Division Of Immunology Research Articles

Editorial introductions

Editorial introductions

Report from the National Institute of Allergy and Infectious Diseases workshop on “Atopic dermatitis and the atopic march: Mechanisms and interventions”

Atopic dermatitis (AD) affects up to 20% of children worldwide and is an increasing public health problem, particularly in developed countries. Although AD in infants and young children can resolve, there is a well-recognized increased risk of sequential progression from AD to other atopic diseases, including food allergy (FA), allergic rhinitis, allergic asthma, and allergic rhinoconjunctivitis, a process referred to as the atopic march. The mechanisms underlying the development of AD and subsequent progression to other atopic comorbidities, particularly FA, are incompletely understood and the subject of intense investigation. Other major research objectives are the development of effective strategies to prevent AD and FA, as well as therapeutic interventions to inhibit the atopic march. In 2017, the Division of Allergy, Immunology, and Transplantation of the National Institute of Allergy and Infectious Diseases sponsored a workshop to discuss current understanding and important advances in these research areas and to identify gaps in knowledge and future research directions. International and national experts in the field were joined by representatives from several National Institutes of Health institutes. Summaries of workshop presentations, key conclusions, and recommendationsare presented herein.

Editorial introductions

Current Opinion in Allergy and Clinical Immunology was launched in 2001. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of allergy and clinical immunology are divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Stephen JollesStephen JollesDr Jolles is a Consultant Clinical Immunologist and Honorary Professor at the University Hospital of Wales, UK. He is Clinical Lead in the Immunodeficiency Centre of Wales and Co-Director of the Hub Immunology Diagnostic Laboratory of Wales. Dr Jolles trained in immunology and allergy, and obtained his PhD on Langerhans cell migration at the National Institute for Medical Research, London. He has a particular interest in the clinical use of immunoglobulin and its mechanism of action and research interests include development of new therapeutic products, new screening strategies to improve the laboratory diagnosis of primary and secondary immunodeficiency and allergy, and better ways to monitor primary immunodeficiency disease and the impact of treatments. M. Teresa (Maite) de la MorenaM. Teresa (Maite) de la MorenaM. Teresa (Maite) de la Morena is Professor of Pediatrics in the Department of Pediatrics, Division of Immunology at University of Washington and Seattle Children's Hospital, USA. She graduated from medical school at Universidad Complutense de Madrid, Spain. This was followed by residency and fellowships training in pediatrics, allergy and immunology, and laboratory immunology at the University of South Florida, St. Petersburg, Florida, USA. Dr de La Morena has a clinical interest in allergy and immunology, clinical immunology with particular focus on the primary immunodeficiency diseases. Her research interests include long term clinical outcomes of patients with X-linked Hyper IgM syndrome, DiGeorge syndrome and microRNAs in primary immunodeficiency disorders, including their role in thymic development. Giovanni PassalacquaGiovanni PassalacquaProf. Giovanni Passalacqua was born in Genoa in 1964, graduated in 1990 from the Genoa University Medical School, Italy, and was appointed by the specialty degrees in Allergy and Clinical Immunology and Respiratory Medicine in 1994 and 2002. He is the Co-Chairman of the Immunotherapy Scientific Committee of the WAO and member of the ARIA editorial board. Prof. Passalacqua serves as a section editor for Current Opinion in Allergy and Clinical Immunology, and also as a reviewer for Allergy, JACI, Clin Exp Allergy and ERJ. Prof. Passalacqua is the co-author of several international position papers, including ARIA guidelines, WAO Pos pap on SLIT, EAACI Pos Pap on local immunotherapy. His main fields of research are sublingual immunotherapy, mechanisms of allergic inflammation, antihistamines, corticosteroids, respiratory allergy, hymenoptera venom allergy. Under the chairmanship of Professor Canonica, he developed and investigated sublingual immunotherapy in the last 20 years. He has had 450 full articles published in peer reviewed journals indexed in MedLine plus 15 chapters in international handbooks. He currently heads the Allergy and Respiratory Diseases Department, and chairs the Specialty School in Respiratory Diseases, University of Genoa, Italy. Robert BushRobert BushDr Robert Bush received his MD degree from West Virginia University, USA. After completing his residency in internal medicine and fellowship in allergy and immunology at the University of Wisconsin – Madison, USA, he joined the faculty. He is currently Professor (Emeritus) of Medicine and was the former Chief of Allergy at the William S Middleton VA Hospital, Madison, Wisconsin, USA. His research interests include sublingual immunotherapy, allergen characterization, fungal allergy, food allergy, and occupational asthma.

Effect of Sirolimus on Immune Reconstitution Following Myeloablative Allogeneic Stem-Cell Transplantation: A Post-Hoc Analysis of a Randomized Controlled Trial Comparing Sirolimus/Tacrolimus with Tacrolimus/Methotrexate (BMT CTN 0402)

Introduction:Although allogeneic hematopoietic cell transplantation (HCT) is a potentially curative therapy for hematologic neoplasms, one of its limiting toxicities continues to be graft versus host disease, both acute and chronic (aGVHD, cGVHD). Sirolimus is a mammalian target of rapamycin (mTOR) inhibitor which has been found to be effective in GVHD prophylaxis, in combination with calcineurin inhibitors like tacrolimus. The impact of sirolimus on immune reconstitution has not been comprehensively investigated in-vivo thus far. We now present a post-hoc analysis of the randomized study BMT-CTN 0402, examining the effect of sirolimus on immune subsets post-transplant. We further examine the association between different lymphocyte subsets and outcomes post-transplant in each arm.Methods:BMT-CTN 0402 was a randomized trial (n=304) which compared two GVHD prophylaxis regimens, sirolimus/tacrolimus (Sir/Tac) versus tacrolimus/methotrexate (Tac/MTX), in AML/ALL/MDS patients, undergoing myeloablative HLA-matched transplantation. There was no difference in 114-day GVHD free survival (primary end-point) as well as acute or chronic GVHD, relapse or overall survival between arms. 264/304 patients had available samples for the current post-hoc analysis. Blood samples were collected at 1,3, 6, 12 and 24 months post-HCT. Multi-parameter flow cytometry was performed at the project lab (Esoterix Clinical Trials Services) in a blinded fashion, and results were compared between arms. Multivariable Cox regression models, treating each phenotypic parameter as a time dependent variable, were constructed to study impact of reconstitution on clinical outcomes.Results:There were no significant differences in patient and transplant characteristics between the Sir/Tac and Tac/MTX arms in this analysis. Absolute lymphocyte count (ALC), CD3+ and CD4+ counts were significantly decreased in the Sir/Tac arm upto 3 months post-HCT while CD8+ cells recovered even slower (upto 6 months) in this arm (Figure 1, Panels A,B and C). Interestingly there was no difference in the absolute number of regulatory T-cells (Tregs/CD4+ CD25+) between arms at any point post-HCT (Figure 1, Panel D). However the Treg:Tcon ratio was significantly greater in the Sir/Tac arm in the first 3 months post-HCT (Figure 1, Panel E). B-lymphocyte recovery was significantly compromised in the Sir/Tac arm from 1 to 6 months post-HCT (Figure 1, Panel F) while NK cells reconstitution was not affected in the sirolimus arm. In the outcomes analysis, higher numbers of CD3+, CD4+. CD8+ and Tregs were associated with better overall survival. Neither Treg numbers nor Treg:Tcon ratio correlated with GVHD.Conclusion:Sir/Tac has a more profound T-cell suppressive effect than the standard of care combination of Tac/MTX in the early post-transplant period, and particularly compromises recovery of CD8+ T-cells with potential implications in the prevention of aGVHD. Sirolimus when used in-vivo with tacrolimus does not result in increased absolute numbers of Tregs, however it does have a beneficial effect on the Treg:Tcon balance in the first 3 months after transplantation, which may be important in the context of cGVHD prevention. Calcineurin-inhibitor free, sirolimus containing GVHD prophylaxis strategies, incorporating other novel agents, should be investigated further to maximize the favorable effect of sirolimus on Treg:Tcon balance in the post-transplant immune repertoire. Sirolimus significantly compromises B-cell recovery in the first 6 months post-HCT with potential complex effects on cGVHD which merit further study.Acknowledgments:Support for this study was provided by grant #U10HL069294 to the Blood and Marrow Transplant Clinical Trials Network from the National Heart, Lung, and Blood Institute and the National Cancer Institute, along with contributions by Wyeth Pharmaceuticals Inc. BMT CTN 0402 biospecimens were obtained from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC). The content is solely the responsibility of the authors and does not necessarily represent the official views of the above mentioned partiesAdditional support was provided by the Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases for the ancillary study, ‘GVHD Prophylaxis - Immune Reconstitution.‘ [Display omitted] DisclosuresSoiffer:Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees. Antin:Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees.

Editorial introductions

Editorial introductions

Brigitte Alice Askonas. 1 April 1923—9 January 2013

Brigitte Alice (Ita) Askonas, immunologist and biochemist, was born in Vienna to Czech parents. After an undergraduate degree in Biochemistry at McGill University, Montreal, and a life changing experience as a PhD student in the Department of Biochemistry, University of Cambridge, UK, she spent 36 years at the National Institute for Medical Research (NIMR) where she was a founding member of the Division of Immunology there, eventually becoming its head in 1976 until her formal retirement in 1988. Thereafter, until her death 25 years later, she continued to take an active interest in immunology research, advising scientists at all levels and especially in training young scientists, ensuring they were not mistreated, ignored or not properly acknowledged.Her influence came from her six decades of active involvement in research into many aspects of immunology, studying antibody production, the role of macrophages in antigen recognition and immunosuppression and the role of T lymphocytes in viral infection. This unusually wide experience supported by her biochemical training underlay her reputation for rigour in scientific experimentation, eye for detail and an exacting memory.She was renowned as a scientific mentor and many high-profile scientists learnt their craft in her laboratory and were introduced there into areas of immunology where they subsequently became well known. She was simultaneously very critical and a really good friend who looked after people. She had an exceptionally generous attitude to publication and was thoughtful in many personal ways. She especially valued friends and colleagues who amused her, a quality obvious from her earliest days until the very end of her life.

Bruno Kyewski 1950‐2018

Bruno Kyewski, a dear friend and colleague, passed away in March 2018 after a long battle against early metastasizing prostate cancer. With him we have lost a remarkable and visionary scientist who more than 40 years ago set out to unravel the immunological secrets of the thymus and its role in self-tolerance. Bruno was born in the idyllic village of Bad Peterstal in the Black Forest and studied medicine in Bonn and Zürich. He earned his MD in 1978 with Hartmut Wekerle at the Max-Planck-Institute for Immunobiology in Freiburg, in those days one of the cradles of immunologists in Germany. Inspired by Wekerle´s thymic nurse cells Bruno developed his interest and passion for the role of the thymus in shaping the T cell repertoire and self-tolerance. He continued to work on the thymus as a postdoc in Henry Kaplan's laboratory at Stanford University Medical School, where he discovered that circulating protein antigens were efficiently presented in the thymus by MHC class II-positive dendritic cells, whereas cortical epithelial cells failed to do so, despite their high MHC class II expression. Thereafter, he joined the German Cancer Research Center in Heidelberg as a principal investigator, where he became Head of the Division of Developmental Immunology in 2004. For a long time it was assumed, and then shown with T cell receptor transgenic mice, that autoreactive T cells could be deleted in the thymus. It was believed that at least some peripheral tissue-restricted antigens could be picked up by dendritic cells and presented in the thymus, resulting in central tolerance. For those organ-specific antigens that would not find their way into the thymus, it was assumed that peripheral tolerance mechanisms would take care of auto-reactivity. This hypothesis was plausible and made perfect sense. No one could imagine the existence of a particular cell type which would express all or almost all organ-specific proteins, but Bruno did. In a brilliant set of experiments he discovered that thymic medullary epithelial cells expressed a large number of antigens that had been believed to be restricted to peripheral tissues, thereby resulting in thymic deletion of T cells specific for peripheral organs. With these stunning findings Bruno provided a crucial part of the mechanistic basis for the groundbreaking observation made by the Nobel laureate Sir Peter Medawar half a century earlier in the 1950s that immunological tolerance to the body's own tissues is not inborn but rather is acquired by the developing immune system. Most importantly, Bruno's elegant studies stimulated new directions of research, such as the genetic mechanisms for promiscuous gene expression and the consequences for autoimmune diseases and cancer vaccination. In addition to that work, Bruno served as associate editor at the International Journal of Cancer for over 15 years. Here, too, he made a significant contribution to the journal's development with his expertise. Bruno was a unique friend and colleague, warmhearted and very modest, almost too modest for this world. He would listen carefully and help to solve scientific problems, but his curiosity and interests were not limited to science. In discussions and conversations he would often drift off to literature, philosophy, art, and music, especially Schubert's music, which deeply moved him. He loved to spend vacations in France together with his family, where he enjoyed French cuisine and savoir vivre. His thoughts and comments were always enlightening and never superficial. Could I choose a piece of art for him it would be Rodin's sculpture The Thinker. Bruno would have loved to continue his research and life with his family, but fate wouldn't let him. We already miss him very much. Günter J. Hämmerling Tumor Immunology Program German Cancer Research Center

Editorial introductions

Editorial introductions

Disease characteristics and causes of early and late death in a group of Croatian patients with systemic lupus erythematosus deceased over a 10-year period.

AimTo assess the causes of early death (ED) and late death (LD) in patients with systemic lupus erythematosus (SLE) and determine the features of deceased SLE patients followed-up in a single Croatian tertiary hospital center, because little if any data on causes of death (CODs) in SLE patients are available for Croatia.MethodWe identified SLE patients regularly followed-up at the Division of Clinical Immunology and Rheumatology, University Hospital Center Zagreb, who died from 2002 to 2011. Death was ascertained by matching our institutional records with the Croatian National Death Database. Patients were grouped according to their disease duration to ED and LD and compared by demographic characteristics, classification criteria, organ damage, and CODs.ResultsWe identified 90 patients (68 women), who died at the age of 58 ± 15 years. The most frequent COD category was cardiovascular diseases (40%), followed by infections (33%), active SLE (29%), and malignancies (17%). No significant difference was found between the frequencies of causes of ED and LD, except for stroke, which caused only LD≥10 years after the diagnosis. SLE was reported in death certificates of only 41 of 90 patients.ConclusionAlthough stroke occurred both in the early and late disease course, it was primarily associated with LD. Given the low proportion of SLE recorded in death certificates of deceased SLE patients, matching of institutional and vital statistics records may be required to assess the true impact of SLE on mortality.

English

Objective: To determine the prevalence of Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index among systemic lupus erythematosus (SLE) patients and to investigate the prevalence of each component of SLICC/ACR damage index. Methods: We performed a cross-sectional study on 110 SLE patients from the Division of Rheumatology and Clinical Immunology, University Hospital Centre Rijeka, Croatia. Damage in SLE patients was assessed by SLICC/ACR damage index. Results: The most frequently observed components of SLICC/ACR damage index were osteoporosis with fracture and cranial or peripheral neuropathy. After that followed cataract and pleural fibrosis. Malignancy was recorded as the fifth most represented component of SLICC/ACR damage index. Hormone-sensitive cancers were more common than hematologic cancers. Conclusion: In our group of SLE patients musculoskeletal system was the most frequently observed organ system of SLICC/ACR damage index. Osteoporosis with fracture was the most common manifestation of musculoskeletal system and the main characteristic of SLICC/ACR damage index.

Comparison of Different Diagnostic Guidelines for the Diagnosis of Macrophage Activation Syndrome Complicating Systemic Juvenile Idiopathic Arthritis: Single Centre Experience.

SUMMARY – Macrophage activation syndrome (MAS) is a potentially fatal complication of systemic juvenile idiopathic arthritis (sJIA), caused by exaggerated but ineffective immune response. The aim of the study was to compare the capacity of the HLH-2004 guidelines with the capacity of the MAS guidelines from 2005, and with the new set of classification criteria from 2016 in diagnosing MAS complicating sJIA. The study included 35 children aged 1-18 diagnosed with sJIA according to ILAR criteria and treated at the Department of Pediatrics, Division of Immunology and Rheumatology, Zagreb University Hospital Centre, in the period from 2009 to 2015. Out of 35 patients diagnosed with sJIA, there were 12 girls and 23 boys, with the mean age at disease onset (±SD) 5.51±3.65 years. Eight patients had flare of disease. With the guidelines from 2005, MAS was diagnosed in six (17.1%) patients with sJIA. With the new set of classification criteria from 2016, MAS was diagnosed in four (11.4%) patients with sJIA. MAS was not diagnosed with the HLH-2004 guidelines. In our study, four out of six patients had MAS at the onset of sJIA, and in the rest two it occurred during relapse. Two patients with MAS developed full-blown clinical picture while another four had incomplete clinical features with minor laboratory alteration. Due to the use of different diagnostic guidelines, we found difference in the prevalence of MAS. It was slightly higher in comparison to available studies, while other researched features, such as clinical characteristics, were similar.

Editorial introductions

Editorial introductions

Drs. Aggarwal and Oddis reply.

We appreciate the feedback from Fritzler, et al 1, on our article “A Negative Antinuclear Antibody Does Not Indicate Autoantibody Negativity in Myositis: Role of Anticytoplasmic Antibody as a Screening Test for Antisynthetase Syndrome,” published in The Journal 2. Our primary goal was to simply call attention to the many clinical laboratories in the United States that will report a negative antinuclear antibody (ANA) and not report the presence of cytoplasmic staining, which could indicate the presence of an antisynthetase autoantibody. This indeed may be in the setting of other commercial autoantibodies (i.e., rheumatoid factor, antineutrophil cytoplasmic antibodies, etc.) also being reported as negative. The clinical correlate of this is that the patient with the antisynthetase syndrome (particularly those with non-Jo1 autoantibodies) may not fully manifest the entire clinical spectrum of the antisynthetase syndrome but could certainly present with lung dominant disease. Thus, when autoantibody testing is ordered on this subset of patients, there is the possibility that the report yields a “negative” ANA. This forme fruste of autoimmune interstitial lung … Address correspondence to Dr. R. Aggarwal, UPMC Arthritis and Autoimmunity Center, Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, 3601 Fifth Ave., Suite 2B, Pittsburgh, Pennsylvania 15213, USA. E-mail: aggarwalr{at}upmc.edu

Editorial introductions

Editorial introductions

Gottron Sign with Ulceration Is Not a Poor Prognostic Factor in Patients with Dermatomyositis and Interstitial Lung Disease

To the Editor: We read the recent article by Cao, et al 1 with great interest. They reported that patients with dermatomyositis (DM) who have Gottron papule/sign with ulceration show an increased risk of interstitial lung disease (ILD) and a significantly lower cumulative survival rate. Unlike Cao, et al , we found that the survival of DM patients with ILD and ulcerated Gottron sign was not worse than that of patients without ulceration. We retrospectively reviewed all the adult patients with DM admitted to our department from 2000 to 2012. The criteria for diagnosis of DM were the same as those used by Cao, et al 1. Clinical features and laboratory test results were assessed from the medical records, with laboratory data being those obtained at the first admission. ILD was diagnosed by detection of interstitial changes on chest computed tomography. Cancer-associated myositis was diagnosed if a malignancy was detected within 3 years … Address correspondence to Dr. T. Nagashima, Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi 329-0498, Japan. E-mail: naga4ma{at}jichi.ac.jp

Targeting innate immunity to downmodulate adaptive immunity and reverse type 1 diabetes.

Type 1 diabetes (T1D) is characterized by specific destruction of pancreatic insulin-producing beta cells accompanied by evidence of beta-cell-directed autoimmunity such as autoreactive T cells and islet autoantibodies (IAAs). Currently, T1D cannot be prevented or reversed in humans. T1D is easy to prevent in the nonobese diabetic (NOD) spontaneous mouse model but reversing new-onset T1D in mice is more difficult. Since the discovery of the T-cell receptor in the 1980s and the subsequent identification of autoreactive T cells directed toward beta-cell antigens (eg, insulin, glutamic acid decarboxylase), the dream of antigen-specific immunotherapy has dominated the field with its promise of specificity and limited side effects. While such approaches have worked in the NOD mouse, however, dozens of human trials have failed. Broader immunosuppressive approaches (originally cyclosporine, subsequently anti-CD3 antibody) have shown partial successes (e.g., prolonged C peptide preservation) but no major therapeutic efficacy or disease reversal. Human prevention trials have failed, despite the ease of such approaches in the NOD mouse. In the past 50 years, the incidence of T1D has increased dramatically, and one explanation is the “hygiene hypothesis”, which suggests that decreased exposure of the innate immune system to environmental immune stimulants (e.g., bacterial products such as Toll-like receptor (TLR) 4-stimulating lipopolysaccharide [LPS]) dramatically affects the adaptive immune system and increases subsequent autoimmunity. We have tested the role of innate immunity in autoimmune T1D by treating acute-onset T1D in NOD mice with anti-TLR4/MD-2 agonistic antibodies and have shown a high rate of disease reversal. The TLR4 antibodies do not directly stimulate T cells but induce tolerogenic antigen-presenting cells (APCs) that mediate decreased adaptive T-cell responses. Here, we review our current knowledge and suggest future prospects for targeting innate immunity in T1D immunotherapy.

Ichtyopathology in Poland: Past, present, future

The aim of the study was to present the history of ichtyopathology in Poland and the main achievements of researchers who developed this discipline. The pioneer of ichtyopathological research in Poland was the ichtyologist prof. Teodor Spiczakov, founder of the first Fish Diseases Laboratory at the Jagiellonian University (JU) and initiator of fishery veterinary service. After the Second World War, dr Stanisław F. Śnieszko, a researcher from JU, established a laboratory in the United States, renamed the National Fisheries Center in 1977. In writing about the beginnings of ichthyopathology in Poland, one must also mention prof. Bronisław Kocyłowski, founder and head of the Department of Fish Diseases at PIW in Puławy and lecturer at the Warsaw University of Life Sciences (WULS) and Maria Curie Skłodowska University in Lublin. Prof. Eugeniusz Grabda also contributed to the development of ichtyopathology. He headed the Inland Fisheries Institute (IFI), Fish Disease Laboratory and the Department of Ichthyology with the Department of Fish Diseases at the Fishery Department of the Academy of Agriculture and Technology (AAT) in Olsztyn and co-founded the Department of Marine Fisheries at the Agricultural Academy and the Department of Fish Diseases in Szczecin. In Żabieniec near Warsaw, IFI established a new Ichtiohygiene Division, renamed the Division of Pathology and Fish Immunology, formerly headed by prof. Maria Studnicka and now by prof. Andrzej K. Siwicki. Veterinary inspection in Poland is conducted by the Fish Diseases Laboratory at ZHW under the substantive supervision of the National Veterinary Research Institute & National Reference Laboratories at Fish Diseases Unit in Puławy, headed by prof. Jerzy Antychowicz. Currently the Unit is the National Reference Laboratory for the diagnostics of diseases of aquaculture animals, run by prof. Michal Reichert. Prof. J. Antychowicz and dr. Jan Żelazny taught for many years at the Faculty of Veterinary Medicine at the WULS in Warsaw and at AAT in Olsztyn. The Polish Academy of Sciences has a Department of Ichtiopatology and Fishery Management in Gołysz, headed by prof. Andrzej Pilarczyk, who studies the biological basis of fish farming. “Fish diseases” is a mandatory subject at faculties of veterinary medicine in Poland, and every graduate of veterinary medicine possesses a basic knowledge in this field. The Division of Fish Diseases and Biology in Lublin has been operating since 1963 and for many years was headed by prof. Maria Prost, an authority on the parasitology of fish. The current head of the Division is prof. Antonina Sopińska. The Division of Hygiene Veterinary Laboratory and Fish Diseases Laboratory (later Division of Ichtyopathology) at the Faculty of Veterinary Medicine, Wrocław University af Environmental and Life Sciences were previously headed by prof. Zbigniew Jara, and now by dr Wiktor Niemczuk. At the University of Warmia and Mazury in Olsztyn, prof. Andrzej K. Siwicki and dr Elżbieta Terech-Majewska run the Fish Disease Laboratory and Veterinary Laboratory for Diagnostics of Fish, Amphibians and Reptiles, carry out scientific research, teach and cooperate with fish farmers.

SWEET SYNDROME IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS FLARE.

20Dec 2016 SWEET SYNDROME IN A PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS FLARE. Muhammad Zeeshan Siddiqui , Rebecca Brown , Arezoo Haghshenas. Qi Tao , Samia Qazi , Marianne Frieri. and Prachi Anand. Department of internal medicine, nassau university medical center. New york institute of technology college of osteopathic medicine. Department of histopathology, nassau univeristy medical center. Division of allergy and immunology, department of internal medicine, nassau univeristy medical center.

Editorial introductions

Editorial introductions

Vitamin D levels in children affected by vernal keratoconjunctivitis

Background: Vernal keratoconjunctivitis (VKC) is a chronic and often severe bilateral conjunctivitis. VKC etiology still remains unclear although endocrine, genetic, neurogenic and environmental factors have been implicated. Vitamin D is a fat-soluble prohormone whose main function is the regulation of calcium and phosphate metabolism. The aim of this study was to evaluate serum vitamin D in children affected by VKC compared to the healthy children and investigate the relationship between its levels and disease severity.Methods: A total of 110 children, 47 affected by VKC, aged between 5 and 12 years were enrolled at the Department of Pediatrics, Division of Allergy and Immunology, “Sapienza” University of Rome. Used as controls were 63 healthy children with negative skin prick test (SPT), without allergic, ocular and systemic disease. Serum samples were obtained in April from all the children included in the study. Vitamin D dosage was repeated in October in 20 patients after therapy and in 20 controls. A conjunctival scraping was performed in all children affected by VKC.Results: Children affected by VKC had lower vitamin D levels compared to healthy controls and we found an increase in vitamin D levels after therapy with cyclosporine eye drops 1% although this increase was lower than that of healthy controls. Moreover we found significant correlations between vitamin D level and the severity of the disease.Conclusions: The study shows that children affected by VKC have lower vitamin D levels when compared to healthy controls and highlights a significant correlation between its levels and disease severity.