Eosinophil granule proteins expressed in ocular cicatricial pemphigoid

Cellular Imprinting Proteomics Assay: A Novel Method for Detection of Neural and Ocular Disorders Applied to Congenital Zika Virus Syndrome

Congenital Zika syndrome was first described due to increased incidence of congenital abnormalities associated with Zika virus (ZIKV) infection. Since the eye develops as part of the embryo central nervous system (CNS) structure, it becomes a specialized compartment able to display symptoms of neurodegenerative diseases and has been proposed as a noninvasive approach to the early diagnosis of neurological diseases. Ocular lesions result from defects that occurred during embryogenesis and can become apparent in newborns exposed to ZIKV. Furthermore, the absence of microcephaly cannot exclude the occurrence of ocular lesions and other CNS manifestations. Considering the need for surveillance of newborns and infants with possible congenital exposure, we developed a method termed cellular imprinting proteomic assay (CImPA) to evaluate the ocular surface proteome specific to infants exposed to ZIKV during gestation compared to nonexposure. CImPA combines surface cells and fluid capture using membrane disks and a large-scale quantitative proteomics approach, which allowed the first-time report of molecular alterations such as neutrophil degranulation, cell death signaling, ocular and neurological pathways, which are associated with ZIKV infection with and without the development of congenital Zika syndrome, CZS. Particularly, infants exposed to ZIKV during gestation and without early clinical symptoms could be detected using the CImPA method. Lastly, this methodology has broad applicability as it could be translated in the study of several neurological diseases to identify novel diagnostic biomarkers. Data are available via ProteomeXchange with identifier PXD014038.

Role of immune cells in the ocular manifestations of pemphigoid diseases

Pemphigoid disease is classified according to the phenotypical location of the disease and the presence of different types of antibodies. The ocular distribution of pemphigoid mainly occurs in patients with bullous pemphigoid and mucous membrane pemphigoid. Several immune cells, including the cells of the innate immune system (neutrophils and γδ T cells) and the adaptive immune system (T and B cells), are involved in pemphigoid disease. The treatment of pemphigoid is still wide-ranging, and the most utilized treatment is the use of immunosuppressants and corticosteroids. In this scenario, it is absolutely important to screen the immune cells that are involved in this group of diseases and to determine if a targeted treatment approach is plausible. In conclusion, this review will identify some newer treatment possibilities for the whole spectrum of pemphigoid diseases.

Tear and Serum Eosinophil Cationic Protein Levels in Seasonal Allergic Conjunctivitis

PURPOSE

Eosinophil cationic protein (ECP) levels in tear fluid and sera of patients with seasonal allergic conjunctivitis (SAC) were measured to assess local and systemic eosinophilic activity in SAC. The correlation between ECP levels and disease activity was evaluated.

METHODS

Tears and sera were collected from 21 patients with SAC and 13 healthy control subjects. ECP levels in tears and sera were measured before and 4 weeks after treatment with 0.1% lodoxamide eyedrops. Clinical signs and symptoms of SAC were scored and the correlation of ECP levels with the clinical scores was evaluated.

RESULTS

Tear and serum levels of ECP were significantly increased (p = 0.01, p = 0.02, respectively) in patients with SAC compared with the control subjects, but ECP levels were not correlated with the severity of the disease. Following treatment with topical 0.1% lodoxamide eyedrops, the mean level of ECP in tears decreased significantly (p = 0.02), whereas no significant change was observed in serum ECP levels. Furthermore, a significant decrease in clinical signs and symptoms scores was found after treatment (both p < 0.0001).

CONCLUSIONS

Increased serum and tear ECP levels in patients with SAC confirms that both local and systemic eosinophil activation occurs in SAC. However, clinical signs and symptoms of SAC were not found to be correlated with the degree of eosinophilic activity. Thus ECP does not seem to have an important role in clinical manifestations of SAC.

Immunohistological analysis of immune cells in blistering skin lesions

BACKGROUND

Bullous skin lesions are characterised by the presence of intraepidermal or subepidermal bullae. Although inflammatory cell infiltrate is a constant feature in these lesions, their immunophenotypic characterisation is still incomplete.

AIM

To determine whether the development of bullous skin diseases is associated with changes in the inflammatory cell infiltrate.

MATERIALS AND METHODS

34 cases representing lesions with both intraepidermal and subepidermal bullae were examined using immunoperoxidase staining methods and antibodies targeting antigens for histiocytes (CD68), B cells (CD20+), T cells (CD3+), T cells with cytotoxic potential (T cell intracellular associated antigen, TIA1+) and activity (granzyme B, GRB+). The adjacent normal skin (lesions) and an additional five cases of normal skin were also examined (controls).

RESULTS

The transition from normal skin to lesional skin (lesions with intraepidermal and subepidermal bullae) was associated with a significant increase (p< or =0.05) in the density of total inflammatory cell infiltrate, CD68+ cells, CD3+ T lymphocytes, CD20+ B lymphocytes, TIA1+ -resting cytotoxic T cells and GRB+ T cells with cytotoxic activity.

CONCLUSIONS

The increase in inflammatory cell infiltrate during the transition from normal to lesional skin may reflect the presence of an increased antigenicity of the lesional cells or a response to some basement membrane components. CD68+ and CD3+ cells, especially the resting cytotoxic ones, achieved numerical dominance in these lesions. Cell-mediated immunity seems to have critical role in the development of these lesions.

[Is the seric eosinophil cationic protein level a valuable tool of diagnosis in clinical practice?]

SCOPE

The eosinophil cationic protein (ECP) is one of the mediators released during eosinophil activation. These cells are effector cells taking part into the Th2-lymphocyte dependent allergic inflammation. Assaying ECP concentrations in blood and sputum may be useful in evaluating allergic inflammation (asthma and rhinitis). This summary considers the value of measuring ECP levels for the diagnosis of various diseases where an eosinophil-mediated tissue inflammation plays a role.

CURRENT SITUATION AND SALIENT POINTS

Levels of eosinophil cationic protein have been determined in nasal secretions, sputum, gastric secretions, feces and serum. They are increased during seasonal allergic rhinitis and perennial rhinitis, allergic asthma and atopic dermatitis. They are also increased in various gastro-intestinal disorders, some of which are associated with IgE: eosinophil intestinal diseases (esophagitis, gastro-enteritis and colitis), gastro-intestinal food allergy and intestinal parasitoses. Finally, they are increased in non IgE-dependent disorders: non allergic asthma with aspirin intolerance, respiratory infections, sinonasal polyposis, Churg-Strauss disease and idiopathic hyper-eosinophilia (HES) syndrome.

PERSPECTIVES

Assaying serum ECP could help in the diagnosis of several diseases. With parasitic disease the pathogenic progression may be accurately assessed, when serological tests are less indicative. ECP assay may point to non allergic asthma, either Fernand-Widal syndrome or Churg-Strauss disease. As for gastro-intestinal disorders, it indicates an eosinophilic tissue reaction. In the event of isolated hypereosinophilia, ECP assay may clarify whether it is benign or tending towards idiopathic HES. The assay of peroxidase and eosinophil-derived neurotoxin (EDN) should be also considered.

Chronic cicatrizing conjunctivitis

Conjunctival fibrosis may result from chronic inflammation and may lead to alterations of conjunctival architecture. This results in ocular dryness, entropion and trichiasis, and corneal complications. Causes of conjunctival cicatrization are not limited to autoimmune diseases, such as ocular cicatricial pemphigoid, a severe disease associated with poor ocular prognosis. Other well-known causes include thermal and chemical burns, postinfectious conjunctivitis, and Stevens-Johnson syndrome. Ocular rosacea and atopic keratoconjunctivitis often are underdiagnosed causes of conjunctival fibrosis. Medical history, physical exam, and laboratory tests often allow for diagnosis of the underlying disease. Medical management varies according to specific causes, and many surgical strategies are available to restore corneal transparency and normal palpebral architecture.