Uso de lisados bacterianos en la prevención de la infección respiratoria recurrente en pediatría. Revisión sistemática de la literatura

Las infecciones respiratorias altas y bajas son una causa común de morbimortalidad infantil. Se ha propuesto el uso de los lisados bacterianos para prevenir las infecciones recurrentes sin embargo su uso aún se considera controversial. Metodología: Se realizó una revisión sistemática de la literatura. La búsqueda se realizó a través de las bases de datos PUBMED, Embase, Ovid, LiLaCS y Cochrane library plus. Se incluyeron metanálisis publicados en idiomas inglés y español, entre los años 1998 y 2012. Se realizó una evaluación de calidad siguiendo la estrategia Quorum y un análisis cualitativo y cuantitativo de los resultados. Resultados: Se incluyeron 4 revisiones sistemáticas de la literatura con metanálisis. Fue apreciable la disminución de las recurrencias de las infecciones respiratorias relacionadas con el uso de los lisados bacterianos. Los lisados bacterianos disminuyen la necesidad de uso de antibióticos. No se encontró evidencia sobre el uso de los lisados sobre desenlaces como la necesidad de intervenciones adicionales, tiempo de hospitalización, costo relacionado con la atención en salud. No se reportaron eventos adversos de importancia. Conclusión: Los lisados bacterianos son eficaces en disminuir la recurrencia de las infecciones respiratorias en pacientes en edad pediátrica.

Immunosenescence, Aging, and Systemic Lupus Erythematous

Senescence is a normal biological process that occurs in all organisms and involves a decline in cell functions. This process is caused by molecular regulatory machinery alterations, and it is closely related to telomere erosion in chromosomes. In the context of the immune system, this phenomenon is known as immunosenescence and refers to the immune function deregulation. Therefore, functions of several cells involved in the innate and adaptive immune responses are severely compromised with age progression (e.g., changes in lymphocyte subsets, decreased proliferative responses, chronic inflammatory states, etc.). These alterations make elderly individuals prone to not only infectious diseases but also to malignancy and autoimmunity. This review will explore the molecular aspects of processes related to cell aging, their importance in the context of the immune system, and their participation in elderly SLE patients

MicroRNA-3148 Modulates Allelic Expression of Toll-Like Receptor 7 Variant Associated with Systemic Lupus Erythematosus

We previously reported that the G allele of rs3853839 at 3′untranslated region (UTR) of Toll-like receptor 7 (TLR7) was associated with elevated transcript expression and increased risk for systemic lupus erythematosus (SLE) in 9,274 Eastern Asians [P = 6.5×10−10, odds ratio (OR) (95%CI) = 1.27 (1.17–1.36)]. Here, we conducted trans-ancestral fine-mapping in 13,339 subjects including European Americans, African Americans, and Amerindian/Hispanics and confirmed rs3853839 as the only variant within the TLR7-TLR8 region exhibiting consistent and independent association with SLE (Pmeta = 7.5×10−11, OR = 1.24 [1.18–1.34]). The risk G allele was associated with significantly increased levels of TLR7 mRNA and protein in peripheral blood mononuclear cells (PBMCs) and elevated luciferase activity of reporter gene in transfected cells. TLR7 3′UTR sequence bearing the non-risk C allele of rs3853839 matches a predicted binding site of microRNA-3148 (miR-3148), suggesting that this microRNA may regulate TLR7 expression. Indeed, miR-3148 levels were inversely correlated with TLR7 transcript levels in PBMCs from SLE patients and controls (R2 = 0.255, P = 0.001). Overexpression of miR-3148 in HEK-293 cells led to significant dose-dependent decrease in luciferase activity for construct driven by TLR7 3′UTR segment bearing the C allele (P = 0.0003). Compared with the G-allele construct, the C-allele construct showed greater than two-fold reduction of luciferase activity in the presence of miR-3148. Reduced modulation by miR-3148 conferred slower degradation of the risk G-allele containing TLR7 transcripts, resulting in elevated levels of gene products. These data establish rs3853839 of TLR7 as a shared risk variant of SLE in 22,613 subjects of Asian, EA, AA, and Amerindian/Hispanic ancestries (Pmeta = 2.0×10−19, OR = 1.25 [1.20–1.32]), which confers allelic effect on transcript turnover via differential binding to the epigenetic factor miR-3148.

Identification of plasmodium vivax proteins with potential role in invasion using sequence redundancy reduction and profile hidden markov models

Background: This study describes a bioinformatics approach designed to identify Plasmodium vivax proteins potentially involved in reticulocyte invasion. Specifically, different protein training sets were built and tuned based on different biological parameters, such as experimental evidence of secretion and/or involvement in invasion-related processes. A profile-based sequence method supported by hidden Markov models (HMMs) was then used to build classifiers to search for biologically-related proteins. The transcriptional profile of the P. vivax intra-erythrocyte developmental cycle was then screened using these classifiers. Results: A bioinformatics methodology for identifying potentially secreted P. vivax proteins was designed using sequence redundancy reduction and probabilistic profiles. This methodology led to identifying a set of 45 proteins that are potentially secreted during the P. vivax intra-erythrocyte development cycle and could be involved in cell invasion. Thirteen of the 45 proteins have already been described as vaccine candidates; there is experimental evidence of protein expression for 7 of the 32 remaining ones, while no previous studies of expression, function or immunology have been carried out for the additional 25. Conclusions: The results support the idea that probabilistic techniques like profile HMMs improve similarity searches. Also, different adjustments such as sequence redundancy reduction using Pisces or Cd-Hit allowed data clustering based on rational reproducible measurements. This kind of approach for selecting proteins with specific functions is highly important for supporting large-scale analyses that could aid in the identification of genes encoding potential new target antigens for vaccine development and drug design. The present study has led to targeting 32 proteins for further testing regarding their ability to induce protective immune responses against P. vivax malaria.

Efectividad de la vacuna acelular antipertussis en adolescentes: una revisión sistemática

La incidencia de la tosferina ha mostrado un incremento en los últimos años; afectando predominantemente a los niños menores de 1 año, adolescentes y adultos. En el 2005 el Comité Asesor de Prácticas en Inmunización (ACIP) recomendó administrar una dosis de refuerzo de la vacuna acelular antipertussis a los adolescentes. Esta estrategia ha sido adoptada por distintos países. Sin embargo hasta el momento no existe una revisión sistemática que evalúe la efectividad de esta medida de prevención primaria. Métodos: Revisión sistemática de la literatura de artículos acerca de la efectividad de la vacuna acelular antipertussis como dosis de refuerzo en adolescentes. Resultados: La búsqueda inicial arrojó un total de 121 resultados, de los cuales solo 4 cumplieron los criterios de selección. Se evaluó en éstos, la inmunogenicidad generada contra tétanos y difteria por la vacuna Tdap vs Td con resultados significativos y similares. Además se documentó la respuesta inmunológica protectora generada por la Tdap contra tosferina. En cuanto a la reactogenicidad, en general fue baja. Discusión: La vacuna Tdap genera inmunogenicidad similar a la Td contra tétanos y difteria. Además proporciona adecuada protección contra la tosferina como dosis de refuerzo en los adolescentes. Conclusión: La evidencia disponible sugiere que se puede recomendar la vacuna Tdap como dosis de refuerzo en adolescentes entre los 10 y los 18 años de edad por su baja reactogenicidad y adecuada inmunogenicidad contra tétanos, difteria y B. Pertussis.

Teoría de conjuntos aplicada a la caracterización matemática de unión de péptidos al HLA clase II

Las bases moleculares para el reconocimiento y la respuesta inmune están en la presentación de péptidos antigénicos. Se utilizaron la teoría de conjuntos y los datos experimentales para realizar una caracterización matemática de la región central de unión del péptido mediante la definición de 8 reglas asociadas a la unión al HLA clase II. Estas reglas se aplicaron a 4 péptidos promiscuos, 25 secuencias peptídicas naturales de la región central, de las cuales 13 presentaron unión, mientras que los demás no, y 19 péptidos sintéticos buscando diferenciar los péptidos. A excepción de uno, todos los péptidos de unión y no unión fueron caracterizados acertadamente. Esta metodología puede ser útil para escoger péptidos clave en el desarrollo de vacunas.

Genotipificación de HLA-B en pacientes colombianos afectados por el síndrome Stevens-Johnson y la Necrólisis Epidérmica Tóxica

Las reacciones alérgicas a medicamentos cutáneas severas (RAM) como el Síndrome Stevens Johnson (SJS) y la Necrólisis Epidérmica Tóxica (NET),caracterizadas por exantema, erosión de la piel y las membranas mucosas, flictenas, desprendimiento de la piel secundario a la muerte de queratinocitos y compromiso ocular. Son infrecuentes en la población pero con elevada morbi-mortalidad, se presentan luego de la administración de diferentes fármacos. En Asia se ha asociado el alelo HLA-B*15:02 como marcador genético para SJS. En Colombia no hay datos de la incidencia de estas RAM, ni de la relación con medicamentos específicos o potenciales y tampoco estudios de aproximación genómica de genes de susceptibilidad.

Inmunoterapia en pacientes con cáncer de pulmón de células no pequeñas versus terapia convencional. Revisión sistemática

RESUMEN Antecedentes y Justificación: El cáncer de pulmón es la principal causa de muerte relacionada con Cáncer en el mundo. El cáncer pulmonar de células no pequeñas (Non-Small-cell lung cancer NSCLC) representa el 85% de todos los cánceres de pulmón y en un 40% es diagnosticado tardíamente y con los tratamientos disponibles actualmente (cirugía, radioterapia y quimioterapia) presenta una supervivencia a 5 años entre el 10 y el 15%. En los últimos años han surgido nuevos tratamientos basados en la inmunoterapia que prometen mejorar la supervivencia de estos pacientes. Objetivo: Determinar la eficacia de la inmunoterapia en el tratamiento del cáncer de pulmón de células no pequeñas (NSCLC) con el fin de integrar la información disponible para su posterior uso en la clínica. Metodología: Se realizó búsqueda exhaustiva de la literatura disponible del 1 de Enero de 2003 al 31 de Diciembre de 2013. Se examinaron las siguientes bases de datos: Pubmed, Scielo, Medline, Lilacs, EMBASE, Bandolier, peDRO y Cochrane. Se utilizaron los términos MeSH de búsqueda: immunotherapy, NSCLC, clinical trials. Resultados: de 163 referencias identificadas en las bases de datos, 12 fueron seleccionadas para la revisión. Se identificaron 11 estrategias inmunoterapéuticas que fueron complementarias al uso de quimioterapia, radioterapia o ambas. No se encontró diferencia significativa entre la supervivencia global de los grupos de intervención y controles con excepción de 1 artículo. La mayoría de efectos secundarios fueron de leves a moderados y no hubo diferencias significativas entre los grupos. Discusión: no se evidenció un aumento significativo de la supervivencia global con la utilización de inmunoterapias, a excepción de la que emplea células asesinas inducidas por citocinas junto a células dendríticas. Sin embargo es necesario esperar resultados de estudios fase III en curso.

Proporción de pacientes que presentan hipotermia peri operatoria durante un reemplazo articular de cadera, rodilla u hombro

Introducción: La hipotermia perioperatoria se ha documentado como factor de riesgo para el aumento de la morbimortalidad de los pacientes aumentando morbilidad miocárdica, riesgo de infección, pérdidas sanguíneas y tiempo de hospitalización. La aplicación de anestésicos toma relevancia ya que causa la pérdida de control central de la temperatura. Nuestro objetivo con este estudio fue describir la proporción de casos de hipotermia en la población sometida a un reemplazo articular durante un periodo de cuatro meses. Materiales y métodos: Se realizó un estudio de cohorte prospectivo. La población a estudio fueron los pacientes que fueron sometidos a un reemplazo total de cadera, rodilla u hombro. Se registró la temperatura central en el momento previo a la inducción anestésica, 30, 60 y 90 minutos después, al finalizar el procedimiento y al ingresar a recuperación. Se reportó el porcentaje de pacientes con hipotermia en cada tiempo. Resultados: Se analizaron en total 88 pacientes, el 55,7% fue llevado a cirugía de cadera, 39,7% de rodilla y 4,5% de hombro. El tipo de anestesia más utilizado fue general y la duración promedio de anestesia fue 164 minutos. La medición de la temperatura central se realizó en nasofaringe, esófago o tímpano. La proporción de pacientes que presentaron hipotermia en la inducción fue 21,6%, a 30 minutos 83%, a 60 minutos 73,9%, a 90 minutos 68,2%, al finalizar 59,1% y en recuperación 58%. Se realizó una prueba Chi cuadrado comparando las proporciones entre la inducción y los cinco periodos posteriores, se encontró que la proporción de pacientes con hipotermia en los cinco tiempos posteriores tuvo una diferencia estadísticamente significativa (p=0,00) comparada con la proporción de pacientes con hipotermia durante la inducción. Conclusión: En los pacientes sometidos a un reemplazo articular la hipotermia fue una condición prevalente posterior a la aplicación de los anestésicos sistémicos. Los dispositivos de calentamiento intraoperatorio usados actualmente son insuficientes para evitar la hipotermia, lo que indica concordancia con la literatura en cuanto a las recomendaciones de calentamiento perioperatorio, con énfasis en el precalentamiento, para prevenir la caída significativa de la temperatura y la morbimortalidad asociada.

Syk-Dependent Cytokine Induction by Dectin-1 Reveals a Novel Pattern Recognition Pathway for C Type Lectins

Pattern-recognition receptors (PRRs) detect molecular signatures of microbes and initiate immune responses to infection. Prototypical PRRs such as Toll-like receptors (TLRs) signal via a conserved pathway to induce innate response genes. In contrast, the signaling pathways engaged by other classes of putative PRRs remain ill defined. Here, we demonstrate that the β-glucan receptor Dectin-1, a yeast binding C type lectin known to synergize with TLR2 to induce TNFα and IL-12, can also promote synthesis of IL-2 and IL-10 through phosphorylation of the membrane proximal tyrosine in the cytoplasmic domain and recruitment of Syk kinase. syk−/− dendritic cells (DCs) do not make IL-10 or IL-2 upon yeast stimulation but produce IL-12, indicating that the Dectin-1/Syk and Dectin-1/TLR2 pathways can operate independently. These results identify a novel signaling pathway involved in pattern recognition by C type lectins and suggest a potential role for Syk kinase in regulation of innate immunity.

The pathology of Plasmodium chabaudi infection is not ameliorated by the secreted filarial nematode immunomodulatory molecule, ES-62

ES-62 is a phosphorylcholine-containing glycoprotein secreted by filarial nematodes. This molecule has been shown to reduce the severity of inflammation in collagen-induced arthritis (CIA) in mice, a model of rheumatoid arthritis, via down-regulation of anti-collagen type 1 immune responses. Malaria parasites induce a pro-inflammatory host immune response and many of the symptoms of malaria are immune system-mediated. Therefore we have asked whether the immunomodulatory properties of ES-62 can down-regulate the severity of malaria infection in BALB/c mice infected with Plasmodium chabaudi. We have found that ES-62 has no significant effect on the course of P. chabaudi parasitaemia, and does not significantly affect any of the measures of malaria-induced pathology taken throughout infection.

In vitro immunomodulatory activity of Lactobacillus fermentum CECT5716 and Lactobacillus salivarius CECT5713: two probiotic strains isolated from human breast milk

Commensal bacteria, including some species of lactobacilli commonly present in human breast milk, appear to colonize the neonatal gut and contribute to protection against infant infections, suggesting that lactobacilli could potentially modulate immunity. In this study, we evaluated the potential of two Lactobacillus strains isolated from human milk to modulate the activation and cytokine profile of peripheral blood mononuclear cell (PBMC) subsets in vitro. Moreover, these effects were compared to the same probiotic species of non-milk origin. Lactobacillus salivarius CECT5713 and Lactobacillus fermentum CECT5716 at 105, 106 and 107 bacteria/mL were co-cultured with PBMC (106/mL) from 8 healthy donors for 24 h. Activation status (CD69 and CD25 expressions) of natural killer (NK) cells (CD56+), total T cells (CD3+), cytotoxic T cells (CD8+) and CD4+ T cells was determined by flow cytometry. Regulatory T cells (Treg) were also quantified by intracellular Foxp3 evaluation. Regarding innate immunity, NK cells were activated by addition of both Lactobacillus strains, and in particular, the CD8+ NK subset was preferentially induced to highly express CD69 (90%, p<0.05). With respect to acquired immunity, approximately 9% of CD8+ T cells became activated after co-cultivation with L. fermentum or L salivarius. Although CD4+ T cells demonstrated a weaker response, there was a preferential activation of Treg cells (CD4+CD25+Foxp3+) after exposure to both milk probiotic bacteria (p<0.05). Both strains significantly induced the production of a number of cytokines and chemokines, including TNFα, IL-1β, IL-8, MIP-1α, MIP-1β, and GM-CSF, but some strain-specific effects were apparent. This work demonstrates that L salivarius CECT5713 and L. fermentum CECT5716 enhanced both natural and acquired immune responses, as evidenced by the activation of NK and T cell subsets and the expansion of Treg cells, as well as the induction of a broad array of cytokines.

Weaning diet induces sustained metabolic phenotype shift in the pig and influences host response to Bifidobacterium lactis NCC2818

Background The process of weaning causes a major shift in intestinal microbiota and is a critical period for developing appropriate immune responses in young mammals.Objective To use a new systems approach to provide an overview of host metabolism and the developing immune system in response to nutritional intervention around the weaning period.Design Piglets (n=14) were weaned onto either an egg-based or soya-based diet at 3 weeks until 7 weeks, when all piglets were switched onto a fish-based diet. Half the animals on each weaning diet received Bifidobacterium lactis NCC2818 supplementation from weaning onwards. Immunoglobulin production from immunologically relevant intestinal sites was quantified and the urinary (1)H NMR metabolic profile was obtained from each animal at post mortem (11 weeks).Results Different weaning diets induced divergent and sustained shifts in the metabolic phenotype, which resulted in the alteration of urinary gut microbial co-metabolites, even after 4 weeks of dietary standardisation. B lactis NCC2818 supplementation affected the systemic metabolism of the different weaning diet groups over and above the effects of diet. Additionally, production of gut mucosa-associated IgA and IgM was found to depend upon the weaning diet and on B lactis NCC2818 supplementation.ConclusionThe correlation of urinary (1)H NMR metabolic profile with mucosal immunoglobulin production was demonstrated, thus confirming the value of this multi-platform approach in uncovering non-invasive biomarkers of immunity. This has clear potential for translation into human healthcare with the development of urine testing as a means of assessing mucosal immune status. This might lead to early diagnosis of intestinal dysbiosis and with subsequent intervention, arrest disease development. This system enhances our overall understanding of pathologies under supra-organismal control.

Isolation of recombinant antibodies against EspA and intimin of Escherichia coli O157:H7

Intimin, Tir, and EspA proteins are expressed by attaching-effacing Escherichia coli, which include enteropathogenic and enterohemorrhagic E. coli pathotypes. EspA proteins are part of the type three secretion system needle complex that delivers Tir to the host epithelial cell, while surface arrayed intimin docks the bacterium to the translocated Tir. This intimate attachment leads to attaching and effacing lesions. Recombinant forms of these effector proteins from enterohemorrhagic E. coli O157:H7 were produced by using E. coli expression vectors. Binding of intimin and Tir fragments in enzyme-linked immunosorbent assay (ELISAs) demonstrated the interaction of intimin fragments containing the C-terminal 282 or 188 amino acids to a Tir fragment containing amino acid residues 258 to 361. Recombinant intimin and EspA proteins were used to elicit immune responses in rabbits and immune phage-display antibody libraries were produced. Screening of these immune libraries by conventional phage-antibody panning and colony filter screening produced a panel of antibodies with specificity for EspA or intimin. Antibodies recognizing different C-terminal epitopes on intimin bound specifically to the gamma intimin of O157:H7 and not to other classes of intimin. Antibodies recognizing EspA from E. coli O157 also recognized the protein from the eae-deficient O157 mutant DM3 and from E. coli O111. Anti-intimin antibodies were also produced as fusion proteins coupled to the reporter molecule alkaline phosphatase, allowing the one-step detection of gamma intimin. The isolated recombinant monoclonal antibodies were functional in a range of assay formats, including ELISA, Western blotting, and dot blots, thus demonstrating their diagnostic potential.

Weaning diet induces sustained metabolic phenotype shift in the pig and influences host response to Bifidobacterium lactis NCC2818

Background: The process of weaning causes a major shift in intestinal microbiota and is a critical period for developing appropriate immune responses in young mammals. Objective: To use a new systems approach to provide an overview of host metabolism and the developing immune system in response to nutritional intervention around the weaning period. Design: Piglets (n¼14) were weaned onto either an eggbased or soya-based diet at 3 weeks until 7 weeks, when all piglets were switched onto a fish-based diet. Half the animals on each weaning diet received Bifidobacterium lactis NCC2818 supplementation from weaning onwards. Immunoglobulin production from immunologically relevant intestinal sites was quantified and the urinary 1H NMR metabolic profile was obtained from each animal at post mortem (11 weeks). Results: Different weaning diets induced divergent and sustained shifts in the metabolic phenotype, which resulted in the alteration of urinary gut microbial co-metabolites, even after 4 weeks of dietary standardisation. B lactis NCC2818 supplementation affected the systemic metabolism of the different weaning diet groups over and above the effects of diet. Additionally, production of gut mucosa-associated IgA and IgM was found to depend upon the weaning diet and on B lactis NCC2818 supplementation. Conclusion: The correlation of urinary 1H NMR metabolic profile with mucosal immunoglobulin production was demonstrated, thus confirming the value of this multiplatform approach in uncovering non-invasive biomarkers of immunity. This has clear potential for translation into human healthcare with the development of urine testing as a means of assessing mucosal immune status. This might lead to early diagnosis of intestinal dysbiosis and with subsequent intervention, arrest disease development. This system enhances our overall understanding of pathologies under supra-organismal control.