The effect of cortico-spinal tract damage on primary sensorimotor cortex activation after rehabilitation therapy

Recently, it was shown that patients have different functional activation patterns within affected primary sensorimotor cortex (SMC) after intensive rehabilitation therapy. This individual difference was supposed to depend on the integrity of the cortico-spinal fibres from the primary motor cortex. In this study, we considered whether patients with different fMRI activation patterns after intensive rehabilitation therapy suffered from different cortico-spinal fibre lesions. To comprehend this circumstance a lesion subtraction analysis was used. To verify these results with the use of transcranial magnetic stimulation motor evoked potentials was also derived. Patients were treated after a modified version of constraint-induced movement therapy (modCIMT; 3 h daily for 4 weeks). Increased and decreased SMC activation showed similar individual patterns as described previously. These activation differences depend on the integrity of the cortico-spinal tract, which was measured via lesion subtraction analysis between patient groups, and was supported by affected motor evoked potentials.     

The long loop reflex in spinocerebellar degeneration and motor neuron disease--its changes with TRH therapy

This study aimed to define the characteristics of the long loop reflex (LLR) in patients with spinocerebellar degeneration (SCD) and motor neuron disease (MND), and observe changes in LLR caused by thyrotropin releasing hormone (TRH), a facilitator of cerebellar and motor neurons. The markers used for LLR were: V1-2 peak Latency (the latency between the V1 and V2 peaks); V2 peak-P24 Latency (the latency between the V2 peak and P24 of a somatosensory evoked potential); V2 Amplitude, and V2 Square (the area of the V2 wave). V1-2 peak Latency was significantly longer, and V2 Amplitude was significantly lower than the control in SCD. We attributed these alterations of the LLR to cerebellar ataxia, since all SCD cases had cerebellar ataxia, and extrapyramidal symptoms were only present in one SCD case; the MND cases with motor neuron disturbance showed no significant difference from the control. TRH injection resulted in an increase in V2 Square and a decrease in V2 peak-P24 Latency in SCD and other neurological disease patients. We regarded these changes as activation of the LLR by TRH. With TRH therapy, activation of the LLR coincided with improvement of cerebellar ataxia in SCD. Symptomatic improvement, however, was not observed and the LLR changes were not stable in MND. These results suggest that TRH-induced activation of LLR is caused by the activation of cerebellar function, and indirectly concerns with upper motor neurons because V2 Square increased in MND without pyramidal tract signs.     

Cimaterol-induced growth in rats: growth pattern and biochemical characteristics

Sixty Sprague-Dawley female rats weighing 170 g were used to investigate the effect of cimaterol on the growth pattern and biochemical characteristics of skeletal muscles. Cimaterol (CIM) was mixed in a powdered rat chow at 10 ppm. A significant (P less than .01) improvement in the weight gain of CIM group was observed during the first 8 days of the 49-day trial period, followed by no significant improvement thereafter. When CIM was withdrawn from the diet, treated rats lost weight, eventually regressing to the same weight as control rats after 28 days. CIM-fed rats showed 28.6% (P less than .01) and 12.9% (P less than .05) increases in plantaris muscle weight over the control at 8 and 14 d, respectively. DNA concentration significantly (P less than .05) decreased, whereas RNA concentration increased at 3 d (31%) and 8 d (12.7%), but decreased at 14 d compared to the control. The increase in RNA concentration preceded the significant improvement of muscle weight in the CIM group. In the soleus muscle, there was no significant difference in muscle weight or DNA concentration between the control and CIM groups. Cimaterol-feeding significantly (P less than .05) increased the size of both type I and II fibers. The size increase of type II fibers in plantaris was twice that of type I fibers in soleus (34.2% vs 17.5%). This may explain why the plantaris muscle (type II predominant) showed a greater weight increase than the soleus muscle (type I predominant).     

Motor hand recovery after stroke. Prognostic yield of early transcranial magnetic stimulation.

Transcranial magnetic stimulation (TMS) was performed in 20 patients within the first days after stroke. Motor evoked potentials (MEPs) were bilaterally recorded over thenar eminence muscles, and central motor conduction time (CMCT), amplitude of the MEPs (A%M) and threshold intensity compared between both sides. Six months later the patients were reexamined. Within the first days after stroke the obtention of MEPs at rest or during voluntary muscle activation have a favorable prognostic value. All patients with early response by TMS reached a good motor function in the following months. The follow-up showed that the electrophysiological improvement was closely related to clinical recovery of the hand function. However, even in cases with a good recovery, the CMCT and, mainly, the A%M, may be significantly different related to those in normal hand. TMS may be an early and valuable prognostic indicator of hand function recovery after stroke, and their prognostic yield is higher than clinical evaluation and CT study. TMS is a quantifiable method of motor disability and may have practical application in the management and rehabilitation therapy in stroke patients.     

Impulses of activation but not motor modules are preserved in the locomotion of subacute stroke patients

It has been hypothesized that the coordinated activation of muscles is controlled by the central nervous system by means of a small alphabet of control signals (also referred to as activation signals) and motor modules (synergies). We analyzed the locomotion of 10 patients recently affected by stroke (maximum of 20 wk) and compared it with that of healthy controls. The aim was to assess whether the walking of subacute stroke patients is based on the same motor modules and/or activation signals as healthy subjects. The activity of muscles of the lower and upper limb and the trunk was measured and used for extracting motor modules. Four modules were sufficient to explain the majority of variance in muscle activation in both controls and patients. Modules from the affected side of stroke patients were different from those of healthy controls and from the unaffected side of stroke patients. However, the activation signals were similar between groups and between the affected and unaffected side of stroke patients, and were characterized by impulses at specific time instants within the gait cycle, underlying an impulsive controller of gait. In conclusion, motor modules observed in healthy subjects during locomotion are different from those used by subacute stroke patients, despite similar impulsive activation signals. We suggest that this pattern is consistent with a neuronal network in which the timing of activity generated by central pattern generators is directed to the motoneurons via a premotor network that distributes the activity in a task-dependent manner determined by sensory and descending control information.     

Improvement with ongoing Enzyme Replacement Therapy in advanced late-onset Pompe disease: a case study

Benefits of enzyme replacement therapy with Myozyme^® (alglucosidase alfa), anecdotally reported in late-onset Pompe disease, range from motor and pulmonary improvement in less severely affected patients, to stabilization with minimal improvement in those with advanced disease. We report a case of a 63-year-old patient with significant morbidity who made notable motor and pulmonary function gains after two years on therapy. Thus, improvements in those with advanced disease may be possible after long-term treatment.     

Synergistic and Additive Effects of Cimetidine and Levamisole on Cellular Immune Responses to Hepatitis B virus DNA Vaccine in Mice

We and others have previously shown that both cimetidine (CIM) and levamisole (LMS) enhance humoral and cellular responses to DNA vaccines via different mechanisms. In this study, we investigated the synergistic and additive effects of CIM and LMS on the potency of antigen‐specific immunities generated by a DNA vaccine encoding the hepatitis B surface antigen (HBsAg, pVax‐S2). Compared with CIM or LMS alone, the combination of CIM and LMS elicited a robust HBsAg‐specific cellular response that was characterized by higher IgG2a, but did not further increase HBsAg‐specific antibody IgG and IgG1 production. Consistent with these results, the combination of CIM and LMS produced the highest level of IL‐2 and IFN‐γ in antigen‐specific CD4⁺ T cells, whereas the combination of CIM and LMS did not further increase IL‐4 production. Significantly, a robust HBsAg‐specific cytotoxic response was also observed in the animals immunized with pVax‐S2 in the presence of the combination of CIM and LMS. Further mechanistic studies demonstrated that the combination of CIM and LMS promoted dendritic cell (DC) activation and blocked anti‐inflammatory cytokine IL‐10 and TGF‐β production in CD4⁺CD25⁺ T cells. These findings suggest that CIM and LMS have the synergistic and additive ability to enhance cellular response to hepatitis B virus DNA vaccine, which may be mediated by DC activation and inhibition of anti‐inflammatory cytokine expression. Thus, the combination of cimetidine and levamisole may be useful as an effective adjuvant in DNA vaccinations for chronic hepatitis B virus infection.     

健侧脑感觉运动区在局灶性脑梗死后偏瘫肢体运动功能康复中的作用

目的 探讨局灶性脑梗死后健侧大脑半球感觉运动区在偏瘫上肢运动功能恢复中的作用和意义。方法 前瞻性非随机对照研究。纳入扬州大学附属医院神经内科2015年6月—2017年12月经严格筛选的17例初次发病的纹状体内囊区脑梗死(SCI)伴单侧严重上肢瘫患者作为研究对象(观察组),同时选取15例健康者作为对照组。分别于发病后1周内(初期)、1个月及3个月时,在偏瘫侧被动手指屈伸(FE)任务下行血氧水平依赖功能磁共振成像(BOLD-fMRI),通过SPM8软件观察健侧大脑半球感觉运动(SMC)区激活情况,再根据健侧大脑半球SMC区激活强度及时程将观察组分成3个亚组。通过Xjview软件对观察组健侧SMC区激活进行观察并同对照组行动态比较,同时对亚组感兴趣区动态变化进行比较分析。采用简化Fugl-Meyer评分量表上肢部分(FM-UL),分别于发病1周内及发病1、3个月行功能磁共振成像(fMRI)扫描前,对观察组患者患侧上肢运动功能进行评定。结果 (1)BOLD-fMRI显示:对照组受试者在一侧手指被动FE运动时,可见对侧大脑半球SMC、辅助运动区(SMA)、双侧下顶叶及同侧小脑激活。根据健侧大脑半球SMC区激活强度及时程将观察组分成3组:组1共6例患者,其发病初期健侧SMC区即存在明显激活,发病后1、3个月,随着患肢的康复,健侧SMC区激活逐渐减低,其成像模式逐渐趋于对照组;组2共5例,发病初期健侧SMC区无明显激活,发病后1、3个月时健侧SMC区激活逐渐增强;组3共6例患者,于发病初期、1个月及3个月时均未见健侧SMC区明显激活表现。发病1周内FM-UL评分3个亚组间比较差异无统计学意义(P＞0.05);发病1个月时患者FM-UL评分3个亚组间,以及亚组间两两比较,差异均具有统计学意义(P值均＜0.01);发病3个月时,观察组1与组2患者FM-UL评分比较差异无统计学意义(P＞0.05),但均高于观察组3,差异均有统计学意义(P值均＜0.01)。结论 健侧大脑半球SMC区参与了皮层下脑梗死后的运动功能重组,其激活时程同患者偏瘫肢体运动功能恢复的速度相关。     

Lymphocyte status in endomyocardial biopsies and blood after heart transplantation

We performed immunological phenotyping of mononuclear cells in tissue sections of 84 endomyocardial biopsies (EMB) showing infiltrates, which were taken from 21 patients after heart transplantation. Data were correlated with histology (grading following Billingham) and cyto-immunologic monitoring (CIM) on blood samples (grading into negative, rejection, or infection, based on leukocyte morphology and T-cell phenotype). Few T lymphocytes were observed in 35 biopsies, and many in 49 biopsies. The semi-quantitative estimate of T cells and CD4/CD8 ratio did not correlate with EMB histology but was related to CIM data. For example, 31 out of 42 cases with a CIM indicative of infection (14 of which showing no rejection on histology) manifested large numbers of T cells. In most cases, the CD4/CD8 ratio was less than 1. The presence of activated cells (bearing interleukin-2 receptors or the CD30 antigen) was not related to EMB histology or to CIM data. The number of T cells (subsets) in EMB was not related to relative or absolute numbers in the blood.     

Tactile stimulus predictability modulates activity in a tactile-motor cortical network

Manipulating objects in the hand requires the continuous transformation of sensory input into appropriate motor behaviour. Using a novel vibrotactile device combined with fMRI, the cortical network associated with tactile sensorimotor transformations was investigated. Continuous tactile stimuli were delivered in a random or predictable pattern to the second digit on the right hand of all subjects. To better distinguish sensory and motor processes, subjects were instructed to make proportionate motor gripping responses with their left hand. A consistent cortical network of activation was revealed that included the supplementary motor, dorsal and ventral premotor, posterior parietal, primary and secondary somatosensory and primary motor cortex. Tracking the unpredictable versus predictable tactile stimulus led to greater delays in motor responses and to increased performance errors. Cortical effects due to stimulus predictability were observed in several components of the network, though it was most evident as increased cortical activation in frontal motor regions during tracking of unpredictable tactile stimuli. In contrast to the proposed hypotheses, primary and secondary somatosensory cortices contralateral to tactile input did not reveal enhanced responses during unpredictable tracking. Facilitation during unpredictable tracking was also observed in primary somatosensory cortex contralateral to motor responses, the receptive site for movement-related afference. The present study provides a novel and controlled approach to investigate the loci associated with tactile-motor processing and to measure the task-specific effect of stimulus predictability on network components.     

Alteration and Role of Interhemispheric and Intrahemispheric Connectivity in Motor Network After Stroke

This study investigated local and global changes in the motor network using longitudinal resting-state functional magnetic resonance imaging (rs-fMRI). Motor impairment was measured in 81 stroke patients using Fugl-Meyer assessment on the same day as rs-fMRI acquisition at both 2 weeks and 3 months post-stroke. The relationships between network measures and motor function scores were assessed. With regard to local connectivity, interhemispheric connectivity was noticeably altered at each time point. Interhemispheric connectivity was also related to residual motor function and improvement in motor function. The anterior intraparietal sulcus and other well-known primary and secondary motor-related regions played important roles in motor function. Changes in global connectivity according to stroke type and initial severity were investigated. In global connectivity, interhemispheric connectivity was disrupted at 2 weeks post-stroke regardless of stroke type and initial severity. During the recovery period, interhemispheric connectivity recovered well in patients with hemorrhagic stroke or low severity. In contrast, there were no significant between-group and within-group alterations in intrahemispheric connectivity. Intrahemispheric connectivity of the inferior frontal cortex (IFC) exhibited opposite alterations compared to other connections. There were no differences between groups in IFC connectivity alterations; however, decreasing ipsilesional IFC connectivity and contralesional IFC during recovery were noticeable in patients with mild to moderate impairments and patients with severe impairments, respectively. These results may be helpful in understanding the network changes that occur after stroke and could have important implications for treatment strategy development in future studies.     

Age-related differences of saccade induced cortical activation

Recent functional MRI (fMRI) studies have described the increased task-related brain activation in older subjects during motor, cognitive and perceptual tasks. Age affects the ability to control saccadic eye movements. To investigate the age-related changes of oculomotor control, we studied the representation of saccades in 11 young (median age 29 years) and 11 older (median age 62 years) healthy individuals using fMRI. Brain activation was measured during a visually guided prosaccade trial. Differences in activation between rest and saccades as well as between younger and older subjects were assessed with statistical parametric mapping (SPM). In both age groups, activation of a frontoparietal network was observed. Older subjects showed increased activation compared to younger subjects with overactivation in bilateral parietal eye fields, the right frontal eye field, as well as in the right extrastriate cortex. We conclude that older adults increase activation in an extended oculomotor and visual network to maintain performance during simple prosaccades. This observation also underlines the importance of using appropriate age-matched control groups in fMRI studies after brain lesions.     

Gastric cardia intestinal metaplasia: biopsy follow-up of 85 patients.

BACKGROUND: Gastric cardia intestinal metaplasia (CIM), denoted by goblet cells is common. The frequency of persistent CIM is unknown. METHODS: 85 patients with CIM and follow-up endoscopies were prospectively identified during the time period of 10/6/94-12/21/97. The presence of goblet cells was the defining feature of CIM, other metaplastic cell types were not evaluated. AU 85 patients initially had biopsies that straddled the squamocolumnar junction (SCJ) showed CIM, an otherwise normal proximal stomach, lower esophagus, and squamocolumnar junction. The SCJ lay within the 2 cm of mucosa immediately proximal to the uppermost gastric fold and overlaid the junction of the tubular esophagus and the saccular dilatation of the stomach in all patients. The patients underwent endoscopy for many reasons. They were randomly identified based on the absence of a hiatal hernia and the presence of CIM. RESULTS: Ten of the 85 patients had CIM on repeat biopsy. Among patients with no CIM in the first repeat endoscopy, the degree of cardia inflammation decreased between the initial and first repeat endoscopy, whereas there was no change in the amount of inflammation among patients who had CIM in the first repeat endoscopy. The changes in mean inflammation score was significantly different between the two groups (P = .024). Twenty-two patients underwent a second repeat endoscopy and five had a third repeat endoscopy. Including all follow-up biopsies, six of the 85 patients (7%) had CIM. Four patients who did not have CIM on initial repeat endoscopy had CIM on their second repeat endoscopy, probably reflecting sampling issues. None of the biopsies had dysplasia. CONCLUSIONS: Cardia inflammation is a stimulus for cardia intestinal metaplasia, and a reduction in inflammation may allow the metaplastic mucosa to revert to normal.     

Effects of mindfulness training on the default mode network in borderline personality disorder

Patients with borderline personality disorder (BPD) present dysfunctions of the default mode network (DMN). Mindfulness training has proven effective to improve the symptoms of BPD. The present study examines the effect of mindfulness training on BPD symptomatology and DMN activity during the performance of a working memory task in patients with BPD. Sixty‐five individuals with BPD were randomized to receive psychotherapy with either the mindfulness module of dialectical behavioural therapy (DBT‐M) or with interpersonal effectiveness module (DBT‐IE). The impact of treatments was evaluated with clinical and mindfulness variables as well as with functional magnetic resonance imaging during performance of the task. Both groups showed improvement in BPD symptoms and other clinical variables after treatment. Unexpectedly, there were no between‐group differences in DMN activation or deactivation. However, activation of the left anterior insula increased in both groups after the intervention. Compared with the control group, participants in the DBT‐M group presented higher deactivation in a cluster extending bilaterally from the calcarine to the cuneus and superior occipital gyri.     

Weak by the machines: muscle motor protein dysfunction – a side effect of intensive care unit treatment

Intensive care interventions involve periods of mechanical ventilation, sedation and complete mechanical silencing of patients. Critical illness myopathy (CIM) is an ICU‐acquired myopathy that is associated with limb muscle weakness, muscle atrophy, electrical silencing of muscle and motor proteinopathy. The hallmark of CIM is a preferential muscle myosin loss due to increased catabolic and reduced anabolic activity. The ubiquitin proteasome pathway plays an important role, apart from recently identified novel mechanisms affecting non‐lysosomal protein degradation or autophagy. CIM is not reproduced by pure disuse atrophy, denervation atrophy, steroid‐induced atrophy or septic myopathy, although combinations of high‐dose steroids and denervation can mimic CIM. New animal models of critical illness and ICU treatment (i.e. mechanical ventilation and complete immobilization) provide novel insights regarding the time course of protein synthesis and degradation alterations, and the role of protective chaperone activities in the process of myosin loss. Altered mechano‐signalling seems involved in triggering a major part of myosin loss in experimental CIM models, and passive loading of muscle potently ameliorates the CIM phenotype. We provide a systematic overview of similarities and distinct differences in the signalling pathways involved in triggering muscle atrophy in CIM and isolated trigger factors. As preferential myosin loss is mostly determined from biochemistry analyses providing no spatial resolution of myosin loss processes within myofibres, we also provide first results monitoring myosin signal intensities during experimental ICU intervention using multi‐photon Second Harmonic Generation microscopy. Our results confirm that myosin loss is an evenly distributed process within myofibres rather than being confined to hot spots.     

Bilateral fetal mesencephalic grafting in two patients with parkinsonism induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)

BACKGROUND. Intracerebral transplantation of fetal dopaminergic neurons is a promising new approach for the treatment of Parkinson's disease. Patients with parkinsonism induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) have a relatively stable lesion limited to the nigrostriatal system, rendering them ideal candidates for transplantation. Improvement of motor function after neural grafting has previously been observed in nonhuman primates with MPTP-induced parkinsonism. METHODS. We grafted human fetal tissue from the ventral mesencephalon (obtained six to eight weeks after conception) bilaterally to the caudate and putamen in two immunosuppressed patients with severe MPTP-induced parkinsonism, using a stereotaxic technique. The patients were assessed regularly with clinical rating scales, timed tests of motor performance, and [18F]fluorodopa positron-emission tomography during the 18 months before the operation and the 22 to 24 months after the operation. RESULTS. Both patients had substantial, sustained improvement in motor function and became much more independent. Postoperatively, the second patient's maintenance dose of levodopa was decreased to 150 mg daily, which was 30 percent of the original dose. Striatal uptake of fluorodopa was unchanged 5 to 6 months postoperatively but was markedly and bilaterally increased at 12 to 13 and 22 to 24 months in both patients, closely paralleling the patients' clinical improvement. There were no serious complications. CONCLUSIONS. Bilateral implantation of fetal mesencephalic tissue can induce substantial long-term functional improvement in patients with parkinsonism and severe dopamine depletion and is accompanied by increased uptake of fluorodopa by the striatum. The results in these patients resemble those obtained in MPTP-treated primates and suggest that this will be a useful model for the assessment of transplantation therapies in Parkinson's disease.     

Sleep stabilizes visuomotor adaptation memory: a functional magnetic resonance imaging study

The beneficial effect of sleep on motor memory consolidation is well known for motor sequence memory, but remains unsettled for visuomotor adaptation in humans. The aim of this study was to characterize more clearly the influence of sleep on consolidation of visuomotor adaptation using a between‐subjects functional magnetic resonance imaging (fMRI) design contrasting sleep to total sleep deprivation. Our behavioural results, based on seven different parameters, show that sleep stabilizes performance whereas sleep deprivation deteriorates it. During training, while a set of cerebellar, striatal and cortical areas is activated in proportion to performance improvement, the recruitment of the hippocampus and frontal cortex protects motor memory against the detrimental effects of sleep deprivation. During retest after sleep loss a cerebello–cortical network, usually involved in the earliest stage of learning, was recruited to perform the task. In contrast, no changes in cerebral activity were observed after sleep, suggesting that it may only support the stabilization of the visuomotor adaptation memory trace.     

Changes of functional connectivity of the motor network in the resting state in Parkinson's disease

We used functional MRI (fMRI) and a network model based on graph theory to measure functional connectivity of brain motor network in the resting state in patients with Parkinson's disease (PD). FMRIs were acquired in 22 PD patients before and after levodopa administration, and in age- and sex-matched normal controls. The total connectivity degree of each region within the motor network was calculated and compared between patients and controls. We found that PD patients at off state had significantly decreased functional connectivity in the supplementary motor area, left dorsal lateral prefrontal cortex and left putamen, and had increased functional connectivity in the left cerebellum, left primary motor cortex, and left parietal cortex compared to normal subjects. Administration of levodopa relatively normalized the pattern of functional connectivity in PD patients. The functional connectivity in most of regions in the motor network correlated with the Unified Parkinson's Disease Rating Scale motor score in the patients. Our findings demonstrate that the pattern of functional connectivity of the motor network in the resting state is disrupted in PD. This change is secondary to dopamine deficiency, and related to the severity of the disease. We postulate that this abnormal functional connectivity of motor network in the baseline state is possibly an important factor contributing to some motor deficits in PD, e.g. akinesia.     

Mirror visual feedback can induce motor learning in patients with callosal disconnection

Mirror therapy using mirror visual feedback (MVF) has been applied to the stroke rehabilitation of hemiparesis. One possible mechanism of mirror therapy is the functional interhemispheric connectivity between sensorimotor areas via corpus callosum. To test this hypothesis, we investigated the MVF-induced motor learning in 2 patients with callosal disconnection. Callosal connection in patients was evaluated by clinical measures and the interhemispheric inhibition (IHI) using transcranial magnetic stimulation. Both patients suffered from somatosensory cognitive disconnection, and one showed the loss of IHI. Motor training with MVF significantly improved the motor behavior of both patients. Extending our previous study, the results of callosal patients suggested that the visual feedback through a mirror might play the crucial important role for the improvement of motor performance, rather than interhemispheric interaction via corpus callosum.     

Anti-interleukin-5 antibody therapy in eosinophilic diseases.

Eosinophilia in atopic diseases and hypereosinophilic syndrome is often associated with a high expression of interleukin-5 (IL-5). IL-5 plays an important role in regulating the production, differentiation, recruitment, activation, and survival of eosinophils. Therefore, neutralizing IL-5 with an antibody is a promising therapeutic strategy in eosinophilic diseases. In patients with hypereosinophilic syndrome and eosinophilic esophagitis, anti-IL-5 antibody therapy resulted in an improvement of symptoms. In patients with bronchial asthma, no effect on the late phase reaction and on airway hyperresponsiveness has been observed. Moreover, patients with atopic dermatitis demonstrated only a moderate improvement of their skin lesions and pruritus. Anti-IL-5 therapy was followed by a rapid and sustained decrease of peripheral blood eosinophil numbers. The decrease of tissue eosinophils was, however, less dramatic. Investigating the effects of anti-IL-5 therapy will improve our understanding of the pathogenic roles of both IL-5 and eosinophils in eosinophilic inflammatory responses.