Cytokines and chemokines associated with Treg/Th17 response in chronic inflammatory periapical disease

Abstract Cytokines and chemokines have a fundamental role in the maintenance of inflammation and bone response, which culminate in the development of chronic periapical lesions. Regulatory (Treg) and Th17 cytokines play a key role in regulating the immune response involved in this process. The aim of this study was to investigate the role of Treg and Th17 cells in chronic inflammatory periapical disease, by comparing the expression of the immunoregulatory mediators TGF-β, IL-10, CCL4, and the proinflammatory IL-17 and CCL20 in the periapical tissue of teeth with pulp necrosis, with and without associated chronic lesions. Eighty-six periapical tissue samples were obtained from human teeth. The samples were divided into three groups: pulp necrosis with a periapical lesion (n=26); pulp necrosis without a periapical lesion (n=30), and control (n=30). All samples were submitted to histopathological analysis and cytokine and chemokine measurement through ELISA. Statistical analyses were done with Kruskal-Wallis and Mann-Whitney tests and Spearman correlation. The group with pulp necrosis and a periapical lesion showed a higher expression of CCL4 and TGF-β in comparison with pulp necrosis without a lesion. CCL20 was higher in the group with a periapical lesion when compared to the control. In all groups there was a weak positive correlation between IL-17/CCL20, IL-10/CCL4, and IL-17/TGF-β. Both types of cytokines, pro-inflammatory and immunoregulatory, occur simultaneously in periapical tissue. However, a rise in immunosuppressive cytokines and chemokines (CCL4 and TGF-β) in periapical lesions suggests a role of these cytokines in stable periapical disease.

Host response and peri-implantitis

Abstract Considering the absence of predictable and effective therapeutic interventions for the treatment of peri-implantitis, scientific evidence concerning the host response profile around dental implants could be important for providing in the future a wider preventive and/or therapeutic window for this peri-implant lesion, indicating biomarkers that provide quantifiable measure of response to peri-implant therapy. Moreover, a better knowledge of pattern of host osteo-immunoinflammatory modulation in the presence of peri-implantitis could either benefit the early diagnostic of the disease or to cooperate to prognostic information related to the status of the peri-implant breakdown. Finally, new evidences concerning the host profile of modulators of inflammation and of osseous tissue metabolism around dental implants could explain the individual susceptibility for developing peri-implant lesions, identifying individuals or sites with increased risk for peri-implantitis. The focus of this chapter was, based on a systematically searched and critically reviewed literature, summarizing the existing knowledge in the scientific research concerning the host osteo-immunoinflammatory response to the microbiological challenge related to periimplantitis.

Evaluation of the profile of inflammatory cytokines, through immunohistochemistry, in the skin of patients with allergic contact dermatitis to nickel in the acute and chronic phases

Abstract: Background: Allergic contact dermatitis to ion nickel (Ni+2) is an inflammatory dermatosis, common in industrialized countries. It involves the activation of nickel-specific T-cells, followed by proliferation and induction of a mixed profile of both proinflammatory and regulatory cytokines, suggesting that several T-cell subtypes (helper - Th and cytotoxic - Tc) are involved. A broader understanding of the cytokine profile may lead to new therapeutic approaches. Objectives: This study aimed to analyze the cytokines TNF-α, INF-γ, IL-2, IL-4, IL-10, IL-13, IL-17 and IL-23 using the immunohistochemistry technique in order to try to identify their prevalence in chronic and acute eczema of patients with allergic contact dermatitis to Ni+2. Methods: We performed an immunohistochemical study for eight cytokines in 20 patients with Ni+2 allergic contact dermatitis, biopsied at the site of chronic eczema, triggered by the patient's daily contact with Ni+2, and at the site of acute eczema caused by nickel sulfate, 48 hours after applying the contact test. Results: The stained samples showed positive results for the eight cytokines studied. TNF-α, IFN-γ, IL-4, IL-13 and IL-17 had a higher prevalence in chronic eczema, IL-2 and IL-23 in acute eczema, and IL-10 presented a similar prevalence in both acute and chronic eczema. However, these prevalences were statistically significant only for IL-4 and IL-13. Study Limitations: Small sample size. Conclusions: In chronic and acute eczema, we observed the presence of a mixed cytokine profile of the T cell subtypes (Th/Tc), suggesting that the responses are expressed at the same time.

Imbalance of γδT17/γδTreg cells in the pathogenesis of allergic asthma induced by ovalbumin

We aimed to explore the imbalance between the T helper 17 γδT cells (γδT17) and the regulatory γδT cells (γδTreg) in asthmatic mice. Male Balb/c mice were randomly divided into the normal control group and the asthmatic model group. The asthmatic model group mice were intraperitoneally injected with the mixture of ovalbumin (OVA)/Al(OH)3 and then activated by exposure of the animals to OVA atomization. Airway hyperresponsiveness (AHR) was determined by a non-invasive lung function machine. Hematoxylin and eosin and Alcian blue-periodic acid Schiff staining were done for histopathological analysis. Interleukin (IL)-17 and IL-35 levels in bronchoalveolar lavage fluid were detected by ELISA. The percentage of IL-17+ γδT cells and Foxp3+ γδT cells in spleen cells suspension were detected and the transcription levels of RORγt and Foxp3 in the lung tissue were determined. Compared with the normal control, the severity of airway inflammation and AHR were higher in the asthmatic mice. Furthermore, mice in the asthmatic group displayed significant increases of IL-17+ γδT cells, expression of IL-17A, and RORγt, whereas control mice displayed marked decreases of Foxp3+ γδT cells, expression of IL-35, and transcription factor Foxp3. In addition, the mRNA expression of RORγt was positively correlated with the percentage of IL-17+γδT cells, and the mRNA level of Foxp3 was positively correlated with the percentage of Foxp3+ γδT cells. The imbalance of γδT17/γδTreg in the asthmatic mice may contribute to the pathogenesis of OVA-induced asthma.

Follicular helper T cell in immunity and autoimmunity

The traditional concept that effector T helper (Th) responses are mediated by Th1/Th2 cell subtypes has been broadened by the recent demonstration of two new effector T helper cells, the IL-17 producing cells (Th17) and the follicular helper T cells (Tfh). These new subsets have many features in common, such as the ability to produce IL-21 and to express the IL-23 receptor (IL23R), the inducible co-stimulatory molecule ICOS, and the transcription factor c-Maf, all of them essential for expansion and establishment of the final pool of both subsets. Tfh cells differ from Th17 by their ability to home to B cell areas in secondary lymphoid tissue through interactions mediated by the chemokine receptor CXCR5 and its ligand CXCL13. These CXCR5+ CD4+ T cells are considered an effector T cell type specialized in B cell help, with a transcriptional profile distinct from Th1 and Th2 cells. The role of Tfh cells and its primary product, IL-21, on B-cell activation and differentiation is essential for humoral immunity against infectious agents. However, when deregulated, Tfh cells could represent an important mechanism contributing to exacerbated humoral response and autoantibody production in autoimmune diseases. This review highlights the importance of Tfh cells by focusing on their biology and differentiation processes in the context of normal immune response to infectious microorganisms and their role in the pathogenesis of autoimmune diseases.

Produção e avaliação do receptor solúvel de IL-10 canina recombinate / Production and evaluation of the soluble receptor of IL-10 Canine recombinant

A interleucina 10 (IL-10) é uma importante citocina anti-inflamatória e imunossupressora que é produzida por uma variedade de células do sistema imune, incluindo linfócitos T e B, células monocíticas, células Natural Killer, células dendríticas, eosinófilos e neutrófilos. O receptor de IL-10 é composto por duas cadeias polipeptídicas denominadas IL-10R1 e IL-10R2. A cadeia IL-10R1 exibe alta afinidade por IL-10 e é responsável pela ligação inicial com a citocina. Depois da ligação entre a IL-10 e a cadeia IL-10R1, a cadeia IL-10R2 se junta ao complexo protéico formado e é realizada a sinalização para o citoplasma da célula alvo. Existem evidências de que a IL-10 participa na susceptibilidade de seres humanos e cães a leishmaniose visceral. Além disso, a imunização de animais com antígenos e o bloqueio concomitante da sinalização por IL-10 pode favorecer a indução de respostas imunes celulares (Th1), úteis no combate a infecções por patógenos intracelulares.OBJETIVO: O objetivo do presente projeto foi produzir o receptor solúvel de IL-10 (domínio extracitoplasmático da cadeia IL-10R1, com atividade antagonista) recombinante (rcasIL-10R1), visando estudos futuros de imunomodulação em cães. METODOLOGIA: Para isso, foram realizadas as seguintes etapas: 1) obtenção de uma construção de DNA codificante de rcasIL-10R1 em um cromossoma artificial de baculovírus desprovido dos genes da catepsina e chitinase, 2) transfecção de células de insetos, obtenção de partículas virais e titulação viral (P1), 3) amplificação e titulação viral (P2), 4) ensaio de otimização para expressão da proteína recombinante em células High five; 5) produção da proteína recombinante em celulas High five e purificação por cromatografia de afinidade e 6) avaliação da capacidade de rcasIL-10R1 bloquear a sinalização de IL-10, utilizando-se células MC/9. RESULTADOS: A julgar pelo sequenciamento de DNA do inserto na construção plasmídeal carreadora (pFastBac1-GP64-casIL-10R1) e da amplificação por PCR do segmento de DNA contendo o inserto no cromossoma artificial do baculovírus, a obtenção de baculovírus recombinante codificando casIL-10R1 foi realizada com sucesso. O ensaio de otimização da produção da rcasIL-10R1 realizado com células de inseto da linhagem High Five mostrou as melhores condições para foram multiplicidade de infecção (MOI) 5 e tempo de infecção (TOI) de 72h. A proteína recombinante produzida e purificada mostrou uma banda principal de 42 kDa pela análise por eletroforese em gel de poliacrilamida e o rendimento foi de 2,8 mg por litro de cultura. O ensaio realizado com células MC/9 cultivadas na presença de IL-4 e IL-10 com ou sem rcasIL-10R1 mostrou que a proteína recombinante produzida inibiu parcialmente a proliferação das células, sugerindo o bloqueio da sinalização através de IL-10. CONCLUSÕES: Portanto, no presente trabalho rcasIL-10R1 com capacidade de bloquear a sinalização por IL-10 foi produzido com sucesso, abrindo a perspectiva de futuros estudos de imunomodulação em cães.

INTRODUCTION: Interleukin 10 (IL-10) is an important anti-inflammatory and immunosuppressive cytokine which is produced by a variety of immune cells, including T and B lymphocytes, monocytes, natural killer and dendritic cells, eosinophils and neutrophils. The IL-10 receptor is composed of two polypeptide chains called IL-10R1 and IL-10R2. IL-10R1 chain exhibits high affinity for IL-10 and is responsible for initial binding to the cytokine. After IL-10 binding to IL-10R1, IL-10R2 joins the protein complex formed and signaling to the cytoplasm of the target cell. There is evidence that IL-10 participates in the susceptibility of human and dog visceral leishmaniasis. Furthermore, immunization of animals with antigens and concomitant blockade of signaling by IL-10 may promote the induction of cellular immune responses (Th1), useful in combating infections caused by intracellular pathogens. OBJECTIVE: The objective of this project was to produce recombinant soluble receptor IL 10 (extracytoplasmic domain of IL-10R1 chain, with antagonist activity) (rcasIL10R1), aiming future studies of immunomodulation in dogs. METHODOLOGY: For this, the following steps were carried out: 1) obtaining a DNA construction encoding casIL-10R1 in an artificial chromosome baculovirus knockout of the cathepsin and chitinase genes, 2) insect cell transfection, obtaining viral particles and viral titration (P1) 3) amplification and viral titration (P2), 4) optimization assay for the recombinant protein production in High Five cells; 5) production of recombinant protein and purification and by affinity chromatography and 6) evaluation of rcasIL-10R1 ability to block IL-10 signaling, using MC / 9 cells. RESULTS: The results of DNA sequencing of shuttle plasmid construction (pFastBac1GP64-casIL-10R1) and PCR of the artificial chromosome baculovírus containing casIL-10R1 insert showed that recombinant baculovirus was successfully obtained. The rcasIL-10R1 expression optimization assay in High Five cells showed that the best conditions were multiplicity of infection (MOI) 5 and time of infection (TOI) 72 h. The recombinant protein produced and purified displayed a major band of 42 kDa by polyacrylamide gel electrophoresis and the yield was 2.8 mg per liter of culture. MC/9 cells cultured in presence of IL-4 and IL-10 proliferated less intensely when rcasIL-10R1 was added, suggesting that rcasIL-10R1 blocked IL-10 signaling...

Antiviral and myocyte protective effects of IL-28A in coxsackievirus B3-induced myocarditis

Objective: This study aimed to investigate whether interleukin-28A (IL-28A) plays a role in murine myocarditis induced by coxsackievirus B3 (CVB3), and to explore its possible mechanism involved. Methods: Male BALB/c mice both infected and not infected by CVB3 were randomly divided into four groups (n = 40), untreated or treated with different doses of IL-28A for 4 days, and then sacrificed on days 4 and 7 post-infection. The heart samples were collected for histopathologic examination. Cardiac viral load was determined by a plaque assay. Additionally, immunoblot analysis, TUNEL assay, and immunohistochemistry were performed to examine the expression of signal transducer, activator of transcription 1 and 2 (STAT1 and STAT2), CVB3-induced apoptosis and the expression of Bcl-2, BAX and Caspase-3. Results: Compared to uninfected mice, the CVB3 infected mice exhibited higher mortality rate (p < 0.001), apparent inflammation and myocardial lesion (p < 0.01), and higher cardiac viral load (p < 0.01). After CVB3 infection, IL-28A treated mice presented no death (p < 0.001), reduced inflammation and myocardial lesion (p < 0.01), and lower viral load (p < 0.01) compared to untreated mice. Besides, treatment with IL-28A markedly increased the expressions of STAT1 and STAT2, and inhibited CVB3-induced apoptosis in myocardial cells with increased ratio of Bcl-2/BAX. Conclusion: The antiviral and myocyte protective effects of IL-28A in CVB3-inducedmyocarditis are regulated by STAT1 and STAT2. .

Análisis molecular del cáncer de colon esporádico / Molecular analysis of sporadic colon cancer

Background: In Chile, colorectal cancer (CRC) is often diagnosed in late stages. Thus, surgical treatment must be complemented with chemotherapy. KRAS mutations and microsatellite instability have been detected in these tumors. However, the response to treatment in patients without KRAS mutations varies and requires a better understanding. Aim: To determine the frequency and distribution of somatic point mutations in KRAS, BRAF and PIK3CA genes and microsatellite instability status (MSI) in patients with colon cancer (CC). Material and Methods: A prospective observational study of patients undergoing surgery for colon cancer. Tumor-derived DNA was analyzed by polymerase chain reaction (PCR) for the most frequent mutations of KRAS, BRAF and PIK3CA. PCR was also used to analyze MSI. Results: Fifty-eight patients with sporadic CC were analyzed, 16 showed KRAS mutations (G12R, G12D, G12V, G13D) and out of the 42 patients that did not show any mutation, 10 had mutations in BRAF (V600E) and PIK3CA (E542K, E545D, E545K, Q546E, H1047R). BRAF mutations alone or in combination with PIK3CA mutations were observed in 27% of high MSI tumors and in 2% of tumors without instability (p < 0.049). A higher percentage of high MSI tumors were located in the right colon (p < 0.001), and showed BRAF mutation (p < 0.020). Conclusions: The highest percentage of high MSI and BRAF mutations was observed in the right colon. Therefore, this study suggests the presence of different molecular features between right and left colon tumors that should be considered when defining the therapeutic management.

In vivo action of IL-27: reciprocal regulation of Th17 and Treg cells in collagen-induced arthritis

Interleukin (IL)-27 is a novel cytokine of the IL-6/IL-12 family that has been reported to be involved in the pathogenesis of autoimmune diseases and has a pivotal role as both a pro- and anti-inflammatory cytokine. We investigated the in vivo effects of IL-27 on arthritis severity in a murine collagen-induced arthritis (CIA) model and its mechanism of action regarding control of regulatory T (Tregs) and IL-17-producing T helper 17 (Th17) cells. IL-27-Fc-treated CIA mice showed a lower severity of arthritis. IL-17 expression in the spleens was significantly decreased in IL-27-Fc-treated CIA mice compared with that in the CIA model. The Th17 population was decreased in the spleens of IL-27-Fc-treated CIA mice, whereas the CD4+CD25+Foxp3+ Treg population increased. In vitro studies revealed that IL-27 inhibited IL-17 production in murine CD4+ T cells, and the effect was associated with retinoic acid-related orphan receptor gammaT and signal transducer and activator of transcription 3 inhibition. In contrast, fluorescein isothiocyanate-labeled forkhead box P3 (Foxp3) and IL-10 were profoundly augmented by IL-27 treatment. Regarding the suppressive capacity of Treg cells, the proportions of CTLA-4+ (cytotoxic T-lymphocyte antigen 4), PD-1+ (programmed cell death protein 1) and GITR+ (glucocorticoid-induced tumor necrosis factor receptor) Tregs increased in the spleens of IL-27-Fc-treated CIA mice. Furthermore, in vitro differentiated Treg cells with IL-27 exerted a more suppressive capacity on T-cell proliferation. We found that IL-27 acts as a reciprocal regulator of the Th17 and Treg populations in CD4+ cells isolated from healthy human peripheral blood mononuclear cells (PBMCs), as well as from humans with rheumatoid arthritis (RA) PBMCs. Our study suggests that IL-27 has the potential to ameliorate overwhelming inflammation in patients with RA through a reciprocal regulation of Th17 and Treg cells.

Vaccination with Trypanosoma rangeli modulates the profiles of immunoglobulins and IL-6 at local and systemic levels in the early phase of Trypanosoma cruzi experimental infection

In America, there are two species of Trypanosoma that can infect humans: Trypanosoma cruzi, which is responsible for Chagas disease and Trypanosoma rangeli, which is not pathogenic. We have developed a model of vaccination in mice with T. rangeli epimastigotes that protects against T. cruzi infection. The goal of this work was to study the pattern of specific immunoglobulins in the peritoneum (the site of infection) and in the sera of mice immunized with T. rangeli before and after challenge with T. cruzi. Additionally, we studied the effects triggered by antigen-antibodies binding and the levels of key cytokines involved in the humoral response, such as IL-4, IL-5 and IL-6. The immunization triggered the production of antibodies reactive with T. cruzi in peritoneal fluid (PF) and in serum, mainly IgG1 and, to a lesser magnitude, IgG2. Only immunized mice developed specific IgG3 antibodies in their peritoneal cavities. Antibodies were able to bind to the surface of the parasites and agglutinate them. Among the cytokines studied, IL-6 was elevated in PF during early infection, with higher levels in non-immunized-infected mice. The results indicate that T. rangeli vaccination against T. cruzi infection triggers a high production of specific IgG isotypes in PF and sera before infection and modulates the levels of IL-6 in PF in the early periods of infection.

Avaliação clínica, histológica e imunológica de enxertos ósseos alógenos fresco-congelados utilizados como técnica na preservação de rebordo alveolar pós-extração / Preservation of alveolar bone in extraction sockets using fresh-frozen bone allograft: a clinical, histological and immunological study

O osso alógeno fresco-congelado (FFBA, do inglês fresh-frozen bone allograft) é uma alternativa para os procedimentos cirúrgicos de enxerto ósseo, principalmente na preparação do rebordo alveolar para a instalação de implantes osseointegráveis. No entanto, existem alguns paradigmas que envolvem a relação entre resposta do sistema imunológico à aloantígenos presentes no enxerto e o seu comportamento clínico. Procurando entender essa relação, o FFBA foi avaliado como enxerto para preservar o rebordo alveolar pós-extração. Os resultados mostraram que embora tenha ocorrido uma redução estatisticamente significante na altura, espessura e volume do rebordo entre a avaliação inicial e final, essa redução não foi clinicamente significante, permitindo a instalação de implantes osseointegráveis. Em adição, as análises histológicas sugerem um bom comportamento do enxerto, com ausência de reação do tipo corpo estranho e formação de novo osso em todos os sítios analisados. Ao analisar o comportamento da resposta imune, os resultados mostraram que a injeção intradérmica de aloantígenos presentes no FFBA, não induziu uma reação de hipersensibilidade tardia nos pacientes após 4 meses do enxerto. Além disso, os monócitos do sangue periférico (PBMCs) dos pacientes não proliferaram frente aos aloantígenos in vitro. No entanto, os dados também demonstraram que os aloantígenos aumentam a produção de IL-2 e IFN-, mas não alteram a produção de IL-4 e IL-10, por PBMCs dos pacientes. Ao avaliar a relação entre a produção dessas citocinas e o comportamento clínico do enxerto, os dados mostram que existe uma correlação estatisticamente significante entre a produção de IL-2 in vitro e a redução (em %) da altura do rebordo alveolar, embora essa redução não tenha sido clinicamente significante. De fato, a presença de aloantígenos no FFBA não é suficiente para sua contraindicação como material de enxertia.

The fresh-frozen bone allograft (FFBA) is an alternative to surgical procedures of bone grafts, mainly in the preservation of alveolar ridge prior the installation of osseointegrated implants. However there are paradigms that surround the relation between immune response to alloantigens present inside the graft and the clinical response of the graft. An attempt to understand this relationship, the FFBA was evaluated as a graft to preserve the alveolar ridge post-extraction. The results show a statistically significant reduction in height, thickness and volume of the ridge between the initial and final examination, however this reduction was not clinically significant. The ridge preservation allowed implant installation and osseointegration. In addition, histologic analysis suggests a good performance of the graft with no foreign body reaction and formation of new bone at all sites. In analyzing the behavior immune response, the results showed that stimulation with alloantigens present in bone allograft induced no delayed hypersensitivity reaction in vivo. Additionally, periphery blood mononuclear cells (PBMC) from patients no proliferate in response to alloantigens in vitro. However, the data also demonstrated that the alloantigens increase IL-2 and IFN- production, but no IL-4 and IL-10 production, by PBMCs from patients. When evaluate the relation between the cytokines production and clinical parameters, the results demonstrate that there statistically significant correlation between IL-2 production in vitro and ridge height changes (%), although this clinical parameter is not clinically significant. In fact, the alloantigens in FFBA are not sufficient for its contraindications as grafting material.

Cyclosporin A-treated Dendritic Cells may affect the outcome of organ transplantation by decreasing CD4+CD25+ regulatory T cell proliferation

One of the mechanisms for generation of tolerance involves immature dendritic cells (DCs) and a subpopulation of regulatory CD4+ CD25+ T lymphocytes (T REG). The purpose of this work was to analyze how Cyclosporine A (CsA), a widely used immunosuppressive drug, may affect T REG proliferation. Purified and activated murine DCs obtained from bone marrow precursors differentiated with rGMCSF were co-cultured with purified CFSE-labeled T REG from OTII mice, and their phenotype and proliferation analyzed by flow cytometry. Our data indicate that DCs differentiated in the presence of CsA show an altered phenotype, with a lower expression of MHC-II and a lower activating capacity. Additionally, these CsA-treated DCs show decreased production of IL-2 and IL-12 and increased IL-10 secretion when stimulated with LPS, indicating an effect on the polarization of the immune response. Interestingly, CsA-treated DCs show an anti-tolerogenic effect since they reduce the proliferation of T REG cells from 72 to 47 percent. Further inhibition to a 24 percent of T REG proliferation was obtained as a direct effect of CsA on T REG. In conclusion, the anti-tolerogenic effect of CsA should be considered in the planning of immunosuppression in the context of clinical transplantation.

Enfermedad inflamatoria intestinal: Una mirada inmunológica: [revisión] / Inflammatory bowel diseases: An immunological approach: [review]

Inflammatory bowel diseases (IBD) are inflammatory diseases with a multifactorial component that involve the intestinal tract. The two relevant IBD syndromes are Crohn's disease (CD) and ulcerative colitis (UC). One factor involved in IBD development is a genetic predisposition, associated to NOD2/CARD15 and Toll-like receptor 4 (TLR4) polymorphisms that might favor infectious enterocolitis that is possibly associated to the development of IBD. The identification of specific immunologic alterations in IBD and their relationship to the etiology of the disease is a relevant research topic. The role of intra and extracellular molecules, such as transcription factors and cytokines that are involved in the inflammatory response, needs to be understood. The relevance of immunologic molecules that might drive the immune response to a T helper (Th) 1, Th 2 or the recently described Th 17 phenotype, has been demonstrated in animal models and clinical studies with IBD patients. CD and UC predominantly behave with a Th 1 and Th 2 immune phenotype, respectively. Recently, an association between CD and Th 17 has been reported. The knowledge acquired from immunologic and molecular research will help to develop accurate diagnostic methods and efficient therapies.

Calcineurin inhibitors in the treatment of allergic dermatitis

OBJETIVO: Revisar o papel dos inibidores da calcineurina no tratamento das dermatoses alérgicas, com ênfase nos mecanismos de ação, eficácia e efeitos adversos tópicos e sistêmicos. FONTES DOS DADOS: Artigos de língua inglesa publicados na MEDLINE, considerando as palavras chave: pimecrolimus, tacrolimo, calcineurin inhibitors. Foram selecionados os artigos originais que apresentaram estudos controlados e estudos abertos para avaliação da eficácia, tolerabilidade e eventos adversos. Também foram avaliados artigos de revisão e relatos e série de casos, sendo estes últimos considerados apenas para avaliação de efeitos adversos. Foram consultados os sites oficiais da Food and Drug Administration e dos fabricantes de inibidores da calcineurina. SíNTESE DOS DADOS: Os dados mostraram que inibidores de calcineurina são eficientes no tratamento da dermatite atópica leve a grave, levando a melhora dos sintomas, diminuição do número de crises e necessidade de corticoterapia tópica. Apresentam boa tolerabilidade e poucos efeitos adversos tópicos. Até o momento, não há evidências que sustentem a maior prevalência de neoplasias nos pacientes que utilizam esses medicamentos; entretanto, um adequado sistema de farmacovigilância está montado para avaliar esse aspecto. CONCLUSÕES: Os inibidores de calcineurina são uma nova classe de medicamentos para o tratamento das dermatoses alérgicas. São eficazes, tolerados e com poucos efeitos adversos. Devem ser sempre utilizados de acordo com as orientações preconizadas, e os pacientes devem ser sempre acompanhados pelo médico durante e após sua administração.

OBJECTIVE: To review the role of calcineurin inhibitors in the treatment of allergic dermatitis, focusing on mechanisms of action, efficacy and topical and systemic adverse effects. SOURCES: Articles written in English and published in MEDLINE using the following keywords: pimecrolimus, tacrolimus, calcineurin inhibitors. Original articles that presented controlled and open studies for assessing efficacy, tolerability and adverse effects were selected. Review articles and case series were also evaluated; the latter was only considered for assessing adverse effects. The official websites of the Food and Drug Administration and of manufacturers of calcineurin inhibitors were also used. SUMMARY OF THE FINDINGS: The data showed that calcineurin inhibitors are efficient in the treatment of mild to severe atopic dermatitis, leading to improvement in symptoms, reduction in number of attacks and need of topical corticotherapy. Calcineurin inhibitors have good tolerability and few topical adverse effects. To date, there has been no evidence to support higher prevalence of neoplasia in patients using these drugs; however, an adequate pharmacovigilance system has been set up to assess this aspect. CONCLUSIONS: Calcineurin inhibitors, which are a new drug class in the treatment of allergic dermatitis, are efficient, well tolerated and have few adverse effects. Calcineurin inhibitors should always be used according to recommended guidelines, and patients should always be followed by the physician during and after their administration.

The role of interferon-gamma on immune and allergic responses

Allergic diseases have been closely related to Th2 immune responses, which are characterized by high levels of interleukin (IL) IL-4, IL-5, IL-9 and IL-13. These cytokines orchestrate the recruitment and activation of different effector cells, such as eosinophils and mast cells. These cells along with Th2 cytokines are key players on the development of chronic allergic inflammatory disorders, usually characterized by airway hyperresponsiveness, reversible airway obstruction, and airway inflammation. Accumulating evidences have shown that altering cytokine-producing profile of Th2 cells by inducing Th1 responses may be protective against Th2-related diseases such as asthma and allergy. Interferon-gamma (IFN-gamma), the principal Th1 effector cytokine, has shown to be crucial for the resolution of allergic-related immunopathologies. In fact, reduced production of this cytokine has been correlated with severe asthma. In this review, we will discuss the role of IFN-gamma during the generation of immune responses and its influence on allergic inflammation models, emphasizing its biologic properties during the different aspects of allergic responses.

Implicações clínicas e imunológicas da associação entre o HTLV-1 e a estrongiloidíase / Clinical and immunological consequences of the association between HTLV-1 and strongyloidiasis

A estrongiloidíase é uma das mais importantes helmintíases em países tropicais e estudos epidemiológicos têm demonstrado associaçäo desta parasitose com o vírus HTLV-1. Em regiöes onde estes dois agentes säo endêmicos a coinfecçäo pode resultar no desenvolvimento de formas disseminadas da estrongiloidíase assim como em estrongiloidíase recorrente. Enquanto que o vírus HTLV-1 está relacionado com uma alta produçäo de IFN-gama e desvio da resposta imune para o tipo Th1, a proteçäo contra helmintos está associada a uma resposta Th2. Devido a este viés da resposta imune, indivíduos infectados pelo HTLV-1 apresentam reduçäo na produçäo de IL-4, IL-5, IL-13 e IgE, componentes participantes dos mecanismos de defesa contra S. stercoralis. Estas anormalidades constituem a base para a ocorrência de maior freqüência e de formas mais graves da estrongiloidíase em pacientes infectados pelo HTLV-1

Efecto del naproxeno sódico en las concentraciones séricas de IL-1, IL-6 y TFN en pacientes con faringoamigdalitis aguda purulenta / The effect of sodium naproxeno in the scrum concentration of IL-1, IL-6 and TNF in acute infectious process

Antecedentes. En el proceso infeccioso las citocinas producidas por los macrófagos y neutrófilos participan en los mecanismos de defensa del huésped. En estos mecanismos de fase aguda intervienen interleucinas como IL-1, IL-6 y el factor de necrosis tumoral (INF). Objetivo. Conocer el efecto del naproxeno sódico en las concentraciones séricas de IL-1, IL-6 y TNF, en un receso infeccioso agudo. Material y método. Se estudiaron al azar 18 pacientes, que se dividieron en dos grupos iguales, con diagnóstico clínico de faringoamigdalitis aguda purulenta. A un grupo se le dio naproxeno sódico y al otro placebo, ambos recibieron tratamiento antibacteriano con penicilina G procaínica. Resultados. El grupo que recibió naproxeno sódico tuvo disminución del síndrome febril e infeccioso a partir de las 72 horas. En los que recibieron placebo los síntomas y signos de los síndromes febril e infeccioso persistieron por más de tres días. Discusión. Los pacientes que recibieron tratamiento con naproxeno sódico tuvieron una disminución en la concentración sérica de IL-1B con diferencias estadísticamente significativas con respecto a las mediciones basal y a las 72 horas; también se observaron diferencias estadísticamente signficativas con los pacientes que recibieron placebo. Los resultados muestran que las concentraciones séricas de IL-1b disminuyeron en ambos grupos pero fue más acentuada la disminución en el grupo que recibió naproxeno sódico con disminución de los síntomas en forma más rápida

Aspectos inmunológicos de la endometriosis / Immunological aspects of endometriosis

Es claro el efecto que la endometriosis en etapas avanzadas tiene sobre la fertilidad, por las alteraciones adherenciales sobre trompas y ovarios; pero es más importante comprender los mecanismos fisiopatológicos por las cuales se presenta la infertilidad en la endometriosis mínima y leve. Aunque se desconoce la causa específica de la endometriosis, los componentes del sistema inmunitario pueden estar afectados y jugar un papel central en la fisiopatogenia de la enfermedad, al alterar el microambiente peritoneal. Por un lado, el aumento de subpoblaciones de leucocitos y su actividad en líquido peritoneal reflejan efectos citotóxicos contra espermatozoides, oocito, interación de gametos y desarrollo embrionario temprano. Por otro lado, la secreción de citocinas y factores de crecimiento que favorecen o estimulan el crecimiento de focos endometrióticos en un ambiente de ®tolerancia inmunológica¼. Se revisan los aspectos inmunológicos de la endometriosis, incluyendo las vías paracrina o autocrina de comunicación entercelular

Humoral and cellular immune response within the subarachnoid space of patients with neurocysticercosis

To study the immune response within the subarachnoid space in patients with neurocysticercosis, we measured the cerebrospinal fluid contents of immunoglobulins A, E, G, and M in 38 patients and the contents of the proinflammatory cytokines TNF-alpha, IL-1b, IL-6 and IFN-gamma in 17 patients. The same measurements were made in 30 neurological patients without inflammatory or immune-mediated disorders. Each immunoglobulin and cytokine, including the gender and age of the patient, was compared by multiple regression analysis with the CSF contents of cells, protein and ELISA for cysticercal antigens. A direct correlation was found of IgM with cell content (p<0.058) and with ELISA values (p<0.027); of age with protein content (p<0.006); of IL-6 with protein content (p<0.018) and of IL-1b with ELISA values (p<0.004). An inverse correlation was found of glucose with ELISA values (p<0.008). A complex function of the immune response within the subarachonid space was observed: mean values of IgG, IgM, IgE and interleukins 1b and 6 were increased, whereas values of IgA, TNF-alpha and IFN-gamma were similar to those of controls

Bases moleculares de la inmunología del cáncer / Molecular basis of cancer immunology

El sistema inmune es una red intrincada en la que participan diferentes tipos de células y de moléculas. La acción coordinada de todos sus elementos permite que se desarrolle una respuesta eficaz contra la célula tumoral. Sin embargo, los tumores presentan diversos mecanismos de evasión que permiten el desarrollo del mismo. En esta revisión se presentan eventos celulares y moleculares que participan en la regulación de la respuesta inmune contra tumores. Se discute la interacción de distintas moléculas como las del complejo principal de histocompatibilidad, receptor de antígenos de linfocitos T, moléculas de adhesión, antígenos tumorales y citocinas, así como lo más reciente sobre los mecanismos de escape tumoral e inmunoterapia

The immune system is a tight network of different types of cells and molecules. The coordinated action of these elements mounts a precise immune response against tumor cells. However, these cells present several escape mechanisms, leading to tumor progression. This paper shows several cellular and molecular events involved in the regulation of the immune response against tumor cells. The interaction of several molecules such as MHC, TcR, adhesins, tumor antigens and cytokines are discussed, as well as the most recent knowledge about escape mechanisms and immunotherapy.