Immune Network Modeling Predicts Specific Nasopharyngeal and Peripheral Immune Dysregulation in Otitis-Prone Children

Acute otitis media (AOM) pathogenesis involves nasopharyngeal colonization by potential otopathogens and a viral co-infection. Stringently-defined otitis prone (sOP) children show characteristic patterns of immune dysfunction. We hypothesized that otitis proneness is largely a result of altered signaling between immune components that are otherwise competent, resulting in increased susceptibility to infection by bacterial otopathogens. To test this, we constructed a regulatory immune network model linking immune cells and signaling elements known to be involved in AOM and/or dysregulated in sOP children. The alignment of immune response mechanisms with data from in vivo and in vitro experimental observations produced 82 putative immune network models, each describing variants of immune regulatory networks consistent with available observations. Analysis of these models suggested that new measurements of serum levels of IL-4 and CXCL8 could refine competing models and resulted in the elimination of 38 of the models. Further analysis of the remaining 44 models suggested specific deviations in the predicted regulation of nasopharyngeal and peripheral immunity during response to AOM. Specifically, immune responses active in sOP children during AOM were characterized by early and constitutive activation of pro-inflammatory signaling in the nasopharynx and a Th2- and Treg-dominated profile in the periphery. We conclude that sOP children have altered regulation of key immune mediators during both health and pathogenesis. This altered regulation may be amenable to therapeutic intervention.

Successful development of methodology for detection of hapten-specific contact hypersensitivity (CHS) memory in swine

Hapten contact hypersensitivity (CHS) elicits a well-documented inflammation response that can be used to illustrate training of immune cells through hapten-specific CHS memory. The education of hapten-specific memory T cells has been well-established, recent research in mice has expanded the “adaptive” characteristic of a memory response from solely a function of the adaptive immune system, to innate cells as well. To test whether similar responses are seen in a non-rodent model, we used hapten-specific CHS to measure the ear inflammation response of outbred pigs to dinitrofluorobenzene (DNFB), oxazolone (OXA), or vehicle controls. We adapted mouse innate memory literature protocols to the domestic pig model. Animals were challenged up to 32 days post initial sensitization exposure to the hapten, and specific ear swelling responses to this challenge were significant for 7, 21, and 32 days post-sensitization. We established hapten-specific CHS memory exists in a non-rodent model. We also developed a successful protocol for demonstrating these CHS responses in a porcine system.

Role of the alternative and classical complement activation pathway in complement mediated killing against Streptococcus pneumoniae colony opacity variants during acute pneumococcal otitis media in mice

There is considerable evidence that phase variation among transparent and opaque colony phenotypes of Streptococcus pneumoniae (Spn) plays an important role in the pneumococcal adherence and invasion. The current study was designed to investigate the interactions of the opacity phenotype variants of Spn with specific complement pathway activation in a mouse model of acute otitis media (AOM). Although the opaque colony phenotype was expected to be more resistant to complement mediated killing compared to the transparent Spn variant, we discovered that C3b deposition on the transparent Spn is, in large part, dependent on the alternative pathway activation. There were no significant differences in resistance to complement mediated opsonophagocytosis between the two variants in factor B deficient mice. In addition, an in vitro study demonstrated that significantly more C4b-binding protein (C4BP) (the classical pathway inhibitor) and factor H (FH) (the alternative pathway inhibitor) bound to the transparent strain compared with the opaque one. Our data suggest that the difference in the relative virulence of Spn opacity phenotypes is associated with its ability to evade complement-mediated opsonophagocytosis in a mouse model of pneumococcal AOM.

[Lymphocyte subsets in patients with recurrent upper airway infections]

The aim of our study was to evaluate the digressions of lymphocyte subsets in patients with recurrent upper airway infectious diseases.

METHODS

We studied 35 patients (mean of age 11.1+/-2.1 years) with recurrent upper airway infections. The first group consisted of patients, who had acute upper airway infections: rhinitis, pharyngitis, laryngitis and tracheitis more than 6 times per last year, sinusitis or otitis more than 4 times per last year. The control group comprised of 9 healthy subjects. Subsets of lymphocytes (CD3+, CD4+, CD8+, CD4+/CD8+, CD16+/56+ and CD19+) were detected by FACS Calibur cytometer.

RESULTS

We found a significantly lower count of CD4+ lymphocytes in the patients' group compared to the control group (37.5+/-1.2 vs 45.7+/-3.1% of total lymphocytes, p<0.01). We did not find any significant differences of other lymphocyte subsets between patients and control groups.

CONCLUSION

We propose that patients with recurrent upper airway infections have alterations of the cellular immunity -- decreased amount of CD4+ lymphocytes.

[Ear, nose, and throat manifestations in patients with primary immunodeficiencies]

OBJECTIVE

To determine the flowgram for the timely diagnosis of the immunodeficiencies congenital primary, based on the demonstrations otorrinolaringol recurrent chronicles to difficult control, with or without associated systemic diseases.

MATERIAL AND METHOD

Retrospective study, descriptive and observational that included patient with diagnostic of primary known immunodeficiency. They were checked the clinical files to know their evolution and medical treatment-surgical.

RESULTS

They were found 10 patient with diagnostic of some primary immunodeficiency; this was made based on the infectious symptoms otolaryngal chronic recurrent to difficult control; they were six men and four women between the four and 36 years old. They were found the following immunodeficiencies: one of hyper-IgM, three by IgG, variable common three, a deficit with C3 of the complement, two of IgA more atopia.

CONCLUSIONS

The chronicle sinusitis or recurrent and the otitis mean chronicle or recurrent can be the only demonstrations of a patient with primary immunodeficiency. The immunology evaluation must include, at least: hematic biometric completes with differential, seric levels of immunoglobulins, the same as subclass of IgG, C4 and C3 of the complement, response to immunization with proteins (diphtheria and tetanus), and polysaccharide antigens (pneumovax).

On the function of the mastoid cavity with emphasis on its role in middle ear defence

The function of the mastoid cavity is still unknown. In the present article a theory of its main function is presented. The mastoid cavity is of vital importance in the non-immunological defence of the middle-ear. It is the most important site for the production of secretions that "wash" the middle-ear free of bacteria and viruses. The mucociliary system and the gravitation force, if the body is in erect position, transports the secretions through the two openings of the ear, the aditus and antrum and the ostia of the Eustachian tube, to be expelled into the epipharynx. Based on this theory pathological disorders of the ear are discussed as well as the effect of ventilation tubes on otosalpingitis and recurrent otitis media. Other plausible mastoid cavity functions are also discussed.

Cholesteatoma debris as an activator of human monocytes. Potentiation of the production of tumor necrosis factor

Tumor necrosis factor (TNF) is a cytokine which stimulates osteoclastic bone resorption and inhibits collagen synthesis in vitro. In this study the effect of human cholesteatoma debris and its constituents on the production of TNF-alpha by human monocytes in vitro was studied. Cultured human peripheral monocytes secreted TNF into the culture medium when exposed to cholesteatoma debris in a dose-dependent manner. The TNF production, however, was partially inhibited by the treatment of the debris with polymyxin B which inhibits biological activities of lipopolysaccharide (LPS). When individual constituents of cholesteatoma debris, i.e. keratin, cholesterol, lauric acid and LPS, were added to the cultured monocytes at concentrations equivalent to those in the debris, significant production of TNF was observed only with the keratin and LPS. These data suggest that cholesteatoma debris is a potent activator of the TNF production of human monocytes in vitro, and that LPS and keratin are responsible for the production.

Age-dependent IgG subclass distribution of phosphocholine antibodies in humans

Plasma antiphosphoryl-choline (Pc) antibodies were analyzed regarding class and subclass distribution (IgG, IgG1-4, IgM and IgA). Plasma was collected from healthy and otitis-prone children, 1 and 3 years of age, and healthy adults. An enzyme-linked immunosorbent assay (ELISA) was used, utilizing monoclonal antibodies to human IgG subclass determinants. Divergent patterns emerged when comparing children with adults. At 1 year of age the anti-PC IgG1 levels were higher in both of the two children groups than in adults, while the reverse pattern was seen for IgG2 antibodies. There was no correlation between total plasma levels of IgG1-4 immunoglobulins and the ELISA value of specific antibody. The age-dependent subclass patterns corresponded to the earlier descriptions of antibodies to certain pneumococcus polysaccharides. Anti-Pc antibody levels were unrelated to predisposition to otitis media.

Protective effect of vaccination against Mycoplasma pulmonis respiratory disease in rats

Intravenous vaccination of rats with either viable or Formalin-inactivated Mycoplasma pulmonis reduced the incidence and severity of lower respiratory tract lesions after intranasal challenge with viable organisms. Intranasal vaccination with killed organisms reduced the severity of rhinitis, but did not affect lesions in any other region of the respiratory tract. The maximum protection against upper tract lesions (rhinitis, otitis, and laryngotracheitis) was provided by intravenous immunization with viable organisms. Dual vaccination (intraperitoneal plus intranasal) with killed organisms provided no significant protection in any segment of the tract. However, these ineffective vaccine regimens did not potentiate the lesions. These results conclusively demonstrate that vaccination of rats against mycoplasma respiratory disease is feasible and also suggest that systemic vaccination may provide greater protection for the lungs than intranasal vaccination, at least when equivalent antigen doses are used.

Chronic infections in a family with hereditary deficiency of IgG2 and IgG4

Two siblings, a girl and a boy, and their mother were abnormally susceptible to infections with bronchopneumonias leading to chronic pulmonary atelectasis in the girl and otitis leading to necrotizing changes with deafness in the mother. The causative micro-organism most often found was Haemophilus influenzae. The serum IgG was within the normal concentration range, but showed restricted electro-phoretic heterogeneity with absence of the anodal component. Serum IgG2 and IgG4 were absent. Absence of antibodies to teichoic acid and haemagglutinating antibodies to Haemophilus influenzae polysaccharide was noted as was the case with isohaemagglutinins and heteroagglutinins against sheep cells. Lymphopenia and poor [³H]thymidine uptake by peripheral lymphocytes after PHA stimulation were demonstrable in the girl and the mother. The girl had developed an epithelial ovarian tumour. The disease was a non-X-linked recessive and expressed selective humoral and selective cellular immunodeficiency. An inherited structural or regulatory gene defect is suggested. Gamma-globulin therapy had a good clinical effect.