qSOFA predicted pneumonia mortality better than minor criteria and worse than CURB-65 with robust elements and higher convergence.

BACKGROUND: Limited data are available on the discriminatory capacity of quick sequential [sepsis-related] organ failure assessment (qSOFA) versus IDSA/ATS minor criteria for predicting mortality in patients with community-acquired pneumonia (CAP). METHODS: An observational prospective cohort study of 2116 patients with CAP was performed. Construct validity was determined using Cronbach α. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC) and net reclassification improvement (NRI). RESULTS: Overall in-hospital mortality was 6.43%. Mortality was 25.96% for patients with a qSOFA score of 2 or higher versus 3.05% for those with a qSOFA score less than 2 (odds ratio for mortality 6.57, P < 0.0001), and 13.85% for patients with at least 3 minor criteria versus 2.03% for those with 2 or fewer minor criteria (odds ratio for mortality 2.27, P < 0.0001). qSOFA had a higher correlation with mortality than minor criteria, as well as higher internal consistency (Cronbach alpha 0.43 versus 0.14) and diagnostic values of individual elements (larger AUROCs and higher Youden's indices). qSOFA ≥2 was less sensitive but more specific for predicting mortality than ≥3 minor criteria (qSOFA sensitivity 59.6%, specificity 88.3% and positive likelihood ratio 5.11 versus ≥3 minor criteria sensitivity 80.1%, specificity 65.8% and positive likelihood ratio 2.34). The predictive validity of qSOFA was good for mortality (AUROC = 0.868), was statistically greater than minor criteria, was equal to pneumonia severity index, and was inferior compared with CURB-65 (AUROC, 0.824, 0.902, 0.919; NRI, 0.088, -0.068, -0.103; respectively). CONCLUSIONS: The qSOFA predicted mortality in CAP better than IDSA/ATS minor criteria and worse than CURB-65 with robust elements and higher convergence. qSOFA as a bedside prompt might be positioned as a proxy for minor criteria and increase the recognition and thus merit more appropriate management of CAP patients likely to fare poorly, which might have implications for more accurate clinical triage decisions.

Cold-inducible RNA-binding protein might determine the severity and the presences of major/minor criteria for severe community-acquired pneumonia and best predicted mortality.

BACKGROUND: Severity of community-acquired pneumonia (CAP) depends on microbial pathogenicity, load and virulence, and immune responses. The Infectious Disease Society of America and the American Thoracic Society (IDSA/ATS) minor criteria responsible for clinical triage of patients with CAP are of unequal weight in predicting mortality. It is unclear whether the IDSA/ATS major/minor criteria might be strongly and positively associated with the immune responses. It is warranted to explore this intriguing hypothesis. METHODS: A prospective cohort study of 404 CAP patients was performed. Cold-inducible RNA-binding protein (CIRP) levels were measured using a sandwich-based enzyme-linked immunosorbent assay. The receiver operating characteristic curves were created and the areas under the curves were calculated to illustrate and compare the accuracy of the indices. RESULTS: Severe CAP patients meeting the major criteria had the highest plasma concentrations of CIRP. The more the number of most predictive minor criteria strongly associated to mortality, i.e. arterial oxygen pressure/fraction inspired oxygen ≤ 250 mmHg, confusion, and uremia, present, the higher the CIRP level. Interestingly, the patients with non-severe CAP meeting the most predictive minor criteria demonstrated unexpectedly higher CIRP level compared with the patients with severe CAP not fulfilling the criteria. Procalcitonin (PCT), interleukin-6 (IL-6), C-reactive protein (CRP), sequential organ failure assessment (SOFA) and pneumonia severity index (PSI) scores, and mortality confirmed similar intriguing patterns. CIRP was strongly linked to PCT, IL-6, CRP, minor criteria, SOFA and PSI scores, and mortality (increased odds ratio 3.433). The pattern of sensitivity, specificity, positive predictive value, and Youden's index of CIRP ≥ 3.50 ng/mL for predicting mortality was the optimal. The area under the receiver operating characteristic curve of CIRP was the highest among the indices. CONCLUSIONS: CIRP levels were strongly correlated with the IDSA/ATS major/minor criteria. CIRP might determine the severity and the presences of major/minor criteria and best predicted mortality, and a CIRP of ≥ 3.50 ng/mL might be more valuable cut-off value for severe CAP, suggesting that CIRP might be a novel and intriguing biomarker for pneumonia to monitor host response and predict mortality, which might have implications for more accurate clinical triage decisions.

Correction to: Scored minor criteria for severe community-acquired pneumonia predicted better.

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Scored minor criteria for severe community-acquired pneumonia predicted better.

BACKGROUND: Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality, but the major problem associated with IDSA/ATS minor criteria might be a lack of consideration of weight in prediction in clinical practice. Would awarding different points to the presences of the minor criteria improve the accuracy of the scoring system? It is warranted to explore this intriguing hypothesis. METHODS: A total of 1230 CAP patients were recruited to a retrospective cohort study. This was tested against a prospective two-center cohort of 1749 adults with CAP. 2 points were assigned for the presence of PaO2/FiO2 ≤ 250 mmHg, confusion, or uremia on admission and 1 point for each of the others. RESULTS: The mortality rates, and sequential organ failure assessment (SOFA) and pneumonia severity index (PSI) scores increased significantly with the numbers of IDSA/ATS minor criteria present and minor criteria scores. The correlations of the minor criteria scores with the mortality rates were higher than those of the numbers of IDSA/ATS minor criteria present. As were the correlations of the minor criteria scores with SOFA and PSI scores, compared with the numbers of IDSA/ATS minor criteria present. The pattern of sensitivity, specificity, positive predictive value, and Youden's index of scored minor criteria of ≥2 scores or the presence of 2 or more IDSA/ATS minor criteria for prediction of mortality was the best in the retrospective cohort, and the former was better than the latter. The validation cohort confirmed a similar pattern. The area under the receiver operating characteristic curve of scored minor criteria was higher than that of IDSA/ATS minor criteria in the retrospective cohort, implying higher accuracy of scored version for predicting mortality. The validation cohort confirmed a similar paradigm. CONCLUSIONS: Scored minor criteria orchestrated improvements in predicting mortality and severity in patients with CAP, and scored minor criteria of ≥2 scores or the presence of 2 or more IDSA/ATS minor criteria might be more valuable cut-off value for severe CAP, which might have implications for more accurate clinical triage decisions.

Rapid and specific detection of porcine parvovirus using real-time PCR and high resolution melting (HRM) analysis.

BACKGROUND: Porcine parvovirus (PPV) is the important causative agent for infectious infertility, which is a fairly tough virus that multiplies normally in the intestine of pigs without causing clinical signs in the world. RESULTS: We developed an assay integrating real-time PCR and high resolution melting (HRM) analysis for the detection of PPV. Primers targeting the VP gene were highly specific, as evidenced by the negative amplification of closely related viruses, such as porcine circovirus 2 (PCV2), porcine reproductive and respiratory syndrome virus (PRRSV), pseudorabies virus (PRV), classical swine fever virus (CSFV), or Japanese encephalitis virus (JEV). The performance of unlabeled real time PCR was compared to TaqMan real time PCR, and the detection limits of the two methods were nearly equal. Moreover, there was good correlation between Cp and diluted genomic DNA when tested with the two methods. The assay has the accuracy of 100% in reference to labeled real time PCR, when it was tested on 45 clinical samples. CONCLUSIONS: The present study demonstrated that the established assay integrating real-time PCR and HRM is relatively cost-effective and more stable, which provides an alternative tool for rapid, simple, specific and sensitive detection of PPV.

Rapid detection and differentiation of Clonorchis sinensis and Opisthorchis viverrini using real-time PCR and high resolution melting analysis.

Clonorchis sinensis and Opisthorchis viverrini are both important fish-borne pathogens, causing serious public health problem in Asia. The present study developed an assay integrating real-time PCR and high resolution melting (HRM) analysis for the specific detection and rapid identification of C. sinensis and O. viverrini. Primers targeting COX1 gene were highly specific for these liver flukes, as evidenced by the negative amplification of closely related trematodes. Assays using genomic DNA extracted from the two flukes yielded specific amplification and their identity was confirmed by sequencing, having the accuracy of 100% in reference to conventional methods. The assay was proved to be highly sensitive with a detection limit below 1 pg of purified genomic DNA, 5 EPG, or 1 metacercaria of C. sinensis. Moreover, C. sinensis and O. viverrini were able to be differentiated by their HRM profiles. The method can reduce labor of microscopic examination and the contamination of agarose electrophoresis. Moreover, it can differentiate these two flukes which are difficult to be distinguished using other methods. The established method provides an alternative tool for rapid, simple, and duplex detection of C. sinensis and O. viverrini.

Updating cut-off values of severity scoring systems for community-acquired pneumonia to orchestrate more predictive accuracy.

Background: The assessment of severity is crucial in the management of community-acquired pneumonia (CAP). It remains unknown whether updating cut-off values of severity scoring systems orchestrate improvement in predictive accuracy.Methods: 3,212 patients with CAP were recruited to two observational prospective cohort studies. Three bettered scoring systems were derived from the corresponding well-established and extensively used pneumonia-specific severity scoring systems, i.e. pneumonia severity index, minor criteria and CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30/min, low blood pressure, and age ≥65 years) score, with the updating cut-off values for tachypnea and low blood pressure. Cronbach α was employed to determine construct validity. Discrimination was valued by calculating the area under the receiver operating characteristic curve (AUROC) and net reclassification improvement (NRI).Results: Respiratory rate ≥22/min and systolic blood pressure ≤100 mm Hg were performed better than respiratory rate ≥30/min and hypotension for predicting mortality in the derivation cohort, respectively (AUROC, 0.823 vs 0.519, 0.688 vs 0.622; NRI, 0.61, 0.13). Bettered scoring systems orchestrated higher convergences, indicated by greater Cronbach α and more decrease in Cronbach α if the updating cut-off values were deleted. The six scoring systems agreed well with one another. Bettered- pneumonia severity index, minor criteria and CURB-65 score showed higher associations with severity and mortality rates and demonstrated greater predictive accuracies for mortality compared with the corresponding original systems (AUROC, 0.939 vs 0.883, 0.909 vs 0.871, 0.913 vs 0.859; NRI, 0.113, 0.076, 0.108; respectively). The validation cohort confirmed a similar pattern.Conclusions: Updating cut-off values of severity scoring systems for CAP orchestrate improvement in predictive accuracy, suggesting that it may facilitate the rationalization of clinical triage decision-making and further reduce mortality. The current studies provide the first known prospective evidence of potential benefit of the updating cut-off values of severity scoring systems for CAP in predictive accuracy.Key messagesUpdating cut-off values were performed better for predicting mortality.Bettered scoring systems orchestrated higher convergences.Bettered scoring systems demonstrated greater predictive accuracies for mortality.

[Study of tacrolimus intranasal treatment for allergic asthma in mice].

OBJECTIVE: To explore the efficacy of intranasal treatment by immunosuppressant tacrolimus for allergic asthma and its mechanism in mice. METHODS: 24 female BALB/c mice were randomly divided into 4 groups: group A (negative control), group B (model control), group C (low dose treatment), and group D (high dose treatment). Mice in group A were treated with saline (100 microl). Other groups were sensitized intraperitoneally with allergen extracts of Dermatophagoides farinae (Der f) absorbed to Al(OH)3 at day 0, 7, and 14. From day 28, groups A, B, C, and D were intranasally treated with saline, PBS, 0.01% tacrolimus, and 0.1% tacrolimus, respectively, once per day for 7 d, and followed by intranasal challenge with 50 microl Der f extracts in the mean time. 24 h after the last challenge, the airway hyper-responsiveness (AHR) were detected. At 48 h after the last challenge, the mice were sacrificed, the bronchoalveolar lavage fluid (BALF) was collected, the lungs and spleen were aseptically removed. The total cell number and cell classification of BALF were recorded. The level of interleukin-4 (IL-4), interleukin-5 (IL-5), interferon-gamma (IFN-gamma) in BALF and in spleen cells culture supernatants was detected by ELISA. The lung inflammation and mucus secretion were observed in mice by HE (haematoxylin and eosin) staining and AB (Alcian Blue) staining. RESULTS: Compared with group B, AHR (P < 0.05) and airway inflammation in group D significantly reduced. The number of total cells [(29.92 +/- 5.20) x 10(4)/ml] (P < 0.05) and eosinophils [(4.33 +/- 0.75) x 10(4)/ml] (P < 0.01) in group D greatly decreased than those of group B [(59.33 +/- 5.99) x 10(4)/ml and (22.67 +/- 5.65) x 10(4)/ml]. The level of IL-4 [(22.49 +/- 4.96) pg/ml] (P < 0.05), IL-5 [(43.90 +/- 13.15) pg/ml] (P < 0.01) and IFN-gamma [(10.17 +/- 1.09) pg/ml] (P < 0.05) in BALF significantly decreased (P < 0.05) than those of group B [(57.02 +/- 7.38), (133.49 +/- 15.63) and (15.32 +/- 3.23) pg/ml, respectively]. The level of IL-4 [(22.54 +/- 4.58) pg/ml], IL-5 [(3631 +/- 20.85) pg/ml] and IFN-gamma [(11.28 +/- 1.79) pg/ml] in spleen cell culture supernatant all significantly decreased (P < 0.05) than those of group B [(56.34 +/- 6.21), (72.3 +/- 6.23) and (18.82 +/- 1.88) pg/ml, respectively]. There was no significant difference between group C and group B. CONCLUSION: Tacrolimus shows certain immune therapeutic effect on dust mite sensitized mice, and this effect may be attributed to its inhibition on T lymphocyte factor secretion.

[Therapeutic effect on murine asthma with sublingual use of Dermatophagoides farinae/chitosan nanoparticle vaccine].

OBJECTIVE: To prepare Dermatophagoides farinae (Der f)/chitosan nanoparticle vaccine (DCN), and to investigate the effect of sublingual administration with DCN in asthma mice model. METHODS: DCN were prepared by ionotropic gelation. 30 BALB/c mice were randomly divided into 5 groups: normal control group(A), PBS control group (B), Chitosan group (C), Der f group (D), DCN group (E). Group A were treated with normal saline (100 microl) all the time. Mice in other groups were sensitized intraperitoneally with 50 microg dust mite extracts plus 2 mg Al(OH)3, and on day 28 given a sublingual vaccination of PBS(group B), or empty CS nanoparticles (group C), or Der f (group D, 1 mg Der f) or DCN (group E, loaded with 1 mg Der f). All the mice received 18 doses at 1-day intervals. One week after the last immunization, mice in group B, C, D, and E were intranasally challenged with 50 microg Der f extract daily for seven days. Twenty-four hours after the last challenge, airway hyper-responsiveness (AHR) was assessed by using whole-body plethysmography. Two days post challenge, mice were sacrificed and bronchoalveolar lavage fluid (BALF) was collected. Number of the total cells and eosinophils was determined. Level of cytokines in the supernatant of splenocyte culture was assayed by ELISA. Level of Der f specific IgE, IgG2a and IgA in the sera was determined by ELISA. Airway inflammation was analyzed by HE staining. Spleen lymphocyte proliferation responses were analyzed by MTT colorimetry. RESULTS: Compared with group B, AHR and the lung inflammation in groups D and E were greatly reduced. Numbers of total cells and eosinophils in BALF of groups D (36.50 x 10(4)/ml, 3.72 x 10(4)/ml) and E (34.25 x 10(4)/ml, 2.25 x 10(4)/ml) were significantly lower than that of group B (61.67 x 10(4)/ml, 14.17 x 10(4)/ml) (P < 0.05). The level of specific IgE was significantly lower in groups D (0.22) and E (0.22), and that of IgA in groups D (0.88) and E (1.03) was significantly higher than that in group B (0.79). The level of IL-4 in BALF (D: 28.49 pg/ml, E: 20.93 pg/ml) and cultured splenocytes (D: 27.82 pg/ml, E: 20.80 pg/ml) of groups D and E was significantly lower than that of group B (56.33 pg/ml, 45.84 pg/ml) (P < 0.05). While IFN-gamma (D: 18.80 pg/ml, E: 37.32 pg/nml) and IL-10 (D: 118.90 pg/ml, E: 129.15 pg/ml) in BALF in groups D and E were significantly higher than that of group B (13.60 pg/ml, 29.61 pg/ml) (P < 0.05), and same with IFN-y (D: 20.68 pg/ml, E: 42.42 pg/ml) and IL-10 (D: 36.31 pg/ml, E: 161.37 pg/ml) in spleen cultured supernatants of groups D and E (P < 0.05). The allergen-specific splenocyte proliferation was inhibited in groups D (SI: 0.14) and E (SI: 0.13), and there was no significant difference between group C (SI: 0.22) and group B (SI: 0.23). CONCLUSION: Dermatophagoides farinae (Der f)/chitosan nanoparticle vaccine has therapeutic effect on murine asthma.

Sublingual immunotherapy efficacy of Dermatophagoides farinae vaccine in a murine asthma model.

BACKGROUND: Allergen-specific sublingual immunotherapy is a potential treatment for allergic diseases. Its effective dose and underlying mechanism are still to be explored. Here, we investigated the efficacy and mechanism of sublingually administered Dermatophagoides farinae (Der f) vaccine in a murine asthma model. METHODS: BALB/c mice were sensitized intraperitoneally with Der f extract absorbed to alum, followed by sublingual treatment with Der f vaccine for 6 weeks. The mice were subsequently challenged intranasally with Der f extract for 1 week. We analyzed their clinical symptoms, antibody levels, cytokine levels, T-cell proliferation and the regulatory T-cell numbers. RESULTS: Mice treated with high-dose Der f sublingual vaccine prior to challenge displayed alleviated symptoms such as airway hyperreactivity, lung inflammation and mucus production, as well as less eosinophilic cells in bronchoalveolar lavage fluid. Interestingly, reduced responses of Der-f-specific IgE and increased responses of Der-f-specific IgA and IgG1 were aroused in the high-dose Der f sublingual vaccine group. We also observed that interleukin-4 was reduced and interferon-gamma and interleukin-10 were increased among splenocytes and in bronchoalveolar lavage fluid, which inhibited Der-f-specific T-cell proliferation of the spleen and increased CD4+CD25+Foxp3+regulatory T cells in the spleen. However, mice treated with low-dose Der f sublingual vaccine developed allergic asthma. CONCLUSION: Our results illustrate that high-dose Der f sublingual vaccine may play a role in immunologic protection in murine allergic asthma, possibly by inducing regulatory T cells and Th1 reaction.

Survivin Impairs the Apoptotic Machinery in CD4+ T Cells of Patients with Ulcerative Colitis.

BACKGROUND: The increase in CD4+ T cell infiltration and overproduction of CD4+ T cell-associated cytokines have been observed in the inflamed colon mucosa of patients with ulcerative colitis (UC); the underlying mechanisms are not fully understood. Survivin plays a critical role in the interference with apoptotic machinery. This study aims to elucidate the role of survivin in the interference with the apoptotic machinery in CD4+ T cells of UC patients. METHODS: Peripheral blood samples were collected from UC patients (UC group) and healthy subjects (healthy group). The apoptotic status in CD4+ T cells was analyzed by flow cytometry. RESULTS: We observed that the expression of survivin was significantly higher in CD4+ T cells of UC patients than in healthy subjects. UC CD4+ T cells were resistant to apoptosis induction. A complex of survivin and c-Myc, the transcription factor of FasL, was detected in CD4+ T cells in UC patients, which prevented the binding of c-Myc to the FasL promoter and interfered with the expression of FasL. Increased expression of survivin prevented the activation-induced CD4+ T cells from apoptosis. CONCLUSIONS: The data indicate that UC CD4+ T cells express high levels of survivin, which impairs the apoptotic machinery in CD4+ T cells and prevents the activation-induced CD4+ T cell apoptosis. Therefore, target therapy against survivin has translational potential in the treatment of UC patients.

Frontline Science: TLR3 activation inhibits food allergy in mice by inducing IFN-γ+ Foxp3+ regulatory T cells.

The pathologic feature of food allergy (FA) is the aberrant Th2-biased immune response in the intestine. Regulatory T cells (Tregs) play an important role in the suppression of aberrant immune response. The activities of the TLRs regulate multiple cell functions. This study aims to investigate the role of TLR3 activation in the regulation of Th2-biased immune response in the intestine by the generation of inducible Tregs (iTregs). In this study, polyinosinic polycytidylic acid (polyI:C) was used as an activator of TLR3. An FA mouse model was developed to establish the Th2-biased inflammation in the intestine. The effects of TLR3 activation on the generation of iTreg were tested in the culture and in mice. We observed that exposure to polyI:C induced IFN-γ+ Foxp3+ iTregs in mouse intestine and in the culture. The IFN-γ+ Foxp3+ iTregs showed immune suppressive functions. Exposure to polyI:C increased T-bet levels in CD4+ T cells. The T-bet formed a complex with GATA3 to dissociate Foxp3 from GATA3/Foxp3 complex in CD4+ T cells. The Foxp3 thus gained the opportunity to move to TGF-ß promoter to generate iTregs. Administration with polyI:C prevented the development of FA and inhibited existing FA. In conclusion, activation of TLR3 induces IFN-γ+ Foxp3+ Tregs, which can prevent FA development and inhibit existing FA in mice.

Priority for Treatment and Intensive Care of Patients With Non-Severe Community-Acquired Pneumonia.

BACKGROUND: The Infectious Disease Society of America/the American Thoracic Society (IDSA/ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality. It is unclear whether the patients with non-severe CAP meeting the minor criteria most strongly associated to mortality should have the priority for treatment and intensive care. It is warranted to explore this intriguing hypothesis. METHODS: A retrospective cohort study of 1230 patients with CAP was performed. This was tested against a prospective 2-center cohort of 1749 adults with CAP. RESULTS: The patients with CAP fulfilling the predictive findings most strongly associated to mortality, i.e. PaO2/FiO2 ≤ 250 mm Hg, confusion, and uremia, showed higher mortality rates than those not fulfilling the predictive findings in subgroup analyses of the retrospective cohort. The more the number of predictive findings present, the higher the mortality rates. The prospective cohort confirmed a similar pattern. Interestingly, the patients with non-severe CAP meeting the predictive findings demonstrated unexpectedly higher mortality rates compared with the patients with severe CAP not meeting the predictive findings in the prospective cohort (P = 0.003), although there only existed death of an uptrend in the retrospective cohort. Two similar and intriguing paradigms about sequential organ failure assessment (SOFA) scores and pneumonia severity index (PSI) scores were confirmed in the 2 cohorts. CONCLUSIONS: The patients with non-severe CAP fulfilling the predictive findings most strongly associated to mortality demonstrated higher SOFA and PSI scores and mortality rates, and might have the priority for treatment and intensive care.

Inhibition of squamous cancer growth in a mouse model by Staphylococcal enterotoxin B-triggered Th9 cell expansion.

Currently, therapy for squamous cancer (SqC) is unsatisfactory. Staphylococcal enterotoxin B (SEB) has strong immune regulatory activity. This study tests the hypothesis that SEB enforces the effect of immunotherapy on SqC growth in a mouse model. C3H/HeN mice and the SqC cell line squamous cell carcinoma VII were used to create an SqC mouse model. Immune cell assessment was performed by flow cytometry. Real-time RT-PCR and western blotting were used to evaluate target molecule expression. An apoptosis assay was used to assess the suppressive effect of T helper-9 (Th9) cells on the SqC cells. The results showed that immunotherapy consisting of SEB plus SqC antigen significantly inhibited SqC growth in the mice. The frequency of Th9 cells was markedly increased in the SqC tissue and mouse spleens after treatment. SEB markedly increased the levels of signal transducer and activator of transcription 5 phosphorylation and the expression of histone deacetylase-1 (HDAC1) and PU.1 (the transcription factor of the interleukin 9 (IL-9) gene) in CD4+ T cells. Exposure to SqC-specific Th9 cells markedly induced SqC cell apoptosis both in vitro and in vivo. In conclusion, the administration of SEB induces Th9 cells in SqC-bearing mice, and theseTh9 cells inhibit SqC growth.

[Immunotherapy with recombinant house dust mite group 2 allergen vaccine inhibits allergic airway inflammation in mice].

OBJECTIVE: To investigate the efficacy and mechanism of subcutaneously given recombinant Der p 2 entrapped PLGA nanoparticles (DEPN) on mouse model with allergic airway inflammation. METHODS: 40 BALB/c mice were randomly divided into 5 groups, group A (normal control) were treated with saline (100 microl) all the time, groups B, C, D and E were sensitized intraperitoneally with crude dust mite extracts (10 microg) and then subcutaneously treated respectively with PBS (100 microl), 2 mg empty PLGA (EP), 100 microg rDerp2, and 2 mg DEPN (loaded with 100 microg rDerp 2) for 3 times, once per day, followed by intranasal challenge of 50 microg rDer p 2. One day post challenge, mice were sacrificed and bronchoalveolar lavage fluid (BALF) was collected. Number of the total cells and eosinophils was determined, and airway inflammation and mucus secretion were analyzed by haematoxylin and eosin (H&E) staining and periodic acid-Schiff (PAS) staining. Level of cytokines in the supernatant of splenocyte culture was assayed by ELISA. Level of rDer p 2 specific IgG2a and IgE in the sera was determined by ELISA. RESULTS: The lung histology showed development of eosinophil infiltration in the airway of mice in groups B and C. The lung inflammation and mucus secretion in groups D and E were significantly alleviated than that of groups B and C. Number of total cells (63.50+/-5.12) and eosinophils (15.32+/-3.04) in BALF decreased in group B. Compared with group B, the number of total cells in groups D (55.3+/-5.20) x 10(4) /ml and E (41.00+/-4.91) x 10(4)/ml greatly decreased (P<0.05), and same with that of eosinophils in groups D (9.56+/-1.09) x 10(4) /ml and E (3.22+/-0.31) x 10(4)/ml. The rDerp 2 specific IgE and IgG2a antibodies in group B were 1.14+/-0.105 and 0.14+/-0.07 respectively. The level of specific IgE was significantly lower (P<0.01) in groups D (0.93+/-0.04) and E (0.77+/-0.09), and that of IgG2a in groups D (1.02+/-0.01) and E (1.17+/-0.46) were significantly higher (P<0.01) than that in group B. The level of IL-4 and IFN-gamma in BALF in group B were (78.90+/-6.07) pg/ml and (27.30+/-3.51) pg/ml respectively. IL-4 in groups D and E was (55.6+/-3.79) pg/ml and (48.6+/-4.50)pg/ml respectively, significantly lower (P<0.01) than that of group B; while IFN-gamma (68.50+/-2.87) pg/ml in group E was significantly higher than that of group B (P<0.01). IL-4 released from cultured splenocytes in groups D and E was (56.30+/-4.85) pg/ml and (40.20+/-4.36) pg/ml respectively, significantly lower than that in group B (81.2+/-6.84 pg/ml) (P<0.01). The released IFN-gamma in group E was (70.20+/-3.85) pg/ml, significantly higher than in group B (34.60+/-2.25) pg/ml (P<0.01). CONCLUSION: DEPN can inhibit airway allergic inflammation, its mechanism may be relevant to a balance of Th1 and Th2.

Interaction of TIM4 and TIM3 induces T helper 1 cell apoptosis.

The T helper 1 (Th1) polarization plays a critical role in the pathogenesis of a number of inflammatory disorders in the body; the remedies in the correction of polarized Th1 cells are limited. This study aims to investigate the role of T cell immunoglobulin mucin domain molecule 4 (TIM4) in the induction of Th1 cell apoptosis. In this study, polarized Th1 cells were generated from naive Th1 cells from the mouse spleen. Recombinant TIM4 was added to the culture to stimulate the polarized Th1 cells. The apoptosis of Th1 cells was assessed by flow cytometry. The expression of FasL was analyzed by chromatin immunoprecipitation, real time RT-PCR, and Western blotting. The results showed that the polarized Th1 cells expressed high levels of TIM3. After exposure of the polarized Th1 cells to TIM4 in the culture, a complex of TIM3 and TIM4 was detected on the surface of Th1 cells, which induced the Th1 cell apoptosis. The engagement of TIM3 by TIM4 increased p300 phosphorylation in Th1 cells, which further increased the levels of Fas ligand in the cells and induced Th1 cell apoptosis. In conclusion, TIM4 binds TIM3 on the surface of polarized Th1 cells to induce Th1 cell apoptosis, which may contribute to the development of Th2-dominant immune disorders.

Thrombospondin 1 Modulates Monocyte Properties to Suppress Intestinal Mucosal Inflammation.

Monocytes (Mos) play an important role in the pathogenesis of intestinal mucosal inflammation. This study aims to investigate the mechanism by which the intestinal epithelial cell-derived thrombospondin 1 (TSP1) modulates Mo properties and regulates intestinal inflammatory responses. In this study, the production of TSP1 by intestinal epithelial cells was evaluated by quantitative real-time PCR and Western blotting. The properties of Mos were analyzed by flow cytometry. A mouse model of colitis was created to assess the role of epithelium-derived TSP1 in the suppression of intestinal inflammation. The results demonstrated that mouse intestinal epithelial cells (IECs) expressed TSP1, which was markedly upregulated by butyrate or feeding with Clostridium butyricum. Coculture of the butyrate-primed IECs and Mos or exposure of Mos to TSP1 in the culture induced the expression of transforming growth factor (TGF)-ß in Mos. These TGF-ß+ Mos had tolerogenic properties that could promote generation of inducible regulatory T cells. Adoptive transfer with TSP1-primed Mos, or feeding C. butyricum could prevent experimental colitis in mice. In summary, C. butyricum induces intestinal epithelial cells to produce TSP1 and induces TGF-ß+ Mos, which further suppress experimental colitis in mice. The results implicate that the administration of C. butyricum or butyrate may have the potential to ameliorate chronic intestinal inflammation through inducing immunosuppressive Mos.