Effects of Repeated Stress on Distal Airway Inflammation, Remodeling and Mechanics in an Animal Model of Chronic Airway Inflammation

Background/Aims: Epidemiological studies suggest that stress has an impact on asthmatic exacerbations. We evaluated if repeated stress, induced by forced swimming, modulates lung mechanics, distal airway inflammation and extracellular matrix remodeling in guinea pigs with chronic allergic inflammation. Methods: Guinea pigs were submitted to 7 ovalbumin or saline aerosols (1-5 mg/ml during 4 weeks; OVA and SAL groups). Twenty-four hours after the 4th inhalation, guinea pigs were submitted to the stress protocol 5 times a week during 2 weeks (SAL-S and OVA-S groups). Seventy-two hours after the 7th inhalation, guinea pigs were anesthetized and mechanically ventilated. Resistance and elastance of the respiratory system were obtained at baseline and after ovalbumin challenge. Lungs were removed, and inflammatory and extracellular matrix remodeling of distal airways was assessed by morphometry. Adrenals were removed and weighed. Results: The relative adrenal weight was greater in stressed guinea pigs compared to non-stressed animals (p < 0.001). Repeated stress increased the percent elastance of the respiratory system after antigen challenge and eosinophils and lymphocytes in the OVA-S compared to the OVA group (p < 0.001, p = 0.003 and p < 0.001). Neither collagen nor elastic fiber contents were modified by stress in sensitized animals. Conclusions: In this animal model, repeated stress amplified bronchoconstriction and inflammatory response in distal airways without interfering with extracellular matrix remodeling. Copyright (C) 2011 S. Karger AG, Basel

Preparation of percentile tables through anthropometric, performance, biochemical, hematological, hormonal and psychological parameters in professional soccer players

Introduction: The lack of reference values of anthropometric, performance, biochemical, hematological, hormonal and psychological parameters is an important limitation in the investigations with soccer players. Objective: To elaborate percentile tables to be used as comparison reference for further studies. Methods: 82 professional soccer players were evaluated approximately 30 days after the beginning of the main competition played by their teams. On the first day of evaluation, fast blood samples were collected for measurement of hematological parameters (i.e. erythrocytes, hemoglobin, hematocrit, mean corpuscular volume - MCV, mean corpuscular hemoglobin - MCH, mean corpuscular hemoglobin concentration - MCHC, leukocytes, eosinophils, lymphocytes, monocytes and platelets) and of concentrations of adrenaline, cortisol, creatine kinase, creatinine, norepinephrine, testosterone and urea. Subsequently, the soccer players had their anthropometric characteristics and psychological parameters assessed. In addition, the evaluation of the lactic anaerobic system efficiency was performed on a 400-m track. On the second day, both the alactic anaerobic and aerobic system efficiency was measured. Results: The percentile distribution (P-0, P-15, P-30, P-50, P-70, P-85 e P-100) was used to present the results. Conclusion: The elaboration of the percentile tables can be used as comparison reference for further studies.

Human eosinophil adhesion and degranulation stimulated with eotaxin and RANTES in vitro: Lack of interaction with nitric oxide

Abstract Background Airway eosinophilia is considered a central event in the pathogenesis of asthma. The toxic components of eosinophils are thought to be important in inducing bronchial mucosal injury and dysfunction. Previous studies have suggested an interaction between nitric oxide (NO) and chemokines in modulating eosinophil functions, but this is still conflicting. In the present study, we have carried out functional assays (adhesion and degranulation) and flow cytometry analysis of adhesion molecules (VLA-4 and Mac-1 expression) to evaluate the interactions between NO and CC-chemokines (eotaxin and RANTES) in human eosinophils. Methods Eosinophils were purified using a percoll gradient followed by immunomagnetic cell separator. Cell adhesion and degranulation were evaluated by measuring eosinophil peroxidase (EPO) activity, whereas expression of Mac-1 and VLA-4 was detected using flow cytometry. Results At 4 h incubation, both eotaxin (100 ng/ml) and RANTES (1000 ng/ml) increased by 133% and 131% eosinophil adhesion, respectively. L-NAME alone (but not D-NAME) also increased the eosinophil adhesion, but the co-incubation of L-NAME with eotaxin or RANTES did not further affect the increased adhesion seen with chemokines alone. In addition, L-NAME alone (but not D-NAME) caused a significant cell degranulation, but it did not affect the CC-chemokine-induced cell degranulation. Incubation of eosinophils with eotaxin or RANTES, in absence or presence of L-NAME, did not affect the expression of VLA-4 and Mac-1 on eosinophil surface. Eotaxin and RANTES (100 ng/ml each) also failed to elevate the cyclic GMP levels above baseline in human eosinophils. Conclusion Eotaxin and RANTES increase the eosinophil adhesion to fibronectin-coated plates and promote cell degranulation by NO-independent mechanisms. The failure of CC-chemokines to affect VLA-4 and Mac-1 expression suggests that changes in integrin function (avidity or affinity) are rather involved in the enhanced adhesion.

A serological follow-up of toxocariasis patients after chemotherapy based on the detection of IgG, IgA, and IgE antibodies by enzyme-linked immunosorbent assay.

A serological follow-up study was carried out on 27 children (1–12 years old) with visceral and/or ocular toxocariasis, after treatment with thiabendazole. A total of 159 serum samples were collected in a period ranging from 22–116 months. Enzyme-linked immunosorbent assays (IgG, IgA, and IgE ELISA) were standardized, using excretory–secretory antigens obtained from the second-stage larvae of a Toxocara canis culture. The sensitivity found for the IgG, IgA, and IgE ELISA, as determined in visceral toxocariasis patients, was 100%, 47.8%, and 78.3%, respectively. Approximately 84% of the patients presented single or multiple parasitosis, as diagnosed by stool examination, yet such variables did not appear to affect the anti-Toxocara immune response. Titers of specific IgE antibody showed a significant decrease during the first year after treatment, followed by a decrease in the IgA titers in the second year, and in the IgG titers from the fourth year onwards. Sera from all patients presented high avidity IgG antibodies, indicating that they were in the chronic phase of the disease. Moreover, 1 year after treatment, the level of leukocytes, eosinophils, and anti-A isohemagglutinin in patients decreased significantly. The present data suggest that IgE antibodies plus eosinophil counts are helpful parameters for patient followup after chemotherapy.

Endotoxin exposure during sensitization to Blomia tropicalis allergens shifts TH2 immunity towards a TH17-mediated airway neutrophilic inflammation: role of TLR4 and TLR2

Experimental evidence and epidemiological studies indicate that exposure to endotoxin lipopolysaccharide (eLPS) or other TLR agonists prevent asthma. We have previously shown in the OVA-model of asthma that eLPS administration during alum-based allergen sensitization blocked the development of lung TH2 immune responses via MyD88 pathway and IL-12/IFN-γ axis. In the present work we determined the effect of eLPS exposure during sensitization to a natural airborne allergen extract derived from the house dust mite Blomia tropicalis (Bt). Mice were subcutaneously sensitized with Bt allergens co-adsorbed onto alum with or without eLPS and challenged twice intranasally with Bt. Cellular and molecular parameters of allergic lung inflammation were evaluated 24 h after the last Bt challenge. Exposure to eLPS but not to ultrapure LPS (upLPS) preparation during sensitization to Bt allergens decreased the influx of eosinophils and increased the influx of neutrophils to the airways. Inhibition of airway eosinophilia was not observed in IFN-γdeficient mice while airway neutrophilia was not observed in IL-17RA-deficient mice as well in mice lacking MyD88, CD14, TLR4 and, surprisingly, TLR2 molecules. Notably, exposure to a synthetic TLR2 agonist (PamCSK4) also induced airway neutrophilia that was dependent on TLR2 and TLR4 molecules. In the OVA model, exposure to eLPS or PamCSK4 suppressed OVA-induced airway inflammation. Our results suggest that B. tropicalis allergens engage TLR4 that potentiates TLR2 signaling. This dual TLR activation during sensitization results in airway neutrophilic inflammation associated with increased frequency of lung TH17 cells. Our work highlight the complex interplay between bacterial products, house dust mite allergens and TLR signaling in the induction of different phenotypes of airway inflammation.

Effects of MK-801 and amphetamine treatments on allergic lung inflammatory response in mice

Glutamate acts as a neurotransmitter within the Central Nervous System (CNS) and modifies immune cell activity. In lymphocytes, NMDA glutamate receptors regulate intracellular calcium, the production of reactive oxygen species and cytokine synthesis. MK-801, a NMDA receptor open-channel blocker, inhibits calcium entry into mast cells, thereby preventing mast cell degranulation. Several lines of evidence have shown the involvement of NMDA glutamate receptors in amphetamine (AMPH)-induced effects. AMPH treatment has been reported to modify allergic lung inflammation. This study evaluated the effects of MK-801 (0.25mg/kg) and AMPH (2.0mg/kg), given alone or in combination, on allergic lung inflammation in mice and the possible involvement of NMDA receptors in this process. In OVA-sensitized and challenged mice, AMPH and MK-801 given alone decreased cellular migration into the lung, reduced IL-13 and IL10 levels in BAL supernatant, reduced ICAM-1 and L-selectin expression in granulocytes in the BAL and decreased mast cell degranulation. AMPH treatment also decreased IL-5 levels. When both drugs were administered, treatment with MK-801 reversed the decrease in the number of eosinophils and neutrophils induced by AMPH in the BAL of OVA-sensitized and challenged mice as well as the effects on the expression of L-selectin and ICAM-1 in granulocytes, the IL-10, IL-5 and IL-13 levels in BAL supernatants and increased mast cell degranulation. At the same time, treatment with MK-801, AMPH or with MK-801+AMPH increased corticosterone serum levels in allergic mice. These results are discussed in light of possible indirect effects of AMPH and MK-801 via endocrine outflow from the CNS (i.e., HPA-axis activity) to the periphery and/or as a consequence of the direct action of these drugs on immune cell activity, with emphasis given to mast cell participation in the allergic lung response of mice.

Metformin attenuates the exacerbation of the allergic eosinophilic inflammation in high fat-diet-induced obesity in mice

A positive relationship between obesity and asthma has been well documented. The AMP-activated protein kinase (AMPK) activator metformin reverses obesity-associated insulin resistance (IR) and inhibits different types of inflammatory responses. This study aimed to evaluate the effects of metformin on the exacerbation of allergic eosinophilic inflammation in obese mice. Male C57BL6/J mice were fed for 10 weeks with high-fat diet (HFD) to induce obesity. The cell infiltration and inflammatory markers in bronchoalveolar lavage (BAL) fluid and lung tissue were evaluated at 48 h after ovalbumin (OVA) challenge. HFD obese mice displayed peripheral IR that was fully reversed by metformin (300 mg/kg/day, two weeks). OVA-challenge resulted in higher influx of total cell and eosinophils in lung tissue of obese mice compared with lean group. As opposed, the cell number in BAL fluid of obese mice was reduced compared with lean group. Metformin significantly reduced the tissue eosinophil infiltration and prevented the reduction of cell counts in BAL fluid. In obese mice, greater levels of eotaxin, TNF-α and NOx, together with increased iNOS protein expression were observed, all of which were normalized by metformin. In addition, metformin nearly abrogated the binding of NF-κB subunit p65 to the iNOS promoter gene in lung tissue of obese mice. Lower levels of phosphorylated AMPK and its downstream target acetyl CoA carboxylase (ACC) were found in lung tissue of obese mice, which were restored by metformin. In separate experiments, the selective iNOS inhibitor aminoguanidine (20 mg/kg, 3 weeks) and the anti-TNF-α mAb (2 mg/kg) significantly attenuated the aggravation of eosinophilic inflammation in obese mice. In conclusion, metformin inhibits the TNF-α-induced inflammatory signaling and NF-κB-mediated iNOS expression in lung tissue of obese mice. Metformin may be a good pharmacological strategy to control the asthma exacerbation in obese individuals.

Development of screening assays to test novel integrin antagonists in allergic inflammation

Aim of the research: to develop a prototype of homogeneous high-throughput screening (HTS) for identification of novel integrin antagonists for the treatment of ocular allergy and to better understand the mechanisms of action of integrin-mediated levocabastine antiallergic action. Results: This thesis provides evidence that adopting scintillation proximity assay (SPA) levocabastine (IC50=406 mM), but not the first-generation antihistamine chlorpheniramine, displaces [125I]fibronectin (FN) binding to human a4b1 integrin. This result is supported by flow cytometry analysis, where levocabastine antagonizes the binding of a primary antibody to integrin a4 expressed in Jurkat E6.1 cells. Levocabastine, but not chlorpheniramine, binds to a4b1 integrin and prevents eosinophil adhesion to VCAM-1, FN or human umbilical vein endothelial cells (HUVEC) cultured in vitro. Similarly, levocabastine affects aLb2/ICAM-1-mediated adhesion of Jurkat E6.1 cells. Analyzing the supernatant of TNF-a-treated (24h) eosinophilic cells (EoL-1), we report that levocabastine reduces the TNF-a-induced release of the cytokines IL-12p40, IL-8 and VEGF. Finally, in a model of allergic conjunctivitis, levocastine eye drops (0.05%) reduced the clinical aspects of the early and late phase reactions and the conjunctival expression of a4b1 integrin by reducing infiltrated eosinophils. Conclusions: SPA is a highly efficient, amenable to automation and robust binding assay to screen novel integrin antagonists in a HTS setting. We propose that blockade of integrinmediated cell adhesion might be a target of the anti-allergic action of levocabastine and may play a role in preventing eosinophil adhesion and infiltration in allergic conjunctivitis.

Der Einfluss von TGF-beta1 auf regulatorische T-Zellen in einem murinen Modell für Asthma

Ziel der vorliegenden Arbeit war es, den Einfluss von regulatorischen T-Zellen (Treg) auf die Pathogenese des Asthmas in einem murinen Modell zu untersuchen. Es konnte gezeigt werden, dass die Co-Expression von TGF-ß1 und IL-10 auf Treg notwendig ist, um im Tiermodell vor einer Atemwegs-Hyperreagibilität (AHR) zu schützen. Natürliche Treg konnten keinen Schutz vermitteln. Weiterhin wurde gezeigt, dass der Schutz vor AHR durch TGF-ß1 über Empfänger T-Zellen vermittelt wird. Dabei reichte die alleinige Anwesenheit von TGF-ß1 nicht aus, vielmehr musste das Zytokin von Treg exprimiert werden. Ein Einfluss von TGF-ß1 überexprimierenden Treg auf die peribronchiale Entzündung konnte nicht festgestellt werden, wohingegen adoptiver Transfer von natürlichen Treg die Eosinophilen Anzahl in der Bronchiallavage signifikant verringern konnte. Dabei korrelierte die Eosinophilie mit den IL-5 Spiegeln in der Bronchiallavage. In dieser Arbeit konnte also eine Entkopplung der Mechanismen von AHR und Entzündung festgestellt werden. Die weitere Aufklärung der Mechanismen der Suppression der AHR durch TGF-ß1 und IL-10 produzierende Treg könnte daher die Entwicklung neuer therapeutischer Ansätze bei Atemwegserkrankungen ermöglichen.

Biomarkers in chronic obstructive pulmonary diseases. Clinical and functional correlations.

Asthma and chronic obstructive pulmonary disease (COPD) are two distinct lung diseases with distinctive clinical and inflammatory features. A proportion of asthmatic patients experience a fixed airflow obstruction that persists despite optimal pharmacologic treatment for reasons that are still largely unknown. We found that patients with asthma and COPD sharing a similar fixed airflow obstruction have an increased lung function decline and frequency of exacerbations. Nevertheless, the decline in lung function is associated with specific features of the underlying inflammation. Airway inflammation increases during asthma exacerbation and disease severity. Less is known about the correlations between symptoms and airway inflammation in COPD patients. We found that there is no correlation between symptoms and lung function in COPD patients. Nevertheless symptoms changes are associated with specific inflammatory changes: cough is associated with an increase of sputum neutrophils in COPD, dyspnoea is associated with an increase of eosinophils. The mechanisms of this correlation remain unknown. Neutrophils inflammation is associated with bacterial colonization in stable COPD. Is not known whether inhaled corticosteroids might facilitate bacterial colonization in COPD patients. We found that the use of inhaled corticosteroids in COPD patients is associated with an increase of airway bacterial load and with an increase of airway pathogen detection. Bacterial and viral infections are the main causes of COPD and asthma exacerbations. Impaired innate immune responses to rhinovirus infections have been described in adult patients with atopic asthma. Whether this impaired immune condition is present early in life and whether is modulated by a concomitant atopic condition is currently unknown. We found that deficient innate immune responses to rhinovirus infection are already present early in life in atopic patients without asthma and in asthmatic subjects. These findings generalize the scenario of increased susceptibility to viral infections to other Th2 oriented conditions.

Pathogenic role of IL-33-mediated eosinophil infiltration and function in experimental inflammatory bowel disease

IL-33/ST2 axis is known to promote Th2 immune responses and has been linked to several autoimmune and inflammatory disorders, including inflammatory bowel disease (IBD), and recent evidences show that it can regulate eosinophils (EOS) infiltration and function. Based also on the well documented relationship between EOS and IBD, we assessed the role of IL-33-mediated eosinophilia and ileal inflammation in SAMP1/YitFc (SAMP) murine model of Th1/Th2 chronic enteritis, and we found that IL-33 is related to inflammation progression and EOS infiltration as well as IL-5 and eotaxins increase. Administering IL-33 to SAMP and AKR mice augmented eosinophilia, eotaxins mRNA expression and Th2 molecules production, whereas blockade of ST2 and/or typical EOS molecules, such as IL-5 and CCR3, resulted in a marked decrease of inflammation, EOS infiltration, IL-5 and eotaxins mRNA expression and Th2 cytokines production. Human data supported mice’s showing an increased colocalization of IL-33 and EOS in the colon mucosa of UC patients, as well as an augmented IL-5 and eotaxins mRNA expression, when compared to non-UC. Lastly we analyzed SAMP raised in germ free (GF) condition to see the microbiota effect on IL-33 expression and Th2 responses leading to chronic intestinal inflammation. We found a remarkable decrease in ileal IL-33 and Th2 cytokines mRNA expression as well as EOS infiltration in GF versus normal SAMP with comparable inflammatory scores. Moreover, EOS depletion in normal SAMP didn’t affect IL-33 mRNA expression. These data demonstrate a pathogenic role of IL-33-mediated eosinophilia in chronic intestinal inflammation, and that blockade of IL-33 and/or downstream EOS activation may represent a novel therapeutic modality to treat patients with IBD. Also they highlight the gut microbiota role in IL-33 production, and the following EOS infiltration in the intestinal mucosa, confirming that the microbiota is essential in mounting potent Th2 response leading to chronic ileitis in SAMP.

Discovery and Pharmacological Characterization of a Novel Small Molecule Antagonist of Integrin α4β1: Focus on Antiallergic Activity

Allergy is a common hypersensitivity disorder that affects 15% to 20% of the population and its prevalence is increasing worldwide. Its severity correlates with the degree of eosinophil infiltration into the conjunctiva, which is mediated by chemokines that stimulate the production of adhesion molecules like intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) on the endothelial cell surface. The α4β1 and α4β7 integrins are expressed in eosinophils and contribute to their activation and infiltration in AC through the binding to VCAM-1 or fibronectin, expressed on vascular endothelial cells. Blockade of α4 integrins might be a therapeutical achievement in allergic eye diseases. DS 70, that show an IC50 in the nanomolar range against α4β1 integrin in Jurkat cells and in the eosinophilic cell line EOL-1. This compound was able to prevent cell adhesion to VCAM-1 and FN in vitro. In a scintillation proximity assay DS70 displaced 125I-FN binding to human α4β1 integrin and, in flow cytometry analysis, it antagonized the binding of a primary antibody to α4β1 integrin expressed on the Jurkat cells surface as well. Furthermore, we analysed also its effects on integrin α4β1 signalling. In an vivo model of allergic conjunctivitis, topical DS70 reduced the clinical aspects of EPR (early phase reaction) and LPR (late phase reaction), by reducing clinical score, eosinophil accumulation, mRNA levels of cytochines and chemochines pro-inflammatory and the conjunctival expression of α4 integrin. In conclusion, DS70 seems a novel antiallergic ocular agent that has significant effects on both early and late phases of ocular allergy.

Lentivirus-mediated knockdown of Galectin-10 and Foxp3 in human immune cells

Die Suppression von autoreaktiven T-Zellen ist eine Funktion von CD4+CD25+ regulatorischen T-Zellen (CD4+CD25+ Tregs). CD4+CD25+ Tregs unterdrücken autoaggressive Immunantworten. Galectin-10 und Foxp3 sind wichtige Proteine, die an dem supprimierenden Mechanismus der Tregs beteiligt sind. Galectin-10 ist eines der ältesten bekannten humanen Proteine, die nicht in anderen Spezies gefunden worden sind. Foxp3 ist ein Transkriptionsfaktor, der in menschlichen CD4+CD25+ Tregs und in CD4+CD25- T-Effektor-Zellen nach Aktivierung exprimiert wird. Ein siRNA-vermittelter Knockdown dieses intrazellulären löslichen Proteins hebt die supprimierende Funktion der humanen CD4+CD25+ Tregs auf.rnDiese Arbeit beinhaltet in vitro durchgeführte Untersuchungen zur Ermöglichung eines Knockdown von Galectin-10 und/oder Foxp3 in humanisierten Mäusen. Es war möglich, ein Verfahren für die Produktion von lentiviralen Partikeln zu etablierten, die sich als effizientes Vehikel für den Gentransfer in humane Stammzellen und verschiedene Tumor- und Immunzellen erwiesen. Nach der Transduktion von AML14.3D10 Tumorzellen mit GFP-codierenden lentiviralen Partikeln konnte eine langfristige Expression von GFP erreicht werden. Außerdem war es möglich lentivirale Partikel zu erzeugen, die mit shRNA gegen Galectin-10 codiert waren. Die erzeugten Partikel erwiesen sich als funktionell, indem sie eine deutliche Herunterregulation von Galectin-10 in konstitutiv Galectin-10 exprimierenden AML14.3D10 Tumorzellen bewirkten. Unsere Studie präsentierte außerdem eine erstmalige Untersuchung zum Nachweis von Galectin-10-Protein in Eosinophilen aus humanen CD34+ hämatopoetischen Stammzellen (HSC). Diese stabile in vitro Galectin-10-Expression bietet ein alternatives Untersuchungsmodell zu CD4+CD25+ Tregs, die nicht aus CD34+ HSC differenziert werden können. Der zusätzliche Einbau des GFP-Gens in die mit shRNA gegen Galectin-10 codierende lentivirale Partikel war ein wichtiger Schritt zur Markierung von Zellen, die einen Galectin-10-Knockdown aufwiesen. Die neuen bicistronischen lentiviralen Partikel erwiesen sich sowohl in aus CD34+ HSC differenzierten Eosinophilen als auch in AML14.3D10 Zellen, die einen eosinophilen Phänotyp aufweisen, als funktionell. Schließlich konnte mit den bicistronischen lentiviralen Partikeln, die mit GFP und shRNA gegen Foxp3 codiert waren, eine Herunterregulation von Foxp3 in CD4+CD25- T-Effektor-Zellen erreicht werden, was erneut die erfolgreiche Herstellung von funktionellen lentiviralen Partikeln bewies.rn

Evaluation zellulärer Mechanismen der allergen-spezifischen Immuntherapie in einem chronischen Modell der allergischen Atemwegsentzündung

Klinische Studien haben gezeigt, dass die allergenspezifische Immuntherapie (SIT) eine effektive Therapieoption für allergische Erkrankungen ist. Obwohl dieses Therapieverfahren seit über 100 Jahren existiert, sind die zugrunde liegenden Suppressionsmechanismen jedoch nicht vollständig verstanden. Bisher wird angenommen, dass der Behandlungserfolg der SIT auf einer Blockade durch allergenspezifische Antikörper, einer Verschiebung des Th1-Th2-Gleichgewichtes und/oder auf einer Suppression durch regulatorische T-Zellen (Tregs) basiert. Um die Effekte der SIT in einer chronischen Erkrankung in vivo untersuchen zu können, wurde in dieser Doktorarbeit ein Mausmodell für chronisches Asthma entwickelt, das die Situation im Menschen nach einer SIT nachahmt. rnDurch eine SIT war es möglich, allergeninduzierte Asthmasymptome wie Atemwegshyperreagibilität (AHR), Eosinophilie in der Lunge, IgE-Produktion und Atemwegsentzündung im Modell zu unterdrücken. Bemerkenswert ist, dass durch OVA-spezifische Immuntherapie (OVA-IT) ebenfalls eine Verringerung der strukturellen Veränderungen im Lungengewebe im chronischen Krankheitsverlauf erreicht wurde.rnDes Weiteren wurde in diesem Modell nach den Prozessen gesucht, die für die toleranzinduzierende Wirkung der SIT verantwortlich sein können. Dabei wurde im Vergleich zur Placebo-behandelten Gruppe eine erhöhte Antwort spezifischer IgG1-Antikörper, eine verstärkte Th1-Antwort, sowie eine erhöhte Frequenz von FoxP3+ Tregs und von IL-10-produzierenden T-Zellen (Tr1-Zellen) nach OVA-IT festge-stellt. Zur weiteren Untersuchung der von SIT-induzierten T-Zellantworten wurden Mausmodelle des allergischen Asthmas mit einem akuten Verlauf gewählt.rnDie Bedeutung der Th1-Zellen für die SIT wurde in T-bet-/- Mäusen untersucht, welche aufgrund des Fehlens des Transkriptionsfaktors T-bet keine stabile Th1-Antwort induzieren können. Durch SIT war es möglich, allergeninduzierte Asthmasymptome wie AHR, eosinophile Granulozyten in der Lunge, IgE-Produktion und Atemwegsentzündung in den T-bet-/- Tieren im gleichen Maße wie in den Wildtyptieren zu unterdrücken. Diese Untersuchung zeigte, dass die SIT auch ohne funktionelle Th1-Zellen die allergische Entzündung unterdrücken kann. rnDie Rolle der Tregs für die SIT wurde in DO11.10 Mäusen und DO11.10 RAG-/- Mäusen untersucht. In beiden Stämmen konnte nach SIT eine Induktion OVA-spezifischer Tregs nachgewiesen werden. In DO11.10 RAG-/- Mäusen können durch den Knockout im rag2-Gen keine natürlichen, d.h. im Thymus gereiften, Tregs entstehen. Im Blut von DO11.10 RAG-/- Mäusen war direkt nach Durchführung der OVA-IT eine FoxP3+ Treg-Population detektierbar. Demnach wird durch die OVA-IT eine de-novo-Induktion von FoxP3+ Tregs in Gang gesetzt. In Abwesenheit der natürlichen Tregs zeigte sich weiterhin, dass diese Zellen zur Produktion von IL-10 in T-Zellen und somit zum Erfolg der SIT beitragen.rnDie Rolle der FoxP3+ Tregs bei der SIT wurde in DEREG Mäusen untersucht. Eine Depletion der FoxP3+ Tregs in DEREG Mäusen während der Durchführung der OVA-IT hob die protektiven Effekte der Therapie jedoch nur teilweise auf. rnUm die Rolle des regulatorischen Zytokins IL-10 bei der SIT zu untersuchen, wurde ein blockierender Antikörper gegen den IL-10-Rezeptor (anti-IL-10R) im chronischen Modell des allergischen Asthmas mit SIT angewendet. Anti-IL-10R hob die protektive Wirkung der SIT auf die AHR, die Atemwegsentzündung und die strukturellen Veränderungen im Lungengewebe auf. Somit ist die protektive Wirkung der SIT abhängig vom IL-10-Signalweg.rnZusammenfassend stellt diese Arbeit die Bedeutung der SIT für allergische Erkrankungen heraus. SIT kann durch die positive Beeinflussung der allergiebedingten, strukturellen Veränderungen in der Lunge auch für Asthmapatienten große Vorteile bringen. Die aus Studien bekannten Mechanismen konnten im Modell bestätigt werden und wurden im weiteren Verlauf untersucht. Die Arbeit stellt im Besonderen die Bedeutung der IL-10-produzierenden und FoxP3+ Tregs für die Effektivität der SIT in den Vordergrund. Zudem ist durch die Etablierung eines neuen Mausmodells der SIT für chronisches allergisches Asthma ein Mittel zur weiteren Erforschung der zugrunde liegenden Prozesse dieser erfolgreichen Therapie geschaffen worden. rn

Drug hypersensitivity reactions involving skin

Immune reactions to drugs can cause a variety of diseases involving the skin, liver, kidney, lungs, and other organs. Beside immediate, IgE-mediated reactions of varying degrees (urticaria to anaphylactic shock), many drug hypersensitivity reactions appear delayed, namely hours to days after starting drug treatment, showing a variety of clinical manifestations from solely skin involvement to fulminant systemic diseases which may be fatal. Immunohistochemical and functional studies of drug-specific T cells in patients with delayed reactions confirmed a predominant role for T cells in the onset and maintenance of immune-mediated delayed drug hypersensitivity reactions (type IV reactions). In these reactions, drug-specific CD4+ and CD8+ T cells are stimulated by drugs through their T cell receptors (TCR). Drugs can stimulate T cells in two ways: they can act as haptens and bind covalently to larger protein structures (hapten-carrier model), inducing a specific immune response. In addition, they may accidentally bind in a labile, noncovalent way to a particular TCR of the whole TCR repertoire and possibly also major histocompatibility complex (MHC)-molecules - similar to their pharmacologic action. This seems to be sufficient to reactivate certain, probably in vivo preactivated T cells, if an additional interaction of the drug-stimulated TCR with MHC molecules occurs. The mechanism was named pharmacological interaction of a drug with (immune) receptor and thus termed the p-i concept. This new concept may explain the frequent skin symptoms in drug hypersensitivity to oral or parenteral drugs. Furthermore, the various clinical manifestations of T cell-mediated drug hypersensitivity may be explained by distinct T cell functions leading to different clinical phenotypes. These data allowed a subclassification of the delayed hypersensitivity reactions (type IV) into T cell reactions which, by releasing certain cytokines and chemokines, preferentially activate and recruit monocytes (type IVa), eosinophils (type IVb), or neutrophils (type IVd).