169 research outputs found

    Redox phospholipidomics of enzymatically generated oxygenated phospholipids as specific signals of programmed cell death

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    High fidelity and effective adaptive changes of the cell and tissue metabolism to changing environments require strict coordination of numerous biological processes. Multicellular organisms developed sophisticated signaling systems of monitoring and responding to these different contexts. Among these systems, oxygenated lipids play a significant role realized via a variety of re-programming mechanisms. Some of them are enacted as a part of pro-survival pathways that eliminate harmful or unnecessary molecules or organelles by a variety of degradation/hydrolytic reactions or specialized autophageal processes. When these β€œpartial” intracellular measures are insufficient, the programs of cells death are triggered with the aim to remove irreparably damaged members of the multicellular community. These regulated cell death mechanisms are believed to heavily rely on signaling by a highly diversified group of molecules, oxygenated phospholipids (PLox). Out of thousands of detectable individual PLox species, redox phospholipidomics deciphered several specific molecules that seem to be diagnostic of specialized death programs. Oxygenated cardiolipins (CLs) and phosphatidylethanolamines (PEs) have been identified as predictive biomarkers of apoptosis and ferroptosis, respectively. This has led to decoding of the enzymatic mechanisms of their formation involving mitochondrial oxidation of CLs by cytochrome c and endoplasmic reticulum-associated oxidation of PE by lipoxygenases. Understanding of the specific biochemical radical-mediated mechanisms of these oxidative reactions opens new avenues for the design and search of highly specific regulators of cell death programs. This review emphasizes the usefulness of such selective lipid peroxidation mechanisms in contrast to the concept of random poorly controlled free radical reactions as instruments of non-specific damage of cells and their membranes. Detailed analysis of two specific examples of phospholipid oxidative signaling in apoptosis and ferroptosis along with their molecular mechanisms and roles in reprogramming has been presented

    ВлияниС Π±ΠΈΠΎΠ³Π΅Π½Π½Ρ‹Ρ… элСмСнтов Π½Π° Ρ„ΠΈΡ‚ΠΎΡΠΊΡΡ‚Ρ€Π°ΠΊΡ†ΠΈΡŽ кадмия ΠΈΠ· загрязнСнной ΠΏΠΎΡ‡Π²Ρ‹

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    The influence of substances containing biogenic elements (potassium chloride, sodium phosphate, ammonium nitrate, potassium and urea nitrate) on phytoextraction degree of cadmium from soil by cultivated oat (Avena sativa L.), cutting lettuce (Lactuca sativa L.) and charlock (Sinapis arvensis L.) has been investigated. As the results of experiment the factors used for estimation of relationship between the environment and a physiological role of a chemical element, and also for revealing of its share in biotic turnover and of a role of organisms-indicators and organisms-concentrators have been calculated: phytotoxic effect and factor of biological absorbing of cadmium by plants. It is shown that potassium nitrate promote the extraction of cadmium from soil in a greater degree in comparison with other substances containing biogenic elements.ИсслСдовано влияниС вСщСств , содСрТащих Π±ΠΈΠΎΠ³Π΅Π½Π½Ρ‹Π΅ элСмСнты ( Ρ…Π»ΠΎΡ€ΠΈΠ΄Π° калия , фосфата натрия , Π½ΠΈΡ‚Ρ€Π°Ρ‚Π° аммония , Π½ΠΈΡ‚Ρ€Π°Ρ‚Π° калия ΠΈ ΠΌΠΎΡ‡Π΅Π²ΠΈΠ½Ρ‹ ) Π½Π° ΡΡ‚Π΅ΠΏΠ΅Π½ΡŒ фитоэкстракции кадмия ΠΈΠ· ΠΏΠΎΡ‡Π²Ρ‹ овсом посСвным (Avena sativa L.), салатом листовым (Lactuca sativa L.) ΠΈ Π³ΠΎΡ€Ρ‡ΠΈΡ†Π΅ΠΉ ΠΏΠΎΠ»Π΅Π²ΠΎΠΉ (Sinapis arvensis L.). По Ρ€Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚Π°ΠΌ экспСримСнта рассчитаны ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»ΠΈ, ΠΈΡΠΏΠΎΠ»ΡŒΠ·ΡƒΡŽΡ‰ΠΈΠ΅ΡΡ для ΠΎΡ†Π΅Π½ΠΊΠΈ связи срСды ΠΈ физиологичСской Ρ€ΠΎΠ»ΠΈ химичСского элСмСнта, Π° Ρ‚Π°ΠΊΠΆΠ΅ для выявлСния Π΅Π³ΠΎ участия Π² биотичСском ΠΊΡ€ΡƒΠ³ΠΎΠ²ΠΎΡ€ΠΎΡ‚Π΅, Ρ€ΠΎΠ»ΠΈ ΠΎΡ€Π³Π°Π½ΠΈΠ·ΠΌΠΎΠ²-ΠΈΠ½Π΄ΠΈΠΊΠ°Ρ‚ΠΎΡ€ΠΎΠ² ΠΈ ΠΎΡ€Π³Π°Π½ΠΈΠ·ΠΌΠΎΠ²-ΠΊΠΎΠ½Ρ†Π΅Π½Ρ‚Ρ€Π°Ρ‚ΠΎΡ€ΠΎΠ²: фитотоксичСский эффСкт ΠΈ коэффициСнт биологичСского поглощСния кадмия растСниями. Показано, Ρ‡Ρ‚ΠΎ Π½ΠΈΡ‚Ρ€Π°Ρ‚ калия Π² большСй стСпСни, ΠΏΠΎ ΡΡ€Π°Π²Π½Π΅Π½ΠΈΡŽ с Π΄Ρ€ΡƒΠ³ΠΈΠΌΠΈ вСщСствами, содСрТащими Π±ΠΈΠΎΠ³Π΅Π½Π½Ρ‹Π΅ элСмСнты, способствуСт ΠΈΠ·Π²Π»Π΅Ρ‡Π΅Π½ΠΈΡŽ кадмия ΠΈΠ· ΠΏΠΎΡ‡Π²Ρ‹

    ΠŸΡ€ΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ янтарной кислоты Π² процСссС фитоэкстракции свинца ΠΈ кадмия ΠΈΠ· загрязнСнных ΠΏΠΎΡ‡Π²

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    Succinic acid influence on migration properties of lead and cadmium in soil-plant system has been investigated. It has been shown that the addition the activator (succinic acid) into soil increases the efficiency of phytoextraction of lead and cadmium. The optimum conditions of succinic acid usage as the process activator have been established.Π’ Ρ€Π°Π±ΠΎΡ‚Π΅ ΠΈΠ·ΡƒΡ‡Π΅Π½ΠΎ влияниС янтарной кислоты Π½Π° ΠΌΠΈΠ³Ρ€Π°Ρ†ΠΈΠΎΠ½Π½Ρ‹Π΅ свойства свинца ΠΈ кадмия Π² систСмС Β«ΠΏΠΎΡ‡Π²Π°-рстСния». УстановлСно, Ρ‡Ρ‚ΠΎ внСсСниС Π² ΠΏΠΎΡ‡Π²Ρƒ Π°ΠΊΡ‚ΠΈΠ²Π°Ρ‚ΠΎΡ€Π° - янтарной кислоты ΠΏΠΎΠ²Ρ‹ΡˆΠ°Π΅Ρ‚ ΡΡ„Ρ„Π΅ΠΊΡ‚ΠΈΠ²Π½ΠΎΡΡ‚ΡŒ процСсса фитоэкстракции свинца ΠΈ кадмия. УстановлСны ΠΎΠΏΡ‚ΠΈΠΌΠ°Π»ΡŒΠ½Ρ‹Π΅ условия примСнСния янтарной кислоты Π² качСствС Π°ΠΊΡ‚ΠΈΠ²Π°Ρ‚ΠΎΡ€Π° процСсса

    The influence of salinity on the effects of Multi-walled carbon nanotubes on polychaetes

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    Salinity shifts in estuarine and coastal areas are becoming a topic of concern and are one of the main factors influencing nanoparticles behaviour in the environment. For this reason, the impacts of multiwalled carbon nanotubes (MWCNTs) under different seawater salinity conditions were evaluated on the common ragworm Hediste diversicolor, a polychaete species widely used as bioindicator of estuarine environmental quality. An innovative method to assess the presence of MWCNT aggregates in the sediments was used for the first time. Biomarkers approach was used to evaluate the metabolic capacity, oxidative status and neurotoxicity of polychaetes after long-term exposure. The results revealed an alteration of energy-related responses in contaminated polychaetes under both salinity conditions, resulting in an increase of metabolism and expenditure of their energy reserves (lower glycogen and protein contents). Moreover, a concentration-dependent toxicity (higher lipid peroxidation, lower ratio between reduced and oxidized glutathione and activation of antioxidant defences and biotransformation mechanisms) was observed in H. diversicolor, especially when exposed to low salinity. Additionally, neurotoxicity was observed by inhibition of Cholinesterases activity in organisms exposed to MWCNTs at both salinities.publishe

    БтратСгия DOTS – ΠΏΡƒΡ‚ΡŒ ΠΊ ускорСнному ΠΈΠ·Π»Π΅Ρ‡Π΅Π½ΠΈΡŽ Π²ΠΏΠ΅Ρ€Π²Ρ‹Π΅ выявлСнных Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Π»Π΅Π³ΠΎΡ‡Π½Ρ‹ΠΌ Ρ‚ΡƒΠ±Π΅Ρ€ΠΊΡƒΠ»Π΅Π·ΠΎΠΌ Π² России

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    DOTS strategy includes several important points, primarily, detection of tuberculosis patients and a strong monitoring of treatment efficacy.Specialists on lung tuberculosis from Tomsk have 5-year experience in work with DOTS programme. They observed 675 patients asked medical care in tuberculosis settings of Tomsk region from the March 1995 to November 1996. The patients ere divided into the group A and B. The group A received anti-tuberculosis therapy adopted in Russia. The group Π’ was given directly observed treatment short course (DOTS) according to WHO standard. It included the intensive phase (2 months for new diagnosed cases and 3 months for repeated therapy course) and the continued phase of 2–4 (new diagnosed cases) to 5 months (repeated course) length. Typical WHO modes were used the first line drugs, such as isoniasid, rifampicin, pyrasinamid, etambutol, streptomycin. The therapy delayed results were assessed with criteria accepted by WHO and in Russia as well. Seventy one per cent of the patients recovered: 69% from the group A and 74% from the group B. The treatment failures were registered in 15 (4.2%) patients of the group A and 18 (5.6%) of the group B. Residual lesions of respiratory system were less severe in the group A patients just at the early period; there was no significant difference between the groups by the 30-th month of the observation. Meantime the cost-effectiveness of WHO standard treatment is 1.9 times less than that of Russian traditional schemes. Generally, a positive tendency in lung tuberculosis patients’ treatment and observation effectiveness has been noted in the Tomsk region for the last 5 years due to the DOTS strategy, so that it takes a positive role for tuberculosis patients’ cure.БтратСгия DOTS Π²ΠΊΠ»ΡŽΡ‡Π°Π΅Ρ‚ ряд Π²Π°ΠΆΠ½Ρ‹Ρ… элСмСнтов, Π² ΠΏΠ΅Ρ€Π²ΡƒΡŽ ΠΎΡ‡Π΅Ρ€Π΅Π΄ΡŒ выявлСниС Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Ρ‚ΡƒΠ±Π΅Ρ€ΠΊΡƒΠ»Π΅Π·ΠΎΠΌ – Π±Π°Ρ†ΠΈΠ»Π»ΠΎΠ²Ρ‹Π΄Π΅Π»ΠΈΡ‚Π΅Π»Π΅ΠΉ ΠΈ строгий ΠΌΠΎΠ½ΠΈΡ‚ΠΎΡ€ΠΈΠ½Π³ эффСктивности лСчСния больного.ВомскиС Ρ„Ρ‚ΠΈΠ·ΠΈΠ°Ρ‚Ρ€Ρ‹ ΠΈΠΌΠ΅ΡŽΡ‚ 5-Π»Π΅Ρ‚Π½ΠΈΠΉ ΠΎΠΏΡ‹Ρ‚ Ρ€Π°Π±ΠΎΡ‚Ρ‹ ΠΏΠΎ ΠΏΡ€ΠΎΠ³Ρ€Π°ΠΌΠΌΠ΅ DOTS. Наблюдалось 675 Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ…, ΠΎΠ±Ρ€Π°Ρ‚ΠΈΠ²ΡˆΠΈΡ…ΡΡ Π² ΠΏΡ€ΠΎΡ‚ΠΈΠ²ΠΎΡ‚ΡƒΠ±Π΅Ρ€ΠΊΡƒΠ»Π΅Π·Π½Ρ‹Π΅ учрСТдСния Вомской области Π² ΠΏΠ΅Ρ€ΠΈΠΎΠ΄ с ΠΌΠ°Ρ€Ρ‚Π° 1995 Π³. ΠΏΠΎ Π½ΠΎΡΠ±Ρ€ΡŒ 1996 Π³. ΠŸΠ°Ρ†ΠΈΠ΅Π½Ρ‚Ρ‹ Π±Ρ‹Π»ΠΈ Ρ€Π°Π·Π΄Π΅Π»Π΅Π½Ρ‹ Π½Π° Π³Ρ€ΡƒΠΏΠΏΡ‹ А ΠΈ Π‘: Π³Ρ€ΡƒΠΏΠΏΠ° А ΠΏΠΎΠ»ΡƒΡ‡Π°Π»Π° Π»Π΅Ρ‡Π΅Π½ΠΈΠ΅ ΠΏΠΎ ΠΏΡ€ΠΈΠ½Ρ†ΠΈΠΏΠ°ΠΌ Ρ‚Ρ€Π°Π΄ΠΈΡ†ΠΈΠΎΠ½Π½ΠΎΠΉ российской Ρ„Ρ‚ΠΈΠ·ΠΈΠ°Ρ‚Ρ€ΠΈΠΈ, Π³Ρ€ΡƒΠΏΠΏΠ΅ Π‘ Π½Π°Π·Π½Π°Ρ‡Π°Π»ΠΈ краткосрочный курс лСчСния ΠΏΠΎΠ΄ нСпосрСдствСнным наблюдСниСм (ККΠ₯) ΠΏΠΎ стандартам Π’ΠžΠ—, состоящий ΠΈΠ· интСнсивной Ρ„Π°Π·Ρ‹ (2 мСс для Π½ΠΎΠ²Ρ‹Ρ… случаСв ΠΈ 3 мСс для ΠΏΠΎΠ²Ρ‚ΠΎΡ€Π½ΠΎΠ³ΠΎ лСчСния) ΠΈ ΠΏΡ€ΠΎΠ΄ΠΎΠ»ΠΆΠ°ΡŽΡ‰Π΅ΠΉ Ρ„Π°Π·Ρ‹ Π΄Π»ΠΈΡ‚Π΅Π»ΡŒΠ½ΠΎΡΡ‚ΡŒΡŽ ΠΎΡ‚ 2–4 мСс (Π½ΠΎΠ²Ρ‹Π΅ случаи) Π΄ΠΎ 5 мСс (ΠΏΠΎΠ²Ρ‚ΠΎΡ€Π½ΠΎΠ΅ Π»Π΅Ρ‡Π΅Π½ΠΈΠ΅). Использовались классичСскиС Ρ€Π΅ΠΆΠΈΠΌΡ‹ Π’ΠžΠ— с Π½Π°Π·Π½Π°Ρ‡Π΅Π½ΠΈΠ΅ΠΌ ΠΏΡ€Π΅ΠΏΠ°Ρ€Π°Ρ‚ΠΎΠ² ΠΏΠ΅Ρ€Π²ΠΎΠΉ Π»ΠΈΠ½ΠΈΠΈ: ΠΈΠ·ΠΎΠ½ΠΈΠ°Π·ΠΈΠ΄, Ρ€ΠΈΡ„Π°ΠΌΠΏΠΈΡ†ΠΈΠ½, ΠΏΠΈΡ€Π°Π·ΠΈΠ½Π°ΠΌΠΈΠ΄, этамбутол, стрСптомицин. ΠžΡ‚Π΄Π°Π»Π΅Π½Π½Ρ‹Π΅ Ρ€Π΅Π·ΡƒΠ»ΡŒΡ‚Π°Ρ‚Ρ‹ лСчСния ΠΎΡ†Π΅Π½ΠΈΠ²Π°Π»ΠΈΡΡŒ ΠΏΠΎ критСриям, принятым ΠΊΠ°ΠΊ Π’ΠžΠ—, Ρ‚Π°ΠΊ ΠΈ Π² российской Ρ„Ρ‚ΠΈΠ·ΠΈΠ°Ρ‚Ρ€ΠΈΠΈ. Π˜Π·Π»Π΅Ρ‡Π΅Π½ΠΎ 71% ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΎΠ²: Π² Π³Ρ€ΡƒΠΏΠΏΠ΅ А – 69%, Π² Π³Ρ€ΡƒΠΏΠΏΠ΅ Π‘ – 74%. ΠΠ΅ΡƒΠ΄ΠΎΠ²Π»Π΅Ρ‚Π²ΠΎΡ€ΠΈΡ‚Π΅Π»ΡŒΠ½Ρ‹Π΅ ΠΈΡ‚ΠΎΠ³ΠΈ лСчСния констатированы Π² Π³Ρ€ΡƒΠΏΠΏΠ΅ А Ρƒ 15 (4,2%) Ρ‡Π΅Π»ΠΎΠ²Π΅ΠΊ, Π² Π³Ρ€ΡƒΠΏΠΏΠ΅ Π‘ – Ρƒ 18 (5,6%) Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ…. Π₯Π°Ρ€Π°ΠΊΡ‚Π΅Ρ€ остаточных ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ со стороны ΠΎΡ€Π³Π°Π½ΠΎΠ² дыхания Π±Ρ‹Π» Π±ΠΎΠ»Π΅Π΅ благоприятным Π² Π³Ρ€ΡƒΠΏΠΏΠ΅ А Ρ‚ΠΎΠ»ΡŒΠΊΠΎ Π½Π° Ρ€Π°Π½Π½Π΅ΠΌ этапС, Π° ΠΊ 30 мСс наблюдСния статистичСски Π·Π½Π°Ρ‡ΠΈΠΌΠΎΠΉ Ρ€Π°Π·Π½ΠΈΡ†Ρ‹ ΠΌΠ΅ΠΆΠ΄Ρƒ Π³Ρ€ΡƒΠΏΠΏΠ°ΠΌΠΈ А ΠΈ Π‘ Π½Π΅ ΠΎΡ‚ΠΌΠ΅Ρ‡Π΅Π½ΠΎ. ВмСстС с Ρ‚Π΅ΠΌ Π·Π°Ρ‚Ρ€Π°Ρ‚Ρ‹ Π½Π° Π»Π΅Ρ‡Π΅Π½ΠΈΠ΅ ΠΏΠΎ ΠΏΡ€ΠΎΡ‚ΠΎΠΊΠΎΠ»Π°ΠΌ Π’ΠžΠ— Π² 1,9 Ρ€Π°Π·Π° мСньшС, Ρ‡Π΅ΠΌ ΠΏΠΎ принятым Π² России ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈΠΊΠ°ΠΌ. Π’ Ρ†Π΅Π»ΠΎΠΌ благодаря стратСгии DOTS Π² Вомской области Π·Π° послСдниС 5 Π»Π΅Ρ‚ достигнута ΠΏΠΎΠ»ΠΎΠΆΠΈΡ‚Π΅Π»ΡŒΠ½Π°Ρ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠ° ΠΏΠΎΠΊΠ°Π·Π°Ρ‚Π΅Π»Π΅ΠΉ эффСктивности лСчСния ΠΈ диспансСрного наблюдСния Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ… Ρ‚ΡƒΠ±Π΅Ρ€ΠΊΡƒΠ»Π΅Π·ΠΎΠΌ, Ρ‡Ρ‚ΠΎ ΠΏΠΎΠ΄Ρ‚Π²Π΅Ρ€ΠΆΠ΄Π°Π΅Ρ‚ ΠΏΠΎΠ·ΠΈΡ‚ΠΈΠ²Π½ΡƒΡŽ Ρ€ΠΎΠ»ΡŒ стратСгии Π² ΠΈΠ·Π»Π΅Ρ‡Π΅Π½ΠΈΠΈ Π±ΠΎΠ»ΡŒΠ½Ρ‹Ρ…

    Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

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    Background: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8Β·0 years [IQR 4Β·2–11Β·4], 1191 [59Β·3%] male and 818 [40Β·7%] female, and 825 [41Β·1%] White). 680 (33Β·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34Β·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24Β·2%) with glucocorticoids alone; 59 (2Β·9%) patients received other combinations, including biologicals, and 85 (4Β·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1Β·09 (95% CI 0Β·75–1Β·58; corrected p value=1Β·00) for intravenous immunoglobulin plus glucocorticoids and 0Β·93 (0Β·58–1Β·47; corrected p value=1Β·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1Β·04 (95% CI 0Β·91–1Β·20; corrected p value=1Β·00) for intravenous immunoglobulin plus glucocorticoids, and 0Β·84 (0Β·70–1Β·00; corrected p value=0Β·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0Β·15 [95% CI 0Β·11–0Β·20]; p<0Β·0001) and glucocorticoids alone (0Β·68 [0Β·50–0Β·93]; p=0Β·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0Β·50 [95% CI 0Β·38–0Β·67]; p<0Β·0001) or glucocorticoids alone (0Β·63 [0Β·45–0Β·88]; p=0Β·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health
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