Bronchiolitis obliterans syndrome is associated with increased p‐glycoprotein expression and loss of glucocorticoid receptor from steroid‐resistant proinflammatory CD8+ T cells

Immunosuppressive therapy fails to suppress the production of proinflammatory cytokines, particularly by CD8⁺ T cells, in stable lung transplant recipients and those undergoing chronic rejection, suggesting that some patients may become relatively resistant to immunosuppressants such as glucocorticoids (GC). We have shown loss of GC receptor (GCR) from the CD8⁺ cells, and we hypothesized that the drug membrane efflux pump, p‐glycoprotein‐1 (Pgp), may also be involved in lymphocyte steroid resistance following lung transplant. Pgp/GCR expression and interferon (IFN)‐γ/tumour necrosis factor (TNF)‐α proinflammatory cytokine production was measured in blood lymphocytes from 15 stable lung transplant patients, 10 patients with bronchiolitis obliterans syndrome (BOS) and 10 healthy aged‐matched controls (± prednisolone ± Pgp inhibitor, cyclosporin A ± GCR activator, Compound A) using flow cytometry. Both Pgp⁺ and Pgp^– lymphocyte subsets from all subjects produced IFN‐γ/TNF‐α proinflammatory cytokines. Pgp expression was increased in CD8⁺Pgp⁺ T cells and correlated with IFN‐γ/TNF‐α expression and BOS grade. Reduced GCR was observed in CD8⁺Pgp^– T, natural killer (NK) T‐like and NK cells from stable patients compared with controls, and reduced further in CD8⁺Pgp^– T cells in BOS. The addition of 2·5 ng/ml cyclosporin A and 1 µM prednisolone inhibit IFN‐γ/TNF‐α production significantly by CD8⁺Pgp⁺ T cells from BOS patients. The addition of 10 µM Compound A and 1 µM prednisolone inhibit IFN‐γ/TNF‐α production significantly by CD8⁺Pgp^– T cells from BOS patients. BOS is associated with increased Pgp expression and loss of GCR from steroid‐resistant proinflammatory CD8⁺ T cells. Treatments that inhibit Pgp and up‐regulate GCR in CD8⁺ T cells may improve graft survival.     

A functional polymorphism of toll-like receptor 4 gene increases risk of gastric carcinoma and its precursors

BACKGROUND AND AIMS: TLR4 is a cell-surface signaling receptor involved in the recognition and host response to Helicobacter pylori. The TLR4+896A>G polymorphism linked with impaired reactivity to bacterial lipopolysaccharide may play a role in gastric carcinogenesis. METHODS: We assessed associations with premalignant gastric changes in 149 relatives of gastric cancer patients, including 45 with hypochlorhydria and gastric atrophy. We also genotyped 2 independent Caucasian population-based case-control studies of upper gastrointestinal tract cancer, initially in 312 noncardia gastric carcinoma cases and 419 controls and then in 184 noncardia gastric carcinomas, 123 cardia carcinomas, 159 esophageal cancers, and 211 frequency-matched controls. Odds ratios were computed from logistic models and adjusted for potential confounding factors. RESULTS: TLR4+896G carriers had an 11-fold (95% confidence interval [CI], 2.5-48) increased odds ratio (OR) for hypochlorhydria; the polymorphism was unassociated with gastric acid output in the absence of H pylori infection. Carriers also had significantly more severe gastric atrophy and inflammation. Seventeen percent of gastric carcinoma patients in the initial study and 15% of the noncardia gastric carcinoma patients in the replication study had 1 or 2 TLR4 variant alleles vs 8% of both control populations (combined OR = 2.3; 95% CI = 1.6-3.4). In contrast, prevalence of TLR4+896G was not significantly increased in esophageal squamous cell (2%, OR = 0.2) or adenocarcinoma (9%, OR = 1.4) or gastric cardia carcinoma (11%, OR = 1.4). CONCLUSIONS: Our data suggest that the TLR4+896A>G polymorphism is a risk factor for noncardia gastric carcinoma and its precursors. The findings underscore the role of the host innate immune response in outcome of H pylori infection.     

特发性肾病综合征患儿血清游离甲状腺激素检测的临床意义

探索特发性肾病综合症（ＩＮＳ）患儿血清游离甲状腺激素（ＴＨ）、甲状腺激素结合球蛋白（ＴＢＧ）的变化情况及其变化的机理和临床意义。对１６例ＩＮＳ患儿及１５例正常儿童对照,用放免法测Ｔ３、Ｔ４、ＦＴ３、ＦＴ４,化学发光酶免疫分析法测ＴＳＨ、ＴＢＧ,放射配基单点饱和饱和结合分析法测糖皮质激素受体（ＧＣＲ）。结果：①ＩＮＳ患儿Ｔ３、Ｔ４、ＦＴ３、ＦＴ４均低于对照组,ＴＳＨ升高,差异非常显著。②ＴＢＧ降低,ＴＢＧ与ＴＨ呈正相关。③ＩＮＳ患儿ＧＣＲ升高,ＴＨ与ＧＣＲ未见相关性。提示对糖皮质激素（ＧＣ）治疗敏感的ＩＮＳ患儿,虽然其ＴＨ是降低的,但其ＧＣＲ是升高的。     

熟地有效成分甘露三糖对高浓度皮质酮损伤的海马神经细胞SGK\BDNF\GCR表达的影响

目的:观察熟地有效成分甘露三糖对高浓度皮质酮诱导海马神经元损伤及学习记忆相关信号转导分子表达的影响。方法:用24小时新生大鼠原代培养海马神经细胞。第八天用药处理,将细胞分为5组:1:正常对照组;2:1×10-4M高浓度皮质酮模型组;3:10-4 M CORT+3nM RU38486拮抗剂组;4:10-4 M CORT+0.1g/L甘露三糖组;5:10-4 M CORT+40uM多奈哌齐阳性对照组。24h后,通过SYTO13-PI双荧光染色观察各组细胞的形态及存活情况,MTT法测定细胞活性,Western Blot检测学习记忆信号转导通路相关分子GCR、BDNF、SGK蛋白表达。结果:与正常组相比,模型组细胞死亡较多,细胞活力下降,GCR、BDNF、SGK蛋白表达均显著性降低;如上改变又均被皮质酮受体拮抗剂RU38486逆转;甘露三糖(0.1g/L)同阳性对照多奈派齐(40μM)均明显减少死细胞数量,提高细胞活力,提高模型细胞GCR、BDNF、SGK蛋白表达。结论:熟地有效成分甘露三糖保护大鼠海马神经细胞免遭高浓度皮质酮的损伤,通过调节学习记忆信号转导途径中的重要蛋白GCR、BDNF、SGK表达从而改善高浓度皮质酮致学习记忆功能退化。     

熟地黄有效成分5-HMF对皮质酮损伤型海马神经元GCR、BDNF、SGK表达的影响

目的:观察熟地黄中有效成分5-羟甲基糠醛(5-HMF)对高浓度皮质酮(CORT)致海马神经元损伤及学习记忆相关蛋白学习记忆相关蛋白(GCR)、脑源性神经营养因子(BDNF)、血清和糖皮质激素调节蛋白激酶(SGK)蛋白表达的影响。方法:用24h新生大鼠原代培养海马神经细胞。第8天细胞用药处理,将细胞分为3组:正常对照组、模型组及5-HMF组。24h后,通过MTT法测定细胞活性,生化方法检测衰老特异性指标β-半乳糖苷酶活性,Western Blot检测学习记忆相关蛋白GCR、BDNF、SGK的基因表达。结果:与正常组相比,模型组细胞活力显著下降,β-半乳糖苷酶活性显著升高,GCR、BDNF、SGK蛋白表达显著性降低;0.5mg/L的5-HMF明显提高细胞活力,降低β-半乳糖苷酶活性,提高模型细胞GCR、BDNF、SGK基因表达(P0.05,P0.01)。结论:0.5mg/L 5-HMF可以保护大鼠海马神经细胞免遭高浓度皮质酮的损伤,通过调节GCR、BDNF、SGK的基因表达,可能在延缓学习记忆功能退化中发挥作用。     

三步序贯法对激素依赖型哮喘患者下丘脑-垂体-肾上腺皮质轴功能及糖皮质激素受体的影响

目的:观察三步序贯法对激素依赖型哮喘患者下丘脑-垂体-肾上腺皮质(hypothalamic-pituitary-adrenal,HPA)轴功能及糖皮质激素受体(glucocorticoid receptor,GCR)的影响.方法:将入选病例按随机数字表分为治疗组29例和对照组26例.在逐渐撤减泼尼松量的过程中,对照组予普米克都保(布地奈德粉吸入剂,100μg/吸),每次400μg,每日2次吸入;治疗组予中药三步序贯方煎剂,每次100ml,每日2次口服,同时给予普米克都保200μg,每日2次吸入.两组疗程均12-14周.观察治疗前后血浆皮质醇(cortisol,COR),促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)以及外周血单个核细胞(Peripheral blood mononuclear cell,PBMC)GCR数目的变化.结果:两组患者血浆ACTH和COR浓度以及PBMC GCR水平较治疗前均明显升高,且两组之间比较差异均具有显著性(P均＜0.05).结论:三步序贯法能够恢复SDA患者被抑制的HPA轴功能,上调PBMC GCR水平,从而具有减轻全身性不良反应,增强糖皮质激素的敏感性,减轻激素依赖的作用.     

Ciclesonide modulates in vitro allergen-driven activation of blood mononuclear cells and allergen-specific T-cell blasts

Background

Ciclesonide, an inhaled corticosteroid with almost no affinity for the glucocorticoid receptor, is highly effective in downregulating in vitro pro-inflammatory activities of airway parenchymal cells when converted into the active metabolite desisobutyryl-ciclesonide.

Objective

We evaluate whether ciclesonide could effectively downregulate also antigen- or allergen-induced activation of peripheral blood mononuclear cell and of allergen-specific T-cell blasts.

Methods

Peripheral blood mononuclear cells were isolated from non atopic and atopic asthmatic children sensitized to Phleum pratense (PhlP5). Proliferation toward Candida albicans or PhlP5 in the presence of ciclesonide or desisobutyryl-ciclesonide (0.003-3.0 μM) was evaluated as [³H]thymidine incorporation. Modulation of PhlP5-specific T-cell blasts proliferation and PhlP5-induced interleukin 4 expression by ciclesonide and desisobutyryl-ciclesonide were measured.

Results

Peripheral blood mononuclear cell proliferation to C. albicans was dose-dependently inhibited by 0.3-3.0 μM ciclesonide and desisobutyryl-ciclesonide but inhibition by desisobutyryl-ciclesonide was higher. A significant proliferation to PhlP5 was observed only in cultures from atopic subjects: an effective downregulation was already detected at 0.03 μM ciclesonide and 0.003 μM desisobutyryl-ciclesonide (complete inhibition at 3 μM ciclesonide and 0.03 μM desisobutyryl-ciclesonide). 3 μM ciclesonide and desisobutyryl-ciclesonide reduced the PhlP5-specific T-cell blast proliferation and interleukin 4-producing cell proportion.

Conclusions and clinical relevance

These in vitro data, obtained at concentrations similar to those reached in vivo at bronchial level, are in favor of an efficient inhibition of ciclesonide on the T-cell mediated response toward allergens. Additional studies are required to confirm these preliminary data on the reduced activity of the drug on allergen-specific T-cell blast activation that may have clinical relevance.     

Clinical relevance of advances in genetics and pharmacogenetics of IBD

Crohn's disease and ulcerative colitis result from an inappropriate response of the mucosal immune system to the normal enteric flora in a genetically susceptible individual. During the past decade, exciting progress has been made in our understanding of the contribution of genetics to inflammatory bowel disease susceptibility and phenotype. This article reviews recent advances in the genetics of inflammatory bowel disease and explores how they might impact on clinical practice. Current knowledge of the genetic basis for disease susceptibility, phenotype, and response to therapy is explored and the factors currently limiting the translation of this knowledge to clinical practice is discussed.     

Expression of glucocorticoid receptors in mononuclear cells in nephrotic syndrome

Coulter flow cytometry was used to determine glucocorticoid receptors (GCR) in the peripheral blood cells of patients with nephrotic syndrome. The expression of GCR in the lymphocytes (CD3/GCR) and monocytes (CD14/GCR) of peripheral blood of 23 (age 4.9±2.7 years) children with steroid-sensitive nephrotic syndrome was assessed before treatment (proteinuria >50 mg/kg per 24 h), after 4–6 weeks of prednisone treatment, without proteinuria, and in remission, without proteinuria and without any treatment. Before treatment the expression of CD3/GCR was 61.8±18.3% and CD14/GCR 43.6.8±20.3%; this did not differ from the results of the normal control group (P>0.05). However, after treatment GCR expression in lymphocytes was 50% (P<0.001) and in monocytes about 20% lower (P<0.05). In remission, the GCR expression increased and did not differ from the results before treatment (P>0.05). A positive correlation between the serum cortisol concentration and the expression of CD3/GCR was found (r=0.504, P=0.02). In summary, we report that in children with steroid-sensitive nephrotic syndrome, prednisone treatment causes the temporary decrease of the expression of GCR in lymphocytes. A positive correlation between GCR expression and serum cortisol was found. A decrease in GCR expression in monocytes did not correlate with cortisol concentration.