Differences in eosinophil molecular profiles between children and adults with eosinophilic esophagitis

Abstract

Background

Eosinophilic esophagitis (EoE) afflicts both children and adults. It has been debated whether pediatric and adult EoE represent different disease entities. The objectives of this study were to determine if the blood eosinophil molecular pattern of children with EoE is: 1) distinct from that of healthy children; and 2) different from that of adults with EoE.

Methods

Blood eosinophils from children and adults with EoE, and healthy controls, were analyzed with flow cytometry regarding levels of CD23, CD44, CD54, CRTH2, FOXP3 and galectin-10. Eosinophil FOXP3 and galectin-10 mRNA levels were determined by qPCR. The data was analyzed by using a multivariate method of pattern recognition.

Results

An eosinophil molecular pattern capable of distinguishing children with EoE from control children was identified. A smaller fraction of eosinophils from children with EoE expressed CD44 and a larger fraction expressed CRTH2 than the controls. Eosinophils from children with EoE also had higher levels of galectin-10 mRNA and lower levels of FOXP3 mRNA. The eosinophils from children with EoE had lower levels of surface CD54 and of FOXP3 mRNA compared with the eosinophils from the adult patients. A key finding was the detection in healthy individuals of age-related differences in the levels of several eosinophil markers.

Conclusions

Children with EoE can be distinguished from healthy children based on the molecular patterns of their blood eosinophils. Age-related physiologic differences in eosinophil molecular patterns may partly explain the different blood eosinophil phenotypes in children versus adults with EoE.

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Phase I trial of low-dose interleukin 2 therapy in patients with Wiskott-Aldrich syndrome

Publication date: Available online 14 February 2017
Source:Clinical Immunology
Author(s): Soma Jyonouchi, Brenda Gwafila, Lavesh A. Gwalani, Maria Ahmad, Chistopher Moertel, Cecil Holbert, Ji Young Kim, Nathan Kobrinsky, Sumita Roy-Ghanta, Jordan S. Orange
BackgroundLow dose IL-2 can restore the function of T and NK cells from Wiskott-Aldrich (WAS) patients. However, the safety of in vivo IL-2 in WAS is unknown.ObjectivesA phase-I study to assess safety of low dose IL-2 in WAS.MethodsPatients received 5 daily subcutaneous IL-2 injections, every 2months, for three courses. A "3+3" dose escalation method was used.Results6 patients received the 0.5millionunits/m²/day dose without serious adverse events. However, 2 of 3 patients receiving the 1millionunits/m²/day dose developed thrombocytopenia requiring platelet transfusions. A statistically significant platelet increase occurred in patients receiving the 0.5millionunits/m²/day dose. A trend toward higher T, B and NK cell numbers and higher T regulatory cell percentages was observed.ConclusionWe have identified a safe IL-2 dose for WAS patients. Additional trials are indicated to study the efficacy of this immunostimulant as a therapy for WAS.



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Decision Support for the Capacity Management of Bronchoscopy Devices: Optimizing the Cost-Efficient Mix of Reusable and Single-Use Devices Through Mathematical Modeling.

BACKGROUND: Increasing costs of material resources challenge hospitals to stay profitable. Particularly in anesthesia departments and intensive care units, bronchoscopes are used for various indications. Inefficient management of single- and multiple-use systems can influence the hospitals' material costs substantially. Using mathematical modeling, we developed a strategic decision support tool to determine the optimum mix of disposable and reusable bronchoscopy devices in the setting of an intensive care unit. METHODS: A mathematical model with the objective to minimize costs in relation to demand constraints for bronchoscopy devices was formulated. The stochastic model decides whether single-use, multi-use, or a strategically chosen mix of both device types should be used. A decision support tool was developed in which parameters for uncertain demand such as mean, standard deviation, and a reliability parameter can be inserted. Furthermore, reprocessing costs per procedure, procurement, and maintenance costs for devices can be parameterized. RESULTS: Our experiments show for which demand pattern and reliability measure, it is efficient to only use reusable or disposable devices and under which circumstances the combination of both device types is beneficial. CONCLUSIONS: To determine the optimum mix of single-use and reusable bronchoscopy devices effectively and efficiently, managers can enter their hospital-specific parameters such as demand and prices into the decision support tool. The software can be downloaded at: http://ift.tt/2lejUcI. (C) 2017 International Anesthesia Research Society

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Peristomal psoriasis

Summary

Background

Psoriasis is a common skin condition, affecting 1.3–2.2% of the population. The prevalence of psoriasis has previously been reported as 11.2% in patients with Crohn disease (CD) and 5.7% in patients with ulcerative colitis.

Aim

To assess the prevalence of psoriasis around stoma sites and identify the most effective treatment.

Methods

A departmental database of all patients attendings stoma clinic was accessed between 1 May 2003 and 15 October 2015. Psoriasis response was determined by clinical resolution of psoriatic plaques in terms of erythema, induration, scaling and stoma bag adherence.

Results

Of 1665 patients, 78 (4.7%) had psoriasis affecting their abdominal stoma. In 8 patients (11.5%), a thicker hydrocolloid stoma bag barrier was sufficient to resolve the peristomal psoriasis. For 75 patients (96.2%), initial management was with nongreasy topical steroid scalp preparations and their usual barrier in the form of their stoma bag. Patients who did not respond to topical treatments initially or who experienced secondary failure (n = 16; 20.5%) received different systemic treatments [ciclosporin (n = 2), methotrexate (n = 2; 1 patient did not respond) or ultraviolet B narrowband phototherapy (n = 8; 2 nonresponders). One patient received infliximab and four patients received adalimumab for treatment of their CD, and their peristomal psoriasis also responded to these treatments. A further patient was prescribed adalimumab by the dermatology departmetn for the management of psoriasis vulgaris, with good response.

Conclusion

Peristomal psoriasis is common but potentially under-recognized. Selecting effective treatment that does not hinder bag appliance is crucial for effective management. Effective treatments include hydrocolloid dressings and topical corticosteroid regimens.

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Verrucous discoid lupus erythematosus in a child

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Immune checkpoint receptors in cancer: redundant by design?

Jing Li | Ling Ni | Chen Dong

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