Immunoglobulin G4 related pancreaticobiliary disease: Report of two cases highlighting the diagnostic criteria

Two cases of immunoglobulin (IgG4)-related biliary and pancreaticobiliary disease are reported to define its diagnostic features. Case 1 presented with obstructive jaundice and showed IgG4-related disease (RD) involving right and left hepatic duct, common bile duct and gallbladder. Case 2 presented as periampullary mass. Both patients underwent surgical intervention. However, certain clinical and radiological features were present in these cases indicative of the possibility of IgG4-RD.

Observations on the Therapeutic Effect of Combined Moxibustion and Medicine on the Clinical Remission Stage of Bronchial Asthma / 上海针灸杂志

Objective To investigate the clinical efficacy of gentle moxibustion plus oral Gushen Dingchuan pills in treating the clinical remission stage of bronchial asthma.Methods Ninety patients with bronchial asthma in the clinical remission stage were randomized to groups A,B and C,30 cases each.group A received moxa-stick gentle moxibustion;group B,oral administration of Gushen Dingchuan pills;group C,moxa-stick gentle moxibustion plus oral administration of Gushen Dingchuan pills.The course of treatment was three months in all the three groups.The TCM symptom score and the Asthma Control Test (ACT) score were recorded and serum immunoglobulin E (IgE) content was measured in the two groups before and after treatment.The clinical therapeutic effects were compared between the groups.Results The total efficacy rate was 76.7％ in group A,80.0％ in group B and 93.3％ in group C.there was a statistically significant difference in the total efficacy rate between group C and group A or B (P＜0.05).There were statistically significant pre-/post-treatment differences in the TCM symptom score,the ACT score and serum IgE content in all the three groups (P＜0.01).There were statistically significant post-treatment differences in the TCM symptom score,the ACT score and serum IgE content between between group C and group A or B (P＜0.01,P＜0.05).Conclusion Gentle moxibustion plus oral Gushen Dingchuan pills can improve immunologic function in patients with bronchial asthma in the clinical remission stage.

Research on the IgE, EOS, LTE-4 content and its clinical significance with the inacute phase of pediatric asthma / 中国生化药物杂志

Objective To explore the clinical significance of total serum immunoglobulin ( IgE) , peripheral blood eosinophils ( EOS) and urinary leukotriene E4 ( LTE-4 ) detection on pediatric asthma clinical symptoms of the inacute phase .Methods 90 cases with pediatric asthma clinical symptoms of the inacute phase from March 2014 to March 2015 were selected as experimental group, and divided into the general asthma group(n=32), the moderate asthma group(n=31), the sereval asthma group(n=27) and another 30 health children as control group.Give each patients children doses of β2 agonists (LABA) as monotherapy, and inhaled corticosteroids (ICS) used as combination therapy.The use of LABA is 3-4 times/d.After three months' treatment, clinical efficacy were evaluated, and IgE, EOS, LTE-4 content were detected.Results After 3 months' treatment, IgE, EOS, LTE-4 contents in three experiment groups were significantly decreased (P<0.05), improved to the basic condition compared to control groups.The clinical efficacy among three groups had no significant differences.Conclusion IgE, EOS, LTE-4 levels detection of patients with pediatric asthma clinical symptoms of the inacute phase had evaluation significance, can be a good indicator of pediatric asthma health recovery in patients of the inacute phase.

Histopathology of the temporal artery in young ischemic stroke patients with elevated serum immunoglobu-lin E / 医学研究生学报

Objective Ischemic stroke with elevated serum immunoglobulin E ( IgE) in some young patients is regarded as cerebral vasculitis clinically though without sufficient pathological evidence .This study was to investigate the characteristics of vascular lesions in these patients by temporal artery biopsy . Methods We performed histopathologic examinations on the temporal arteries of 32 young ischemic stroke patients with unknown etiology , 16 with normal and the other 16 with elevated serum IgE .We observed inflammatory cells infiltration and mast cells by HE staining and toluidine blue stai-ning respectively and determined the expressions of matrix metalloproteinase -9 (MMP-9), monocyte chemotaxis protein -1 (MCP-1) and serum IgE by immunohistochemistry . Results Compared with the patients with normal IgE , those of the elevated IgE group showed a significantly higher rate of inflammatory cells infiltration (12.5%vs 62.5%, P0.05).Nor was any signifi-cant difference observed in the number of the mast cells between the normal and elevated IgE groups (2.8 ±1.5 vs 3.6 ±2.3, P>0.05). Conclusion The infiltration and necrosis of inflammatory cells and fibrin exudation in the temporal artery of the young pa-tient with elevated serum IgE are likely to be the manifestations of vasculitis , and MCP-1 may play a role in the pathogenesis of the disease.

A Case of Pancreatic Cancer with Markedly Elevated Serum Immunoglobulin G4 / 대한췌담도학회지

Differential diagnosis between autoimmune pancreatitis (AIP) and pancreatic cancer is often difficult due to similar clinical manifestations and radiological findings. Serum immunoglobulin G4 (IgG4) is a marker to differentiate AIP from pancreatic cancer. Although serum IgG4 can be elevated in 10% of patients with pancreatic cancer, most of serum IgG4 elevation in pancreatic cancer is limited within two times of upper normal limit. Herein, we report a case of pancreatic cancer with markedly elevated serum IgG4 over six times of upper normal limit that needed steroid trial to differentiate from AIP.

A study on human leukocyte antigen class I molecules in paediatric bronchial asthma.

Childhood asthma, often associated with atopy, is more common in boys and may persist throughout life in 50% of cases. This case-control study was carried out to examine if any association of paediatric bronchial asthma with human leukocyte antigen (HLA) class I antigens. Thirty-six children with bronchial asthma diagnosed on basis of Global Initiative for Asthma (GINA) criteria and an equal number of healthy controls without history of bronchial asthma were studied. Low resolution HLA- ABC typing was performed by sequence specific primers (SSP) and the frequency of HLA–ABC antigens in the two groups was compared. Total serum immunoglobulin E (IgE) estimation was done as a marker of atopy by ELISA. The study included 24 boys and 12 girls aged 13 months to 11 yrs, of which 16 (44%) had positive family history. Serum IgE levels were elevated in 20 (55%) of the cases and 33% of controls with peak values of 4877 and 627 IU/ml, respectively. No statistically significant correlation was observed between childhood asthma and HLA class I antigens, however, a statistically significant correlation was observed between serum IgE levels and asthma, which was elevated in cases, as compared to normal population. Serum IgE levels did not show a linear trend, in that a direct correlation with the severity of disease was not observed.

Evaluation of Immunomodulatory activity of the flavanoid from Kigelia africana.

Modulation of the immune responses to alleviate the diseases has been of interest for many years. Thus a real need exists to protect our immune systems and lead healthier lives. Hence the present study is aimed to evaluate the immunomodulatory activity of Flavanoid of Kigelia africana. The effect of flavanoid of Kigelia africana on the immune system of rats and mice was evaluated by using different experimental models such asmice lethality test, Serum immunoglobulin level, Haemagglutination reaction, hypersensitivity reaction, and delayed type hypersensitivity reaction test. Flavanoid of Kigelia africana was administered orally at low dose and high dose of 100mg/kg/day, poand 200 mg/kg/day, po respectively and Levamisole (2.5 mg/kg/day, po) was used as standard drug. Flavanoid of Kigelia africanain both doses increased the levels of serum immunoglobulin and prevented the mortality induced by bovine Pasteurella multocida in mice. Exhibits a dose related increase in the early hypersensitivity reaction and Delayed type hypersensitivity reaction to the SRBC antigen. It also resulted in a significant increase in the antibody titer value, to SRBC, in experimental animals. Hence, it was concluded that flavanoid of Kigelia africana increases both humoral immunity and cell mediated immunity.

Serum immunoglobulin E (IgE) levels and dietary intake of Korean infants and young children with atopic dermatitis

Atopic dermatitis (AD) has become a serious epidemic in Korean children. We aimed to investigate the association between vitamin C, E and other nutrients, and serum total IgE/specific IgE levels in children with AD. A total of 119 children (0-24 mo) diagnosed with AD were recruited for this cross-sectional study from a medical center in Seoul. A 24 h recall was used to assess dietary intakes. Serum total and six food-allergen specific IgE levels were measured by CAP-FEIA. Serum vitamin E was also measured but only in 25 out of the total 119 participants. Multiple linear regression analysis was performed to estimate the coefficients between serum IgE levels and dietary intake as well as serum vitamin E. Serum vitamin E levels showed a significantly inverse association with serum total IgE and all specific IgE levels (P < 0.05). Fat intake was inversely related with specific-IgEs for egg whites, milk, buck wheat, soy, and peanuts (P < 0.05). Positive associations were found between carbohydrate (CHO) intake and total IgE and specific IgEs to egg whites, milk, soy, and peanuts (P < 0.05). Vitamin C, E and n-3/n-6 fatty acids were not related with serum total IgE and specific IgE levels except for the association between buck wheat and vitamin E. In addition, there were no significant differences between males and females in dietary intake and serum IgE levels by student's t-test. Although dietary vitamin E showed no association with serum IgE levels, serum vitamin E drew a significant inverse relationship with serum IgE levels. The evidence seems to suggest that vitamin E may possibly lower total and specific-IgEs in children with AD, and that it is important to maintain a relatively high serum vitamin E level in children with AD.

Serum immunoglobulin fused interferon-alpha inhibited tumor growth in athymic mice bearing colon 26 adenocarcinoma cells

Interferon (IFN) has therapeutic potential for a wide range of infectious and proliferative disorders. However, the half-life of IFN is too short to have a stable therapeutic effect. To overcome this problem, serum immunoglobulin has been fused to IFN. In this study, the efficacy of serum immunoglobulin fused INFs (si-IFN1 and si-IFN2) was evaluated on athymic mice bearing colon 26 adenocarcinoma cells. Seven days after the implantation of tumor cells, each group of mice was injected once a week with si-IFN1 and si-IFN2 at two different concentrations (10 x : 30 microgram/kg and 50 x : 150 microgram/kg). A slight anti-tumoral effect was observed in all 10 x groups compared to the control. In the 50 x groups, however, si-IFN1 and si-IFN2 showed significant anti- tumoral effects compared to the control. To gain more information on the mechanisms associated with the decrease of tumor size, a Western blot assay of apoptosis-related molecules was performed. The protein expression of cytochrome c, caspase 9, 6, and 3 were increased by si-IFN1 and si-IFN2. These 2 IFNs also increased the expressions of p53, p21, Bax and Bad. Interestingly, si-IFN1 and si-IFN2 decreased the expression of VEGF-beta. Taken together, serum immunoglobulin fused IFNs increased therapeutic efficacy under current experimental condition.

Decreased Serum Immunoglobulin in Recurrent Otitis Media with Effusion

BACKGROUND: Defective or immature antibody responses to pathogens in children may explain the increased susceptibility to acute otitis media. However, there is no study in Korea patients whether a correlation exists between otitis media with effusion and the levels of serum immunoglobulins, IgG subclasses, IgA, IgM and IgE. METHODS: 45 children with otitis media with effusion more than 4 episodes in 12 months or 3 episodes in 6 months, 62 children with otitis media with effusion less than 3 episodes in 12 months and 102 children for control group took part in the study at the Department of Otorhinolaryngology of the KyungHee University from May 2004 to Feburary 2007. Serum immunoglobulin levels were determined by nephelometry. And then the relationship between otitis media with effusion and serum immunoglobulin level was evaluated. RESULTS: In otitis media prone group, serum IgG1, IgG2, IgG4, and IgA level was lower than those level of control group, it was significantly decreased (p0.05). CONCLUSION: Lower immunoglobulins in children with otitis media with effusion suggest a generalized decreased antibody responses. Lower levels of serum IgG1, IgG2, IgG4, and IgA may be related with chronicity or intractability of otitis media with effusion.

Significance of Detection of Allergen-Specific Serum Immunoglobulin E in Children with Asthma / 实用儿科临床杂志

Objective To investigate the positive rates of food allergen (fx5),mixed molds (mx1),phadiatop and house dust mites (d1) allergen-specific serum immunoglobulin E(sIgE) in children with asthma or cough variant asthma (CVA).Their age distribution characte-ristics were also compared and analysed.Methods Blood samples of 597 asthmatic children aging from 6 months to 16 years old were applied to fx5,mx1,pha-diatop and d1 test by using fluoroenzyme-immunometricassay,UniCAP100.The positive rate of fx5,mx1,phadiatop and d1 were compared.Age distribution characteristics of children with positive sIgE were analysed.Results 1.The positive rate of fx5,mx1,pha-diatop and d1 were 34.6%,30.0%,35.2% and 23.5%,respectively.2.The highest positive rate of phadiatop and d1 were highest in children of 6-16 age group(67.8% and 46.3%);The positive rate of fx5,mx1 peaked in children of 2 years and 5 years separately(44.1% and 53.6%);3.Among 181 children with mx1 positivity 90 cases manifested phadiatop negativity.4.Sixty-five percent of children with clinically diagnosed asthma or CVA presented positivity in test in fx5,mx1 or phadiatop at least.Conclusions Two thirds asthma and CVA patients exist sIgE.Asthmatic infants mainly manifest food allergen sensitization.The positive of phadiatop increased with age.Positivity of mx1 increased with age ≤5 years old in children,and it decreases in older children(≥6 years old).Mx1 is one of the main allergens in asthmatic children.

Changes of Eosinophils Count an Total IgE Levels in Patients With Myocoplasm Pneumoniae / 中国医师杂志

Objective To investigate the number of eosinophils in peripheral blood and total serum immunoglobulin E levels from children during infection of mycoplasma pneumoniae,which may elucidate what mycoplasma pneumoniae plays a role in persistent cough and asthma onset.Methods The number of eosinophils in peripheral blood was counted under microscope and total serum immunoglobulin E levels were determined by ELISA in 20 children with mycoplasmal infection ,30 patients with asthma and 25 control subjects.Results The number of eosinophils and total serum immunoglobulin E levels during mycoplasmal infection were significantly higher than in control group,and lower than in asthma.Conclusion The high eosinophil counts and total serum immunoglobulin E induced by mycoplasma pnemoniae play a key role in persistent cough and asthma attack.

The Effectiveness of the Serum IgA Level in Diagnosing IgA Nephropathy / 대한신장학회잡지

BACKGROUND: Immunoglogulin A(IgA) nephropathy is the most common primary glomerular disease throughout the world. 30-50% of patients with IgA nephropathy(IgAN) have high serum IgA concentrations. However, we do not know if the degree of elevation in IgA level increases the likelihood of having IgAN. Neither do we know if the IgA level has any association with pathological findings of IgAN. METHODS: We analyzed the relationships between IgAN and the levels of serum IgA which has been a routine part of the study in all patients with glomerulonephritis in our institution for the last 4 years. We reviewed 270 patients in whom the pathological diagnosis and the results of their IgA levels were both available. RESULTS: Of 80 patients who were IgA nephropathy, 26 patients(32.5%) had higher than normal cut- off value of serum IgA(385 mg/dL). In contrast, 8.9 % of patients with other types of glomerulonephropathies showed the values above normal(p<0.0001). The risk ratio for an increase of one unit of the IgA level was 1.0025(logistic regression, p=0.0043), which was increased to 1.0079 when patients with low complement levels were excluded from the analysis. The data were also analyzed according to the immunofluorescence microscopic findings of IgAN, which were found to have no significant correlation with IgA concentrations. CONCLUSION: The IgA level is a risk factor for IgAN throughout the whole range. However, it does not correlate with the IgA deposition in the renal tissue. We believe that this study will help understanding the interpretation of IgA levels in patients with IgAN.

The Influence of Valproic acid and Carbamazepine on the Immunologic Status of Children / 대한소아신경학회지

PURPOSE: Antiepileptic drug (AED) therapy has been reported to induce immunological alterations in epileptic patients. However, despite extensive studies, the accumulated data are not consistent and there is still confusion and controversy over the effects of AEDs on the immune system. This study tries to elucidate the effects of anticonvulsant on some immune parameters, and serum concentration of IgA, IgG, IgM. METHODS: Thirty pediatric epileptic patients[Group A (n=12) : patients on carbamazepine, Group B (n=10) : patients on valproic acid and Group C (n=8) : patients on carbamazepine and valproic acid] were enrolled in this study and the levels of IgA, IgG, and IgM were determined before treatment and after 10 months of anticonvulsant therapy. Paired t-test was used to evaluate the data. p values<0.05 were considered significant. RESULTS: The mean serum concentratrions of IgG was elevated in patients receiving anticonvulsants (p<0.05) but mean concentrations of IgA and IgM were not different significantly. CONCLUSION: Our results demonstrate that anticonvulsants elevate the serum concentrations of IgG level, suggesting that anticonvulsants may increase humoral immunity and decrease the opportunity of infectious disease, thus decreasing the convulsion.

Serum Immunoglobulins in Childrens with Recurrent Sinusitis / 대한이비인후과학회지

BACKGROUND: Sinusitis is a common and frequently recurrent illness in children. Respiratory allergy has been recognized as a major factor that predisposes children to recurrent and chronic sinusitis. Another important causative factors of recurrent sinusitis in children is immunodeficiency diseases. Among them, humoral immunodeficient disease especially is associated with recurrent sinusitis. Most common immune defect in recurrent sinusitis is immunoglobulin deficiency. OBJECTIVES: The aim of this study is to obtain a quantitative data of serum immunoglobulins in children with recurrent sinusitis, to investigate a relationship between recurrent sinusitis and immunoglobulin deficiency. MATERIALS AND METHODS: 30 childrens were selected who had been diagnosed as recurrent sinusitis at Nowon Eulji hospital in 1996. The serum immunoglobulins were evaluated by Latex agglutination immunoassay and ELISA. RESULTS: The serum IgG was within normal limits and IgA deficiency appeared in 1 patient but serum IgM appeared higher than normal value over 3 years patients. The serum IgG subclass deficiency appeared in 3 patients for IgG(1), 7 patients for IgG(2), 14 patients for IgG(3), 10 patients for IgG(4). The combined serum IgG subclass deficiency appeared in 4 patients for IgG(2) and IgG(3), 1 patient for IgG(2) and IgG(4), 4 patient for IgG(3) and IgG(4), 1 patient for IgG(1) and IgG(2) and IgG(3). CONCLUSION: Immunoglobulin deficiency is approved to be closely associated with recurrent sinusitis in children.

Effect of training on physical exersice-induced changes in non-specific humoral immunity / 体力科学

Although it is generally thought that habitual exercise protects an individual from infections, few careful scientific studies have been conducted. To clarify the influences of physical training on non-specific humoral immunity, both serum opsonic activity, which is a more direct indicator for the strength of non-specific humoral immunity to infections, and serum immunoglobulin and complement levels of 18 healthy male volunteers were assayed before and after a 10-week of training as indices of immuno defense.<BR>The serum levels of three immunoglobulins (IgG, IgA and 1gM) and one complement (C3) were compared prior to and immediately after exercise both before and after training. Paired t-test revealed that before training exercise-induced increases in IgG and C 3 were significant and after training increases in IgG, IgA, IgM and C 3 were significant. But baseline (prior to exercise) levels of these immunoglobulins and complement were significantly suppressed during the training period.<BR>Serum opsonic activity was compared with each other in the same way as serum protein levels. The noutrophilic chemiluminescence Peak Height (PH), which is one of the indicators of serum opsonic activity, was significantly decreased immediately after exercise at the beginning stage of the training. After the training period, serum opsonic activity showed no noteworthy exercise-induced variations and baseline levels were slightly increased during the training period.<BR>These findings suggest that resistance and reactivity to the physical stress are improved and the non-specific humoral immunity, self-defense ability against infections, is considered to be improved by the training.

A study on serum immunoglobulins and complements in newborn infants by gestational weeks

The author investigated serum immunoglobulin (IgG, IgA, and IgM) and complements (C3) of cord blood in 74 cases of normal fullterm infants and 50 cases of premature infants. Serum immunogloblin and complement levels were measured by the single radial immunodiffusion method. The following results were obtained; 1) The mean seru IgG levels of cord blood in 74 cases of the normal full term infants was 1407.3+/-230.5mg/dl. 2) The mean serum IgG levels of cord blood in 50 cases of the premature infants was 675.2+/-329.4mg/dl. In comparison of serum IgG levels between the premature infants and the normal full term infants, serum IgG levels in the premature infants was significantly lower than that level of the normal infants (P< 0.05). 3) The serum IgA levels were measured in 28 (37.8%) of 74 cases of the normal full term infants and in 6 912%) of 50 cases of the premature infants. The serum IgA levels measured ranged from 0.4mg/dl to 3.7mg/dl in the normal full term infants and ranged from 0.4mg/dl to 2.4mg/dl in the prematre infants. 4) The mean serum IgM levels of cord blood in 74 cases of the normal full term infants was 4.05+/-3.53mg/dl and that in 50 cases of the premature infants was 2.20+/-2.15mg/dl. 5) The mean serum C3 levels of cord blood in 74 cases of normal full term infants was 49.7+/-18.1mg/dl and those of the premature infants was 30.9+/-10.5mg/dl. In comparison of serum C3 levels between the premature infants and the normal full term infants, the mean levels of serum C3 in the premature infants was significantly lower A statistically significant increase of IgG and C3 levels of cord blood in newborn infants were observed in accordance with the increase of the gestational age. It has been suggested that decreased IgG levels among premature infants may provide a rationale for prophylactic gamma globulin administration.

Analysis, characterization and diagnostic use of circulating filarial antigen in bancroftian filariasis.

Sodium dodecyl sulphate-polyacrylamide gel electrophoresis of circulating filarial antigen fraction-2 isolated from plasma of microfilaraemic patients with Wuchereria bancrofti infection has shown 21 bands with molecular weights ranging from 12 to 120 kDa. The gel (12 cm) was sliced at an interval of one cm and the eluates of all the gel slices viz., CFA2–1 to CFA2–12 showed the presence of filarial antigen by sandwich enzyme-linked immunosorbent assay. The low molecular weight circulating filarial antigen fractions were found to share a common epitope with Wuchereria bancrofti microfilariae excretory-secretory antigen and urinary filarial antigen. The 3 antigen fractions CFA2-1, CFA2–9 and CFA2–12 showed higher sensitivity in detecting filarial immunoglobulin Μ antibodies than immunoglobulin G antibodies. However CFA2–9 fraction was found useful in serological differentiation of microfilaraemics from those with disease manifestations when filarial immunoglobulin G antibodies were detected. The antigenic epitope of CFA2–1 appears to be a carbohydrate, whereas CFA2–9 appears to be protein in nature.

Stick enzyme-linked immunosorbent assay using the avidin–biotin system for detection of circulating antigen in bancroftian filariasis.

Detection of filarial antigen in different groups of sera was carried out by sandwich as well as inhibition enzyme-linked immunosorbent assays using antibody-coated sticks. Both systems were found to be equally sensitive in detecting antigen in 90% of microfilariae carriers. Incorporation of avidin-biotin in the sandwich assay system increased the sensitivity of antigen detection from 10–6 to 10–16 pg. A 67% decrease in the number of false negative results was observed when the sensitive avidin-biotin inhibition enzymelinked immunosorbent assay system was used for analysis of filaria blood samples.