Monocyte chemotactic protein-4 [MCP-4/CCL-13] and CC chemokine receptor 3 [CCR3] in the sputum of asthmatic children

Monocyte chemotactic protein-4 [MCP-4/CCL-13] is a potent chemoattractant to eosinophils, monocytes and lymphocytes. We aimed to investigate MCP-4 and its CC chemokine receptor 3 [CCR3] expression on cells of induced sputum during acute asthma exacerbation. Immunohistochemistry was used to assess MCP-4 and CCR3 expression on induced sputum cells of 30 children during asthma exacerbation and 20 healthy matched controls. Patients were divided into three groups according to exacerbation severity; mild, moderate and severe [n = 10 for each]. Patients were followed until quiescence, when sputum was re-examined. MCP-4 and CCR3 were expressed on eosinophils and monocytes. Lymphocytes expressed only MCP-4. The percentages of sputum total cells, eosinophils and lymphocytes expressing MCP-4 and/or CCR3 were significantly higher during asthma exacerbation than in controls and negatively correlated with peak expiratory flow rate, whereas that of monocytes was not. The percentages of sputum total cells, eosinophils, monocytes and lymphocytes expressing MCP-4; and total cells and eosinophils expressing CCR3 were significantly higher in patients with severe than those with mild and moderate exacerbations. When patients were followed till remission, the percentages of sputum cells expressing MCP-4 and CCR3 decreased. Sputum eosinophil percentage correlated positively with the percentage of eosinophils expressing MCP-4 and CCR3 [r = 0.69, p < 0.0001; r = 0.62, p < 0.001, respectively]. The percentage of sputum eosinophils expressing MCP-4 correlated positively with that of cells expressing CCR3 [r = 0.95, p < 0.0001]. The expression of MCP-4 and CCR3 on sputum cells increases during acute asthma exacerbation and this increase correlates with exacerbation severity, and it decreases during remission. Modification of their expression could be a potential target for asthma therapy

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

Serum leptin levels in female children and adolescents with insulin-dependent diabetes mellitus

This study aimed to investigate whether serum leptin concentrations in female children and adolescents with insulin-dependent diabetes mellitus [IDDM, type I] were related to age, body mass index [BMI], percentage of body fat, insulin dose and pubertal stage. In this study, 74 girls with IDDM were studied and followed up, their ages ranged from 9 to 18 years with mean of 12.5 +/- 2.4 years. 28 healthy age matched girls served as controls. Diabetics were subjected to thorough history taking and clinical examination. To study the relationship between serum leptin and puberty, both patients and controls were grouped according to stage of puberty into three groups: Prepubertal [Tanner stage I], pubertal [Tanner stage II-IV] and postpubertal [Tanner stage V]. There was progressive increase in serum leptin with progress of puberty in diabetics and controls. It was most pronounced when prepubertal girls were compared with postpubertal ones whether diabetics or healthy controls. In conclusion, serum leptin in diabetic female children and adolescents is significantly correlated to age, diabetes duration, percentage of body fat and stage of puberty and not correlated to insulin dose or BMI. Serum leptin is lower in non-obese children and adolescents with IDDM than in non-obese healthy controls