The Future of Clinical Immunology Laboratory Testing.

For decades, autoantibody detection has comprised the bulk of clinical laboratory immunology. However, most immune disorders are caused by imbalances in both humoral and cellular immunity. Our knowledge of the immune system has grown exponentially, resulting in new treatment paradigms in immunology. Extensive functional characterization of lymphocyte subsets is routinely carried out in a research laboratories, facilitated by the emergence of high-dimensional analysis technologies for low cell numbers. It will not be long before these approaches enter the diagnostic realm. This chapter outlines emerging trends in laboratory immunology testing with a focus on deep immune profiling or high-dimensional testing modalities.

Autoimmunity in psychotic disorders. Where we stand, challenges and opportunities.

Psychotic disorders are debilitating mental illnesses associated with abnormalities in various neurotransmitter systems. The development of disease-modifing therapies has been hampered by the mostly unknown etiologies and pathophysiologies. Autoantibodies against several neuronal antigens are responsible for autoimmune encephalitis. These autoantibodies disrupt neurotransmission within the brain, resulting in a wide range of psychiatric and neurologic manifestations, including psychosis. The overlap of symptoms of autoimmune encephalitis with psychotic disorders raised the question as to whether autoantibodies against a number of receptors, ion channel and associated proteins could ultimately be responsible for some forms of psychosis. Here we review our current knowledge, on antibody mediated autoimmunity in psychotic disorders, the different diagnostic methods and their limitations, as well as on varying therapeutic approaches targeting the immune system.

Detection of Colorectal Neoplasia in a Cohort Before and After the Change of Fecal Occult Blood Test in a French Colorectal Cancer Screening Program.

OBJECTIVE: To estimate the change in the participation rate and the change in neoplasia incidence before and after the change of the Fecal Occult Blood Test (FOBT) in the cohort included in the Colorectal Cancer Screening Program (CRCSP). METHODS: Cohort of 279,210 people, aged 50-74 years, invited at least once before 2009, to participate in a CRCSP campaign. The participation rate and the cumulative neoplasia incidence were described on 4 campaigns (≤2008, 2009-2010, 2011-2012 and 2013-2014) with a Guaiac FOBT (gFOBT) and a first campaign (2015-2016) with a Fecal Immunochemical Test (FIT). The cumulative incidence was estimated by the actuarial method and its confidence interval by the Greenwood method. RESULTS: The participation rate decreased from 32.7% (first gFOBT-campaign) to 24.4% (fourth gFOBT-campaign) then, made a significant bound in the FIT-campaign (28.4%; p < 0.001). 35.4% of the 965 high-risk-polyps screened in this cohort were detected in the FIT-campaign. CRC incidence gradually decreased from 0.4 to 0.1/1000 person-years from the first to the fourth gFOBT-campaign before reaching a bound to 0.4/1000 person-years in the FIT-campaign. CONCLUSION: Although it was still below the minimum European target (45%), the participation rate has increased between the last gFOBT-campaign and FIT-campaign, justifying the impact of promotional campaigns and the acceptance of the new test by people and GPs. A decline in the neoplasia incidence was observed between the initial and the fourth gFOBT-campaign. The change from gFOBT to FIT between the fourth and fifth campaigns, was associated with a significant increase in detection of neoplasia.

Un nuevo paradigma en la práctica de la Patología: la moderna Inmuno-Oncopatología / Modern Immuno-oncology: a new paradigm in Pathology

No disponible

Moving Forward: Recent Developments for the Ferret Biomedical Research Model.

Since the initial report in 1911, the domestic ferret has become an invaluable biomedical research model. While widely recognized for its utility in influenza virus research, ferrets are used for a variety of infectious and noninfectious disease models due to the anatomical, metabolic, and physiological features they share with humans and their susceptibility to many human pathogens. However, there are limitations to the model that must be overcome for maximal utility for the scientific community. Here, we describe important recent advances that will accelerate biomedical research with this animal model.

Pattern of inpatient referrals to a drug allergy unit in Kuwait.

SUMMARY: Introduction. There is no information regarding the pattern of inpatient referrals to drug allergy units in Kuwait. Objectives. The main goal of this study is to clarify the pattern of inpatient referrals to a drug allergy unit in terms of incidence, drugs implicated and allergy evaluation outcomes in comparison with studies in other countries. Patients and Methods. A retrospective chart review of inpatient drug allergy consultations at Al-Rashed Allergy Center over a 3-year period was performed. Results. A total of 51 patients were referred for drug allergy consultations, with an estimated incidence of reported drug allergy among inpatients of 0.008%. There is an increasing trend of referrals from public health centres located in proximity to Al-Rashed Allergy Center. Beta-lactams, contrast media, and general anaesthetics were the most common drugs leading to referrals. In total, 30% of patients were diagnosed with an allergy to the offending drug after a full allergy evaluation. Conclusion. Inpatient drug allergy referrals are highly underreported in Kuwait.

[Short history of laboratory diagnostics of allergy in Hungary, current possibilities and future perspectives]. / Az allergia laboratóriumi diagnosztikájának rövid hazai története, a jelen lehetoségei és a jövo perspektívája.

Up to know the indications for the optimal applications of laboratory diagnosis of allergic diseases have become widely known. Measurements of allergy specific IgE and various tests of cell mediated immunity are included in the practice. It can be stated that measurements of total serum IgE and allergen specific IgE (kU/l and RAST classes) can be maintained further in the Hungarian practice with the expected continuous participation of all laboratories in the external quality control program (QualiCont). However, it is also apparent that regional introduction of the urgent "molecular (component) based allergy diagnostics" has become necessary for efficient allergen specific immunotherapy in Hungary. In cases of the allergen specific cell mediated immunologic reactions, allergen induced cell proliferation and cytokine release measurements are recommended. However, it is also obvious that application of these measurements in clinical practice need correct financial support from health care authorities.

Immune profiling in patients with recurrent miscarriage.

The central role of the maternal immune system for successful and disturbed pregnancies such as recurrent miscarriage (RM) is apparent. Recent studies have increased understanding of the complex interaction of the different immunological players and the adaptation of the maternal immune system to the semi-allogeneic embryo. There is growing evidence for immunological abnormalities in RM patients, including autoimmune and allogeneic factors. However, the question remains unsolved whether these changes represent the cause or the consequence of RM. As in half of the RM patients the underlying mechanism remains unknown, further diagnostic methods are urgently needed. Within this review we summarize (recent) literature on the immunological diagnosis in RM patients to find out current trends and to identify potential targets of therapy. As the exact mechanisms of feto-maternal tolerance have not yet been determined we suggest that the immunological diagnosis should be implemented only in well-designed clinical trials in specialized centers to establish a standardized immunological work-up in RM patients.

Translation in solid cancer: are size-based response criteria an anachronism?

The purpose of translation is the development of effective medicinal products based on validated science. A parallel objective is to obtain marketing authorization for the translated product. Unfortunately, in solid cancer, these two objectives are not mutually consistent as evidenced by the contrast between major advances in science and the continuing dismal record of pharmaceutical productivity. If the problem is unrelated to science, then the process of translation may require a closer examination, namely, the criteria for regulatory approval. This realization is important because, in this context, the objective of translation is regulatory approval, and science does not passively translate into useful medicinal products. Today, in solid cancer, response criteria related to tumor size are less useful than during the earlier cytotoxic drugs era; advanced imaging and biomarkers now allow for tracking of the natural history of the disease in the laboratory and the clinic. Also, it is difficult to infer clinical benefit from tumor shrinkage since it is rarely sustained. Accordingly, size-based response criteria may represent an anachronism relative to translation in solid cancer and it may be appropriate to align preclinical and clinical effort and shift the focus to local invasion and metastasis. The shift from a cancer cellcentric model to a stroma centric model offers novel opportunities not only to interupt the natural history of the disease, but also to rethink the relevance of outdated criteria of clinical response. Current evidence favors the opinion that, in solid cancer, a different, broader, and contextual approach may lead to interventions that could delay local invasion and metastasis. All elements supporting this shift, especially advanced imaging, are in place(AU)

No disponible

La necesaria proyección clínica de la especialidad sanitaria de inmunología / The need to highlight the clinical implications of immunology

No disponible

Human toxocariasis: current advances in diagnostics, treatment, and interventions.

Toxocariasis is a neglected zoonosis caused by the nematodes Toxocara canis and Toxocara cati. This disease is widespread in many countries, reaching high prevalence independently of the economic conditions. However, the true number of cases of toxocariasis is likely to be underestimated owing to the lack of adequate surveillance programs. Although some diagnostic tests are available, their sensitivity and specificity need to be improved. In addition, treatment options for toxocariasis are limited and are non-specific. Toxocariasis is listed as one of the five most important neglected diseases by the CDC. This review presents recent advances related to the control of toxocariasis, including new immunodiagnostics, therapies, and drug formulations, as well as novel interventions using DNA vaccines, immunomodulators, and probiotics.

[What place and what future for the pathology of infectious and tropical diseases in France?]. / Quelle place et quel avenir pour l'anatomo-cyto-pathologie des maladies infectieuses et tropicales en France?

The management of tissues and cellular samples by the pathologists in the infectious and tropical diseases pathology field in 2014 needs a strong knowledge of both morphological and molecular domains which includes the good control: (i) of the taxonomy of infectious and tropical diseases pathology leading to the pathogens identification and (ii) of the ancillary methods which can be used in fixed samples in order to detect or better identify these pathogens. There is a recent paradox in France concerning the frequency of infectious diseases to be diagnosed in pathology laboratories and the progressive loss of pathologist's expertise in this domain. Different reasons could explain this statement including the omnipresence of the tumour lesions to be managed in a pathology laboratory as well as the recent constraints associated with the different biomarkers that are mandatory to be detected by immunohistochemistry and/or by molecular biology. Even if the microbiologists play a pivotal role for identifying the different pathogens as well as for the assessment of their sensitivity to the anti-microbial drugs, a large number of infectious diseases can be diagnosed only on fixed tissue and/or cells by the pathologists. The purpose of this review is to describe the current and future issues of infectious and tropical diseases diagnoses in pathology laboratories, in particular in France.

Informe de actividades de la Sociedad Española de Inmunología 2013 / Report on the scientific activity of Spanish Immunology Society 2013

No disponible