Percepción de los pacientes respecto a la humanización del cuidado enfermero en una unidad de hemodiálisis / Patients' perception of the humanization of nursing care in a hemodialysis unit

Objetivo:Analizar la percepción de los pacientes sobre la humanización de los cuidados de enfermería en una unidad de hemodiálisis.Material y Método: Estudio descriptivo transversal, realizado en 2023 en la unidad de hemodiálisis del Hospital Universitario de Jaén. Se utilizó el cuestionario PCHE 3ªversión (32 ítems, escala Likert 1-4), obteniéndose una puntuación sobre percepción global del cuidado humanizado y 3 puntuaciones correspondientes a las dimensiones: “Cualidades del hacer de enfermería”, “Apertura a la comunicación para proporcionar educación para la salud a la persona” y “Priorizar el sujeto de cuidado”. También se recogieron las variables sexo, edad y tiempo en hemodiálisis. Se realizó un análisis descriptivo, y se comparó la puntuación global y de las 3 dimensiones con la variable sexo (U-Mann-Whitney) y con las otras variables (Rho-Spearman). Resultados: Se analizaron 38 cuestionarios, 57,9% hombres, edad media: 65,2±15,28años, mediana tiempo en hemodiálisis: 42 (P25:8-P75:96) meses. Alpha de Cronbach del cuestionario: 0,919. Un 73,7% calificó como “siempre” la percepción global del cuidado humanizado, y un 5,3% “nunca”. Analizando las respuestas “siempre” y “nunca” en cada dimensión, encontramos: “Comunicación” (63,2% vs 5,3%), “Priorizar al paciente” (63,2% vs 5,3%) y “Cualidades del hacer” (84,2% vs 5,3%). Los pacientes con >1 año en hemodiálisis presentaron peor puntuación total PCHE (p=0,03), también encontramos correlación entre “tiempo en diálisis” y la dimensión “Cualidades del hacer” (Rho-Spearman:-0,346; p=0,039).Conclusiones: La percepción por parte de los pacientes en hemodiálisis sobre el cuidado humanizado de enfermería ha sido buena, identificándose áreas de mejora en la comunicación y priorización del paciente (AU)

Objective: To analyze patients’ perception of the humaniza-tion of care in a hemodialysis unit.Material and Methods: A descriptive cross-sectional study was conducted in 2023 in the hemodialysis unit of the Uni-versity Hospital of Jaén.The PCHE questionnaire 3rd version was used (32 items, Li-kert scale 1-4), obtaining a score on the overall perception of humanized care and three scores corresponding to the dimensions: “Qualities of nursing care,” “Openness to com-munication for providing health education to the individual, and “Prioritizing the subject of care”. Sex, age, and time on hemodialysis were also collected as variables. Descriptive analysis was performed, and the overall score and the scores of the three dimensions were compared with the sex variable (U-Mann-Whitney) and other variables (Rho-Spearman).Results: Thirty-eight questionnaires were analyzed, 57.9% male, mean age: 65.2±15.28 years, median time on hemo-dialysis: 42 (P25:8-P75:96) months. Cronbach’s alpha for the questionnaire was 0.919. 73.7% rated the overall perception of humanized care as “always,” and 5.3% as “never.” Percen-tages for “always” and “never” responses in each dimension were: “Communication” (63.2% vs. 5.3%), “Prioritizing the patient” (63.2% vs. 5.3%), and “Qualities of care” (84.2% vs. 5.3%). Patients with >1 year on hemodialysis had a lower to-tal PCHE score (p=0.03), and we also found a correlation be-tween “time on dialysis” and the “Qualities of care” dimension (Rho-Spearman: -0.346; p=0.039).Conclusions: The perception of humanized nursing care by hemodialysis patients has been high, identifying areas for im-provement in communication and patient prioritization (AU)

Intimidad percibida por los pacientes en una unidad de hemodiálisis / Patient-perceived privacy in a hemodialysis unit

Objetivo:Evaluar la intimidad percibida por los pacientes en una unidad de hemodiálisis, identificando posibles áreas de mejora.Material y Método: Estudio descriptivo, realizando tres puntos de corte, años 2018, 2019 y 2021. Se utilizó el cues-tionario de Mozota-Duarte, (11 ítems recogen las dimen-siones intimidad auditiva, visual y privacidad global, escala Likert 1-5). Se utilizó el Alpha de Cronbach para el análisis de fiabilidad. Se llevó a cabo un análisis descriptivo, utilizán-dose pruebas no paramétricas para analizar la variabilidad de la intimidad a lo largo de los tres años, así como su rela-ción con las variables sexo y edad. Resultados: se recogieron 125 cuestionarios (tasa respues-ta 80,13%). Mediana de edad 68 años (P25:46,5-P75:80), siendo 65(52%) hombres. Alpha de Cronbach del cuestio-nario: 0,843. La mediana de puntuación de la privacidad global fue 4,66 (P25:4-P75:5), la intimidad auditiva 4,75 (P25:4,25-P75:5) y la intimidad visual 4,75 (P25:4,25-P75:5). No se encontraron diferencias estadísticamente significati-vas en las puntuaciones a lo largo de los 3 años estudiados. Los atributos peor calificados (puntuación<3) fueron “haber escuchado conversaciones de otros pacientes” (19,2%) y “haber visto explorar a otros pacientes” (20,8%).Las mujeres puntuaron peor el ítem “poder haber sido vista por otras personas” (p=0,046), no hallándose significación estadística en ningún otro atributo. Encontramos una rela-ción inversa entre la edad y los 4 ítems relativos a la intimi-dad auditiva (p≤0,05).Conclusiones: La intimidad percibida por los pacientes en hemodiálisis ha sido alta, manteniéndose estable en el tiem-po, tanto en las dimensiones auditiva, visual como global. (AU)

Objective:To evaluate patient-perceived privacy in a hemo-dialysis unit, identifying possible areas for improvement.Material and Method:Descriptive study, with three cut-off points in 2018, 2019 and 2021. The Mozota-Duarte questionnaire was used (11 items covering the dimensions of auditory and visual intimacy and global privacy, Likert-type scale 1-5). Cronbach’s Alpha was used for reliability analysis. A descriptive analysis was carried out, using non-parametric tests to analyse the variability of intimacy over the three years, as well as the relationship with the variables sex and age.Results: 125 questionnaires were collected (response rate 80.13%). The median age was 68 years (P25:46.5-P75:80) and 65 (52%) were male. Cronbach’s alpha of the questionnaire was 0.843. The median score for global privacy was 4.66 (P25:4-P75:5), auditory privacy 4.75 (P25:4.25-P75:5) and visual privacy 4.75 (P25:4.25-P75:5). No statistically significant differences in scores were found across the 3 years studied.The lowest rated attributes (score <3) were “having listened to other patients’ conversations” (19.2%) and “having seen other patients explore” (20.8%).Women scored worse on the item “being able to be seen by others” (p=0.046), with no statistical significance found for any other attribute. An inverse relationship between age and the 4 items related to auditory intimacy was found (p≤0.05).Conclusions: The privacy perceived by hemodialysis patients has been high, remaining stable over time, both in the auditory, visual and global dimensions. (AU)

An SI-traceable reference material for virus-like particles.

A reference material for virus-like particles traceable to the International System of Units (Système International d'Unités - the SI) is reported. The material addresses the need for developing reference standards to benchmark virus-like gene delivery systems and help harmonize measurement approaches for characterization and testing. The material is a major component of synthetic polypeptide virus-like particles produced by the state-of-the-art synthetic and analytical chemistry methods used to generate gene delivery systems. The purity profile of the material is evaluated to the highest metrological order demonstrating traceability to the SI. The material adds to the emerging toolkit of reference standards for quantitative biology.

The qNMR Summit 5.0: Proceedings and Status of qNMR Technology.

The goal of the qNMR Summit is to take stock of the status quo and the recent developments in qNMR research and applications in a timely and accurate manner. It provides a platform for both advanced and novice qNMR practitioners to receive a well-rounded update and discuss potential qNMR-related applications and collaborations. For over a decade, scientists from academia, industry, nonprofit institutions, and governmental bodies have focused on the standardization of qNMR methodology, as well as its metrological and pharmacopeial utility. This paper reviews key content of qNMR Summits 1.0 to 4.0 and puts into perspective the outcomes and available transcripts of the October 2019 Summit 5.0, with attendees from the United States, Canada, Japan, Korea, and several European countries. Summit presentations focused on qNMR methodology in the pharmaceutical industry, advanced quantitation algorithms, and promising developments.

Structurally related peptide impurity identification and accurate quantification for synthetic oxytocin by liquid chromatography-high-resolution mass spectrometry.

Oxytocin (OXT) is an important peptide that is mainly used as a therapeutic drug to induce labor or strengthen uterine contractions, or to control bleeding after childbirth. OXT has also been reported as a biomarker linked to emotion, and as a potential biomarker for cancer diagnosis. The accurate purity characterization of OXT calibrators is critical for quality control of pharmaceuticals and the development of reference measurement systems for this analyte in laboratory medicine. OXT possesses the particular analytical measurement challenge of a disulfide bond. Accurate value assignment of the purity of oxytocin calibrators can be carried out by applying the mass balance approach or alternative approaches such as amino acid analysis, quantitative nuclear magnetic resonance spectrometry, and nitrogen determination. In order to avoid biases, all these approaches require a correction for structurally related peptide impurities. Structurally related peptide impurities present in a synthetic OXT material have been identified and quantified by a newly developed and in-house-validated liquid chromatography-high-resolution mass spectrometry (LC-hrMS) method. This method was adopted for the measurement of the study material used for an international comparison evaluating the competencies of laboratories to perform peptide characterization. Eighteen structurally related impurities were identified, confirmed, and accurately quantified in the OXT study material by using LC-hrMS. The study material contained a total mass fraction of 31.1 mg/g structurally related OXT impurities with an associated expanded uncertainty of 1.7 mg/g.

Development of a certified reference material for anti-ß2-glycoprotein I IgG - commutability studies.

Objectives: In this paper, we describe the steps followed for the development of a certified reference material for immunoglobulin G antibodies against ß2-glycoprotein I (also known as apolipoprotein H). These steps include processing of the material, commutability, the impact of dilution, the appropriate reconstitution conditions, homogeneity and stability during transport and storage. Methods: We analysed 69 clinical samples from patients suffering from antiphospholipid syndrome with several commercial enzyme-linked immunosorbent assays (ELISA) purchased from in vitro diagnostic manufacturers. Results: Analysis of the results indicated that the candidate reference material can be safely freeze-dried, and that the user should carefully follow the reconstitution instructions as small changes in e.g. temperature may have unwanted effects. The statistical analysis of the commutability studies indicated that the analytical response of the reference material upon dilution is similar to that of clinical samples, and that correlation between results may differ from assay to assay. Finally yet importantly, the presented and developed candidate reference material is commutable for most assays tested, homogeneous and stable. Conclusions: Immunoglobulin G antibodies against ß2-glycoprotein I are associated with a higher risk of thrombosis and pregnancy complications. Their measurement is essential for the diagnosis and monitoring of antiphospholipid syndrome. These antibodies are detected by specific immunoassays, routinely used in clinical diagnostics, but various of these methods show enormous variability, in part due to the lack of a reference material.

The BIPM Mycotoxin Metrology Capacity Building and Knowledge Transfer Program: Accurate Characterization of a Pure Aflatoxin B1 Material to Avoid Calibration Errors.

Background: The contamination of food and feed by mycotoxins, Aflatoxin B1 (AfB1) being one of the most prominent examples, is of imminent concern to many countries. Regulatory limits for mycotoxins have been implemented, and these need to be supported by a sound measurement infrastructure for mycotoxin analysis in order to enforce and verify products, protect populations, and avoid technical barriers to trade in food stuffs. Objective: A Capability Building and Knowledge Transfer program on Metrology for Safe Food and Feed in Developing Economies was started at the International Bureau of Weights and Measures to allow National Metrology Institutes or Designated Institutes to work together to strengthen their national mycotoxin metrology infrastructure. Methods: Knowledge transfer to scientists is provided to enable the characterization of selected pure mycotoxin materials and the production of corresponding certified reference material solutions. Results: This higher-order measurement capability can in turn support mycotoxin testing laboratories within their countries through the provision, for example, of standard solutions of critical analytes that are traceable to the International System of Units (SI). Conclusions and Highlights: The purity characterization and value assignment for a high-purity AfB1 material (979.6 ± 2.3 mg/g, k = 2) intended to be used for the gravimetric production of SI traceable calibration solutions for AfB1 is described using an approach combining quantitative NMR and LC-diode array detection-tandem MS for the correction of the mycotoxin-related impurity content.

Colletotrichum acutatum M11 can suppress the defence response in strawberry plants.

MAIN CONCLUSION: Colletotrichum acutatum M11 produces a diffusible compound that suppresses the biochemical, physiological, molecular and anatomical events associated with the defence response induced by the plant defence elicitor AsES. The fungal pathogen Colletotrichum acutatum, the causal agent of anthracnose disease, causes important economical losses in strawberry crop worldwide and synthetic agrochemicals are used to control it. In this context, the control of the disease using bioproducts is gaining reputation as an alternative of those toxic and pollutant agrochemicals. However, the success of the strategies using bioproducts can be seriously jeopardized in the presence of biological agents exerting a defence suppression effect. In this report, we show that the response defence induced in plant by the elicitor AsES from the fungus Acremonium strictum can be suppressed by a diffusible compound produced by isolate M11 of C. acutatum. Results revealed that strawberry plants treated with conidia of the isolated M11 or the culture supernatant of the isolate M11 suppress: ROS accumulation (e.g., H2O2, O2·- and NO), cell wall reinforcement (e.g., lignin and callose), and the up-regulation of defence-related genes (e.g., FaPR1, FaCHI23, FaPDF1.2, FaCAT, FaCDPK, FaCML39) induced by the elicitor AsES. Additionally, we show that the defence suppressing effect causes a systemic sensitization of plants. Results presented here highlights the necessity to make an integral study of the microbiome present in soils and plant biosphere before applying defence activation bioproducts to control crop diseases.

Provisional standardization of hepcidin assays: creating a traceability chain with a primary reference material, candidate reference method and a commutable secondary reference material.

Background Hepcidin concentrations measured by various methods differ considerably, complicating interpretation. Here, a previously identified plasma-based candidate secondary reference material (csRM) was modified into a serum-based two-leveled sRM. We validated its functionality to increase the equivalence between methods for international standardization. Methods We applied technical procedures developed by the International Consortium for Harmonization of Clinical Laboratory Results. The sRM, consisting of lyophilized serum with cryolyoprotectant, appeared commutable among nine different measurement procedures using 16 native human serum samples in a first round robin (RR1). Harmonization potential of the sRM was simulated in RR1 and evaluated in practice in RR2 among 11 measurement procedures using three native human plasma samples. Comprehensive purity analysis of a candidate primary RM (cpRM) was performed by state of the art procedures. The sRM was value assigned with an isotope dilution mass spectrometry-based candidate reference method calibrated using the certified pRM. Results The inter-assay CV without harmonization was 42.1% and 52.8% in RR1 and RR2, respectively. In RR1, simulation of harmonization with sRM resulted in an inter-assay CV of 11.0%, whereas in RR2 calibration with the material resulted in an inter-assay CV of 19.1%. Both the sRM and pRM passed international homogeneity criteria and showed long-term stability. We assigned values to the low (0.95±0.11 nmol/L) and middle concentration (3.75±0.17 nmol/L) calibrators of the sRM. Conclusions Standardization of hepcidin is possible with our sRM, which value is assigned by a pRM. We propose the implementation of this material as an international calibrator for hepcidin.

Ellagitannin HeT obtained from strawberry leaves is oxidized by bacterial membranes and inhibits the respiratory chain.

Plant secondary metabolism produces a variety of tannins that have a wide range of biological activities, including activation of plant defenses and antimicrobial, anti-inflammatory and antitumoral effects. The ellagitannin HeT (1-O-galloyl-2,3;4,6-bis-hexahydroxydiphenoyl-ß-d-glucopyranose) from strawberry leaves elicits a strong plant defense response, and exhibits antimicrobial activity associated to the inhibition of the oxygen consumption, but its mechanism of action is unknown. In this paper we investigate the influence of HeT on bacterial cell membrane integrity and its effect on respiration. A ß-galactosidase unmasking experiment showed that HeT does not disrupt membrane integrity. Raman spectroscopy analysis revealed that HeT strongly interacts with the cell membrane. Spectrochemical analysis indicated that HeT is oxidized in contact with bacterial cell membranes, and functional studies showed that HeT inhibits oxygen consumption, NADH and MTT reduction. These results provide evidence that HeT inhibits the respiratory chain.

The ellagitannin HeT induces electrolyte leakage, calcium influx and the accumulation of nitric oxide and hydrogen peroxide in strawberry.

HeT (1-0-galloyl-2,3; 4,6-bis-hexahydroxydiphenoyl-ß-D-glucopyranose) is a penta-esterified ellagitannin obtained from strawberry leaves. Previous studies have shown that foliar application of HeT prior to inoculation with a virulent pathogen increases the resistance toward Colletotrichum acutatum in strawberry plants and to Xanthomonas citri subsp. citri in lemon plants. In this work we report that HeT induces an immediate leak of electrolytes, the hyperpolarization of the cellular membrane, a rapid Ca2+ influx to the cytoplasm during the first few seconds, which in turn modulates the accumulation of nitric oxide 5 min after treatment. At longer times, a biphasic accumulation of H2O2 with peaks at 2 and 5 h post treatment could be observed. In addition, HeT elicited the increase of alternative oxidase capacity during the first 12 h post treatment.

The Elicitor Protein AsES Induces a Systemic Acquired Resistance Response Accompanied by Systemic Microbursts and Micro-Hypersensitive Responses in Fragaria ananassa.

The elicitor AsES (Acremonium strictum elicitor subtilisin) is a 34-kDa subtilisin-like protein secreted by the opportunistic fungus Acremonium strictum. AsES activates innate immunity and confers resistance against anthracnose and gray mold diseases in strawberry plants (Fragaria × ananassa Duch.) and the last disease also in Arabidopsis. In the present work, we show that, upon AsES recognition, a cascade of defense responses is activated, including: calcium influx, biphasic oxidative burst (O2⋅- and H2O2), hypersensitive cell-death response (HR), accumulation of autofluorescent compounds, cell-wall reinforcement with callose and lignin deposition, salicylic acid accumulation, and expression of defense-related genes, such as FaPR1, FaPG1, FaMYB30, FaRBOH-D, FaRBOH-F, FaCHI23, and FaFLS. All these responses occurred following a spatial and temporal program, first induced in infiltrated leaflets (local acquired resistance), spreading out to untreated lateral leaflets, and later, to distal leaves (systemic acquired resistance). After AsES treatment, macro-HR and macro-oxidative bursts were localized in infiltrated leaflets, while micro-HRs and microbursts occurred later in untreated leaves, being confined to a single cell or a cluster of a few epidermal cells that differentiated from the surrounding ones. The differentiated cells initiated a time-dependent series of physiological and anatomical changes, evolving to idioblasts accumulating H2O2 and autofluorescent compounds that blast, delivering its content into surrounding cells. This kind of systemic cell-death process in plants is described for the first time in response to a single elicitor. All data presented in this study suggest that AsES has the potential to activate a wide spectrum of biochemical and molecular defense responses in F. ananassa that may explain the induced protection toward pathogens of opposite lifestyle, like hemibiotrophic and necrotrophic fungi.

Development of a Certified Reference Material for myeloperoxidase-anti-neutrophil cytoplasmic autoantibodies (MPO-ANCA).

A serum Certified Reference Material (CRM) for supporting reliable autoimmune diagnostics was recently released by the Institute for Reference Materials and Measurements (IRMM) of the Joint Research Centre of the European Commission. It was produced in collaboration with a Working Group on the Harmonisation of Autoimmune Tests of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC WG-HAT). This material is aimed at facilitating the standardisation of measurements of anti-myeloperoxidase immunoglobulin G antibodies. The CRM could be used as a common calibrant by clinicians and manufacturers thereby significantly improving the comparability of results from commercial immunoassays used for IgG anti-MPO measurements. This paper provides information on the new CRM and its intended use.

Reduced ß-lactoglobulin IgE binding upon in vitro digestion as a result of the interaction of the protein with casein glycomacropeptide.

The aim of this work was to evaluate the effect of the presence of casein glycomacropeptide (CMP) on the in vitro digestibility and potential allergenicity of ß-lactoglobulin (ß-lg)-CMP mixtures. The digestion products were analyzed by RP-HPLC and RP-HPLC-ESI-MS/MS. The potential allergenicity of the digestion products was studied by human IgE binding by inhibition ELISA with serum samples from children with clinical allergic symptoms to ß-lg. No differences were observed by HPLC in the mixtures hydrolysates due to CMP-ß-lg interactions. RP-HPLC-ESI-MS/MS results showed different peptides occurring in the mixtures hydrolysates. Additionally, it was observed a significant reduction of ß-lg IgE binding in the presence of CMP. The disappearance of epitopes in the digested mixtures could explain the lower IgE binding observed in these systems compared to ß-lg. It can be concluded that the presence of CMP in products containing ß-lg may modify the digestion products that may reduce the potential allergenicity of ß-lg.

The defence elicitor AsES causes a rapid and transient membrane depolarization, a triphasic oxidative burst and the accumulation of nitric oxide.

The newly characterized elicitor AsES obtained from Acremonium strictum induces a strong defence response in strawberry plants and confers plants resistance against the fungal pathogen Colletotricum acutatum the casual agent of anthracnose disease. Previous studies showed that AsES causes the accumulation of reactive oxygen species (ROS) that peaked 4 h post treatment (hpt), but due to the experimental approach used it was not clear whether the accumulation of ROS observed was intracellular or extracellular or took place as a single peak. By using a different experimental setup, a more complex early events associated to the activation of the innate immunity were observed. In this paper we report that strawberry plant cells treated with AsES exhibits a triphasic production of H2O2 and a rapid intracellular accumulation of NO. The first phase consists in a progressive extracellular accumulation of H2O2 that starts immediately after the treatment with AsES and is preceded by a rapid and transient cell membrane depolarization. During this phase takes place also a rapid intracellular accumulation of NO. Microscopic observations of mesophyll cells treated with AsES reveals that NO accumulates at the chloroplast. After the first extracellular H2O2 production phase, two intracellular H2O2 accumulation events occur, the first 2 hpt, and the second 7 hpt. Cells treated with AsES also show a transient increase of ion leakage, and a progressive alkalinization of the extracellular medium.

Infrared thermography for monitoring of freeze-drying processes: instrumental developments and preliminary results.

Coupling an infrared (IR) camera to a freeze dryer for on-line monitoring of freeze-drying cycles is described for the first time. Normally, product temperature is measured using a few invasive Pt-100 probes, resulting in poor spatial resolution. To overcome this, an IR camera was placed on a process-scale freeze dryer. Imaging took place every 120 s through a Germanium window comprising 30,000 measurement points obtained contact-free from -40 °C to 25 °C. Results are presented for an empty system, bulk drying of cheese slurry, and drying of 1 mL human serum in 150 vials. During freezing of the empty system, differences of more than 5 °C were measured on the shelf. Adding a tray to the empty system, a difference of more than 8 °C was observed. These temperature differences probably cause different ice structures affecting the drying speed during sublimation. A temperature difference of maximum 13 °C was observed in bulk mode during sublimation. When drying in vials, differences of more than 10 °C were observed. Gradually, the large temperature differences disappeared during secondary drying and products were transformed into uniformly dry cakes. The experimental data show that the IR camera is a highly versatile on-line monitoring tool for different kinds of freeze-drying processes.

Immunoreactivity of hen egg allergens: influence on in vitro gastrointestinal digestion of the presence of other egg white proteins and of egg yolk.

Hen egg white comprises of a complex mixture of proteins, which greatly differ in their physicochemical characteristics and relative abundance. We aimed to identify potential undiscovered egg allergens within the egg white proteome and investigated the existence of matrix effects on the proteolytic stability and resultant IgE-binding of the allergenic proteins. In addition to the main egg allergens: ovalbumin (OVA), ovomucoid (OM) and lysozyme (LYS), two minor egg white proteins, tentatively identified as ovoinhibitor and clusterin, were found to react with serum IgE from egg-allergic patients. Egg white exhibited residual immunoreactivity after gastrointestinal digestion due to the presence of intact OVA and LYS, as well as of several IgE-binding peptides derived from OVA. The presence of egg yolk slightly increased the susceptibility to hydrolysis of egg white proteins and abrogated bile salt-induced precipitation of LYS in the duodenal medium. However, the resultant immunoreactivity against IgE of egg white proteins after in vitro digestion was not significantly modified by the presence of yolk components.

Oral immunotherapy induces local protective mechanisms in the gastrointestinal mucosa.

BACKGROUND: Oral immunotherapy (OIT) is a promising treatment for food allergy. Studies are needed to elucidate mechanisms of clinical protection and to identify safer and potentially more efficacious methods for desensitizing patients to food allergens. OBJECTIVE: We established a mouse model of OIT to determine how the dose or form of antigen may affect desensitization and to identify mechanisms of desensitization. METHODS: Increasing doses of egg white or ovomucoid as OIT were administered orally to sensitized mice. The impact of OIT on anaphylaxis elicited by oral allergen challenge was determined. Allergen-specific antibody and cytokine responses and mast cell and basophil activation in response to OIT were measured. Gene expression in the small intestine was studied by microarray and real-time PCR. RESULTS: OIT resulted in desensitization but not tolerance of mice to the allergen. OIT did not result in desensitization of systemic effector cells, and protection was localized to the gastrointestinal tract. OIT was associated with significant changes in gene expression in the jejunum, including genes expressed by intestinal epithelial cells. Extensively heated ovomucoid that does not trigger anaphylaxis when given orally to sensitized mice was as efficacious as native ovomucoid in desensitizing mice. CONCLUSIONS: OIT results in clinical protection against food-induced anaphylaxis through a novel mechanism that is localized to the intestinal mucosa and is associated with significant changes in small intestinal gene expression. Extensively heating egg allergen decreases allergenicity and increases safety while still retaining the ability to induce effective desensitization.

Identification of an IgE reactive peptide in hen egg riboflavin binding protein subjected to simulated gastrointestinal digestion.

Riboflavin binding protein (RfBP) is a minor protein in hen egg; its potential involvement in egg allergy has seldom been studied. The aim of this work was to investigate the IgE binding capacity of RfBP before and after simulated gastrointestinal digestion. It was shown that digestion of RfBP mainly occurred during the gastric phase. The protein fragments resulting from the subsequent duodenal phase remained linked through disulfide bonds. Both the intact protein and its digests were subjected to inhibition ELISA with sera obtained from patients allergic to egg. The results revealed significant IgE binding to intact RfBP, whereas the digests showed reduced but substantial IgE binding levels, with serum-to-serum variability. The RfBP digests were then subjected to immunoblot with allergic patients' sera, and the IgE-reactive peptides were further analyzed by MALDI-TOF/TOF mass spectrometry for sequence determination. The RfBP sequence 41-84 was identified as a novel IgE binding peptide in patients allergic to egg.