Potential role of extracellular vesicle-meditated antigen presentation in Helicobacter pylori hypersensitivity during eradication therapy

Publication date: Available online 11 April 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Takamasa Ito, Takashi Shiromizu, Shunsuke Ohnishi, Shotaro Suzuki, Katsuhiro Mabe, Akito Hasegawa, Hideyuki Ujiie, Yasuyuki Fujita, Yuichi Sato, Shuji Terai, Mototsugu Kato, Masahiro Asaka, Takeshi Tomonaga, Hiroshi Shimizu, Riichiro Abe
Hypersensitivity to Helicobacter pylori, a bacterium in the stomach, is induced during eradication therapy, resulting in skin manifestations. extracellular vesicles-mediated antigen presentation could play a role in this process.



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Nanoemulsion adjuvant–driven redirection of TH2 immunity inhibits allergic reactions in murine models of peanut allergy

Publication date: Available online 11 April 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Jessica J. O'Konek, Jeffrey J. Landers, Katarzyna W. Janczak, Rishi R. Goel, Anna M. Mondrusov, Pamela T. Wong, James R. Baker
BackgroundImmunotherapy for food allergies involves progressive increased exposures to food that result in desensitization to food allergens in some subjects but not tolerance to the food. Therefore new approaches to suppress allergic immunity to food are necessary. Previously, we demonstrated that intranasal immunization with a nanoemulsion (NE) adjuvant induces robust mucosal antibody and TH17-polarized immunity, as well as systemic TH1-biased cellular immunity with suppression of pre-existing TH2-biased immunity.ObjectiveWe hypothesized that immunization with food in conjunction with the nanoemulsion adjuvant could lead to modulation of allergic reactions in food allergy by altering pre-existing allergic immunity and enhancing mucosal immunity.MethodsMice were sensitized to peanut with aluminum hydroxide or cholera toxin. The animals were then administered 3 monthly intranasal immunizations with peanut in the nanoemulsion adjuvant or saline. Mice were then challenged with peanut to examine allergen reactivity.ResultsThe NE intranasal immunizations resulted in marked decreases in TH2 cytokine, IgG1, and IgE levels, whereas TH1 and mucosal TH17 immune responses were increased. After allergen challenge, these mice showed significant reductions in allergic hypersensitivity. Additionally, the NE immunizations significantly increased antigen-specific IL-10 production and regulatory T-cell counts, and the protection induced by NE was dependent in part on IL-10. Control animals immunized with intranasal peanut in saline had no modulation of their allergic response.ConclusionsNE adjuvant–mediated induction of mucosal TH17 and systemic TH1-biased immunity can suppress TH2-mediated allergy through multiple mechanisms and protect against anaphylaxis. These results suggest the potential therapeutic utility of this approach in the setting of food allergy.



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Asian atopic dermatitis serum is characterized by Th2/Th22-activation, highly correlated with non-lesional skin measures.

Publication date: Available online 11 April 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Huei-Chi Wen, Tali Czarnowicki, Shinji Noda, Kunal Malik, Ana B. Pavel, Saeko Nakajima, Tetsuya Honda, Jung U. Shin, Hemin Lee, Margaret Chou, Yeriel Estrada, Xiuzhong Zheng, Hui Xu, James G. Krueger, Kwang-Hoon Lee, Kenji Kabashima, Emma Guttman-Yassky

Teaser

Asian AD serum is characterized by prominent Th2 and Th22 signatures that correlate with the non-lesional skin profile, suggesting that serum phenotyping can serve as a surrogate for assessing disease extent beyond apparent AD lesions.


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Personalized cancer vaccines: adjuvants are important, too

Abstract

Therapeutic cancer vaccines have shown limited clinical efficacy so far. Nevertheless, in the meantime, our understanding of immune cell function and the interactions of immune cells with growing tumors has advanced considerably. We are now in a position to invest this knowledge into the design of more powerful vaccines and therapy combinations aimed at increasing immunogenicity and decreasing tumor-induced immunosuppression. This review focuses essentially on peptide-based human vaccines. We will discuss two aspects that are critical for increasing their intrinsic immunogenicity: the selection of the antigen(s) to be targeted, and the as yet unmet need for strong adjuvants.

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Bilateral dislocation of the Temporo-Mandibular Joint in children

Publication date: Available online 11 April 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Sicard Ludovic, Diane O'hana, Roman Hossein Khonsari, Abdelkhaled Kaddour Brahim
Aim and scopeBilateral non-traumatic temporo-mandibular joint (TMJ) dislocation is an acute situation that can lead to a chronic and recurrent condition. Few paediatric cases have been reported in the literature and no standardized care protocol has been established to date.Material and MethodsTwo cases of chronic bilateral dislocation of the TMJ in young children are reported and their medical management is discussed based on data from the literature.ConclusionTMJ dislocations in children raise specific concerns such as the need for screening for underlying congenital disorders of connective tissues. Surgical options in children are furthermore very limited. Here we proposed an indicative management protocol for recurrent joint dislocation in pediatric populations based on two new cases and the data from the literature.



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CTA perforator localization for virtual surgical planning of osteocutaneous fibular free flaps in head and neck reconstruction

Publication date: Available online 10 April 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Kyle S. Ettinger, Amy E. Alexander, Kevin Arce
Virtual surgical planning (VSP), computer aided design (CAD)/computer aided modeling (CAM), and 3D printing are three distinct technologies that have become increasingly employed within head and neck oncology and microvascular reconstruction. While each of these technologies have long been utilized for treatment planning within other surgical disciplines such as craniofacial surgery, trauma surgery, temporomandibular joint surgery, and orthognathic surgery, its widespread use within the field of head and neck reconstructive surgery remains a much more recent event.In response to the growing trend of VSP being employed for the planning of fibular free flaps within head and neck reconstruction, some surgeons have questioned the technology's implementation on the basis of its inadequacy in addressing other reconstructive considerations beyond hard tissue anatomy. Detractors of VSP for head and neck reconstruction highlight its lack of capability in accounting for multiple reconstructive factors such as recipient vessel selection, vascular pedicle reach, need for dead space obliteration, and skin paddle perforator location. It is with this premise in mind that that we report a straightforward technique for anatomically localizing peroneal artery perforators during virtual surgical planning for osteocutaneous fibular free flaps where both bone and a soft tissue skin paddle are required for ablative reconstruction. The technique allows for anatomical perforator localization during the virtual surgical planning session solely based on data existent within the preoperative computed tomographic angiography (CTA); it does not require any modifications to preoperative clinical workflows. It is our presumption that many surgeons within the field are unaware of this planning capability within the context of modern VSP for head and neck reconstruction. The primary purpose of this manuscript is to introduce and further familiarize surgeons with the technique of CTA perforator localization as a method of improving intraoperative fidelity for virtual surgical planning of osteocutaneous fibular free flaps.



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Nasotracheal intubation: the preferred airway in oral cavity microvascular reconstructive surgery?

Publication date: Available online 11 April 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jordan Gigliotti, Godwin Cheung, Omar Suhaym, Ramanakumar V. Agnihotram, Michel El-Hakim, Nicholas Makhoul
PurposeTo describe the safety and effectiveness of nasotracheal intubation (NTI) in a cohort of patients undergoing reconstruction of oral cavity defects with free tissue transfer (FTT).MethodsThe authors implemented a retrospective cohort study and enrolled a sample composed of consecutive patients undergoing FTT reconstruction of oral cavity, maxillary, or mandibular defects between 2013 and 2017. These patients were all subject to a newly developed Enhanced Recovery After Surgery (ERAS) protocol. The primary outcome measurement was hospital length of stay (LOS). Secondary outcome variables were the duration of mechanical ventilation, intensive care unit (ICU) LOS, need for gastrostomy, and airway-related complications directly associated with either NTI or tracheostomy. Descriptive statistics and a multivariate logistic regression analysis were completed.ResultsThe sample was composed of 141 patients that had undergone oral cavity FTT for both benign and malignant diseases (NTI, n=111; tracheostomy, n=30). Patients managed with NTI had a statistically significant shorter hospital LOS (8 vs.15.5 days; P<0.0001), ICU LOS (1 vs. 2 days; P=0.0006), and a decreased requirement for gastrostomy (17.1 vs. 76.7%; P<0.0001). Airway-related complications were rare in both the tracheostomy (13.3%) and NTI (3.6%) groups. Multivariate analysis demonstrated that patients undergoing tracheostomy were 3.14 (P=0.004) times more likely to have a prolonged hospitalization and 10.4 (P<0.0001) times more likely to require a gastrostomy. A sensitivity analysis of patients' with malignant diagnoses only had similar statistically significant results. The delayed tracheostomy rate in the NTI group was 3.6%.ConclusionTo date, this is the largest study to evaluate the use of NTI in patients undergoing oral cavity reconstruction with FTT. Our results suggest, that in the appropriate institutional setting, the majority of patients can be safely managed with NTI. This approach results in a decreased hospital and ICU LOS and an earlier resumption of oral intake with less need for gastrostomy.



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