ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma a

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods: We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings: Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation: Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding: Bill & Melinda Gates Foundation

Inhibition of nonspecific tumoricidal activity by activated macrophages with antiserum against a soluble cytotoxic factor

Mouse peritoneal macrophages activated for tumor cytotoxicity by any of several in vivo or in vitro treatments released a soluble cytotoxin into culture fluids only after exposure to small amounts of bacterial lipopolysaccharides. This cytotoxic factor was physicochemically similar to the cytotoxic factor (tumor necrosis factor) in sera of BCG-infected mice injected with lipopolysaccharide. A rabbit antiserum against partially purified serum cytotoxic factor also inhibited the activity of macrophage-derived cytotoxic factor. Of special interest was the observation that rabbit anti-cytotoxic factor inhibited the cytotoxic activity of macrophages both in the presence and in the absence of exogenously added lipopolysaccharide. Inhibition was not complete but was consistent in all experiments. Thus, cytotoxic factor was implicated as a possible effector molecule in the nonspecific tumoricidal activity of activated macrophages

Macrophage activation for tumor cytotoxicity: increased lymphokine responsiveness of peritoneal macrophages during acute inflammation

Peritoneal inflammation induced by sterile irritants led to accumulation of macrophages that were more responsive to lymphokines than macrophages from resident cell populations of untreated mice. Lymphokine responsiveness was quantitated by measurement of macrophage-mediated tumor cytotoxicity induced by supernatants from antigen-stimulated immune spleen cell cultures. Tumor cytotoxicity by lymphokine-activated inflammatory macrophages was about 10-fold greater than that by equal numbers of lymphokine-treated resident cells. Analysis of the time course of activation and of lymphokine dose-response demonstrated that the increased responsiveness of inflammatory cells was a consequence of quantitative changes. Lymphokine-responsive cells in both resident and inflammatory populations were identical; the numbers of response cells increased with inflammation. Changes in numbers of lymphokine-responsive cells during acute inflammation were coincident with similar changes in numbers of peroxidase-positive macrophages. This finding suggested that the increased lymphokine responsiveness of inflammatory cells was dependent upon influx of young peroxidase-positive mononuclear phagocytes rather than stimulation of resident macrophages. This concept was further strengthened by the finding that whole body x-irradiation diminished the numbers of both peroxidase-positive and of lymphokine-responsive macrophages in inflammatory and resident cell populations. These data suggest that the lymphokine-responsive precursor or the activated tumoricidal macrophage during both steady-state and acute inflammatory conditions was the newly formed blood-derived mononuclear phagocyte. The 10-fold increase in numbers of lymphokine responsive macrophages in peritoneal exudate over resident cell populations reflected a similar increase in macrophage turnover induced by inflammation

Macrophage activation for tumor cytotoxicity: Control of macrophage tumoricidal capacity by the LPS gene

In contrast to cells from C3H/HeN mice, macrophages from LPS-unresponsive C3H/HeJ mice fail to develop tumoricidal capacity after a variety of in vivo or in vitro activation stimuli. The macrophage-tumoricidal defect of C3H/HeJ mice was evident with treatments not dependent upon exogenously added LPS: BCG infection, T cell mitogens, or in vitro exposure to lymphokines. This study was designed to determine if macrophage-tumoricidal capacity was controlled by the LPS gene. Tumoricidal responses of macrophages from BCG-infected F1 hybrids (C3H/HeJ x C3H/HeN) were intermediate to those of the parental strains. There were no differences in cytotoxic responses between macrophages from BCG-infected male or female F1 hybrids. These responses suggest an autosomal codominant pattern of inheritance for control of macrophage cytotoxicity similar to that previously reported for B cell responsiveness to LPS. In a backcross linkage analysis (C3H/HeJ x F1), there was complete concordance in the expression of macrophage-tumoricidal capacity and spleen cell capacity to proliferate in response to LPS. Furthermore, macrophage-tumoricidal capacity correlated with LPS responsiveness in other inbred mouse strains. Macrophages from BCG-infected, LPS-unresponsive C57BL/10ScCR mice were not tumoricidal in vitro, whereas cells from BCG-infected, LPS-responsive C57BL/10Sn mice were. Moreover, analysis of tumoricidal responses in eight different BXH recombinant inbred strains of mice revealed that the development of cytotoxic macrophages during BCG infection was associated with the capacity of each strain to respond to LPS. These findings strongly suggest that the gene for control of macrophage-tumoricidal capacity is either closely linked or identical to the LPS gene