Serum Eosinophil Cationic Protein Levels Research Articles

Airway inflammation in asthma and perennial allergic rhinitis. Relationship with nonspecific bronchial responsiveness and maximal airway narrowing.

Eosinophilic airway inflammation is the hallmark of asthma, but it has also been reported in other conditions such as allergic rhinitis. We have tested whether the analysis of cells and chemicals in sputum can distinguish between patients with mild allergic asthma, those with allergic rhinitis, and healthy controls. The relationship between inflammation markers in sputum and nonspecific bronchial hyperresponsiveness to methacholine (BHR) (PD20 and maximal response plateau [MRP] values) was also evaluated. We selected 31 mild asthmatics and 15 rhinitis patients sensitized to house-dust mite. As a control group, we studied 10 healthy subjects. Every subject underwent the methacholine bronchial provocation test (M-BPT) and sputum induction. Blood eosinophils and serum ECP levels were measured. Sputum cell differentials were assessed, and eosinophil cationic protein (ECP), tryptase, albumin, and interleukin (IL)-5 levels were measured in the entire sputum supernatant. Blood eosinophils and serum ECP levels were higher in asthma patients and rhinitis than in healthy controls, but no difference between asthma patients and rhinitis patients was found. Asthmatics had higher eosinophil counts and higher ECP and tryptase levels in sputum than rhinitis patients or control subjects. Sputum albumin levels were higher in asthmatics than in controls. Rhinitis patients exhibited higher sputum eosinophils than healthy controls. An association between sputum eosinophil numbers and MPR values (r= -0.57) was detected, and a trend toward correlation between sputum ECP levels and PD20 values (r= -0.47) was found in the rhinitis group, but not in asthmatics. No correlation between blood eosinophilic inflammation and lung functional indices was found. Induced sputum is an accurate method to study bronchial inflammation, allowing one to distinguish between rhinitis patients and mildly asthmatic patients. The fact that no relationship was detected between sputum inflammation and BHR suggests that other factors, such as airway remodeling, may be at least partly responsible for BHR in asthma.

Urinary eosinophil protein X and serum eosinophil cationic protein in infants and young children with atopic dermatitis: Correlation with disease activity

Background: Eosinophil cationic protein (ECP) and eosinophil protein X (EPX) or eosinophil-derived neurotoxin (EDN) are released by eosinophil granulocytes in allergic diseases. Serum ECP (s-ECP) levels have been correlated with disease activity in atopic dermatitis (AD) in adults and young patients, and high urinary EPX (u-EPX) levels in asthmatic patients seem to reflect active disease. A relationship between AD severity and u-EPX concentration in young children has not been previously studied. Objective: This study was performed to evaluate whether the severity of AD in infants and young children was correlated with s-ECP and u-EPX levels. Methods: Fifty-four infants and children (mean age, 17.7 months; range, 4-48 months) with AD and without other allergic conditions were evaluated. The severity of AD was measured by using the SCORAD index. S-ECP, serum total IgE, serum-specific IgE for common allergens, and peripheral blood eosinophil counts (PBECs) were determined. In forty-two children u-EPX was also measured. Seven age-matched control patients underwent the same determinations. Results: S-ECP and u-EPX were significantly higher in children with AD than in control children (mean, 23.9 vs 3.5 μg/dL [P < .001] and 57.7 vs 6.0 μg/mmol creatinine [P < .001]). A significant correlation was found between SCORAD and s-ECP (P = .002), u-EPX (P = .01), and PBECs (P = .01) and between symptom index and uEPX (P = .0004). PBECs were strongly correlated to s-ECP and u-EPX (P < .0001). However, 5 patients with moderate and severe AD (11.9%) showed low levels of s-ECP, u-EPX, and PBECs. Conclusion: S-ECP and u-EPX were useful markers of AD activity in infants and young children. When taken together, the two determinations could give more information about the clinical course of the illness. Some patients seemed to have clinical exacerbations without an involvement of eosinophils and their products. (J Allergy Clin Immunol 2000;105:353-7.)

Influence of Atopy and Concomitant Sinusitis on Serum Eosinophil Cationic Protein Levels in Asthmatic Children

We investigated the influence of atopy as determined by allergen-specific IgE and concomitant sinusitis on serum eosinophil cationic protein (S-ECP) levels in 62 newly diagnosed asthmatic children at exacerbation. Children with atopic asthma had higher S-ECP levels (37.9 ± 5.5 μg/L) as compared to those with nonatopic asthma (8.8 ± 2.1 μg/L, p < 0.01) and controls (6.7 ± 1.1 μg/L,p < 0.01). Neither S-ECP levels nor absolute eosinophil counts (AEC) in peripheral blood correlated with % predicted forced expiratory volume in one second (% FEV1 in children with atopic asthma. In asthmatic children with atopy, there is no difference of % FEV1, serum total IgE levels, and AEC between those who also had sinusitis and those who did not. However, S-ECP levels were significantly higher in asthmatic children with concomitant sinusitis, compared to those without, in atopic children (49.5 ± 8.0 μg/L vs. 22.9 ± 5.9 μg/L, p < 0.01), and in nonatopic children alike (15.1 ± 3.0 μg/L vs. 6.7 ± 1.5 μg/L,p = 0.012). Nonatopic children with sinusitis but without asthma had S-ECP levels similar to controls. Thus, S-ECP was confounded by the presence of atopy and sinusitis, and may reflect eosinophilic inflammation of both upper and lower airways.

Determination of Serum Eosinophil Cationic Protein, Eosinophil Count, and Total IgE in Children with Different Severities of Atopic Diseases

ABSTRACT Eosinophil cationic protein (ECP) levels may be of value in assessing tissue inflammation in atopic diseases. However, conflicting results have been reported regarding levels of serum ECP (s-ECP) and symptom activity in asthma, atopic dermatitis, or allergic rhinitis. To examine s-ECP levels, eosinophil counts and total immunoglobulin E (IgE) in relation to atopic disease activity in a random population of children admitted to hospital for atopic and nonatopic conditions. s-ECP, eosinophil counts, and total IgE were evaluated in all the children admitted to a pediatric ward, excluding patients treated with systemic steroids. A total of 216 children were studied. Skin prick tests (SPT) and a validated questionnaire for asthma, atopic dermatitis, and allergic rhinitis were obtained. s-ECP was significantly higher in children with symptomatic atopic disease (19.88 μg/L) compared with nonatopic control patients (8.58 μg/L). The levels of s-ECP were also elevated in patients with a positive response t...

Immunnohistological assessment of intestinal eosinophil activation in patients with eosinophilic gastroenteritis and inflammatory bowel disease.

To assess the activation grade of intestinal eosinophils in patients with eosinophilic gastroenteritis (EOG), ulcerative colitis (UC), Crohn's disease (CD), and controls by immunohistochemistry. Cecal biopsies were collected from healthy controls and from patients with EOG, CD, UC, and other noninflammatory GI diseases. Immunohistochemistry was performed in sequential sections stained with monoclonal antibodies directed against eosinophil cationic protein (ECP) or eosinophil protein X (EPX) stored in eosinophil granules (EG1) and that secreted by activated eosinophils (EG2). The ratio of EG1 to EG2-positive eosinophils expressed as percentage of lamina propria cells was calculated. ECP and EPX were measured in serum and feces. The percentage of EG1 and EG2-positive lamina propria cells was elevated in EOG and slightly, but not significantly, in UC. The ratio of EG1 to EG2-positive cells was decreased in CD, UC, and other patients as compared to healthy controls. Particularly low EG1 to EG2 ratios were found in EOG. Correspondingly, fecal and serum levels of ECP and EPX, respectively, were highest in patients with EOG. The EG1 to EG2 ratio was negatively correlated with fecal ECP and EPX levels. At sites of actively inflamed mucosa, the EG1 to EG2 ratio was lower than in noninflamed tissue. Our data strongly suggest that the EG1 to EG2 ratio may be a marker of tissue eosinophil activation. Low ratios (<1) indicate eosinophil activation, whereas ratios > or =1 are found in healthy controls. Furthermore, we show that EOG is characterized by a pronounced intestinal eosinophil accumulation and activation, whereas in CD and UC, eosinophils seem to be activated but their number is not or only slightly elevated compared to controls.

Immunohistological assessment of intestinal eosinophil activation in patients with eosinophilic gastroenteritis and inflammatory bowel disease

OBJECTIVE: To assess the activation grade of intestinal eosinophils in patients with eosinophilic gastroenteritis (EOG), ulcerative colitis (UC), Crohn’s disease (CD), and controls by immunohistochemistry. METHODS: Cecal biopsies were collected from healthy controls and from patients with EOG, CD, UC, and other noninflammatory GI diseases. Immunohistochemistry was performed in sequential sections stained with monoclonal antibodies directed against eosinophil cationic protein (ECP) or eosinophil protein X (EPX) stored in eosinophil granules (EG1) and that secreted by activated eosinophils (EG2). The ratio of EG1 to EG2-positive eosinophils expressed as percentage of lamina propria cells was calculated. ECP and EPX were measured in serum and feces. RESULTS: The percentage of EG1 and EG2-positive lamina propria cells was elevated in EOG and slightly, but not significantly, in UC. The ratio of EG1 to EG2-positive cells was decreased in CD, UC, and other patients as compared to healthy controls. Particularly low EG1 to EG2 ratios were found in EOG. Correspondingly, fecal and serum levels of ECP and EPX, respectively, were highest in patients with EOG. The EG1 to EG2 ratio was negatively correlated with fecal ECP and EPX levels. At sites of actively inflamed mucosa, the EG1 to EG2 ratio was lower than in noninflamed tissue. CONCLUSIONS: Our data strongly suggest that the EG1 to EG2 ratio may be a marker of tissue eosinophil activation. Low ratios (<1) indicate eosinophil activation, whereas ratios ≥1 are found in healthy controls. Furthermore, we show that EOG is characterized by a pronounced intestinal eosinophil accumulation and activation, whereas in CD and UC, eosinophils seem to be activated but their number is not or only slightly elevated compared to controls.

Repeated Inhalation of Low Doses of Cat Allergen That Do Not Induce Clinical Symptoms Increases Bronchial Hyperresponsiveness and Eosinophil Cationic Protein Levels

The aim of this study was to investigate whether repeated exposure to subclinical doses of cat allergens, not inducing asthma symptoms, could affect eosinophil cationic protein (ECP) levels in bronchoalveolar lavage (BAL) or in peripheral blood, without the appearance of clinical symptoms. Twelve patients with mild asthma, all sensitized to cats and not exposed to cat allergen at home, underwent a series of inhalations of cat allergen or placebo for 8 days over 2 weeks. A methacholine challenge was performed before and after the allergen and saline exposures, and BAL and blood were sampled for ECP measurements and eosinophil counts. No patients experienced asthma symptoms. However, PD20 methacholine (geometric mean) decreased significantly from 263 μg before to 126 μg after inhalation of allergen. Inhalation of saline did not induce any significant change in PD20. The change in log PD20 before and after cat allergen exposure was statistically different from the change in log PD20 before and after saline. Median ECP levels in BAL and serum increased significantly after allergen exposure, from 0.8 to 3.1 μg/l (p<0.02) and from 15.9 to 31.4 μg/l (p<0.05), respectively. No change was observed after saline inhalations. The change in BAL and serum ECP levels was statistically significant compared to that in the control group. The number of eosinophils did not change, however, nor did IL–5 and RANTES levels in BAL and serum. In conclusion, our results show that (1) exposure of asthma patients to repeated low doses of allergen, which did not provoke any clinical symptoms, is capable of inducing a local eosinophil activation associated with an increase in nonspecific bronchial hyperresponsiveness and (2) the increase in serum ECP levels due to eosinophil activation precedes the occurrence of asthma symptoms and may thus be a marker of allergen exposure in allergic asthma.

Effects of inhaled fluticasone and oral prednisolone on clinical and inflammatory parameters in patients with asthma

BACKGROUNDGuidelines state that oral and inhaled corticosteroids are the cornerstone of asthma treatment. The effect of both types of treatment can be assessed by measuring lung and systemic parameters. Treatment...

Major basic protein, but not eosinophil cationic protein or eosinophil protein X, is related to atopy in cystic fibrosis.

Increased eosinophil granule proteins have been described in serum and sputum samples of patients with cystic fibrosis (CF). It has been assumed that eosinophil degranulation is enhanced in atopic subjects - as in asthmatics. Since in CF no differences in eosinophil cationic protein (ECP), eosinophil protein X (EPX), and eosinophil peroxidase between atopic and nonatopic subjects have been detected, we investigated whether major basic protein (MBP) is increased in serum and sputum samples derived from atopic (n = 14) compared with nonatopic CF subjects (n = 26). In CF patients, high mean serum (sputum) levels of ECP 29.7 microg/l (2.7 mg/l), EPX 53.7 microg/l (7.9 mg/l), and MBP 984.6 microg/l but low sputum MBP levels (57.4 microg/l) were measured. In addition, in serum and in sputum samples, a significant correlation between MBP and ECP (P<0.03 and P<0.0001, respectively) or EPX (P<0.05 and P<0.0004, respectively) was detected. By subdivision of the patients into allergic and nonallergic subjects, significant differences were found for serum MBP values only(mean 1382.2 microg/l vs. 770.5 microg/l; P<0.0001), but not for ECP or EPX serum levels or for eosinophil proteins in sputum. Although no differences between atopic and nonatopic CF patients in ECP and EPX were found, serum MBP levels were higher in patients sensitized to inhalant allergens than in nonsensitized subjects. These results indicate differential release of eosinophil granule proteins in peripheral blood from eosinophils, and they also indicate that MBP in serum likely is to be a better discriminator of atopy in CF.

Circadian Variation in Nasal Reactivity in Children with Allergic Rhinitis: Correlation with the Activity of Eosinophils and Basophilic Cells

Background: In allergic rhinitis, the major symptoms of runny nose, sneezing, and stuffy nose tend to become worse upon waking up in the morning, and yet the mechanisms underlying this phenomenon are poorly understood. We investigated whether the worsening of allergic rhinitis in the morning is associated with changes in the activity of inflammatory cells. Methods: Nasal reactivity to methacholine was assessed twice in 8 children with allergic rhinitis and 8 healthy control subjects at 6.00 a.m. and 3.00 p.m. The amounts of eosinophil cationic protein (ECP), histamine and tryptase in induced nasal secretions and peripheral blood were also measured. Results: Nasal reactivity to methacholine was higher at 6.00 a.m. not only in patients but also in healthy controls. Serum ECP and plasma histamine levels showed no circadian patterns. On the other hand, significantly higher levels of inflammatory activation products were found in nasal secretions at 6.00 a.m., thus showing a direct association with nasal reactivity. Conclusion: These results suggest that the circadian variation in nasal reactivity is associated with changes in the activity of eosinophils and basophilic cells in the nasal mucosa.

Mechanisms of Eosinophil Cationic Protein Release in the Serum: Role of Adhesion Molecules

Background: Measurement of eosinophil cationic protein (ECP) in serum has been utilized as a marker for allergic inflammation. The serum level of ECP represents the level found in vivo plus additional proteins released in vitro from peripheral blood eosinophils during the coagulation period. The mechanisms of release, however, are unclear. We investigated a possible involvement of adhesion molecules in the ECP release. Materials and Methods: Venous blood was drawn in the presence of EDTA from allergic donors. The blood was incubated with neutralizing monoclonal antibodies to CD18, CD11a, CD11b, CD29, CD49d, CD54, α₄β₇, or isotype-matched control antibodies, respectively, at 4°C for 30 min. Calcium gluconate (calcium) was then added to induce coagulation. The blood was further incubated for 90 min and centrifuged to obtain the serum. ECP in the serum was measured with RIA. In some experiments, purified eosinophils were incubated with plasma and calcium, then ECP in the supernatants was assayed. Results: ECP in the samples with calcium was significantly higher than in those without calcium. Purified eosinophils released ECP upon plasma coagulation. Anti-CD18, CD49d, and α₄β₇ antibodies significantly suppressed ECP levels in the serum. Conclusions: These results suggest that ECP release in the serum is calcium and plasma coagulation-dependent and that cell adhesion through α_Lβ₂, α_Mβ₂, α₄β₁ and α₄β₇ integrins is at least in part responsible for ECP release.

Serum Eosinophil Cationic Protein and Bronchial Responsiveness in Pediatric and Adolescent Asthma Patients

Serum eosinophil cationic protein (ECP) has been promoted as a marker of inflammatory activity in bronchial asthma. Bronchial responsiveness, measured either by inhaling pharmacologically active substances such as histamine or methacholine, or by applying physical stimuli such as the hyperventilation of cold dry air, is also considered to be an indirect marker of bronchial inflammation. In this study, we investigated the possible relationship between serum ECP and bronchial responsiveness to both cold dry air and histamine in presently symptom- and medication-free pediatric and adolescent asthma patients. Thirty-six children and adolescents with atopic asthma were studied. On 2 consecutive days, bronchial responsiveness was assessed nonpharmacologically by cold dry air and pharmacologically by histamine in random order. Blood samples for determination of ECP were collected before each challenge. Serum ECP levels correlated with neither cold dry air-induced changes in FEV1 nor the provocation concentrations of histamine causing a 20% fall in FEV1. Subjects with bronchial hyperresponsiveness to cold dry air and histamine had somewhat higher levels of serum ECP than subjects with normal responses, but these differences were insignificant. Our results indicate a lack of relationship both between serum ECP and bronchial responsiveness to cold dry air and between serum ECP and bronchial responsiveness to histamine.

Assessment of eosinophil granule proteins in various body fluids: is there a relation to clinical variables in childhood asthma?

The eosinophil plays a central role in the inflammatory process in bronchial asthma. Recent studies have indicated that the assessment of eosinophil-derived proteins in various body fluids could be used for monitoring disease activity of childhood asthma. Till now, no study exists which compared the levels of eosinophil-derived proteins in various body fluids such as serum, nasal lavage fluid (NALF) and urine. To investigate whether eosinophil granule proteins in different compartments were correlated and whether there is a relationship between disease activity, pulmonary function and bronchial hyperreactivity. Twenty-eight children with atopic bronchial asthma were recruited. Serum, NALF and urine samples were obtained and assessed for eosinophil cationic protein (ECP) and eosinophil protein X (EPX). The levels of eosinophil proteins were analysed for a relationship with lung function variables, bronchial hyperreactivity and disease activity. Eleven healthy control subjects were used as controls. Median ECP and EPX concentrations in serum (31.4 and 74.8 microg/L vs 15.8 and 24.3 microg/L, respectively), NALF (9.9 and 44. 9 microg/L vs 0 and 2.5 microg/L, respectively) and urine (49.4 vs 16.5 microg/mmol creatinine) were significantly raised in children with bronchial asthma compared with healthy control subjects. In addition, ECP and EPX levels in serum and urine samples were significantly higher in symptomatic patients compared with asymptomatic subjects with asthma. Although no relationship between eosinophil-derived proteins in serum, NALF or urine and the level of nonspecific bronchial hyperreactivity could be detected, the concentrations of EPX in serum and urine were correlated with variables of pulmonary function. Our findings demonstrate increased eosinophil activity in serum, NALF and urine derived from children with bronchial asthma. Due to the relationship between levels of eosinophil proteins in serum/urine samples and lung function, as well as significant concentration differences between symptomatic and asymptomatic asthmatic children, the assessment of eosinophil proteins in serum or urine samples appear to be more appropriate in monitoring disease activity than measurement of ECP or EPX in NALF. Thus, the determination of serum ECP/EPX or urinary EPX may be preferentially used in monitoring eosinophilic inflammation in childhood asthma.

Serum levels of soluble CD23 in patients with asthma or rhinitis monosensitive to Parietaria. Its relation to total serum IgE levels and eosinophil cationic protein during and out of the pollen season.

The diagnostic value for allergies of the low affinity IgE receptor and its soluble circulating fragment (sCD23) remains unclear. In particular, little is know about seasonal influences on serum sCD23 levels in subjects with pollen allergy. In the present study, to gain insight into pathophysiological role of sCD23, we have analyzed, in blood from patients allergic to Parietaria sCD23, IgE, and eosinophil cationic protein (ECP) serum levels. IgE were assessed as atopy markers and ECP as an inflammation marker. Patients were studied during and out of pollen season, and results were compared to those obtained in nonallergic subjects. The study population included 42 nonsmoking outpatients, living in Palermo (Sicily, Italy) or in other west Sicilian towns, with a clinical diagnosis of seasonal asthma or rhinitis and monopositive skin test to Parietaria pollen. The group of asthmatic subjects consisted of 25 patients who had one or more of the usual asthma symptoms (wheezing, dyspnea, and cough) only during the pollen season. The group of rhinitis patients consisted of 17 patients, who, during pollen season, had the nasal symptoms (nasal blockage, sneezing, nasal itching, and rhinorrhoea) but no signs of asthma. As a control group, we studied 10 nonatopic subjects from laboratory staff. They had no history of seasonal or perennial rhinitis, asthma, or urticaria and had negative skin tests to a panel of allergens. Soluble CD23, IgE, and ECP were assessed in blood during and out of pollen season. Total serum IgE levels were clearly higher in atopic patients, as classically established. Concerning sCD23 serum levels, a similar pattern of results was obtained. Accordingly, significant correlations were shown between the levels of sCD23 and IgE in all groups of patients. A completely different pattern was observed by analyzing serum ECP levels because ECP levels were significantly increased only in asthmatic patients during pollen season. Accordingly, no significant correlations were observed between the levels of sCD23 and those of ECP. Identifying immune factors associated with the development of atopy can enhance our understanding of the in vivo mechanisms involved and may have utility in paradigms designed to prevent diseases. As demonstrated by the close correlation with total serum IgE values and the lack of correlation with serum ECP values, serum levels of sCD23 appear to be an additional marker for the diagnosis of atopy but not for the follow-up of allergic diseases.

Serum eosinophil cationic protein (ECP) as a mediator of inflammation in acute asthma, during resolution and during the monitoring of stable asthmatic patients treated with inhaled steroids according to a dose reduction schedule.

The main objective was to establish the level of serum ECP in a group of adult asthmatic patients with acute exacerbation and the following resolution and in another group of adult, stable asthmatic patients during reduction of inhaled steroids. Acute group: Twenty-one asthmatic patients admitted to the asthma clinic with acute deterioration of their asthma were set on oral steroids which were reduced to 0 within one week. Reduction group: Forty-four stable asthmatic patients on maintenance inhaled steroids were included and, on the basis of their peak expiratory flow (PEF) values, adjustments in the doses of steroids were made. Twenty stable asthmatics on a constant dose of inhaled steroids were enrolled as controls. All patients registered daily PEF measurements and spirometry was performed at each visit. Blood samples were drawn and analysed for eosinophil cationic protein (ECP), myeloperoxidase (MPO), eosinophils and neutrophils. ECP was low and within the normal range for all three groups at study entry. (Acute group = 8.4 microg/l, reduction group = 3.7 microg/l and control group = 4.6 microg/l). Nevertheless, the value in the acute group was significantly higher than in the control group (p=0.005). The levels in the acute group decreased significantly (p=0.004) after one week on oral steroids. No significant changes in ECP were observed in the reduction group or in the control group during the follow-up period. The lung function was low in the acute group at inclusion, forced expiratory volume in one second (FEV1)=47.1% of predicted, and increased significantly during the treatment period (p = 0.006). The patients in the reduction- and control group showed small variations in lung function during the whole study, FEV1 >70% and PEF > 80% of predicted, respectively. No correlation between atopy and ECP was found in the patients irrespective of the stage of disease. This study suggests that the resolution of acute asthma exacerbations during treatment could be followed using ECP determinations. In stable asthmatics on inhaled steroids and with normal ECP levels, a dose reduction could be indicated. A longer period after tapering off steroids is proposed to confirm the benefit of ECP measurements for controlling asthma.

Effect of Ebastine on Serum Eosinophil Cationic Protein Levels in Patients with Bronchial Asthma

Objective: This study evaluated the effects of ebastine on serum eosinophil cationic protein (ECP) levels in patients with bronchial asthma. Patients: Twenty patients with bronchial asthma (11 patients with atopic disease and nine with non-atopic disease) were enrolled in the study. Methods: In an open-label design, all patients received ebastine 10 mg/day for 4 weeks and serum ECP levels, peripheral blood eosinophil counts, morning peak expiratory flow rate (PEFR) and thresholds for airway hyper-responsiveness (Dmin in asthgraphy) were determined before and after treatment. Results: Serum ECP levels and peripheral blood eosinophil counts were significantly decreased. By disease type, no significant change was found in the non-atopic patients, while the serum ECP level was significantly (p < 0.001) decreased in the atopic patients. Furthermore, no significant change in Dmin was found, but PEFR was significantly (p < 0.019) increased in the atopic type. Conclusion: Ebastine not only inhibits type I allergic reactions, but may also inhibit airway inflammation by reducing serum ECP levels, particularly in patients with atopic bronchial asthma.

The Significance of Sputum ECP Levels in Differential Diagnosis of Asthma in Children

Asthma and chronic bronchitis are diseases that may present similar symptoms. Because eosinophil granulocytes play an important role in the pathogenesis of asthma, the assessment of eosinophilic inflammation may be useful in making a differential diagnosis of these two diseases. This study investigated the serum and sputum eosinophil cationic protein (ECP) levels in children with asthma and chronic bronchitis and compared them with controls. Fifty asthmatic patients being treated for mild or moderately severe asthma at a university hospital were enrolled in the study. Fifteen children with symptoms of cough and sputum production lasting more than 3 months were studied in the chronic bronchitis group and 25 healthy children were included in the control group. Asthmatic patients were divided into subgroups according to the presence or absence of asthmatic exacerbations. Clinical evaluation and determination of ECP concentrations in serum and sputum were performed for each group. In-creased activity of eosinophils was found in patients with asthma as assessed by high serum ECP (mean 21.44 ± 20.33 ug/L) and sputum ECP (mean 129.65 ± 125.01 u.g/L) levels. In patients diagnosed with chronic bronchitis, serum ECP levels were similar to those of the control group (mean serum ECP 11.04 44 10.23 ug/L and 12.07 ± 6.12 ug/L, respectively). More importantly, sputum ECP levels of the chronic bronchitis group were much lower (mean 53.36 ± 55.43 ug/L) than those in patients with asthma (mean 129.65 ± 125.01 ug/L). The serum and sputum ECP levels of the asthmatic patients who were evaluated during an acute exacerbation were also higher than those in the chronic bronchitis group. Sputum ECP levels may be helpful in the differential diagnosis of asthma and chronic bronchitis in children.

The Effect of Corticosteroid Therapy on Blood Eosinophils and Eosinophilic Cationic Protein in Patients with Acute and Chronic Asthma

There is evidence that eosinophils are involved in inflammation in asthma, a correlation having been observed between blood eosinophil (B-EOS) count and pulmonary function. It has been suggested that eosinophils, and its product, eosinophil cationic protein (ECP), can serve as markers of disease activity. This paper examines this hypothesis. B-EOS count, serum ECP level, and peak expiratory flow (PEF) were estimated in two groups of asthmatics and controls at three visits in 4 weeks. The mean B-EOS count in acute and stable asthmatic groups was higher than in controls at presentation; the difference was statistically significant (p < 0.02). Similarly, mean ECP was higher in the two groups than in controls, but with no statistically significant difference. The B-EOS count and serum ECP level within the groups fell between week 0 and week 4 because of treatment. There was positive correlation between ECP and PEF and also between B-EOS and ECP and PEF. The findings reveal that blood eosinophils reflect some degree of activity in asthmatic patients in the acute and chronic state.

Relation of Interleukin-10 in Bronchoalveolar Lavage Fluid and Airway Inflammation in Bronchial Asthma

Background : Airway infiltration by inflammatory cells, particularly of eosinophils, is one of the characteristic features of asthma. Several mechanisms for the recruitment of eosinophil is focused on the CD4+ T lymphocyte for the preferential production of Th2-c1erived cytokines. Interleukin-10(IL-10) is identified cytokine with potent antiinflammatory activity. This molecule has been shown to inhibit the release of cytokine from inflammatory cells including Th2 cell, and also to inhibit eosinophil survival. We therefore attempted to determine whether decreased synthesis of IL-10 in the lung of bronchial asthma may contribute to inflammation that is characteristics of this dease. Method: Subjects were patients with bronchial asthma(n=23) and normal controls(n=11). IL-10 produced from peripheral mononuclear cell(PBMC) and in bronchoalveolar lavage(BAL) fluid was measured by ELISA method. Degree of bronchial inflammation was assessed by total cell counts and eosinophil percents in BAL fluid, eosinophil infiltration on bronchial biopsy tissue and for methacholine. Results: The IL-10 level produced by PBMC and in BAL fluid from patient with bronchial asthma were not different with normal controls(respectively, pg/ml, pg/ml for PBMC, pg/mL pg/ml for BAL fluid p>0.05). There were significant negative correlation between IL-10 in BAL fluid and eosinophil percents in BAL fluid or degree of eosinophil infiltration in bronchial biopsy (respectively r=-0.522, r=-0.4486 p for methacholine. There were no correlation between IL-10 production by PBMC and peripheral blood eosinophil counts or serum eosinophilic cationic protein levels(respectively r=0.1146, r=0.0769 p>0.05). Conclusion: These observation suggest that IL-10 may participate but not acts the crucial role in regulation of the airway inflammation in bronchial asthma.

Soluble E-selectin and eosinophil cationic protein are distinct serum markers that differentially represent clinical features of atopic dermatitis.

The serum levels of eosinophil cationic protein (ECP), soluble E-selectin (sE-selectin), soluble CD14 (sCD14) and interleukin (IL)-4 are known to be elevated in patients with atopic dermatitis (AD). However, little is known of the mutual relationship between these factors. To elucidate the clinical and mutual relevance of these markers, we examined the serum levels of ECP, sE-selectin, sCD14 and IL-4 as compared with eruption scores, itch scores, total IgE and numbers of peripheral eosinophils in patients with AD (n = 43), non-atopic eczema (n = 24) and urticaria (n = 13) and in normal individuals (n = 45). In 27 patients with AD the levels of these markers were compared before and after treatment. Levels of ECP were elevated only in the patients with AD, whereas the sE-selectin levels were higher not only in AD but also in non-atopic eczema in a severity-dependent manner. The levels of both markers significantly diminished after treatment. Significant correlations existed between ECP levels and numbers of eosinophils, sE-selectin levels and itch scores, and sE-selectin levels and IgE levels. No significant changes were observed in the sCD14 and IL-4 levels. Taken together, sE-selectin and ECP are good but distinct serum markers that reflect different clinical features of AD.