Lymphocyte Reaction Research Articles

CytogeneticsPathBrowser: an educational tool to convert textbook images and captions into flashcards

Abstract Background Competence in reaching the correct diagnosis from analysis of clinical pathology specimens requires exposure to a large volume and breadth of cases. Images from textbooks are critical resources that supplement actual cases with well curated information. However, learning from textbooks has several setbacks. Images from individual textbooks are limited in number and often do not adequately capture variation of the disease entity. Textbooks also do not usually provide a platform for learners to assess their diagnostic abilities. This burdens the learner with creating flashcards for self-assessment, which is manually intensive. Methods To address these limitations, we developed PathBrowser, a web browser-accessible program that leverages the PyMuPDF Python package (Artifex) to extract images and captions from textbooks in PDF format. Captions are written to the image files using ExifTool (Phil Harvey), making the images searchable by keywords. The program then displays the image while hiding the caption, challenging the user to enter the appropriate diagnosis. To minimize work by the user to prepare flashcard questions and answers, the program can automatically generate quiz questions by using natural language processing tools and a Naïve Bayes (NB) classifier (NLTK and SpaCy packages) to identify important terms from the caption as either diagnoses or cytologic features. Results As a proof of principle, we used PathBrowser to build an image repository of myeloblasts and common mimickers, including reactive lymphocytes and chronic lymphoid leukemias, towards training junior pathology residents to identify blasts in peripheral blood and body fluids. In total, PathBrowser extracted 173 images (63 myeloblasts and 110 non-blasts) from 2 textbook sources (Atlas of Diagnostic Hematology by Salama et al., and Hematopathology by Jaffe et al.). We trained a NB classifier to label images as “myeloblast” or “non-myeloblast,” based on keywords in the caption. We manually ascertained that PathBrowser extracted the appropriate caption from 30/30 (100%) images of myeloblasts. Of these, the NB classifier correctly extracted the term “myeloblast” in 28 (93%) images. A survey of pathology residents showed that 89% of respondents agreed the program is a useful pathology learning tool. Conclusions We developed a program that makes reading from textbooks an interactive learning experience. By automating the manual-intensive steps of extracting images and captions and preparing flashcards with quiz questions using caption terms classified by machine learning tools, learners can focus on recognizing the diagnostic features represented by the images. Finally, our program enables the rapid generation of a repository of images from diverse sources, so that learners can browse a wide spectrum of disease entities and their variants.

Applying decision tree algorithms to early differential diagnosis between different clinical forms of acute Lyme borreliosis and tick-borne encephalitis

Background: Tick-borne encephalitis and Lyme borreliosis are the most common natural focal infections in Russia often arising as a mixed infection, which is often clinically difficult to distinguish from a monoinfection at the onset of the disease that is a result of delayed laboratory verification of the diagnosis and it requires further searching for fundamentally new approaches to the issue of early differential diagnosis of tick-borne infections.Aims: is to develop decision tree algorithms for early differential diagnosis between the mono- and mixed forms of acute Lyme borreliosis and tick-borne encephalitis with prevailing febrile syndrome in clinical picture based on clinical and laboratory data.Materials and methods: We retrospectively analyzed 55 clinical and laboratory parameters obtained from 291 hospitalized tick-borne infections patients with or without erythema migrans at the site of ixodid tick bites in the first week of the disease, who were included in the single-center study from 2010 to 2023. In 211 patients without erythema, the analysis was carried out between three classes depending on the diagnosis: the mixed infection of non-erythematous Lyme borreliosis and tick-borne encephalitis, the mono-infection of non-erythematous Lyme borreliosis or the monoinfection of tick-borne encephalitis. The other two classes, which included 80 patients with erythema, had the mixed infection of acute erythematous Lyme borreliosis and tick-borne encephalitis or erythematous Lyme borreliosis monoinfection. Python programming language was applied to develop two decision tree models. Feature importance was assessed for all predictors. Each patient class was randomly divided into training (70%) and testing (30%) datasets. Accuracy evaluation of the models was based on ROC analysis.Results: The decision tree algorithm for early differential diagnosis among the tick-borne infection patients without erythema migrans included the following most important predictors: maximal fever rise, chills, neutrophil-to-monocyte ratio, ESR, absolute number of reactive lymphocytes and immature granulocytes, and percentage of eosinophils. The model for differential diagnosis between the patients with erythema migrans included the following predictors: maximal fever rise, the absolute number of reactive lymphocytes and immature granulocytes, and the percentage of basophils. Both decision tree models showed excellent predictive values based on sensitivity, specificity, precision, accuracy, and F1 scores, as well as areas under the ROC curve, which were higher than 0.90.Conclusions: Based on clinical and laboratory parameters, two decision tree models with high sensitivity have been developed, which can be easily applied in clinical practice for early differential diagnosis of the tick-borne infections with prevailing fever syndrome.

Variations in complete blood counts and cellular morphological alterations in blood smear of COVID-19 patients from a tertiary care center

Corona viruses are a large family of viruses of which Corona virus disease 19 (COVID 19) infection evokes a hyperinflammatory response and severe acute respiratory distress syndrome in human beings. Complete blood count evaluation and peripheral smear examination is an essential tool for early diagnosis and management of COVID-19 positive patients. This study was aimed to evaluate the variations in complete blood counts (CBC) and changes in the cellular morphology in the blood smear in patients affected with COVID-19. This was an observational study, undertaken in a tertiary care center. The study included baseline blood samples from 96 proven COVID-19 positive cases. The samples were subjected for automated complete blood count analysis and peripheral smear examination.Thequantitative data were expressed by mean and Standard deviation. Qualitative categorical variables were expressed as numbers and percentages. Out of the total 96 cases, the most common quantitative finding was neutrophilic leukocytosis with relative lymphopenia. Five cases of absolute lymphopenia was observed. Majority of the cases had normal hemoglobin values and normal platelet counts. The characteristic morphological changes were seen in neutrophils and lymphocytes. The neutrophils showed presence of toxic granules, cytoplasmic vacuolations and hypolobation.The morphological alteration in lymphocytes included reactive lymphocytes with plasmacytoid and monocytoid morphology, large granular lymphocytes and Turk cells. Infrequent finding of leukoerythroblastic reaction was also observed in our study.To summarize, hematological investigation of COVID 19 cases may show several abnormal findings. Quantitative findings like Neutrophilia and lymphopenia were characteristic, whereas, the most common morphological alteration observed was atypical lymphocytes. Quantitative and qualitative alterations of hematological parameters are one of the investigations which would aid timely diagnosis of the disease. Toxic granules and cytoplasmic vacuolations in neutrophils may indicate ongoing sepsis in COVID 19 patients which in turn aids in efficient management of the patients to reduce the mortality rate.

Quantitative analysis of protective T cell immunity against brucellosis

The results of study relationship between antigen reactivity of T-lymphocyte population under ex vivo conditions and the intensity of protective post-vaccination immunity to causative agent of brucellosis are presented. Тaking into account the peculiarities of immunopathogenesis brucellosis and prevailing role of adaptive T-cell immunity to protect against the causative agent of infection, possibility predictive evaluation of protective immunity against brucellosis using CAST-tests is considered as the most important aspect of brucellosis problems. There is an obvious need for an ex vivo correlation analysis of the activity of antigen stimulation of T cells and the intensity of protective immunity formed after vaccination. A close direct proportional relationship was established between the number of live microbial cells Brucella abortus 19BA vaccine strain administered and increase in ex vivo CD3-cell activation. A close correlation was revealed between ex vivo value of antigen-induced stimulation CD3-lymphocytes and level of post-vaccination immunological protection against brucellosis infection. It has been shown that in biomodels vaccinated against brucellosis with a T-lymphocyte stimulation coefficient of 50% or more (according to intensity of antigen-induced ex vivo expression CD25), 100% protection from the development of brucellosis infection after infection with Brucella melitensis at a dose of 1 × 103 live microbial cells are provided. At the same time, there was a lack of a close correlation between an increase in the dose of brucella vaccine strain administered to biomodels and a change in geometric mean antibody titer, presence of a weakly pronounced relationship between level of agglutinins and immunological protection of biomodels from development brucellosis infection and indicators bacterial contamination body.Based on results of study, it was demonstrated that it is possible to quantify the formation and protective activity of T-cell immunity to causative agent of brucellosis based on analysis of level antigen reactivity of CD3-lymphocytes ex vivo. The data obtained and described methodological approach can be used as a predictive criterion in assessing protective level of cellular immunity to causative agent of brucellosis in vaccinated or recovering patients, as well as in order to analyze effectiveness of specific prophylaxis brucellosis and study immunogenicity and protective properties candidate for brucellosis vWe present the results of studies related to antigen reactivity of T lymphocyte population under ex vivo conditions and the intensity of protective post-vaccination immunity to causative agent of brucellosis. Due to peculiarities of immunopathogenesis in brucellosis infection and prevailing role of adaptive T cell immunity for protection against the causative agent of infection, a predictive evaluation of protective immunity against brucellosis using CAST-tests is considered the most important issue in the field. There is an obvious need for ex vivo analysis of correlations between the activity of antigen stimulation of T cells, and the intensity of protective immunity raised after vaccination. A close direct relationship was established between the number of live microbial cells of Brucella abortus 19BA vaccine strain administered, and increase in ex vivo CD3 cell activation. A close correlation (r = -0.841 ÷ -0.966, R2 = 0.708 ÷ 0.969) was revealed between ex vivo values of antigeninduced stimulation of CD3 lymphocytes, and the levels of post-vaccination immunological protection against brucellosis infection. We have shown that, in biomodels vaccinated against brucellosis with a T lymphocyte stimulation coefficient of 50% or more (according to intensity of antigen-induced ex vivo CD25 expression), 100% protection against brucellosis infection was achieved after contamination with Brucella melitensis at a dose of 1×103 live microbial cells. At the same time, a lack of a close correlation was noted between an increased dose of Brucella vaccine strain administered to biomodels, and a change in geometric mean of antibody titer (R2 = 0.357÷0.404), along with a weak relationship between the levels of agglutinins and immunological protection of biomodels from developing brucellosis infection and indices of in vivo bacterial contamination.These results suggest an opportunity to quantify development and protective activity of T cell immunity to the causal agent of brucellosis based ex vivo levels of antigen reactivity of CD3 lymphocytes. A correlation analysis between the state of T cell antigen reactivity and immunological resistance to brucellosis infection indicated a high degree of closeness between these indices. The key influence on activity of protective immunity is exerted by the levels of antigen reactivity of T lymphocytes, whereas the quotient of antigenic stimulation in CD3+CD25+ population may be considered the most informative index of immune protective activity. The data obtained and the described methodology may be used as a predictive criterion in assessing protective level of cellular immunity to causative agent of brucellosis in vaccinated or recovering patients, testing the efficiency of specific prophylaxis in brucellosis and studying immunogenicity and protective properties of candidate vaccines against brucellosis.

Can sPD-1 and sPD-L1 Plasma Concentrations Predict Treatment Response among Patients with Extraparenchymal Neurocysticercosis?

Extraparenchymal neurocysticercosis (EP-NC) is a chronic, potentially life-threatening disease that responds poorly to initial anthelmintic drug therapy. A depressed specific reactivity of peripheral lymphocytes and an increased level of specific Tregs accompanies EP-NC. The immune checkpoint pathway PD-1 and its ligand PD-L1 downregulates effector T cells, causing specific immune suppression in chronic diseases. This study explored whether their soluble forms, sPD-1/sPD-L1, are present in plasma among patients with EP-NC and if their levels could be associated with treatment response. A total of 21 patients with vesicular EP-NC and 22 healthy controls were included. Patients received standard treatment and were followed for six months to assess treatment response by assessing changes in cyst volume determined with 3D MRI. The presence of both sPD-1 and sPD-L1 was more frequently detected among patients with EP-NC than in healthy controls and had higher concentrations. Among patients, higher pre-treatment levels of both markers were associated with a poor treatment response, and the sensitivity and specificity of the sPD-1/sPD-L1 ratio for predicting any response to treatment were high. Our results are consistent with the presence of lymphocyte exhaustion and open new research perspectives to improve the prognosis of patients with this severe disease.

Artificial intelligence and the blood film: Performance of the MC-80 digital morphology analyzer in samples with neoplastic and reactive cell types.

Implementing artificial intelligence-based instruments in hematology laboratories requires evidence of efficiency in classifying pathological cells. In two-Universities, we assessed the performance of the Mindray® MC-80 for hematology patients with frequent leukemic and dysplastic cells. The Mindray MC-80® locates and pre-classifies cells in blood films. In a two-university study, four films were prepared from 591 samples, two each for the analyser MC-80 and the microscope reference method, using reagents from two different manufacturers. We used Microsoft Excel® statistics for imprecision and distributional inaccuracy and a matrix table model (H20-A2 CLSI standard) for sensitivity, specificity and predictive value for atypical cells. The results indicate minimal within-run imprecision (ICSH method) and good intra-method consistency even on duplicate analysis of 413 samples with a high incidence of hematological abnormalities (r = 0.942 or more, except for basophils, r = 0.841, and reactive lymphocytes, r = 0.847). Distributional inaccuracy was also very low compared to the microscope reference, with a pass rate higher than 80% for pathological cells (except 75.1% for reactive lymphocytes). The primary causes of discrepancy were bizarre shapes of dysplastic neutrophils and inconsistent nomenclature for lymphoma cells. Sensitivity for critical samples containing cells typically absent in circulating blood (immature or malignant) was 98.8% for immature granulocytes, 83.8% for all types of neoplastic cells, 93.6% for reactive lymphocytes and 97.5% for nucleated red blood cells. The negative predictive values of MC-80 were 98.8% for immature granulocytes, 88.4% for the different types of neoplastic cells, 97.8% for reactive lymphocytes, and 96.9% for nucleated red blood cells. Our study highlights the outstanding diagnostic performance of this artificial intelligence-based blood film analyzer for hematology patients with circulating abnormal cells. We appreciated the morphological harmonization of cells observed on the screen and those seen in the microscope.

Comparison of the performance of two automatic cell morphology analyzers for peripheral-blood leukocyte morphology analysis: Mindray MC-100i and Sysmex DI-60.

To compare the morphological classification ability of peripheral-blood leukocytes of the automatic cell morphology analyzers MC-100i and DI-60. (1) MC-100i and DI-60 were used to analyze leukocytes in 432 venous blood samples collected from three tertiary hospitals across China. The preclassification results were compared with the results reported by senior morphological experts (postclassification results) to evaluate the accuracy, sensitivity, specificity, and consistency of leukocyte preclassification for both instruments. (2) In 200 of the 432 blood samples, morphological experts conducted manual microscopic examination for various types of leukocytes. The correlation between the MC-100i and DI-60 leukocyte postclassification results and the expert microscopist results were analyzed. (1) MC-100i preclassified leukocytes and nucleated red blood cells (RBCs). Compared with the postclassification results, the total leukocyte preclassification accuracy of MC-100i was 97.16%, while that of DI-60 was 87.24%. The sensitivity of MC-100i to abnormal cells (including blasts, promyelocytes, neutrophilic myelocytes, neutrophilic metamyelocytes, reactive lymphocytes, abnormal promyelocytes, plasma cells, abnormal lymphocytes and nucleated RBCs) was 90.24%, which was significantly higher than the 50.72% sensitivity of DI-60. (2) Comparing the postclassification results with manual microscopy, except for reactive lymphocytes and basophils, the MC-100i and DI-60 results had good correlations with various leukocyte types and nucleated RBCs (r > 0.85), and MC-100i was better than DI-60 in the recognition of basophils. Both MC-100i and DI-60 have good detection ability for five normal types of leukocytes in peripheral blood. MC-100i has significantly better detection sensitivity for abnormal cells in peripheral blood than DI-60.

A Retrospective Comparative Evaluation of Selected Blood Cell Ratios, Acute Phase Proteins, and Leukocyte Changes Suggestive of Inflammation in Cats.

Neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), and platelet-to-lymphocyte (PLR) ratios have been proposed as diagnostic and prognostic markers for neoplastic and inflammatory diseases in dogs and cats. The aim of this retrospective preliminary study was to evaluate the relationship between these ratios and markers of inflammation routinely measured in cats. A total of 275 cats were enrolled. Complete blood count, serum amyloid A (SAA), albumin, globulin, and albumin-to-globulin ratio (AGR) data were analyzed, as well as the presence of leukocyte alterations considered suggestive of inflammation (LAI: neutrophils left shift, toxic neutrophils, and reactive lymphocytes) evaluated in blood smears. The NLR and MLR correlated positively with SAA and globulins and negatively with albumin and AGR. Higher NLR and MLR were found in cats with increased SAA and globulins and decreased albumin and AGR. The PLR correlated negatively with albumin and AGR. A higher PLR was found in cats with hypoalbuminemia. Cats with LAI had higher NLR, MLR, and PLR. In cats with no changes in parameters indicative of inflammation, 11.25, 0.42, and 528.3 were identified as upper limits for NLR, MLR, and PLR, respectively. In conclusion, the NLR, MLR, and PLR act as good inflammatory markers easily evaluated by routine hematology.

Antinuclear Antibody Seropositivity in Fibromyalgia Associated with Borrelia-specific T Lymphocytes.

Our group have recently reported that there is no evidence of an association between fibromyalgia and Borrelia-specific T lymphocytes. However, a small number of case reports has suggested that infection by the bacterial genus Borrelia may be associated with the presence of antinuclear antibodies (ANAs). To test the hypothesis that those fibromyalgia patients who are ANA seropositive are more likely to show evidence of Borrelia-specific T lymphocyte reactivity than those who are seronegative. T lymphocyte reactivity to Borrelia burgdorferi sensu stricto (full antigen) was assessed using the enzyme-linked immunospot and serum ANA status was assessed using immunofluorescence in 27 fibromyalgia patients fulfilling the revised diagnostic criteria of the American College of Rheumatology. The ANA seropositive and seronegative groups were matched for age, sex and ethnicity; the T lymphocyte reactivity to Borrelia burgdorferi sensu stricto (full antigen) in the former group (mean 5.60) was significantly higher than that in the seronegative group (mean 1.77; p < 0.05). This novel study points to an association of ANA seropositivity in fibromyalgia with Borrelia-specific T lymphocytes.

Avian Erythrocytes and Agranulocytes - a Review

This study reports on the morphology of red blood cells and agranulocytes in various types of birds, such as rheas, emus, ostriches, chickens, and geese. Though all of them have the typical avian similarity in blood cells, yet there are some differences. Along with normal and mature erythrocytes, lymphocytes, and monocytes, the present study also focuses on rubricytes, reticulocytes, poikilocytes, polychromatophilic erythrocytes, reactive lymphocytes, pleomorphic monocyte nuclei, etc.

White blood cell differentials performance of a new automated digital cell morphology analyzer: Mindray MC-80.

The manual differential count has been recognized for its disadvantages, including large interobserver variability and labor intensiveness. In this light, automated digital cell morphology analyzers have been increasingly adopted in hematology laboratories for their robustness and convenience. This study aims to evaluate the white blood cell differential performance of the Mindray MC-80, the new automated digital cell morphology analyzer. The cell identification performance of Mindray MC-80 was evaluated for sensitivity and specificity using pre-classification and post-classification of each cell class. The method comparison study used manual differentials as the gold standard for calculating Pearson correlation, Passing-Bablok regression, and Bland-Altman analysis. In addition, the precision study was performed and evaluated. The precision was within the acceptable limit for all cell classes. Overall, the specificity of cell identification was higher than 95% for all cell classes. The sensitivity was greater for 95% for most cell classes, except for myelocytes (94.9%), metamyelocytes (90.9%), reactive lymphocytes (89.7%), and plasma cells (60%). Pre-classification and post-classification results correlated well with the manual differential results for all the cell types investigated. The regression coefficients were greater than 0.9 for most cell classes except for promyelocytes, metamyelocytes, basophils, and reactive lymphocytes. The performance of Mindray MC-80 for white blood cell differentials is reliable and seems to be acceptable even in abnormal samples. However, the sensitivity is less than 95% for certain abnormal cell types, so the user should be aware of this limitation where such cells are suspected.

IL-15 promotes self-renewal of progenitor exhausted CD8 T cells during persistent antigenic stimulation.

In chronic infections and cancer, exhausted CD8 T cells exhibit heterogeneous subpopulations. TCF1+PD-1+ progenitor exhausted CD8 T cells (Tpex) can self-renew and give rise to Tim-3+PD-1+ terminally differentiated CD8 T cells that retain their effector functions. Tpex cells are thus essential to maintaining a pool of antigen-specific CD8 T cells during persistent antigenic stimulation, and only they respond to PD-1-targeted therapy. Despite their potential as a crucial therapeutic target for immune interventions, the mechanisms controlling the maintenance of virus-specific Tpex cells remain to be determined. We observed approximately 10-fold fewer Tpex cells in the spleens of mice chronically infected with lymphocytic choriomeningitis virus (LCMV) one-year post-infection (p.i.) than at three months p.i. Similar to memory CD8 T cells, Tpex cells have been found to undergo self-renewal in the lymphoid organs, prominently the bone marrow, during chronic LCMV infection. Furthermore, ex vivo treatment with IL-15 preferentially induced the proliferation of Tpex cells rather than the terminally differentiated subsets. Interestingly, single-cell RNA sequencing analysis of LCMV-specific exhausted CD8 T cells after ex vivo IL-15 treatment compared with those before treatment revealed increased expression of ribosome-related genes and decreased expression of genes associated with the TCR signaling pathway and apoptosis in both Tpex and Ttex subsets. The exogenous administration of IL-15 to chronically LCMV-infected mice also significantly increased self-renewal of Tpex cells in the spleen and bone marrow. In addition, we assessed the responsiveness of CD8 tumor-infiltrating lymphocytes (TILs) from renal cell carcinoma patients to IL-15. Similar to the data we obtained from chronic viral infection in mice, the expansion of the Tpex subset of PD-1+ CD8 TILs upon ex vivo IL-15 treatment was significantly higher than that of the terminally differentiated subset. These results show that IL-15 could promote self-renewal of Tpex cells, which has important therapeutic implications.

Systematic Evaluation of Hematologic Parameters and Blood Smear Findings in Patients With SARS-CoV-2 vs Other Viral Respiratory Infections.

We evaluated and compared the peripheral blood findings in patients with acute COVID-19 vs other viral respiratory infections. We retrospectively reviewed peripheral blood counts and smear morphology in patients with a positive viral respiratory panel (VRP) or SARS-CoV-2 test. A total of 97 peripheral blood samples (COVID-19 infection, 53; VRP positive, 44) from 50 patients (mean [SD] age, 45.8 [20.8] years; females 52%) were reviewed. There were no statistically significant differences in the demographic characteristics between the 2 groups. The most common peripheral blood abnormalities were anemia, thrombocytopenia, absolute lymphopenia, and reactive lymphocytes. The following peripheral blood findings were significantly associated with other viral respiratory infections compared with COVID-19 infection: low red blood cell count, low hematocrit, high mean corpuscular volume, thrombocytopenia, low mean platelet volume, high red cell distribution width, band neutrophilia, and toxic granulation in neutrophils. Our study showed that there are several peripheral blood count and morphologic abnormalities seen in patients with COVID-19, but most of these findings lack specificity as they are also seen in the other viral respiratory infections.

CD32 Expression by CD4+ T and CD8+ T Lymphocytes Is Increased in Patients with Chronic Hepatitis B Virus Infection.

FcγR is expressed by many immune cells and plays an important role in the immune response to hepatitis B virus (HBV) infection. CD32 belongs to the FcγR family. This study aimed to observe changes in CD32 expression by CD4+ T and CD8+ T lymphocytes in chronic HBV infection patients and evaluate the clinical utility of CD4+ T and CD8+ T CD32 expression to assess the severity of liver injury in chronic HBV-infected patients. A total of 68 chronic HBV patients and 40 healthy individuals were recruited, and the median fluorescence intensity (MFI) of CD32 expression on CD4+ T, CD8+ T lymphocytes was measured using flow cytometry and the CD4+ T, CD8+ T CD32 index was calculated. The reactivity of the healthy individual lymphocytes to mixed patients' plasma containing HBV was observed. Finally, the correlation between CD4+ T, CD8+ T lymphocytes CD32 MFI and liver function indicator levels was analyzed. The CD4+ T, CD8+ T CD32 MFI and index were significantly elevated in HBV patient groups than in normal control group (p < 0.001, for all). Furthermore, the CD32 MFI of healthy persons' CD4+ T and CD8+ T lymphocytes were remarkably increased when stimulated with mixed patients' plasma containing high HBV copies (p < 0.001; P < 0.001). More importantly, in HBV patients, there was a significant positive correlation between CD4+ T, CD8+ T CD32 MFI and the level of serum aspartate aminotransferase (p < 0.05, p < 0.05). In conclusion, the increased expression of CD32 on CD4+ T and CD8+ T lymphocytes might be potential promising biomarkers for the severity of liver function impairment in chronic HBV patients.

Low responsiveness of peripheral lymphocytes in extraparenchymal neurocysticercosis

The morbidity and mortality of extraparenchymal neurocysticercosis (EP-NC) remain high and effectiveness of current medical treatment is suboptimal. Various factors have been implicated in the severity of EP-NC and in the poor response to treatment, but the possible role of host immune and endocrine systems has not yet been examined thoroughly. 42 participants with EP-NC before receiving standard treatment and 25 healthy controls were included in the study. Treatment response was assessed by comparing pre/post treatment parasite volumes from 3D MRI. Prior to treatment among participants with EP-NC, specific stimulation induced an increased specific proliferative response accompanied by a significant increase in IL-4, NK, NKT, Bregs and Tregs cells, whereas in healthy controls, specific stimulation induced a significant increase in IL-1β, IL-5, CCL5, IL-6, TNF-α, NK and Bregs cells. Significant differences between participants with EP-NC and healthy controls in the specific inflammatory response were observed. Participants with EP-NC prior to treatment had significantly weaker responses of proinflammatory cytokines (IL-6, TNF-α) and NK cells, and stronger IL-4 response. Anthelmintic treatment did not promote significant peripheral immunological changes at any time, although inflammation was sustained in the cerebrospinal fluid. Serum estradiol concentration significantly decreased after anthelmintic treatment among males, and cortisol correlated negatively with IL-6 and positively with IFN-γ levels. No pre-treatment immunologic or endocrinologic parameters were significantly associated with response to treatment. Prior to anthelmintic treatment, EP-NC was characterized by low lymphocyte reactivity accompanied by a regulatory response, which may be involved in the lack of peripheral immunological changes during and after treatment, although a central inflammatory response was present. This weak specific peripheral response could favor the chronicity of the infection and the poor response to treatment. Our findings highlight the need for new anti-inflammatory treatment focused on the central nervous system with less systemic immunosuppressive effects.

Automatic normalized digital color staining in the recognition of abnormal blood cells using generative adversarial networks

Background and ObjectivesCombining knowledge of clinical pathologists and deep learning models is a growing trend in morphological analysis of cells circulating in blood to add objectivity, accuracy, and speed in diagnosing hematological and non-hematological diseases. However, the variability in staining protocols across different laboratories can affect the color of images and performance of automatic recognition models. The objective of this work is to develop, train and evaluate a new system for the normalization of color staining of peripheral blood cell images, so that it transforms images from different centers to map the color staining of a reference center (RC) while preserving the structural morphological features. MethodsThe system has two modules, GAN1 and GAN2. GAN1 uses the PIX2PIX technique to fade original color images to an adaptive gray, while GAN2 transforms them into RGB normalized images. Both GANs have a similar structure, where the generator is a U-NET convolutional neural network with ResNet and the discriminator is a classifier with ResNet34 structure. Digitally stained images were evaluated using GAN metrics and histograms to assess the ability to modify color without altering cell morphology. The system was also evaluated as a pre-processing tool before cells undergo a classification process. For this purpose, a CNN classifier was designed for three classes: abnormal lymphocytes, blasts and reactive lymphocytes. ResultsTraining of all GANs and the classifier was performed using RC images, while evaluations were conducted using images from four other centers. Classification tests were performed before and after applying the stain normalization system. The overall accuracy reached a similar value around 96% in both cases for the RC images, indicating the neutrality of the normalization model for the reference images. On the contrary, it was a significant improvement in the classification performance when applying the stain normalization to the other centers. Reactive lymphocytes were the most sensitive to stain normalization, with true positive rates (TPR) increasing from 46.3% - 66% for the original images to 81.2% - 97.2% after digital staining. Abnormal lymphocytes TPR ranged from 31.9% - 95.7% with original images to 83% - 100% with digitally stained images. Blast class showed TPR ranges of 90.3% - 94.4% and 94.4% - 100%, for original and stained images, respectively. ConclusionsThe proposed GAN-based normalization staining approach improves the performance of classifiers with multicenter data sets by generating digitally stained images with a quality similar to the original images and adaptability to a reference staining standard. The system requires low computation cost and can help improve the performance of automatic recognition models in clinical settings.

Maternal dendritic cells influence fetal allograft response following murine in-utero hematopoietic stem cell transplantation

BackgroundIntrauterine hematopoietic stem cell transplantation (IUT), potentially curative in congenital haematological disease, is often inhibited by deleterious immune responses to donor cells resulting in subtherapeutic donor cell chimerism (DCC). Microchimerism of maternal immune cells (MMc) trafficked into transplanted recipients across the placenta may directly influence donor-specific alloresponsiveness, limiting DCC. We hypothesized that dendritic cells (DC) among trafficked MMc influence the development of tolerogenic or immunogenic responses towards donor cells, and investigated if maternal DC-depletion reduced recipient alloresponsiveness and enhanced DCC.MethodsUsing transgenic CD11c.DTR (C57BL/6) female mice enabled transient maternal DC-depletion with a single dose of diphtheria toxin (DT). CD11c.DTR females and BALB/c males were cross-mated, producing hybrid pups. IUT was performed at E14 following maternal DT administration 24 h prior. Bone marrow-derived mononuclear cells were transplanted, obtained from semi-allogenic BALB/c (paternal-derived; pIUT), C57BL/6 (maternal-derived; mIUT), or fully allogenic (aIUT) C3H donor mice. Recipient F1 pups were analyzed for DCC, while maternal and IUT-recipient immune cell profile and reactivity were examined via mixed lymphocyte reactivity functional assays. T- and B-cell receptor repertoire diversity in maternal and recipient cells were examined following donor cell exposure.ResultsDCC was highest and MMc was lowest following pIUT. In contrast, aIUT recipients had the lowest DCC and the highest MMc. In groups that were not DC-depleted, maternal cells trafficked post-IUT displayed reduced TCR & BCR clonotype diversity, while clonotype diversity was restored when dams were DC-depleted. Additionally, recipients displayed increased expression of regulatory T-cells and immune-inhibitory proteins, with reduced proinflammatory cytokine and donor-specific antibody production. DC-depletion did not impact initial donor chimerism. Postnatal transplantation without immunosuppression of paternal donor cells did not increase DCC in pIUT recipients; however there were no donor-specific antibody production or immune cell changes.ConclusionsThough maternal DC depletion did not improve DCC, we show for the first time that MMc influences donor-specific alloresponsiveness, possibly by expanding alloreactive clonotypes, and depleting maternal DC promotes and maintains acquired tolerance to donor cells independent of DCC, presenting a novel approach to enhancing donor cell tolerance following IUT. This may have value when planning repeat HSC transplantations to treat haemoglobinopathies.

Warts, hypogammaglobulinemia, infections, and myelokathexis (WHIM) syndrome and tetralogy of fallot; Case report and literature review

WHIM (Warts, Hypogammaglobulinemia, Infections, and Myelokathexis) syndrome is a rare primary immunodeficiency disorder characterized by susceptibility to human papillomavirus (HPV) infections, neutropenia, and hypogammaglobulinemia. WHIM syndrome is caused by a gain-of-function mutation CXCR4, leading to increased responsiveness of neutrophils and lymphocytes to CXCL12. This results in an accumulation of atypical hypersegmented mature neutrophils in the bone marrow and peripheral blood neutropenia. This case report discusses a 10-year-old girl who was diagnosed with WHIM syndrome at the age of four years following Haemophilus influenzae meningitis. She was found to have Tetralogy of Fallot at birth, which was surgically repaired when she was one year old. She was also found to have significant neutropenia during surgery and received multiple doses of G-CSF with a good response. She presented to the hospital at the age of four years with fever, neck stiffness, lethargy, and headache and was diagnosed with H. influenzae meningitis. Her immunology workup revealed significant neutropenia and hypogammaglobulinemia, as well as low antibody levels to H. influenza type B, tetanus toxoid, and Streptococcus pneumonia, despite up-to-date vaccination. Furthermore, decreased levels of T cells and B cells were detected. The patient was started on IgG replacement therapy and Bactrim prophylaxis. Bone marrow biopsy revealed granulocytic hyperplasia and occasional hypersegmented neutrophils, suggesting myelokathexis. Genetic testing revealed a heterozygous CXCR4 mutation with a premature stop codon (p.Ser338Ter), confirming the diagnosis of WHIM syndrome. This case report highlights the association of WHIM syndrome with congenital heart defects, such as Tetralogy of Fallot. A literature review revealed three other cases of congenital heart defects in patients with WHIM syndrome, indicating a potential role for CXCR4 and CXCL12 in septum formation. The rarity of the disorder and the lack of a universal screening tool makes the diagnosis of WHIM syndrome difficult. Therefore, physicians should consider WHIM syndrome in patients with congenital heart defects, particularly if they have recurrent HPV infections, neutropenia, and hypogammaglobulinemia.

Analysis of leukogram parameters and blood cytokine profile in tick-borne infections of various etiologies

Introduction. Studies aimed at identifying pathogenetic features of tick-borne natural focal infections depending on etiological agent are relevant to seek out for new associations of biomarkers characterizing the structural and functional phenotype of immune cells significant for the differential diagnosis and prognosis of diseases. The aim of the study was to evaluate the parameters of a leukogram with an expanded profile in relation to the parameters of cytokine status in patients with viral tick-borne encephalitis as well as erythemic tick-borne borreliosis at acute stage of the disease. Materials and methods. The study involved 28 patients with the non-erythemic tick-borne borreliosis and 27 patients with tick-borne encephalitis at the acute stage of the disease, as well as 16 healthy individuals (control group). Venous blood samples were examined using a Sysmex XN1000 analyzer based on reflex testing technology with extended profile allowing to characterize leukocyte reaction during infection and inflammation, including parameters such as the absolute and relative count of immature granulocytes (IG), neutrophil granularity index (NEUT-GI), neutrophil reactivity index (NEUT-RI), count of reactive lymphocytes (RE-LYMP), count of antibody-producing lymphocytes (AS-LYMP). Concentrationof IL-2, IL-4, IL-6, IL-8, IL-10, IFN and TNF in blood serum was determined by enzyme immunoassay using specific reagent kits (Vector-Best, Russia). Results. It was found that changes in the quantitative composition of blood leukocytes in patients with viral tick-borne encephalitis and non-erythemic form of tick-borne borreliosis have a unidirectional tendency characterized by increased count of metabolically active neutrophils (NEUT-RI) and a decreased count of reactive lymphocytes (RE-LYMP) compared to healthy individuals. Changes in the leukogram occur along with high blood concentration of proinflammatory cytokines IL-8 and TNF and a low level of IFN. A positive direct correlation was revealed between the fluorescence intensity parameter characterizing the metabolic activity of neutrophil granulocytes (NEUT-RI) and blood serum IL-8 level both in tick-borne encephalitis (r = 0.422, p 0.05) and non-erythemic form of tick-borne borreliosis (r = 0.551, p 0.05). Additionally, in the former, a positive correlation was established between the total leukocyte count (WBC) and concentration of TNF in the blood serum (r = 0.532, p 0.05).

Abstract 5854: Suppression of phosphorylated focal adhesion kinase+ (pFAK+) fibroblasts and C-X-C chemokine receptor type 4 (CXCR4) expressing granulocytes is associated with exceptional clinical outcomes in pancreatic ductal adenocarcinoma (PDAC)

Abstract Background: PDAC is an aggressive and treatment-refractory cancer due to its desmoplastic and immunosuppressive tumor microenvironment (TME). Overexpression of pFAK, a master regulator of the TME, and CXCR4, a receptor involved immunosuppression and tumor progression, are associated with poorer outcomes in PDAC. Exceptional responders, broadly defined by extended survival and durable treatment responses, represent a rare subset in PDAC. We hypothesize that the immune and stromal signatures of exceptional responders vary significantly from non-exceptional responders, specifically exhibiting decreased p-FAK and CXCR4 expression and decreased immunosuppressive myeloid phenotypes in the TME. Methods: We performed correlative quantitative analysis of multiplex immunohistochemistry (mIHC) employing 40 biomarkers on stage I/II PDAC, surgically resected formalin-fixed paraffin-embedded tissues from 9 non-exceptional responders and 11 exceptional responders. Exceptional responders were selected based on degree and duration of disease-free survival or overall survival more than double the historical matched medians. mIHC and image cytometry were used to distinguish and quantify total immune cell populations and colocalize biomarker expression across each distinct cell type. Cell populations and expression levels were compared using unpaired T-tests. Results: Exceptional responders showed significantly decreased overall pFAK expression (p=0.02) and overall CXCR4 expression (p=0.04). In exceptional responders, pFAK expression and CXCR4 expression were significantly decreased in immunosuppressive CD66b+ granulocytes (p=0.01, p=0.03, respectively) and in tumor associated macrophages (p=0.01, p=0.006, respectively). While not significant, exceptional responders demonstrated a marked decrease in immunosuppressive pFAK+ fibroblasts (p=0.12) when compared to non-exceptional responders. No change was seen in the CD8+ T cell infiltration between groups; however, a trend was observed towards an increased proportion of granzyme B+ CD3+ CD8+ cytotoxic lymphocytes (p=0.57) in exceptional responders. Conclusion: Exceptional responders selected in this preliminary study have significantly lower FAK and CXCR4 expression and markedly reduced populations of immunosuppressive FAK+ and CXCR4+ myeloid cells. Suppression of pFAK and CXCR4 in fibroblasts and granulocytes, respectively are associated with exceptional clinical outcomes. Future expanded research comparing the distinct TME and genetic signatures of exceptional responders to non-exceptional is warranted. Citation Format: John Davelaar, Anser A. Abbas, Angela Minasyan, Omer H. Elmadbouh, Natalie Moshayedi, Brent Larson, Nicholas Nissen, Simon Lo, Srinivas Gaddam, Kambiz Kosari, Jun Gong, Andrew Hendifar, Stephen Pandol, Arsen Osipov. Suppression of phosphorylated focal adhesion kinase+ (pFAK+) fibroblasts and C-X-C chemokine receptor type 4 (CXCR4) expressing granulocytes is associated with exceptional clinical outcomes in pancreatic ductal adenocarcinoma (PDAC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5854.