Development Of Clinical Disease Research Articles

Pathogenic analysis of Borrelia garinii strain SZ isolated from northeastern China

BackgroundVarious genospecies of Borrelia burgdorferi sensu lato (s.l.) have been identified from patients and animals worldwide. Genospecies-related dissemination of disease has been reported. The present study aimed to elucidate the pathogenicity of infections caused by B. garinii SZ isolated in China. B. burgdorferi B31 and B. afzelii BO23 were used for comparison.MethodsSpirochete load in blood and tissue samples of infected mice were measured by minor groove binder-based real-time polymerase chain reaction. The kinetics of spirochete dissemination and disease severity were assessed in BALB/c mice.ResultsThe pattern of bacterial load differed between the three genospecies. The B. garinii SZ strain is highly pathogenic and can trigger multi-system pathological damage in mice.ConclusionsSpirochete dissemination, persistence, tissue tropism and disease severity varied significantly, suggesting that different genospecies may play an important role in the pathogenicity and development of clinical diseases.

Challenges in the research and development of new human vaccines

The field of vaccinology was born from the observations by the fathers of vaccination, Edward Jenner and Louis Pasteur, that a permanent, positive change in the way our bodies respond to life-threatening infectious diseases can be obtained by specific challenge with the inactivated infectious agent performed in a controlled manner, avoiding the development of clinical disease upon exposure to the virulent pathogen. Many of the vaccines still in use today were developed on an empirical basis, essentially following the paradigm established by Pasteur, “isolate, inactivate, and inject” the disease-causing microorganism, and are capable of eliciting uniform, long-term immune memory responses that constitute the key to their proven efficacy. However, vaccines for pathogens considered as priority targets of public health concern are still lacking. The literature tends to focus more often on vaccine research problems associated with specific pathogens, but it is increasingly clear that there are common bottlenecks in vaccine research, which need to be solved in order to advance the development of the field as a whole. As part of a group of articles, the objective of the present report is to pinpoint these bottlenecks, exploring the literature for common problems and solutions in vaccine research applied to different situations. Our goal is to stimulate brainstorming among specialists of different fields related to vaccine research and development. Here, we briefly summarize the topics we intend to deal with in this discussion.

A vaccine strategy that protects against genital herpes by establishing local memory T cells

The majority of successful existing vaccines rely on neutralizing antibodies, which may not require specific anatomical localization of B cells. However, efficacious vaccines that rely on T cells for protection have been difficult to develop, as robust systemic memory T cell responses do not necessarily correlate with host protection1. In peripheral sites, tissue-resident memory T cells provide superior protection compared to circulating memory T cells2,3. Here, we describe a simple and non-inflammatory vaccine strategy that enables the establishment of a protective memory T cell pool within peripheral tissue. The female genital tract, which is a portal of entry for sexually transmitted infections (STIs), is an immunologically restrictive tissue that prevents entry of activated T cells in the absence of inflammation or infection4. To overcome this obstacle, we explored a vaccine strategy we term “prime and pull” to establish local tissue-resident memory T cells at a site of potential viral exposure. This approach relies on two steps: 1) conventional parenteral vaccination to elicit systemic T cell responses (prime), followed by 2) recruitment of activated T cells via topical chemokine application to the restrictive genital tract (pull), where such T cells establish a long-term niche and mediate protective immunity. Prime and pull protocol reduces the spread of infectious HSV-2 into the sensory neurons and prevents development of clinical disease. These results reveal a promising vaccination strategy against HSV-2, and potentially against other STIs such as HIV-1.

A highly sensitive and specific qPCR assay for quantification of the biomarker SOX11 in mantle cell lymphoma

Mantle cell lymphoma (MCL) is one of the most heterogeneous lymphoid neoplasms with a variable course of disease. Although t(11;14)(q13;q32) is the hallmark of MCL resulting in cyclin D1 (CCND1) overexpression in 90% of patients, this is difficult to validate by immunohistochemistry. We hypothesised that SOX11 could be a robust molecular biomarker for MCL. We have developed very sensitive and specific RT-qPCR assay employing a poly-A specific RT primer to circumvent contamination from gDNA caused by the intron-less nature of SOX11. We found a significant difference between the expression levels of SOX11 in patients with MCL at diagnosis (n = 21) and in healthy donors (n = 18) (blood: P < 0.0001; marrow: P = 0.0001). SOX11 expression of very low levels close to the assay sensitivity was detected in only 2 of 18 healthy donors, while low levels of CCND1 expression was observed in all blood and 12 of 13 marrow samples within the defined detection limit of Cq = 40. In spiking experiments of the GRANTA-519 MCL cell line into mononuclear cells from normal donor, the sensitivity of the SOX11 assay was found to be 2 × 10(-4) , while the sensitivity of the CCND1 assay was estimated to 2 × 10(-3) because of the normal background expression. In longitudinal sampling from patients with MCL the minimal residual disease (MRD) values based on the SOX11 expression mirrored the clinical disease development. This SOX11 RT-qPCR assay could be a useful tool for MRD monitoring in patients with MCL.

Pathogenesis of NOD diabetes is initiated by reactivity to the insulin B chain 9-23 epitope and involves functional epitope spreading

Type 1 diabetes (T1D) is mediated by destruction of pancreatic β-cells by CD4 and CD8 T cells specific for epitopes on numerous diabetogenic autoantigens resulting in loss of glucose homeostasis. Employing antigen-specific tolerance induced by i.v. administration of syngeneic splenocytes ECDI cross-linked to various diabetogenic antigens/epitopes (Ag-SP), we show that epitope spreading plays a functional role in the pathogenesis of T1D in NOD mice. Specifically, Ag-SP coupled with intact insulin, Ins B9-23 or Ins B15-23, but not GAD65509-528, GAD65524-543 or IGRP206-214, protected 4–6 week old NOD mice from the eventual development of clinical disease; infiltration of immune cells to the pancreatic islets; and blocked the induction of DTH responses in a Treg-dependent, antigen-specific manner. However, tolerance induction in 19–21 week old NOD mice was effectively accomplished only by Ins-SP, suggesting Ins B9-23 is a dominant initiating epitope, but autoimmune responses to insulin epitope(s) distinct from Ins B9-23 emerge during disease progression.

Differential gene expression changes associated with sub-clinical Mycobacterium avium subsp. paratuberculosis infection in cattle: a transcriptomic study (160.2)

Abstract Paratuberculosis or Johne's disease is characterised by a lengthy sub-clinical phase that may persist for years prior to development of clinical disease. Mechanisms leading up to clinical disease are poorly understood although the early sub-clinical phase is reportedly characterised by a pro-inflammatory response largely driven by Th1 cytokines. The objectives of this study were to evaluate early gene expression changes in calves exposed to the causative agent, Mycobacterium avium subsp. paratuberculosis (MAP). Blood samples were drawn at three early time points, from a Johne’s field trial consisting of a mixed population of Holstein and Holstein Red cattle. Four MAP exposed and four unexposed control cattle were sampled at each time point and processed to Affymetrix GeneChip Bovine Arrays. Ontological analysis revealed a number of differences in gene expression between the two populations at the individual time points. In addition a subset of genes associated with the MHC were consistently altered across all MAP-exposed samples in comparison to the unexposed controls, suggesting significant changes to the antigen processing and presentation pathways in MAP-exposed animals. This differential regulation in response to MAP is a significant finding in the understanding of the mechanisms of pathogenesis and may lead to an aid to test for susceptibility.

Dispensability of APRIL to the development of systemic lupus erythematosus in NZM 2328 mice

To determine the role of APRIL in the development of systemic lupus erythematosus (SLE) in mice. Wild-type (WT) NZM 2328, NZM. April(-/-) , NZM.Baff(-/-) , and NZM.Baff(-/-) .April(-/-) mice were evaluated for lymphocyte phenotype by flow cytometry, for serum total IgG and IgG autoantibody levels by enzyme-linked immunosorbent assay, for glomerular deposition of IgG and C3 by immunofluorescence, for renal changes by histopathology, and for clinical disease by laboratory assessment (severe proteinuria). In comparison to WT mice, NZM.April(-/-) mice harbored increased spleen B cells, T cells, and plasma cells (PCs), increased serum levels of IgG antichromatin antibodies, and decreased numbers of bone marrow (BM) PCs. Glomerular deposition of IgG and C3 was similar in NZM.April(-/-) mice and WT mice, renal changes on histopathology tended to be more severe in NZM.April(-/-) mice than in WT mice, and development of clinical disease was identical in NZM.April(-/-) mice and WT mice. BM (but not spleen) PCs and serum IgG antichromatin and anti-double-stranded DNA antibody levels were lower in NZM.Baff(-/-) .April(-/-) mice than in NZM.Baff(-/-) mice, whereas renal immunopathology in each cohort was equally mild. APRIL is dispensable for the development of full-blown SLE in NZM mice. Moreover, the elimination of both APRIL and BAFF had no discernible effect on the development of renal immunopathology or clinical disease beyond that of elimination of BAFF alone. The reduction in BM PCs in hosts doubly deficient in APRIL and BAFF beyond that in hosts deficient only in BAFF raises concern that combined antagonism of APRIL and BAFF may lead to greater immunosuppression without a concomitant increase in therapeutic efficacy.

Has the Genomic Revolution Failed?

Has the Genomic Revolution Failed?

Adjudication of the Alleged Role of Vitamin D in the Antimicrobial Pathway

Dynamic interactions between microorganism and host have evolved in such a way that while microbial pathogens are the cause of many human infections, a symbiotic relationship is also known to exist. Another important anomaly is that exposure to pathogenic organisms does not necessarily result in development of clinical disease. The latter conclusion infers that susceptibility to infectious disease can be modified by host-related factors. Arguably the two most prominent factors are genetic variability and immunologic status of the exposed individual. Because of the Human Genome and the HapMap projects, developments in genotyping technology have brought the possibility of identifying associations between specific genetic alterations and common diseases closer to reality. In addition, a growing body of evidence suggests vitamin D has an important contributory role in the antimicrobial pathway.

Crohn's disease and Mycobacterium avium subsp. paratuberculosis: The need for a study is long overdue

The initial suggestion that Mycobacterium avium subsp. paratuberculosis (Map) might be involved in the pathogenesis of Crohn's disease (CD) was based on the apparent similarity of lesions in the intestine of patients with CD with those present in cattle infected with Map, the etiological agent of Johne's disease (JD). Recent investigations have now revealed the presence of Map or Map DNA in blood or lesions from adults and children with CD. Of special interest, Map has also been found in patients with other diseases as well as healthy subjects. The latter observations indicate all humans are susceptible to infection with Map and that, like with other mycobacterial pathogens such as Mycobacterium tuberculosis, infection does not invariably lead to development of clinical disease but rather development of a persistent latent stage of infection where an immune response controls but does not eliminate the pathogen. Limited information has been obtained on the immune response to Map in healthy subjects and patients with CD. Understanding how Map may be involved in the pathogenesis of CD will require a better understanding of the immune response to Map in one of its common hosts as well as healthy humans and patients with CD.

Highly pathogenic avian influenza virus H5N1 infection in a long-distance migrant shorebird under migratory and non-migratory states.

Corticosterone regulates physiological changes preparing wild birds for migration. It also modulates the immune system and may lead to increased susceptibility to infection, with implications for the spread of pathogens, including highly pathogenic avian influenza virus (HPAIV) H5N1. The red knot (Calidris canutus islandica) displays migratory changes in captivity and was used as a model to assess the effect of high plasma concentration of corticosterone on HPAIV H5N1 infection. We inoculated knots during pre-migration (N = 6), fueling (N = 5), migration (N = 9) and post-migration periods (N = 6). Knots from all groups shed similar viral titers for up to 5 days post-inoculation (dpi), peaking at 1 to 3 dpi. Lesions of acute encephalitis, associated with virus replication in neurons, were seen in 1 to 2 knots per group, leading to neurological disease and death at 5 to 11 dpi. Therefore, the risk of HPAIV H5N1 infection in wild birds and of potential transmission between wild birds and poultry may be similar at different times of the year, irrespective of wild birds' migratory status. However, in knots inoculated during the migration period, viral shedding levels positively correlated with pre-inoculation plasma concentration of corticosterone. Of these, knots that did not become productively infected had lower plasma concentration of corticosterone. Conversely, elevated plasma concentration of corticosterone did not result in an increased probability to develop clinical disease. These results suggest that birds with elevated plasma concentration of corticosterone at the time of migration (ready to migrate) may be more susceptible to acquisition of infection and shed higher viral titers—before the onset of clinical disease—than birds with low concentration of corticosterone (not ready for take-off). Yet, they may not be more prone to the development of clinical disease. Therefore, assuming no effect of sub-clinical infection on the likelihood of migratory take-off, this may favor the spread of HPAIV H5N1 by migratory birds over long distances.

Delta-Like Ligand 4 Regulates Central Nervous System T Cell Accumulation during Experimental Autoimmune Encephalomyelitis

Experimental autoimmune encephalomyelitis (EAE) is a CD4(+) T cell-mediated inflammatory demyelinating disease of the CNS that serves as a model for multiple sclerosis. Notch receptor signaling in T lymphocytes has been shown to regulate thymic selection and peripheral differentiation. In the current study, we hypothesized that Notch ligand-receptor interaction affects EAE development by regulating encephalitogenic T cell trafficking. We demonstrate that CNS-infiltrating myeloid dendritic cells, macrophages, and resident microglia expressed Delta-like ligand 4 (DLL4) after EAE induction. Treatment of mice with a DLL4-specific blocking Ab significantly inhibited the development of clinical disease induced by active priming. Furthermore, the treatment resulted in decreased CNS accumulation of mononuclear cells in the CNS. Anti-DLL4 treatment did not significantly alter development of effector cytokine expression by Ag-specific T cells. In contrast, anti-DLL4 treatment reduced T cell mRNA and functional cell surface expression of the chemokine receptors CCR2 and CCR6. Adoptive transfer of Ag-specific T cells to mice treated with anti-DLL4 resulted in decreased clinical severity and diminished Ag-specific CD4(+) T cell accumulation in the CNS. These results suggest a role for DLL4 regulation of EAE pathogenesis through modulation of T cell chemokine receptor expression and migration to the CNS.

Recombination-Mediated Changes in Coreceptor Usage Confer an Augmented Pathogenic Phenotype in a Nonhuman Primate Model of HIV-1-Induced AIDS

Evolution of the env gene in transmitted R5-tropic human immunodeficiency virus type 1 (HIV-1) strains is the most widely accepted mechanism driving coreceptor switching. In some infected individuals, however, a shift in coreceptor utilization can occur as a result of the reemergence of a cotransmitted, but rapidly controlled, X4 virus. The latter possibility was studied by dually infecting rhesus macaques with X4 and R5 chimeric simian simian/human immunodeficiency viruses (SHIVs) and monitoring the replication status of each virus using specific primer pairs. In one of the infected monkeys, both SHIVs were potently suppressed by week 12 postinoculation, but a burst of viremia at week 51 was accompanied by an unrelenting loss of total CD4+ T cells and the development of clinical disease. PCR analyses of plasma viral RNA indicated an env gene segment containing the V3 region from the inoculated X4 SHIV had been transferred into the genetic background of the input R5 SHIV by intergenomic recombination, creating an X4 virus with novel replicative, serological, and pathogenic properties. These results indicate that the effects of retrovirus recombination in vivo can be functionally profound and may even occur when one of the recombination participants is undetectable in the circulation as cell-free virus.

Leukogram abnormalities in gnotobiotic pigs infected with porcine circovirus type 2

Porcine circovirus type 2 (PCV2) is a single-stranded circular DNA virus that is the causative agent of porcine circovirus associated disease (PCVAD), a disease complex affecting swine around the world. Although this virus is believed to negatively affect the host's immune system, the mechanism by which PCV2 induces disease is not completely understood. This report describes a series of PCV2 experiments using the gnotobiotic pig model in which a relationship was demonstrated between abnormal leukograms and development of clinical disease in PCV2-infected pigs. When compared to control pigs the leukogram was characterized by a decrease in lymphocytes within 14 days post inoculation (dpi) followed by an increase in neutrophils 7–14 days later. No significant changes in the circulating monocyte, basophil, and eosinophil cell populations were detected. The combination of an absolute neutrophilia and lymphopenia produced a neutrophil/lymphocyte ratio that was predictive of clinical disease and was inversely correlated with the presence of neutralizing antibodies. Based on previous reports, the lymphopenia may be attributed to a direct cytolytic effect of the virus and could negatively affect the pig's immune response. The role of the neutrophilia in the pathogenesis of PCVAD in gnotobiotic pigs is unknown.

Evidence of Long Latency Periods Prior to Development of Mantle Cell Lymphoma

AbstractAbstract 323Mantle cell lymphoma (MCL) is an aggressive B-cell lymphoma characterized by treatment failures and short survival. At presentation, MCL is often widely disseminated. Occasionally, early lymphoma can be seen as in situ lesions involving the mantle zones of secondary follicles. The primary genetic lesion involved in the pathogenesis of the disease is the t(11;14)(q13;q32)/(IGH/CCND1) which leads to the overexpression of cyclin D1, a cell cycle regulatory protein that is not normally expressed in B-cells. However, MCL frequently has numerous additional chromosomal alterations making it one of the most genetically unstable lymphomas. Thus, while the IGH/CCND1 rearrangement is the critical initiating event, it appears that additional alterations are necessary to develop MCL. However, little is known about the latency period required to accumulate sufficient lesions to develop MCL. Recently, it has been appreciated that the initiating chromosomal events in other B-cell malignancies may precede the development of overt disease by many years. In particular, the defining chromosomal events in childhood ALL may be found in the heel sticks of children at birth, even if leukemia does not develop until a number of years later. We recently reported a unique case of mantle cell lymphoma arising simultaneously in the donor and recipient 12 years following allogeneic bone marrow transplantation for chronic myelogenous leukemia(J. Clin. Oncol., in press). This suggested that MCL may exhibit long latency periods prior to the development of frank lymphoma. In order to determine whether in situ MCL may be identified in patients with MCL, we identified 7 patients who were diagnosed with mantle cell lymphoma and who had previous pathological material available that contained lymphoid tissue and that was unrelated to the subsequent MCL. Remarkably, all 7 specimens showed evidence of in situ mantle cell lymphoma, as judged by cyclin D1 over-expression localized to lymphoid cells. Pathological specimens ranged from 2.1–15.5 years prior to the diagnosis of MCL. In all 7 specimens, cyclin D1 positive collections of lymphocytes were identified, 5 with distinct homing to mantle zones, one with follicular colonization and mantle homing, and 1 with a diffuse distribution. FISH studies were undertaken to identify cyclin D1 chromosomal translocations, and evidence of chromosomal translocations could be identified in 2/3 cases evaluated whereas no signals were seen in adjacent uninvolved lymphoid tissue. Taken together, the data presented strongly suggest that a long latency period following the initiating IGH/CCND1 translocation may occur in MCL with patients harboring in situ lesions for years prior to the development of clinical disease. These findings shed interesting new light on the natural history of MCL.Pre-lymphoma locationPattern of in situ MCLLatency (yrs)Lymphoma locationCCND1 FISH in pre-lymphoma specimenObturator node from radical prostatectomyCyclinD1+ focal colonized follicles, scattered cells in mantles7.4Sigmoid colon biopsyNDDuodenal serosal lymph node (perforated benign gastric ulcer)Diffuse scattered CyclinD1+ cells2.1Sigmoid colon biopsyNDRight neck subcutaneous lymph node (neurofibroma excision)CyclinD1+ cells in follicular mantles3.2Bone marrow biopsyNDPeriesophageal lymph nodes from esophagectomySeveral CyclinD1+ colonized primary follicles8.0Right cervical lymph nodeNDAxillary lymph node from mastectomyCyclinD1+ cells in follicular mantles15.5Mesenteric lymph node<5% positive signalsMesenteric lymph node dissection for colon cancerCyclinD1+ cells in follicular mantles10.6Base of tongue lesionPositiveCervical lymph node involved with T cell lymphomaCyclinD1+ cells in follicular mantles3.1Right axillary lymph nodePositive Disclosures:No relevant conflicts of interest to declare.

Singular PCV2a or PCV2b infection results in apoptosis of hepatocytes in clinically affected gnotobiotic pigs

Porcine circovirus type 2 (PCV2) is clinically associated with respiratory disease, failure-to-thrive, hepatitis, and diarrhea; however, the precise pathogenesis of PCV2-associated disease and in particular its involvement in apoptosis is still controversial. The objectives of this study were (1) to determine whether PCV2 is associated with apoptosis by examining and comparing hepatic tissues from clinically affected or unaffected gnotobiotic pigs that were experimentally infected with PCV2, (2) to determine if there are differences between PCV2a and PCV2b in inducing hepatocyte apoptosis, and (3) to determine if there are differences between apoptosis detection systems. Forty-eight gnotobiotic pigs were separated into five groups based on inoculation status and development of clinical disease: (1) sham-inoculated, clinically-unaffected ( n = 4), (2) inoculated with PCV2a, clinically-unaffected ( n = 10), (3) inoculated with PCV2a, clinically-affected ( n = 6), (4) inoculated with PCV2b, clinically-unaffected, ( n = 13) and (5) inoculated with PCV2b, clinically-affected ( n = 15). Formalin-fixed, paraffin-embedded sections of liver from all pigs were analyzed for signs of apoptosis [presence of single strand DNA breaks in the nucleus by the terminal transferase dUTP nick end labeling (TUNEL) assay or presence of intra-nuclear cleaved caspase 3 (CCasp3) demonstrated by CCasp3 immunohistochemistry (IHC)]. In addition, the liver tissues were also tested for presence of cytoplasmic and intra-nuclear PCV2 antigen by an IHC assay. Specific CCasp3 and TUNEL labeling was detected in the nucleus of hepatocytes in PCV2a and PCV2b infected pigs with significantly ( P < 0.05) higher levels of apoptotic cells in clinically-affected pigs. Regardless of PCV2 subtype (PCV2a; PCV2b), there were higher levels of PCV2 antigen in clinically-affected pigs compared to clinically-unaffected pigs. There was no significant difference in detection rate of apoptotic cells between the TUNEL assay and CCasp3 IHC. When high amounts of PCV2 antigen were present, the incidence of CCasp3 and TUNEL staining also increased regardless of the PCV2 genotype. This suggests that PCV2-induced apoptosis of hepatocytes is important in the pathogenesis of PCV2-associated lesions and disease.

Implications of the 2010 rheumatoid arthritis classification criteria

Since their last revision in 1987, nurses and other health professionals have looked to the American College of Rheumatology Classification Criteria for Rheumatoid Arthritis in working with arthritis patients. At the time of their development, these criteria reflected our current understanding and definition of established disease and allowed us to stratify patients into those with and without rheumatoid arthritis (RA) (Arnett et al, 1987). Unfortunately, the 1987 criteria have been limited in their ability to recognize those with early RA among patients who present with undifferentiated inflammatory arthritis. This limitation has been more fully appreciated over the past several years since the discovery of new disease modifying anti-rheumatic drugs (DMARDs), such as biologics, and more sensitive laboratory testing, such as anti-cyclic citrullinated peptide, which can precede the development of clinical disease by years. (Rantapaa-Dahlqvis et al, 2003). Early implementation of modern DMARD treatment regimens have also shown us that RA patients can often be prevented from reaching a chronic, erosive disease state as defined by the 1987 criteria. With this in mind, the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) collaborated to publish the 2010 RA Classification Criteria in September (Aletaha et a, 2010).

The association of hormonal contraceptive use and HPV prevalence

Women diagnosed with cervical cancer report longer duration and more recent use of combined oral contraceptives (COCs). It is unclear whether COC use is associated with upstream events of human papillomavirus (HPV) infection prior to development of clinical disease. The objective of our study was to assess the association of contraceptive use on the risk for prevalent HPV infection in a cohort of long-term hormonal contraceptive (HC) users. One thousand and seventy (n = 1,070) HIV-negative women aged 20-37 from Thailand enrolled in a prospective study of the natural history of HPV. Baseline HPV genotype information, recency and duration of HC use, sexual behavior, other sexually transmitted infection (STI) information and cervical cytology and histology were assessed. At enrollment, 19.8% and 11.5% of women were infected with any HPV or any high-risk (HR)-HPV, respectively. After adjustment for age, current and past sexual risk behaviors, STI history and cytology, the use of COCs for >6 years was found to be associated with an increased risk of infection with any HPV [prevalence ratio (PR): 1.88 (1.21, 2.90)] and any HR-HPV [PR: 2.68 (1.47, 4.88)] as compared to never users. Recent, long-term COC use was associated with an increased risk for prevalent HPV infection independent of sexual behavior and cervical abnormalities. No similar association was observed for recent or long duration use of progestin-only contraceptives (i.e., depomedroxyprogesterone acetate). These data suggest that COC use may impact early upstream events in the natural history of HPV infection.

CCL22 regulates experimental autoimmune encephalomyelitis by controlling inflammatory macrophage accumulation and effector function

EAE is a demyelinating disease of the CNS and serves as a mouse model of MS. Expression of CCL22 in the draining LNs and spinal cord correlated with the onset of clinical EAE development and remained elevated. Administration of anti-CCL22 at the time of autoantigen immunization delayed the initiation of clinical disease and dampened the severity of peak initial disease and relapses. Reduced EAE severity correlated with the reduction of pathology and leukocytes in the CNS, particularly, activated CD11b+Ly6C(hi) macrophages. There were no differences in effector T cell-proliferative responses or effector T cell IFN-γ or IL-17 responses. However, treatment at the onset of disease did not reduce disease progression. Treatment of adoptive T cell transfer recipient mice with anti-CCL22 resulted in decreased clinical disease development accompanied by a decrease in CNS accumulation of CD11b+Ly6C(hi) macrophages. Neutralization of CCL22 resulted in a macrophage population whose effector cytokine expression consisted of decreased TNF and increased IL-10, a phenotype more consistent with M2 macrophages. This was corroborated by in vitro cultures of macrophages with CCL22. These results suggest that CCL22 functions to regulate development of EAE through macrophage chemoattraction and effector function.

A comparison of the long-term durability of nevirapine, efavirenz and lopinavir in routine clinical practice in Europe: a EuroSIDA study

The durability of combination antiretroviral therapy (cART) regimens can be measured as time to discontinuation because of toxicity or treatment failure, development of clinical disease or serious long-term adverse events. The aim of this analysis was to compare the durability of nevirapine, efavirenz and lopinavir regimens based on these measures. Patients starting a nevirapine, efavirenz or lopinavir-based cART regimen for the first time after 1 January 2000 were included in the analysis. Follow-up started ≥ 3 months after initiation of treatment if viral load was <500 HIV-1 RNA copies/mL. Durability was measured as discontinuation rate or development/worsening of clinical markers. A total of 603 patients (21%) started nevirapine-based cART, 1465 (51%) efavirenz, and 818 (28%) lopinavir. After adjustment there was no significant difference in the risk of discontinuation for any reason between the groups on nevirapine and efavirenz (P=0.43) or lopinavir (P=0.13). Compared with the nevirapine group, those on efavirenz had a 48% (P=0.0002) and those on lopinavir a 63% (P<0.0001) lower risk of discontinuation because of treatment failure and a 31% (P=0.01) and 66% (P<.0001) higher risk, respectively, of discontinuation because of toxicities or patient/physician choice. There were no significant differences in the incidence of non-AIDS-related events, worsening anaemia, severe weight loss, increased aspartate aminotransferase (AST)/alanine aminotransferase (ALT) levels or increased total cholesterol. Compared with patients on nevirapine, those on lopinavir had an 80% higher incidence of high-density lipoprotein (HDL) cholesterol decreasing below 0.9 mmol/L (P=0.003), but there was no significant difference in this variable between those on nevirapine and those on efavirenz (P=0.39). The long-term durability of nevirapine-based cART, based on risk of all-cause discontinuation and development of long-term adverse events, was comparable to that of efavirenz or lopinavir, in patients in routine clinical practice across Europe who initially tolerated and virologically responded to their regimen.