Double-Stranded Structure of the Polyinosinic-Polycytidylic Acid Molecule to Elicit TLR3 Signaling and Adjuvant Activity in Murine Intranasal A(H1N1)pdm09 Influenza Vaccination.

Polyinosinic-polycytidylic acid (PIC) is a potent double-stranded RNA (dsRNA) adjuvant useful in intranasal influenza vaccination. In mice, the intensity and duration of immune responses to PIC correlated with the double-stranded chain length. A rational method to avoid PIC chain extension in PIC production is to use multiple short poly(I) molecules and one long poly(C) molecule for PIC assembly. In this study, we elucidate that a newly developed uPIC100-400 molecule comprising multiple 0.1 kb poly(I) molecules and one 0.4 kb poly(C) molecule effectively enhanced the immune responses in mice, by preventing the challenged viral propagation and inducing hemagglutinin-specific IgA, after intranasal A(H1N1)pdm09 influenza vaccination. Reduced intraperitoneal toxicity of PIC prepared with multiple short poly(I) molecules in mice indicates the widened effective range of uPIC100-400 as an adjuvant. In contrast to uPIC100-400, the PIC molecule comprising multiple 0.05 kb poly(I) molecules failed to elicit mouse mucosal immunity. These results were consistent with TLR3 response but not retinoic acid inducible gene I (RIG-I)-like receptor response in the cell assays, which suggests that the adjuvant effect of PIC in mouse intranasal immunization depends on TLR3 signaling. In conclusion, the double-stranded PIC with reduced toxicity developed in this study would contribute to the development of PIC-adjuvanted vaccines.

Fractional Laser-Assisted Topical Imiquimod 5% Cream Treatment for Recalcitrant Common Warts in Children: A Pilot Study.

BACKGROUND: Conventional treatments for warts like cryotherapy are limited by the pain during procedures, especially in pediatric patients. Imiquimod is a topical immune response modifier, but the thick stratum corneum of common warts prevents drug permeation through skin. OBJECTIVE: To evaluate the efficacy and safety of fractional laser/topical 5% imiquimod cream for the treatment of warts in children. METHODS: Eleven pediatric patients with multiple recalcitrant common warts were included. Lesions were treated using an ablative fractional 2,940-nm Er:YAG laser at 1- or 2-week interval. After each laser treatment session, imiquimod 5% cream was self-applied once daily 5 days a week. Response and adverse effects were assessed 2 weekly until complete clearance or up to maximum of 48 weeks. Pain during fractional laser was assessed using a visual analogue scale (0-10). RESULTS: Eight of the 11 (72.7%) children experienced complete clearance. Mean duration was 29.7 (16-48) weeks, and the mean number of fractional laser was 17.5 (8-37). No significant adverse effect was observed. Pain visual analogue scale during fractional laser was 2.4 (1-4) compared to 6.2 (5-8) during cryotherapy. CONCLUSION: This pilot study indicates that fractional laser-assisted topical imiquimod may provide benefit for recalcitrant warts in children.

Polymeric nanoparticles for co-delivery of synthetic long peptide antigen and poly IC as therapeutic cancer vaccine formulation.

The aim of the current study was to develop a cancer vaccine formulation for treatment of human papillomavirus (HPV)-induced malignancies. Synthetic long peptides (SLPs) derived from HPV16 E6 and E7 oncoproteins have been used for therapeutic vaccination in clinical trials with promising results. In preclinical and clinical studies adjuvants based on mineral oils (such as incomplete Freund's adjuvant (IFA) and Montanide) are used to create a sustained release depot at the injection site. While the depot effect of mineral oils is important for induction of robust immune responses, their administration is accompanied with severe adverse and long lasting side effects. In order to develop an alternative for IFA family of adjuvants, polymeric nanoparticles (NPs) based on hydrophilic polyester (poly(d,l lactic-co-hydroxymethyl glycolic acid) (pLHMGA)) were prepared. These NPs were loaded with a synthetic long peptide (SLP) derived from HPV16 E7 oncoprotein and a toll like receptor 3 (TLR3) ligand (poly IC) by double emulsion solvent evaporation technique. The therapeutic efficacy of the nanoparticulate formulations was compared to that of HPV SLP+poly IC formulated in IFA. Encapsulation of HPV SLP antigen in NPs substantially enhanced the population of HPV-specific CD8+ T cells when combined with poly IC either co-encapsulated with the antigen or in its soluble form. The therapeutic efficacy of NPs containing poly IC in tumor eradication was equivalent to that of the IFA formulation. Importantly, administration of pLHMGA nanoparticles was not associated with adverse effects and therefore these biodegradable nanoparticles are excellent substitutes for IFA in cancer vaccines.

Efficacy of combination therapy of oral zinc sulfate with imiquimod, podophyllin or cryotherapy in the treatment of vulvar warts.

AIM: Zinc sulfate is beneficial in the treatment of epithelial warts. We conducted this study to compare the efficacy of combination therapy of oral zinc sulfate with conventional treatments in the treatment of vulvar warts. MATERIAL AND METHODS: This study was a randomized controlled trial. The sample size was 42 in each group. Women aged 20-50 years were placed by the block randomized method into six groups: the podophyllin-, imiquimod- and cryotherapy-treated groups, and another three groups receiving 8-week combination therapy of 400 mg oral zinc sulfate with one of the above-mentioned treatments. Data were analyzed using anova and Fischer's exact test with spss16. RESULTS: A total of 228 patients were recruited and completed the study in six treatment groups. No significant difference was observed in the response to treatment among these groups. Relapse after 6 months was significantly higher in the podophyllin-, imiquimod- and cryotherapy-treated patients compared to patients receiving these treatments in combination with oral zinc sulfate (P<0.05). CONCLUSIONS: Combined therapy of oral zinc sulfate with conventional treatments of vulvar warts appears to reduce the relapse rate.

[Syndrome "sickly child"].

Scientific review is devoted to the urgent problem of child health care--Syndrome "sickly child" described in detail the category of "frequently ill children" repeated respiratory diseases, the pathogens that cause diseases of the respiratory tract. Paying attention to factors contributing to re-respiratory morbidity, including genetically determined causes (disturbances in the state of health of the mother), is represented by the genetic determinism of repeated and recurrent diseases related to blood groups. The development of an immune imbalance is manifested by changes in the cellular, humoral immune response and nonspecific resistance factors characterizing the changes of local immunity in this category of children that shape the development of chronic disease. We describe the effect of an allergic component to the severity of respiratory disease and the relationship with the mechanisms of neuroendocrine and immune systems. Correction of the immune resistance of sickly children was conducted cycloferon contributing to reduce the incidence and duration of repeated episodes of acute respiratory infections per year.

[Influence of immunotropic preparation cycloferon and phytopreparations of Cynara scolimus L. on blood cytokines profile of the patients with chronic viral hepatitis C in medical rehabilitation period].

The effect of the immunotropic drug cycloferon and herbal medicine resources on the basis of Cynara scolimus L. on the blood cytokine profile in the patients with chronic viral hepatitis C (CVHC) in medical rehabilitation (MR) period. Established that prior to MR period in the patients with CVHC was noted significantly increased levels of proinflammatory cytokines (CK) at the blood serum, and the level of antiinflammatory CK changed significantly. The use of cycloferon and herbal medicine resources on the basis of Cynara scolimus L. in the MR complex provided to normalize the studied CK concentration in the serum of the patients with CVHC.

Novel antiviral therapeutics to control foot-and-mouth disease.

Foot-and-mouth disease virus (FMDV) causes a highly contagious disease of cloven-hoofed animals. Vaccines require ∼7 days to induce protection; thus, before this time, vaccinated animals are still susceptible to the disease. Our group has previously shown that swine inoculated with 1×10(11) focus forming units (FFU) of a replication-defective human adenovirus containing the gene for porcine interferon alpha (Adt-pIFN-α) are sterilely protected from FMDV serotypes A24, O1 Manisa, or Asia 1 when the animals are challenged 1 day postadministration, and protection can last for 3-5 days. Polyriboinosinic-polyribocytidylic acid stabilized with poly-l-lysine and carboxymethyl cellulose (poly ICLC) is a synthetic double-stranded RNA that is a viral mimic and activates multiple innate immune pathways through interaction with toll-like receptor 3 and MDA-5. It is a potent inducer of IFNs. In this study, we initially examined the effect of poly IC and IFN-α on FMDV replication and gene induction in cell culture. Poly ICLC alone or combined with Adt-pIFN-α was then evaluated for its therapeutic efficacy in swine against intradermal challenge with FMDV A24, 1 day post-treatment. Groups of swine were subcutaneously inoculated either with poly ICLC alone (4 or 8 mg) or in combination with different doses of Adt-pIFN-α (2.5×10(9), 1×10(9), or 2.5×10(8) FFU). While different degrees of protection were achieved in all the treated animals, a dose of 8 mg of poly ICLC alone or combined with 1×10(9) FFU of Adt-pIFN-α was sufficient to sterilely protect swine when challenged 24 h later with FMDV A24. IFN-stimulated gene (ISG) expression in peripheral blood mononuclear cells at 1 day post-treatment was broader and higher in protected animals than in nonprotected animals. These data indicate that poly ICLC is a potent stimulator of IFN and ISGs in swine and at an adequate dose is sufficient to induce complete protection against FMD.

The role of imiquimod 3.75% cream in the treatment of external genital warts.

Imiquimod 3.75% cream has recently been approved by both the U.S. Federal Drug Administration and Health Canada for the treatment of external genital warts. Herein, we provide an overview of external genital warts, review the phase 3 clinical trials leading to the approval of imiquimod 3.75% cream, and compare its efficacy and clinical use with imiquimod 5% cream. Moreover, therapeutic options have further expanded with the relatively recent introduction of sinecatechins 15% ointment, an extract of green tea leaves.

[Monitoring of side effects and estimation of cycloferon efficacy in treatment of children with frequent and prolonged diseases].

Two hundred fifty patients, including 100 children with frequent and prolonged diseases at the age of 4 to 7 years, 76 children at the age of 7 to 18 years and 74 subjects at the age of 22 to 57 years were observed. The patients were treated with cycloferon in two courses with a 2-week interval according to the standard scheme. The tonsil surface microflora and its susceptibility to antibiotics were determined. Cycloferon lowered the Staphylococcus aureus titre and increased the culture susceptibility to benzylpenicillin, oxacillin, rifampicin, and erythromycin, reducing the variety of the fauces nonpathogenic microflora. The use of cycloferon induced no adverse (pathologic) reactions in 94.8% of the cases. In 4.4% of the children under school age the adverse reactions were transitory and did not require discontinuation of the drug use. Unforeseen reactions were recorded in 0.8% of the children and the use of the drug in them was discontinued. The use of cycloferon in two courses with a 2-week interval according to the standard scheme is recommended for prophylaxis of acute respiratory diseases in the group of children with frequent and prolonged diseases during epidemiologically unfavourable periods and for complex therapy of rhinopharinx infections as an agent increasing efficacy of other antibacterials.

[Characteristics of immune response to etiotropic and pathogenetic therapy in children with chronic hepatitis C].

Features of the immune response of children with chronic hepatitis C to the antiviral and pathogenetic therapy have been studied. It is shown that the antiviral therapy is accompanied by stimulation of the immune response as manifested by the synthesis of cytokines (IL-4, IFN-alpha, IFN-gamma) with retention of increased production of IFN-a for more than two years after the end of the course of treatment. In children that previously received interferon inductor (cycloferon) for 12 months, high level of IFN-a production is retained, which ensures antiviral protection. Phytotherapy did not influence the production of cytokines.

The sickness behaviour and CNS inflammatory mediator profile induced by systemic challenge of mice with synthetic double-stranded RNA (poly I:C).

Poly inosinic:poly cytidylic acid (poly I:C) is a synthetic double-stranded RNA and is a ligand for the Toll like receptor-3. This receptor is involved in the innate immune response to viral infection and poly I:C has been used to mimic the acute phase of a viral infection. The effects of TLR3 activation on brain function have not been widely studied. In the current study we investigate the spectrum of sickness behavioural changes induced by poly I:C in C57BL/6 mice and the CNS expression of inflammatory mediators that may underlie this. Poly I:C, at doses of 2, 6 and 12 mg/kg, induced a dose-responsive sickness behaviour, decreasing locomotor activity, burrowing and body weight, and caused a mild hyperthermia at 6h. The 12 mg/kg dose caused significant hypothermia at later times. The Remo400 remote Telemetry system proved a sensitive measure of this biphasic temperature response. The behavioural responses to poly I:C were not significantly blunted upon a second poly I:C challenge either 1 or 3 weeks later. Plasma concentrations of IL-6, TNF-alpha and IFN-beta were markedly elevated and IL-1 beta was also detectable. Cytokine synthesis within the CNS, as determined by quantitative PCR, was dominated by IL-6, with lesser inductions of IL-1 beta, TNF-alpha and IFN-beta and there was a clear activation of cyclooxygenase-2 at the brain endothelium. These findings demonstrate clear CNS effects of peripheral TLR3 stimulation and will be useful in studying aspects of the effects of systemic viral infection on brain function in both normal and pathological situations.

[Actinic keratosis]. / Krebsvorstufe aktinische Keratose. So erkennen Sie gefährliche Sonnenschäden.

Actinic keratosis is a precancerous lesion that is commonly seen in the elderly patient and requires treatment. It shows a predilection for areas of the skin that are exposed to the sun, and usually manifests as multiple skin-colored or discrete reddish scaly verrucous plaques. The diagnosis is usually based on the clinical appearance of the lesion. Therapeutic options include physical, immunological and chemical measures. The choice of treatment is determined by numerous factors, and can be adapted to the individual situation presenting.

[Non-surgical therapy of basal cell carcinoma of the head-neck region]. / Nichtoperative Therapie von Basalzellkarzinomen der Kopf-Hals-Region.

Basal cell carcinoma is a semi-malignant epithelial skin tumour with a locally destructive growth pattern but a very low tendency to metastases. Basal cell carcinoma represent the most frequent malignant cutaneous tumour worldwide in white population with a lifetime risk of 30 % and still increasing incidence. Lifetime cumulative UV-exposure, as well as frequent sunburns are the most common exogeneous risk factors, others are ionising radiation, exposure to chemical carcinogens, genetic predisposition, and chronic immunosuppression. Basal cell carcinoma are predominantly located in the central region of the face. The characteristic clinical feature is a single nodule with multiple teleangiectasia, as well as an irregular shaped ulceration with and elevated border. The very rarely observed occurrence of metastases seems to be a result of insufficient therapy or a metatypic basal cell carcinoma type. Therapy of first choice of basal cell carcinoma is the complete, micrographically controlled excision. In addition, radiotherapy, topical immunotherapy with Imiquimod or photodynamic therapy may be considered as therapeutic alternatives in selected cases.

[Interferon-inducing properties of dry birch bark extract and its effect on experimental infection caused by hepatitis C virus].

The interferon-inducing activity of dry birch bark extract containing betulin and its effect on hepatitis C virus (HCV)-induced infection were studied in the cultured cells. All samples of the extract induced increased interferon (IFN) production when it was orally and intraperitoneally administered. The dose-dependence of the production of IFN showed a direct relation of the extract to interferon induction. There is strong evidence for that the extract can decrease the antigenic and infective activity of HCV in both in vitro experiments and HCV-induced infection in mice. The preventive effect of the extract was found in both the HCV-infected cell cultures and the HCV-infected mice.

The anti-tetanus immune response of neonatal mice is augmented by retinoic acid combined with polyriboinosinic:polyribocytidylic acid.

Neonates are highly susceptible to infectious diseases and, in general, respond poorly to conventional vaccines due to immaturity of the immune system. In the present study, we hypothesized that the anti-tetanus toxoid (TT) vaccine response of neonatal mice could be enhanced by retinoic acid (RA), a bioactive retinoid, and polyriboinosinic:polyribocytidylic acid (PIC), an inducer of IFN. Early-life treatments with RA and/or PIC were well tolerated and stimulated both primary anti-TT IgG production in infancy and the memory response in adulthood. TT-specific lymphocyte proliferation and type 1/type 2 cytokine production were also significantly augmented. In addition, RA and PIC modulated the maturation and/or differentiation of neonatal B cells, natural killer (NK)/NKT cells, and antigen-presenting cells. Although RA alone increased the neonatal anti-TT antibody response, it selectively increased anti-TT IgG1 and IL-5, resulting in a skewed type 2 response. PIC, a potent adjuvant in adult mice, elevated neonatal anti-TT IgG as well as all IgG isotypes (IgG1, IgG2a, and IgG2b) and induced TT-specific IFN-gamma, an important type 1 cytokine; however, PIC alone failed to benefit the memory response. The combination of RA plus PIC was more potent than either agent alone in elevating primary and secondary anti-TT IgG responses as well as IgG isotypes. Moreover, RA plus PIC increased TT-specific IFN-gamma and IL-5, suggesting the combination effectively promoted both type 1 and type 2 responses in neonatal mice. Thus, RA combined with PIC, a nutritional-immunological intervention, seems promising as an adjuvant for early-life vaccination.

Treatment of patch and plaque stage mycosis fungoides with imiquimod 5% cream.

BACKGROUND: Systemic interferon is effective in the treatment of mycosis fungoides (MF). Imiquimod is effective in the treatment of some epidermal neoplasms and induces localized interferon production. OBJECTIVE: To evaluate the safety and efficacy of topical imiquimod 5% cream for the treatment of patch and plaque stage MF. METHODS: Six patients with stage IA to IIB MF were treated with topical imiquimod 5% cream 3 times per week for 12 weeks in this open label pilot study. Index lesions were biopsied pre- and post- treatment, and up to 4 additional treated lesions were monitored for 16 weeks. RESULTS: Three of 6 patients had histologic clearance of disease in index lesions, and also demonstrated significant improvement in the clinical scores for all treated lesions. A fourth patient had 2 of 4 lesions respond clinically. Application site reactions were limited to those patients responding to treatment. CONCLUSION: In this preliminary open label study topical imiquimod 5% cream was well tolerated and associated with a histologic and clinical response rate of 50%.

Evaluation of the effectiveness of imiquimod and 5-fluorouracil for the treatment of actinic keratosis: Critical review and meta-analysis of efficacy studies.

BACKGROUND: Actinic keratosis lesions occur frequently on sun-exposed skin of Caucasians. They become more prevalent with advancing age and are important in identifying the risk factor of those people possibly predisposed to invasive squamous cell carcinoma. Topical therapies are useful alternatives to cryotherapy for treating diffuse actinic damage and a number of preparations have been developed for treating actinic keratosis. OBJECTIVES: A cumulative meta-analysis was performed to determine the efficacy of imiquimod 5% cream, which presents a new alternative topical therapy for actinic keratosis, and to compare it to 5-fluorouracil for the treatment of actinic keratosis lesions of the face and scalp. METHODS: We searched MEDLINE (1966 to October 2004) for relevant studies evaluating the efficacy of actinic keratosis topical agents imiquimod and 5-fluorouracil (0.5%, 1%, and 5%). Studies included in this meta-analysis required a dosage regimen that was not significantly different from that approved by Health Canada and the U.S. FDA. Studies also required a well-defined treatment duration and followup period, with the primary efficacy variable being the complete (100%) clearance of all actinic keratosis lesions defined as the proportion of patients at followup with no clinically visible lesions in the treatment area. To determine the average efficacy rate for both drugs, the data from each study were combined for that drug. RESULTS: Ten studies were included in the analysis. The average efficacy rate for each drug (with 95% confidence interval) was 5-fluorouracil, 52 +/- 18% (n = 6 studies, 145 subjects) and imiquimod, 70 +/- 12% (n = 4 studies, 393 subjects). CONCLUSIONS: The results of this meta-analysis show that both imiquimod and 5-fluorouracil are effective methods for the treatment of actinic keratosis and provide a useful alternative to cryotherapy. However, this analysis suggests that imiquimod may have higher efficacy than 5-fluorouracil for actinic keratosis lesions located on the face and scalp and therefore provides another option to dermatologists.

[Intraocular correction of aphakia in patients after kidney transplantation]. / Intraokuliarnaia korrektsiia afakii u bol'nykh, perenesshikh transplantatsiiu pochki.

It was for the first time in the ophthalmologic practice that a possibility was demonstrated to ensure relatively high and stable functional results, in a significant number of patients with transplanted kidney (TK), related with different-type cataract extraction and with implantation of a variety of PMMA IOLs, i.e. model of B.A. Alexeev, "Storz" company models made from domestic and foreign-made PMMA and domestic-silicone models (P = 70). It was established that IOL implantation in patients with TK is possible in all cases provided the kidney transplant is compensated for and there are no foci of acute or chronic inflammation in the body. A minimal trauma caused by surgery and the suggested scheme of postoperative management (intramuscular injections of antibiotics and supplementary administration of solutions of poludan, naclof, catachrom and actovegin-gel made alongside with routine instillations) cuts the risk of infectious-and-inflammatory as well as of degenerative-and-dystrophic complications in patients with TK receiving the suppressor therapy. Clinical examinations denoted that the intraocular aphakia correction in patients with TK is a method of choice accelerating the medical and social rehabilitation in the discussed patients' category provided the therapeutic-and-diagnostic as well as preventive measures, as required by their status, are being taken.

[Use of cycloferon in a combined treatment of chlamydial conjunctivitis]. / Primenenie preparata tsikloferona pri kompleksnom lechenii khlamidiinogo kon"iunktivita.

A high therapeutic efficiency of cycloferon, an interferon inductor, was demonstrated when it is combined with antibiotics in the treatment of chlamidial conjuctivitis. The use of the mentioned drug for acute chlamidial conjuctivitis prevents relapses.