Genetic and serological markers to identify phenotypic subgroups in a Dutch Crohn's disease population

Background and aims. Both genetic and microbial factors seem to play a pivotal role in the aetiopathogenesis of Crohn's disease. The CARD15 frameshift mutation might link host genetic factors and the indigenous microbial flora, since CARD15 expression is stimulated by peptidoglycan, thereby activating NF-kappaB. It is hypothesised that CARD15 mutation carriers have defective anti-microbial reactions, resulting in more penetrating lesions and antibody responses, which are now being used as highly specific markers for Crohn's disease. The serological marker anti-Saccharomyces cerevisiae antibody directed against cell wall oligomannosidic epitopes has high specificity for Crohn's disease. Perinuclear anti-neutrophil cytoplasmic antibodies have been found in a subgroup of Crohn's disease patients, mostly with colonic involvement. Methods. We investigated the incidence of two CARD15 mutations (3020insC and 2722G > C), anti-S. cerevisiae antibody, and perinuclear anti-neutrophil cytoplasmic antibody in 108 (73F/35M) patients with Crohn's disease with a mean duration of disease since diagnosis of 16 (1-41) years in relation to their phenotype, according to the Vienna classification. Results. The prevalence of CARD15 frameshift mutation was 21%. Of all patients, 62% were anti-S. cerevisiae antibody positive, and 9% had perinuclear anti-neutrophil cytoplasmic antibodies. The prevalence of both anti-S. cerevisiae antibodies and perinuclear anti-neutrophil cytoplasmic antibodies was higher in the mutation carriers compared to non-carriers. Remarkably, all patients with a CARD15 mutation and positive anti-S. cerevisiae antibody had ileal disease. Carriership of the mutation was significantly associated with penetrating behaviour of the disease and weakly associated with stricturing behaviour. Furthermore, anti-S. cerevisiae antibody was associated with ileal disease involvement. Finally, most perinuclear anti-neutrophil cytoplasmic antibody positive patients showed ulcerative-like behaviour of disease (by means of colonic localisation). Conclusions. Genetic and serologic markers might be useful in defining patient subgroups. This may result in a more accurate prediction of disease behaviour, prognosis and therapeutic approach. (C) 2003 Editrice Gastroenterologica Italiana S.H. Published by Elsevier Ltd. All rights reserved

Peripheral blood IFN-gamma-secreting V alpha 24(+)V beta 11(+) NKT cell numbers are decreased in cancer patients independent of tumor type or tumor load

Natural killer T (NKT) cells are CDld-restricted lvmphoid cells and are characterized by an invariant T-cell receptor, which in humans consists of a V alpha 24 chain paired with a V beta 11 chain. These cells are known for their rapid production of large amounts of cytokines (e.g., IFN-gamma and IL-4), thereby modulating other cells of the immune system such as T cells, Nk cells and dendritic cells. NKT cells have been reported to play important regulatory roles in many immune responses, including antitumor immune responses. Here, we demonstrate an age-dependent decrease in circulating V alpha 24(+)V beta 11(+) NKT cell numbers in both healthy controls and cancer patients and demonstrate that in both groups females have higher NKT cell levels compared to males. In a large group of 120 cancer patients, we show that circulating V alpha 24(+)V beta 11(+) NKT cell numbers are about 50% lower than in age-and gender-matched healthy controls and that this decrease is independent of tumor type or tumor load. This decrease was not restored upon tumor removal by means of surgery or radiotherapy. Even though the percentage of NKT cells that secrete IFN-gamma, as detected by ELISPOT, is normal in cancer patients, the absolute number of circulating IFN-gamma-secreting NKT cells is reduced. Together, our results suggest that the reduced circulating V alpha 24(+)V beta 11(+) NKT cell numbers in cancer patients are not affected by tumor load, but might actually reflect a risk factor for tumor development, e.g., by hampering efficient tumor immunosurveillance. (c) 2005 Wiley-Liss. Inc

Consumption of gluten with gluten-degrading enzyme by celiac patients: A pilot-study

AIM: To assesses the safety and efficacy of Aspergillus niger prolyl endoprotease (AN-PEP) to mitigate the immunogenic effects of gluten in celiac patients. METHODS: Patients with initial diagnosis of celiac disease as confirmed by positive serology with subtotal or total villous atrophy on duodenal biopsies who adhere to a strict gluten-free diet (GFD) resulting in normalised antibodies and mucosal healing classified as Marsh 0 or. were included. In a randomised double-blind placebo-controlled pilot study, patients consumed toast (approximately 7 g/d gluten) with AN-PEP for 2 wk (safety phase). After a 2-wk washout period with adherence of the usua RESULTS: In total, 16 adults were enrolled in the study. No serious adverse events occurred during the trial and no patients withdrew during the trial. The mean score for the gastrointestinal subcategory of the celiac disease quality (CDQ) was relatively high throughout the study, indicating that AN-PEP was well tolerated. In the efficacy phase, the CDQ scores of patients consuming gluten with placebo or gluten with AN-PEP did not significantly deteriorate and moreover no differences between the CONCLUSION: AN-PEP appears to be well tolerated. However, the primary endpoint was not met due to lack of clinical deterioration upon placebo, impeding an effect of AN-PEP. (C) 2013 Baishideng. All rights reserved

Mechanisms of allergic contact dermatitis

Allergenicity depends on several factors determined by the very physicochemical nature of the molecules themselves, i.e., their capacity to penetrate the horny layer, lipophilicity, and chemical reactivity. The sensitizing property of the majority of contact allergens could be predicted from these characteristics (Patlewicz et al., Contact Dermatitis 50:91-97, 2004; Gerberick et al., Altern Lab Anim 36(2):215-242, 2008). Two other factors, however, further contribute to the allergenicity of chemicals, namely, their pro-inflammatory activity and capacity to induce maturation of LC. These issues will be dealt with in more detail in the following sections. Along with their migration and settling within the draining lymph nodes, haptenized LC further mature, as characterized by their increased expression of costimulatory and antigen-presentation molecules (Cumberbatch et al., Arch Dermatol Res 289:277-284, 1997; Heufler et al. J Exp Med 167:700-705, 1988). In addition, they adopt a strongly veiled, interdigitating appearance, thus maximizing the chances of productive encounters with naive T lymphocytes and recognition of altered self (Steinman et al., J Invest Dermatol 105:2S-7S, 1995; Furue et al., Br J Dermatol 135:194-198, 1996; Schuler and Steinman, J Exp Med 161:526-546, 1985). The intricate structure of lymph node paracortical areas, the differential expression of chemokines and their receptors, the characteristic membrane ruffling of IDC, and the predominant circulation of naive T lymphocytes through these lymph node areas provide optimal conditions for T-cell-receptor binding, i.e., the first signal for induction of T-cell activation (Banchereau and Steinman, Nature 392:245-252, 1998). Intimate DC-T-cell contacts are further strengthened by secondary signals, provided by sets of cellular adhesion molecules, and growth-promoting cytokines (reviewed in Hommel, Immunol Cell Biol 82:62-66, 2004; Cella et al., Curr Opin Immunol 9:10-16, 1997). In healthy individuals, primary skin contacts with contact allergens lead to differentiation and expansion of allergen-specific effector T cells displaying Th1, Th2, and/or Th17 cytokine profiles. The same allergens, if encountered along mucosal surfaces, favor the development of allergen-specific Th2 and Th17 effector cells, and/or Th3 and Tr1 allergen-specific regulatory T cells. Whereas the first two subsets may assist or replace Th1 cells in pro-inflammatory effector functions, the latter two subsets are mainly known for downregulating immune responsiveness. For most, if not all allergens, along with prolonged allergenic contacts, the role of Th2 cells as effector cells gradually increases given reduced longevity of Th1 responses. The respective contributions of similar subsets of allergen-specific CD8 + T cells are still unknown, but distinct effector roles of allergen-specific Tc1 and Tc2 have been postulated. Priming via the skin results in CLA positive T cells, which upon inflammatory stimuli preferentially enter the skin; on the other hand, gut homing T cells have been primed and generated along mucosal surfaces. Upon priming, T cells loose much of their capacity to recirculate via the lymph nodes, but gain the capacity to enter the tissues. In particular recently activated T cells will enter skin inflammatory sites. ACD reactions are primarily infiltrated by CD4 and/or CD8 pro-inflammatory cells, later reactions may be dominated by Th2 cells and regulatory T cells. Skin infiltation by T cells is fine-tuned by sets of adhesion molecules and chemokine receptors, whose expression is not rigid, but can be modulated by micro-environmental factors. After antigenic activation the progeny of primed T cells is released via the efferent lymphatics into the bloodstream. Circulating allergen-specific cells can be challenged in vitro to provide diagnostic parameters for contact hypersensitivity. At least for water-soluble allergens, like metal salts, the degree of allergen-specific proliferation and cytokine production, in particular type-2 cytokines, correlate with clinical allergy. For routine application of a broad spectrum of allergens, culture conditions still need to be improved. For mechanistic in vitro studies in ACD, however, with selected sets of relatively nontoxic allergens, peripheral blood provides an excellent source of lymphocytes and antigen-presenting cells. ACD reactions can be mediated by classical effector cells, i.e., allergen-specific CD4+ type-1 T cells which, upon triggering by allergen-presenting cells, produce IFN-? to activate nonspecific inflammatory cells like macrophages. However, CD8 + T cells, and other cytokines, including IL-4, IL-17, and IL-22 can also play major roles in ACD. The conspicuous difference with DTH reactions induced by intradermal administration of protein antigens, i.e., the epidermal infiltrate, can largely be attributed to hapten-induced chemokine release by keratinocytes