Predictors of bone loss in childhood hematologic malignancies: a prospective study.

SUMMARY: Twenty-nine children with malignancies and age, gender-matched controls were prospectively studied over 14 months. Patients had higher parathyroid hormone (PTH) levels and fat mass, lower bone mass, and bone mass increments at follow-up than controls. Lean mass, age at diagnosis, systemic and intrathecal therapy were predictors of bone mass changes on adjusted analyses. INTRODUCTION: Children with hematologic malignances have low bone mass. We prospectively investigated anthropometric, clinical, and hormonal predictors of changes in bone mass in children receiving cancer therapy. METHODS: Twenty-nine children, mean age of 9 ± 2.9 years and 32 age and gender-matched controls, were studied. Seven had completed their course 40 ± 22 weeks prior, while 22 were still receiving therapy for 80 ± 28 weeks. Age at diagnosis, calcium intake, exercise activity, systemic corticosteroids in dexamethasone (Dex) dose, and methotrexate (MTX), and intrathecal MTX therapy received within follow-up period were assessed. Routine chemistries, PTH, 25-hydroxy vitamin D (25-OHD), bone remodeling markers, bone mass, and body composition were measured at baseline and 14 months. RESULTS: Patients had lower exercise activity, sun exposure, and bone markers levels than controls. They had higher PTH levels and fat mass, lower bone mass at the spine, hip, and total body, and lower increments at these sites on follow-up. Predictors of bone mass changes on univariate analyses were: age at diagnosis (R = -0.50 to -0.44, p < 0.05), Dex-MTX doses (R = -0.58 to -0.41, p < 0.05), intrathecal therapy (p < 0.03),% changes in lean mass (R = 0.37 to 0.54, p < 0.04), 25-OHD levels (R = 0.39, p < 0.03), and PTH levels (R = -0.47 to -0.41, p < 0.05). Lean mass, age at diagnosis, systemic and intrathecal therapy were predictors of bone mass changes on adjusted analyses. CONCLUSION: This study provides insight into the pathophysiology of bone loss in children receiving cancer therapy and possible interventions to optimize their skeletal health.

Cell adhesion molecule and lymphocyte activation marker expression during experimental vaginal candidiasis.

Cell-mediated immunity by Th1-type CD4(+) T cells is the predominant host defense mechanism against mucosal candidiasis. However, studies using an estrogen-dependent murine model of vaginal candidiasis have demonstrated little to no change in resident vaginal T cells during infection and no systemic T-cell infiltration despite the presence of Candida-specific systemic Th1-type responses in infected mice. The present study was designed to further investigate these observations by characterizing T-cell activation and cell adhesion molecule expression during primary and secondary C. albicans vaginal infections. While flow cytometry analysis of activation markers showed some evidence for activation of CD3(+) draining lymph node and/or vaginal lymphocytes during both primary and secondary vaginal Candida infection, CD3(+) cells expressing the homing receptors and integrins alpha(4)beta(7), alpha(M290)beta(7), and alpha(4)beta(1) in draining lymph nodes of mice with primary and secondary infections were reduced compared to results for uninfected mice. At the local level, few vaginal lymphocytes expressed integrins, with only minor changes observed during both primary and secondary infections. On the other hand, immunohistochemical analysis of vaginal cell adhesion molecule expression showed increases in mucosal addressin cell adhesion molecule 1 and vascular cell adhesion molecule 1 expression during both primary and secondary infections. Altogether, these data suggest that although the vaginal tissue is permissive to cellular infiltration during a vaginal Candida infection, the reduced numbers of systemic cells expressing the reciprocal cellular adhesion molecules may preempt cellular infiltration, thereby limiting Candida-specific T-cell responses against infection.

Analysis of the CD4 protein on human vaginal T lymphocytes.

PROBLEM: Although T lymphocytes at the human vaginal mucosa have been partially characterized, there remains a paucity of information regarding cell-mediated immune mechanisms at this mucosal site. In mice and humans, there are several phenotypic distinctions between vaginal T lymphocytes and those in the peripheral circulation. Recently, we observed as well that the N-terminus of the CD4 protein on murine vaginal T lymphocytes is atypically expressed compared to its systemic counterpart, and that the atypical expression extends to the mRNA level. METHOD OF STUDY: The purpose of this study was to evaluate the CD4 protein on human vaginal T lymphocytes by flow cytometry and RT-PCR. RESULTS: Results showed that, in contrast to mice, the CD4 protein on human vaginal and peripheral blood T lymphocytes are similar at both the molecular and protein levels. CONCLUSIONS: These results indicate that based on several differences between human and mouse vaginal T cells, caution is urged when using mice as a model to study human vaginal immunity.

Monitoring of immune response by blood serum profiling using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.

The application of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOFMS) to the analysis of blood serum leads to the observation of a large variety of reproducible mass spectral peaks corresponding to blood components. In this study, the use of MALDI-TOFMS was developed as a tool for monitoring immune response to bacterial infection. Employing the MALDI-TOFMS approach, the levels of many components of blood were found to be immune response independent whereas others were found to correlate directly with the response of the immune system to two known types of bacteria (Staphylococcus aureus and Enterococcus faecalis). The methodologies reported here should be useful for the rapid monitoring of blood, especially that of the immune response mechanisms in various animal species.

Evidence for a unique expression of CD4 on murine vaginal CD4+ cells.

Mucosal cell-mediated immunity (CMI) by CD4+ T cells is postulated to be important for host defence against several vaginal pathogens. In addition to the recognized phenotypic distinctions of resident vaginal T lymphocytes, we recently provided evidence by fluorescence-activated cell sorter (FACS) that murine vaginal CD4+ T lymphocytes, are differentially recognized by two epitope-distinct anti-CD4 antibodies, suggesting that the CD4 protein on vaginal CD4+ cells is atypically expressed. In the present study, we confirm this by FACS and immunohistochemistry under non-denaturing conditions using two additional anti-CD4 antibodies. However, positive immunohistochemical staining of vaginal CD4+ cells under denaturing conditions revealed that the CD4 epitope in question is indeed present within the CD4 protein. Using reverse transcription polymerase chain reaction, amplification of CD3, T-cell receptor-beta (TCR-beta), and TCR-delta mRNA from lymph node and vaginal tissue, and CD4 mRNA from lymph node tissue was demonstrable. In contrast, amplification of CD4 mRNA from vaginal tissue, vaginal enriched lymphoid cells, or a purified (FACS-sorted) population of vaginal-specific CD4+ cells using two distinct primer sets was not demonstrable. Altogether, our results provide evidence that the CD4 protein on vaginal CD4+ T cells is conformationally distinct compared with its systemic counterpart, either as a result of a unique CD4 mRNA sequence or from a stable interaction of soluble CD4 with the surface of vaginal T cells.