM, Al-Janabi J, Yahia A. The predictive value of eosinophil cationic protein and lactate dehydrogenase in asthma: a comparative study of serum versus sputum. World Allergy Organ J 2009; 2:144-9. [PMID: 23283064 PMCID: PMC3651008 DOI: 10.1097/wox.0b013e3181b2fe64] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND : Serum and sputum eosinophil cationic protein (ECP) levels are correlated with asthma disease severity. OBJECTIVE : To establish a diagnostic accuracy of ECP and lactate dehydrogenase (LDH) in serum (indirectly) and sputum (directly) as inflammatory markers in asthma. PATIENTS AND METHODS : In a cross sectional study, 76 asthmatic patients with exacerbation were enrolled in the study. ECP was determined using enzyme linked immuno-assay. RESULTS : Asthmatic patients compared with control subjects, had a significant higher levels of ECP and LDH in sputum. Both sputum and serum ECP and LDH were reduced significantly with prednisolone treatment. FEV1 was inversely correlated with sputum ECP, serum ECP, and sputum LDH. A significant positive correlation was noted between sputum ECP and sputum LDH. Serum LDH does not demonstrate any significant correlations with other variables. The area under receiver operating characteristic curve showed that sputum ECP (0.92) was a significantly an accurate marker more than serum ECP (0.81), sputum (0.80) LDH, and serum (0.65) LDH. Furthermore, the area under curve was lower for serum ECP (0.81) than that for sputum ECP (0.92). However, serum ECP (0.81) was more accurate marker than serum LDH (0.65). CONCLUSION : Serum and sputum ECP as eosinophilic inflammatory markers are associated with poor asthma control. Sputum ECP and LDH were significantly an accurate markers more than serum ECP and LDH.
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Draycott RAH, Woodburn MIA, Ling DE, Sage RB. The effect of an indirect anthelmintic treatment on parasites and breeding success of free-living pheasantsPhasianus colchicus. J Helminthol 2007; 80:409-15. [PMID: 17125551 DOI: 10.1017/joh2006367] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIn Great Britain free-living common pheasantsPhasianus colchicusare often managed at high densities owing to their popularity as a quarry species. They are prone to infection by a range of parasite species includingHeterakis gallinarum,Capillariaspp. andSyngamus trachea. In 1995 the efficacy of an indirect anthelmintic technique for controlling parasitic worm burdens of pheasants was determined in a pilot study on a shooting estate in the south of England. Between 2000 and 2003 a large-scale field experiment was conducted on nine estates in eastern England to determine the effect of the technique on parasite burden and pheasant breeding success. In the absence of anthelmintic treatment worm burdens increased rapidly through March and April, whereas birds given anthelmintic-treated grain had lower worm burdens during the same period. The breeding success of pheasants was significantly higher on plots provided with anthelmintic treatment, although no long-term increases in population densities were observed. The burdens of the most common parasiteH. gallinarumwere significantly lower in pheasants from treatment plots six weeks after the anthelmintic treatment had ceased, but spring treatment did not influence parasite burden in the following winter.
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Affiliation(s)
- R A H Draycott
- The Game Conservancy Trust, Fordingbridge, Hampshire, UK.
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Magnaval JF, Faufingue JH, Morassin B, Fabre R. Eosinophil cationic protein, specific IgE and IgG4 in human toxocariasis. J Helminthol 2007; 80:417-23. [PMID: 17125552 DOI: 10.1017/joh2006369] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAmong 67 French patients presenting a toxocaral infection, various demographic, environmental, clinical and laboratory parameters (blood eosinophil count, eosinophil cationic protein (ECP), serum total IgE, specific IgE against common inhalant allergens, specific IgE and IgG4 againstToxocaraexcretory-secretory antigens) were investigated. Correlation studies and logistic regression analyses were conducted, testing elevated levels of ECP, specific anti-ToxocaraIgE or IgG4 as outcome variables An elevated ECP level was significantly associated with both cough and rhinitis, a high level of specific anti-ToxocaraIgE with itchy rashes and possible atopic status, and an increase of specific anti-ToxocaraIgG4 with rural residence.
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Affiliation(s)
- J-F Magnaval
- Department of Parasitology, CH Rangueil, University Hospitals, 31059 Toulouse 9, France.
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5
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Ohta N, Okazaki S, Fukase S, Akatsuka N, Aoyagi M, Yamakawa M. Serum concentrations of eosinophil cationic protein and eosinophils of patients with Kimura's disease. Allergol Int 2007; 56:45-9. [PMID: 17259809 DOI: 10.2332/allergolint.o-06-442] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Accepted: 09/28/2006] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To clarify the role of eosinophils in the pathogenesis of Kimura's disease and the values of measuring serum levels of eosinophil cationic protein (ECP) for monitoring disease activity might be very important, but there are few reports about this matter. METHODS A total 14 serum and 7 tissue samples from patients with Kimura's disease were studied. The concentrations of ECP and cytokines (interleukin-4 (IL-4), granulocyte-macrophage colony-stimulating factor (GM-CSF), and interleukin 5 (IL-5)) in sera from patients with Kimura's disease were measured by enzyme-linked immunosorbent assay (ELISA). The density of eosinophils and the degree of activation of eosinophils in the tissue were also studied immunohistochemically. RESULTS The concentration of ECP in sera from patients with Kimura's disease was significantly higher than that in the control group (p<0.05). At the time of the remission, a significant decrease of ECP was observed. In interfollicular areas, most infiltrated eosinophils were positive for EG2 antibody (64.0-94.0%) and the mean percentage of EG2-positive eosinophils was 75.7%. The concentrations of IL-4, GM-CSF, and IL-5 in sera from patients with Kimura's disease were within normal ranges or below the detectable level in all sera examined. CONCLUSIONS Our findings suggest that eosinophils play an important role in the pathogenesis of Kimura's disease and ECP may be used as an additional parameter of disease activity.
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Affiliation(s)
- Nobuo Ohta
- Department of Otolaryngology, Yamagata University School of Medicine, Japan.
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Nakazato A, Momoi Y, Kadoya M, Iwasaki T. Measurement of Feline Serum Interleukin-5 Level. J Vet Med Sci 2007; 69:843-6. [PMID: 17827893 DOI: 10.1292/jvms.69.843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A bioassay was developed to measure feline interleukin-5 (IL-5). Human IL-5 receptor alpha chain transfected murine Ba/F3 cells (Ba/F3-IL-5R) showed feline IL-5-dependent proliferation in a dose-dependent manner. IL-5 levels in serum samples from 54 cats with suspected allergic dermatitis and from 11 control cats could be successfully measured using Ba/F3-IL-5R cells. The number of eosinophils in peripheral blood was not correlated with serum IL-5 level.
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Affiliation(s)
- Ayumi Nakazato
- Department of Veterinary Internal Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan
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Abstract
The deleterious role thought to be played by eosinophils in many situations is linked to their ability to secrete various inflammatory substances, mainly toxic proteins and lipid mediators, in body tissue. This ability is a particular feature of activated eosinophils, which have undergone numerous metabolic, functional, and phenotypic changes from their resting state. Characterizing the properties of these activated cells is an essential step in improving our understanding of their contributions to local inflammatory response, as both regulatory and effector cells. Improvements in existing methods as well as the development of new technical approaches have facilitated the ex vivo and in vitro study of activated eosinophils and their contribution to various disease states.
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Affiliation(s)
- Patricia Couissinier-Paris
- Unité de virologie tropicale, Institut de médecine tropicale du service de santé des armées (IMTSSA), Parc du Pharo, Marseille.
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Huang CS, Chen SJ, Chung RL, Tang RB. Serum interleukin-5 measurements for monitoring acute asthma in children. J Asthma 2005; 42:297-300. [PMID: 16032939 DOI: 10.1081/jas-200057886] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Cytokine-mediated interactions among the inflammatory cells may play a role in the pathogenesis of bronchial asthma. Interleukin-5 (IL-5) is a major cytokine in the recruitment of neutrophils to the area of inflammation. Serum IL-5 is a marker of disease activity and treatment efficacy in bronchial asthma. To understand the role of IL-5 in disease activity in acute asthma, changes in serum concentrations of IL-5 elaborated by activated eosinophil before and after prednisolone therapy with clinical improvement were determined in the present study. Circulating levels of IL-5 in 16 normal control subjects and in sera from 22 allergic asthmatic children with acute exacerbation and in stable condition were determined by using commercially available assay kits. The mean concentration of serum IL-5 was higher in patients with acute exacerbation (6.30 +/- 2.21 pg/mL) and in stable asthmatics (5.55 +/- 2.23 pg/mL) compared to control group subjects (4.81 +/- 0.54 pg/mL; p > 0.05). However, the difference was not statistically significant between the acute exacerbation and stable asthmatics groups (p > 0.05). Serum IL-5 is a poor indicator of disease activity in acute asthma; therefore, monitoring serum IL-5 concentration is of limited value. The clinical value of serum IL-5 as a marker of disease activity remains to be established.
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Affiliation(s)
- Chen-Shen Huang
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, Republic of China
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El-Gamal Y, Heshmat N, Mahran M, El-Gabbas Z. Expression of the apoptosis inhibitor Bcl-2 in sputum eosinophils from children with acute asthma. Clin Exp Allergy 2005; 34:1701-6. [PMID: 15544593 DOI: 10.1111/j.1365-2222.2004.02089.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Apoptosis of eosinophils is of increasingly important value in modulating allergic airway inflammation in asthma. Our purpose was to investigate the degree of expression of the antiapoptotic B-cell lymphoma/leukaemia-2 (Bcl-2) protein in sputum eosinophils during acute asthma exacerbation and its relationship with exacerbation severity. METHODS Sputum was obtained from 33 asthmatic children and 15 healthy children as a control group. Patients were studied during an acute asthma exacerbation. They were classified according to the severity of exacerbation into mild, moderate and severe (n=11 for each). Patients with severe exacerbation were followed up until remission and another sputum sample was obtained. Number of sputum eosinophils was expressed as percentage of leucocytes. Bcl-2 expression in sputum eosinophils was assessed by immunohistochemical staining techniques; the results were expressed as percentage of positively stained cells over total eosinophils. RESULTS Sputum eosinophils and Bcl-2(+) eosinophils' percentages were significantly higher in patients with acute exacerbation than controls (P<0.01). Patients with severe exacerbation had significantly higher sputum Bcl-2(+) eosinophils' percentage than those with mild-to-moderate exacerbation (mean+/-SD=42.4+/-31.96% vs. 5.7+/-14.5%, P<0.01). A significant negative correlation was found between Bcl-2(+) eosinophils' percentage and peak expiratory flow rate % predicted (P<0.05). After remission, patients with severe exacerbation showed a significant decrease of Bcl-2(+) eosinophils' percentage (P<0.05). CONCLUSION Our findings suggest that Bcl-2 prolongs survival and decreases apoptosis of airway eosinophils in asthma especially during exacerbation. Eosinophil apoptosis and Bcl-2 represent a target for new and effective therapeutic strategies of asthma.
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Affiliation(s)
- Y El-Gamal
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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10
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Tateno H, Nakamura H, Minematsu N, Nakajima T, Takahashi S, Nakamura M, Fukunaga K, Asano K, Lilly CM, Yamaguchi K. Plasma eotaxin level and severity of asthma treated with corticosteroid. Respir Med 2004; 98:782-90. [PMID: 15303645 DOI: 10.1016/j.rmed.2004.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Our understanding of asthma severity was advanced by the identification of biomarkers which account for differences in lung function impairment. We tried to examine the effects of corticosteroid treatment on known correlates of asthma severity including peripheral eosinophil counts, total IgE, IL-5, and eotaxin Levels in plasma. We compared these biomarkers among groups of stable asthmatics categorized by the dose of corticosteroid (N: steroid-free, n = 25; L: low-dose inhaled, n = 27; MH: medium or high-dose inhaled, n= 19; O: inhaled plus oral, n= 8). Next we compared these markers and peak expiratory flow rate (PEFR) in unstable asthmatics before and after treatment with steroids (n = 22). Eotaxin levels in the O group were higher than those in the N and MH groups (P < 0.05). Logistic regression analysis demonstrated that plasma eotaxin level was correlated with the severity of asthma defined by treatment intensity (P = 0.01) and % FEV1 (P = 0.04) while the other markers were not. Eotaxin levels did not change after steroid treatment in unstable patients, whereas eosinophil counts decreased in parallel with PEFR. Among biomarkers of asthma severity studied, plasma eotaxin level was not significantly affected by corticosteroid treatment, and was associated with the severity even in the presence of steroid therapy.
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Affiliation(s)
- H Tateno
- Department of Medicine, Cardiopulmonary Division, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-Ku, Tokyo 160-8582, Japan
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11
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Shen H, O'Byrne PM, Ellis R, Wattie J, Tang C, Inman MD. The effects of intranasal budesonide on allergen-induced production of interleukin-5 and eotaxin, airways, blood, and bone marrow eosinophilia, and eosinophil progenitor expansion in sensitized mice. Am J Respir Crit Care Med 2002; 166:146-53. [PMID: 12119225 DOI: 10.1164/rccm.2008161] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We have previously demonstrated that allergen inhalation induces expansion of bone marrow eosinophil progenitors in sensitized mice and subjects with asthma and that the inhaled corticosteroid, budesonide, reduced baseline but not allergen-induced increase in bone marrow eosinophil/basophil progenitors (EoB-CFU) in subjects with asthma. Here, we evaluated the effects of intranasal budesonide on allergen-induced increases in interleukin (IL)-5 and eotaxin in the airway and peripheral blood, expansion of bone marrow Eo-CFU and eosinophilia in bone marrow, peripheral blood and airway, as well as airway hyperresponsiveness, in ovalbumin (OVA)-sensitized mice. Budesonide treatment attenuated allergen-induced eosinophilia in bone marrow, peripheral blood, and airways as well as allergen-induced increases in bone marrow eosinophil progenitors but not allergen-induced increases in IL-5 or eotaxin 12 h following the second of two daily exposures to allergen; at later time points treatment was associated with attenuation of IL-5, eosinophilia, Eo-CFU, and airway hyperresponsiveness. These results suggest that a component of the mechanism by which corticosteroid treatment attenuates allergen-induced airway inflammation is through suppression of bone marrow eosinophilopoiesis, and that this is likely not mediated simply through the blocking of IL-5 production at the airway.
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Affiliation(s)
- Huahao Shen
- Asthma Research Group, Department of Medicine, McMaster University and St. Joseph's Hospital, Hamilton, Ontario, Canada
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12
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Magnaval JF, Berry A, Fabre R, Morassin B. Eosinophil cationic protein as a possible marker of active human Toxocara infection. Allergy 2001; 56:1096-9. [PMID: 11703226 DOI: 10.1034/j.1398-9995.2001.00284.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Human toxocariasis is a common, worldwide helminthozoonosis that may elicit syndromes including various allergy symptoms. The diagnosis relies upon specific serology. However, this parasitosis is often self-limiting, and many subjects have residual antibodies, thus making differential diagnosis quite difficult when blood eosinophilia, a commonly accepted criterion of active helminthiasis due to tissue-dwelling parasites, is lacking. METHODS AND RESULTS We present a patient with chronic irritant cough displaying negative allergologic screening, normal blood eosinophilia, but positive toxocariasis immunodiagnosis. Therefore, this case presented the fortuitous association of an unexplained allergic picture with residual anti-Toxocara antibodies. In an attempt to distinguish between active and past toxocaral infection, the subject's level of eosinophil cationic protein (ECP) was assessed and then compared to those of four control groups, namely, healthy volunteers, subjects presenting anti-Toxocara residual antibodies, patients with various helminthiases, and patients with active toxocaral disease. Since the patient's ECP level was found to be sharply elevated, we hypothesized that viable Toxocara larvae were still present in the tissues, and the patient was given anthelmintic therapy. At the control checkup, the cough had waned and the ECP level had decreased to below the mean value observed in both healthy subjects and in subjects with past toxocaral infections. CONCLUSIONS These data suggest, first, that patients presenting unexplained allergic syndromes should be checked for helminthiases, even if blood eosinophilia is lacking, and, second, in such subjects displaying positive toxocariasis immunodiagnosis, ECP assessment would be a useful marker to distinguish between active and past toxocaral disease.
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Affiliation(s)
- J F Magnaval
- Service de Parasitologie, Centre Hospitalier Universitaire Rangueil, Toulouse, France
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13
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Abstract
BACKGROUND Eosinophilopoetic cytokine IL-5 enhances cysteinyl-leukotriene (cys-LT) synthesis in eosinophils in vitro. In patients with aspirin-induced asthma (AIA) bronchial biopsies revealed eosinophil infiltration and a marked increase in IL-5 positive cells. OBJECTIVE We wondered whether in AIA patients the bronchial IL-5 increase is reflected in peripheral blood, and if so, whether it is related to overproduction of cys-LT. METHODS In 11 stable patients with AIA, 32 with ATA (aspirin-tolerant asthma) and in 16 controls we measured serum IL-5 concentrations and urinary LTE4, believed to reflect global cys-LT production. RESULTS Serum IL-5 was detectable in 12 of 43 asthmatics, but in none of the control subjects. It was highest in the ATA group and differed significantly from the controls. There was no significant difference in IL-5 levels between: (i) the asthmatic groups studied, and (ii) AIA patients and controls. No relationship was found between serum IL-5 and urinary cys-LT. CONCLUSION Overexpression of IL-5 reported in the airways of aspirin-sensitive patients with asthma was not reflected in their blood. If IL-5 affects cys-LT production, it is rather in the bronchi of the patients than in the blood.
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Affiliation(s)
- L Mastalerz
- Department of Medicine, Jagellonian University School of Medicine, 31-066 Krakow, Poland
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14
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Hughes JM, Rimmer SJ, Salome CM, Hodge L, Liu-Brennan D, Woolcock AJ, Armour CL. Eosinophilia, interleukin-5, and tumour necrosis factor-alpha in asthmatic children. Allergy 2001; 56:412-8. [PMID: 11350304 DOI: 10.1034/j.1398-9995.2001.056005412.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are few paediatric studies of the interrelationships between inflammatory markers and asthma severity. We therefore assessed the relationships between eosinophil-associated markers, cytokines, and asthma severity in asthmatic children aged 8-12 years. METHODS Forty-five children were tested twice, 2 weeks apart. Asthma severity was measured in terms of symptoms, lung function, medication needs, and histamine responsiveness. Peripheral inflammatory markers measured included eosinophil numbers, serum ECP, IL-5, and TNF-alpha and mononuclear cell IL-5, and TNF-alpha production. RESULTS Histamine responsiveness was correlated with circulating eosinophils (r = 0.56, P = 0.0001) and serum ECP (r = 0.54, P = 0.003). Eosinophilia was increased in children with severe as opposed to mild airway hyperresponsiveness (P = 0.02) and those who lost days at school as opposed to those who did not (P = 0.01). There were no other associations between markers of asthma severity and inflammation. Children taking inhaled corticosteroids had lower serum IL-5 levels than those on beta-agonists +/- cromolyn (mean and 95% CI: 20.5 [11.7-35.7] pg/ml vs 64.3 [26.6-155.4] pg/ml; P = 0.04). Cellular IL-5 production correlated with serum TNF-alpha (r = 0.63, P = 0.0062) and IL-5 (r = -0.59, P = 0.005). CONCLUSION Serum levels of TNF-alpha and IL-5 were not related to peripheral eosinophilia and asthma severity in these children but were related to their own cellular production ex vivo. This study confirms that eosinophilia is the index of inflammation that is most closely related to the clinical severity of childhood asthma.
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Affiliation(s)
- J M Hughes
- Faculty of Pharmacy, University of Sydney, Sydney, Australia
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15
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Sahid El-Radhi A, Hogg CL, Bungre JK, Bush A, Corrigan CJ. Effect of oral glucocorticoid treatment on serum inflammatory markers in acute asthma. Arch Dis Child 2000; 83:158-62. [PMID: 10906027 PMCID: PMC1718442 DOI: 10.1136/adc.83.2.158] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Acute asthma is associated with elevated serum concentrations of products of activated T cells and eosinophils. AIMS To compare the changes in concentrations of these products with disease severity and changes in lung function following oral prednisolone treatment. METHODS Twenty patients (mean age 8.7 years) were recruited on admission with acute asthma to a district general hospital. Disease severity was recorded before and after treatment with oral prednisolone using a validated pulmonary index score. Serum concentrations of interleukin (IL)-4, IL-5, soluble (s)CD25 (soluble IL-2 receptor), using a specific enzyme linked immunosorbent assay, and eosinophil cationic protein (ECP), using radioimmunoassay, were measured concomitantly. Non-asthmatic children (n = 6, mean age 9.2 years) undergoing elective surgery were recruited as controls, and serum samples were obtained on one occasion without treatment. Main outcome measures were changes in serum concentrations of cytokines and ECP, clinical asthma severity score, and peak expiratory flow rate. RESULTS As expected, oral glucocorticoid treatment in the children with asthma was associated with clinical improvement and also with significant reductions in serum concentrations of IL-5 (mean 5.59 to 2.19 pg/ml, p = 0.0001), sCD25 (mean 2236 to 1772 pg/ml, p = 0.002), and ECP (mean 54.3 to 33. 1 pg/ml, p = 0.0001). Serum IL-4 concentrations, in most patients and all the controls, remained below the sensitivity of the assay. However, serum concentrations of IL-5, sCD25, and ECP remained significantly higher than in controls, even after treatment with oral glucocorticoids (p = 0.03). CONCLUSIONS These data suggest that T cell mediated inflammation may persist in childhood asthma despite apparent clinical remission associated with conventional doses of prednisolone. The long term consequences of persistent inflammation after an apparently treated acute attack of asthma require clarification. Clinical assessment and pulmonary function are inadequate surrogates for airway inflammation.
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Affiliation(s)
- A Sahid El-Radhi
- Department of Paediatrics, Queen Mary's Hospital, Sidcup, Kent DA14 6LT, UK
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Abstract
Eosinophils play important roles in adaptive immune responses, inflammatory processes, and disease states. Recently, considerable research has been devoted to better defining the normal and abnormal biology of these cells, specifically their origin and mechanisms of stimulation, chemotaxis, regulation, and activation. Interleukin-5 has been identified as a major regulator of eosinophil development and function. This review highlights current literature on interleukin-5 and eosinophil production. Areas covered include molecular signaling, physiologic sources of interleukin-5, and interactions between interleukin-5, eosinophils, and the bone marrow microenvironment. Clinical correlates are also presented.
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Affiliation(s)
- G J Roboz
- Joan and Sanford I. Weill Medical College of Cornell University, Division of Hematology and Oncology, New York, New York 10021, USA
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17
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Abstract
Asthma is a disease characterized by chronic eosinophilic inflammation of the airways. Serum eosinophil cationic protein (ECP) has been increasingly used as a noninvasive inflammatory marker in asthma. The serum ECP level seems to reflect, although indirectly, the intensity of ongoing eosinophilic inflammation of the airways and respond sensitively to intervention, whereas it is unlikely to be useful for establishing the diagnosis of asthma in an individual patient. Monitoring of serum ECP could be of utility in the long-term follow-up of asthmatic patients. However, further longitudinal studies are required to establish the role of serum ECP measurement in the treatment modulation in asthma.
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Affiliation(s)
- A Niimi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
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