Diagnostic accuracy of G-CSF, IL-8, and IL-1ra in critically ill children with suspected infection.

OBJECTIVE: To elucidate the diagnostic accuracy of granulocyte colony-stimulating factor (G-CSF), interleukin-8 (IL-8), and interleukin-1 receptor antagonist (IL-1ra) in identifying patients with sepsis among critically ill pediatric patients with suspected infection. DESIGN AND SETTING: Nested case-control study in a multidisciplinary neonatal and pediatric intensive care unit (PICU) PATIENTS: PICU patients during a 12-month period with suspected infection, and plasma available from the time of clinical suspicion (254 episodes, 190 patients). MEASUREMENTS AND RESULTS: Plasma levels of G-CSF, IL-8, and IL-1ra. Episodes classified on the basis of clinical and bacteriological findings into: culture-confirmed sepsis, probable sepsis, localized infection, viral infection, and no infection. Plasma levels were significantly higher in episodes of culture-confirmed sepsis than in episodes with ruled-out infection. The area under the receiver operating characteristic curve was higher for IL-8 and G-CSF than for IL-1ra. Combining IL-8 and G-CSF improved the diagnostic performance, particularly as to the detection of Gram-negative sepsis. Sensitivity was low (<50%) in detecting Staphylococcus epidermidis bacteremia or localized infections. CONCLUSIONS: In this heterogeneous population of critically ill children with suspected infection, a model combining plasma levels of IL-8 and G-CSF identified patients with sepsis. Negative results do not rule out S. epidermidis bacteremia or locally confined infectious processes. The model requires validation in an independent data-set.

Elf-1 contributes to the function of the complex interleukin (IL)-2-responsive enhancer in the mouse IL-2 receptor alpha gene.

Lymphocytes regulate their responsiveness to IL-2 through the transcriptional control of the IL-2R alpha gene, which encodes a component of the high affinity IL-2 receptor. In the mouse IL-2R alpha gene this control is exerted via two regulatable elements, a promoter proximal region, and an IL-2-responsive enhancer (IL-2rE) 1.3 kb upstream. In vitro and in vivo functional analysis of the IL-2rE in the rodent thymic lymphoma-derived, CD4- CD8- cell line PC60 demonstrated that three separate elements, sites I, II, and III, were necessary for IL-2 responsiveness; these three sites demonstrate functional cooperation. Site III contains a consensus binding motif for members of the Ets family of transcription factors. Here we demonstrate that Elf-1, an Ets-like protein, binds to site III and participates in IL-2 responsiveness. In vitro site III forms a complex with a protein constitutively present in nuclear extracts from PC60 cells as well as from normal CD4- CD8- thymocytes. We have identified this molecule as Elf-1 according to a number of criteria. The complex possesses an identical electrophoretic mobility to that formed by recombinant Elf-1 protein and is super-shifted by anti-Elf-1 antibodies. Biotinylated IL-2rE probes precipitate Elf-1 from PC60 extracts provided site III is intact and both recombinant and PC60-derived proteins bind with the same relative affinities to different mutants of site III. In addition, by introducing mutations into the core of the site III Ets-like motif and comparing the corresponding effects on the in vitro binding of Elf-1 and the in vivo IL-2rE activity, we provide strong evidence that Elf-1 is directly involved in IL-2 responsiveness. The nature of the functional cooperativity observed between Elf-1 and the factors binding sites I and II remains unresolved; experiments presented here however suggest that this effect may not require direct interactions between the proteins binding these three elements.

IRF4 regulates IL-17A promoter activity and controls RORγt-dependent Th17 colitis in vivo.

Background: The transcription factor IRF4 is involved in several T-cell-dependent chronic inflammatory diseases. To elucidate the mechanisms for pathological cytokine production in colitis, we addressed the role of the IRF transcription factors in human inflammatory bowel disease (IBD) and experimental colitis.Methods: IRF levels and cytokine production in IBD patients were studied as well as the effects of IRF4 deficiency in experimental colitis.Results: In contrast to IRF1, IRF5, and IRF8, IRF4 expression in IBD was augmented in the presence of active inflammation. Furthermore, IRF4 levels significantly correlated with IL-6 and IL-17 mRNA expression and to a lesser extent with IL-22 mRNA expression in IBD. To further explore the role of IRF4 under in vivo conditions, we studied IRF4-deficient and wildtype mice in experimental colitis. In contrast to DSS colitis, IRF4 deficiency was protective in T-cell-dependent transfer colitis associated with reduced ROR alpha/gamma t levels and impaired IL-6, IL-17a, and IL-22 production, suggesting that IRF4 acts as a master regulator of mucosal Th17 cell differentiation. Subsequent mechanistic studies using database analysis, chromatin immunoprecipitation, and electrophoretic mobility shift assays identified a novel IRF4 binding site in the IL-17 gene promoter. Overexpression of IRF4 using retroviral infection induced IL-17 production and IL-17 together with IL-6 induced ROR gamma t expression.Conclusions: IRF4 can directly bind to the IL-17 promotor and induces mucosal ROR gamma t levels and IL-17 gene expression thereby controlling Th17-dependent colitis. Targeting of this molecular mechanism may lead to novel therapeutic approaches in human IBD.

L'Ancien Testament légitime-t-il un "droit du sol" ou un "droit du sang"?

(Résumé de l'ouvrage) Résister aux extrémismes racistes et xénophobes : c'est dans une telle perspective que cet ouvrage s'inscrit. Ecrit à plusieurs voix, dans une pluralité d'approches historique, théologique, témoignages..., ce livre aide chaque lecteur à débusquer la tentation du rejet de l'autre, à se forger une opinion sur cette question, à nourrir ses engagements, à discerner les chemins de sa fidélité ; il appelle aussi chaque communauté à devenir lieu de guérison, de réconciliation et de pardon. Le livre ne fait pas de l'Evangile une valeur d'où le lecteur déduirait des valeurs opposables à l'idéologie de l'extrême droite, mais il le recentre sur l'essentiel : la rencontre avec le Christ, l'écoute de sa Parole qui toujours et d'abord appelle à sa propre conversion. C'est donc fondamentalement une parole théologique qui résonne ici."

IL-13 induces expression of CD36 in human monocytes through PPARgamma activation.

The class B scavenger receptor CD36 is a component of the pattern recognition receptors on monocytes that recognizes a variety of molecules. CD36 expression in monocytes depends on exposure to soluble mediators. We demonstrate here that CD36 expression is induced in human monocytes following exposure to IL-13, a Th2 cytokine, via the peroxisome proliferator-activated receptor (PPAR)gamma pathway. Induction of CD36 protein was paralleled by an increase in CD36 mRNA. The PPARgamma pathway was demonstrated using transfection of a PPARgamma expression plasmid into the murine macrophage cell line RAW264.7, expressing very low levels of PPARgamma, and in peritoneal macrophages from PPARgamma-conditional null mice. We also show that CD36 induction by IL-13 via PPARgamma is dependent on phospholipase A2 activation and that IL-13 induces the production of endogenous 15-deoxy-Delta12,14-prostaglandin J2, an endogenous PPARgamma ligand, and its nuclear localization in human monocytes. Finally, we demonstrate that CD36 and PPARgamma are involved in IL-13-mediated phagocytosis of Plasmodium falciparum-parasitized erythrocytes. These results reveal a novel role for PPARgamma in the alternative activation of monocytes by IL-13, suggesting that endogenous PPARgamma ligands, produced by phospholipase A2 activation, could contribute to the biochemical and cellular functions of CD36.

Constitutive expression of a chimeric receptor that delivers IL-2/IL-15 signals allows antigen-independent proliferation of CD8+CD44high but not other T cells.

We have prepared transgenic mice whose T cells constitutively express a chimeric receptor combining extracellular human IL-4R and intracellular IL-2Rbeta segments. This receptor can transmit IL-2/IL-15-like signals in response to human, but not mouse, IL-4. We used these animals to explore to what extent functional IL-2R/IL-15R expression controls the capacity of T cells to proliferate in response to IL-2/IL-15-like signals. After activation with Con A, naive transgenic CD8+ and CD4+ T cells respond to human IL-4 as well as to IL-2. Without prior activation, they failed to proliferate in response to human IL-4, although human IL-4 did prolong their survival. Thus, IL-2-induced proliferation of activated T cells requires at least one other Ag-induced change apart from the induction of a functional IL-2R. However, a fraction of CD8+CD44high T cells proliferate in human IL-4 without antigenic stimulation or syngeneic feeder cells. In contrast, CD4+CD44high T cells are not constitutively responsive to human IL-4. We conclude that although all transgenic T cells express a functional chimeric receptor, only some CD8+CD44high T cells contain all molecules required for entry into the cell cycle in response to human IL-4 or IL-15.

Interleukin-4 (IL-4) and interferon-gamma (IFN-gamma) in pregnant C57BL/6 mice infected with L. major at different gestational periods.

BACKGROUND AND OBJECTIVE: To assess if gestational factors affect the resistance of C57BL/6 mice to L major infection, this study determined the levels of IL-4 and IFN-gamma in popliteal lymph node cells of pregnant C57BL/6 mice infected with L. major at 16 hours, 5 days-, 10 days- and 15 days- post plug by PCR, ELISA and BIOASSAY. DESIGN/SETTING: Experimental. RESULTS: Infected pregnant C57BL/6 mice developed larger cutaneous footpad lesions compared with non-pregnant C57BL/6 mice (that showed signs of resolution 7-10 weeks after infection). But, the lesions in infected pregnant C57BL/6 mice and infected non-pregnant C57BL/6 mice were not as large as in susceptible BALB/c mice. The mean litter weight was also reduced in pregnant infected C57BL/6 mice particularly in the groups infected at later stages of pregnancy (day 10- and day 15-post plug). The levels of both IL-4 and IFN-gamma increased with gestation in pregnant infected C57BL/6 mice compared with pregnant non-infected group, while only IL-4 was raised in pregnant infected mice compared with infected non pregnant mice. CONCLUSIONS: It may be concluded that increased IL-4 in pregnant infected C57BL/6 mice caused the transient susceptibility to L major infection while reduced litter weight was associated with increased IFN-gamma. These effects were pronounced in C57BI/6 mice infected with L major in late pregnancy.

Fractures non traumatiques liées à la grossesse et à l'allaitement : s'agit-il toujours d'une ostéoporose? A propos de 2 cas

Introduction : L'ostéoporose et/ou les fractures liées à la grossesse sont souvent sous-diagnostiquées. Nous rapportons 2 cas de fractures diagnostiquées peu après l'accouchement de 2èmes grossesses. Patientes. Cas 1. Patiente de 30 ans présentant des dorso-lombalgies à la fin de sa 2ème grossesse. Une IRM après l'accouchement montre 2 fractures vertébrales (L1 et L2). Densité minérale osseuse (DMO): T-score colonne: -3.9 DS, col fémoral -1.7 DS et hanche totale -0.6 DS. Cas 2. Patiente de 32 ans, présentant des douleurs fessières à la fin de sa 2ème grossesse. L'IRM pelvienne après l'accouchement montre une fracture de l'aile sacrée droite S1-S3 et de l'aile sacrée gauche S1.DMO: T-score colonne -1.4 DS, col fémoral 0.2 DS et hanche totale 0.0 DS. La microarchitecture est normale (TBS 1.429). Nous retenons dans le 1er cas le diagnostic d'une ostéoporose fracturaire liée à la grossesse. De l'ibandronate trimestriel iv est prescrit. Dans le 2ème cas, au vu de la DMO quasi normale, de la trabéculométrie normale et du site atypique de la fracture, nous concluons à une fracture non ostéoporotique sur augmentation du stress mécanique lié à la grossesse. Aucun traitement à visée osseuse n'est prescrit. Discussion : " L'ostéoporose " liée à la grossesse et à l'allaitement se manifeste le plus souvent par des fractures vertébrales non traumatiques pendant le 3ème trimestre de la 1ère grossesse ou durant le post-partum. Une DMO et un bilan à la recherche d'une cause secondaire sont indispensables. Cette pathologie est sous-diagnostiquée, car les douleurs dorsolombaires sont souvent mises sur le compte d'une hyperlaxité ligamentaire physiologique liée aux hormones. Les facteurs de risque sont les mêmes que pour une ostéoporose post-ménopausique. Les apports bas en calcium et en vitamine D3 ainsi qu'un capital osseux moindre à la fin de l'adolescence seraient des facteurs prédisposants. La DMO lombaire diminue de 7.6 +/-0.1%, celle du corps entier de 3.9 +/-0.1% pendant la grossesse et l'allaitement. Habituellement on assiste à une récupération de la DMO dans les mois qui suivent la fin de l'allaitement. Conclusion : Devant des douleurs rachidiennes en fin de grossesse il faut évoquer une fracture ostéoporotique liée à la grossesse. La densitométrie osseuse peut aider au diagnostic même s'il faut l'interpréter prudemment dans les mois qui suivent l'accouchement. Il n'y a pas de consensus concernant le traitement spécifique.

Carence en fer sans anémie chez l'enfant et l'adolescent: un traitement intraveineux est-il indiqué? Justifié?

ABSTRACT 1. Il existe des données épidémiologiques et expérimentales mettant en lien une carence en fer sans anémie (CF-A) et troubles de la concentration, fatigue, faiblesse musculaire, ainsi que diminution des performances sportives, et ce surtout chez le grand adolescent et l'adulte jeune. Certaines études sont toutefois sujettes à critique, souvent en raison de la présence de facteurs confondants importants associés à la CF-A (niveau d'évidence 1b à 4). Chez l'enfant, les données sont également plus hétérogènes, et d'autant plus difficiles à interpréter que les études à disposition présentent elles-aussi de nombreux facteurs confondants. De manière générale, une certaine prudence doit en conséquence être de mise avant d'attribuer de tels symptômes à une carence en fer (CF).