Selective development of a strong Th2 cytokine profile in high-risk children who develop atopy: risk factors and regulatory role of IFN-gamma, IL-4 and IL-10.

BACKGROUND: The immunological processes in early life and their relation to allergic sensitization leading to a Th2 cytokine profile are still not well understood. OBJECTIVE: To analyse the environmental and genetic risk factors and immunological responses at birth in relation to the development of atopic disease at 12 months of age in a longitudinal study of high-risk children. METHODS: High-risk children were followed from birth till 12 months of age. Mononuclear cells obtained at birth and 6 and 12 months thereafter were analysed for their proliferative and cytokine responses after polyclonal and allergen-specific stimulation. RESULTS: At 12 months of age 25% children had developed an atopic disease. Two atopic parents, parental smoking and atopic dermatitis of at least one of the parents were significant risk factors. In cord blood of newborns who developed atopy, an increased percentage of CD4+CD45RO+ cells and an increased polyclonal-stimulated proliferation were observed. Furthermore, an impaired allergen-induced, but not polyclonal-stimulated IFN-gamma production was found, suggesting a regulatory defect. At 6 and 12 months of age, a strong Th2 profile (characterized by increased levels of IL-4, IL-5, and IL-13) after both polyclonal and, to a lesser extent, allergen-specific stimulation was found in the children developing atopy. Allergen-induced IL-10 production at 12 months of age was only observed in the non-atopic children. CONCLUSION: Our data indicate that the first 6 months of life represent a critical time window for the initiation of immunological changes resulting in the development of atopy. The selective development of a Th2 cytokine profile in high-risk children who develop atopy is due to increased production of Th2 cytokines, possibly caused by impaired allergen-induced IFN-gamma production in the neonatal period. Furthermore, the decreased allergen-induced IL-10 levels observed in the atopic children at 12 months of age may result in a lack of down-regulation of the inflammatory process.

Markers for early sensitization and inflammation in relation to clinical manifestations of atopic disease up to 2 years of age in 133 high-risk children.

BACKGROUND: The combination of genetic susceptibility and environmental factors induce allergic sensitization and subsequently local inflammation, resulting in atopic manifestations. OBJECTIVE: To examine whether immunological features reflecting sensitization (total and specific IgE levels, allergen-induced proliferative responses and skin tests) and markers of inflammation (plasma sE-selectin and blood eosinophils) are related to the clinical expression of atopy and whether they precede atopic disease in children up to 2 years of age. METHODS: The development of these markers during the first 2 years of life was studied prospectively in 133 newborns at high risk to develop atopic disease. RESULTS: The prevalence of atopic disease increased from 25% at 12 months to 32% at 24 months of age. The children with food allergy at 12 months, who all had atopic dermatitis (AD), turned out to have asthma-like disease in 40% and AD in 100% at the age of 24 months. Total IgE levels increased with time and from 12 months onward levels started to differ markedly between atopics and nonatopics. Food-specific IgE antibodies were significantly associated with AD (relative risk [RR] = 2.39), food (RR = 1.32) and upper-airway allergy (RR = 1.20), and house dust mite-specific IgE antibodies with upper-airway allergy (RR = 5.00). A positive skin test was significantly associated with AD (RR = 2.90) and food allergy (RR = 1.36). The inflammation markers investigated, were not related to the clinical expression or preceded atopic disease at 2 years of age in high-risk children. CONCLUSION: Positive skin tests and specific IgE to food or inhalant allergens were related to the clinical expression of different atopic diseases. The combination of AD and food allergy at 12 months reflected the strongest risk factor in this high risk cohort for the development of asthma-like disease at 24 months of age.

Differential mRNA expression and production of interleukin-4 and interferon-gamma in stimulated peripheral blood mononuclear cells of house-dust mite-allergic patients.

Optimal culture conditions were established for the analysis of interleukin-4 (IL-4) and interferon-gamma (IFN-gamma) mRNA expression and protein production, as well as proliferative capacity of peripheral blood mononuclear cells (PBMC). These culture conditions permitted the analysis of differences in the responses of house-dust mite (HDM) allergic patients and healthy controls after polyclonal and allergen-specific stimulation. Proliferative responses were optimal when PBMC were cultured in RPMI, whereas for studying mRNA expression by RT-PCR and protein production by ELISA, PBMC should be stimulated in Yssels's medium. Blood holding period influenced the cytokine mRNA expression and proliferative capacity of primarily the unstimulated cells. It is thus crucial to isolate PBMC as soon as possible, and in any event no later than 7 hours after blood collection. Proliferative responses to Dermatophagoides pteronyssinus-extract were observed in HDM allergic patients (mean stimulation index (SI) = 5.3+/-0.75), but not in non-allergic subjects (mean SI = 2.3+/-0.21). After D. pteronyssinus-specific stimulation, IL-4 mRNA expression was significantly (p = 0.03) increased in HDM-allergic subjects compared to non-allergic subjects. No significant differences were found in IFN-gamma mRNA expression between HDM-allergic and non-allergic subjects. Both IFN-gamma (p = 0.04) and IL-4 (p = 0.06) protein production were increased after D. pteronyssinus-specific stimulation in HDM-allergic subjects compared to non-allergic subjects. Our data suggest activation of both Th1 and Th2-like cells, as well as CD8+ T cells in allergic patients. Furthermore, analysis of possible functional differences in PBMC between allergic and non-allergic patients, necessitates polyclonal and allergen-specific stimulation of PBMC. Moreover, proliferative responses as well as cytokine mRNA expression and protein production should be studied under optimal culture conditions to highlight the often subtle differences.

Soluble E-selectin, other markers of inflammation and disease severity in children with atopic dermatitis.

E-selectin, P-selectin, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) are membrane-bound adhesion molecules which mediate the attachment of leucocytes to endothelial cells. These molecules are preferentially expressed on activated endothelium. The soluble forms of these molecules (sE-selectin, sP-selectin, sICAM-1 and sVCAM-1) are present in the circulation as a result of shedding. Some of the soluble adhesion molecules have been thought to reflect disease activity in atopic dermatitis (AD). To evaluate their potential to reflect disease activity in AD, we correlated their plasma concentration with clinical severity measured by objective SCORAD (SCORing Atopic Dermatitis). Furthermore, levels of total IgE, specific IgE, and eosinophil cationic protein (ECP) were determined. SCORAD and sE-selectin levels were significantly increased in children with specific IgE for both food and inhalation allergens (P < 0.05). ECP consistently showed an increase with the scores of SCORAD, but no statistical significance was reached. Disease activity was significantly correlated with the plasma levels of sE-selectin (rs = 0.6, P < 0.0005) but not with sP-selectin, sICAM-1 and sVCAM-1. This agrees with recent studies performed in adults with AD, and supports the potential of sE-selection as a parameter for monitoring disease activity in young children with AD.

CD4+ cells proliferate after peanut-extract-specific and CD8+ cells proliferate after polyclonal stimulation of PBMC of children with atopic dermatitis.

BACKGROUND: Few studies describe in vitro food-allergen induced proliferative responses and cytokine production of PBMC of children with atopic dermatitis. This is especially true for peanut-allergen. OBJECTIVES: To analyse the specificity of the T cell in proliferative responses, in children with atopic dermatitis with or without peanut allergy and healthy age-matched children. METHODS: Proliferative responses were measured by [3H]-thymidine incorporation and by expression of the intracellular Ki67-antigen using flow cytometry after antigen-specific stimulation of PBMC with peanut-extract (day 7) or polyclonal stimulation with Phorbol-12myristate-13acetate and Ca-ionophore (day 3). Cytokine mRNA (Interferon-gamma (IFNgamma), IL-4) was detected by semiquantitative RT-PCR. Cytokine production (IL-4, IFNgamma) was measured by ELISA. RESULTS: Peanut-extract induced proliferative responses of PBMC from children with atopic dermatitis and peanut allergy (AD+PA+) were significantly higher as compared with the other groups studied. Ki67-antigen double staining revealed that 80-100% of the proliferating cells were CD4+. These proliferative responses correlated significantly with the increase in IL-4 mRNA expression after peanut-extract specific stimulation. After polyclonal stimulation, however, CD8+ cells preferentially proliferated. The degree of proliferation after polyclonal stimulation correlated inversely with the ratio of IL-4/IFNgamma production. CONCLUSIONS: The principal responding population of T cells in proliferative responses is different after peanut-extract specific and polyclonal stimulation of PBMC from AD+PA+ patients. Furthermore, we found indirect evidence that the PBMC fraction of AD+PA+ children contains increased frequencies of peanut-specific T helper-2 cells.

Levels of soluble intercellular adhesion molecule-1, soluble E-selectin, tumor necrosis factor-alpha, and soluble tumor necrosis factor receptor p55 and p75 in atopic children.

During inflammation, membrane expression of adhesion molecules and tumor necrosis factor (TNF)-receptors (TNF-R) are increased, and soluble forms of these molecules are released. This study analyzed plasma levels of sICAM-1 and sE-selectin as well as TNF-alpha, sTNF-R55, and sTNF-R75 in nonallergic (NAA) and allergic asthma patients (AA), atopic dermatitis patients (AD), and healthy children (HC) by ELISA. Plasma levels of sICAM-1, sE-selectin, and sTNF-R, but not TNF-alpha, were detectable, but were not significantly different between the patient groups and healthy children. In the AA group, a significant correlation (rs = 0.78, P = 0.008) was found between sICAM-1 and sE-selectin levels. Furthermore, a significant correlation was found between sTNF-R55 and sTNF-R75 levels in the AA group (rs = 0.70, P = 0.025) and in the AD group (rs = 0.69, P = 0.027). In AD patients, a significant correlation was observed between sE-selectin and the disease severity, as measured by the SCORAD index (rs = 0.73, P = 0.038). Our data demonstrate that plasma levels of sICAM-1, sE-selectin, TNF-alpha, sTNF-R55, and sTNF-R75 were not different between atopic and nonatopic children during a stable phase of the disease. In AD patients, levels of sE-selectin seemed to be related to clinical severity of the disease.