Comprehensive real-time epidemiological data from respiratory infections in Finland between 2010 and 2014 obtained from an automated and multianalyte mariPOC® respiratory pathogen test.

Respiratory viruses cause seasonal epidemics every year. Several respiratory pathogens are circulating simultaneously and typical symptoms of different respiratory infections are alike, meaning it is challenging to identify and diagnose different respiratory pathogens based on symptoms alone. mariPOC® is an automated, multianalyte antigen test which allows the rapid detection of nine respiratory infection pathogens [influenza A and B viruses, respiratory syncytial virus (RSV), human metapneumovirus, adenovirus, parainfluenza 1-3 viruses and pneumococci] from a single nasopharyngeal swab or aspirate samples, and, in addition, can be linked to laboratory information systems. During the study period from November 2010 to June 2014, a total of 22,485 multianalyte respi tests were performed in the 14 participating laboratories in Finland and, in total, 6897 positive analyte results were recorded. Of the tested samples, 25 % were positive for one respiratory pathogen, with RSV (9.8 %) and influenza A virus (7.2 %) being the most common findings, and 0.65 % of the samples were multivirus-positive. Only small geographical variations in seasonal epidemics occurred. Our results show that the mariPOC® multianalyte respi test allows simultaneous detection of several respiratory pathogens in real time. The results are reliable and give the clinician a picture of the current epidemiological situation, thus minimising guesswork.

Rapid mobilization of cytotoxic lymphocytes induced by dasatinib therapy.

Tyrosine kinase inhibitors (TKIs) have potent effects on malignant cells, and they also target kinases in normal cells, which may have therapeutic implications. Using a collection of 55 leukemia patients treated with TKI therapy (chronic myeloid leukemia, n=47; acute lymphoblastic leukemia, n=8), we found that dasatinib, a second-generation broad-spectrum TKI, induced a rapid, dose-dependent and substantial mobilization of non-leukemic lymphocytes and monocytes in blood peaking 1-2 h after an oral intake and the blood counts closely mirrored drug plasma concentration. A preferential mobilization was observed for natural killer (NK), NK T, B and γδ+ T cells. Mobilization was coupled with a more effective transmigration of leukocytes through an endothelial cell layer and improved cytotoxicity of NK cells. Platelet numbers decreased markedly after the drug intake in a proportion of patients. Similar effects on blood cell dynamics and function were not observed with any other TKI (imatinib, nilotinib and bosutinib). Thus, dasatinib induces a unique, rapid mobilization and activation of cytotoxic, extravasation-competent lymphocytes, which may not only enhance antileukemia immune responses but can also be causally related to the side-effect profile of the drug (pleural effusions, thrombocytopenia).

Coordinate NF-kappaB and STAT1 activation promotes development of myeloid type 1 dendritic cells.

NF-kappaB and STAT1 are critically involved in the initiation of the inflammatory cascade. Using semi-automated imaging cytometry and fluorescent antibodies, we screened several factors for their ability to induce nuclear translocation of RelA/NF-kappaB and STAT1 in subsets of monocyte-derived dendritic cells (DC). Detailed kinetics and dose-response studies are presented for IL-1-, LPS-, CD40L-, IFN-gamma- and IFN-alpha-stimulated responses. The results are consistent with the notion that simultaneous activation of both STAT1 and NF-kappaB pathways at the initiation of differentiation culture is required for efficient priming of IL-12 production by DC. Maturation of DC led to characteristic NF-kappaB and STAT1 distribution and response patterns. During the resting stage, DC differentiated under the presence of IFN-gamma showed sustained STAT activation and remained responsive to LPS. By contrast, PGE2-supplemented DC could be characterized by negligible responses to LPS and IFN-gamma and a remarkable NF-kappaB response to CD40L. STAT1 pathway was suppressed in PGE2-supplemented cells. We conclude that the magnitude and temporal kinetics of the nuclear shift of STAT1 and NF-kappaB in myeloid DC are associated with IL-12p70 production and are dependent on the nature of the stimulating factors and the polarization state of cells.

A novel modification of a flow cytometric assay of phosphorylated STAT1 in whole blood monocytes for immunomonitoring of patients on IFN alpha regimen.

We explored whether episodes stimulating leucocytes in vivo could be tracked from whole blood samples by monitoring activation of STAT1 by flow cytometry. The method was tested in hepatitis C patients (n = 9) that were on interferon (IFN)alpha regimen. CD14+ monocytes responded strongly to IFNalpha/gamma being sensitive indicators for recent immune activation. At 45 min after s.c. IFNalpha 91% of monocytes were phosphorylated STAT1+. The frequency of responding cells decreased to a base level within 6 h. Monocytes, however, had a long-term deficient phosphorylated STAT1 response to IFNalphain vitro that in patients on standard IFNalpha regimen lasted for 48 h. In patients on pegylated IFNalpha the phosphorylated STAT1 response was completely absent. We conclude that whole blood analysis of STAT1 activation by flow cytometry is applicable to monitor immune cells in patient material.

Circulating dendritic cell subset levels after allogeneic stem cell transplantation in children correlate with time post transplant and severity of acute graft-versus-host disease.

We examined the recovery of circulating monocytoid (Lin- CD11+ HLA-DR+) and plasmacytoid (Lin- CD123+ HLA-DR+) precursor (pre) dendritic cell (DC) subsets after allogeneic stem cell transplantation (SCT) in 39 children, using age-matched healthy children as controls. The frequencies of DCs in peripheral blood samples were determined by flow cytometry. The initial recovery of DC occurred simultaneously with myeloid engraftment. However, with time, DC subset values declined, being very low 40-50 days after SCT. Low monocytoid and plasmacytoid DC values were associated significantly with the development of severe acute graft-versus-host disease (aGVHD) (P=0.042 and 0.017, respectively). Plasmacytoid DC values were lower than in the age-matched controls for the entire follow-up period (range 102-2569 days), although, with time, values approached normal levels. Normal monocytoid DC numbers were observed within 300-400 days post SCT. The severity of chronic GVHD did not correlate with quantitative recovery of DC. We conclude that in pediatric SCT, initial recovery of DC production is concurrent with that of myelopoiesis, yet with time, DC subset values decline and low counts are associated with severe aGVHD. Monocytoid DC numbers approach normal levels within a year of SCT, but plasmacytoid DC counts recover very slowly.

Dendritic cell subsets in childhood and in children with cancer: relation to age and disease prognosis.

Dendritic cells (DC) are a heterogeneous group of uniquely well-equipped bone marrow-derived antigen-presenting cells. They circulate in blood as precursor cells (preDC). In humans, two blood-borne subtypes of preDC can be distinguished by their differential expression of CD11c (CD11c+ preDC; monocytoid DC) and CD123 (CD123+ preDC; plasmacytoid DC). We studied the incidence of monocytoid and plasmacytoid DC in peripheral blood samples from 39 children of various ages (0.4-16.8 years) by flow cytometry, and found a significant negative correlation between the number of plasmacytoid DC and age (r = 0.421, P = 0.012). Monocytoid DC counts did not change significantly with age. Similarly, we analysed DC subsets in 19 children with cancer at the time of diagnosis prior to initiation of any myelosuppressive or antiproliferative treatment and compared the results with those obtained from gender- and age-matched control children. Patients with cancer had significantly less circulating monocytoid DC than controls (medians 13.2 versus 21.4 cells/ micro l, respectively, P = 0.042) at diagnosis, whereas absolute plasmacytoid DC counts did not differ significantly between the study groups. However, clinical outcome of the children with cancer (2.9-5 years follow-up after diagnosis) correlated with plasmacytoid DC count. Children with high plasmacytoid DC counts at diagnosis (above median) survived significantly worse (6/10 deceased) than those with low counts (1/9 deceased) (P = 0.034). Thus, circulating plasmacytoid DC counts are related to age during childhood, and development of cancer is associated with low number of monocytoid DC. A low circulating plasmacytoid DC count at diagnosis was a good prognostic sign.

Naive CD4+ T cells can be sensitized with IL-7.

We addressed the question whether it is possible to lower the threshold for naive T cells to respond to antigens. Purified adult and cord blood derived CD4+ CD45RA+ naive T cells were incubated in the presence of various cytokines for two days ("primed T cells"), after which the cytokines were removed by extensive washing. Primed and unprimed cells were activated with solid phase-coupled anti-CD3 and soluble anti-CD28 monoclonal antibodies (MoAb). Naive T cells, primed with interleukin(IL)-7 proliferated more vigorously than unprimed cells. Primed cells required 6 h for antigenic stimulation, whereas unprimed cells required 20 h. The priming also shifted the threshold of naive T cells in order to stimulate the antigen concentration to a lower level. The addition of IL-10 almost completely abrogated the enhancing effect of IL-7 on naive T cells. Other cytokines (IL-1, IL-2, IL-6, IL-12, interferon (IFN)-gamma, tumour necrosis factor (TNF)-alpha had less effect on the cell proliferation. However, priming of naive T cells with IL-7 had no impact on the proliferation to allogeneic immature or mature dendritic cells (DC). We conclude that the antigen-independent activation of naive T cells with IL-7 prior to antigen stimulation sensitizes cells, and may be of help in trying to stimulate immune responses against weak antigens. This approach, however, does not enhance proliferative responses stimulated by DC.

Poor yield of dendritic cell precursors from untreated pediatric cancer.

We have studied the generation of dendritic cells (DC) in vitro from healthy children and children with newly diagnosed cancer. Peripheral blood derived adherent cells were harvested and cultured in the presence of granulocyte-macrophage colony-stimulating-factor (GM-CSF) and interleukin-4 (IL-4). Differentiated DC were characterized morphologically and analyzed by flow cytometry and allogenic mixed lymphocyte reaction (MLR). The numbers of adherent cells were two-fold higher in healthy children than in those with malignant tumors: 1.5 x 10(5)/ml of blood (mean) versus 0.7 x 10(5)/ml, respectively (p = 0.025). No significant differences were found in the cell survival or yield after the in vitro cultivation of adherent cells. Cytological examination of cultured cells showed that they were similar to DC in adults, being large, irregularly shaped, with several thin membrane protrusions, and bean-shaped nuclei. Differentiated DC from healthy controls expressed CD86 and HLA-DR, but did not express monocyte markers CD14 and CD64 (FcgammaRI). The phenotype of DC from cancer patients was otherwise similar, except that a substantial proportion (24-85%) continued to express CD64 (p = 0.001). DC derived both from cancer patients and controls were strong stimulators in allogeneic MLR. We conclude that functionally capable DC can be generated in vitro from blood-derived adherent cells in children, but children with untreated cancer yield lower numbers of DC than healthy children. The continued expression of CD64 on DC derived from cancer patients may indicate that adherent cells from cancer patients are more resistant to signals inducing differentiation into DC.

Human peripheral blood-derived dendritic cells do not produce interleukin 1 alpha, interleukin 1 beta, or interleukin 6.

Little is known about the non-antigen-specific signals delivered to T cells by dendritic cells (DC). Because several monocyte-derived factors like interleukins 1 alpha, 1 beta, and 6 (IL-1 alpha, IL-1 beta, and IL-6) enhance the T-cell proliferative responses, we studied the production of the above-mentioned cytokines by DC separated from human peripheral blood. The intracellular expression of the proteins (IL-1 alpha and IL-6) was studied at a single-cell level using an immunolabelling technique. The supernatants and cell lysates were studied with ELISA (IL-1 alpha and IL-1 beta). Northern blotting analysis was used to quantitate the mRNA levels. Several approaches were taken to stimulate the production of IL-1 alpha, IL-1 beta, and IL-6 by DC. These included the incubation of the DC in the presence of either LPS, rIL-1, or monoclonal anti-HLA-DR antibody, or the stimulation of cells with resting allogeneic T cells. None of the stimuli was able to induce the production of IL-1 alpha, IL-1 beta, or IL-6 by DC, whereas LPS-stimulated monocytes were strong producers of these mentioned cytokines and expressed the respective mRNA. Thus we concluded that IL-1 alpha, IL-1 beta, and IL-6 are primarily monocyte-derived factors and that these factors are not needed or produced during the activation of resting T cells by DC.

Both dendritic cells and monocytes induce autologous and allogeneic T cells receptive to interleukin 2.

Activation of resting T cells to proliferate is usually accompanied by their expression of interleukin 2 receptors (IL-2R) and secretion of (IL-2). We studied the mechanisms by which human blood-derived dendritic cells (DC) and monocytes induce IL-2R and stimulate IL-2 secretion in autologous and allogeneic mixed luecocyte reaction (auto- and allo-MLR, respectively). We found that only DC were fully effective as stimulator cells in MLR. DC stimulated both autologous and allogeneic T cells to express high-affinity IL-2R, secrete IL-2, and vigorously proliferate in MLR. The stimulatory properties of monocytes were more complicated: although they stimulated the proliferation in allogeneic MLR, the proliferation rates, duration, and amount of IL-2 secretion were different than in DC-induced MLR. Autologous T cells did not proliferate in response to monocytes, but were induced to express the low-affinity IL-2R. If the cultures were supplemented with exogenous recombinant IL-2, the proliferative responses to DC and monocytes in auto- and allo-MLR were of the same magnitude, indicating that the responsiveness to IL-2 was stimulated by both the stimulator cells. The stimulator cell number was important, since large numbers of monocytes, but not of DC, were suppressive to the proliferative responses. Thus, we concluded that the higher capacity of DC, as compared to monocytes, to stimulate T-cell proliferation is based primarily on the more efficient stimulation of IL-2 secretion.

Both virgin and memory T cells cluster with dendritic cells during autologous and allogeneic mixed leukocyte reaction.

The T cell population is comprised of two distinct reciprocal subsets identifiable by UCHL1 and 2H4 antibodies. 2H4+ cells are virgin T cells and UCHL1+ cells are memory T cells. Previously it has been shown that dendritic cells (DC) form clusters with T cells. In this study we have examined the proportions of UCHL1+ and 2h4+ T cell subtypes in DC-T cell clusters. DC and T cells were purified from human peripheral blood and cultured in autologous or allogeneic combinations. Clusters, which were visible after culture for 24-48 h, were separated and the phenotype of the cells in the clusters was analyzed. It was found that the ratio of UCHL1+ and 2H4+ cells was the same among both clustered and nonclustered cells. Autologous clusters contained the same proportions of UCHL1+ and 2H4+ cells as allogeneic clusters. Experiments with separated UCHL1+ and UCHL1- T cells demonstrated that in autologous mixed leukocyte reaction mainly UCHL1- cells proliferated. Separated clusters were cultured for a total period of 7 days, which demonstrated that the majority of the T cells derived either from autologous or allogeneic clusters were UCHL1+ activated blasts. The remaining 2H4+ T cells resembled inactivated T cells. Thus it is concluded that the initial binding of T cells to autologous or allogeneic DC is mediated by a mechanism which is unaffected by the differentiation of virgin T cells into memory T cells. The low proliferative response of memory T cells to autologous DC suggested that clustering with DC does not necessarily lead to proliferative activity. Autoreactive T cells do not differ from alloreactive cells in acquiring the antigenic phenotype of memory T cells after activation.

Accessory cells, dendritic cells, or monocytes, are required for the lymphokine-activated killer cell induction from resting T cell but not from natural killer cell precursors.

In this study we have investigated the role of accessory cells in the development of lymphokine-activated killer cells (LAK) from highly purified human NK and small resting T cell progenitors. As accessory cells we used autologous, as well as allogeneic, monocytes, and dendritic cell enriched cells. Both NK and T cells were able to generate LAK activity, but their activation requirements were different. NK cells were activated merely by IL-2, and accessory cells did not enhance their lytic activity in the presence or absence of IL-2. Conversely, T cells were practically unresponsive to even high concentrations of IL-2 having a strict requirement for accessory cells for the development of lytic activity and proliferation. Accessory cells differed in their ability to activate T cells presumably depending on their ability to induce IL-2 synthesis, allogeneic dendritic cells being the most effective accessory cells and IL-2 synthesis stimulators. Allogeneic accessory cells could induce lytic activity in T cells even in the absence of exogenous IL-2. Thus, accessory cells play a central role in expanding the LAK effector cell population.

Dendritic cells in human peripheral blood: effective enrichment from the nonadherent cells.

Dendritic cells (DC) from human peripheral blood were enriched using a method including adherence on plastic, depletion of phagocytic cells, flotation on density gradient column and panning on antibody-coated surfaces. The course of cell separation was evaluated by characterizing the morphological, antigenic and functional features of the different cell fractions. Using the population depleted of strongly adherent cells as the source, we were able to achieve a cell fraction containing 40-65% of DC (the main contaminants being monocytes and natural killer cells). Functionally these cells were highly stimulatory in autologous mixed leukocyte reaction. On the other hand, cells which primarily adhered well and were detached after overnight culture contained less than 5% of DC (the main contaminants being monocytes) after the same purification protocol. The calculated yields of DC were 1-2 X 10(6) and less than 0.5 X 10(6) from the nonadherent and adherent populations, respectively. Thus we concluded that the adhesiveness of DC from human blood is so weak that they can more efficiently and in a more reproducible way be enriched from the primarily nonadherent cell fraction.

Amount and type of leukocytes in 'leukocyte-free' red cell and platelet concentrates.

The exact number of leukocytes remaining in 'leukocyte-free' red cell and platelet concentrates cannot be measured by standard methods. We have therefore developed methods to harvest all the leukocytes from blood components. The leukocytes were then counted and identified using monoclonal antibodies. The leukocyte-free red cell concentrates were prepared by combining buffy coat removal and filtration through a Cellselect filter. The mean number of leukocytes per unit was 1.0 X 10(5). Most of the leukocytes were granulocytes and T cells. Only a few B cells or monocytes could be detected. Leukocyte-free platelets were prepared by filtering 4 units of PC through a cotton-wool (Imugard) filter. The mean number of leukocytes per PC unit was 0.4 X 10(5) of which 85-95% were T cells.