[Circulating populations of CD4+ CD25+ CD127- regulatory t lymphocytes in peripheral blood of allergic asthmatic children]

OBJECTIVE

To carry out a preliminary analysis on the Treg lymphocyte counts present in the peripheral blood of allergic asthmatic children from the city of Cartagena, Colombia, compared to healthy controls.

METHODS

We compared cytometry counts of ten asthmatic patients (age 7-16 years) and seven healthy controls (6-12 years), recruited in the city of Cartagena. Peripheral blood samples were stained using Cytek's 14-color cFluor Immunoprofiling kit (Cytek® cFluor® Immunoprofiling Kit 14 Color RUO kit), and analyzed on a Northern Lights™ spectral cytometer (Cytek® Biosciences, Fremont, CA, USA), to read 50.000 events per sample. The data obtained were analyzed in SpectroFlo® and FlowJo. The study was approved by the ethics committee of the University of Cartagena (SGR, Grant BPIN2020000100405).

RESULTS

The frequency of CD3+, CD4+, CD25+, CD127- Tregs was 11% of all CD4+ T cells, with a range of minimum 8,1% and maximum 17,7%. There was no significant difference in the proportion of Tregs between allergic asthmatic patients and healthy controls (P = 0,2).

CONCLUSIONS

With this preliminary sample size, no significant differences were found in the Treg lymphocyte population between allergic asthmatic patients and healthy controls. The 14-color multiplexed panel is a useful tool not only to count CD3+ and CD4+ populations, but also to obtain the percentage of regulatory T cells using cell surface markers.

Expression of CD4+CD25+CD127Low regulatory T cells and cytokines in peripheral blood of patients with primary liver carcinoma

Objective: To assess the clinical utility of the ratio of CD4+CD25+CD127^low regulatory T cells (Tregs) in subjects at high risk of HCC, investigate the relationship between the percentage of Tregs and the expression of transforming growth factor (TGF)-β1 and interleukin (IL)-10 in patients with hepatocellular carcinoma before and after treatment. Methods: Peripheral venous blood was collected from patients with liver cancer before and after treatment. The proportion of CD4+CD25+CD127^low Tregs was detected by flow cytometry. The levels of TGF-β1 and IL-10 in serum were detected by enzyme-linked immunosorbent assay, and were compared with healthy subjects as a control group. Results: The proportion of CD4+CD25+CD127^low to CD4+T lymphocytes in patients with hepatocellular carcinoma was significantly higher than that in healthy controls (P<0.01). The proportion of CD4+CD25+CD127^lowTregs, whose AUC of ROC curve was 0.917, could effectively separate the HCC patients from the healthy subjects with a diagnostic sensitivity of 90%, specificity of 80%. The proportion of CD4+CD25+CD127^low to CD4+T lymphocytes and the levels of TGF-β1 and IL-10 in patients with hepatocellular carcinoma after the operation and chemotherapy were significantly lower than those before treatment (P<0.05).The proportion of CD4+CD25+CD127^lowTregs was positively correlated with the concentrations of TGF-β1 and IL-10 before and after treatment of primary liver cancer (P<0.05). Conclusion: CD4+CD25+CD127^lowTregs may be a significant predictor of HCC biopsy outcome and play an inhibitory role on effector T cells by regulating cytokines.

Effect and analysis of ulinastatin combined with thymosin on cardiopulmonary function and delirium in sepsis patients

The aim of this study was to explore the clinical effect of ulinastatin combined with thymosin in patients with sepsis and its influence on cardiopulmonary function and delirium. Sixty-eight sepsis patients were enrolled as study subjects. The patients were randomly divided into a symptomatic treatment group (n=34) and a combined treatment group (n=34) on the basis of random number table. The two groups were first operated and then, the symptomatic treatment group was given symptomatic support treatment, whilst the combined treatment group was treated with ulinastatin and thymosin on the prerequisite of the symptomatic treatment group. After 7 days of treatment, the evaluation of the curative effect was performed, followed by the comparison of the cardiopulmonary function, immune level and safety between the two groups of patients. The cardiac index and oxygenation index of the combined treatment group were higher than those of the symptomatic treatment group 7 days after treatment (P<0.05). Whereas, the levels of plasma D-dimer and cTnI were lower than those of the symptomatic treatment group (P<0.05). In addition, CD3+, CD4⁺, CD4⁺/CD8+ levels of the combined treatment group were higher than those of the symptomatic treatment group 7 days after treatment (P<0.05). On the contrary, CD8+ levels of the combined treatment group were lower than those of the symptomatic treatment group 7 days after treatment. There was no significant (P>0.05) difference in drug safety between the two groups during treatment.

Serum Lipid Profile and Its Relationship with Host Immunity in Carcinomas of the Breast and Uterine Cervix

Carcinomas of the uterine cervix and breast, which have a different etiopathogenesis, are the most common malignancies among Indian women. Between these two cancers a comparative study was undertaken in which serum lipids were assessed along with host immunity. Thirty randomly selected cases each of breast and cervical carcinoma, and 20 matched healthy control women were studied by means of standard procedures. Significantly higher (P < 0.001) mean levels of triglycerides (x = 192.1 mg/dl, SD ± 113.5) and total cholesterol (x = 212.9 mg/dl, SD ± 49.78) were observed in breast cancer as compared to controls or cervical cancer patients. Patients with cervical cancer had low mean values of all lipid fractions. Women with the above malignancies also showed a significantly decreased CD3+ and CD4+ population (P < 0.001), while there was a significant increase in CD8+ cells (P < 0.005) compared to normal controls. Interestingly, a significant relationship (P < 0.05) was observed between CD8+cells and LDL-cholesterol among the cancer patients (r = 0.3652 and r = 0.4298 for carcinomas of breast and cervix, respectively).

Prediction of extended high viremia among newly HIV-1-infected persons in sub-Saharan Africa

Objective

Prompt identification of newly HIV-infected persons, particularly those who are most at risk of extended high viremia (EHV), allows important clinical and transmission prevention benefits. We sought to determine whether EHV could be predicted during early HIV infection (EHI) from clinical, demographic, and laboratory indicators in a large HIV-1 incidence study in Africa.

Design

Adults acquiring HIV-1 infection were enrolled in an EHI study assessing acute retroviral syndrome (ARS) symptoms and viral dynamics.

Methods

Estimated date of infection (EDI) was based on a positive plasma viral load or p24 antigen test prior to seroconversion, or the mid-point between negative and positive serological tests. EHV was defined as mean untreated viral load ≥5 log₁₀ copies/ml 130–330 days post-EDI. We used logistic regression to develop risk score algorithms for predicting EHV based on sex, age, number of ARS symptoms, and CD4 and viral load at diagnosis.

Results

Models based on the full set of five predictors had excellent performance both in the full population (c-statistic = 0.80) and when confined to persons with each of three HIV-1 subtypes (c-statistic = 0.80–0.83 within subtypes A, C, and D). Reduced models containing only 2–4 predictors performed similarly. In a risk score algorithm based on the final full-population model, predictor scores were one for male sex and enrollment CD4<350 cells/mm³, and two for having enrollment viral load >4.9 log₁₀ copies/ml. With a risk score cut-point of two, this algorithm was 85% sensitive (95% CI: 76%-91%) and 61% specific (55%-68%) in predicting EHV.

Conclusions

Simple risk score algorithms can reliably identify persons with EHI in sub-Saharan Africa who are likely to sustain high viral loads if treatment is delayed. These algorithms may be useful for prioritizing intensified efforts around care linkage and retention, treatment initiation, adherence support, and partner services to optimize clinical and prevention outcomes.

Characterization of broadly neutralizing antibody responses to HIV-1 in a cohort of long term non-progressors

Background

Only a small fraction of HIV-1-infected patients develop broadly neutralizing antibodies (bNAbs), a process generally associated to chronic antigen stimulation. It has been described that rare aviremic HIV-1-infected patients can generate bNAbs but this issue remains controversial. To address this matter we have assessed bNAb responses in a large cohort of long-term non-progressors (LTNPs) with low or undetectable viremia.

Methods

Samples from the LTNP cohort of the Spanish AIDS Research Network (87 elite and 42 viremic controllers) and a control population of 176 viremic typical-progressors (TPs) were screened for bNAbs using Env-recombinant viruses. bNAb specificities were studied by ELISA using mutated gp120, neutralization assays with mutated viruses, and peptide competition. Epitope specificities were also elucidated from the serum pattern of neutralization against a panel of diverse HIV-1 isolates.

Results

Broadly neutralizing sera were found among 9.3% LTNPs, both elite (7%) and viremic controllers (14%). Within the broadly neutralizing sera, CD4 binding site antibodies were detected by ELISA in 4/12 LTNPs (33%), and 16/33 of TPs (48%). Anti-MPER antibodies were detected in 6/12 LTNPs (50%) and 14/33 TPs (42%) whereas glycan-dependent HIV-1 bNAbs were more frequent in LTNPs (11/12, 92%) as compared to TPs (12/33, 36%). A good concordance between standard serum mapping and neutralization-based mapping was observed.

Conclusion

LTNPs, both viremic and elite controllers, showed broad humoral immune responses against HIV-1, including activity against many major epitopes involved in bNAbs-mediated protection.

Occult hepatitis B virus infection in HIV positive patients at a tertiary healthcare unit in eastern India

Occult HBV infection (OBI), defined by the presence of HBV DNA in absence of hepatitis B surface antigen (HBsAg), is a significant concern in the HIV-infected population. Of 441 HIV+/HBsAg- patients analyzed, the overall prevalence of OBI was 6.3% (28/441). OBI was identified in 21 anti-HBc positives (17.8%), as well as among those who lacked any HBV-specific serological markers (2.2%). Comparison with HIV/HBV co-infection revealed that the levels of CD4, ALT, and HBV DNA were significantly lower during occult infection. Discrete differences were also observed with respect to quasispecies divergence. Additionally, subgenotype D1 was most frequent in occult infection, while D2 was widespread during chronic infection. The majority (~90%) of occult D1 sequences had the sQ129R mutation in the surface gene. This study highlights several distinct features of OBI in India and underscores the need for additional HBV DNA screening in HIV-positive individuals.

Decreased Frequencies of Peripheral Blood CD4+CD25+CD127-Foxp3+ in Patients with Graves' Disease and Graves' Orbitopathy: Enhancing Effect of Insulin Growth Factor-1 on Treg Cells

Graves' orbitopathy (GO) is characterized by orbital T cell infiltration. We evaluated the regulatory T (Treg) cell fractions induced with IGF-1 in Graves' disease (GD) with and without GO. Peripheral blood mononuclear cells (PBMCs) were obtained from 13 patients with GD without eye manifestations; 10 patients with active GO; and 12 patients with nodular goiter (NG). All the patients from GD, GO, and NG were subclinical hyperthyroid. We analyzed the expression of Treg cell markers (CD4, CD25, CD127^-, Foxp3) on T cells and their ability to respond to IGF-1 stimulation. In patients with GD without GO, we found lowered percentages of CD4⁺ Foxp3⁺ cells, as compared to nodular goiter 1.77 vs. 5.42% (p=0.0276). Similarly, significantly reduced frequencies of CD4⁺CD25⁺CD127^-Foxp3⁺ and CD4⁺CD25⁺CD127^- cells were observed in GD patients as compared to nodular goiter patients with hyperthyreosis, (0.7 vs. 1.48%) (p=0.0071) and (14.5 vs. 37.2%) (p=0.0051), respectively. In GO with active GO, only the percentage of CD4⁺CD25⁺CD127^- cells was found to be decreased versus nodular goiter (9.35 vs. 37.2) (p=0.0275). Stimulation of PBMC derived from GO patients with IGF-1 resulted in significant increase of frequency of both CD4⁺ Foxp3⁺ and CD4⁺CD25⁺CD127^- Foxp3 cells. Decreased frequencies of peripheral blood CD4⁺CD25⁺CD127^-Foxp3⁺ in patients with GD and GO could be an useful marker of autoimmune process and perhaps a possible target for future therapies. This is the first study demonstrating Treg-enhancing effects of IGF-1. Thus IGF-1 can be accounted for modulating Treg cell-related action in GO.

Biomarkers of Environmental Enteropathy are Positively Associated with Immune Responses to an Oral Cholera Vaccine in Bangladeshi Children

Environmental enteropathy (EE) is a poorly understood condition that refers to chronic alterations in intestinal permeability, absorption, and inflammation, which mainly affects young children in resource-limited settings. Recently, EE has been linked to suboptimal oral vaccine responses in children, although immunological mechanisms are poorly defined. The objective of this study was to determine host factors associated with immune responses to an oral cholera vaccine (OCV). We measured antibody and memory T cell immune responses to cholera antigens, micronutrient markers in blood, and EE markers in blood and stool from 40 Bangladeshi children aged 3-14 years who received two doses of OCV given 14 days apart. EE markers included stool myeloperoxidase (MPO) and alpha anti-trypsin (AAT), and plasma endotoxin core antibody (EndoCab), intestinal fatty acid binding protein (i-FABP), and soluble CD14 (sCD14). We used multiple linear regression analysis with LASSO regularization to identify host factors, including EE markers, micronutrient (nutritional) status, age, and HAZ score, predictive for each response of interest. We found stool MPO to be positively associated with IgG antibody responses to the B subunit of cholera toxin (P = 0.03) and IgA responses to LPS (P = 0.02); plasma sCD14 to be positively associated with LPS IgG responses (P = 0.07); plasma i-FABP to be positively associated with LPS IgG responses (P = 0.01) and with memory T cell responses specific to cholera toxin (P = 0.01); stool AAT to be negatively associated with IL-10 (regulatory) T cell responses specific to cholera toxin (P = 0.02), and plasma EndoCab to be negatively associated with cholera toxin-specific memory T cell responses (P = 0.02). In summary, in a cohort of children 3-14 years old, we demonstrated that the majority of biomarkers of environmental enteropathy were positively associated with immune responses after vaccination with an OCV.

Risk Factors for Hyperlactataemia in HIV-Infected Patients, Aquitaine Cohort, 1999–2003

The objectives of our study were to describe the characteristics of a subset of patients who had been prescribed serum lactate in clinical practice within a large cohort of HIV-infected patients and to determine the factors associated with hyperlactataemia. Hyperlactataemia (⩾T2 mmol/l) was found in 219 [29% (95% confidence interval: 25.3–31.7)] of the 768 HIV-infected participants. In multivariate analysis (logistical regression), an increased risk of hyperlactataemia was associated with increasing age, CD4 count <500/mm3, triglycerides >2.2 mmol/L, lipoatrophy and stavudine use. In a second model coding for the NRTI-based drug combinations, only those including stavudine were associated with an increased risk of hyperlactataemia. In a third model including exposure duration to NRTIs, we estimated a 20% increased risk of hyperlactataemia per year of exposure to didanosine or stavudine. The risk of hyperlactataemia could increase over time in patients treated with these drugs and is also closely associated with increased age, decreased CD4 count, lipodystrophy and increased plasma triglycerides. It could be proposed that patients having one or more of these risk factors undergo regular monitoring of plasma lactate and renal function to prevent lactic acidosis.

[Immuknow and long term kidney graft]

INTRODUCTION

The survival of transplanted kidneys has improved over time, but there is an increased risk of neoplastic disease. In the long time follow up, non-melanoma skin cancers (NMSC) are the most frequent diseases and at the time of the occurrence of a NMSC we should evaluate a reduction or a change of IS. From a clinical point of view, the evaluation of immunosuppression is still a problem. The Immuknow assay may be of help in evaluating the immune response of transplanted patients. Here, by means of the ImmKnow assay, we tried to evaluate if long term renal transplant patients with NMSC are more immunosuppressed than patients without NMSC.

METHODS

33 long term kidney transplant patients, 16 with NMSC and 17 without NMSC, were recruited and blood samples were drawn at baseline, 4 months, 8 months and 12 months to check renal function, blood levels of cni and to perform immuknow assay.

RESULTS

most values of T CD4+ reactivity were comprised between (atp) 225 and 525 ng/ml as for an moderate immunosuppression. No major differences have been observed between the two groups. No correlation with blood level of CNI was detected. T CD4+ activity changed over time for both the groups. 3 patients of the group without NMSC had levels of CD4+ reactivity constantly under (ATP) 225 ng/ml, classified as low per manifacturers definition.

CONCLUSION

in our limited experience the measure of cell-mediated immunity by immuknow assay years after transplantation, has not evidenced any significant difference between patients positive for NMSC and negative patients. We observed variation of the CD4 reactivity with time, no correlation with the level of CNI and the useful identification of some cases of low levels of cell reactivity.

IL12p40 regulates functional development of human CD4+ T cells: enlightenment by the elevated expressions of IL12p40 in patients with inflammatory bowel diseases

The proinflammatory effects of IL12p40 had been documented in the literature, and anti-IL12p40 treatment had been proved to be effective in therapy of Crohn disease (CD) in a phase 2b clinical trial. However, the precise role of IL12p40 in the pathogenesis of inflammatory bowel disease (IBD) was still poorly understood. In this study, we investigated the expressions of IL12p40 and its receptor interleukin-12 receptor β 1 both locally and systemically in IBD cases and healthy controls, and the contribution of IL12p40 in IBD pathogenesis. We found that the expression of IL12p40 was elevated both at messenger RNA and protein levels systematically and locally in IBD patients but more significantly in CD patients. Our genetic association study revealed that the polymorphisms of IL12B rs6887695 were associated with both CD and ulcerative colitis (UC) susceptibility in Chinese population, but did not affect the serum IL12p40 level in either CD patients or UC patients. In addition, CD4⁺ T cells isolated from peripheral blood of CD patients secreted the most abundant IL12p40 production, compared with the UC patients and healthy controls. We also found for the first time that neutralizing IL12p40 secretion could inhibit proliferation, enhance apoptosis, induce a G0/G1 arrest, restrain T helper 1 type immune responses, and promote chemokine C-C motif ligand 20-mediated migration of human CD4⁺ T cells, which might be the mechanisms why anti-IL12p40 treatment presented efficacy in CD.

Adherence, Quality of Life, and General Satisfaction with Co-formulated Zidovudine, Lamivudine, and Abacavir on Antiretroviral-Experienced Patients

PURPOSE

The main objective of the study was to evaluate patients' adherence to a fixed dose combination containing abacavir, zidovudine, and lamivudine (TZV) and to evaluate whether TZV might improve general satisfaction and quality of life (QOL) with anti-HIV treatment.

METHOD

Patients with viral load (VL) <400 copies switched their antiretroviral therapy to TZV. Adherence was assessed by patient self-report and medication accountability at week 24. General satisfaction was evaluated with 10-point Visual Analog Scale (VAS) at baseline and week 24. QOL was assessed with MOS-HIV questionnaire at baseline and weeks 12 and 24. Biochemical and hematological parameters were evaluated for safety reasons.

RESULTS

A total of 224 patients were included in the study. Overall, 81% (intent to treat [ITT]) and 98% (per protocol [PP]) of patients reported an adherence >95%, reaching 75% and 100% among the intravenous drug user population by ITT and PP analysis, respectively. General satisfaction was significantly higher at week 24 (90 +/- 14 vs. 53 +/- 26) in both ITT and PP populations (p<.0001). There were no statistically significant differences in QOL. Total cholesterol and triglycerides levels decreased significantly at week 24 compared to baseline (p<.05).

CONCLUSION

Patients who switched to TZV showed an increase in general satisfaction and high levels of adherence.

An association of hypochondroplasia and immune deficiency

A 4-year-old boy with hypochondroplasia was admitted to our clinic with complaints of bronchopneumonia. He also had immune deficiency characterized by low CD3, CD4 T-lymphocyte subsets and a low level of serum immunoglobulin A (IgA). The diagnosis of hypochondroplasia was made on clinical, radiological, and laboratory findings by the pediatric endocrinology department. The focus of our study is hypochondroplasia associated with immune deficiency which was unpublished in English medical literature previously.

Increased apoptosis of regulatory T cells in Crohn's disease

BACKGROUND/AIMS

Crohn's disease (CD) is characterized by a transmural often granulomatous Th1-driven inflammatory process hallmarked by an increased production of IL-12, TNF-alpha and IFN-gamma. Accumulating evidence suggests that the numerical defect within the regulatory T cell (Tregs) compartment might contribute to this imbalance between pro- and antiinflammatory factors. This study was aimed to investigate whether the numerical defect of Tregs observed in CD resulted from an increased apoptosis of these cells.

METHODOLOGY

The cytometric analysis was performed to evaluate the percentage of CD4 + FOXP3 + Tregs in peripheral blood of 55 investigated subjects, as well as to estimate the rate of Treg apoptosis.

RESULTS

The cytometric analysis showed a significantly lower percentage of Tregs in peripheral blood of CD patients compared with the healthy control group (P = 0.03) as well as an increased rate of apoptosis within this cell subpopulation (P = 0.000001). Interestingly, a significantly higher rate of Treg apoptosis was observed in female than male CD patients (P = 0.03).

DISCUSSION

Current data suggest that CD is associated with a numerical deficiency of the Treg compartment. Presented study indicates that an increased apoptosis might contribute to this numerical deficiency. A higher rate of Tregs apoptosis found in female patients might suggest the involvement of hormonal factors and possibly contribute to the female predominance observed in CD as well as to the tendency of female patients to develop a more severe form of the disease.

The administration of milk fermented by the probiotic Lactobacillus casei CRL 431 exerts an immunomodulatory effect against a breast tumour in a mouse model

Antitumour activity is one of the health-promoting effects attributed to probiotics specially analysed from preclinical models, mostly murine. Here, the effect of milk fermented by the probiotic bacterium Lactobacillus casei CRL 431, on a murine breast cancer model was analysed. Mice were fed with milk fermented by Lactobacillus casei or unfermented milk before and after tumour injection. Rate of tumour development, cytokines in serum, IgA, CD4, CD8, F4/80 and cytokines positive cells in mammary glands were determined. Microvasculature in the tumour tissues was monitored. The effect of fermented milk administration after tumour injection was also evaluated. It was observed that probiotic administration delayed or blocked tumour development. This effect was associated to modulation of the immune response triggered by the tumour. The area occupied by blood vessels decreased in the tumours from mice given fermented milk which agrees with their small tumours, and fewer side effects. Finally, it was observed that probiotic administration after tumour detection was also beneficial to delay the tumour growth. In conclusion, we showed in this study the potential of milk fermented by the probiotic Lactobacillus casei CRL431 to stimulate the immune response against this breast tumour, avoiding or delaying its growth when it was preventively administrated and also when the administration started after tumour cells injection.

[Clinical course and characteristics of cellular and humoral immunity in patients with allergic rhinitis]

In research the condition cellular and humoral immunity is defined at allergic rhinitis--AR (n = 45) for an estimation of mechanisms pathogeny this disease. The AR in 76% of cases has the hereditary nature mainly from outside mothers (36%), begins more often at children's and teenage age (88%) and in 44% is accompanied by other allergic pathology. In structure of a sensibilization of patients the allergic rhinitis the basic place is occupied with pollen, household, fungoid and epidermal allergens, allergic reaction (83% of cases) thus prevailed. As a result of the spent researches rising of relative quantity CD4+CD25+Foxp3+ regulatory T cells is taped, at the same time rising of an average level of the general IgE--(198,20 +/- 11,42) IU/ml is noted. In cytokine regulations at patients an allergic rhinitis rising IL-4 and depression IL-10 is noted. Thus, the conducted research suggests that an allergic rhinitis--disease with involving in process of regulation of the immune answer of certain type regulatory T of cells.

Viral escape from HIV-1 neutralizing antibodies drives increased plasma neutralization breadth through sequential recognition of multiple epitopes and immunotypes

Identifying the targets of broadly neutralizing antibodies to HIV-1 and understanding how these antibodies develop remain important goals in the quest to rationally develop an HIV-1 vaccine. We previously identified a participant in the CAPRISA Acute Infection Cohort (CAP257) whose plasma neutralized 84% of heterologous viruses. In this study we showed that breadth in CAP257 was largely due to the sequential, transient appearance of three distinct broadly neutralizing antibody specificities spanning the first 4.5 years of infection. The first specificity targeted an epitope in the V2 region of gp120 that was also recognized by strain-specific antibodies 7 weeks earlier. Specificity for the autologous virus was determined largely by a rare N167 antigenic variant of V2, with viral escape to the more common D167 immunotype coinciding with the development of the first wave of broadly neutralizing antibodies. Escape from these broadly neutralizing V2 antibodies through deletion of the glycan at N160 was associated with exposure of an epitope in the CD4 binding site that became the target for a second wave of broadly neutralizing antibodies. Neutralization by these CD4 binding site antibodies was almost entirely dependent on the glycan at position N276. Early viral escape mutations in the CD4 binding site drove an increase in wave two neutralization breadth, as this second wave of heterologous neutralization matured to recognize multiple immunotypes within this site. The third wave targeted a quaternary epitope that did not overlap any of the four known sites of vulnerability on the HIV-1 envelope and remains undefined. Altogether this study showed that the human immune system is capable of generating multiple broadly neutralizing antibodies in response to a constantly evolving viral population that exposes new targets as a consequence of escape from earlier neutralizing antibodies.

Increased soluble CD4 in serum of rheumatoid arthritis patients is generated by matrix metalloproteinase (MMP)-like proteinases

Higher soluble CD4 (sCD4) levels in serum have been detected in patients of infectious and chronic inflammatory diseases. However, how and why sCD4 is produced remains poorly understood. We establish sensitive ELISA and WB assays for sCD4 detection in conditioned medium of in vitro cell culture system and serum of chronic inflammatory patients. Serum samples from patients with systemic lupus erythematosus (SLE) (n = 79), rheumatoid arthritis (RA) (n = 59), ankylosing spondylitis (AS) (n = 25), gout (n = 31), and normal controls (n = 99) were analyzed using ELISA for sCD4 detection. Results from each assay were analyzed by the Kruskal-Wallis test. Dunn's multiple comparison post-test was then applied between groups. We confirm that cells expressing exogenous CD4 produce sCD4 in a constitutive and PMA-induced manner. Importantly, sCD4 production in a heterologous expression system is inhibited by GM6001 and TAPI-0, suggesting receptor shedding by matrix metalloproteinase (MMP)-like proteinases. Moreover, similar findings are recapitulated in human primary CD4(+) T cells. Finally, we show that serum sCD4 levels are increased in patients of chronic inflammatory diseases including RA and SLE, but not in those with gout. Intriguingly, sCD4 levels in RA patients are correlated positively with the disease activities and higher sCD4 levels seem to associate with poor prognosis. Taken together, we conclude that CD4 is shed from cell surface by a MMP-like sheddase and sCD4 level is closely related with the inflammatory condition in certain chronic diseases. Hence, sCD4 might be considered an important parameter for RA disease progression with potential diagnostic importance.

[Immune elements of pathogenesis of multiorgan failure syndrome in newborns]

Expression of clusters determination of T-cells immune links (CD4, CD8, CD95) and level of interferon-alpha at newborns with multiorgan failure syndrome were investigated. It were shown supressive character of immune reactions and reduction the level of interferon-alpha in this contingent of patients.

A clinical prediction score in addition to WHO criteria for anti-retroviral treatment failure in resource-limited settings--experience from Lesotho

Objective

To assess the positive predictive value (PPV) of a clinical score for viral failure among patients fulfilling the WHO-criteria for anti-retroviral treatment (ART) failure in rural Lesotho.

Methods

Patients fulfilling clinical and/or immunological WHO failure-criteria were enrolled. The score includes the following predictors: Prior ART exposure (1 point), CD4-count below baseline (1), 25% and 50% drop from peak CD4-count (1 and 2), hemoglobin drop≥1 g/dL (1), CD4 count<100/µl after 12 months (1), new onset papular pruritic eruption (1), and adherence<95% (3). A nurse assessed the score the day blood was drawn for viral load (VL). Reported confidence intervals (CI) were calculated using Wilsons method.

Results

Among 1'131 patients on ART≥6 months, 134 (11.8%) had immunological and/or clinical failure, 104 (78%) had blood drawn (13 died, 10 lost to follow-up, 7 did not show up). From 92 (88%) a result could be obtained (2 samples hemolysed, 10 lost). Out of these 92 patients 47 (51%) had viral failure (≥5000 copies), 27 (29%) viral suppression (<40) and 18 (20%) intermediate viremia (40–4999). Overall, 20 (22%) had a score≥5. A score≥5 had a PPV of 100% to detect a VL>40 copies (95%CI: 84–100), and of 90% to detect a VL≥5000 copies (70–97). Within the score, adherence<95%, CD4-count<100/µl and papular pruritic eruption were the strongest single predictors. Among 47 patients failing, 8 (17%) died before or within 4 weeks after being switched. Overall mortality was 4 (20%) among those with score≥5 and 4 (5%) if score<5 (OR 4.3; 95%CI: 0.96–18.84, p = 0.057).

Conclusion

A score≥5 among patients fulfilling WHO-criteria had a PPV of 100% for a detectable VL and 90% for viral failure. In settings without regular access to VL-testing, this PPV may be considered high enough to switch this patient-group to second-line treatment without confirmatory VL-test.

Effects of valacyclovir on markers of disease progression in postpartum women co-infected with HIV-1 and herpes simplex virus-2

Objective

Herpes simplex virus type 2 (HSV-2) suppression has been shown to reduce HIV-1 disease progression in non-pregnant women and men, but effects on pregnant and postpartum women have not been described.

Methods

We analyzed data from a cohort of Kenyan women participating in a randomized clinical trial of HSV-2 suppression. Pregnant HIV-1-seropositive, HSV-2-seropositive women who were not eligible for antiretroviral therapy (WHO stage 1–2, CD4>250 cells/µl) were randomized to either 500 mg valacyclovir or placebo twice daily from 34 weeks gestation through 12 months postpartum. Women received zidovudine and single-dose nevirapine for prevention of mother-to-child HIV-1 transmission. HIV-1 progression markers, including CD4 count and plasma HIV-1 RNA levels, were measured serially. Multivariate linear regression was used to compare progression markers between study arms.

Results

Of 148 women randomized, 136 (92%) completed 12 months of postpartum follow-up. While adjusted mean CD4 count at 12 months (565 cells/µl placebo arm, 638 cells/µl valacyclovir arm) increased from antenatal levels in both arms, the mean CD4 count increase was 73 cells/µl higher in the valacyclovir arm than placebo arm (p = 0.03). Mean increase in CD4 count was 154 cells/µl in the valacyclovir arm, almost double the increase of 78 cells/µl in the placebo arm. At 12 months, adjusted HIV-1 RNA levels in the placebo arm increased by 0.66 log₁₀ copies/ml from baseline, and increased by only 0.21 log₁₀ copies/ml in the valacyclovir arm (0.40 log₁₀ copies/ml difference, p = 0.001).

Conclusion

Women randomized to valacyclovir suppressive therapy during pregnancy and postpartum had greater increases in CD4 counts and smaller increases in plasma HIV-1 RNA levels than women in the placebo arm. Valacyclovir suppression during pregnancy and breastfeeding may improve outcomes and delay antiretroviral therapy for HIV-1/HSV-2 co-infected women.

Impact of fish oil enriched total parenteral nutrition on elderly patients after colorectal cancer surgery

BACKGROUND

Polyunsaturated omega-3 fatty acids may beneficially influence healing processes and patient outcomes. The aim of this research was to study the clinical efficacy of fish oil enriched total parenteral nutrition in elderly patients after colorectal cancer surgery.

METHODS

Fifty-seven elderly patients with colorectal cancer were enrolled in this prospective, randomized, double-blind, controlled clinical trial. All patients received isocaloric and isonitrogenous total parenteral nutrition by continuous infusion (20 - 24 hours per day) for seven days after surgery. The control group (n = 28) received 1.2 g/kg soybean oil per day, whereas the treatment group (n = 29) received 0.2 g/kg fish oil and 1.0 g/kg soybean oil per day. Blood samples were taken pre-operatively, and at days one and eight after the operation. The plasma levels of CD4, CD8, CD4/CD8, interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) were measured. Clinical outcomes were then analysed.

RESULTS

Patient characteristics were comparable between the two groups. At day eight post-surgery, IL-6, TNF-α and CD8 titres were lower in the treatment group when compared to the control group; these results reached statistical significance. In the treatment group, there were fewer infectious complications and incidences of systemic inflammatory response syndrome (SIRS), and shorter lengths of hospital stay were observed. The total cost of medical care was comparable for the two groups. No serious adverse events occurred in either group.

CONCLUSIONS

Fish oil 0.2 g/kg per day administrated to elderly patients after colorectal surgery was safe and may shorten the length of hospital stay and improve clinical outcomes.

[Evaluation of CD4+CD161+CD196+ and CD4+IL-17+ Th17 cells in the peripheral blood of young patients with Hashimoto's thyroiditis and Graves' disease]

INTRODUCTION

Up till now, altered balance of Th1 and Th2 immune cells has been postulated to play an important role in the pathogenesis of autoimmune thyroid diseases (AITD). However, recent studies on thyroid diseases suggest a new role for Th17 (T helper 17) cells that have been classified as a new lineage, distinct from Th1, Th2 and Treg cells. Despite wide interest, the role of Th17 cells in the pathogenesis of inflammatory and autoimmune diseases is still being debated. Th17 cells are involved in immune responses against extracellular pathogens and have the ability to secrete cytokines: IL-17, IL-17F, IL-22 and IL-21. Th17 cells can be characterized by several surface markers, i.e. CCR6 (CD196), IL-23R, IL-12Rbeta2 and CD161.

AIM OF THE STUDY

Was to estimate the frequencies of circulating CD4+CD161+CD196+ and CD4+IL-17+ Th17 cells in patients with Graves' disease (GD, n=20, mean age ± SEM 14.9 ± 6 years), Hashimoto's thyroiditis (HT, n=20, mean age ± SEM 15.2±3 yrs) and in healthy controls (C, n=20, mean age ± SEM 15.4 ± 2 yrs).

MATERIAL AND METHODS

Polychromatic flow cytometry and several fluorochrome-conjugated monoclonal antibodies were applied to delineate Th17 cells with either CD4+CD161+CD196+ or CD4+IL-17+ phenotype using apparatus FACSCalibur (BD Biosciences). Thyroid anti-TSH receptor immunoglobulins (TRAK), anti-thyroperoxidase (anti-TPO) and anti-thyroglobulin (anti-TG) antibodies were measured in all the samples using electrochemiluminescence "ECLIA" with Modular Analytics E170 analyzer (Roche Diagnostics, Poland).

RESULTS

In untreated HT children we observed an increased percentage of CD4+CD161+CD196+ (7.1 ± 3.5 vs. 3.7 ± 1.8; p <0.04) and CD4+IL-17+ (3.7 ± 2.7 vs. 1.4±0.4; p <0.01) Th17 lymphocytes in comparison to the healthy controls. In untreated and treated GD children we did not reveal such abnormalities in the population of these cells compared to the controls. In cases with HT, a positive correlation between the percentage of CD4+IL-17+ and CD4+CD161+CD196+ T cells and serum level of anti-TPO antibodies (r=0.48; p <0.025; r=0.65; p <0.01; respectively) was detected.

CONCLUSIONS

We conclude that the increased percentage of Th17 cells in children with untreated Hashimoto's thyroiditis can suggest their role in initiation and development of immune and inflammatory processes in this endocrinopathy.

Elevated Th22 cells correlated with Th17 cells in patients with rheumatoid arthritis

BACKGROUND

T-helper (Th) 22 and Th17 cells are implicated in the pathogenesis of autoimmune diseases. The roles of Th22 cells in the pathophysiology of rheumatoid arthritis (RA) remain unsettled.

MATERIALS AND METHODS

CD4(+)IFNγ(-)IL17(-)IL-22(+) T cells (Th22 cells), CD4(+)IFNγ(-)IL-22(-)IL17(+) T cells (pure Th17 cells), CD4(+)IL17(+) T cells (Th17 cells), and CD4(+)IFNγ(+) T cells (Th1 cells) in RA, osteoarthritis patients, and healthy controls were examined by flow cytometry. Plasma IL-22 and IL-17 levels were examined by enzyme-linked immunosorbent assay.

RESULTS

Th22 cells, pure Th17 cells, Th17 cells, and interleukin-22 were significantly elevated in RA patients compared with osteoarthritis and healthy controls, but there were no significant differences regarding Th1 cells and interleukin-17. Th22 cells showed a positive correlation with interleukin-22 as well as pure Th17 cells or Th17 cells in RA patients. Additionally, the percentages of Th22 cells, pure Th17 cells as well as Th17 cells correlated positively with both C-reactive protein levels and 28-joints disease activity score.

CONCLUSION

Together, our results indicated a possible role of Th22 pure Th17 cells and Th17 cells in RA, and blockade of the interleukin-22 may be a reasonable therapeutic strategy for RA.

[Analysis of frequency of peripheral blood CD4+; CD25(high);Tregs and CD4+; CD25(low);T cells and expression of PD-1 in SLE and RA patients]

AIM

To explore the frequencies of peripheral blood CD4(+);CD25(high);Treg and CD4(+);CD25(low);T cells and the expression of the co-stimulatory molecule PD-1 on these two group cells surface in SLE and RA patients, and to explore their roles in cell immunity disorder of SLE and RA.

METHODS

Flow cytometry (FCM) was used to determine the frequencies of peripheral blood CD4(+);CD25(high);Treg and CD4(+);CD25(low);T cells, and the expression percentage of PD-1.

RESULTS

Compared with healthy control, the frequencies of peripheral blood CD4(+);CD25(high);Treg from both SLE and RA patients groups decreased significantly(P<0.05). Compared between two disease groups, the frequency of peripheral blood CD4(+);CD25(high);Treg in SLE patients was significantly lower(P<0.05). The expression percentage of PD-1 on CD4(+);CD25(high);Treg surface in RA group was obviously lower than that in both healthy control and SLE patients groups(P<0.05), while the percentage had no significant difference between SLE patients and healthy control(P>0.05). There was no significant difference in both the frequency of CD4(+);CD25(low);T cells and the expression percentage of PD-1 on this subset cells among three groups.

CONCLUSION

The weakened ability of peripheral blood CD4(+);CD25(high);Treg to suppress effector T cells resulted from their production deficiency is the common characteristic of SLE and RA patients. Decreased expression of PD-1 is the primary cause leading to the suppressive function of peripheral blood CD4(+);CD25(high);Treg weakened in RA patients. However, PD-1 does not play major role in weakening the suppression activity of CD4(+);CD25(high);Treg from SLE patients.

Altered expression of CD4(+)CD25(+) regulatory T cells and its 5-HT(1a) receptor in patients with major depression disorder

BACKGROUND

There is growing interest in immune imbalance observed in major depression, but the mechanism of this imbalance is still not well understood. CD4(+)CD25(+) regulatory T (Treg) cells are known to play an important role in immune regulation. However, their role in major depression has rarely been explored. The aims of this study are to determine the immune imbalance status in patients when first diagnosed with major depression, and to explore possible indications of Treg cell involvement in immune imbalance of major depression.

METHODS

27 patients with major depression and 27 healthy individuals were recruited in the study. The immune imbalance was observed by the analysis of Th cell cytokines and CD4(+)CD25(+) Treg cell level. The 5-HT in peripheral serum was measured with HPLC, and changes of Foxp3 and 5-HT(1a) receptor were observed by RT-PCR and double-immunofluorescence.

RESULTS

Despite the similar total lymphocyte count between patients and healthy individuals, the Th1/Th2 ratio increased and the CD4(+)CD25(+) Treg cells decreased in patients' peripheral blood. Moreover, we found that the level of 5-HT was decreased in peripheral serum, and the expression of 5-HT(1a) receptor was also decreased in peripheral lymphocytes of major depression patients, notably in the CD4(+)CD25(+) Treg cells rather than CD4(+)CD25(-) T cells.

LIMITATIONS

The details of interaction between 5-HT(1a) receptors and Treg cells in major depression need further exploration.

CONCLUSION

CD4(+)CD25(+) Treg cells may contribute to the immune imbalance in patients with major depression, which could involve its interaction with 5-HT system.

Neurocognitive correlates of alexithymia in asymptomatic individuals with HIV

Alexithymia, an impairment of affective and cognitive emotional processing, is often associated with human immunodeficiency virus (HIV) and may reflect effects of the virus on brain areas that are also important for multiple cognitive functions, such as the prefrontal and anterior cingulate cortices. We hypothesized that there would be a correlation between extent of alexithymia and cognitive performance associated with these brain areas, including attention, executive function, and visuospatial processing. Thirty-four asymptomatic HIV+ participants and 34 matched healthy HIV- volunteers were administered the Toronto Alexithymia Scale, a series of neuropsychological tests, and measures of apathy, depression, and quality of life (QoL). The HIV+ participants had significantly higher levels of alexithymia, depression and apathy than the HIV- group. The extent of alexithymia and two of its processing components (Difficulty Describing Feelings [DDF] and Externally Oriented Thinking), but not depression, correlated with performance on measures of executive and visuospatial abilities, consistent with dysfunction of the frontostriatal circuits and their cortical projections. Apathy was related to alexithymia and two processing components (Difficulty Identifying Feelings and DDF) but to only one cognitive measure. The higher rate of alexithymia, as well as cognitive dysfunction, in HIV may be a consequence of the infection on the frontostriatal system and its cortical connections. Our findings also demonstrated a dissociation of apathy and alexithymia in HIV, pointing to overlapping but distinct neural substrates within frontostriatal circuits. Alexithymia correlated strongly with QoL ratings, underscoring the importance of assessment and treatment of HIV-associated emotional and cognitive processing deficits.

Percentage of regulatory T cells CD4+CD25+CD127- in HIV-infected patients is not reduced after cryopreservation

Interest in regulatory T cells (Treg) has been continuously growing over the last 10years. In particular, a role for Treg has been recently reported in HIV. It is crucial to investigate their conservation over time, once sampled and purified. The objective of the present study was to investigate whether cryopreservation may modify recognition and measurement of relative frequency of Treg (CD4(+)CD25(+)CD127(-)) among PBMCs purified from 17 HIV-infected patients. Ours results indicate that cryopreservation does not affect this specific T lymphocyte subset.

[The use of cytoflavin in combined neurometabolic therapy of acute cerebral insufficiency associated with acute poisoning with neurotropic poisons]

Examination and treatment of 262 patients with severe acute intoxication by neurotropic poisons and unaffected oxygen delivery system showed that inclusion of cytoflavin in combined neurometabolic therapy of acute cerebral insufficiency significantly reduced severity of metabolic disorders. Specifically, tissue hypoxy, endotoxicosis, lipid peroxidation activity, and immunosuppression decreased while antioxidative protection and clinical picture were improved. Duration of comatose state and artificial lung ventilation was reduced from 64.5 +/- 15.1 to 28.8 +/- 10.2 hours and that of critical condition from 117.2 +/- 17.2 to 63.7 +/- 9.2 hours. Overall lethality dropped from 16 to 9.9%.

[Comparison of selected elements of neonate immunological system with relation to indications for cesarean section and time of delivery]

AIM OF STUDY

To define to what degree time and the way of delivery cause changes in CD3+ lymphocytes and their subpopulations CD4+, CD8+, CD25+ and CD19+ lymphocytes and their subpopulations CD5+, CD23+.

MATERIAL AND METHODS

49 healthy neonates born in the years 1998-2003 in the Clinical Ward of Perinatology and Gynecology of Silesian Medical University in Zabrze were examined. Taking into account the time of pregnancy and the way of delivery the children were divided into the following groups: Group Ib--23 full-term neonates born by Cesarean section, including 15 neonates with elective indications (Ibe), 8 with emergency indications (Ibn). Group IIb--26 pre-term neonates born by Cesarean section, including 18 with elective indications (IIbe) and 8 with emergency indications (IIbn). Our study applied a method of umbilical blood sampling with the following red blood cells lysis.

RESULTS

Statistically significant lower mean number of B CD5+ lymphocytes was found in full-term neonates born by Cesarean section in comparison to pre-term neonates born by the same method. Similar differences concern full-term and pre-term neonates born by elective Cesarean section. Statistically significant lower mean number of CD3+, CD4+ and CD25+ lymphocytes was found in pre-term neonates born by elective Cesarean section in comparison to pre-term neonates by emergency Cesarean section.

CONCLUSIONS

Time of pregnancy termination in a mother by Cesarean section can be related to the occurrence of statistically significant changes in B CD5+ lymphocytes quantities in her neonate. Emergency Cesarean section in a mother can be related to the increased quantity of T lymphocytes, helper T lymphocytes, activated T lymphocytes in her pre-term born neonate. No statistically significant differences were found in mean values of other immunological parameters among study groups.

Upregulation of CD4+CD25+T lymphocyte by adenovirus-mediated gene transfer of CTLA4Ig fusion protein in experimental autoimmune myocarditis

OBJECTIVE

To explore the effects of adenovirus vector-mediated gene transfer of CTLA4Ig fusion protein on CD4+CD25+ T cells in experimental autoimmune myocarditis (EAM).

METHODS

EAM was induced by porcine cardiac myosin as previously described. Adenovirus vector-mediated CTLA4Ig gene was administrated intravenously in EAM rats on days 1, 4 and 7, with EGFP as control. On day 21, myocardium histopathology was examined and CD4+CD25+ T cells were isolated. Proliferation and suppression assays were used to evaluate the suppressive capacity of CD4+CD25+ T cells in vitro. Relative mRNA level of Foxp3 and TGF-beta was determined by quantitative real-time RT-PCR; expression of CTLA-4, B7-1 and B7-2 protein was compared with Western blot in CD4+CD25+ Tregs.

RESULTS

Severe inflammatory lesions were observed in the hearts of EGFP-treated EAM rats and the untreated ones, while Ad-CMV-CTLA4Ig alleviated the myocarditis histologically. Adenovirus vector-mediated CTLA4Ig gene transfer up-regulated the proportion of CD4+CD25+ Tregs significantly. T cell proliferation was greatly inhibited in the CTLA4Ig group compared with the untreated and EGFP-treated groups in vitro. CTLA-4 and B7-2 proteins were down-regulated in the CTLA4Ig group, Foxp3 and TGF-beta mRNA was up-regulated significantly by CTLA4Ig treatment.

CONCLUSIONS

Adenovirus vector-mediated CTLA4Ig gene transfer alleviated inflammation in EAM, one of the potential mechanisms is up-regulation of CD4+CD25+ Tregs.

Determination of intracellular cytokines IFN-gamma and IL-4 in canine T lymphocytes by flow cytometry following whole-blood culture

This report describes a whole-blood flow cytometric method for the determination of intracellular cytokines IFN-gamma and IL-4 in canine T lymphocyte subpopulations. Conjugated anti-cytokine antibodies and commercially available reagents for cell fixation and permeabilization were used. Canine peripheral blood was cultured with a combination of phorbol-12-myristate-13-acetate (PMA) and ionomycin to promote cytokine synthesis in each cell, along with monensin to increase the sensitivity of the method by retaining IFN-gamma and IL-4 within the cell to detectable levels. The optimum concentrations of PMA and ionomycin were determined. Maximum IFN-gamma expression from both CD4+ and CD8+ T lymphocytes was detected after 6 h of incubation of cell culture, while maximum IL-4 production took 6 h from CD4+ cells and 4 h from CD8+ cells. This method is a simple immunologic technique for measuring intracellular cytokines which could be of value in the investigation of canine immunological response mainly in various intracellular and extracellular infections, since IFN-gamma and IL-4 are considered key cytokines activating the cellular and humoral immunity, respectively.

[Galavit-induced change of immunologic parameters in patients with non-small lung cancer]

Administration of an immunomodulator, galavit, for stage II-III non-small lung cancer along with standard therapy was followed by immunological vigor improvement by the end of the course. CD3, CD4, IgA, IgM and IgG indices were normal in more than 80% of the study group by day 51 after surgery; CD8, CD20 and HLA-DR--in more than 50%; CD16--in 45.2%. In control, by day 51, normal IgG and HLA-DR levels were reported in 60%. The remaining indices were normal in less than 50%. Our results point to immunological vigor improvement due to use of galavit. The drug is well tolerated, has neither side effects nor toxicity.

[Evaluation of CD4+ CD25+ regulatory T cells in the peripheral blood of recurrent spontaneous abortion patients]

OBJECTIVE

To explore the role of CD4+ CD25+ regulatory T cells (CD4+ CD25+ Tr) in the pathogenesis of recurrent spontaneous abortion.

METHODS

Peripheral blood samples were collected from 29 women with unexplainable recurrent spontaneous abortion (the URSA group) and another 20 with normal pregnancy (the control group). The percentage of CD4+ CD25+ Tr in the peripheral blood was measured by flow cytometry.

RESULTS

The rate of CD4+ CD25bright Tr in the URSA patients ([1.98 +/- 0.96]%) was significantly lower than that in the control group ([3.21 +/- 1.25]%, P < 0.05), while the percentages of CD4+ CD25+ and CD4+ CD25dim and the ratio of CD4+ CD25bright/CD4+ were not significantly different between the two groups (P > 0.05).

CONCLUSION

URSA might be associated with the decreased percentage of CD4+ CD25bright Tr, which plays an important role in fetomaternal immunologic tolerance.

CD4+CD25+ regulatory cells from human peripheral blood express very high levels of CD25 ex vivo

Selective isolation of only those CD4+ T cells that display the highest levels of CD25 by FACS results in a highly homogeneous regulatory population as defined by functional activity and the expression of multiple surface antigens. Thus greater than 98% of CD4+CD25high cells express CD45RO in the absence of CD45RA expression. Upon TCR stimulation CD4+CD25high cells are both anergic and tolerogenic as they inhibit proliferation and cytokine secretion by activated CD4+CD25- responder T cells in a contact-dependent manner. In contrast, CD4+ cells that express lower levels of CD25 are more heterogeneous in their levels of expression of CD45RO, HLA-DR and CD122, and do not exhibit anergic or suppressive characteristics. Providing either CD28 co-stimulation or IL2 to a maximal anti-CD3 stimulus results in a modest induction of proliferation and the loss of observable suppression by CD4+CD25high regulatory cells. Unlike CTLA4 blockade, blocking the interaction of PD-1 with its ligand PD-L1 affects the level of suppression. However, since this reduction in suppression by alphaPD-L1 can be overcome by increasing the number of CD4+CD25high T cells in the co-culture assay, the mechanism of CD4-CD25high regulation can proceed in the absence of PD-1/PD-L1 interactions, although it is not as efficient.

Correlation between CD4 counts of HIV patients and enteric protozoan in different seasons - an experience of a tertiary care hospital in Varanasi (India)

BACKGROUND

Protozoan infections are the most serious among all the superimposed infections in HIV patients and claim a number of lives every year. The line of treatment being different for diverse parasites necessitates a definitive diagnosis of the etiological agents to avoid empirical treatment. Thus, the present study has been aimed to elucidate the associations between diarrhoea and CD4 counts and to study the effect of HAART along with management of diarrhoea in HIV positive patients. This study is the first of its kind in this area where an attempt was made to correlate seasonal variation and intestinal protozoan infestations.

METHODS

The study period was from January 2006 to October 2007 wherein stool samples were collected from 366 HIV positive patients with diarrhea attending the ART centre, inpatient department and ICTC of S.S. hospital, I.M.S., B.H.U., Varanasi. Simultaneously, CD4 counts were recorded to assess the status of HIV infection vis-à-vis parasitic infection. The identification of pathogens was done on the basis of direct microscopy and different staining techniques.

RESULTS

Of the 366 patients, 112 had acute and 254 had chronic diarrhea. The percentages of intestinal protozoa detected were 78.5% in acute and 50.7% in chronic cases respectively. Immune restoration was observed in 36.6% patients after treatment on the basis of clinical observation and CD4 counts. In 39.8% of HIV positive cases Cryptosporidium spp. was detected followed by Microsporidia spp. (26.7%). The highest incidence of intestinal infection was in the rainy season. However, infection with Cyclospora spp. was at its peak in the summer. Patients with chronic diarrhea had lower CD4 cell counts. The maximum parasitic isolation was in the patients whose CD4 cell counts were below 200 cells/microl.

CONCLUSION

There was an inverse relation between the CD4 counts and duration of diarrhea. Cryptosporidium spp. was isolated maximum among all the parasites in the HIV patients. The highest incidence of infection was seen in the rainy season.

[Changes in proportion of decidua and peripheral blood CD(4)(+)CD(25)(+) regulatory T cells in unexplained recurrent spontaneous abortion patients]

OBJECTIVE

To study the changes in the percentage of CD(4)(+)CD(25)(+) regulatory T (Tr) cells in peripheral blood and deciduas in unexplained recurrent spontaneous abortion (URSA) patients, normal non-pregnant and pregnant women respectively.

METHODS

The percentage of CD(4)(+)CD(25)(+) Tr cells in deciduas and peripheral blood from 25 URSA patients, 22 normal non-pregnant (NNP) women, and 34 normal early pregnant (NP) women were measured by double-staining followed by flow cytometric analysis.

RESULTS

(1) The percentage of CD(4)(+)CD(25)(bright) T cells in peripheral blood in both URSA and NP [(1.55 +/- 0.77)%, (2.65 +/- 1.10)%, respectively] women were increased significantly than that in NNP women [(0.39 +/- 0.14)%, P < 0.05]. The percentage of CD(4)(+)CD(25)(bright) T cells in peripheral blood in URSA women was significantly lower than that in NP women (P < 0.05). (2) The percentage of CD(4)(+)CD(25)(bright) T cells in decidua in URSA women was significantly lower than that in NP women [(0.59 +/- 0.23)%, (1.24 +/- 0.55)%, respectively, P < 0.01]. There was no significant difference in the percentage of CD(4)(+)CD(25)(dim) T cells in decidua between URSA women and NP women [(4.23 +/- 1.52)%, (3.75 +/- 1.88)%, respectively, P > 0.05]. (3) The proportion of CD(4)(+)CD(25)(bright)/CD(4)(+) cells in deciduas was significantly higher than that in peripheral blood in NP women [(13.10 +/- 10.25)%, (5.59 +/- 2.62)%, respectively, P < 0.05]. However, a significant difference in the proportion of CD(4)(+)CD(25)(bright)/CD(4)(+) between decidua and peripheral blood was not found in URSA patients [(5.16 +/- 2.83)%, (4.64 +/- 2.07)%, respectively, P > 0.05)].

CONCLUSIONS

The number of CD(4)(+)CD(25)(+) Tr cells is increased in normal pregnancy and decreased in URSA. Therefore, CD(4)(+)CD(25)(+) Tr cells may play an important role in maintaining maternal-fetal tolerance and may be involved in the pathogenesis of URSA.

[Effect of laparoscopic surgery on the immune function of patients with endometriosis]

OBJECTIVE

To investigate the effect of laparoscopic surgery on the immune function of patients with endometriosis.

METHOD

Blood samples were obtained from 36 patients undergoing laparoscopy for endometriosis before and 1 day and 3 days after the operation. Peripheral blood T-cell subsets CD3, CD4, and CD8 were determined with flow cytometry, the levels of IgM, IgG, IgA, Complement (C)3, C4, C-reactive protein and (CRP) were detected with turbidimetry, and the levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were measured with enzyme linked immunosorbent assay (ELISA).

RESULTS

No significant variation were found in the T-cell subsets, IgM, IgA, C4 after the operation (P>0.05). The levels of IgG and C3 1 day after the operation were significantly lower than the preoperative levels (P<0.05) and nearly recovered the preoperative level 3 days after operation. Serum concentration of IL-6, TNF-alpha, and CRP 1 day after the operation were significantly higher than the preoperative levels (P<0.01) and decreased 3 days after the operation.

CONCLUSIONS

The immune function of patients with endometriosis is mildly affected by laparoscopic surgery and recover rapidly, which may be one of the reasons for quick recovery of patients after laparoscopy for endometriosis.

[The prophylactic effect of thymosin alpha 1 on the acute exacerbation of chronic obstructive pulmonary disease]

OBJECTIVES

To investigate the prophylactic effect of thymosin alpha 1 and its mechanism on patients with chronic obstructive pulmonary disease.

METHODS

Eighty patients with chronic obstructive pulmonary disease were divided into two groups. In the treatment group, 42 patients received thymosin alpha 1 1.6 mg hypodermic injection, quague die alterna, for 10 times. All patients were followed for 6 months, and were assessed the number and days of patients with acute exacerbation at 3 and 6 months. In two groups, before treatment and 3 and 6 months after treatment, the pulmonary function tests were measured, and the blood samples were collected for the measurement of the blood IgA, IgG, IgM, CD3, CD4 and CD8 levels.

RESULTS

In the treatment group, the number and days of patients with acute exacerbation were significantly lower in comparison with those of the control group. After treatment of thymosin alpha 1, blood CD4 and CD4/CD8 levels were significantly increased.

CONCLUSION

Thymosin alpha 1 has a good protection for the acute exacerbation of chronic obstructive pulmonary disease, by incresing body cellular immune activity.

[Identification of correlations between numbers of CD4+ CD25+ Treg cells, levels of sera anti-AChR antibodies and transfer growth factor-beta in patients with myasthenia gravis]

OBJECTIVE

The purpose of the current study is to demonstrate possible involvement of CD4+ CD25+ Treg cells and TGF-beta in immune activation in patients with myasthenia gravis (MG). If so, how does CD4+ CD25+ Treg cells and TGF-beta, collaborate to impact on the production of pathogenic anti-AChR antibodies (Ab)?

METHODS

40 MG in-patients with recent onset or deterioration and age and gender-matched 38 healthy subjects were consecutively enrolled. Flow cytometry was employed to detect circulating CD4+ CD25+ Treg cells. Levels of AChR-Abs and TGF-beta1 in serum were detected by radioimmunoassay and enzyme-linked immunoabsorbance assay respectively.

RESULTS

Numbers of CD4+ CD25+ Treg cells were significantly decreased in MG patients (3.0% +/- 2.5%) compared with healthy controls(4.6% +/- 3.7% , P = 0.03). Decreased production of CD4+ CD25+ Treg cells was associated with late-onset, longer-duration, positive-MG sera for AChR-Abs, normal or atrophic thymus, and non-thymectomy treatment et al, respectively. Although CD4+ CD25+ Treg cells were not linear-correlated with serum anti-AChR Ab titers, but were conversely correlated with each other in MG patients without thymoma (non-MGT) (r = -0.37, P = 0.02). Likewise, levels of TGF-beta1 in 31 non-MGT patients (112 ng/L +/- 83 ng/L) were decreased compared with those of healthy subjects (215 ng/L +/- 134 ng/L, P = 0.00), and was conversely correlated with titers of anti-AChR Abs (r = -0.37, P = 0.02). The titer of anti-AChR Abs were correlated with Osserman classification and MGFA grade (r = 0.34, P = 0.03).

CONCLUSION

Numbers of CD4+ CD25+ Treg cells and levels of TGF-beta1 in MG patients were significantly decreased compared with healthy controls, and may thus contribute to the pathogenesis of MG. Numbers of CD4+ CD25+ Treg cells were conversely correlated with levels of anti-AChR Abs in non-MGT patients.

Skewed distribution of proinflammatory CD4+CD28null T cells in rheumatoid arthritis

Expanded populations of CD4+ T cells lacking the co-stimulatory molecule CD28 (CD4+CD28null T cells) have been reported in several inflammatory disorders. In rheumatoid arthritis, increased frequencies of CD4+CD28null T cells in peripheral blood have previously been associated with extra-articular manifestations and human cytomegalovirus (HCMV) infection, but their presence in and contribution to joint manifestations is not clear. In the present article we investigated the distribution of CD4+CD28null T cells in the synovial membrane, synovial fluid and peripheral blood of RA patients, and analysed the association with erosive disease and anti-citrullinated protein antibodies. CD4+CD28null T cells were infrequent in the synovial membrane and synovial fluid, despite significant frequencies in the circulation. Strikingly, the dominant TCR-Vbeta subsets of CD4+CD28null T cells in peripheral blood were often absent in synovial fluid. CD4+CD28null T cells in blood and synovial fluid showed specificity for HCMV antigens, and their presence was clearly associated with HCMV seropositivity but not with anti-citrullinated protein antibodies in the serum or synovial fluid, nor with erosive disease. Together these data imply a primary role for CD4+CD28null T cells in manifestations elsewhere than in the joints of patients with HCMV-seropositive rheumatoid arthritis.

[Experimental treatment using combined Fructus psoraleae and dihydroartemisinin in mouse cryptosporidiosis]

A combination of Fructus psoraleae (3.4 g/kg) and dihydroartemisinin (60 mg/(kg x d)) was used for 7 d in mice infected with Cryptosporidium parvum infection induced by oral administration of dexamethasone. The results indicated that number of Cryptosporidium parvum oocysts in feces, proportion of CD4+, CD3+ T lymphocytes in blood, serum IFN-gamma, and nitric oxide (NO) content in intestinal tissue were all higher than those of infected control group (P < 0.01). The pathogenic change in intestine of treated mice was lighter than that of infected control. It indicates that the combination of Fructus psoraleae and dihydroartemisinin is effective to mice cryptosporidiosis probably through upregulating serum IFN-gamma, proportion of CD4+ and CD3+ T cells and NO concentration in intestine.

[Expression of CD4+ CD25+ CD127(low/-) T cells in patients with systemic lupus erythematosus]

OBJECTIVE

To detect the new and old surface markers of regulatory T cells (Treg cells) in the CD4+ T cells of the patients with systemic lupus erythematosus (SLE) in order to reveal the role of Treg cells in the pathogenesis of SLE.

METHODS

Peripheral blood samples were collected from 29 newly diagnosed and treatment-naïve SLE patients, 3 males and 26 females, aged (34 +/- 13), and 24 sex and aged-matched healthy controls. Three-color flow cytometry was used to detect the CD4+CD25+ CD127(low/-) T cells, CD4+CD25high T cells, and CD4+CD25+FOXP3+ T cells. The serum anti-nuclear antibody (ANA), anti-ds-DNA antibody, anti-smooth muscle antibody, anti-nucleosome antibody, anti-C1q, C3, and C4 were detected. Blood and urine routine examinations were conducted.

RESULTS

The proportion of blood CD4+ CD25+CD127(low/-) T cells of the SLE patients was not significantly different from that of the controls (P > 0.05), however, the proportions of CD4+CD25+FOXP3+ T cells and CD4+CD25high T cells of the SLE patients were 2.1 +/- 1.2 and 0.8 +/- 0.4 respectively, both significantly lower than those of the controls (4.0 +/- 1.4 and 1.8 +/- 0.8 respectively, both P <0.01). The ratios of the CD4+CD25+CD127(low/-) T cells, CD4+CD25high T cells, and CD4+CD25+FOXP3+ T cells to the CD4+CD25+ T cells of the SLE patients were 0.5 +/- 0.1, 0.1 +/- 0, and 0.3 +/- 0.1 respectively, all significantly lower than those of the controls (0.6 +/- 0.1, 0.2 +/- 0.1, and 0.5 +/- 0. respectively, all P <0.01). The level of CD4+CD25+CD127(low/-) T cell was positively correlated with the levels of CD4+CD25+FOXP3+ T cells and CD4+CD25high T cell (both P < 0.01). The levels of these 3 kinds of cells and their ratios to CD4+CD25+ T cells had no correlation with age, sex, course, IgG, IgA, IgM, urine protein, TIPU, anti-dsDNA, anti-C1q, anti-nuclear body antibody (all P > 0.05), however, were significantly associated negatively with SLE disease activity index, P < 0.05). Only the CD4+CD25+CD127(low/-) T cells/ CD4+CD25+ T cells was negatively correlated with C4 (P <0.01).

CONCLUSION

The relative ratio of Treg cells to the activated CD4+ T cells may play an important role in the pathogenesis of SLE.

Correlation between clinical features and degree of immunosuppression in HIV infected children

We conducted this study to find out correlation of CD4% with clinical status in 102 HIV infected antiretroviral naive children. Mean age of presentation was 4.8 years. Perinatal transmission was the commonest mode of transmission (94%). Fever (53%), chronic diarrhea (36%), and cough (29%) were the commonest presenting symptoms. Protein energy malnutrition was seen in 56.7% of children. 33.3% children were asymptomatic, whereas 45.1% were in WHO clinical stages III and IV at the time of presentation. The most common opportunistic infection was tuberculosis. CD4% correlated significantly with the deterioration of the WHO clinical stages (P<0.01) and increasing grades of protein energy malnutrition (P< 0.05).