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Céspedes JA, Fernández-Santamaría R, Ariza A, Bogas G, Doña I, Rondón C, Salas M, Labella M, Frecha C, Mayorga C, Torres MJ, Fernández TD. Diagnosis of immediate reactions to amoxicillin: Comparison of basophil activation markers CD63 and CD203c in a prospective study. Allergy 2023; 78:2745-2755. [PMID: 36478407 DOI: 10.1111/all.15610] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Amoxicillin (AX) combined or not with clavulanic acid (CLV) is frequently involved in IgE-mediated reactions. Drug provocation test (DPT) is considered as the gold standard for diagnosis, although contraindicated in high-risk patients. Basophil activation test (BAT) can help diagnose immediate reactions to beta-lactams, although controversy exists regarding the best activation marker. We have performed a real-life study in a prospective cohort to analyze the real value of BAT as diagnostic tool and the best activation marker, CD63 and CD203c, for the evaluation of immediate reactions to these drugs. METHODS We prospectively evaluated patients with a clinical suspicion of immediate reactions after AX or AX-CLV administration during a 6-year period. The allergological work-up was done following the EAACI recommendations. BAT was performed in all patients using CD63 and CD203c as activation markers. RESULTS In AX-allergic patients, both activation markers, CD63 and CD203c, showed similar SE values (48.6% and 46.7%, respectively); however, specificity was of 81.1% and 94.6%, respectively, with CD203c showing good positive predictive value and like-hood ratio. In CLV-allergic patients, CD203c showed higher SE (50%) than CD63 (42.9%), maintaining the same value of SP (80%). Combining the results of both markers can slightly increase the sensitivity (51.4% for AX and 54.8% for CLV), although decreasing the specificity (79.7% and 73%, respectively). Interestingly, all patients with an anaphylactic shock showed a positive BAT to CLV using CD203c. CONCLUSIONS BAT using CD203c showed a good confirmatory power, especially for AX allergy. Placing BAT as a first step in the diagnostic procedure can help reduce the need of performing a complete allergological work-up in 46.6% of patients, diminishing the risk of reinducing allergic reactions.
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Affiliation(s)
- Jose A Céspedes
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
| | - Rubén Fernández-Santamaría
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Adriana Ariza
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- RETICS Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
| | - Gador Bogas
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - Inmaculada Doña
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- RETICS Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - Carmen Rondón
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- RETICS Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - María Salas
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- RETICS Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - Marina Labella
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - Cecilia Frecha
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
| | - Cristobalina Mayorga
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- RETICS Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - María J Torres
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- RETICS Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - Tahia D Fernández
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- RETICS Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
- Departamento de Biología Celular, Genética y Fisiología, Universidad de Málaga, Málaga, Spain
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Bourgoin P, Busnel JM. Promises and Remaining Challenges for Further Integration of Basophil Activation Test in Allergy-Related Research and Clinical Practice. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3000-3007. [PMID: 37634807 DOI: 10.1016/j.jaip.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
More than 20 years after having been initially proposed, the relevance and usefulness of basophil activation test (BAT) for the field of allergy research and testing were demonstrated on many occasions. Leveraging the fully open format of a flexible, whole blood-based functional assay, BAT has been shown to be equally important for fundamental research, clinical research, and diagnosis. Regardless of whether the focus of a study is on the characterization of the allergenic moiety, on the patient side, or on the study of the fundamental processes involved in the allergic disease or its treatment, BAT enables the gathering of very important insights. In spite of this, its full capabilities have yet to be leveraged. Various bottlenecks, including but not limited to assay logistics, robustness, flow cytometry access, and/or expertise, have indeed been limiting its development beyond experts and long-term users. Now, various initiatives, aiming at resolving these bottlenecks, have been launched. If successful, a broader use of BAT could then be contemplated. In such a situation, its more thorough integration in clinical practice has the potential to significantly change the allergic patient's journey.
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Affiliation(s)
- Pénélope Bourgoin
- Global Research Organization, Beckman Coulter Life Sciences, Marseille, France
| | - Jean-Marc Busnel
- Global Research Organization, Beckman Coulter Life Sciences, Marseille, France.
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David CAW, de la Fonteyne-Blankestijn LJJ, Vermeulen JP, Plant-Hately AJ, Vandebriel RJ, Liptrott NJ. Application of KU812 cells for assessing complement activation related effects by nano(bio)materials. Biomed Pharmacother 2023; 163:114841. [PMID: 37167727 DOI: 10.1016/j.biopha.2023.114841] [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: 03/24/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023] Open
Abstract
Immunocompatibility issues related to nano(bio)materials, particularly liposomal formulations, involving activation of the complement system have been relatively well described however, they highlight the importance of preclinical evaluation of such interactions. These complement-mediated hypersensitivity reactions, in which basophils are implicated, are associated with complement activation-related pseudoallergy (CARPA). Ex vivo investigation of such events using primary basophils is technically challenging due to the relatively limited number of circulating basophils in peripheral blood. In the current work, the KU812 cell line has been applied as an in vitro model for basophil activation to investigate CARPA-related responses following exposure to test materials obtained from the REFINE consortium. To that end, we developed a standard operating procedure measuring a panel of cell-surface markers indicative of basophilic activation. Two laboratories performed the assays, demonstrating a clear difference in responses between liposomal and polymeric nano(bio)materials, while interlaboratory comparison of the standard operating procedure demonstrated reproducibility in results, between the two facilities. These results suggest the potential to use this protocol as a screening method for such responses however, validation using primary basophils is now warranted.
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Affiliation(s)
- Christopher A W David
- Immunocompatibility Group, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | | | - Jolanda P Vermeulen
- National Institute for Public Health & the Environment, Bilthoven, the Netherlands
| | - Alexander J Plant-Hately
- Immunocompatibility Group, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Rob J Vandebriel
- National Institute for Public Health & the Environment, Bilthoven, the Netherlands
| | - Neill J Liptrott
- Immunocompatibility Group, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK.
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4
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Plant-Hately AJ, Eryilmaz B, David CAW, Brain DE, Heaton BJ, Perrie Y, Liptrott NJ. Exposure of the Basophilic Cell Line KU812 to Liposomes Reveals Activation Profiles Associated with Potential Anaphylactic Responses Linked to Physico-Chemical Characteristics. Pharmaceutics 2022; 14:pharmaceutics14112470. [PMID: 36432660 PMCID: PMC9695975 DOI: 10.3390/pharmaceutics14112470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022] Open
Abstract
Lipidic nanoparticles (LNP), particularly liposomes, have been proven to be a successful and versatile platform for intracellular drug delivery for decades. Whilst primarily developed for small molecule delivery, liposomes have recently undergone a renaissance due to their success in vaccination strategies, delivering nucleic acids, in the COVID-19 pandemic. As such, liposomes are increasingly being investigated for the delivery of nucleic acids, beyond mRNA, as non-viral gene delivery vectors. Although not generally considered toxic, liposomes are increasingly shown to not be immunologically inert, which may have advantages in vaccine applications but may limit their use in other conditions where immunological responses may lead to adverse events, particularly those associated with complement activation. We sought to assess a small panel of liposomes varying in a number of physico-chemical characteristics associated with complement activation and inflammatory responses, and examine how basophil-like cells may respond to them. Basophils, as well as other cell types, are involved in the anaphylactic responses to liposomes but are difficult to isolate in sufficient numbers to conduct large scale analysis. Here, we report the use of the human KU812 cell line as a surrogate for primary basophils. Multiple phenotypic markers of activation were assessed, as well as the release of histamine and inflammasome activity within the cells. We found that larger liposomes were more likely to result in KU812 activation, and that non-PEGylated liposomes were potent stimulators of inflammasome activity (four-fold greater IL-1β secretion than untreated controls), and a lower ratio of cholesterol to lipid was also associated with greater IL-1β secretion ([Cholesterol:DSPC ratio] 1:10; 0.35 pg/mL IL-1β vs. 5:10; 0.1 pg/mL). Additionally, PEGylation appeared to be associated with direct KU812 activation. These results suggest possible mechanisms related to the consequences of complement activation that may be underpinned by basophilic cells, in addition to other immune cell types. Investigation of the mechanisms behind these responses, and their impact on use in vivo, are now warranted.
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Affiliation(s)
- Alexander J. Plant-Hately
- Immunocompatibility Group, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, The University of Liverpool, Liverpool L7 3NY, UK
| | - Burcu Eryilmaz
- Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
| | - Christopher A. W. David
- Immunocompatibility Group, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, The University of Liverpool, Liverpool L7 3NY, UK
| | - Danielle E. Brain
- Immunocompatibility Group, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, The University of Liverpool, Liverpool L7 3NY, UK
| | - Bethany J. Heaton
- Immunocompatibility Group, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, The University of Liverpool, Liverpool L7 3NY, UK
| | - Yvonne Perrie
- Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
| | - Neill J. Liptrott
- Immunocompatibility Group, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, The University of Liverpool, Liverpool L7 3NY, UK
- Correspondence: ; Tel.: +44-(0)15-1795-7566
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5
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Chandler J, Prout M, Old S, Morgan C, Ronchese F, Benoist C, Le Gros G. BCL6 deletion in CD4 T cells does not affect Th2 effector mediated immunity in the skin. Immunol Cell Biol 2022; 100:791-804. [PMID: 36177669 PMCID: PMC9828354 DOI: 10.1111/imcb.12589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 09/05/2022] [Accepted: 09/28/2022] [Indexed: 01/12/2023]
Abstract
Recent studies propose that T follicular helper (Tfh) cells possess a high degree of functional plasticity in addition to their well-defined roles in mediating interleukin-4-dependent switching of germinal center B cells to the production of immunoglobulin (Ig)G1 and IgE antibodies. In particular Tfh cells have been proposed to be an essential stage in Th2 effector cell development that are able to contribute to innate type 2 responses. We used CD4-cre targeted deletion of BCL6 to identify the contribution Tfh cells make to tissue Th2 effector responses in models of atopic skin disease and lung immunity to parasites. Ablation of Tfh cells did not impair the development or recruitment of Th2 effector subsets to the skin and did not alter the transcriptional expression profile or functional activities of the resulting tissue resident Th2 effector cells. However, the accumulation of Th2 effector cells in lung Th2 responses was partially affected by BCL6 deficiency. These data indicate that the development of Th2 effector cells does not require a BCL6 dependent step, implying Tfh and Th2 effector populations follow separate developmental trajectories and Tfh cells do not contribute to type 2 responses in the skin.
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Affiliation(s)
- Jodie Chandler
- Malaghan Institute of Medical ResearchWellingtonNew Zealand
| | - Melanie Prout
- Malaghan Institute of Medical ResearchWellingtonNew Zealand
| | - Sam Old
- Malaghan Institute of Medical ResearchWellingtonNew Zealand
| | - Cynthia Morgan
- Malaghan Institute of Medical ResearchWellingtonNew Zealand
| | | | | | - Graham Le Gros
- Malaghan Institute of Medical ResearchWellingtonNew Zealand
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6
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Ebo DG, Bridts CH, Mertens CH, Sabato V. Principles, potential, and limitations of ex vivo basophil activation by flow cytometry in allergology: A narrative review. J Allergy Clin Immunol 2021; 147:1143-1153. [DOI: 10.1016/j.jaci.2020.10.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
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7
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Carstensen S, Benediktus E, Litzenburger T, Hohlfeld JM, Müller M. Basophil activation test: Assay precision and BI 1002494 SYK inhibition in healthy and mild asthmatics. Cytometry A 2021; 101:86-94. [PMID: 33797185 DOI: 10.1002/cyto.a.24338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/09/2021] [Accepted: 03/17/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Application of basophil activation test (BAT) in clinical trials requires assay validity. Whether assay variability differs between healthy and asthmatic subjects is mostly unknown. This study compares basophil stimulation using blood from healthy and asthmatic subjects with or without inhibition of spleen tyrosine kinase (SYK). METHODS Whole blood of healthy and mild asthmatic subjects was stimulated with anti-dinitrophenyl (DNP) IgE/DNP bovine serum albumin and anti-IgE. Basophil activation was detected by CD63 and CD203c expression. CD63 expression levels were compared with serum IgE levels. Three operators repeated experiments with three subjects each from both groups at 3 days to observe assay precision. The effect of the SYK inhibitor BI 1002494 was assessed in BAT for both healthy and asthmatic subjects. RESULTS BAT was reproducible in both groups. Acceptance criteria of <25% CV were mostly fulfilled. Stimulation with anti-DNP (p < 0.001, r = -0.80) but not anti-IgE (p = 0.74, r = 0.05) was related to serum IgE with levels > 200 IU/ml limiting anti-DNP stimulation. BI 1002494 IC50 values were 497 nM and 1080 nM in healthy and 287 nM and 683 nM in asthmatics for anti-DNP and anti-IgE stimulation, respectively. CONCLUSION BAT, performed with blood from healthy or asthmatic subjects, is a robust test for the measurement of a physiological response in clinical trials. Blood from asthmatic donors with serum IgE > 200 IU/ml is less feasible when using anti-DNP stimulation. SYK inhibition was not affected by disease status.
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Affiliation(s)
- Saskia Carstensen
- Department of Biomarker Analysis and Development, Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
| | - Ewald Benediktus
- Department of Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Tobias Litzenburger
- Department of Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Jens M Hohlfeld
- Division of Airway Research, Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany.,Member of the German Center for Lung Research, Hannover, Germany.,Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Meike Müller
- Department of Biomarker Analysis and Development, Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
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Kim T, Yu J, Li H, Scarupa M, Wasserman RL, Economides A, White M, Ward C, Shah A, Jones D, Rathkopf M, Frye K, Aybar A, Shayegan S, Enav B, Ispas L, Loizou D, Fitzhugh D, Tracy J, Friedlander J, Jacobs Z, Matz J, Golden D, McNeil D, McCann W, Copenhaver C, Factor J, Gupta R, Alpan O, Plassmeyer M, Sønder SU. Validation of inducible basophil biomarkers: Time, temperature and transportation. CYTOMETRY PART B-CLINICAL CYTOMETRY 2021; 100:632-644. [PMID: 33539657 PMCID: PMC9291082 DOI: 10.1002/cyto.b.21991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/26/2020] [Accepted: 12/31/2020] [Indexed: 12/23/2022]
Abstract
Background The short stability window of several hours from blood collection to measuring basophil activation has limited the use of flow cytometry‐based basophil activation assays in clinical settings. We examine if it is possible to extend this window to 1 day allowing for shipment of samples between laboratories. Several options exist for reporting the results including reporting all the measured values directly, calculating ratios and reporting a single value covering all measured results. Each of these options have different stability and value to the physician. Methods Whole blood samples from peanut allergic patients were stimulated with four different peanut concentrations at Day 0, Day 1, and Day 2. Samples were stored under temperature‐controlled conditions. Flow cytometry was used to analyze the samples. The basophil activation and degranulation were measured as percentage of positive CD63 basophils and CD203c MFI fold change. Shipped samples were transported under ambient conditions. Results The results show that CD63 is a stable marker at Day 1. The CD203c ratio decreases significantly at Day 1. Calculating the CD63/IgE ratio proves to be more stable than CD63 alone. The most stable readouts are the semi‐quantitative results and the trajectory of the dose response curve. Finally, we confirmed that the stability can be extended to samples shipped overnight to the laboratory. Conclusions It is possible to extend the stability of the basophil activation assay to 1 day for samples stored at 18–25°C as well as samples shipped under ambient conditions as long as the temperature is within the 2–37°C range.
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Affiliation(s)
- Theodore Kim
- Allergy Partners of Northern Virginia, Chantilly, Virginia, USA
| | - Jing Yu
- Institute for Asthma and Allergy, Wheaton, Maryland, SA
| | - Henry Li
- Institute for Asthma and Allergy, Wheaton, Maryland, SA
| | - Mark Scarupa
- Institute for Asthma and Allergy, Wheaton, Maryland, SA
| | | | | | - Martha White
- Institute for Asthma and Allergy, Wheaton, Maryland, SA
| | - Carla Ward
- Institute for Asthma and Allergy, Wheaton, Maryland, SA
| | - Atul Shah
- New York Food Allergy and Wellness Center, Centereach, New York, USA
| | | | - Melinda Rathkopf
- Allergy Asthma and Immunology Center of Alaska, Anchorage, Alaska, USA
| | | | - Ahmet Aybar
- Annapolis Pediatric Gastroenterology and Nutrition, Annapolis, Maryland, USA
| | | | - Benjamin Enav
- Pediatric Gastroenterology of Northern Virginia, Fairfax, Virginia, USA
| | - Laura Ispas
- Allergy, Asthma and Immunology Institute, Leesburg, Virginia, USA
| | | | - David Fitzhugh
- Allergy Partners of Chapel Hill, Chapel Hill, North Carolina, USA
| | - James Tracy
- Allergy, Asthma and Immunology Associates, Omaha, Nebraska, USA
| | | | - Zachary Jacobs
- The Center for Allergy and Immunology, Kansas City, Missouri, USA
| | - Jonathan Matz
- Allergy and Asthma Specialists of Maryland, Baltimore, Maryland, USA
| | - David Golden
- Allergy and Asthma Specialists of Maryland, Baltimore, Maryland, USA
| | | | - William McCann
- Allergy Partners of Western North Carolina, Asheville, North Carolina, USA
| | | | - Jeffrey Factor
- New England Food Allergy Treatment Center, Farmington, Connecticut, USA
| | - Raavi Gupta
- Amerimmune, Fairfax, Virginia, USA.,Department of Pathology, SUNY, New York, New York, USA
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Spadaro G, Giurato G, Stellato C, Marone G, Casolaro V. Basophil degranulation in response to IgE ligation is controlled by a distinctive circadian clock in asthma. Allergy 2020; 75:158-168. [PMID: 31355941 DOI: 10.1111/all.14002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/14/2019] [Accepted: 07/08/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Several factors may contribute to the circadian variability of clinical manifestations in asthma and allergy. Basophils play a pivotal role in allergic inflammation. However, evidence for a functional clock governing the effector function of these cells is sparse and contradictory. We have systematically sampled the 24-hour response of basophils to IgE- and non-IgE-dependent ligands in asthma to understand their possible contribution to the diurnal variations of allergic symptoms. METHODS Leukocytes were collected every 4 hours for 24 hours from 10 patients with moderate, persistent asthma and 10 matched, nonallergic controls, and then incubated with concentrations of anti-IgE, formyl-methionyl-leucylphenylalanine (fMLP), or the Ca2+ ionophore, A23187. Histamine release (HR) was tested for time-of-day- or disease-related variability by conventional statistics and for 24-hour rhythmicity by the cosinor method. RESULTS HR induced by anti-IgE was significantly increased at 08:00 vs. 20:00 in basophils from asthmatics but not controls. No significant differences were seen at any time in the response to A23187, while the response to fMLP was significantly higher at 08:00 vs. 20:00 in controls but not asthmatics. The basophil response to anti-IgE, but not fMLP or A23187, varied significantly across the 24 hours in asthma, and its amplitude, percent rhythm, and acrophase were comparable to those of peak expiratory flow or serum cortisol. CONCLUSION Using an integrated statistical approach, we show that basophil responsiveness undergoes significant circadian variability and that distinct patterns of rhythmicity can be recognized depending on the signal delivered, the activation parameters assessed, and the disease status.
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Affiliation(s)
- Giuseppe Spadaro
- Department of Translational Medicine, Center for Basic and Clinical Immunology Research (CISI), World Allergy Organization (WAO) Center of Excellence University of Naples Federico II Naples Italy
| | - Giorgio Giurato
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, Laboratory of Molecular Medicine and Genomics and Genomix4Life s.r.l University of Salerno Baronissi Italy
| | - Cristiana Stellato
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” University of Salerno Baronissi Italy
| | - Gianni Marone
- Department of Translational Medicine, Center for Basic and Clinical Immunology Research (CISI), World Allergy Organization (WAO) Center of Excellence University of Naples Federico II Naples Italy
- Institute of Experimental Endocrinology and Oncology “Gaetano Salvatore” National Research Council (CNR) Naples Italy
| | - Vincenzo Casolaro
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” University of Salerno Baronissi Italy
- Institute of Experimental Endocrinology and Oncology “Gaetano Salvatore” National Research Council (CNR) Naples Italy
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Ariza A, Torres MJ, Moreno-Aguilar C, Fernández-Santamaría R, Fernández TD. Early Biomarkers for Severe Drug Hypersensitivity Reactions. Curr Pharm Des 2019; 25:3829-3839. [DOI: 10.2174/1381612825666191107105440] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/06/2019] [Indexed: 02/08/2023]
Abstract
Drug hypersensitivity reactions (DHRs) are typically classified into immediate and delayed reactions
based on the time interval between drug exposure and onset of symptoms. Clinical manifestations range from
mild to severe and life-threatening reactions. The most severe clinical entities are anaphylaxis and anaphylactic
shock for immediate reactions, and severe cutaneous adverse reactions such as Steven Johnson Syndrome and
Toxic Epidermal Necrolysis for delayed reactions. The diagnosis is complex and challenging, as drug provocation
tests and even skin tests can be very risky procedures, which makes them not recommended. Therefore, it is necessary
to search for useful early biomarkers to manage the diagnosis of these reactions. These biomarkers could
be useful to determine the clinical entity, but not to identify the culprit drug. Some of the currently available
biomarkers are few genetic associations of drug allergy with polymorphisms of human leukocyte antigen (HLA),
the detection of inflammatory and lipid mediators in serum, or the detection of cytokines, chemokines, and cytotoxic
markers in skin biopsies. In this literature review, it has been summarize the immunological mechanisms
involved in severe reactions, both immediate and delayed, and different early biomarkers: those currently used for
the diagnosis of these reactions as well as possible early biomarkers that could be useful with further studies to
standardize their clinical use.
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Affiliation(s)
- Adriana Ariza
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA, Malaga, Spain
| | - Maria J. Torres
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA, Malaga, Spain
| | - Carmen Moreno-Aguilar
- Immunology and Allergy Unit, IMIBICHospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Tahia D. Fernández
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA, Malaga, Spain
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New Insights of Biomarkers in IgE and Non-IgE-Mediated Drug Hypersensitivity. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-0201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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The Basophil Activation Test Can Be of Value for Diagnosing Immediate Allergic Reactions to Omeprazole. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1628-1636.e2. [DOI: 10.1016/j.jaip.2017.12.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/13/2017] [Accepted: 12/06/2017] [Indexed: 01/15/2023]
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13
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Abstract
Mast cells and basophils represent the most relevant source of histamine in the immune system. Histamine is stored in cytoplasmic granules along with other amines (e.g., serotonin), proteases, proteoglycans, cytokines/chemokines, and angiogenic factors and rapidly released upon triggering with a variety of stimuli. Moreover, mast cell and basophil histamine release is regulated by several activating and inhibitory receptors. The engagement of different receptors can trigger different modalities of histamine release and degranulation. Histamine released from mast cells and basophils exerts its biological activities by activating four G protein-coupled receptors, namely H1R, H2R, H3R (expressed mainly in the brain), and the recently identified H4R. While H1R and H2R activation accounts mainly for some mast cell- and basophil-mediated allergic disorders, the selective expression of H4R on immune cells is uncovering new roles for histamine (possibly derived from mast cells and basophils) in allergic, inflammatory, and autoimmune disorders. Thus, the in-depth knowledge of mast cell and basophil histamine release and its biologic effects is poised to uncover new therapeutic avenues for a wide spectrum of disorders.
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Hoffmann HJ, Knol EF, Ferrer M, Mayorga L, Sabato V, Santos AF, Eberlein B, Nopp A, MacGlashan D. Pros and Cons of Clinical Basophil Testing (BAT). Curr Allergy Asthma Rep 2017; 16:56. [PMID: 27411319 DOI: 10.1007/s11882-016-0633-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW We review basophil testing by flow cytometry with an emphasis on advantages and disadvantages. RECENT FINDINGS There are many tools available to assess the presence and severity of allergic diseases in patients. For 50 years, peripheral blood basophils have been used as tools to study these diseases. It is a very accessible cell that binds IgE antibody and secretes the classical mediators responsible for the symptoms of allergic reactions. In the last decade, an even more accessible methodology, using flow cytometry, has been developed to enhance the ability to use basophils for both mechanistic and clinical diagnostics. Basophil testing has been included in diagnostics for different forms of allergies as well as to monitor disease status. A variety of studies have begun to establish both precise methods and their clinical relevance for disease diagnosis, but there remain some important questions on how to take optimal advantage of the behaviours of basophils.
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Affiliation(s)
- Hans Jürgen Hoffmann
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Nørrebrogade 44, Aarhus, 8000, Denmark.
| | - Edward F Knol
- Departments of Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martha Ferrer
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Lina Mayorga
- Research Laboratory and Allergy Service, IBIMA-Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - Vito Sabato
- Department of Immunology-Allergology-Rheumatology, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Alexandra F Santos
- Department of Paediatric Allergy, Division of Asthma, Allergy & Lung Biology, King's College London, London, UK
- Children's Allergy Service, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Bernadette Eberlein
- Department of Dermatology and Allergy Biederstein, Technische Universität München, Munich, Germany
| | - Anna Nopp
- Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
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15
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Montañez MI, Mayorga C, Bogas G, Barrionuevo E, Fernandez-Santamaria R, Martin-Serrano A, Laguna JJ, Torres MJ, Fernandez TD, Doña I. Epidemiology, Mechanisms, and Diagnosis of Drug-Induced Anaphylaxis. Front Immunol 2017; 8:614. [PMID: 28611774 PMCID: PMC5446992 DOI: 10.3389/fimmu.2017.00614] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/09/2017] [Indexed: 12/14/2022] Open
Abstract
Anaphylaxis is an acute, life-threatening, multisystem syndrome resulting from the sudden release of mediators by mast cells and basophils. Although anaphylaxis is often under-communicated and thus underestimated, its incidence appears to have risen over recent decades. Drugs are among the most common triggers in adults, being analgesics and antibiotics the most common causal agents. Anaphylaxis can be caused by immunologic or non-immunologic mechanisms. Immunologic anaphylaxis can be mediated by IgE-dependent or -independent pathways. The former involves activation of Th2 cells and the cross-linking of two or more specific IgE (sIgE) antibodies on the surface of mast cells or basophils. The IgE-independent mechanism can be mediated by IgG, involving the release of platelet-activating factor, and/or complement activation. Non-immunological anaphylaxis can occur through the direct stimulation of mast cell degranulation by some drugs, inducing histamine release and leading to anaphylactic symptoms. Work-up of a suspected drug-induced anaphylaxis should include clinical history; however, this can be unreliable, and skin tests should also be used if available and validated. Drug provocation testing is not recommended due to the risk of inducing a harmful reaction. In vitro testing can help to confirm anaphylaxis by analyzing the release of mediators such as tryptase or histamine by mast cells. When immunologic mechanisms are suspected, serum-sIgE quantification or the use of the basophil activation test can help confirm the culprit drug. In this review, we will discuss multiple aspects of drug-induced anaphylaxis, including epidemiology, mechanisms, and diagnosis.
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Affiliation(s)
- Maria Isabel Montañez
- Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain.,Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain
| | - Cristobalina Mayorga
- Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain.,Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Gador Bogas
- Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Esther Barrionuevo
- Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | | | - Angela Martin-Serrano
- Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain.,Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain
| | | | - Maria José Torres
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain.,Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Tahia Diana Fernandez
- Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Inmaculada Doña
- Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
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16
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Zhang K, Liu J, Truong T, Zukin E, Chen W, Saxon A. Blocking Allergic Reaction through Targeting Surface-Bound IgE with Low-Affinity Anti-IgE Antibodies. THE JOURNAL OF IMMUNOLOGY 2017; 198:3823-3834. [PMID: 28396318 DOI: 10.4049/jimmunol.1602022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/13/2017] [Indexed: 11/19/2022]
Abstract
Allergic disorders have now become a major worldwide public health issue, but the effective treatment options remain limited. We report a novel approach to block allergic reactivity by targeting the surface-bound IgE of the allergic effector cells via low-affinity anti-human IgE Abs with dissociation constants in the 10-6 to 10-8 M range. We demonstrated that these low-affinity anti-IgE mAbs bind to the cell surface-bound IgE without triggering anaphylactic degranulation even at high concentration, albeit they would weakly upregulate CD203c expression on basophils. This is in contrast to the high-affinity anti-IgE mAbs that trigger anaphylactic degranulation at low concentration. Instead, the low-affinity anti-IgE mAbs profoundly block human peanut- and cat-allergic IgE-mediated basophil CD63 induction indicative of anaphylactic degranulation; suppress peanut-, cat-, and dansyl-specific IgE-mediated passive cutaneous anaphylaxis; and attenuate dansyl IgE-mediated systemic anaphylaxis in human FcεRIα transgenic mouse model. Mechanistic studies reveal that the ability of allergic reaction blockade by the low-affinity anti-IgE mAbs was correlated with their capacity to downregulate the surface IgE and FcεRI level on human basophils and the human FcεRIα transgenic mouse bone marrow-derived mast cells via driving internalization of the IgE/FcεRI complex. Our studies demonstrate that targeting surface-bound IgE with low-affinity anti-IgE Abs is capable of suppressing allergic reactivity while displaying an excellent safety profile, indicating that use of low-affinity anti-IgE mAbs holds promise as a novel therapeutic approach for IgE-mediated allergic diseases.
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Affiliation(s)
- Ke Zhang
- Sixal Inc., Los Angeles, CA 90095; and .,Section of Clinical Immunology/Allergy, Division of Pulmonary, Critical Care, and Clinical Immunology/Allergy, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095
| | | | - Thao Truong
- Section of Clinical Immunology/Allergy, Division of Pulmonary, Critical Care, and Clinical Immunology/Allergy, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095
| | - Elyssa Zukin
- Section of Clinical Immunology/Allergy, Division of Pulmonary, Critical Care, and Clinical Immunology/Allergy, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095
| | - Wendy Chen
- Section of Clinical Immunology/Allergy, Division of Pulmonary, Critical Care, and Clinical Immunology/Allergy, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095
| | - Andrew Saxon
- Sixal Inc., Los Angeles, CA 90095; and.,Section of Clinical Immunology/Allergy, Division of Pulmonary, Critical Care, and Clinical Immunology/Allergy, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095
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17
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Uyttebroek A, Sabato V, Cop N, Decuyper I, Faber M, Bridts C, Mertens C, Hagendorens M, De Clerck L, Ebo D. Diagnosing cefazolin hypersensitivity: Lessons from dual-labeling flow cytometry. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:1243-1245. [DOI: 10.1016/j.jaip.2016.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/18/2016] [Accepted: 08/31/2016] [Indexed: 10/20/2022]
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18
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Kirshenbaum AS, Cruse G, Desai A, Bandara G, Leerkes M, Lee CCR, Fischer ER, O’Brien KJ, Gochuico BR, Stone K, Gahl WA, Metcalfe DD. Immunophenotypic and Ultrastructural Analysis of Mast Cells in Hermansky-Pudlak Syndrome Type-1: A Possible Connection to Pulmonary Fibrosis. PLoS One 2016; 11:e0159177. [PMID: 27459687 PMCID: PMC4961407 DOI: 10.1371/journal.pone.0159177] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/28/2016] [Indexed: 02/06/2023] Open
Abstract
Hermansky-Pudlak Syndrome type-1 (HPS-1) is an autosomal recessive disorder caused by mutations in HPS1 which result in reduced expression of the HPS-1 protein, defective lysosome-related organelle (LRO) transport and absence of platelet delta granules. Patients with HPS-1 exhibit oculocutaneous albinism, colitis, bleeding and pulmonary fibrosis postulated to result from a dysregulated immune response. The effect of the HPS1 mutation on human mast cells (HuMCs) is unknown. Since HuMC granules classify as LROs along with platelet granules and melanosomes, we set out to determine if HPS-1 cutaneous and CD34+ culture-derived HuMCs have distinct granular and cellular characteristics. Cutaneous and cultured CD34+-derived HuMCs from HPS-1 patients were compared with normal cutaneous and control HuMCs, respectively, for any morphological and functional differences. One cytokine-independent HPS-1 culture was expanded, cloned, designated the HP proMastocyte (HPM) cell line and characterized. HPS-1 and idiopathic pulmonary fibrosis (IPF) alveolar interstitium showed numerous HuMCs; HPS-1 dermal mast cells exhibited abnormal granules when compared to healthy controls. HPS-1 HuMCs showed increased CD63, CD203c and reduced mediator release following FcɛRI aggregation when compared with normal HuMCs. HPM cells also had the duplication defect, expressed FcɛRI and intracytoplasmic proteases and exhibited less mediator release following FcɛRI aggregation. HPM cells constitutively released IL-6, which was elevated in patients' serum, in addition to IL-8, fibronectin-1 (FN-1) and galectin-3 (LGALS3). Transduction with HPS1 rescued the abnormal HPM morphology, cytokine and matrix secretion. Microarray analysis of HPS-1 HuMCs and non-transduced HPM cells confirmed upregulation of differentially expressed genes involved in fibrogenesis and degranulation. Cultured HPS-1 HuMCs appear activated as evidenced by surface activation marker expression, a decrease in mediator content and impaired releasibility. The near-normalization of constitutive cytokine and matrix release following rescue by HPS1 transduction of HPM cells suggests that HPS-1 HuMCs may contribute to pulmonary fibrosis and constitute a target for therapeutic intervention.
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Affiliation(s)
- Arnold S. Kirshenbaum
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Glenn Cruse
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Avanti Desai
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Geethani Bandara
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Maarten Leerkes
- Bioinformatics and Computational Biosciences Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Chyi-Chia R. Lee
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Elizabeth R. Fischer
- Research Technologies Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Kevin J. O’Brien
- Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Bernadette R. Gochuico
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Kelly Stone
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - William A. Gahl
- Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Dean D. Metcalfe
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
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19
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Fernández TD, Ariza A, Palomares F, Montañez MI, Salas M, Martín-Serrano A, Fernández R, Ruiz A, Blanca M, Mayorga C, Torres MJ. Hypersensitivity to fluoroquinolones: The expression of basophil activation markers depends on the clinical entity and the culprit fluoroquinolone. Medicine (Baltimore) 2016; 95:e3679. [PMID: 27281069 PMCID: PMC4907647 DOI: 10.1097/md.0000000000003679] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Although fluoroquinolones (FQs) are generally well-tolerated antibiotics, increasing numbers of hypersensitivity reactions have been reported. These can be evaluated in vitro by basophil activation tests (BATs); however, sensitivity is not optimal. Many factors could influence sensitivity such as basophil activation markers. The objective of this study was to evaluate the influence of 2 different activations markers, CD63 and CD203c, on the sensitivity of BAT to FQ. We studied 17 patients with immediate allergic reactions to FQ. BAT was performed with moxifloxacin and ciprofloxacin using CD193 (CCR3) for basophil selection and CD203c or CD63 as activation markers. Stimulation with ciprofloxacin induced a significantly higher expression of CD63 in ciprofloxacin-allergic patients compared to moxifloxacin-allergic patients (P = 0.002). In patients allergic to moxifloxacin with anaphylactic shock, we have observed an increase in the percentage of cells that upregulate CD203c, whereas patients with anaphylaxis preferentially upregulate CD63. The best sensitivity-specificity was obtained using a cutoff of 3 and the culprit FQ, using CD203c for moxifloxacin-allergic patients (sensitivity = 36.4%; specificity = 94.4%), and CD63 for ciprofloxacin-allergic patients (sensitivity = 83.3%; specificity = 88.9%). A negative correlation was found between the upregulation of CD63 and CD203c and the time interval between the reaction occurrence and the performance of the test (Spearman r = -0.446; P < 0.001 for CD63 and Spearman r = -0.386; P < 0.001 for CD203c). The performance of BAT for FQ allergy must be optimized for each drug, taking into account possible differences in the stimulation mechanism that leads to the upregulation of different activation markers.
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Affiliation(s)
- Tahia D. Fernández
- Research Unit for Allergic Diseases, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Adriana Ariza
- Research Unit for Allergic Diseases, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Francisca Palomares
- Research Unit for Allergic Diseases, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - María I. Montañez
- Research Unit for Allergic Diseases, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - María Salas
- Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Angela Martín-Serrano
- Research Unit for Allergic Diseases, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Rubén Fernández
- Research Unit for Allergic Diseases, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Arturo Ruiz
- Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Miguel Blanca
- Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Cristobalina Mayorga
- Research Unit for Allergic Diseases, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
- Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
- ∗ Correspondence: Cristobalina Mayorga, Research Unit for Allergic Diseases, IBIMA-Regional University Hospital of Malaga, Pl. Hospital Civil, 29009 Malaga, Spain (e-mail: )
| | - María J. Torres
- Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
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20
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Alexander V, MacGlashan D. The relationship between total cellular content of CD203c and cell surface expression on human basophils. Clin Exp Allergy 2016; 45:1138-41. [PMID: 25818197 DOI: 10.1111/cea.12545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- V Alexander
- Johns Hopkins Asthma and Allergy Center, Baltimore, MD, USA
| | - D MacGlashan
- Johns Hopkins Asthma and Allergy Center, Baltimore, MD, USA
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21
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Mangodt EA, Van Gasse AL, Decuyper I, Uyttebroek A, Faber MA, Sabato V, Bridts CH, Hagendorens MM, Ebo DG. In vitro Diagnosis of Immediate Drug Hypersensitivity: Should We Go with the Flow. Int Arch Allergy Immunol 2015; 168:3-12. [PMID: 26524156 DOI: 10.1159/000440663] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diagnosis of immediate drug hypersensitivity reactions (IDHRs) is based upon history taking, skin prick or intradermal tests and quantification of specific immunoglobulin E (IgE) antibodies. Unfortunately, this is often insufficient to correctly identify patients with IgE-mediated IDHRs and is impossible in the case of non-IgE-mediated IDHRs. Drug provocation tests (DPT) are considered the 'gold standard' diagnostic but are not always possible, for ethical and practical reasons. Therefore, the validation of new cellular tests such as basophil activation testing (BAT) was necessary. This review focuses on the applications of BAT in IDHRs. METHODS A literature search was conducted, using the words basophil, flow cytometry, immediate drug allergy and drugs; this was complemented by the authors' own expertise. RESULTS BAT/HistaFlow® is a useful diagnostic tool in IDHRs, mainly used to diagnose allergy to neuromuscular blocking agents (NMBAs), antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs) and iodinated radiocontrast media. Its sensitivity varies between 50 and 60%, and specificity attains 80%, except for with quinolones and NSAIDs. CONCLUSIONS The diagnostic utility of BAT (and to lesser extent HistaFlow) has been demonstrated and is mostly applied in IDHRs. However, larger-scale collaborative studies are necessary to optimize test protocols and validate the entry of BAT as a diagnostic instrument in drug allergy.
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Affiliation(s)
- Evelyne A Mangodt
- Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
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22
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Holt PG, Strickland D, Bosco A, Belgrave D, Hales B, Simpson A, Hollams E, Holt B, Kusel M, Ahlstedt S, Sly PD, Custovic A. Distinguishing benign from pathologic TH2 immunity in atopic children. J Allergy Clin Immunol 2015; 137:379-87. [PMID: 26518094 DOI: 10.1016/j.jaci.2015.08.044] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/12/2015] [Accepted: 08/14/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although most children with asthma and rhinitis are sensitized to aeroallergens, only a minority of sensitized children are symptomatic, implying the underlying operation of efficient anti-inflammatory control mechanisms. OBJECTIVE We sought to identify endogenous control mechanisms that attenuate expression of IgE-associated responsiveness to aeroallergens in sensitized children. METHODS In 3 independent population samples we analyzed relationships between aeroallergen-specific IgE and corresponding allergen-specific IgG (sIgG) and associated immunophenotypes in atopic children and susceptibility to asthma and rhinitis, focusing on responses to house dust mite and grass. RESULTS Among mite-sensitized children across all populations and at different ages, house dust mite-specific IgG/IgE ratios (but not IgG4/IgE ratios) were significantly lower in children with asthma compared with ratios in those without asthma and lowest among the most severely symptomatic. This finding was mirrored by relationships between rhinitis and antibody responses to grass. Depending on age/allergen specificity, 20% to 40% of children with allergen-specific IgE (sIgE) of 0.35 kU/L or greater had negative skin test responses, and these children also expressed the high sIgG/sIgE immunophenotype. sIgG1 from these children inhibited allergen-induced IgE-dependent basophil activation in a dose-dependent fashion. Profiling of aeroallergen-specific CD4(+) TH memory responses revealed positive associations between sIgG/sIgE ratios and IL-10-dependent gene signatures and significantly higher IL-10/TH2 cytokine (protein) ratios among nonsymptomatic children. CONCLUSION In addition to its role in blocking TH2 effector activation in the late-phase allergic response, IL-10 is a known IgG1 switch factor. We posit that its production during allergen-induced memory responses contributes significantly to attenuation of inflammation through promoting IgG1-mediated damping of the FcεRI-dependent acute-phase reaction. sIgG1/sIgE balance might represent a readily accessible therapeutic target for asthma/rhinitis control.
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Affiliation(s)
- Patrick G Holt
- Telethon Kids Institute, University of Western Australia, Perth, Australia; Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Australia.
| | - Deborah Strickland
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Anthony Bosco
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Danielle Belgrave
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, United Kingdom
| | - Belinda Hales
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Angela Simpson
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, United Kingdom
| | - Elysia Hollams
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Barbara Holt
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Merci Kusel
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Staffan Ahlstedt
- Centre for Allergy Research, Karolinska Institute, Stockholm, Sweden
| | - Peter D Sly
- Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Australia
| | - Adnan Custovic
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, United Kingdom
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23
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Imoto Y, Takabayashi T, Sakashita M, Tokunaga T, Ninomiya T, Ito Y, Narita N, Yamada T, Fujieda S. Peripheral basophil reactivity, CD203c expression by Cryj1 stimulation, is useful for diagnosing seasonal allergic rhinitis by Japanese cedar pollen. IMMUNITY INFLAMMATION AND DISEASE 2015; 3:300-8. [PMID: 26417444 PMCID: PMC4578528 DOI: 10.1002/iid3.69] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/08/2015] [Accepted: 05/06/2015] [Indexed: 01/03/2023]
Abstract
Measuring specific IgE can yield direct, accurate, and objective data. Nevertheless, clinical symptoms of allergy are often inconsistent with these data. Recently, the expression of CD203c, a surface marker of basophils, has been reported as capable of distinguishing allergic patients. This study compared specific IgE in serum and skin tests against antigen to assess CD203c as a biomarker correlated with allergic rhinitis (AR). We asked 3,453 subjects whether they experienced any AR related symptom. All subjects were assessed for six specific IgEs for common aeroallergens. Skin tests were also conducted for six aeroallergens. We observed the reactivity of peripheral basophil by measuring the levels of CD203c by Cryj1 stimulation using flow cytometry. Of the 3,453 participants, 1,987 (57.5%) possessed Japanese cedar pollen (JCP) specific IgE in their serum. Among those 1,987 JCP specific IgE positive participants, 552 (27.8%) had not experienced any allergic symptom during the JCP season. The levels of CD203c in the peripheral basophil by Cryj1 stimulation were significantly higher in SAR-JCP subjects than in non-SAR-JCP subjects (Cryj1 0.5 ng/ml: 2.25 ± 0.90% vs. 60.2 ± 27.4%, p < 0.01, Cryj1 50 ng/ml: 1.89 ± 0.90% vs. 68.0 ± 21.2%, p < 0.01). Our results indicate that the levels of CD203c in peripheral basophils by Cryj1 stimulation is a more objective and reliable marker that better reflects the allergic reaction by SAR-JCP in vivo than measuring specific IgE in serum or skin tests.
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Affiliation(s)
- Yoshimasa Imoto
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui Fukui, Japan
| | - Tetsuji Takabayashi
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui Fukui, Japan
| | - Masafumi Sakashita
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui Fukui, Japan
| | - Takahiro Tokunaga
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui Fukui, Japan
| | - Takahiro Ninomiya
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui Fukui, Japan
| | - Yumi Ito
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui Fukui, Japan
| | - Norihiko Narita
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui Fukui, Japan
| | - Takechiyo Yamada
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui Fukui, Japan
| | - Shigeharu Fujieda
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medical Sciences, University of Fukui Fukui, Japan
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24
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Lambert C. Testing Basophil reactivity in monitoring allergen specific immunotherapy: comments on Chirumbolo's paper. Hum Vaccin Immunother 2015; 10:3722-3. [PMID: 25668675 DOI: 10.4161/21645515.2014.979696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Claude Lambert
- a Immunology Laboratory; Pole de Biologie-Pathologie ; University Hospital ; Saint-Etienne , France
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Boita M, Heffler E, Pizzimenti S, Raie A, Saraci E, Omedè P, Bussolino C, Bucca C, Rolla G. Regulation of B-cell-activating factor expression on the basophil membrane of allergic patients. Int Arch Allergy Immunol 2015; 166:208-12. [PMID: 25924578 DOI: 10.1159/000381343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/27/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To investigate the modulation of B-cell-activating factor (BAFF) expression on the basophil membrane of allergic patients. BAFF is an important regulator of B-cell activation, proliferation and immunoglobulin production, which may play a role in respiratory allergic diseases in promoting the production of IgE by B cells. METHODS Peripheral blood samples of 10 patients with allergic rhinitis, 3 with severe asthma and fungal sensitization (SAFS), 3 with allergic bronchopulmonary aspergillosis (ABPA) and 11 healthy controls were assessed regarding BAFF (CD257) expression using the basophil activation test before and after stimulation with IgE and allergens, as well IgE-independent stimuli, like fMLP, lipotheichoic acid from Staphylococcus aureus (LTA-SA) and lipopolysaccharide (LPS). RESULTS BAFF membrane expression did not change after IgE and allergen stimulation both in patients and controls, while it was upregulated by Aspergillus stimulation, both in sensitized patients and controls. In both patients and controls, BAFF expression was significantly upregulated following LTA-SA and β-1,3-glucan exposure (toll-like receptor-2 ligands), but not following LPS stimulation. CONCLUSIONS Basophils from allergic and healthy subjects constitutively express membrane BAFF, which is not upregulated by IgE or specific allergens but by TLR-2 ligands (LTA-SA and β-1,3-glucan). Aspergillus fumigatus stimulation was able to upregulate BAFF expression on the basophils of sensitized asthmatic patients, but not via IgE-dependent mechanisms, since results did not differ between the patient and control groups. These findings suggest that basophils may contribute to the polyclonal production of IgE commonly observed in patients with SAFS and ABPA.
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Affiliation(s)
- Monica Boita
- Division of Allergy and Immunology, Department of Medical Science, Azienda Ospedaliera Ordine Mauriziano Umberto I, Turin, Italy
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Uyttebroek AP, Sabato V, Faber MA, Cop N, Bridts CH, Lapeere H, De Clerck LS, Ebo DG. Basophil activation tests: time for a reconsideration. Expert Rev Clin Immunol 2014; 10:1325-35. [DOI: 10.1586/1744666x.2014.959498] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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27
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Basophils and Skin Disorders. J Invest Dermatol 2014; 134:1202-1210. [DOI: 10.1038/jid.2014.16] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/30/2013] [Accepted: 12/09/2013] [Indexed: 02/08/2023]
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28
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Schroeder JT, Bieneman AP, Chichester KL, Keet CA, Hamilton RG, MacGlashan DW, Wood R, Frischmeyer-Guerrerio PA. Spontaneous basophil responses in food-allergic children are transferable by plasma and are IgE-dependent. J Allergy Clin Immunol 2013; 132:1428-31. [PMID: 24139604 DOI: 10.1016/j.jaci.2013.08.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 08/01/2013] [Accepted: 08/15/2013] [Indexed: 11/18/2022]
Affiliation(s)
- John T Schroeder
- Department of Medicine, Division of Allergy and Clinical Immunology, Johns Hopkins Asthma and Allergy Center, Baltimore, Md.
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29
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Basophil activation testing. J Allergy Clin Immunol 2013; 132:777-87. [PMID: 23958648 DOI: 10.1016/j.jaci.2013.06.038] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 06/12/2013] [Accepted: 06/19/2013] [Indexed: 01/03/2023]
Abstract
Both the treatment of patients with allergic diseases and the study of allergic disease mechanisms depend on a wide variety of assays that in various ways assess the presence and function of IgE antibody. The study of allergic diseases could benefit from the study of its 2 principle cellular participants, mast cells and basophils, but the basophil is more accessible than mast cells for ex vivo studies. Its functionality is tested by using 2 predominant methodologies: the secretion of mediators of allergic inflammation and the expression of proteins on the plasma membrane after stimulation. Each approach has benefits. There are also many operational details to consider regardless of which general approach is taken, and proper interpretation of the methods requires a good understanding of the reagents used and the receptors expressed on basophils and a detailed understanding of the factors regulating aggregation of cell-surface IgE.
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Abstract
The basophil activation test (BAT) is a flow-cytometry-based functional assay that assesses the degree of cell activation after exposure to a stimuli. Though no standardized technique currently exists, recent advances have improved the performance of this assay, including identification of new basophil-specific markers and comparisons of the expression of CD63 to CD203c during activation. The basophil activation test has also been validated for many IgE-mediated disease conditions, which have been extensively reviewed elsewhere. This review focuses on the most recent applications of this test to the diagnosis of allergy to drugs, foods, venoms, and pollens, and the evolving role of the BAT in monitoring immunotherapy.
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Saini SS, MacGlashan DW. Assessing basophil functional measures during monoclonal anti-IgE therapy. J Immunol Methods 2012; 383:60-4. [PMID: 22664098 DOI: 10.1016/j.jim.2012.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 04/26/2012] [Accepted: 05/24/2012] [Indexed: 11/20/2022]
Abstract
Assessing the impact of therapeutic interventions on the clinical and immunologic responses of allergic subjects is a topic of extensive investigation. Available approaches include the measurement of in vivo allergen challenge responses, serologic measures, or in vitro studies of cells that participate in the allergic reaction. Several decades of work support that measures of allergen responses of IgE-bearing peripheral blood basophils can reflect clinical expression of allergic disease. In the last decade, an immune-based therapy targeting IgE, omalizumab, has emerged as an adjunct treatment for a variety of allergic diseases. This monoclonal humanized IgG antibody specifically binds circulating IgE at a region in the Fc tail that prevents IgE attachment to high affinity IgE receptor (FcεRI) bearing cell types such as tissue mast cells and blood basophils. This review focuses on methods to monitor changes of basophil allergen reactivity with a focus on omalizumab therapy and the implications for clinical disease management.
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