Antineuronal antibodies in autistic children: relation to blood mercury

It was recently suggested that autism, a severe neuro developmental disorder, may involve an autoimmune pathogenesis. Mercury [Hg] is a potential risk factor for autoimmunity in autistic children. We sought to investigate the expression of antineuronal antibodies, as an index of autoimmunity to brain, in autistic children. The potential relationship between blood mercury and these antibodies was also investigated. Forty autistic children [20 with mild to moderate and 20 with severe disease] were studied in comparison to 40 healthy children. After complete clinical and neuropsychiatric evaluation, serum antineuronal antibodies and blood Hg levels were estimated. Autistic children had significantly higher seropositivity for antineuronal antibodies [67.5%] than healthy controls [5%]. Similarly, the former group had significantly higher blood Hg levels than the latter [p<0.0001]. Seropositivity of antineuronal antibodies had a significant positive association with elevated blood Hg. which was found in 70% of autistic children, [p<0.0001]. In addition, the two markers were positively associated with some parameters such as the family history of autoimmunity, autistic severity and some important clinical manifestations of autism [mental retardation, behavioral abnormalities and autistic regression] as well as EEG abnormalities. Autism may be, in part, one of the pediatric autoimmune neuropsychiatric disorders. Such autoimmunity may be triggered by environmental Hg exposure. Further studies are warranted to enforce these concepts. If these assumptions could be proved, routine assessment of serum antineuronal antibodies and blood mercury in autistic children would be mandatory Studies assessing the role of immunotherapy and Hg chelators as new therapeutic modalities for autism are also recommended

Sputum epithelial cell-derived neutrophil-activating peptide-78 [ENA-78/CXCL5] in asthmatic children: relation to eosinophil activation

Epithelial cell-derived neutrophil-activating peptide-78 [ENA-78] is a chemokine that recruits, and activates neutrophils, possesses angiogenic properties and promotes, connective tissue remodeling. Thus, it could play a pathogenic role in allergic airway inflammation. Eosinophils are the major source for this chemokine in inflamed airways. To evaluate sputum ENA-78 expression and its relation to acute asthma exacerbations of varying severity, and eosinophil cationic protein [ECP] as a marker of eosinophil activation, as well as eosinophil counts in blood and sputum. Sputum ENA-78 and serum ECP were measured by ELISA in 21 children, during and after acute asthma exacerbation and 21 healthy matched controls. Patient, were subdivided according to exacerbation severity into three equal subgroups; mild moderate and severe. Sputum ENA-78 was significantly higher in asthmatic children during acute exacerbation than controls [310.1 +/- 156.9 pg/ml vs 65.9 +/- 11.6 pg/ml, p<0.0001]. It was significantly higher in severe than moderate and in moderate than mild exacerbations, and was negatively correlated to the expiratory flow rate. Sputum ENA-78 showed significant positive correlations with serum ECP and eosinophil counts in blood and sputum. By flow up of patients with acute asthma exacerbation till remission of symptoms and signs, sputum ENA-78, serum ECP and eosinophil counts in blood and sputum decreased significantly, but their levels remained significantly higher than the control values. Sputum ENA-78 is increased during acute asthma exacerbation and it positively correlates with exacerbation severity and eosinophil activation. Thus, it may play a role in the evolution of acute asthma exacerbation and may be a future target for new asthma therapeutic madalities

Interleukin-8 as a diagnostic marker of neonatal sepsis

Early diagnosis of sepsis in the neonate is often difficult as symptoms and signs are usually non-specific and there are cases that are clinically suggestive of sepsis with negative blood culture. So we should try to find out diagnostic markers to diagnose neonatal sepsis very early. The aim of this study was to evaluate plasma IL-8 as a predictor of neonatal sepsis to facilitate early diagnosis and initiation of appropriate therapy. This study comprised 54 full-term neonates divided into 2 groups; group I included 24 neonates with proven sepsis diagnosed clinically and by positive blood culture. Group II included 30 neonates with suspected or possible infection [they had 2 or fewer clinical signs of sepsis +/- positive CRP with a high risk factor of infection and negative blood culture]. Thirty healthy age and sex matched full-term newborns were studied as controls. After history taking and clinical examination, the following laboratory investigations were performed: complete blood count, CRP [latex agglutination], blood culture and sensitivity and estimation of IL-8 by ELISA technique The 30 patients with suspected infection were followed up clinically and CRP as well as blood culture were repeated after 48 hours. Patients who developed sepsis later on as evidenced clinically and by laboratory investigations including positive blood culture were considered as patients with early sepsis at the time of admission. Plasma IL-8 of neonates with proven sepsis [1794.38 +/- 1816 9 pg/ml] or early sepsis [229.16 +/- 221.02 pg/ml] was significantly higher than of the control group [35.53 +/- 17.8 pg/ml]. IL-8 had a sensitivity of 100% for sepsis [either at its early or late stages] as it was elevated in all patients with proven and early sepsis. The sensitivity of CRP for diagnosing neonatal sepsis before the evolution of overt clinical manifestations was 50% only. In addition, IL-8 had an excellent negative predictive value [100%] for early sepsis. IL-8 was significantly elevated in non-survivor neonates with sepsis when compared to the survivors indicating that high IL-8 values are associated with poor prognosis. In conclusion, IL-8 is a highly sensitive marker for diagnosing neonatal sepsis at its early stage. Also, it had an excellent negative predictive value [100%] thus it facilitates the exclusion of the infection in high-risk neonates to avoid the unnecessary antibiotic use. In addition, IL-8 is a useful prognostic marker of neonatal sepsis This highlights the importance of our recommendation of adding IL-8 to the laboratory investigations performed in neonatal sepsis especially in suspected cases