A sulfonyl fluoride derivative inhibits EGFRL858R/T790M/C797S by covalent modification of the catalytic lysine

The emergence of the C797S mutation in EGFR is a frequent mechanism of resistance to osimertinib in the treatment of non-small cell lung cancer (NSCLC). In the present work, we report the design, synthesis and biochemical characterization of UPR1444 (compound 11), a new sulfonyl fluoride derivative which potently and irreversibly inhibits EGFR^{L858R/T790M/C797S} through the formation of a sulfonamide bond with the catalytic residue Lys745. Enzymatic assays show that compound 11 displayed an inhibitory activity on EGFR^WT comparable to that of osimertinib, and it resulted more selective than the sulfonyl fluoride probe XO44, recently reported to inhibit a significant part of the kinome. Neither compound 11 nor XO44 inhibited EGFR^{del19/T790M/C797S} triple mutant. When tested in Ba/F3 cells expressing EGFR^{L858R/T790M/C797S}, compound 11 resulted significantly more potent than osimertinib at inhibiting both EGFR autophosphorylation and proliferation, even if the inhibition of EGFR autophosphorylation by compound 11 in Ba/F3 cells was not long lasting.

Chemical modification of NSC12 leads to a specific FGF-trap with antitumor activity in multiple myeloma

Inhibition of FGF/FGFR signaling is a promising strategy for the treatment of malignances dependent from FGF stimulation, including multiple myeloma (MM). The steroidal derivative NSC12 (compound 1) is a pan-FGF trap endowed with antitumor activity in vivo. Chemical modifications of compound 1 were explored to investigate structure-activity relationships, focusing on the role of the bis(trifluoromethyl)1,3-propanediol chain, the stereochemistry at C20 and functionalization of C3 position. Our studies unveiled compound 25b, the pregnane 3-keto 20R derivative of compound 1 as an effective agent, blocking the proliferation of MM cells in vitro by inhibiting FGF-dependent receptor activation and slowing MM growth in vivo. Importantly, the absence of the hydroxyl group at C3 prevents binding to estrogen receptors, which might concur to the antitumor activity observed for compound 1, leading to a specific FGF/FGFR system inhibitor, and further supporting the role of FGFR in anticancer therapy in MM.

Deconstructing Noncovalent Kelch-like ECH-Associated Protein 1 (Keap1) Inhibitors into Fragments to Reconstruct New Potent Compounds

Targeting the protein-protein interaction (PPI) between nuclear factor erythroid 2-related factor 2 (Nrf2) and Kelch-like ECH-associated protein 1 (Keap1) is a potential therapeutic strategy to control diseases involving oxidative stress. Here, six classes of known small-molecule Keap1-Nrf2 PPI inhibitors were dissected into 77 fragments in a fragment-based deconstruction reconstruction (FBDR) study and tested in four orthogonal assays. This gave 17 fragment hits of which six were shown by X-ray crystallography to bind in the Keap1 Kelch binding pocket. Two hits were merged into compound 8 with a 220-380-fold stronger affinity (K_i = 16 μM) relative to the parent fragments. Systematic optimization resulted in several novel analogues with K_i values of 0.04-0.5 μM, binding modes determined by X-ray crystallography, and enhanced microsomal stability. This demonstrates how FBDR can be used to find new fragment hits, elucidate important ligand-protein interactions, and identify new potent inhibitors of the Keap1-Nrf2 PPI.

Fibroblast growth factor receptor inhibitors: patent review (2015-2019)

Introduction: fibroblast growth factor receptors (FGFRs) are a family of tyrosine-kinase receptors whose signaling cascade regulates cellular proliferation, differentiation, and survival. Deregulation of the FGFR pathway is recognized as a driving factor in tumor development. On this basis, FGFR is an attractive target for anti-cancer small-molecule therapeutic agents.Areas covered: This review summarizes patent and literature publications spanning from 2015 to 2019 pertaining to small-molecule FGFR kinase inhibitors.Expert opinion: The first generation of non-covalent FGFR inhibitors is characterized by a broad spectrum of activity and a relatively high toxicity profile. The second generation of FGFR inhibitors shows higher selectivity and a more favorable toxicity profile, but the clinical use appears restricted only to small subsets of cancers strongly dependent on FGFR signaling. Nevertheless, erdafitinib has been approved for the treatment of metastatic urothelial carcinoma, becoming the first marketed selective FGFR inhibitor. The insurgence of mutant kinases, resistant to available therapies, has led to the development of irreversible FGFR inhibitors. The adoption of safer and more selective covalent inhibitors might supersede reversible inhibitors in specific therapeutic areas. Alternative strategies, such as FGF trapping by protein or small-molecule therapeutics, deserve attention and further investigations to unravel their potential.

Expanding the Arsenal of FGFR Inhibitors: A Novel Chloroacetamide Derivative as a New Irreversible Agent With Anti-proliferative Activity Against FGFR1-Amplified Lung Cancer Cell Lines

Fibroblast Growth Factor Receptors (FGFR1-4) have a critical role in the progression of several human cancers, including Squamous Non-Small-Cell Lung Cancer (SQCLC). Both non-selective and selective reversible FGFR inhibitors are under clinical investigation for the treatment of patients with tumors harboring FGFR alterations. Despite their potential efficacy, the clinical development of these drugs has encountered several challenges, including toxicity, and the appearance of drug resistance. Recent efforts have been directed at development of irreversible FGFR inhibitors, which have the potential to exert superior anti-proliferative activity in tumors carrying FGFR alterations. With this in mind, we synthetized, and investigated a set of novel inhibitors possessing a warhead potentially able to covalently bind a cysteine in the P-loop of FGFR. Among them, the chloroacetamide UPR1376 resulted able to irreversible inhibit FGFR1 phosphorylation in FGFR1 over-expressing cells generated from SQCLC SKMES-1 cells. In addition, this compound inhibited cell proliferation in FGFR1-amplified H1581 cells with a potency higher than the reversible inhibitor BGJ398 (infigratinib), while sparing FGFR1 low-expressing cells. The anti-proliferative effects of UPR1376 were demonstrated in both 2D and 3D systems and were associated with the inhibition of MAPK and AKT/mTOR signaling pathways. UPR1376 inhibited cell proliferation also in two BGJ398-resistant cell clones generated from H1581 by chronic exposure to BGJ398, although at concentrations higher than those effective in the parental cells, likely due to the persistent activation of the MAPK pathway associated to NRAS amplification. Combined blockade of FGFR1 and MAPK signaling, by UPR1376 and trametinib respectively, significantly enhanced the efficacy of UPR1376, providing a means of circumventing resistance to FGFR1 inhibition. Our findings suggest that the insertion of a chloroacetamide warhead on a suitable scaffold, as exemplified by UPR1376, is a valuable strategy to develop a novel generation of FGFR inhibitors for the treatment of SQCLC patients with FGFR alterations.

Serum IgE for Bet v 1 in Patients Affected by Atopic Dermatitis

Atopic dermatitis (AD) is a common allergic disorder and may be associated with respiratory allergy. In this study serum levels of IgE specific for the major allergen of birch (Bet v 1) were measured in two groups of AD patients with specific IgE to birch: the first with associated respiratory birch allergy and the second with cutaneous symptoms alone. The results show that the patients suffering from AD associated with respiratory allergy had the highest serum levels of IgE specific for Bet v 1. In conclusion, this study shows that the measurement of serum specific IgE for a major allergen may be useful in common practice as high levels are associated with complicated pathology.

Serum neopterin levels in spontaneous urticaria and atopic dermatitis

Serum neopterin may be considered a diagnostic marker of the degree of activation of the immune system. This preliminary study was performed to measure serum neopterin levels in patients with acute spontaneous urticaria (ASU), chronic spontaneous urticaria (CSU) and atopic dermatitis (AD). In total, 180 patients [96 men, 84 women; mean age 23.1 years; 41 with spontaneous urticaria (13 ASU and 28 CSU), 48 with AD] and 96 healthy controls were enrolled in the study. Patients with ASU had the highest neopterin levels, and all three groups of patients (ASU, CSU and AD) had higher values than normal subjects. This preliminary study demonstrates that serum neopterin could be a biomarker of immune activation in patients with SU or AD.

Immunoglobulin Production Pattern in Allergic and Non-Allergic Subjects

Allergic rhinitis (AR) is characterized by Th2 polarized immune response, such as increased IL-4 and reduced IFN-γ production, and by a functional defect of T regulatory cells. This impaired immune response profile influences the pattern of immunoglobulin (Ig) production in allergic patients. However, no studies have compared the pattern of inhalant allergen-specific Ig classes between allergic patients and normal subjects. The aim of this study is to therefore investigate the allergen-specific IgE, IgG, IgG4, and IgA serum level pattern in a group of patients with pollen allergy and in non-allergic healthy subjects. One hundred and two allergic patients (evaluated both out of and in the pollen season) were enrolled. In addition, 50 healthy non-allergic subjects were recruited during the whole year. Serum allergen-specific IgE, IgG, IgG4, and IgA for Parietaria, grasses, and birch were quantitatively determined by the ImmunoCAP System method. Allergen-specific IgE, IgG, IgG4, and IgA serum levels were significantly different for each tested allergen (p=0.0001 for each class) among groups. Allergic patients, mainly during pollen season, showed the highest IgG, IgG4, and IgA levels. The present study therefore provides the preliminary evidence that Ig production pattern toward inhalant allergens may depend on the specificity of the allergenic response both in non-allergic subjects and allergic patients Allergic patients do not show a defect of IgG and IgA classes. In addition, this study is the first that quantitatively evaluates the Ig classes. However, further studies should include non-allergic subjects evaluated both during and out of the pollen season.

Allergen-specific Ig classes in non-allergic individuals

Allergic rhinitis (AR) is characterized by Th2 polarized immune response, such as increased IL-4 and reduced IFN-gamma production, and by a functional defect of T regulatory cells. This impaired immune response profile influences the pattern of immunoglobulin production in allergic patients. However, there is no study that has explored the pattern of allergen-specific Immunoglobulin (Ig) classes in normal subjects. Therefore, the aim of this study is to investigate the allergen-specific IgE, IgG, IgG4, and IgA serum level pattern in a group of non-allergic individuals. Forty healthy non-allergic subjects were enrolled. Serum allergen-specific IgE, IgG, IgG4, and IgA for mites, cat, Parietaria, grasses, and birch were quantitatively determined by ELISA method. Allergen-specific IgE, IgG, IgG4, and IgA serum levels were significantly different for each tested allergen (p=0.0001 for each class). In conclusion, the present study provides the first evidence that immunoglobulin production pattern depends on the specificity of the allergenic response in non-allergic subjects as well as in allergic patients. In addition, this study is the first that quantitatively evaluates the Ig classes.

Soluble serum HLA-G in children with allergic rhinitis and asthma

Allergic rhinitis (AR) and asthma are characterized by Th2 polarized immune response. Soluble HLA (sHLA) molecules play an immunomodulatory activity. It has been reported that both molecules are increased in sera of patients with pollen-induced allergic rhinitis studied outside the pollen season. To date, however, no study has investigated them in AR children. The aim of this preliminary study is to evaluate serum sHLA-G levels in children with AR or asthma patients and in a group of healthy controls. Forty-seven symptomatic allergic patients were enrolled. A group of 50 healthy subjects was considered as control. Serum sHLA-G levels were determined by the immunoenzymatic method. Children with AR had significantly higher levels of sHLA-G molecules than normal controls or children with allergic asthma. However, there is no difference between children with AR and asthmatics. In conclusion, the present study provides the preliminary evidence that serum sHLA-G molecules are significantly increased in children with AR.

Elispot and Elisa Assessment of Interferon-Gamma after Sublingual Immunotherapy

Allergic rhinitis (AR) is characterized by a Th2 polarized immune response, and specific immunotherapy modifies this arrangement, restoring a physiologic Th1 profile. Sublingual immunotherapy (SLIT) is widely prescribed. The aim of the study is to evaluate two different methods for assessing IFN-γ, namely ELISPOT and ELISA, before and after a pre-seasonal SLIT course as marker for Th1 response. Thirty-eight AR patients with pollen allergy assumed pre-seasonal SLIT for 3 months. Patients' blood samples for assessing IFN-γ serum levels were collected before initiating SLIT (baseline – T0), after 3 months pre-seasonal SLIT course (T1), and three months after completion of SLIT (T2). IFN-γ-specific producing cells, after allergen stimulation, were assessed by cytokine ELISPOT at the same time points. IFN-γ-specific producing cells significantly increased after SLIT both at T1 and T2 (p=0.0002). On the contrary, ELISA assessment did not reveal an increase in IFN-γ serum levels at any time point. In conclusion, these results demonstrate that ELISA assessment of serum IFN-γ is not suitable for identifying an early response.

Peripheral TH-17 cells in children with allergic rhinitis: preliminary report

Th17 is a subset of T helper lymphocytes and exerts pro-inflammatory activities. Recently, it has been reported that serum IL-17 levels are high in the most severe patients with birch allergy studied both outside and during the pollen season. This study aims to compare the frequency of peripheral IL-17-producing T cells in children with allergic rhinitis and in healthy controls. Ten children with allergic rhinitis and 5 healthy non-allergic subjects were evaluated. Th17 were evaluated by intracellular staining in ex-vivo T cell compartment. Ex- vivo PBMNC evaluation showed that allergic patients had higher frequencies of IL-17 producing T cells, both concerning CD4+ and CD8+ cells. In particular, there is a subset co-expressing IL-17 and IFN-gamma both for CD4+ and CD8+ cells. In conclusion, this preliminary study suggests a possible role of Th-17 cells in the response to allergens in children.

Visual analogue scale assessment of respiration might be a surrogate for spirometry in allergic rhinitis

Allergic rhinitis (AR) may be frequently associated with or precede asthma. Bronchial involvement in AR is usually detected by spirometry, however, spirometers are rarely available. The aim of this study is to verify the suitability of the use of visual analogue scales (VAS) as a surrogate for screening spirometry in assessing respiration in AR patients. One hundred twenty patients with allergic rhinitis were studied. VAS for respiration assessment and spirometry were performed in all patients. There was a significant, though weak, relationship between VAS assessment of respiration and FEV(1) (p=0.0076; r=0.244). In conclusion, this preliminary study suggests the use of VAS as screening to assess the respiration of patients with allergic rhinitis who may be candidates for spirometry.

Serum interleukin-17 levels are related to clinical severity in allergic rhinitis

BACKGROUND

T helper (Th)-17 cells are a subset of T helper lymphocytes that exert regulatory activities. Recently, it has been reported that serum interleukin (IL)-17 levels are high in the most severe cases of birch allergy studied outside the pollen season.

OBJECTIVE

The aim of this study was to investigate a possible relationship between serum IL-17 levels and clinical parameters in patients with allergic rhinitis studied during the pollen season.

METHODS

In all, 56 patients with persistent pollen-induced allergic rhinitis were evaluated during the pollen season. Serum IL-17 levels were evaluated by enzyme-linked immunosorbent assay. Symptoms were assessed by visual analogue scale, drug use was monitored and peripheral eosinophils were counted.

RESULTS

Serum IL-17 levels were significantly related to clinical symptoms, drug use and peripheral eosinophil counts (P = 0.0001 for all).

CONCLUSION

This study provides evidence that serum IL-17 level assessment might be considered to classify allergy severity.

Serum Il-17 after one Course of Sublingual Immunotherapy in Allergic Rhinitis to Birch

Recently, it has been reported that IL-17 may be involved in allergic reaction. Sublingual immunotherapy (SLIT) is the unique curative treatment for allergic rhinitis. This study aims at investigating whether one course of birch SLIT could affect serum IL-17 levels. The findings provided show that some IL-17 producer patients had a reduction of serum IL-17 levels after one SLIT course. Therefore, this preliminary study shows that a single pre-seasonal SLIT course may induce a significant decreasing trend in serum IL-17 levels; further study should be carried out to define the role exerted by IL-17 in allergic rhinitis.

Reference values for IgG and IgG4 serum levels specific for inhalant allergens in non-atopic subjects

The IgG response to allergens is well-known, however few studies have investigated IgG and IgG4 production in normal subjects. Therefore, total IgG and IgG4 serum levels specific for 6 common inhalant allergens were measured in 282 non-allergic subjects to establish reference values at different ages and sex. Thus, 282 subjects were studied (141 female and 141 male) ranging from pre-school to adult age, all living in Northern Italy at the time of the study. Family history of first degree relatives and personal history were negative for allergic diseases. The findings obtained in this study indicate that: i) reference values for specific IgG4 and IgG levels against the allergen studied should take into account both the sex and age of the subject evaluated; ii) there is a difference in trend for age between seasonal and perennial allergens and iii) the relationships between age and specific IgG4 and IgG levels have different slopes. In conclusion, relevant differences exist in the distribution of IgG and IgG4 levels in normal subjects.

Role of respiratory pathogens in infants hospitalized for a first episode of wheezing and their impact on recurrences

In order to evaluate the infectious agents associated with the first episode of severe acute wheezing in otherwise healthy infants and to define the role of each of them in recurrences, 85 patients in Italy, aged <12 months, hospitalized because of a first acute episode of wheezing, were prospectively enrolled between 1 October 2005 and 31 March 2006. Upon enrollment, nasopharyngeal swabs were collected for the real-time PCR detection of respiratory syncytial virus (RSV) types A and B, influenza virus types A and B, adenovirus, parainfluenza viruses types 1, 2, 3 and 4, rhinovirus, human metapneumovirus, human coronavirus types 229E, OC43, NL63, and HKU1, bocavirus, enterovirus, and paraechovirus; nasopharyngeal aspirates were also obtained to detect atypical bacteria. At least one infectious agent was identified in 76 children (89.4%). RSV was the most frequently detected pathogen and its prevalence was significantly higher than that of the other pathogens in both age groups, and significantly higher in the children aged 3-12 months than in those aged <3 months. Only the children with RSV infection experienced recurrent wheezing. Viral load was significantly higher in children with than in those without recurrent wheezing. This study shows that RSV is the main reason for hospitalization during the first wheezing episode in infants, and that it appears to be the only pathogen associated with a high frequency of recurrences. A high viral load seems to be strictly related to the likelihood of recurrence.

Serum IL-4 as a marker of immunological response to sublingual immunotherapy

Allergic rhinitis (AR) is characterized by a Th2 polarized immune response. Specific Immunotherapy modifies this bias restoring a physiologic Th1 profile. Sublingual immunotherapy (SLIT) is widely prescribed, but there is no early, simple marker of response. This study was undertaken in order to determine whether serum IL-4 might be a possible marker of SLIT immunological response in order to quickly and easily detect responder patients. Thirty-nine AR patients with a pollen allergy assumed preseasonal SLIT for 3 months. VAS for symptoms and medication efficacy were evaluated. Serum IL-4 was assessed before and 3 and 6 months after SLIT initiation. Eighty-two percent of patients (32/39) showed a clinical response to SLIT. Serum IL-4 significantly decreased at 6 months post-therapy in responders, whereas it increased in non-responders. In conclusion, these results may be considered clinically relevant proof that SLIT treatment induces a quick reduction in Th2 polarization. Serum IL-4 appears to be an early marker of immunological response to SLIT.

Allergic patients have more numerous and prolonged respiratory infections than nonallergic subjects

BACKGROUND

Allergic disorders are characterized by type 2 helper T cell (Th2)-polarization, thus physiological type 1 helper T cell (Th1)-dependent mechanisms involved in fighting respiratory infections (RI) may be defective. It has previously been reported that allergic children have more numerous and severe RI than nonallergic ones.

OBJECTIVE

The aim of the study was to evaluate the number and duration of RI in adult allergic and nonallergic subjects.

METHODS

Six hundred and twenty-four subjects were studied; 202 of them were allergic (i.e. suffering from allergic rhinitis). The number of RI as well as the duration of the disease were recorded for 2 years.

RESULTS

Allergic subjects showed a significantly higher rate of RI episodes [adjusted incidence rate ratio (IRR) = 2.16, 95% confidence interval (CI) 1.94-2.41, P < 0.001] than subjects without allergy. The number of mild RI episodes was slightly higher in allergic subjects (IRR = 1.68, 95% CI 1.50-1.89, P < 0.001), while the number of severe episodes was markedly higher (IRR = 15.71, 95% CI 10.35-23.84, P < 0.001) when compared with nonallergic subjects. Moreover, allergic patients showed a longer total duration of RI than nonallergic subjects, with a mean difference of 17.4 days (95% CI 15.5-19.4, P < 0.001).

CONCLUSIONS

This study provides evidence that adult allergic patients have more numerous and prolonged RI than nonallergic subjects.

[Risk evaluation of contact with pesticides in Naples municipality gardeners]

Pesticide use still now is a remarkable risk for all cultivation operators, including farmers and flower-growing workers. Recently, pesticides use on ornamental plant has been demonstrated to be able to determine a risk extension to general population. Aim of the project was to elaborate and to apply a method for pesticides risk evaluation in ornamental plant cultivations, as to define workers exposure and its possible diffusion to not occupationally exposed populations. Main features of method will be sampling and analysis approach. The first will estimate air dispersion of pesticides in garden centre, skin and garment smarminess in nurserymen and leaf adhered amounts, in concomitance with treatment and periodically to estimate natural decay. The latter will characterize pesticides by means of different methods (liquid and gaseous chromatography, spectrophotometry and spectrometry). Final aim will also be to identify the most reliable analytic method, as concerns accuracy, sensitivity and specificity.

Practice parameters for sublingual immunotherapy

The efficacy and safety of sublingual immunotherapy (SLIT) are currently supported by clinical trials, meta-analysis and post-marketing surveys. Practice parameters for clinical use of SLIT are proposed here by a panel of Italian specialists, with reference to evidence based criteria. Indications to SLIT include allergic rhinoconjunctivitis, asthma, and isolated conjunctivitis (strength of recommendation: grade A). As to severity of the disease, SLIT is indicated in moderate/severe intermittent rhinitis, persistent rhinitis and mild to moderate asthma (grade D). SLIT may be safely prescribed also in children aged three to five years (grade B), and its use in subjects aged more than 60 years is not prevented when the indications and contraindication are ascertained (grade D). The choice of the allergen to be employed for SLIT should be made in accordance with the combination of clinical history and results of skin prick tests (grade D). Polysensitisation, i.e. the occurrence of multiple positive response does not exclude SLIT, which may be done with the clinically most important allergens (grade D). As to practical administration, co-seasonal, pre co-seasonal, and continuous schedules are available, being the latter recommended for perennial allergens or for pollens with particularly prolonged pollination, such as Parietaria (grade D). For pollens with relatively short pollination, such as grasses and trees (cypress, birch, alder, hazelnut, olive) the pre co-seasonal and perennial schedules are preferred (grade C). The build-up phases suggested by manufacturers can be safely used (grade A), but they can be modified according to the patient's tolerance (grade C). A duration of SLIT of 3-5 years is recommended to ensure a long-lasting clinical effect after the treatment has been terminated (grade C).

Screening spirometry to detect respiratory allergy

BACKGROUND

Recently, it has been evidenced that the forced expiratory flow at the 25 and 75% of the pulmonary volume (FEF25-75) might be considered as a possible marker of early bronchial impairment in patients with allergic rhinitis alone.

OBJECTIVES

The aim of this study was to determine whether a spirometric impairment may predict allergy during screening visit.

METHODS

The study included 283 Navy soldiers (255 males, mean age 27.1 + 8.2) who had to undergo spirometry for attending specific courses. Fifty-four showed slight spirometric anomalies. Thus, they referred to Navy Hospital of La Spezia for standardized tests: skin prick test, spirometry, and methacholine bronchial challenge.

RESULTS

Forty seven (87%) subjects were sensitized (47% monosensitized and 53% polysensitized). Allergic rhinitis was diagnosed in 25 subjects with median nasal TSS 5. FVC and FEV1 values were normal, whereas FEF25-75 values were reduced (61.8 + 14.8 % of predicted), bronchodilation test was significant for FEF25-75 (82.9 + 16.8% of predicted; p<0.001) only. Bronchial hyperreactivity (BHR) was detected in 28 subjects, all but 1 were sensitized.

CONCLUSIONS

This study provides evidence, relevant to clinical care, that mild spirometric impairment may generate the suspect of allergic disorders, thus spirometry could be more frequently performed in general population screening.

Bronchial hyperreactivity and spirometric impairment in patients with allergic rhinitis

BACKGROUND

The Link between allergic rhinitis and asthma is well known. Bronchial hyperreactivity (BHR) may be present in rhinitics. The present study is aimed at evaluating a large group of subjects suffering from allergic rhinitis alone to investigate the presence of spirometric impairment and BHR both during and outside the pollen season.

METHODS

360 rhinitics (subdivided in 3 groups: seasonal, SAR, perennial, PAR, and polysensitized, PolysR) were investigated by spirometry and methacholine challenge.

RESULTS

There was a significant seasonal difference concerning the number of rhinitics with impaired FEV1 (p<0.01 for SAR, p<0.02 for PAR, and p<0.03 for PolysR) and FEF25-75 (p<0.05 for SAR, p<0.03 for PAR, and p<0.05 for PolysR) as well as with BHR (p<0.05 for SAR and p<0.03 for PAR).

CONCLUSIONS

This study evidences that an impairment of spirometric parameters and BHR may be observed in patients with allergic rhinitis alone. Thus, careful evaluation of lower airways should be performed in patients with allergic rhinitis alone.

Sublingual specific immunotherapy reduces PBMC proliferations

BACKGROUND

Subcutaneous specific immunotherapy has been demonstrated capable of inducing T regulatory response. There is few evidence concerning immunological changes induced by sublingual immunotherapy.

OBJECTIVE

The aim of this study was to evaluate T cell proliferation in subjects successfully treated with SLIT for HDM.

METHODS

PBMCs were isolated from patients after at least 3 years of successful HDM SLIT and from matched untreated allergic and healthy control subjects. After 3 and 6 days of in vitro stimulation with PHA, Candida albicans, Dermatophagoides farinae, grasses, Parietaria judaica, and cat, proliferation.

RESULTS

Subjects treated with SLIT showed significant reduction of proliferation induced by Candida albicans, Parietaria, and grasses in comparison with untreated atopics (p=0.0002, 0.0033, and 0.009 respectively).

CONCLUSION

This pilot study confirms reduced T cell proliferation in allergic subjects treated with SLIT.

Long term persistence of anti-HBs protective levels in young patients with type 1 diabetes after recombinant hepatitis B vaccine

The aim of the present study was to evaluate the persistence of anti-hepatitis B protective levels in young patients with type 1 diabetes, successfully immunised with a recombinant hepatitis B vaccine. We re-evaluated, after a 4 year follow-up, 54 patients and 70 age and sex-matched healthy subjects. Protective antibodies levels were found in 50/54 (92%) patients and in 67/70 (96%) controls. Moreover, anti-HBs levels were similar in diabetic patients and controls (means of log-titre and (sd); 1.95 (0.88) and 2.18 (0.64) patients and controls, respectively; P=0.11). No cases of clinical hepatitis were reported and all patients and controls remained HBc negative. These data demonstrate the persistence of anti-HBs levels in children, adolescents and young patients with type 1 diabetes after recombinant hepatitis B vaccine showing evidence of longterm immunogenity and protective effect.

Acquired immune deficiency syndrome in childhood: impaired production of interleukin-2 by HIV (LAV/HTLV III) infected patients

The phenotype and functions of T lymphocytes and of natural killer (NK) cells have been investigated in four children and five adults from three Italian families infected with HIV (LAV/HTLV III). The results show a heterogeneous pattern of immunological derangements involving distribution of T and natural killer subsets, proliferation in response to T cell mitogens and natural killer activity. However, all infected patients tested showed a very low or absent phytohaemagglutinin induced interleukin-2 production regardless of age and clinical conditions, while concanavalin A-induced interleukin-2 production was within the normal range. The impaired interleukin-2 production in response to phytohaemagglutinin in some patients is not related to phytohaemagglutinin-induced proliferation, to clinical conditions or to a defective distribution of T cell subsets. These results suggest that, in our patients, both adults and children, HIV (LAV/HTLV III) has an "early" tropism for a subset of T cells involved in interleukin-2 production.

AIDS: outcome of children born to HTLV-III/LAV infected mothers. Report of 15 Italian cases

The characteristics of acquired immunodeficiency syndrome (AIDS) in children have been described in several reports. The occurrence of specific anti-HTLV-III/LAV seropositivity in children born to seropositive mothers is also becoming more frequent in Italy. We report 15 cases of seropositive children born to 14 seropositive, drug-addicted mothers. Among them, 5 died of AIDS, 8 developed a variable, non-progressive AIDS-related complex (ARC), while only two remained persistently asymptomatic. Liver disease was present in 2 patients, CNS disease in 4, gastrointestinal troubles were never a major problem. Only 2 cases of HBV infection and 3 of thrombocytopenia were observed. In our experience, homosexual behaviour of the parents was never a cause of family risk. Children presented with failure to thrive and/or signs of disease usually within the first five months of life. In one family the first child was affected by fatal AIDS while the younger child showed only passive, transient immunization by maternal specific IgG. One ARC patient, observed for over 3 years, showed apparently complete healing from the disease.

Association of neutrophil and complement defects in two twins with Shwachman syndrome

Immunological functions were studied in two 22-month-old dizygotic twins with the characteristic features of Shwachman syndrome. A severe defect of neutrophil motility was found in both children, but not in their parents. An impairment of the activity of the alternative pathway of complement was present in the sera of both patients. This defect, in association with the neutropenia and the chemotactic defect, might be related to the recurrent infections displayed by the twins.

Effects of aminoglycoside antibiotics on neutrophil chemotaxis

The inhibitory effect of neutrophil chemotaxis of gentamicin, tobramycin, and sisomicin was shown. The combined effect of aminoglycosides and histamine was not additive.