微小核糖核酸在缺血性心脏病中的研究进展

微小核糖核酸是一类参与生长发育、肿瘤发生、器官形成等生物学过程的重要调控因子。近期研究发现,微小核糖核酸与缺血性心脏病有重要关联,调节缺血或梗死后心肌纤维化、心律失常发生、血管成形术后再狭窄、新生血管形成以及心肌再生,影响心脏的机械重构、电重构及血管重构。以上发现使得微小核糖核酸有望成为缺血性心脏病新的治疗靶点。     

Climate Change and Allergic Disease

Allergies are prevalent throughout the United States and impose a substantial quality of life and economic burden. The potential effect of climate change has an impact on allergic disorders through variability of aeroallergens, food allergens and insect-based allergic venoms. Data suggest allergies (ocular and nasal allergies, allergic asthma and sinusitis) have increased in the United States and that there are changes in allergies to stinging insect populations (vespids, apids and fire ants). The cause of this upward trend is unknown, but any climate change may induce augmentation of this trend; the subspecialty of allergy and immunology needs to be keenly aware of potential issues that are projected for the near and not so distant future.     

Role of Cockroach Proteases in Allergic Disease

Allergic asthma is on the rise in developed countries, and cockroach exposure is a major risk factor for the development of asthma. In recent years, a number of studies have investigated the importance of allergen-associated proteases in modulating allergic airway inflammation. Many of the studies have suggested the importance of allergen-associated proteases as having a direct role on airway epithelial cells and dendritic cells. In most cases, activation of the protease activated receptor (PAR)-2 has been implicated as a mechanism behind the potent allergenicity associated with cockroaches. In this review, we focus on recent evidence linking cockroach proteases to activation of a variety of cells important in allergic airway inflammation and the role of PAR-2 in this process. We will highlight recent data exploring the potential mechanisms involved in the biological effects of the allergen.     

Indoor Allergens and Allergic Respiratory Disease

Purpose of review

The purpose of this review is to evaluate the most recent findings on indoor allergens and their impact on allergic diseases.

Recent findings

Indoor allergens are present inside buildings (home, work environment, school), and given the chronic nature of the exposures, indoor allergies tend to be associated with the development of asthma. The most common indoor allergens are derived from dust mites, cockroaches, mammals (including wild rodents and pets), and fungi. The advent of molecular biology and proteomics has led to the identification, cloning, and expression of new indoor allergens, which have facilitated research to elucidate their role in allergic diseases. This review is an update on new allergens and their molecular features, together with the most recent reports on their avoidance for allergy prevention and their use for diagnosis and treatment.

Summary

Research progress on indoor allergens will result in the development of new diagnostic tools and design of coherent strategies for immunotherapy.

     

Omalizumab in the Treatment of Allergic Respiratory Disease

In children and young adults, asthma often presents many of the following features: atopy is common; airflow obstruction is fully reversible; differential diagnoses are few (except in the very young); and concomitant illnesses are uncommon. Although asthma in the elderly (meaning, for the purposes of this discussion, age 65 years and older) may share all of these characteristics, exceptions become increasingly common with advancing age. In older persons, the prevalence of allergic asthma (as defined by skin test sensitivity) is relatively small; fixed airflow obstruction may be present during clinical remissions of asthma; the differential diagnosis of new-onset wheezing is broad; and comorbid disease, especially coronary artery disease, often complicates both diagnosis and therapy. Even the definition of asthma becomes somewhat obscured in an older population: persons with chronic bronchitis and emphysema who exhibit episodic dyspnea and wheezing and a reversible component to their airflow obstruction challenge our nosology. One must attempt to decide whether their asthmaticlike condition, often referred to as “asthmatic bronchitis,” is the same illness that we call asthma. Thus, although in some instances asthma in the elderly is simply a continuation of this chronic condition into old age, in others it raises a host of special diagnostic and therapeutic considerations.     

The Dietary Prophylaxis of Allergic Disease in Infancy

There is little doubt that the incidence of allergic disease is steadily increasing, both relatively and absolutely. Deesl reviewed evidence that the sickness rate for allergy had increased tenfold in the 20 years preceding 1960. Presently about 20 percent of children up to the age of 15 years are allergic,² and in at least one-third of the children who visit the pediatrician's office the question of possible allergic disease must be considered.³ Nothing, however, has illustrated the importance of allergy in childhood as strikingly as the recent publication from the U. S. Department of Health, Education and Welfare⁴ which indicates that allergy accounts for about one-third of all chronic conditions reported in children under 17 years of age and that nearly one-fourth of the days reported lost from school because of chronic conditions in this age group were due to asthma. Even more startling is the report of Anderson.⁵ In a collaborative study involving pediatricians and pediatric allergists in the Dallas, Texas, area, of over 2,000 successive unselected newborn infants thus far observed, the immediate familial history of allergy approaches the 50% level.     

Indoor Fungal Exposure and Allergic Respiratory Disease

A gathering body of evidence has repeatedly revealed associations between indoor fungi and initiation, promotion, and exacerbation of allergic respiratory disease. The relationship between the exposure and outcome are complicated by the difficulties in measuring both exposure and outcome, the multifactorial nature of the disease, and the wide range of potential confounders. New technologies are becoming available that may enable better measurement of exposure and tighter case definitions so as to build more confidence in the associations discovered. The growing strength of the evidence base will aid the design of future public health interventions and generate new hypotheses on the cause of the rapid increase in allergic respiratory disease prevalence.     

Allergic Bronchopulmonary Fungal Disease Caused by Saccharomyces cerevisiae

We describe a patient who presented with dry cough, low‐grade fever, and focal patchy shadow of pulmonary infiltrates. Remarkably, the prospective etiological agent, Saccharomyces cerevisiae was purely and repeatedly cultured from her sputum. Allergic bronchopulmonary mycosis (ABPM) was diagnosed based on clinical, serological, and pathological criteria. Although the patient described here satisfied only three of the criteria, the conclusion that the allergic bronchopulmonary disease in our case was induced by S. cerevisiae was made based on the following evidence: 1) S. cerevisiae was repeatedly isolated from the patient's sputum, 2) anti‐S. cerevisiae antibody was detected in her serum, and 3) bronchoprovocation test to S. cerevisiae antigen was positive. We present here a case of allergic bronchopulmonary fungal disease caused by S. cerevisiae antigen.     

Mucosal Immunity and the Onset of Allergic Disease

Mucosal barriers encounter an environment that is rich in pathogens that possess mechanisms for invading mucosal tissues. These barriers also encounter innocuous antigens, such as foods, airborne antigens, and microbiota. The mucosa has developed a sophisticated immune system that can mount robust immune responses against pathogenic antigens, while maintaining mucosal tolerance against non-pathogenic antigens. Accumulating evidence indicates that the mucosal epithelium, dendritic cells, and a subtype of T cells with regulatory properties play important roles in the development and maintenance of mucosal tolerance. Moreover, the micribiota also contribute to regulating the mucosal immune system. A failure to develop or the breakdown of mucosal tolerance can result in allergic diseases, such as food allergy and asthma. By taking advantage of the unique characteristics of the mucosal immune system, strategies that induce regulatory cells in vivo and, thereby, reconstitute mucosal tolerance may be used to develop novel therapies that are suitable for treating or preventing of allergic diseases.     

Allergic Bronchopulmonary Fungal Disease Caused by Saccharomyces cerevisiae

We describe a patient who presented with dry cough, low-grade fever, and focal patchy shadow of pulmonary infiltrates. Remarkably, the prospective etiological agent, Saccharomyces cerevisiae was purely and repeatedly cultured from her sputum. Allergic bronchopulmonary mycosis (ABPM) was diagnosed based on clinical, serological, and pathological criteria. Although the patient described here satisfied only three of the criteria, the conclusion that the allergic bronchopulmonary disease in our case was induced by S. cerevisiae was made based on the following evidence: 1) S. cerevisiae was repeatedly isolated from the patient's sputum, 2) anti-S. cerevisiae antibody was detected in her serum, and 3) bronchoprovocation test to S. cerevisiae antigen was positive. We present here a case of allergic bronchopulmonary fungal disease caused by S. cerevisiae antigen.     

Role of Sensitization to Mammalian Serum Albumin in Allergic Disease

Serum albumin (SA) constitutes an intriguing puzzle that is involved in allergic sensitizations from different sources and induces different clinical manifestations. In this article, we describe the role of sensitization to SAs in inducing allergic diseases and the complex interactions and cross-reactivity between SA resulting from its presence in various mammalian tissues and fluids. SAs alone are an uncommon cause of allergic sensitization in airways, but these allergenic proteins likely play a significant role as cross-reacting allergens in individuals sensitized to several types of animal dander. SAs are a minor allergen in milk but a major allergen in meats. Recently, bovine SA has been added to the culture medium of spermatozoids used for artificial insemination. As a consequence, some case reports have shown that bovine SA may be a causative agent in severe anaphylaxis after standard intrauterine insemination or in vitro fertilization.