Development of high-throughput methods to quantify cysts of Toxoplasma gondii.

Toxplasma is a protozoan parasite, which forms persistent cysts in tissues of chronically infected animals and humans. Cysts can reactivate leading to severe pathologies. They also contribute to the transmission of Toxoplasma infection in humans by ingestion of undercooked meat. Classically, the quantification of cyst burden in tissues uses microscopy methods, which are laborious and time consuming. Here, we have developed automated protocols to quantify cysts, based on flow cytometry or high-throughput microscopy. Brains of rodents infected with cysts of Prugniaud strain were incubated with the FITC-Dolichos biflorus lectin and analyzed by flow cytometry and high-throughput epifluorescence microscopy. The comparison of cyst counts by manual epifluorescence microscopy to flow cytometry or to high-throughput epifluorescence microscopy revealed a good correlation (r = 0.934, r = 0.993, P < 0.001 respectively). High-throughput epifluorescence microscopy was found to be more specific and sensitive than flow cytometry and easier to use for large series of samples. This reliable and easy protocol allow the specific detection of Toxoplasma cysts in brain, even at low concentrations; it could be a new way to detect them in water and in contaminate food.

Differences in circulating dendritic cell subtypes in peripheral, placental and cord blood in African pregnant women.

Dendritic cells (DC) are important for induction of primary immune responses and immunological tolerance. Changes in the frequency of DC subsets were analyzed in peripheral blood from pregnant women (mPB) and compared to placental blood (PB) and cord blood (CB). DCs were identified by flow cytometry in whole blood as lineage negative and HLA-DR-positive cells. Different DC subtypes were identified with CD123 and CD11c markers. In these data, the percentage of DC was significantly lower in mPB, PB and CB than in control women, but the absolute number of DC was higher in CB, suggesting that numbers of DC in CB do not explain the decrease of the immune response in newborn infants. Myeloid DCs (MDC) decreased in all compartments of pregnant women compared to control women, especially in mPB where MDC became lower than lymphoid DCs. An increase of less differentiated DC was observed in mPB and CB from pregnant women. DCs in pregnant women were mainly immature DC with a proportion of CD83-positive DC, identical as control women. The levels of IFNgamma, TNFalpha, IL-2, IL-4, IL-5 and IL-10 were not different in the three compartments (mPB, PB, CB). In conclusion, the phenotype and subset of DCs were different in pregnant women than in control women, suggesting a role in maintenance of immune tolerance against the fetus. The distribution of DC subsets was different in mPB, PB and CB. Their role in the regulation of immune response remains to be elicited.

[Role of local immunity in invasive pulmonary aspergillosis]. / Le rôle de l'immunité locale dans l'aspergillose pulmonaire invasive.

A LEADING CAUSE OF MORTALITY: Inhalation of fungal spores may cause infection and/or inflammation, which is dependent on the nature of the fungus as well as the individual's immune status. Aspergillus fumigatus is responsible for a dramatic pathology, invasive aspergillosis (IA). IA has become a leading cause of death, mainly among bone marrow transplantation or solid-organ recipients, but also among AIDS patients. IMMUNE RESPONSE: The diversity of immune failure suggests that many lines of immunity are implicated in the A. fumigatus elimination process. Non specific immunity plays a major role in the defence against A. fumigatus, including three major lines: anatomical barriers, humoral components, phagocytic cells. But acquired immunity plays a role with different T-cell subsets and their associated cytokines. FUNGUS-HOST RELATIONSHIPS: The relationship between the fungus and its host is complex and could be again study to improve the prevention and the treatment of IA. The aim of this review is a synthesis of the knowledge about the immunity response against Aspergillus fumigatus in IA.

Evidence for tumor necrosis factor receptors (TNFRs) in human MRC5 fibroblast cells.

Previous reports have shown that tumor necrosis factor alpha (TNF-alpha) controls the functions of fibroblasts cells, such as proliferation, cell migration and secretion of factors. The signaling for the biological effects of this and other cytokines is usually exerted through cell surface receptors. In this study, we demonstrated the presence of a surface and soluble TNF receptor in MRC5 fibroblasts. The presence of TNFRI and TNFRII mRNA was demonstrated by reverse-transcriptase-PCR (RT-PCR). Both surface TNFRI and TNFRII are expressed and the number of both membrane receptors is 9,251 sites per cell. Using TNF receptor specific antibodies and flow cytometry, we showed that MRC5 cells express mainly TNFRI.

Emerging pathogens.

The ever increasing numbers of immunosuppressed individuals has led to a significant increase in the incidence of opportunistic infections, particularly those caused by fungi. The epidemiology of infections caused by the common fungal pathogens such as Candida albicans, Cryptococcus neoformans and Aspergillus fumigatus has been well documented. However, in addition to these, a number of species which have previously been unrecognized (e.g., C. dubliniensis) or have previously been assumed to be non-pathogenic (e.g., Saccharomyces cerevisiae, Scedosporium spp. and Fusarium spp.) have emerged as agents of human disease. Since these species have only been identified recently as human pathogens, their role in disease is poorly understood. In most cases, identification of these species is problematic and therefore their epidemiology has yet to be elucidated adequately. In addition, several of these species fail to respond to conventional antifungal therapies. In this article, we describe the emergence of two separate yeast species (C. dubliniensis and S. cerevisiae) and two separate groups of moulds (Scedosporium prolificans and Fusarium spp.), as human pathogens. It is apparent from what we already know, that much work has yet to be performed before we have a clear understanding of how these species cause disease and most importantly how they can be controlled.

Relationship between interleukin-5 production and variations in eosinophil counts during HIV infection in West Africa: influence of Mycobacterium tuberculosis infection.

Eosinophils are important effectors of the non-specific immune response and we studied whether perturbations in the production of the type 2 cytokine, interleukin-5 (IL-5), could account for the variations in eosinophil counts observed in human immunodeficiency virus (HIV) infection. HIV-infected patients without helminthiasis were investigated in a cross-sectional study in West Africa. Eosinophil counts were significantly higher in CDC-B patients than in controls, but were dramatically decreased at the CDC-C stage. Phorbol 12-myristate 13-acetate (PMA)+ ionomycin-induced IL-5 production by peripheral blood mononuclear cells (PBMC) was decreased from the A stage of the disease, and significant correlations were observed between IL-5 production and eosinophil counts in tuberculosis (TB)-negative HIV-1-positive, TB-positive HIV-1-positive and TB-positive HIV-negative patient groups. Nevertheless, the production of IL-5 was not decreased in HIV-positive patients with TB, in contrast to HIV-positive patients without TB presenting with the same ranges of CD4+ counts. Our data suggest that, during HIV infection, the impairment in IL-5 production is one of the factors associated with the 'paradoxal' eosinopenia observed in tropical areas, but that IL-5 production during active TB is compensated by cellular subsets, yet to be identified.

PIP: Eosinophils are important effectors of nonspecific immune response, with eosinophilia being a classic sign of helminthic infection, allergies, and some inflammatory processes. The authors explored whether perturbations in the production of interleukin-5 (IL-5) could account for the variations in eosinophil counts seen in HIV infection. The 491 study subjects were recruited between 1993 and 1995 in Bobo-Dioulasso, Burkina Faso. Eosinophil counts were significantly higher in CDC-B AIDS patients than in controls, but were dramatically lower among CDC-C stage subjects. Phorbol 12-myristate 13-acetate (PMA)+ionomycin-induced IL-5 production by peripheral blood mononuclear cells (PBMC) was decreased from the A stage of the disease, and significant correlations were observed between IL-5 production and eosinophil counts in tuberculosis (TB)-negative HIV-1-positive, TB-positive HIV-1-positive, and TB-positive HIV-negative patient groups. The production of IL-5 was not decreased among HIV-positive patients with TB, in contrast to HIV-positive patients without TB presenting with the same ranges of CD4+ counts. These data suggest that during HIV infection, impairment in IL-5 production is one factor associated with the paradoxal eosinopenia observed in tropical areas, but that IL-5 production during active TB is compensated by as yet unidentified cellular subsets.

Immunoglobulin G subclass distribution of anti-endothelial cell antibodies (AECA) in patients with ulcerative colitis or Crohn's disease.

Anti-endothelial cell antibodies have been described in sera from patients with inflammatory bowel disease. The aim of this study was to determine, by ELISA, the IgG subclass distribution of anti-endothelial cell antibodies, in patients with ulcerative colitis (N = 28) or Crohn's disease (N = 82) as compared with blood donors (N = 95). Thirty-six percent of ulcerative colitis and 23% of Crohn's disease patients were positive for at least one of the IgG anti-endothelial cell subclasses. Interestingly, the pattern of IgG anti-endothelial cell subclass observed in the two inflammatory bowel diseases differs. In Crohn's disease, the IgG1 anti-endothelial cell antibody level was significantly increased (P < 0.05) while IgG2 and IgG4 anti-endothelial cell antibody levels were decreased (P < 0.0001 and P < 0.01, respectively) as compared to ulcerative colitis patients. The immunoglobulin G3 anti-endothelial cell antibody level was decreased in both ulcerative colitis and Crohn's disease patients as compared to healthy blood donors. No relationship was detected between disease activity of ulcerative colitis or Crohn's disease patients and anti-endothelial cell IgG subclasses. Finally, the disparity of IgG anti-endothelial cell subclass distribution in these two inflammatory bowel diseases suggests that the ability to activate effector mechanisms is not identical, and hence, deals with the concept of distinctive pathogenetic mechanisms in these two diseases.

Induction by interferons of human eosinophil apoptosis and regulation by interleukin-3, granulocyte/macrophage-colony stimulating factor and interleukin-5.

The effects of recombinant human interferon alpha (rhIFN-alpha) and interferon gamma (rhIFN-gamma) were examined on the apoptosis of human cord blood derived eosinophils, obtained after 4 weeks of culture with recombinant human interleukin-3 (rhIL-3), granulocyte-macrophage-colony stimulating factor (rhGM-CSF) and interleukin-5 (rhIL-5). Eosinophil viability decreased remarkably after 1 week culture with rhIFN-alpha and rhIFN-gamma. Recombinant rhIFN-alpha also decreased the viability of co-existing monocytes/macrophages, whereas in contrast, rhIFN-gamma increased the percentage of viable monocytes/macrophages. There was no synergistic or additional effect of rhIFN-alpha and rhIFN-gamma on eosinophil viability. Apoptotic eosinophils, detected by their morphological characteristics, or by DNA nick end labeling in situ, increased remarkably after incubation with rhIFN-alpha and increased to a lesser extent with rhIFN-gamma. The numbers of eosinophil-phagocytosing macrophages increased after culture with rhIFN-alpha and also with rhIFN-gamma. In contrast, eosinophilopoietic cytokines such as rhIL-3, rhIL-5 and specially rhGM-CSF, significantly increased eosinophil viability, and partially rescued the effects of rhIFNs. They also decreased apoptotic eosinophil numbers and eosinophil-phagocytosing macrophage numbers. These results indicate that eosinophil viability, at least in vitro, can be differentially regulated by cytokines produced during the immune response.

Synthesis of type 1 (IFN gamma) and type 2 (IL-4, IL-5, and IL-10) cytokines by human eosinophils.

Eosinophils are not only the source of cytotoxic and proinflammatory mediators but they can also generate cytokines and growth factors, including their own factors of differentiation, namely IL-3, GM-CSF, and IL-5. Synthesis of IL-5 by eosinophils was demonstrated by in situ hybridization and immunostaining in a variety of diseases, such as coeliac disease, asthma, hypereosinophilic syndrome, or skin diseases. However, IL-5 synthesis by eosinophils was not shown in Crohn's disease, whereas in other diseases, it was restricted to a subpopulation of eosinophils, suggesting some heterogeneity in cytokine-producing eosinophils. Here, we report that human eosinophils, in addition to the synthesis of IL-5, and Th2 cytokine, can synthesize IFN gamma, a Th1 cytokine, as well as IL-10 and IL-4, known to be mainly produced by Th2 cells. Double immunostaining procedures reveal the coexpression of IL-5, IL-4, and IL-10 by the same eosinophil populations, different from IFN gamma-producing eosinophils. We propose that distinct subpopulations of human eosinophils express Th2 or Th1 cytokines. These results point to the importance of cytokines derived from non T cells in the regulation of the immune response.

Eosinophils express a functional receptor for interferon alpha: inhibitory role of interferon alpha on the release of mediators.

Recent reports describe the beneficial use of alpha interferon (IFNalpha) for the treatment of idiopathic hypereosinophilic syndrome (HES) unresponsive to conventional therapy. A clinical improvement associated with a rapid decrease of peripheral blood eosinophilia suggested possible direct effects of IFNalpha on eosinophils through the presence of IFNalpha receptors (IFNalphaR). Reverse transcriptase-polymerase chain reaction (RT-PCR) and cytochemistry were used respectively to detect the presence and define the distribution of IFNalphaR on enriched eosinophil preparations purified from blood cells. IFNalphaR was found on eosinophils collected from patients with various eosinophilic disorders. In addition, IFNalpha inhibited the release of eosinophil granule proteins such as eosinophil cationic protein (ECP), neurotoxin (EDN, or interleukin-5 (IL-5). Moreover, antiparasite cytotoxicity was also strongly reduced in a dose-dependent manner by IFNalpha. These results provide the first evidence that human eosinophils express a functional receptor for IFNalpha and represent a potential basis for the beneficial effects of IFNalpha in patients with hypereosinophilic syndromes.

Anti-endothelial cell antibodies in sera from patients with inflammatory bowel disease.

IgG anti-endothelial cell antibodies (AECA) have been described in sera from patients with vasculitis and other immune disorders such as systemic lupus erythematosus. Presence of AECA may be relevant to the hypothesis that Crohn's disease (CD) is a form of intestinal vasculitis. The aim of this study was to search for IgG AECA among 141 patients with CD, 94 patients with ulcerative colitis (UC) and 71 healthy blood donors and to assess the relationship between AECA and demographic or disease data. The cut-off point was defined from the mean OD values + 2 SD obtained from healthy blood donors. Seventeen percent of sera from patients with CD were positive for IgG AECA, whereas 24.5% of sera from patients with UC were positive. Among disease data, only a significant relationship between presence of IgG AECA and CD activity was noticed. These results might reinforce the hypothesis that intestinal vascular injury may be an important event in CD. However, detection of AECA in an almost similar percentage of patients with UC is more suggestive of an immune response to hidden endothelial self-antigen exposed after endothelial cell damage or a further marker of disturbed immunoregulation in inflammatory bowel disease.

Synthesis of cytokines by eosinophils and their regulation.

In addition to cytotoxic and proinflammatory mediators, eosinophils can produce a variety of cytokines and growth factors. Besides interleukin (IL)-5, we show in the present work that human eosinophils can synthesize interferon (IFN)-gamma and IL-10, by RT-PCR, in situ hybridization and immunostaining. Double-labelling procedures revealed the coexpression of IL-5 and IL-10 but not IL-5 and IFN-gamma, indicating the existence of subpopulations of eosinophils expressing type 1 or type 2 cytokines. IFN-alpha efficiently used for the treatment of hypereosinophilic syndromes can significantly decrease eosinophil degranulation and IL-5 release by eosinophils, through binding to a receptor for IFN-alpha. Thus, eosinophils can represent major sources of cytokines with regulatory functions, especially in allergic diseases and parasitic infections.

CD40 ligand is functionally expressed on human eosinophils.

CD40 ligand (CD40L), a surface molecule which can be expressed by T cells, mast cells and basophils, has been shown to be involved in the control of B cell proliferation, immunoglobulin class switching as well as in the activation of monocytes and T cells. We demonstrate that CD40L can also be expressed constitutively by eosinophils from an hypereosinophilic patient or, upon activation, by the eosinophilic cell line EOL-3 and normal blood eosinophils. Eosinophils were able to induce, in conjunction with IL-4, CD40L-dependent B cell proliferation in vitro. These results suggest that CD40L could play a role in the inflammatory processes during which eosinophil infiltration and activation are observed.

Elevation of soluble CD23 in serum from patients with blood eosinophilia.

The levels of soluble CD23 (sCD23) were evaluated by a two-site immunoradiometric assay in the sera of 41 patients with eosinophilia-associated disorders and 20 normal subjects. We observed that, in the absence of treatment, sCD23 levels were elevated in patients with eosinophilia-associated Gleich's syndrome, IgA deficiency, T lymphoma or hypereosinophilic syndrome (HES), but not in patients with a parasitic infection. A significant reduction in the sCD23 levels was found after treatment, with a parallel decrease in eosinophil counts and in sCD25 levels, a marker of disease activity in HES. The lack of increase in membrane CD23+ B cells in eosinophilic patients together with the detection of sCD23 in eosinophil supernatants suggest that activated eosinophils present in eosinophilia-associated disorders can release soluble molecules cross-reacting with CD23. In conclusion, our results suggest that eosinophils themselves can represent one cellular source of sCD23. These findings are not only basic but also of clinical interest.

Eosinophil IgE receptor and CD23.

In the present review, eosinophil Fc epsilon RII was compared to CD23, a differentiation marker of B cells. Biochemical analysis revealed that molecules of similar molecular weight were immunoprecipitated from eosinophils and B cells by an anti-CD23 monoclonal antibody (mAb) or by BB10, and anti-eosinophil Fc epsilon RII. By flow cytometry, a correlation was found between the binding of anti-CD23 mAb and myeloma IgE. However, a low expression of different epitopes of CD23 was observed in various hypereosinophilic patients. Northern blot analysis of eosinophil RNA with the cDNA probe of CD23 revealed a weak message in only 3 of the 6 patients expressing membrane CD23. The inhibition by anti-CD23 mAbs of IgE-mediated cytotoxicity and IgE binding to eosinophils clearly indicated the participation of CD23 or a related molecule in IgE-dependent eosinophil functions. However, the differential effects of anti-CD23 mAbs on eosinophils and B cells suggest major differences in the characteristics of the molecule expressed by eosinophils and by B cells.

Elevated serum levels of soluble interleukin-2 receptor: a marker of disease activity in the hypereosinophilic syndrome.

We report here the presence of very high serum levels of the soluble interleukin-2 receptor (sIL-2R) in patients with blood hypereosinophilia with or without detectable markers of malignancy or signs of visceral involvement. The highest sIL-2R levels were observed in 16 eosinophilic patients with T-cell lymphoma (3,440 to 79,500 U/mL). Elevated levels of sIL-2R were also present (1,330 to 22,500 U/mL) in sera from 38 patients with the hypereosinophilic syndrome (HES) without detectable T-cell lymphoma. In this group of patients, the highest levels were noted in the patients with the malignant form of HES. Significantly lower levels were measured in sera of patients with hypereosinophilia associated with parasitic diseases, allergic disorders, or other miscellaneous diseases. Elevated serum sIL-2R levels were not closely paralleled by changes in the number of CD25-positive peripheral blood mononuclear cells as assessed by flow cytometric analysis. However, expression of IL-2R messenger RNA was detected in blood mononuclear cells collected from HES patients. In eight eosinophilic patients with T-cell lymphoma, the serum sIL-2R levels were significantly correlated with the eosinophil counts, and with the total number of blood hypodense eosinophils. alpha-Interferon (alpha-IFN) therapy resulted in both a dramatic clinical improvement and a rapid decrease in sIL-2R levels and blood hypereosinophilia. Similar beneficial effects of alpha-IFN were noted in patients with malignant HES who lacked a detectable T-cell lymphoma. Our data indicate that HES is associated with elevated serum IL-2R levels. The highest levels were observed in the most severe forms of HES with hematologic markers of malignancy or evident visceral involvement. Serum levels of sIL-2R might represent a useful indicator for the management of HES patients. In addition, the respective changes of sIL-2R and blood eosinophilia might reflect distinct processes of mononuclear cell activation affecting the eosinophil lineage.

Heterogeneous expression of CD23 epitopes by eosinophils from patients. Relationships with IgE-mediated functions.

The receptor for IgE (Fc epsilon RII) on human eosinophils presents some common characteristics with CD23, a differentiation marker of B cells. We have used flow cytometry for evaluating the expression of various epitopes of CD23 on purified eosinophils from patients with eosinophilia. A correlation was found between the binding of myeloma IgE protein and the binding of a monoclonal antibody (mAb 135), directed against the IgE-binding site of B cell CD23. Using two additional anti-CD23 mAb, directed (8-30) or not (3-5) against the IgE-binding site, a low expression of these CD23 epitopes was observed on eosinophils from different eosinophilic patients. Northern blot analysis of eosinophil RNA with the cDNA probe of CD23 revealed a low-abundance transcript in three of the six patients expressing membrane CD23. The inhibition by all anti-CD23 mAb of IgE-mediated cytotoxicity and IgE binding to eosinophils clearly indicated the participation of a CD23-related molecule in IgE-dependent eosinophil functions.

Human eosinophils from hypereosinophilic patients spontaneously express the p55 but not the p75 interleukin 2 receptor subunit.

The expression of interleukin 2 receptor (IL2R) on eosinophils was investigated in patients with hypereosinophilia. Hypodense activated eosinophils have been described in various diseases such as parasitic or allergic diseases, hypereosinophilic syndrome (HES) associated in some cases to myeloproliferative markers, and more recently described in patients undergoing recombinant IL2 treatment. The presence of p55 alpha chain of IL2R (CD25) on purified eosinophils collected from blood of hypereosinophilic patients was detected by flow cytometry. In 10 out of 19 cases, more than 10% of eosinophils were CD25+. Cross-linking studies on enriched eosinophils showed one 64-75-kDa band, consisting of IL2 (15 kDa) cross-linked to the IL2R p55 subunit. In Northern blot analysis the two messenger mRNA (3.5 and 1.5 kb) encoding the IL2R p55 subunit were identified after hybridization with a CD25 cDNA probe. In contrast, the presence of the IL2R p75 subunit was not detected. These data provide preliminary evidence for the expression of a low-affinity receptor for IL2 on in vivo activated eosinophils and raise the question of the role played by this cytokine in eosinophil differentiation and activation.

[Rupture of the palmar plate--conservative or surgical therapy]. / Rupturen der palmaren Platte--konservative oder operative Therapie.

Disruptions of the palmar plate are frequently overlooked injuries. As the palmar plate stabilises the PIP joint in combination with the collateral ligaments untreated injuries may result in severe complaints. Detailed anatomical and functional knowledge is therefore necessary to diagnose the degree of injury. In addition to ligamentous disruption osseous chips may occur and can be divided into four degrees (Hintringer 1987). By the study of results of 178 cases specific treatment has been established. Surgical intervention is indicated in the presence of an unstable PIP joint, subluxation or osseous chips grade 3 and 4 (Hintringer). The aim should be a painfree and stable joint. Small limitations in movement can be tolerated.