T-lymphocyte Subgroups Research Articles

The Predictive Value of T-Lymphocyte Subset Distribution for the Occurrence and Prognosis of Atrial Fibrillation

Introduction: The effect of T lymphocytes on atrial fibrillation (AF) is still unclear. We aimed to assess the associations between the T-lymphocyte subgroup distribution and incident AF and AF prognosis. Methods: Consecutive patients were enrolled from June 2020 to October 2021. Their T-cell subgroups, including CD3, CD4, and CD8 T cells, and the CD4/CD8 ratio (CDR) were measured. We assessed the relationships between the CDR and composite endpoints, including hospitalization due to heart failure, stroke or systemic embolism, and cardiovascular mortality rates. Results: A total of 45,905 patients, among whom 818 had AF, were enrolled. The proportions of the T-lymphocyte subgroups CD3 (OR: 0.9995; 95% CI: 0.9993–0.9997, p < 0.001), CD4 (OR: 0.9995; 95% CI: 0.9991–0.9998, p = 0.004), and CD8 (OR: 0.9988; 95% CI: 0.9984–0.9992, p < 0.001) and the CDR (OR: 1.2714; 95% CI: 1.1355–1.4165, p < 0.001) were correlated with AF incidence. The CDR was associated with AF incidence (OR: 1.1998; 95% CI: 1.0746–1.3336, p < 0.001) after adjustment. High CDR was associated with a higher rate of hospitalization due to heart failure (HR: 3.45; 95% CI: 1.71–6.96, p < 0.001), stroke, or systemic embolism (HR: 2.54; 95% CI: 1.32–4.91, p = 0.005), and cardiovascular mortality (HR: 2.25; 95% CI: 1.05–4.84, p = 0.038). There was no significant difference in all-cause mortality between CDR strata (HR: 1.61; 95% CI: 0.90–2.87, p = 0.111). Conclusion: Elevated CDR was positively associated with the incidence and prognosis of AF. This finding may help improve the prevention and treatment of AF.

CLL-079 The Effect of T-Lymphocyte Subgroups at Diagnosis on the Prognosis of Chronic Lymphocytic Leukemia (CLL)

CLL-079 The Effect of T-Lymphocyte Subgroups at Diagnosis on the Prognosis of Chronic Lymphocytic Leukemia (CLL)

POSTER: CLL-079 The Effect of T-Lymphocyte Subgroups at Diagnosis on the Prognosis of Chronic Lymphocytic Leukemia (CLL)

POSTER: CLL-079 The Effect of T-Lymphocyte Subgroups at Diagnosis on the Prognosis of Chronic Lymphocytic Leukemia (CLL)

The Impact of Obstructive Sleep Apnea-Hypopnea Syndrome on T-Lymphocyte Subgroups and Natural Killer Cell Activity in the Peripheral Blood of Children

Background: Obstructive sleep apnea-hypopnea syndrome (OSAHS) can impact multiple organ systems in children. Objectives: To investigate the effects of OSAHS on T-lymphocyte subgroups and natural killer (NK) cell activity in the peripheral blood of affected children. Methods: A total of 85 children with OSAHS were enrolled into an experimental group (OSAHS) and 76 healthy children were placed in a control group (CON) to compare peripheral blood levels of CD3+, CD4+, CD8+, and NK cell activity using flow cytometry. Meanwhile, their polysomnography results were monitored to analyze the correlation between T-lymphocyte subgroups/NK cell activity and lowest pulse oxygen saturation (LSaO2)/apnea-hypopnea index (AHI). Results: Compared to the CON group, the CD3+ percentage in the OSAHS group showed no significant difference (65.98 ± 6.54 vs 64.36 ± 5.32; P &gt; 0.05), but the CD4+ percentage, CD4+/CD8+ ratio, and NK cell activity decreased markedly (33.52 ± 3.04 vs 35.26 ± 3.68,1.29 ± 0.14 vs 1.43 ± 0.26, and 11.47 ± 4.58 vs 12.69 ± 2.36, respectively; P &lt; 0.05). In addition, the CD8+ percentage increased significantly (26.18 ± 4.76 vs 24.36 ± 2.32; P &lt; 0.05). Linear regression analysis indicated that the CD3+ percentage was not related to LSaO2/AHI (P &gt; 0.05), but the CD4+ and CD8+ percentages, CD4+/CD8+ ratio, and NK cell activity were linearly related to LSaO2 and AHI (P &lt; 0.05). Conclusions: OSAHS can affect the cellular immunity of children. The AHI and LSaO2 may be involved in cellular immunity function.

Novel nucleotide variants in SLA-DOB and CD4 are associated with immune traits in pregnant sows

Reinforcing the immunity of pregnant sows can not only improve their own health condition but also increase the survival rate and healthy status of their piglets. This study aims to find single-nucleotide polymorphism (SNP) and molecular markers that are associated with the immune traits of pregnant sows. SLA-DOB and CD4 were selected as candidate genes, and blood samples were randomly collected from pregnant Landrace sows and used to detect T-lymphocyte subsets, interferon alpha, interleukin 6, Toll-like receptor 3, serum antibody immunoglobulin G, and porcine reproductive and respiratory syndrome virus-specific antibody. Then, association analyses were conducted for the polymorphic sites of candidate genes with immune traits. We found 12 mutations in the two genes and conducted an association study with eight of them. Our results indicated that among the eight mutations, SNP1, SNP2, and SNP3 of the SLA-DOB gene and Ins9, SNP10, and SNP11 in the CD4 gene are newly discovered mutations. Except for SNP1, SNP3, and SNP11, the other five SNPs are associated with at least one immune trait tested. Especially, SNP2 and Ins9 are significantly associated with at least one of the T-lymphocyte subgroups and at least one antibody. These novel mutations have potential important effects on the polymorphic loci of the above immune traits in pregnant sows. The results suggest that the SLA-DOB and CD4 genes and their genetic mutations can be considered as important candidate genes and mutations for the immunity of pregnant sows.

Polysaccharide PRM3 from Rhynchosia minima root enhances immune function through TLR4-NF-κB pathway

BackgroundPolysaccharides, one of the active ingredients in herbal medicine, are proved to enhance innate immunity against infections. The aim of this study is to explore the immunoregulatory ability of polysaccharides from Rhynchosia minima root in vitro and in vivo. MethodsPolysaccharide fractions of R. minima root were obtained by chromatographic column. The content of NO was measured by spectrophotometry. The levels of cytokines (tumor necrosis factor-α, TNF-α; interleukin-6, IL-6; and monocyte chemoattractant protein-1, MCP-1) were determined by enzyme-linked immuno-sorbent assay (ELISA) kits. The translocation of p65 into the nucleus was imaged by confocal microscopy. The mRNA expression of TNF-α, IL-6, and MCP-1 was determined by quantitative real-time PCR. T-lymphocyte subgroups of spleen from immunosuppressive mouse were evaluated by flow cytometry. ResultsPRM3 remarkably enhanced the phagocytic ability of macrophages and promoted the release of NO and the secretion of cytokines (TNF-α, IL-6, and MCP-1) from macrophages. Simultaneously, PRM3 potently activated NF-κB signaling pathway via Toll-like receptor 4 (TLR4). In addition, PRM3 obviously increased the levels of serum cytokines, markedly up-regulated the percentages of CD3+ and CD4+ T lymphocytes and the CD4+/CD8+ ratio of splenocytes, and effectively attenuated cyclophosphamide induced immunosuppression in mice. ConclusionsPRM3 profoundly enhanced the immune function in vitro and in vivo through TLR4-NF-κB pathway and is a promising candidate of immunopotentiator which could be applied in functional foods or drugs. General significanceThis study reported a polysaccharide PRM3 from R. minima root exhibited potent immunoenhancing activity and significantly alleviated cyclophosphamide-induced immunosuppression through TLR4-NF-κB pathway.

The effect of zinc and melatonin supplementation on immunity parameters in breast cancer induced by DMBA in rats

Objective: The aim of the study was to determine the effects of zinc and melatonin supplements on the immunity parameters of female rats with breast cancer induced by DMBA.Methods: Group 1; Control, Group 2; 7,12-dimethylbenz[a]anthracene (DMBA), Group 3; DMBA + zinc, Group 4; DMBA + melatonin, Group 5; DMBA + zinc + melatonin. The rats’ breast cancer was induced by DMBA 80 mg/kg. Groups 3–5 received daily 5 mg/kg doses of zinc, melatonin, and zinc + melatonin, respectively. Lymphocyte rates, T-lymphocyte subgroups, B-lymphocyte and natural killer cells (NK), and natural killer T (NKT) were evaluated.Results: The most significant increase in lymphocyte, T-lymphocyte, and CD4 lymphocyte rates was found in Group 5. The highest NKT cell rates were found in Group 3.Conclusions: Findings show that zinc and melatonin supplements have led to an increase in the immunity parameters of rats with breast cancer.

The changes of immunin function in pediatric patients with severe sepsis

Objective To investigate the association of immunological indicators with the severity and prognosis of pediatric patients with severe sepsis. Methods We enrolled 82 pediatric patients with severe sepsis admitted to pediatric intensive care unit (PICU) at Shanghai Children′s Hospital between March 2013 and February 2017 as septic group.Fifteen healthy children served as control group.The blood samples were collected within 24 hours after admission and on day 7 after treatment.The levels of immunoglobulin (IgG, IgM and IgA) were analyzed by automatic special protein analyzer, and the proportion of T-lymphocyte subgroup (CD3+ , CD4+ , CD8+ and CD19+ ) and natural killer (NK) cells (CD16+ and CD56+ ) in peripheral blood were detected by flow-cytometry. Results The levels of IgG, IgM and IgA had no statistical differences between septic group and control group(P>0.05). Interestingly, the proportion of NK cells in pediatric patients with severe sepsis was significantly lower compared to the control group, and the number of NK cells was significantly increased after 7 days treatment compared with that within 24 hours after admission[(3.7±1.9)% vs.(11.5±1.9)%, P<0.05]. In addition, the proportions of T-lymphocyte subgroups including CD3+ , CD4+ and CD8+ were significantly decreased in patients of septic group compared with control group[(62.8±8.5)% vs.(70.9±2.3)%, (33.3±7.0)% vs.(39.8±1.8)% and(22.6±2.8)% vs.(34.8±15.6)%, respectively, all P<0.05]. Moreover, the proportions of NK cells, CD3+ and CD4+ T lymphocytes subsets in peripheral blood of patients with severe sepsis were positively associated with pediatric critical illness score(P<0.05), and negatively associated with pediatric risk of mortality score Ⅲ and the number of dysfunction organs(all P<0.05). Furthermore, the proportions of NK cells and CD3+ and CD4+ T lymphocytes in peripheral blood of non-survivor with severe sepsis were significantly lower than those in the survivor[(1.5±0.5)% vs.(4.7±1.4)%, (55.1±5.0)% vs.(66.4±7.4)%, (29.7±5.2)% vs.(35.0±7.2), P< 0.05]. Conclusion The proportion of NK cells and CD3+ and CD4+ T lymphocytes subsets in peripheral blood decreases in pediatric patients with severe sepsis, which is associated with severity and prognosis of severe sepsis. Key words: Severe sepsis; Immunoglobulin; T-lymphocytes subsets; Natural killer; Children,

The CD4+ T-lymphocyte count is an important predictor for the prognosis of cryptococcosis

There is great heterogeneity of immunity among patients with cryptococcosis, and severe immunodeficiency can lead to negative clinical outcomes. Underlying disease is a poor surrogate for immune status and inferior in predicting an individual’s prognosis. This study was intended to determine whether T-lymphocyte subgroups would be more suitable indicators regarding the severity of infection and clinical outcomes of such patients. We retrieved clinical data on 101 patients with cryptococcosis and compared the validity of multiple parameters (underlying disease and T-lymphocyte subgroups) in predicting the severity of infection and clinical outcome in these patients. For patients with CD4+ T-lymphocyte counts lower than 400/μL, the odds ratio of disseminated cryptococcosis was 23.3 (P = 0.005). There was a moderate negative correlation between CD4+ T-cell count and Apache II score (−0.609, P < 0.001). Mortality among patients with low levels of CD4+ T lymphocytes was significantly higher than among those with normal levels (23.8% vs 5.3%, P = 0.016). However, the difference was not significant if the patients were grouped by underlying disease (P = 0.067). The CD4+ T-lymphocyte count in peripheral blood is a simple and more accurate biomarker for predicting severity of infection and clinical outcome in patients with cryptococcosis.

Effects of salbutamol aerosol combined with magnesium sulfate on T-lymphocyte subgroup and Th1/Th2 cytokines of pediatric asthma.

The aim of the study was to analyze the effects of the intravenous infusion of salbutamol aerosol combined with magnesium sulfate in the treatment of pediatric asthma and the subsequent effects on the levels of T-lymphocyte subgroups and Th1/Th2 cytokines. A total of 86 patients with pediatric asthma, first diagnosed and treated at the Xuzhou Children's Hospital, were continuously selected and randomly divided into an observation group of 44 cases and control group of 42 cases. The patients in the control group were treated with budesonide atomization inhalation, while the children in the observation group were treated with intravenous infusion of salbutamol aerosol combined with magnesium sulfate. The therapeutic effects in the groups were compared. After treatment, the levels of serum CD3+ and CD8+ decreased when compared to before treatment; the levels of CD4+ and CD4+/CD8+ also increased, but the observation group had more significant improvement. Differences were statistically significant (P<0.05). After treatment, the levels of serum interleukin-2 (IL-2) and interferon-γ (IFN-γ) increased when compared to before, while levels of IL-4 and IL-6 decreased, and the observation group had more significant improvement. The differences were statistically significant (P<0.05). After treatment, the levels of VT, t-PTEF/t-E, MTIF/MTEF and TEF75/PTEF increased when compared to before; the observation group had more significant improvement. The differences were statistically significant (P<0.05). The effective rate and degree of treatment for the observation group were significantly higher than those of the control group and differences were statistically significant (P<0.05). The intravenous infusion of salbutamol aerosol combined with magnesium sulfate in the treatment of pediatric asthma can significantly improve therapeutic effects and lung functions, improve immune functions and relieve inflammatory reactions. Therefore, it indicates better clinical application and promotion value.

Observation on the the effect of Xuebijing injection in the treatment of patients with severe pneumonia

Objective To investigate the effects of Xuebijing injection on T-lymphocyte subgroups and clinical efficacy in treatment of patients with severe pneumonia.Methods 60 patients with severe pneumonia were selected into the study.The patients were randomly divided into Xuebijing group (n =30) and control group (n =30).Patients in the control group were given routine therapy.The Xuebijing group received the treatment of routine therapy combined with Xuebijing injection.The changes of T lymphocyte subgroups and clinical efficacy were compared between the two groups.Results The levels of CD3,CD4,CD4/CD8 after treatment in Xuebijing group and control group were significantly higher than those of before treatment (t =4.95,4.89,4.96,3.13,3.11,3.09,all P ＜ 0.05),those in the Xuebijing group were significantly higher than control group (t =3.89,3.56,3.78,all P ＜ 0.05).The total effective rate in the Xuebijing group was 93.3％,which was significantly higher than 76.6％ in the control group (x2 =4.55,P ＜ 0.05).Conclusion Xuebijing injection combined with routine western medicine is quite effective in treatment severe pneumonia.Xuebijing can improve the immune function of patients. Key words: Pneumonia; Medicine, Chinese traditional; Lymphocytes subsets; Treatment outcome

Therapeutic efficacy evaluation of rabbit anti-thymocyte globulin combined with cyclosporine A in children with aplastic anemia

This study was aimed to investigate the therapeutic efficacy of rabbit anti-thymocyte globulin (r-ATG) combined with cyclosporine A (CsA) and to analyse the efficacy-related factors in children with aplastic anemia (AA). Twenty five AA children treated with r-ATG [3.5 mg/(kg·d)×5 days] combined with CsA were analyzed retrospectively. The lymphocyte subgroups, CD4(+)/CD8 ratio and expression of CD55, CD59 on surface of neutrophils and erythrocytes in peripheral blood were detected by direct immunofluorescence method and flow cytometry; the responsive time, effective rate, adverse effects and infections after immunosuppressive therapy (IST) were analyzed; the distribution of T-lymphocyte subgroups in IST-effective and IST-uneffective groups was compared, and therapeutic efficacy-related factors were evaluated. The results showed that the response to treatments was found in 21 out of 25 cases, the total responsive rate was 84.0%; the response time was 3 - 6 months, average of 4 months; the effective rates in month 3, 6, 9, 12 after treatment were 56.0%, 72.0%, 80.0% and 84.0% respectively. The AA children with age ≥ 5 years old, course of disease < 6 months and absolute neutrophil value ≥ 1.5 ×10(9)/L on 30 days after IST had good curative effect; the effective rate in AA children with age ≥ 5 years old, course of disease < 6 months, high or reverse ratio of CD4(+)/CD8(+) and absolute neutrophil value ≥ 1.5×10(9)/L after IST was higher than that in AA children with age < 5 years old, course of disease ≥ 6 months, normal ratio of CD4(+)/CD8(+) and absolute neutrophil value after IST < 1.5×10(9)/L (94.4% vs 57.1%, 90.4% vs 50.0%, 94.1% vs 62.5%, 94.1% vs 62.5%) (P < 0.05). The high effective rate was observed in AA children with decrease of CD55 and CD59 expression, but there was no significant difference (P > 0.05) as compared with normal expression of CD55, CD59. It is concluded that the treatment using r-ATG (3.5 mg/kg·d × 5 d) combined with CsA is a safe and effective for children with AA. Age, course of disease and absolute neutrophil value on 30 days after IST are the main factors affecting curative affect.

Comparative Studies of the AgNORS Motifs in Phytohemagglutinin-Stimulated Human T-Lymphocytes with T-Lymphocyte Subgroups

OZET Objective: Using of argyrophilic nucleolar organiser region (AgNOR) patterns, instead of the fluorescent T-lymphocyte markers, in specification of sub-groups of T-lymphocyte was researched in the study. For this, it was aimed to indicate that AgNOR pattern of each T-lymphocyte sub-group remains stable in a stage of cell cycle stimulated by phytohaemagglutinin (PHA) and that these patterns are different from each other. Material and Methods: Peripheral blood samples of four healthy volunteers were cultured according to whole blood and/or isolated blood culture methods. The slides were stained by using AgNOR and immunohistochemical staining methods. Results: As we expected, the CD8 staining is not observed in a single style of the nucleolar organiser region (NOR) motif, but rather occurred in the forms of different kinds of nucleolus. It was found that the different types of NOR motifs formed with AgNOR staining are not related to the Tlymphocyte subgroup. Conclusion: It was concluded that the NOR motifs are not specific to sub-groups of T-lymphocytes. Further investigations are needed to support our results.

Effect of transfer factor on immunity and its efficacy in patients with varruca plana

Objective To observe the effect of transfer factor on immunity in patients with varruca plana and the clinical effect of treatment. Methods Sixty patients with varruca plana were randomly divided into a treatment group (treated with transfer factor) and a control group (treated with routine therapy). Before and after the treatment, T-lymphocyte subgroups in peripheral blood of all the patients were determined by flow cytometry and serum levels of interleukin-10 (IL-10)and in-terferon-gamma (INF-γ)were detected by ELISA. The same detections were done to the twenty healthy volunteers as healthy controls. Results Effective rates in the treatment group and control group were 76.67 % and 43. 33 %, respectively (x2=5. 63,P<0.05). Decrease of CD3+ cells, CD4+ cells, CD4+/CD8+ ratio and increase of CD8+ cells were found in varruca plana group as com-pared with the healthy controls(P<0.01 ). After the treatment of transfer factor, increase of CD3+ cells ,CD4+ cells (P<0.05), CD4+/CD8+ ratio (P<0. 01)and decrease of CD8+ cells(P<0.01)were found in the treatment group as compared with those before treatment, while there were no significant difference in the control group before and after the treatment. Higher IL-10 and lower INF-γ in serum were found in varruca plana group as compared with the healthy controls (P<0.05). After the treat-ment of transfer factor, decrease of IL-10 and increase INF-γ in serum (P<0. 05)were found in the treatment group as compared with those before treatment, while there were no significant difference in control group before and after the treatment. Conclusion The results reveal that immunity is im-paired in patients with varruca plana. Transfer factor can enhance the immunity of the patients. Therefore, varruca plana patients treated with transfer factor receive better effects. Key words: Varruca plana; Immunity; Transfer factor

Effects of kanglaite capsules combined with transcatheter arterial chemoembolization (TACE) on patients with mid or late-stage primary hepatocellular carcinoma (HCC)

To observe the clinical effects of kanglaite (KLT) capsules combined with transcatheter arterial chemoembolization (TACE) in treating patients with mid or late-stage primary hepatocellular carcinoma (HCC). Sixty-five cases were randomly divided into 2 groups, 32 patients in combination group received the treatment of KLT capsules + TACE and 33 patients in control group were treated with TACE alone. The objective response rate (RR), serum alpha fetoprotein (AFP), peripheral blood T lymphocyte subgroups (T-LS), quality of life (QOL), time to progression (TTP) and adverse reaction were observed and compared between 2 groups. The objective response rate and serum alpha fetoprotein levels had no significant difference between the two groups (P > 0.05). Combination group was superior to control group in quality of life (QOL), time to progression (TTP), peripheral blood T lymphocyte subgroups (CD3+, CD4+, CD4+∖CD8 ratio) and liver adverse reactions, with significant differences (P < 0.05). KLT capsules combined with TACE is an effective method to treat primary hepatocellular carcinoma (HCC) patients who have lost the opportunity of surgical therapy.

Flow Cytometrical Analysis of Adhesion Molecules, T-Lymphocyte Subpopulations and Inflammatory Markers in Pterygium

Background/Aim: Pterygium is a relatively frequent ocular surface disease with an unexplained etiopathogenesis. Our study was carried out with the aim to identify the presence of inflammatory cells and mediators such as T-lymphocyte subgroups (CD4 and CD8), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and human leukocyte antigen-DR (HLA-DR) in pterygium tissue. Methods: Pterygium tissue, obtained from 24 patients, and normal conjunctival tissue, from the nasal bulbar conjunctiva obtained from 14 patients operated for ocular perforations or vitrectomy, were separated into epithelial and stromal components under the microscope and suspended with phosphate-buffered saline solution to form a suspension. Cell suspensions were treated with specific antibodies for ICAM-1, VCAM-1, and HLA-DR and T-lymphocyte subgroups and evaluated with flow cytometry. The obtained data were compared statistically. Results: When compared to the control tissue samples, higher rates of ICAM-1-positive cells, VCAM-1-positive cells and HLA-DR-positive cells were recorded in pterygium tissue samples. CD4 and CD8 lymphocytes were also found to be at higher levels when compared to the control group. There was a statistically significant difference between the two groups. Conclusion: When compared with normal conjunctival tissue, pterygium tissue had increased levels of T-lymphocyte infiltration and inflammatory markers demonstrating the possible contribution of cellular immunity to the pathogenesis.

The effect of iron deficiency anemia on the function of the immune system

We aimed to study the effect of iron deficiency anemia (IDA) on immunity. In 32 children with IDA and 29 normal children, the percentage of T-lymphocyte subgroups, the level of serum interleukin-6 (IL-6); and the phagocytic activity, the oxidative burst activity of neutrophils and monocytes and the levels of immunoglobulins were compared. There was no difference in the distribution of T-lymphocyte subgroups. The mean IL-6 levels was 5.6+/-3.9 pg/ml in children with IDA and 10.3+/-5.3 pg/ml in the control group (P<0.001). The percentage of neutrophils with oxidative burst activity when stimulated with pma was 53.4+/-32.7% in children with IDA and 81.7+/-14.3% in the control group (P=0.005). The percentage of monocytes with oxidative burst activity was 13.8+/-11.7% in children with IDA and 35+/-20.0% in the control group (P<0.001) when stimulated with pma. and 4.3+/-3.1 versus 9.7+/-6.0% (P=0.008) when stimulated with fMLP. The ratio of neutrophils with phagocytic activity was 58.6+/-23.3% in the anemic group; and 74.2+/-17.7% in the control group (P=0.057). The ratio of monocytes with phagocytic activity was 24.3+/-12.0% in the anemic group; and 42.9+/-13.4% in the control group (P=0.001). IgG4 level was 16.7+/-16.6 mg/dl in children with IDA and 51.8+/-40.7 mg/dl in healthy children (P<0.05). These results suggest that humoral, cell-mediated and nonspecific immunity and the activity of cytokines which have an important role in various steps of immunogenic mechanisms are influenced by iron deficiency anemia.

Life-threatening cervicofacial infection in a child with hyperimmunoglobulin-E syndrome

The hyperimmunoglobulin E (hyper-IgE) syndrome (Job syndrome) is characterized by recurrent staphylococcal sinopulmonary and skin abscesses, pneumonia with pneumatocele formation, and elevations of serum IgE. The pathophysiology is unclear, and no specific defect in the immune system has been found in all patients.1 Studies have detected pronounced blood and sputum and abscess eosinophilia, chemotactic defects in the circulating neutrophils, abnormalities in T-lymphocyte subgroups, defective antibody production, and decreased production of, or response to, cytokines such as interleukin-4 and interferon-gamma.1 Recently, it has been demonstrated that the T-cell–derived lymphokine interleukin-4 plays a central role in the regulation of IgE.2 Hyper-IgE syndrome affects multiple systems including the dentition, the skeleton, connective tissues, and the immune system. It is inherited as a single-locus autosomal dominant trait with variable expressivity.1 All hyper-IgE patients have elevated IgE levels at least 10 times greater than the upper limits of normal ( 2,000 IU/mL).3 From as early as infancy, clinical manifestations include recurrent, severe bouts of furunculosis and pneumonia caused by Staphylococcus aureus. Recurrent bronchitis is another frequent finding.3 Lobectomy secondary to lung abscesses is common. A peculiar tendency of the abscesses to localize about the scalp, face, and neck is observed in infants and younger children. There is often a history of pruritic dermatitis earlier in life. The rash is predominantly in the flexural areas of the body, behind the ears, and around the hairline, and may become impetiginized.3 Also, otitis externa and chronic otitis media are frequently seen.3 Deep-seated infections other than pneumonias are unusual.3 Urinary tract infections and gastrointestinal infections are not increased in frequency. Other common features of the syndrome include coarse facies as evidenced by a broad nasal bridge and fleshy nasal tip, a prominent forehead, a prominent nose, a high-arched palate, and irregularly proportioned cheeks and a prognathic jaw. Infrequently, instances of craniosynostosis have been reported. Unexplained osteopenia is present in most patients with the hyper-IgE syndrome; many of whom have problems with recurrent fractures. An unrecognized feature of the hyper-IgE syndrome, the failure to shed primary teeth, was recently reported to occur in 72% of 30 patients old enough for evaluation in the study.1 The following report describes the diagnosis and management of a case of hyper-IgE syndrome complicated by a periapical abscess leading to a life-threatening deep space neck infection.

Cellular profile and cytokine production at prosthetic interfaces

The tissues surrounding 65 cemented and 36 cementless total joint replacements undergoing revision were characterised for cell types by immunohistochemistry and for cytokine expression by in situ hybridisation. We identified three distinct groups of revised implants: loose implants with ballooning radiological osteolysis, loose implants without osteolysis, and well-fixed implants. In the cemented series, osteolysis was associated with increased numbers of macrophages (p = 0.0006), T-lymphocyte subgroups (p = 0.03) and IL-1 (p = 0.02) and IL-6 (p = 0.0001) expression, and in the cementless series with increased numbers of T-lymphocyte subgroups (p = 0.005) and increased TNFα expression (p = 0.04). For cemented implants, the histological, histochemical and cytokine profiles of the interface correlated with the clinical and radiological grade of loosening and osteolysis. Our findings suggest that there are different biological mechanisms of loosening and osteolysis for cemented and cementless implants. T-lymphocyte modulation of macrophage function may be an important interaction at prosthetic interfaces.

Cellular profile and cytokine production at prosthetic interfaces. Study of tissues retrieved from revised hip and knee replacements.

The tissues surrounding 65 cemented and 36 cementless total joint replacements undergoing revision were characterised for cell types by immunohistochemistry and for cytokine expression by in situ hybridisation. We identified three distinct groups of revised implants: loose implants with ballooning radiological osteolysis, loose implants without osteolysis, and well-fixed implants. In the cemented series, osteolysis was associated with increased numbers of macrophages (p = 0.0006), T-lymphocyte subgroups (p = 0.03) and IL-1 (p = 0.02) and IL-6 (p = 0.0001) expression, and in the cementless series with increased numbers of T-lymphocyte subgroups (p = 0.005) and increased TNF alpha expression (p = 0.04). For cemented implants, the histological, histochemical and cytokine profiles of the interface correlated with the clinical and radiological grade of loosening and osteolysis. Our findings suggest that there are different biological mechanisms of loosening and osteolysis for cemented and cementless implants. T-lymphocyte modulation of macrophage function may be an important interaction at prosthetic interfaces.