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Chen TK, Batra JS, Michalik DE, Casillas J, Patel R, Ruiz ME, Hara H, Patel B, Kadapakkam M, Ch'Ng J, Small CB, Zagaliotis P, Ragsdale CE, Leal LO, Roilides E, Walsh TJ. Recombinant Human Granulocyte-Macrophage Colony-Stimulating Factor (rhu GM-CSF) as Adjuvant Therapy for Invasive Fungal Diseases. Open Forum Infect Dis 2022; 9:ofac535. [PMID: 36381625 PMCID: PMC9645583 DOI: 10.1093/ofid/ofac535] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/07/2022] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Sargramostim (yeast-derived, glycosylated recombinant human granulocyte-macrophage colony-stimulating factor [rhu GM-CSF]) augments innate and adaptive immune responses and accelerates hematopoietic recovery of chemotherapy-induced neutropenia. However, considerably less is known about its efficacy as adjunctive immunotherapy against invasive fungal diseases (IFDs). METHODS The clinical courses of 15 patients with pediatric malignancies and IFDs treated adjunctively with sargramostim at a single institution were analyzed in a retrospective cohort review. Further, a systematic review of published reports of rhu GM-CSF for IFDs was also conducted. RESULTS Among 65 cases, 15 were newly described pediatric patients and 50 were previously published cases of IFDs treated with rhu GM-CSF. Among the newly reported pediatric patients, IFDs were caused by Candida spp., Trichosporon sp., and molds (Aspergillus spp., Rhizopus sp., Lichtheimia sp., and Scedosporium sp). Twelve (80%) were neutropenic at baseline, and 12 (80%) were refractory to antifungal therapy. Among 12 evaluable patients, the overall response rate was 92% (8 [67%] complete responses, 3 [25%] partial responses, and 1 [8%] stable). Treatment is ongoing in the remaining 3 patients. Among 50 published cases (15 Candida spp., 13 Mucorales, 11 Aspergillus spp., 11 other organisms), 20 (40%) had baseline neutropenia and 36 (72%) were refractory to standard therapy before rhu GM-CSF administration. Consistent with responses in the newly reported patients, the overall response rate in the literature review was 82% (40 [80%] complete responses, 1 [2%] partial response, and 9 [18%] no response). CONCLUSIONS Sargramostim may be a potential adjunctive immunomodulator for selected patients with hematological malignancies and refractory IFDs.
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Affiliation(s)
- Tempe K Chen
- Department of Pediatric Infectious Diseases, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Department of Pediatrics, Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California, USA
| | - Jagmohan S Batra
- Department of Pediatric Infectious Diseases, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Department of Pediatrics, Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California, USA
| | - David E Michalik
- Department of Pediatric Infectious Diseases, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Department of Pediatrics, Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California, USA
| | - Jacqueline Casillas
- Department of Pediatric Hematology/Oncology, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Division of Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Ramesh Patel
- Department of Pediatric Hematology/Oncology, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Division of Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Maritza E Ruiz
- Department of Pediatric Hematology/Oncology, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Division of Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Harneet Hara
- Department of Pediatric Hematology/Oncology, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Division of Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Bhavita Patel
- Department of Pediatric Hematology/Oncology, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Division of Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Meena Kadapakkam
- Department of Pediatric Hematology/Oncology, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Division of Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - James Ch'Ng
- Department of Pediatric Hematology/Oncology, MemorialCare Miller Children's & Women's Hospital Long Beach, Long Beach, California, USA
- Division of Hematology/Oncology, Department of Pediatrics, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Catherine B Small
- Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York, New York, USA
| | - Panagiotis Zagaliotis
- Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York, New York, USA
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
- Department of Pharmacology and Therapeutics, School of Pharmacy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Luis O Leal
- Partner Therapeutics, Inc., Lexington, Massachusetts, USA
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine, New York, New York, USA
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
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Wu Y, Xu H, Li Y, Huang D, Chen L, Hu Y, Li L, Zhang D, Huang W. miRNA-344b-1-3p modulates the autophagy of NR8383 cells during Aspergillus fumigatus infection via TLR2. Exp Ther Med 2019; 18:139-146. [PMID: 31258647 DOI: 10.3892/etm.2019.7569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 03/22/2019] [Indexed: 11/05/2022] Open
Abstract
Autophagy serves a pivotal role in host defense during fungal infections, and the contribution by toll-like receptor 2 (TLR2) has been well demonstrated. It has been reported that microRNA-344a-1-3p (miR-344a-1-3p) can directly target TLR2. However, the expression of TLR2 significantly decreases during Aspergillus fumigatus infection. Therefore, the specific role of miR-344a-1-3p in the host defense against A. fumigatus infection remains to be elucidated. In the present study, A. fumigatus infection increased the expression of TLR2 and induced autophagy, which was indicated by increasing expression levels of autophagy-related protein 5 (ATG5), Beclin-1, light chain 3 (LC3)-1 and LC3-II, as measured by western blot analysis, and an increased number of GFP-LC3 puncta, as measured by fluorescence. Following transfection with miR-344a-1-3p mimics and/or TLR2, miR-344b-1-3p significantly inhibited the expression of TLR2, Beclin-1, ATG5, LC3-I and LC3-II, whereas the overexpression of TLR2 significantly attenuated the inhibitory effect on autophagy by miR-344b-1-3p. Collectively, these findings demonstrate that A. fumigatus can be controlled by the induction of autophagy following de-repression of the expression of TLR2, mediated by miR-344a-1-3p.
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Affiliation(s)
- Yuting Wu
- Department of Geriatric Respiratory Medicine, General Hospital of Southern Theater Command, PLA, Guangzhou, Guangdong 510010, P.R. China
| | - Hong Xu
- Respiratory Center of PLA, General Hospital of Southern Theater Command, PLA, Guangzhou, Guangdong 510010, P.R. China
| | - Yongqiang Li
- Department of Geriatric Respiratory Medicine, General Hospital of Southern Theater Command, PLA, Guangzhou, Guangdong 510010, P.R. China
| | - Dongwei Huang
- Department of Geriatric Respiratory Medicine, General Hospital of Southern Theater Command, PLA, Guangzhou, Guangdong 510010, P.R. China
| | - Lu Chen
- Department of Geriatric Respiratory Medicine, General Hospital of Southern Theater Command, PLA, Guangzhou, Guangdong 510010, P.R. China
| | - Yahui Hu
- Department of Geriatric Respiratory Medicine, General Hospital of Southern Theater Command, PLA, Guangzhou, Guangdong 510010, P.R. China
| | - Li Li
- Respiratory Center of PLA, General Hospital of Southern Theater Command, PLA, Guangzhou, Guangdong 510010, P.R. China
| | - Deming Zhang
- Department of Geriatric Respiratory Medicine, General Hospital of Southern Theater Command, PLA, Guangzhou, Guangdong 510010, P.R. China
| | - Wenjie Huang
- Respiratory Center of PLA, General Hospital of Southern Theater Command, PLA, Guangzhou, Guangdong 510010, P.R. China
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Carvalho A, Cunha C, Iannitti RG, De Luca A, Giovannini G, Bistoni F, Romani L. Inflammation in aspergillosis: the good, the bad, and the therapeutic. Ann N Y Acad Sci 2013; 1273:52-9. [PMID: 23230837 DOI: 10.1111/j.1749-6632.2012.06754.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aspergillosis includes a spectrum of diseases caused by different Aspergillus spp. New insights into the cellular and molecular mechanisms of resistance and immune tolerance to the fungus in infection and allergy have been obtained in experimental settings. The fact that virulence factors, traditionally viewed as fungal attributes, are contingent upon microbial adaptation to various environmental stresses encountered in the human host implies that the host and fungus are jointly responsible for pathogenicity. Ultimately, despite the occurrence of severe aspergillosis in immunocompromised patients, clinical evidence indicates that aspergillosis also occurs in the setting of a heightened inflammatory response, in which immunity occurs at the expense of host damage and pathogen eradication. Thus, targeting pathogenicity rather than microbial growth, tolerance rather than resistance mechanisms of defense may pave the way to targeted anti-inflammatory strategies in difficult-to-treat patients. The challenge now is to translate promising results from experimental models to the clinic.
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Affiliation(s)
- Agostinho Carvalho
- Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy
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Rammaert B, Desjardins A, Lortholary O. New insights into hepatosplenic candidosis, a manifestation of chronic disseminated candidosis. Mycoses 2012; 55:e74-84. [DOI: 10.1111/j.1439-0507.2012.02182.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Sarazin A, Poulain D, Jouault T. In vitropro- and anti-inflammatory responses to viableCandida albicansyeasts by a murine macrophage cell line. Med Mycol 2010; 48:912-21. [DOI: 10.3109/13693781003767592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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6
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Ribeiro AM, Bocca AL, Amaral AC, Souza ACC, Faccioli LH, Coelho-Castelo AA, Figueiredo F, Silva CL, Felipe MSS. HSP65 DNA as therapeutic strategy to treat experimental paracoccidioidomycosis. Vaccine 2010; 28:1528-34. [DOI: 10.1016/j.vaccine.2009.11.062] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 11/13/2009] [Accepted: 11/20/2009] [Indexed: 11/16/2022]
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Walsh TJ. Advances and challenges in infectious diseases supportive care of patients with hematologic malignancies, hematopoietic stem cell transplantation, and severe aplastic anemia. Semin Hematol 2009; 46:191-7. [PMID: 19549573 DOI: 10.1053/j.seminhematol.2009.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infectious diseases are important causes of morbidity and mortality in immunocompromised patients with hematological malignancies, severe aplastic anemia (SAA), and myelodysplasia. Major advances in infectious diseases supportive care have been critical to improving the outcome of patients suffering from these life-threatening diseases. Advances in diagnosis, treatment, and prevention of life-threatening infections have reduced morbidity and mortality, improved quality of life, and enabled the use of potentially curative chemotherapy, radiation, hematopoietic stem cell transplantation (HSCT), and immunosuppressive therapy to patients battling these devastating diseases. Despite these advances, the continued development of antimicrobial resistance, emergence of new pathogens, and the evolution of host factors present evolving challenges to the successful management of infectious complications in this expanding patient population.
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Affiliation(s)
- Thomas J Walsh
- Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA
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8
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Legrand F, Lecuit M, Dupont B, Bellaton E, Huerre M, Rohrlich PS, Lortholary O. Adjuvant corticosteroid therapy for chronic disseminated candidiasis. Clin Infect Dis 2008; 46:696-702. [PMID: 18230039 DOI: 10.1086/527390] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Chronic disseminated candidiasis (CDC) is typically observed during neutrophil recovery in patients with acute leukemia and requires protracted antifungal therapy. OBJECTIVE Our objective was to document the efficacy and tolerance of corticosteroid therapy (CST) in patients with symptomatic CDC, including those who experienced fever and abdominal pain despite ongoing antifungal therapy. METHODS We performed a retrospective, multicenter study involving 10 pediatric and adult patients who experienced ongoing symptomatic CDC despite receipt of appropriate antifungal therapy for whom adjuvant oral CST was initiated. RESULTS All cases of CDC were proven or probable, as determined on the basis of the European Organization for Research and Treatment of Cancer-Mycosis Study Group definition criteria, and occurred in patients with leukemia. CDC-attributable clinical symptoms resolved with CST, which was started a mean of 33.8 days after antifungal therapy had been initiated. Fever and abdominal pain disappeared a median of 4-5 days, and serum fibrinogen and C-reactive protein levels returned to normal values within 14-30 days. The median duration of hospitalization after CST initiation was 8.8 days. Hepatosplenic microabscesses decreased or disappeared within a mean period of 107 days (range, 30-210 days). No relapses of CDC were observed during a median duration of follow-up of 6.5 years (range, 4-9 years). CONCLUSIONS In children and adults who experience persistently symptomatic CDC despite ongoing receipt of antifungal therapy, CST involving a prednisone equivalent at a dosage of > or =0.5 mg/kg per day for at least 3 weeks is associated with a prompt resolution of symptoms and of inflammatory response. These findings support the pathophysiological hypothesis that CDC belongs to the spectrum of fungus-related immune reconstitution inflammatory syndrome.
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Affiliation(s)
- Faézeh Legrand
- Université Paris-7, Service d'Hématologie-Pédiatrique, Hôpital Robert Debré, Paris, France
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Kontny U, Walsh TJ, Rossler J, Uhl M, Niemeyer CM. Successful treatment of refractory chronic disseminated candidiasis after prolonged administration of caspofungin in a child with acute myeloid leukemia. Pediatr Blood Cancer 2007; 49:360-2. [PMID: 16444677 DOI: 10.1002/pbc.20751] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This report documents the clinical activity of caspofungin in a 13-year-old girl with acute myeloid leukemia (AML) and chronic disseminated candidiasis (CDC), refractory to amphotericin B and fluconazole. Caspofungin was started at 50 mg/d resulting in a temporary response. With no further clinical improvement and radiological progress after 2 months of therapy, the dose of caspofungin was increased to 100 mg/d, leading to a sustained clinical response. Therapy was given for a total of 12 months and had no attributable adverse effects. This approach resulted in successful treatment of refractory CDC with caspofungin.
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Affiliation(s)
- Udo Kontny
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, University of Freiburg, Freiburg, Germany.
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Gimenes VMF, Criado PR, Martins JEC, Almeida SR. Cellular immune response of patients with chromoblastomycosis undergoing antifungal therapy. Mycopathologia 2006; 162:97-101. [PMID: 16897587 DOI: 10.1007/s11046-006-0041-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Accepted: 06/21/2006] [Indexed: 10/24/2022]
Abstract
One of the most characteristic features of the chromoblastomycosis is its unresponsiveness to treatment. In order to analyzed whether during therapy could be observed a change of cellular immune response pattern, we evaluated the production of IL-10, TNF-alpha and IFN-gamma, as well as proliferation of peripheral blood mononuclear cell (PBMC) from patients in different periods of chemotherapy treatment. Our results showed that after 6 months of treatment cells from patients proliferated to fungal antigens and produced a significant level of IFN-gamma. However, after 1 year of treatment a low proliferation of T cells and production of IFN-gamma accompanied by an increase of IL-10 were observed when compared with 6 months of treatment.
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Affiliation(s)
- Viviane Mazo Fávero Gimenes
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, Avenida Prof. Lineu Prestes, 580, Bloco 17, São Paulo, CEP: 05508-900, Brazil
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Walsh TJ, Roilides E, Cortez K, Kottilil S, Bailey J, Lyman CA. Control, immunoregulation, and expression of innate pulmonary host defenses against Aspergillus fumigatus. Med Mycol 2005; 43 Suppl 1:S165-72. [PMID: 16114132 DOI: 10.1080/13693780500064672] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The innate host defense system (IHDS) against Aspergillus fumigatus includes dedicated phagocytic cells (peripheral blood monocytes, monocyte derived macrophages, pulmonary alveolar macrophages, neutrophils, myeloid dendritic cells and natural killer cells), cytokines, chemokines, toll-like receptors, and antimicrobial peptides. During the past decade, the advances in the field of the IHDS have been enormous, allowing a better understanding of the immunopharmacological control, immunoregulation, and expression of innate host defense molecules against Aspergillus fumigatus.
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Affiliation(s)
- T J Walsh
- Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bldg. 10, Rm 13N-240, 10 Center Drive, Bethesda, MD 20892, USA.
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12
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Mazo Fávero Gimenes V, Da Glória de Souza M, Ferreira KS, Marques SG, Gonçalves AG, Vagner de Castro Lima Santos D, Pedroso e Silva CDM, Almeida SR. Cytokines and lymphocyte proliferation in patients with different clinical forms of chromoblastomycosis. Microbes Infect 2005; 7:708-13. [PMID: 15848277 DOI: 10.1016/j.micinf.2005.01.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2004] [Revised: 01/18/2005] [Accepted: 01/19/2005] [Indexed: 10/25/2022]
Abstract
Chromoblastomycosis is a chronic, often debilitating, suppurative, granulomatus mycosis of the skin and subcutaneous tissues beginning after inoculation trauma. It occurs world-wide, but is more frequently observed in tropical countries such as Brazil. The disease is usually insidious, and the lesions increase slowly but progressively, not responding to the usual treatments and quite often reappearing. The host defense mechanism in chromoblastomycosis has not been extensively investigated. Some studies have focused on fungus-host interaction, showing a predominantly cellular immune response, with the activation of macrophages involved in fungus phagocytosis. Although phagocytosis did occur, death of fungal cells was rarely observed. The ability of Fonsecaea pedrosoi to produce secreted or cell wall-associated melanin-like components, protects against destruction by host immune cells in vitro. Until now, the T cell immune response in chromoblastomycosis is undefined. In the present work, it was shown that, in patients with the severe form of the disease, predominant production of IL-10 cytokine, low levels of IFN-gamma and inefficient T cell proliferation were induced. In contrast, in patients with a mild form of the disease, predominant production of IFN-gamma cytokine, low levels of IL-10 and efficient T cell proliferation were observed.
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Affiliation(s)
- Viviane Mazo Fávero Gimenes
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, Avenida Prof. Lineu Prestes, 580 Bloco 17, CEP 05508-900, São Paulo, Brazil
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Choi EH, Taylor JG, Foster CB, Walsh TJ, Anttila VJ, Ruutu T, Palotie A, Chanock SJ. Common polymorphisms in critical genes of innate immunity do not contribute to the risk for chronic disseminated candidiasis in adult leukemia patients. Med Mycol 2005; 43:349-53. [PMID: 16110781 DOI: 10.1080/13693780412331282322] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Chronic disseminated candidiasis is a serious fungal infection in immunocompromised patients, particularly those undergoing therapy for acute leukemia. Coordination between innate and adaptive immune system is critical to resistance or susceptibility to Candida infection. In order to investigate possible genetic contribution to chronic disseminated candidiasis of key molecules in the innate immune pathway, we performed a case control study using the candidate gene approach. Forty subjects with chronic disseminated candidiasis and 50 controls without chronic disseminated candidiasis but an underlying diagnosis of leukemia were enrolled in the Helsinki University Central Hospital during the period 1980-1998. Candidate genes were selected for analysis based upon the following criteria: a common polymorphism (>5% frequency) and existence a priori of clinical and biological data suggesting a role for the variant in the pathogenesis of chronic disseminated candidiasis. Six genes were selected from critical microbicidal and innate immune pathways, including three low-affinity Fcgamma receptors (FCGR2A, FCGR3A and FCGR3B), chitotriosidase (CHIT1), p22-phox NADPH oxidase (CYBA), and mannose binding lectin (MBL2). There was no statistically significant association of susceptibility to chronic disseminated candidiasis with the polymorphisms in this study. Common variants in the six studied genes most likely do not contribute to the risk for chronic disseminated candidiasis in patients with acute leukemia.
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Affiliation(s)
- Eun Hwa Choi
- Section of Genomic Variation, Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Masood A, Sallah S. Chronic disseminated candidiasis in patients with acute leukemia: emphasis on diagnostic definition and treatment. Leuk Res 2004; 29:493-501. [PMID: 15755501 DOI: 10.1016/j.leukres.2004.10.003] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2004] [Accepted: 10/13/2004] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic disseminated candidiasis (CDC) is a form of invasive fungal infection that occurs most commonly in patients with acute leukemia treated with chemotherapy. Recent studies have provided evidence for diagnostic alternatives to invasive procedures and more therapeutic options for the management of this complication. In order to put diagnostic criteria and methodological approach to the disease into the perspective of developing strategies for therapy, all relevant studies published in the English literature over the last 30 years were examined. MATERIALS AND METHODS The English-language articles located through MEDLINE (1966 to present) and from selected bibliographies. RESULTS There is increased recognition of CDC as complication of treatment with chemotherapy in patients with acute leukemia. Liver biopsy may not always be revealing or feasible to perform in some patients. Among the imaging modalities, magnetic resonance imaging has obtained preeminence as a non-invasive tool for the diagnosis of hepatosplenic fungal infections. Administration of amphotericin B (Amp B) in relatively large cumulative doses is needed to ensure appropriate control of the infection and prevention of future relapse. Patients intolerant of, or refractory to conventional Amp B have been successfully salvaged using fluconazole or lipid formulations of Amp B. A constellation of clinical, laboratory and radiologic parameters should be used to determine response and efficacy of therapy. There is sufficient evidence to support the safety and feasibility of continuing chemotherapy for acute leukemia in conjunction with antifungal treatment in patients diagnosed with CDC. CONCLUSION The development of CDC in patients with acute leukemia does not preclude further chemotherapy or constitute contraindication for bone marrow transplantation. Knowledge of the course and pattern of evolution of the disease and adopting aggressive therapeutic approach will likely reduce the morbidity and mortality from this complication.
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Affiliation(s)
- Aisha Masood
- Divison of Hematology/Oncology, Louisiana State University, 1501 Kings Highway, Shreveport, LA 71119, USA.
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Pylkkänen L, Gullstén H, Majuri ML, Andersson U, Vanhala E, Määttä J, Meklin T, Hirvonen MR, Alenius H, Savolainen K. Exposure to Aspergillus fumigatus spores induces chemokine expression in mouse macrophages. Toxicology 2004; 200:255-63. [PMID: 15212821 DOI: 10.1016/j.tox.2004.03.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2003] [Accepted: 03/18/2004] [Indexed: 11/15/2022]
Abstract
Inhalation of fungal spores may cause inflammation and respiratory diseases, such as bronchitis, allergic alveolitis, and asthma. Alveolar macrophages provide the first line of defense in the respiratory tract. To examine the cellular mechanisms involved in Aspergillus fumigatus-induced airway inflammation, mouse macrophage cell line (RAW 264.7) cells were exposed for 2 h or 6 h to graded doses of A. fumigatus spores that were either alive or heat-killed. Furthermore, the ability of the cells to phagocytize the spores was visualized by electron microscopy. Expression of selected cytokines and chemokines was assessed by a real time quantitative PCR method and by enzyme-linked immunoabsorbent assay (ELISA) after exposure. A significant increase in mRNA expression of TNF-alpha, MIP-1alpha, MIP-1beta, and MCP-1 was observed with a maximal induction at 6h after exposure to the highest (1 x 10(7)) concentration of live spores. Similar response was not detected with heat-killed spores in the expression of chemokines and cytokines, even though there were no differences between the phagocytosis of live and heat-killed spores. These results suggest that exposure to live spores of A. fumigatus can modulate the expression of proinflammatory cytokines and chemokines in mouse macrophages and thus influence the development of inflammatory processes in the airways.
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Affiliation(s)
- Lea Pylkkänen
- Department of Industrial Hygiene and Toxicology, Finnish Institute of Occupational Health, Helsinki
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Mocellin S, Marincola F, Rossi CR, Nitti D, Lise M. The multifaceted relationship between IL-10 and adaptive immunity: putting together the pieces of a puzzle. Cytokine Growth Factor Rev 2004; 15:61-76. [PMID: 14746814 DOI: 10.1016/j.cytogfr.2003.11.001] [Citation(s) in RCA: 164] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Interleukin-10 (IL-10) is a pleiotropic cytokine that modulates the function of several adaptive immunity-related cells. Although generally considered an immunosuppressive molecule, IL-10 possesses immunostimulatory properties in several in vitro and in vivo models. These very different outcomes are believed to depend upon experimental conditions, the dominant immune effector mediating a given immune response, the timing of IL-10 production/administration, and IL-10 dose and/or location of expression. In the present work, we review the current knowledge regarding IL-10 activity on adaptive immunity related cells, emphasize new insights on IL-10 molecular/cellular targets, and summarize the available data on the relationship between IL-10 and some pathological conditions (e.g. infectious diseases, autoimmunity, allergy, cancer and transplantation) involving adaptive immunity.
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Affiliation(s)
- Simone Mocellin
- Department of Oncological and Surgical Sciences, University of Padova, Clinica Chirurgica II, Via Giustiniani, 2, 35128 Padova, Italy.
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17
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Abstract
The topic of immunity to fungal infections is of interest to a wide range of disciplines, from microbiology to immunology. It is of particular interest in terms of therapy of HIV-infected individuals, and patients with cancer or individuals who have received transplants. Understanding the nature and function of the immune response to fungi is an exciting challenge that might set the stage for new approaches to the treatment of fungal diseases, from immunotherapy to vaccines. The past decade has witnessed the development of a wide range of new approaches to elucidate events that occur at the host-fungus interface.
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Affiliation(s)
- Luigina Romani
- Department of Experimental Medicine and Biochemical Sciences, Microbiology Section, University of Perugia, Via del Giochetto, 06122 Perugia, Italy.
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18
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Abstract
Interleukin-10 (IL-10), first recognized for its ability to inhibit activation and effector function of T cells, monocytes, and macrophages, is a multifunctional cytokine with diverse effects on most hemopoietic cell types. The principal routine function of IL-10 appears to be to limit and ultimately terminate inflammatory responses. In addition to these activities, IL-10 regulates growth and/or differentiation of B cells, NK cells, cytotoxic and helper T cells, mast cells, granulocytes, dendritic cells, keratinocytes, and endothelial cells. IL-10 plays a key role in differentiation and function of a newly appreciated type of T cell, the T regulatory cell, which may figure prominently in control of immune responses and tolerance in vivo. Uniquely among hemopoietic cytokines, IL-10 has closely related homologs in several virus genomes, which testify to its crucial role in regulating immune and inflammatory responses. This review highlights findings that have advanced our understanding of IL-10 and its receptor, as well as its in vivo function in health and disease.
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MESH Headings
- Animals
- Autoimmune Diseases/genetics
- Autoimmune Diseases/immunology
- Clinical Trials as Topic
- Clinical Trials, Phase II as Topic
- Dendritic Cells/immunology
- Diabetes Mellitus, Type 1/immunology
- Disease Models, Animal
- Encephalomyelitis, Autoimmune, Experimental/immunology
- Gene Expression Regulation
- Herpesviridae/physiology
- Humans
- Infections
- Inflammation
- Interleukin-10/genetics
- Interleukin-10/physiology
- Interleukin-10/therapeutic use
- Lupus Erythematosus, Systemic/genetics
- Lupus Erythematosus, Systemic/immunology
- Lymphocyte Subsets/immunology
- Mice
- Mice, Inbred NOD
- Mice, Inbred NZB
- Mice, Knockout
- Neoplasms/immunology
- Neutrophils/immunology
- Primates
- Protein-Tyrosine Kinases/physiology
- Receptors, Interleukin/genetics
- Receptors, Interleukin/physiology
- Receptors, Interleukin-10
- Signal Transduction
- Transcription Factors/physiology
- Transcription, Genetic
- Viral Proteins/physiology
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Affiliation(s)
- K W Moore
- Department of Molecular Biology, DNAX Research Institute of Molecular and Cellular Biology Inc., Palo Alto, California 94304, USA.
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19
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Letterio JJ, Lehrnbecher T, Pollack G, Walsh TJ, Chanock SJ. Invasive candidiasis stimulates hepatocyte and monocyte production of active transforming growth factor beta. Infect Immun 2001; 69:5115-20. [PMID: 11447193 PMCID: PMC98607 DOI: 10.1128/iai.69.8.5115-5120.2001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2000] [Accepted: 04/17/2001] [Indexed: 11/20/2022] Open
Abstract
Candida albicans is an opportunistic fungal pathogen and a major cause of morbidity and mortality in patients with compromised immune function. The cytokine response to tissue invasion by C. albicans can influence the differentiation and function of lymphocytes and other mononuclear cells that are critical components of the host response. While the production of transforming growth factor beta (TGF-beta) has been documented in mice infected with C. albicans and is known to suppress phagocyte function, the cellular source and role of this cytokine in the pathogenesis of systemic candidiasis are not well understood. We have investigated the source of production of TGF-beta by immunohistochemical studies in tissue samples from patients with an uncommon complication of lymphoreticular malignancy, chronic disseminated candidiasis (CDC), and from a neutropenic-rabbit model of CDC. Liver biopsy specimens from patients with documented CDC demonstrated intense staining for extracellular matrix-associated TGF-beta1 within inflammatory granulomas, as well as staining for TGF-beta1 and TGF-beta3 within adjacent hepatocytes. These results correlate with the immunolocalization of TGF-beta observed in livers of infected neutropenic rabbits, using a neutralizing antibody that recognizes the mature TGF-beta protein. Human peripheral blood monocytes incubated with C. albicans in vitro release large amounts of biologically active TGF-beta1. The data demonstrate that local production of active TGF-betas by hepatocytes and by infected mononuclear cells is a component of the response to C. albicans infection that most probably contributes to disease progression in the immunocompromised host.
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Affiliation(s)
- J J Letterio
- Laboratory of Cell Regulation and Carcinogenesis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
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20
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Abstract
Interleukin-10 (IL-10), first recognized for its ability to inhibit activation and effector function of T cells, monocytes, and macrophages, is a multifunctional cytokine with diverse effects on most hemopoietic cell types. The principal routine function of IL-10 appears to be to limit and ultimately terminate inflammatory responses. In addition to these activities, IL-10 regulates growth and/or differentiation of B cells, NK cells, cytotoxic and helper T cells, mast cells, granulocytes, dendritic cells, keratinocytes, and endothelial cells. IL-10 plays a key role in differentiation and function of a newly appreciated type of T cell, the T regulatory cell, which may figure prominently in control of immune responses and tolerance in vivo. Uniquely among hemopoietic cytokines, IL-10 has closely related homologs in several virus genomes, which testify to its crucial role in regulating immune and inflammatory responses. This review highlights findings that have advanced our understanding of IL-10 and its receptor, as well as its in vivo function in health and disease.
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Affiliation(s)
- Kevin W. Moore
- Departments of Molecular Biology, DNAX Research Institute of Molecular and Cellular Biology Inc., Palo Alto, California 94304
- Departments of Pharmacology, DNAX Research Institute of Molecular and Cellular Biology Inc., Palo Alto, California 94304
- Departments of Immunology, DNAX Research Institute of Molecular and Cellular Biology Inc., Palo Alto, California 94304;,
| | - Rene de Waal Malefyt
- Departments of Molecular Biology, DNAX Research Institute of Molecular and Cellular Biology Inc., Palo Alto, California 94304
- Departments of Pharmacology, DNAX Research Institute of Molecular and Cellular Biology Inc., Palo Alto, California 94304
- Departments of Immunology, DNAX Research Institute of Molecular and Cellular Biology Inc., Palo Alto, California 94304;,
| | - Robert L. Coffman
- Departments of Molecular Biology, DNAX Research Institute of Molecular and Cellular Biology Inc., Palo Alto, California 94304
- Departments of Pharmacology, DNAX Research Institute of Molecular and Cellular Biology Inc., Palo Alto, California 94304
- Departments of Immunology, DNAX Research Institute of Molecular and Cellular Biology Inc., Palo Alto, California 94304;,
| | - Anne O'Garra
- Departments of Molecular Biology, DNAX Research Institute of Molecular and Cellular Biology Inc., Palo Alto, California 94304
- Departments of Pharmacology, DNAX Research Institute of Molecular and Cellular Biology Inc., Palo Alto, California 94304
- Departments of Immunology, DNAX Research Institute of Molecular and Cellular Biology Inc., Palo Alto, California 94304;,
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21
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Makhseed M, Raghupathy R, Azizieh F, Farhat R, Hassan N, Bandar A. Circulating cytokines and CD30 in normal human pregnancy and recurrent spontaneous abortions. Hum Reprod 2000; 15:2011-7. [PMID: 10967006 DOI: 10.1093/humrep/15.9.2011] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Concentrations of the T-helper (Th) 1 cytokines interleukin (IL)-2, tumour necrosis factor (TNF) -alpha, TNF-beta and interferon-gamma, Th2 cytokines IL-4, IL-5, IL-6, IL-10 as well as those of soluble CD30 in sera have been examined during the three trimesters of gestation, at delivery in normal pregnancy, and at the time of spontaneous abortion in women with a history of unexplained recurrent spontaneous abortion (RSA). Significantly higher concentrations of the Th2 cytokines IL-6 and IL-10 were found at normal delivery than in women with RSA, and conversely significantly increased concentrations of the Th1-type cytokine TNF-alpha were found in RSA as compared with successful pregnancy. In abortion-prone women who had a successful pregnancy, significantly higher concentrations of IL-6 and significantly lower concentrations of TNF-alpha were found as compared with abortion-prone women who had another abortion, supporting the notion that Th2- and Th1-bias are associated with successful and unsuccessful pregnancy respectively. Serum CD30 concentrations did not correlate with the outcome of pregnancy. These findings support observations drawn from experiments on the cytokine secretion profiles of peripheral blood mononuclear cells and decidual lymphocytes which suggest that normal pregnancy is Th2-biased and that unexplained RSA is associated with Th1-type reactivity.
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Affiliation(s)
- M Makhseed
- Departments of 1Obstetrics and Gynecology and Microbiology, Faculty of Medicine, Kuwait University, and Maternity Hospital, Kuwait
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22
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Kontoyiannis DP, Luna MA, Samuels BI, Bodey GP. Hepatosplenic candidiasis. A manifestation of chronic disseminated candidiasis. Infect Dis Clin North Am 2000; 14:721-39. [PMID: 10987117 DOI: 10.1016/s0891-5520(05)70128-8] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Much progress has been made over the last decade in diagnosing and treating CDC, a chronic and debilitating infection that interferes with the delivery of intensive cytotoxic chemotherapy in patients with leukemia. The use of fluconazole prophylaxis in these patients has decreased the incidence of CDC dramatically. The greatest future challenges are gaining a better understanding of its pathophysiology, and the continued development of effective diagnostic and therapeutic strategies to treat this unusual manifestation of systemic candidiasis.
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Affiliation(s)
- D P Kontoyiannis
- Department of Internal Medicine Specialties, University of Texas MD Anderson Cancer Center, Houston, USA
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23
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Romani L. Innate and adaptive immunity in
Candida albicans
infections and saprophytism. J Leukoc Biol 2000. [DOI: 10.1189/jlb.68.2.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Luigina Romani
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Via del Giochetto, 06122 Perugia, Italy
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24
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Roilides E, Katsifa H, Tsaparidou S, Stergiopoulou T, Panteliadis C, Walsh TJ. Interleukin 10 suppresses phagocytic and antihyphal activities of human neutrophils. Cytokine 2000; 12:379-87. [PMID: 10805220 DOI: 10.1006/cyto.1999.0567] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We investigated the effects of human interleukin 10 (IL-10) on the antibacterial and antifungal activities of human neutrophils (PMNs) against Staphylococcus aureus and Candida albicans. Incubation of PMNs from healthy volunteers with 20-100 ng/ml of IL-10 at 37 degrees C for 1 h suppressed phagocytosis of serum-opsonized S. aureus (P=0.02) and blastoconidia of C. albicans (P<0.01). In contrast, 2-100 ng/ml of IL-10 had no effect on superoxide anion production upon stimulation with phorbol myristate acetate, N-formylmethionyl leucyl phenylalanine, C. albicans blastoconidia or pseudohyphae; neither did it significantly affect conidiocidal or bactericidal activities of PMNs. However, 20-100 ng/ml of IL-10 significantly decreased PMN-induced damage of C. albicans pseudohyphae (P=0.008). The suppression of phagocytic activity of PMNs against S. aureus and blastoconidia of C. albicans as well as the impairment of PMN-induced hyphal damage may have important implications for understanding the immunosuppressive profile of IL-10 in clinical usage.
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Affiliation(s)
- E Roilides
- 3rd Dept of Pediatrics, University of Thessaloniki, Greece
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25
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Abstract
Resistance to Candida albicans infection in mice results from the development of T helper (Th) type 1 cell responses. Cytokines produced by Th1 cells activate macrophages and neutrophils to a candidacidal state. The development of Th2 responses underlines susceptibility to infection, because cytokines produced by Th2 cells inhibit Th1 development and deactivate phagocytic effector cells. With the recognition of the reciprocal influences between innate and adaptive Th immunity, it appears that the coordinated action of these two lines of immune defense is required to efficiently oppose the infectivity of the fungus and to determine its lifelong commensalism at the mucosal level.
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Affiliation(s)
- L Romani
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Italy.
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