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Shimoda M, Tanaka Y, Fujiwara K, Furuuchi K, Osawa T, Morimoto K, Yano R, Kokutou H, Yoshimori K, Ohta K. Waterproofing spray-associated pneumonitis review: Comparison with acute eosinophilic pneumonia and hypersensitivity pneumonitis. Medicine (Baltimore) 2021; 100:e25054. [PMID: 33725891 PMCID: PMC7969297 DOI: 10.1097/md.0000000000025054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/13/2021] [Indexed: 01/05/2023] Open
Abstract
Waterproofing spray-associated pneumonitis (WAP) proceeds to acute respiratory failure and is characterized by diffuse bilateral ground-glass opacities on computed tomography; however, the detailed characteristics of WAP are unknown. Therefore, this study identified the characteristics of WAP from comparisons with those of acute eosinophilic pneumonia (AEP) and hypersensitivity pneumonitis (HP), which show similar features to WAP.Adult patients with WAP, AEP, and HP treated in Fukujuji Hospital from 1990 to 2018 were retrospectively enrolled. Furthermore, data from patients with WAP were collected from publications in PubMed and the Japan Medical Abstracts Society and combined with data from our patients.Thirty-three patients with WAP, eleven patients with AEP, and thirty patients with HP were reviewed. Regarding age, sex, smoking habit, and laboratory findings (white blood cell count, C-reactive protein level, and serum Krebs von den Lungen-6 level), WAP and AEP were not significantly different, while WAP and HP were significantly different. The duration from symptom appearance to hospital visit was shorter in patients with WAP (median 1 day) than in patients with AEP (median 3 days, P = .006) or HP (median 30 days, P < .001). The dominant cells in the bronchoalveolar lavage fluid of patients with WAP, AEP, and HP were different (macrophages, eosinophils, and lymphocytes, respectively).The characteristic features of WAP were rapid disease progression and macrophage dominance in the bronchoalveolar lavage fluid, and these characteristics can be used to distinguish among WAP, AEP, and HP.
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Miao R, Zhu Y, Wang Z, Luo S, Wan C. Distinguishment of parasite-infected children from pediatric inpatients with both eosinophilia and effusion. Medicine (Baltimore) 2020; 99:e19625. [PMID: 32243388 PMCID: PMC7440094 DOI: 10.1097/md.0000000000019625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patients with both serous effusion and eosinophilia are rarely reported and geographically distributed; their early diagnosis is difficult.According to the ultimate diagnosis, patients (≤14 years) in West China Second hospital with serous effusion and eosinophilia were divided into two groups including a parasitic group and a non-parasitic group. Clinical data were collected and analyzed between the two groups. Subsequently, significant measurement indicators were evaluated by receiver operating characteristic (ROC) curve to explore the optimal cut-off points for the most appropriate sensitivity and specificity.A total of 884 patients were diagnosed with serous effusion and 61 of them displayed co-morbidity with eosinophilia during enrolled time. Among 61 patients, 34 patients had parasitic infection and 27 had non-parasitic diseases. There were statistical difference in effusion position, the levels of white blood cell count (WBC), eosinophil (EOS), EOS%, C-reactive protein (CRP) between parasitic group and non-parasitic group. ROC curve demonstrated that the areas under the curve of EOS count and EOS% were >80%, and the corresponding optimal cut-off values were 1.71 × 10/L and 25.6% for distinguishing between parasitic and non-parasitic infections in our patients.This study provided a quantified index for potentially quick and convenient indicators of pediatric patients presenting with both eosinophilia and effusion. Eosinophils were helpful to improve the initial diagnosis with awareness of parasitic diseases. For the cases with EOS > 1.71 × 10/L or EOS% > 25.6%, parasitic infection should be considered and serological tests are recommended in our region.
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Affiliation(s)
- Ruixue Miao
- Department of Pediatrics, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P.R. China
| | - Yu Zhu
- Department of Pediatrics, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P.R. China
| | - Zhiling Wang
- Department of Pediatrics, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P.R. China
| | - Shuanghong Luo
- Department of Pediatrics, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P.R. China
| | - Chaomin Wan
- Department of Pediatrics, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P.R. China
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Affiliation(s)
- Shuwei Zheng
- Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore.
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Ikeda M, Katoh S, Oka M. A recurrent case of eosinophilic pneumonia with high IL-25 levels. Allergol Int 2018; 67S:S38-S40. [PMID: 29779833 DOI: 10.1016/j.alit.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/08/2018] [Accepted: 03/22/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Masaki Ikeda
- Department of Respiratory Medicine, Kawasaki Medical School, Okayama, Japan.
| | - Shigeki Katoh
- Department of Respiratory Medicine, Kawasaki Medical School, Okayama, Japan
| | - Mikio Oka
- Department of Respiratory Medicine, Kawasaki Medical School, Okayama, Japan
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Chipps BE, Newbold P, Hirsch I, Trudo F, Goldman M. Benralizumab efficacy by atopy status and serum immunoglobulin E for patients with severe, uncontrolled asthma. Ann Allergy Asthma Immunol 2018; 120:504-511.e4. [PMID: 29409951 DOI: 10.1016/j.anai.2018.01.030] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/09/2018] [Accepted: 01/24/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with severe asthma can have eosinophilic inflammation and/or allergen sensitization. Benralizumab is an anti-eosinophilic monoclonal antibody indicated for add-on maintenance treatment of patients with severe asthma aged 12 years and older, and with an eosinophilic phenotype. OBJECTIVE To investigate the efficacy of benralizumab by atopic status and serum immunoglobulin E (IgE) concentrations. METHODS We analyzed pooled results from the SIROCCO (NCT01928771) and CALIMA (NCT01914757) phase III studies. Patients 12 to 75 years old with severe, uncontrolled asthma on high-dosage inhaled corticosteroids plus long-acting β2-agonists received 30 mg of subcutaneous benralizumab every 4 weeks or every 8 weeks (first 3 doses every 4 weeks) or placebo every 4 weeks. The analysis stratified patients who did and did not meet similar omalizumab-qualifying criteria of atopy and serum IgE levels 30 to 700 kU/L. Patients also categorized as having high serum IgE (≥150 kU/L) or low serum IgE (<150 kU/L) and as having atopy or no atopy. Efficacy outcomes were for all patients and by blood eosinophil counts and included annual exacerbation rate ratio and pre-bronchodilator forced expiratory volume in 1 second change at treatment end vs placebo. RESULTS Benralizumab every 8 weeks decreased exacerbations by 46% (95% confidence interval 26-61, P = .0002) and increased forced expiratory volume in 1 second by 0.125 L (95% confidence interval 0.018-0.232, P = .0218) vs placebo for patients with at least 300 eosinophils/μL who met the atopy and IgE criteria. For patients with eosinophilia and high or low IgE, treatment with benralizumab every 8 weeks resulted in 42% and 43% decreases in exacerbation rate (P ≤ .0004) and 0.123- and 0.138-L increases in forced expiratory volume in 1 second (P ≤ .0041) vs placebo, respectively. CONCLUSION Benralizumab treatment decreased exacerbations and improved lung function for patients with severe, uncontrolled eosinophilic asthma regardless of serum IgE concentrations and atopy status.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California.
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Abstract
BACKGROUND AND OBJECTIVE Eosinophilic pneumonia (EP) is an important subset of patients who present with pulmonary infiltrates and eosinophilia (PIE). EP is classified by chronicity and etiology and drug-induced EP is the main cause of secondary EP. The primary goal of this review was to examine all the case reports published since the syndrome was defined in 1990. It remains unclear whether acute or chronic EP (AEP or CEP) represent different diseases, and the secondary goal of this review is to determine if there are factors that may help distinguish these 2 entities. METHODS PubMed (MEDLINE and Medical Subject Headings) was searched for case reports of drug-induced EP or PIE syndrome published between 1990 and 2017. Case reports were only included if the diagnostic criteria for AEP or CEP were fulfilled. For each case, data were extracted pertaining to age, sex, type of medication associated with the disease, time from the onset of symptoms to diagnosis, eosinophil counts in the blood, eosinophil fractions in bronchoalveolar lavage (BAL) fluid, initial chest radiograph and computed tomography results, use of mechanical ventilation, and use of steroid treatment and recurrence. RESULTS We found 196 case reports describing drug-induced EP. The leading cause was daptomycin. From our review, we found that AEP is more common in younger patients with no gender preference. Eosinophilia in the blood at the time of diagnosis characterized only the CEP patients (80% in CEP vs. 20% in AEP). Abnormal findings on radiographic imagine was similar in both syndromes. A significant portion of AEP patients (20%) presented with acute respiratory failure requiring mechanical ventilation. Most patients with EP were treated with steroids with a higher rate of relapse observed in patients with CEP. CONCLUSION AEP is a much more fulminant and severe disease than the gradual onset and slowly progressive nature of CEP. The pathogenesis of AEP and CEP remains unclear. However, there is significant clinical overlap among AEP and CEP that are associated with drug toxicity, suggesting the possibility that AEP and CEP are distinct clinical presentations that share a common pathogenic pathway.
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FitzGerald JM, Bleecker ER, Nair P, Korn S, Ohta K, Lommatzsch M, Ferguson GT, Busse WW, Barker P, Sproule S, Gilmartin G, Werkström V, Aurivillius M, Goldman M. Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 2016; 388:2128-2141. [PMID: 27609406 DOI: 10.1016/s0140-6736(16)31322-8] [Citation(s) in RCA: 872] [Impact Index Per Article: 109.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/01/2016] [Accepted: 08/03/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Benralizumab is a humanised, afucosylated, anti-interleukin-5 receptor α monoclonal antibody that induces direct, rapid, and nearly complete depletion of eosinophils. We aimed to assess the efficacy and safety of benralizumab as add-on therapy for patients with severe, uncontrolled asthma and elevated blood eosinophil counts. METHODS In this randomised, double-blind, parallel-group, placebo-controlled, phase 3 study (CALIMA) undertaken at 303 sites in 11 countries, we enrolled patients aged 12-75 years with severe asthma uncontrolled by medium-dosage to high-dosage inhaled corticosteroids plus long-acting β₂-agonists (ICS plus LABA) and a history of two or more exacerbations in the previous year. Patients were randomly assigned (1:1:1) to receive 56 weeks of benralizumab 30 mg every 4 weeks (Q4W), benralizumab 30 mg every 8 weeks (Q8W; first three doses 4 weeks apart), or placebo (all subcutaneous injection). Patients were stratified (2:1) by baseline blood eosinophil counts 300 cells per μL or greater and less than 300 cells per μL, respectively. Patients and study centre staff were masked to treatment allocation. The primary endpoint was annual exacerbation rate ratio versus placebo for patients receiving high-dosage ICS plus LABA with baseline blood eosinophils 300 cells per μL or greater (intention-to-treat analysis). Key secondary endpoints were pre-bronchodilator forced expiratory volume in 1 s (FEV1) and total asthma symptom score. This study is registered with ClinicalTrials.gov, number NCT01914757. FINDINGS Between Aug 21, 2013, and March 16, 2015, 2505 patients were enrolled, of whom 1306 patients were randomised; 425 patients were randomly assigned to and received benralizumab 30 mg Q4W, 441 to benralizumab 30 mg Q8W, and 440 to placebo. 728 patients were included in the primary analysis population. Benralizumab resulted in significantly lower annual exacerbation rates with the Q4W regimen (rate 0·60 [95% CI 0·48-0·74], rate ratio 0·64 [95% CI 0·49-0·85], p=0·0018, n=241) and Q8W regimen (rate 0·66 [95% CI 0·54-0·82], rate ratio 0·72 [95% CI 0·54-0·95], p=0·0188, n=239) compared with placebo (rate 0·93 [95% CI 0·77-1·12], n=248). Benralizumab also significantly improved pre-bronchodilator FEV1 (Q4W and Q8W) and total asthma symptom score (Q8W only) in these patients. The most common adverse events were nasopharyngitis (90 [21%] in the Q4W group, 79 [18%] in the Q8W group, and 92 [21%] in the placebo group) and worsening asthma (61 [14%] in the Q4W group, 47 [11%] in the Q8W group, and 68 [15%] in the group). INTERPRETATION Benralizumab significantly reduced annual exacerbation rates and was generally well tolerated for patients with severe, uncontrolled asthma with blood eosinophils 300 cells per μL or greater. Our data further refine the patient population likely to receive the greatest benefit from benralizumab treatment. FUNDING AstraZeneca and Kyowa Hakko Kirin.
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Affiliation(s)
- J Mark FitzGerald
- The Lung Centre, Vancouver General Hospital, UBC Institute for Heart and Lung Health, Vancouver, BC, Canada.
| | | | | | | | - Ken Ohta
- National Hospital Organization, Tokyo National Hospital, Tokyo, Japan
| | | | - Gary T Ferguson
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USA
| | - William W Busse
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Chen S, Shamriz O, Toker O, Fridlender ZG, Tal Y. Recurrent Eosinophilic Pneumonia in a Patient with Isolated Immunoglobulin M Deficiency and Celiac Disease. Isr Med Assoc J 2015; 17:526-527. [PMID: 26394501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Schuster GU, Bratt JM, Jiang X, Pedersen TL, Grapov D, Adkins Y, Kelley DS, Newman JW, Kenyon NJ, Stephensen CB. Dietary long-chain omega-3 fatty acids do not diminish eosinophilic pulmonary inflammation in mice. Am J Respir Cell Mol Biol 2014; 50:626-36. [PMID: 24134486 PMCID: PMC4068931 DOI: 10.1165/rcmb.2013-0136oc] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 10/07/2013] [Indexed: 12/30/2022] Open
Abstract
Although the effects of fish oil supplements on airway inflammation in asthma have been studied with varying results, the independent effects of the fish oil components, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), administered separately, are untested. Here, we investigated airway inflammation and hyperresponsiveness using a mouse ovalbumin exposure model of asthma assessing the effects of consuming EPA (1.5% wt/wt), DHA (1.5% wt/wt), EPA plus DHA (0.75% each), or a control diet with no added omega-3 polyunsaturated fatty acids. Consuming these diets for 6 weeks resulted in erythrocyte membrane EPA contents (molar %) of 9.0 (± 0.6), 3.2 (± 0.2), 6.8 (± 0.5), and 0.01 (± 0.0)%; DHA contents were 6.8 (± 0.1), 15.6 (± 0.5), 12.3 (± 0.3), and 3.8 (± 0.2)%, respectively. The DHA group had the highest bronchoalveolar lavage (BAL) fluid eosinophil and IL-6 levels (P < 0.05). Similar trends were seen for macrophages, IL-4, and IL-13, whereas TNF-α was lower in omega-3 polyunsaturated fatty acid groups than the control (P < 0.05). The DHA group also had the highest airway resistance, which differed significantly from the EPA plus DHA group (P < 0.05), which had the lowest. Oxylipins were measured in plasma and BAL fluid, with DHA and EPA suppressing arachidonic acid-derived oxylipin production. DHA-derived oxylipins from the cytochrome P450 and 15-lipoxygenase pathways correlated significantly with BAL eosinophil levels. The proinflammatory effects of DHA suggest that the adverse effects of individual fatty acid formulations should be thoroughly considered before any use as therapeutic agents in asthma.
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Affiliation(s)
- Gertrud U. Schuster
- United States Department of Agriculture (USDA), Agricultural Research Service (ARS), Western Human Nutrition Research Center, Immunity and Disease Prevention Unit, Davis, California
- Nutrition Department, University of California, Davis, California
| | - Jennifer M. Bratt
- Division of Pulmonary and Critical Care Medicine, University of California, Davis, California; and
| | - Xiaowen Jiang
- United States Department of Agriculture (USDA), Agricultural Research Service (ARS), Western Human Nutrition Research Center, Immunity and Disease Prevention Unit, Davis, California
| | - Theresa L. Pedersen
- USDA, ARS, Western Human Nutrition Research Center, Obesity and Metabolism Research Prevention, Davis, California
| | - Dmitry Grapov
- Nutrition Department, University of California, Davis, California
| | - Yuriko Adkins
- United States Department of Agriculture (USDA), Agricultural Research Service (ARS), Western Human Nutrition Research Center, Immunity and Disease Prevention Unit, Davis, California
| | - Darshan S. Kelley
- United States Department of Agriculture (USDA), Agricultural Research Service (ARS), Western Human Nutrition Research Center, Immunity and Disease Prevention Unit, Davis, California
- Nutrition Department, University of California, Davis, California
| | - John W. Newman
- Nutrition Department, University of California, Davis, California
- USDA, ARS, Western Human Nutrition Research Center, Obesity and Metabolism Research Prevention, Davis, California
| | - Nicholas J. Kenyon
- Division of Pulmonary and Critical Care Medicine, University of California, Davis, California; and
| | - Charles B. Stephensen
- United States Department of Agriculture (USDA), Agricultural Research Service (ARS), Western Human Nutrition Research Center, Immunity and Disease Prevention Unit, Davis, California
- Nutrition Department, University of California, Davis, California
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Teng Y, Gao Y. Tobacco smoking associated with the increases of the bronchoalveolar levels of interleukin-5 and interleukin-1 receptor antagonist in acute eosinophilic pneumonia. Eur Rev Med Pharmacol Sci 2014; 18:887-893. [PMID: 24706315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND There is a strong association between tobacco smoking and acute eosinophilic pneumonia (AEP) and tobacco smoking has been related to onset of AEP, but the mechanisms for causing AEP are largely unknown. AEP is characterized by locally high levels of interleukin-5 (IL-5) and interleukin-1 receptor antagonist (IL-1RA). Thus, tobacco smoking may relate to the high levels of IL-5 and IL-1RA in AEP. AIM We aimed to determine whether the rate of tobacco smoking positively related to the high levels of IL-5 and IL-1RA. PATIENTS AND METHODS In the study, 155 AEP patients and 135 control healthy subjects were recruited by the Clinical Research Center at General Hospital of Shenyang Military Area Command (Shenyang, China). All the subjects were interviewed regarding for the tobacco smoking rate. The number of eosinophils was counted in all subjects. The relative expressive levels of IL-5 and IL-1RA were measured with ELISA in Bronchoalveolar lavage (BAL) and serum. RESULTS The BAL levels of IL-5, IL-1ra, eosinophils and lymphocytes positively correlates with the rate of tobacco smoking in AEP patients (p < 0.005) comparing with those in healthy control groups. No significant association was observed between the serum levels IL-5 and IL-1ra and the rate of tobacco smoking in AEP patients (p > 0.05) comparing with those in healthy control groups. CONCLUSIONS Smoking increases the BAL levels of IL-5 and IL-1RA, which is associated with the onset of AEP.
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Affiliation(s)
- Y Teng
- Department of Emergence, General Hospital of Shenyang Military Area Command, Shenyang, China.
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Pavord ID, Korn S, Howarth P, Bleecker ER, Buhl R, Keene ON, Ortega H, Chanez P. Mepolizumab for severe eosinophilic asthma (DREAM): a multicentre, double-blind, placebo-controlled trial. Lancet 2012; 380:651-9. [PMID: 22901886 DOI: 10.1016/s0140-6736(12)60988-x] [Citation(s) in RCA: 1531] [Impact Index Per Article: 127.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Some patients with severe asthma have recurrent asthma exacerbations associated with eosinophilic airway inflammation. Early studies suggest that inhibition of eosinophilic airway inflammation with mepolizumab-a monoclonal antibody against interleukin 5-is associated with a reduced risk of exacerbations. We aimed to establish efficacy, safety, and patient characteristics associated with the response to mepolizumab. METHODS We undertook a multicentre, double-blind, placebo-controlled trial at 81 centres in 13 countries between Nov 9, 2009, and Dec 5, 2011. Eligible patients were aged 12-74 years, had a history of recurrent severe asthma exacerbations, and had signs of eosinophilic inflammation. They were randomly assigned (in a 1:1:1:1 ratio) to receive one of three doses of intravenous mepolizumab (75 mg, 250 mg, or 750 mg) or matched placebo (100 mL 0·9% NaCl) with a central telephone-based system and computer-generated randomly permuted block schedule stratified by whether treatment with oral corticosteroids was required. Patients received 13 infusions at 4-week intervals. The primary outcome was the rate of clinically significant asthma exacerbations, which were defined as validated episodes of acute asthma requiring treatment with oral corticosteroids, admission, or a visit to an emergency department. Patients, clinicians, and data analysts were masked to treatment assignment. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01000506. FINDINGS 621 patients were randomised: 159 were assigned to placebo, 154 to 75 mg mepolizumab, 152 to 250 mg mepolizumab, and 156 to 750 mg mepolizumab. 776 exacerbations were deemed to be clinically significant. The rate of clinically significant exacerbations was 2·40 per patient per year in the placebo group, 1·24 in the 75 mg mepolizumab group (48% reduction, 95% CI 31-61%; p<0·0001), 1·46 in the 250 mg mepolizumab group (39% reduction, 19-54%; p=0·0005), and 1·15 in the 750 mg mepolizumab group (52% reduction, 36-64%; p<0·0001). Three patients died during the study, but the deaths were not deemed to be related to treatment. INTERPRETATION Mepolizumab is an effective and well tolerated treatment that reduces the risk of asthma exacerbations in patients with severe eosinophilic asthma. FUNDING GlaxoSmithKline.
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Affiliation(s)
- Ian D Pavord
- Institute for Lung Health, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK.
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Affiliation(s)
- Andrew W Barritt
- Department of Respiratory Medicine, Royal Sussex County Hospital, Brighton BN2 5BE, UK.
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13
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Ray D, Subramanyam S, Krishna SH, Ramanathan VD. Serum C3d levels in tropical pulmonary eosinophilia. Indian J Med Res 2010; 131:555-558. [PMID: 20424307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND & OBJECTIVES Results of earlier studies to evaluate the possible role of complement system in tropical pulmonary eosinophilia (TPE) using classical methods like serum haemolyte component CH50, C3 and C4 levels were inconclusive. In this study we determined levels of serum C3d which is a catabolic fragment of C3, to find out any direct evidence of activation of the complement system in TPE. METHODS The study population consisted of 3 groups. Group A consisted of 37 patients with well characterized TPE. In group B, 26 patients with pulmonary eosinophilia had similar respiratory and haemotological features as in Group A but had associated worm infestation in stool. The control group consisted of 39 healthy volunteers. Serum C3d levels were determined by sandwich ELISA technique. RESULTS The serum C3d levels in TPE patients were not significantly different from those of the patients of group B or the normal controls. INTERPRETATION & CONCLUSIONS Absence of significant change in serum C3d goes against the possibility of complement activation in TPE. Results of our study suggest that complement system is unlikely to play a pivotal role in pathogenesis of TPE.
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Affiliation(s)
- Debidas Ray
- Tuberculosis Research Centre, Indian Council of Medical Research, Chennai, India
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Miyazaki E, Nureki SI, Ono E, Ando M, Matsuno O, Fukami T, Ueno T, Kumamoto T. Circulating thymus- and activation-regulated chemokine/CCL17 is a useful biomarker for discriminating acute eosinophilic pneumonia from other causes of acute lung injury. Chest 2007; 131:1726-34. [PMID: 17565019 DOI: 10.1378/chest.06-2596] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The presentation of acute eosinophilic pneumonia (AEP) closely resembles that of acute lung injury (ALI)/ARDS, including its idiopathic form, acute interstitial pneumonia (AIP). AEP usually lacks peripheral eosinophilia at the acute phase; therefore, the establishment of serum biomarkers for AEP would be clinically useful. METHODS We measured the levels of thymus- and activation-regulated chemokine (TARC)/CCL17, eotaxin/CCL11, KL-6, and surfactant protein-D (SP-D) in serum for patients with acute parenchymal lung diseases including AEP (n = 17), AIP (n = 13), pneumonia-associated ALI/ARDS (n = 12), and alveolar hemorrhage (n = 7). To evaluate diagnostic ability, each marker was estimated by measuring the area under the receiver operating characteristic curve (AUC). RESULTS Serum TARC/CCL17 levels of AEP patients were much higher than those of patients in other disease groups. More importantly, high circulating TARC/CCL17 levels were observed in AEP even at acute phase when peripheral eosinophilia was absent. TARC/CCL17 showed the largest AUC, and the TARC/CCL17 levels with cutoff points from 6,259 to 7,039 pg/mL discriminated AEP from other syndromes with sensitivity and specificity of 100%. The KL-6 level was low in most patients with AEP, and the sensitivity was 81.6% in cutoff with 100% specificity. The AUC for eotaxin/CCL11 and SP-D was small, with values of 0.73 (95% confidence interval [CI], 0.60 to 0.86) and 0.53 (95% CI, 0.31 to 0.64), respectively. CONCLUSIONS This study indicates that the measurement of circulating TARC/CCL17 and KL-6 is useful for discriminating AEP from other causes of ALI.
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Affiliation(s)
- Eishi Miyazaki
- Division of Pulmonary Disease, Department of Brain and Nerve Science, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593, Japan.
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Abstract
The relationship between the blood level of rheumatoid factor (RF) and the peripheral blood eosinophil (Eo) count (white blood cellsx%Eo, Eo count) in a patient diagnosed with chronic eosinophilic pneumonia was evaluated from before the onset till resolution of the disease. RF levels correlated with Eo counts, and showed a strong correlation with the logarithmic value of the Eo counts (r=0.816). RF levels tended to become elevated earlier and decline later than Eo counts or abnormal X-ray shadows. We concluded that the RF level may reflect the activity of this disease. The mechanism of RF elevation in eosinophil-activated disorders needs to be clarified.
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Affiliation(s)
- Megumi Kudou
- Department of Respiratory Medicine, Takatsuki Red Cross Hospital, Osaka, Japan.
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Marchand E, Cordier JF. [Idiopathic chronic eosinophilic pneumonia]. Rev Mal Respir 2006; 23:13S99-108. [PMID: 17057635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Idiopathic chronic eosinophilic pneumonia (ICEP) is one of the hypereosinophilic lung diseases. BACKGROUND ICEP is a rare disease of unknown cause that combines non-specific respiratory and general symptoms with predominantly peripheral radiological infiltrates. The presence of blood and alveolar eosinophilia points strongly to the diagnosis. ICEP is very sensitive to systemic corticosteroids but relapses are common following stopping treatment or reducing the dose. A background of asthma is commonly found and many patients with ICEP develop severe asthma which, together with the relapses, often necessitates prolonged systemic corticosteroid treatment. The long term prognosis, however, remains excellent. VIEWPOINT The role of inhaled corticosteroids in non-asthmatic patients remains uncertain and should be evaluated further. The links between asthma and ICEP could lead to a better understanding of the mechanisms underlying hypereosinophilic lung diseases. CONCLUSION ICEP is a rare disease that is important to recognise on account of its potentially disabling nature and its good response to corticosteroid treatment though long term maintenance is some times necessary on account of relapses or the development of severe asthma.
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Affiliation(s)
- E Marchand
- Groupe d'Etudes et de Recherche sur les Maladies Orphelines Pulmonaires (GERMOP), Hôpital Louis Pradel, Lyon (Bron), France.
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Hattori T, Hizawa N, Takahashi D, Isada A, Takahashi A, Maeda Y, Fukui Y, Konno S, Nishimura M. [Total serum IgE levels in eosinophilic lung diseases]. Arerugi 2006; 55:647-54. [PMID: 16883101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Accepted: 03/07/2006] [Indexed: 05/11/2023]
Abstract
BACKGROUND We previously reported elevated levels of total serum IgE in patients with asthma, regardless of their atopic status. We hypothesized that certain factors inherent to asthma may contribute to this non-specific elevation of total serum IgE. In the current study, to evaluate the role of eosinophils in the regulation of total serum IgE, we examined whether peripheral blood eosinophil count is associated with total serum IgE level in patients with eosinophilic lung diseases. METHODS Ninety-nine healthy controls, 277 patients with asthma, 15 patients with acute eosinophilic pneumonia, 21 patients with chronic eosinophilic pneumonia were studied for total serum IgE levels and peripheral blood eosinophil counts. RESULTS Patients with acute or chronic eosinophilic pneumonia had significantly increased total serum IgE levels compared with healthy controls regardless as atopic status (p<0.001). In non-atopic subjects with eosinophilic lung diseases, total serum IgE level was significantly correlated with peripheral blood eosinophil count (r=0.42, p<0.001, n=57). CONCLUSION Our findings suggest that, in addition to antigen-specific IgE production, non-specific IgE production may contribute to elevated levels of total serum IgE in patients with asthma or eosinophilic pneumonia. An increased number of activated eosinophils may underlie an increased total serum IgE level in these conditions.
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Affiliation(s)
- Takeshi Hattori
- First Department of Medicine, School of Medicine, Hokkaido University
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18
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Rådinger M, Sergejeva S, Johansson AK, Malmhäll C, Bossios A, Sjöstrand M, Lee JJ, Lötvall J. Regulatory role of CD8+ T lymphocytes in bone marrow eosinophilopoiesis. Respir Res 2006; 7:83. [PMID: 16740158 PMCID: PMC1534027 DOI: 10.1186/1465-9921-7-83] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2006] [Accepted: 06/01/2006] [Indexed: 01/22/2023] Open
Abstract
Background There is a growing body of evidence to suggest that CD8+ T lymphocytes contribute to local allergen-induced eosinophilic inflammation. Since bone marrow (BM) responses are intricately involved in the induction of airway eosinophilia, we hypothesized that CD8+ T lymphocytes, as well as CD4+ T lymphocytes, may be involved in this process. Methods Several approaches were utilized. Firstly, mice overexpressing interleukin-5 (IL-5) in CD3+ T lymphocytes (NJ.1638; CD3IL-5+ mice) were bred with gene knockout mice lacking either CD4+ T lymphocytes (CD4-/-) or CD8+ T lymphocytes (CD8-/-) to produce CD3IL-5+ knockout mice deficient in CD4+ T lymphocytes (CD3IL-5+/CD4-/-) and CD8+ T lymphocytes (CD3IL-5+/CD8-/-), respectively. Secondly, CD3+, CD4+ and CD8+ T lymphocytes from naïve CD3IL-5+ and C57BL/6 mice were adoptively transferred to immunodeficient SCID-bg mice to determine their effect on BM eosinophilia. Thirdly, CD3IL-5+, CD3IL-5+/CD8-/- and CD3IL-5+/CD4-/- mice were sensitized and allergen challenged. Bone marrow and blood samples were collected in all experiments. Results The number of BM eosinophils was significantly reduced in CD3IL-5+/CD8-/- mice compared to CD3IL-5+ mice and CD3IL-5+/CD4-/- mice. Serum IL-5 was significantly higher in CD3IL-5+/CD4-/- mice compared to CD3IL-5+ mice but there was no difference in serum IL-5 between CD3IL-5+/CD4-/- and CD3IL-5+/CD8-/- mice. Adoptive transfer of CD8+, but not CD4+ T lymphocytes from naïve CD3IL-5+ and C57BL/6 mice restored BM eosinophilia in immunodeficient SCID-bg mice. Additionally, allergen challenged CD3IL-5+/CD8-/- mice developed lower numbers of BM eosinophils compared to CD3IL-5+ mice and CD3IL-5+/CD4-/- mice. Conclusion This study shows that CD8+ T lymphocytes are intricately involved in the regulation of BM eosinophilopoiesis, both in non-sensitized as well as sensitized and allergen challenged mice.
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Affiliation(s)
- Madeleine Rådinger
- Lung Pharmacology Group, Department of Internal Medicine/Respiratory Medicine and Allergology, Göteborg University, Göteborg, Sweden
| | - Svetlana Sergejeva
- Lung Pharmacology Group, Department of Internal Medicine/Respiratory Medicine and Allergology, Göteborg University, Göteborg, Sweden
- The Unit for Lung Investigations, Faculty of Science, Department of Gene Technology, Tallinn University of Technology, Estonia
| | - Anna-Karin Johansson
- Lung Pharmacology Group, Department of Internal Medicine/Respiratory Medicine and Allergology, Göteborg University, Göteborg, Sweden
| | - Carina Malmhäll
- Lung Pharmacology Group, Department of Internal Medicine/Respiratory Medicine and Allergology, Göteborg University, Göteborg, Sweden
| | - Apostolos Bossios
- Lung Pharmacology Group, Department of Internal Medicine/Respiratory Medicine and Allergology, Göteborg University, Göteborg, Sweden
| | - Margareta Sjöstrand
- Lung Pharmacology Group, Department of Internal Medicine/Respiratory Medicine and Allergology, Göteborg University, Göteborg, Sweden
| | - James J Lee
- Divison of Pulmonary Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Jan Lötvall
- Lung Pharmacology Group, Department of Internal Medicine/Respiratory Medicine and Allergology, Göteborg University, Göteborg, Sweden
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Daimon T, Tajima S, Oshikawa K, Bando M, Ohno S, Sugiyama Y. KL-6 and surfactant proteins A and D in serum and bronchoalveolar lavage fluid in patients with acute eosinophilic pneumonia. Intern Med 2005; 44:811-7. [PMID: 16157978 DOI: 10.2169/internalmedicine.44.811] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECT The serum levels of KL-6, surfactant protein A (SP-A), and SP-D are useful biomarkers and prognostic factors for the activity of interstitial pneumonias. The aim of this study was to determine the clinical roles of the levels of KL-6, SP-A, and SP-D in the serum and bronchoalveolar lavage fluid (BALF) of patients with acute eosinophilic pneumonia (AEP). MATERIALS AND METHODS We researched 5 cases of AEP. The levels of KL-6, SP-A, and SP-D in the sera and BALF of those patients were measured by enzyme-linked immunosorbent assay. RESULTS KL-6 levels in BALF did not differ between AEP patients and the healthy control group, while SP-A and SP-D levels in BALF were significantly higher in the AEP patients than in the healthy control group. In sera, AEP patients had significantly higher than normal levels of SP-A and SP-D, but not of KL-6. Only in sera there was a positive correlation between SP-A and SP-D, but no apparent correlations in BALF and also between KL-6 and the others. Furthermore, the BALF levels of SP-D, but not of SP-A or KL-6, statistically correlated with the concentration of albumin in BALF. After clinical improvement, the elevated levels of serum SP-A or SP-D in AEP patients decreased until normal levels were reached within 2 months. CONCLUSION These results suggest that the serum or BALF levels of SP-D appear to be more sensitive than those of SP-A or KL-6 at reflecting the inflammatory response in AEP lungs.
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Affiliation(s)
- Tadahisa Daimon
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical School, Tochigi, Japan
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20
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Irie M, Nagata S, Endo Y. Anterior hypothalamic lesions inhibit antigen-induced airway eosinophilia in rats. Neuroimmunomodulation 2005; 10:305-9. [PMID: 12759567 DOI: 10.1159/000069974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2002] [Accepted: 08/30/2002] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Although previous studies have found that electrolytic lesions of the anterior hypothalamic area (AHA) resulted in the suppression of anaphylaxis, their effect on late allergic responses has scarcely been investigated. To clarify the role of the AHA on possible late asthmatic responses, including their neuroendocrinological mechanisms, we examined the effect of electrolytic AHA lesions on antigen-induced eosinophilic infiltration into the airway tract and measured the plasma corticosterone and catecholamine levels in sensitized rats, i.e. a model of bronchial asthma. METHODS The rats were randomly divided into 3 groups, including: (1) an unoperated control group; (2) a sham AHA-lesioned group and (3) an AHA-lesioned group. Then, we investigated antigen-induced eosinophilic infiltration into right bronchoalveolar lavage fluid (BALF) and the lamina propria mucosae of the left main bronchus. RESULTS The AHA-lesioned group showed the significantly lowest number of eosinophils in both the BALF (p < 0.01) and the main bronchus (p < 0.05). The plasma adrenaline levels in the AHA-lesioned group were significantly higher than those in the other groups (p < 0.05). No differences were found in the plasma corticosterone or noradrenaline levels among the 3 groups. CONCLUSION This study provides evidence that AHA lesions inhibit not only anaphylaxis, but also late asthmatic response related to airway eosinophilic infiltration, possibly via an alteration of the sympathetic nervous function.
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Affiliation(s)
- Masahiro Irie
- Institute for Occupational Health Sciences, Aichi Medical University, Nagakute-cho, Aichi, Japan.
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21
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Fujii M, Tanaka H, Kameda M, Fujii M, Tanaka S, Ohashi K, Chiba H, Takahashi H, Abe S. Elevated serum surfactant protein A and D in a case of acute eosinophilic pneumonia. Intern Med 2004; 43:423-6. [PMID: 15206558 DOI: 10.2169/internalmedicine.43.423] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 29-year-old man was admitted to our hospital because of fever elevation, dry cough, malaise, skin eruption, and dyspnea with hypoxemia. His serum levels of surfactant protein (SP) -A and SP-D were markedly high, but serum KL-6 was not. He was diagnosed as acute eosinophilic pneumonia (AEP) on the basis of CT imaging, bronchoalveolar lavage findings and the clinical course. He showed good response to steroid therapy and serum levels of SP-A and SP-D returned to almost normal levels. Our experience suggested that serum SP-A and SP-D might be helpful markers for monitoring the clinical course in AEP.
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Affiliation(s)
- Masaru Fujii
- Third Department of Internal Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo 060-8543
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22
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Załeska M, Roszkowska-Sliz B, Wiatr E, Tomkowski W, Bestry I, Roszkowski-Sliz K. [Churg-Strauss syndrome--cardiac problem in lung disease department]. Pneumonol Alergol Pol 2003; 71:349-58. [PMID: 15052969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Eosinophilia and pleural effusion may suggest pulmonary eosinophilia. We present a case of 42 years old woman with hypereosinophilia history since 5 months and no evidence of parasitic infections. She had no history of heart disease. Laboratory tests revealed eosinophilia (13.0 x 10(9)/l) and elevated serum IgE (2050 IU/ml), ANCA was not detected. ECP was not elevated. Pleural effusion contained 37% of eosinophils. An ECG revealed low voltage of QRS in all leads and Q waves in leads Vi-V-3. An echocardiography showed enlargement of left auricle and left ventricle with ejection fraction = 35%. The only pulmonary manifestation in this case was eosinophilic pleural effusions associated with congestive heart failure. A women was treated with prednisone 1 mg/kg/d and cyclophosphamide 2 mg/kg/d with clinical improvement and normalisation of eosinophil number in peripheral blood. But echocardiographic picture of the heart was nor better during 2 months of observation.
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Affiliation(s)
- Monika Załeska
- III Kliniki Chorób Płuc, Instytutu Gruźlicy i Chorób Płuc w Warszawie
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23
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Peixoto CA, Alves LC, Ferreira Da Silva L, Pires ML, Rocha A. Localisation and distribution of Wuchereria bancrofti antigens recognised by antisera from tropical pulmonary eosinophilia and from individuals with intestinal helminths. J Submicrosc Cytol Pathol 2003; 35:61-8. [PMID: 12762653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Serological analyses of sera from patients with a typical picture of filarial tropical pulmonary eosinophilia (TPE) and sera from patients from a region non-endemic for filariasis harbouring intestinal helminths, as Ascaris lumbricoides and Strongyloids stercoralis, revealed equally high titers of IgG4, usually considered diagnostic for filariasis. Ultrathin sections of adult worms of W. bancrofti embedded in the hydrophilic resin L.R. White were incubated with sera from patients with a typical picture of filarial tropical pulmonary eosinophilia (TPE) and sera from patients of a region that was non-endemic for filarial TPE but endemic for intestinal helminths. Both groups had a similar pattern of labelling, except that the labelling intensity was higher with the sera of patients with filarial TPE. The present study indicates relevant epitopes recognised by sera from TPE-patients and also individuals with intestinal helminths in all tissues of adult and intra-uterine microfilaria of W. bancrofti, instead of being localised in a specific nematode region. These findings suggest that people from areas not endemic for filariasis, but who harbour intestinal helminths, also share antifilarial antibodies in their serum that recognise antigens of adult worms and intrauterine microfilaria of W. bancrofti.
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Affiliation(s)
- C A Peixoto
- Department of Cellular Pathology and Biology, Research Center 'Aggeu Magalhães, Recife, Brazil.
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24
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Swirski FK, Sajic D, Robbins CS, Gajewska BU, Jordana M, Stämpfli MR. Chronic exposure to innocuous antigen in sensitized mice leads to suppressed airway eosinophilia that is reversed by granulocyte macrophage colony-stimulating factor. J Immunol 2002; 169:3499-506. [PMID: 12244139 DOI: 10.4049/jimmunol.169.7.3499] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In this study we investigated the impact of chronic allergen exposure on airway inflammation and humoral responses in sensitized mice. We observed marked eosinophilia in the bronchoalveolar lavage, lung tissue, and peripheral blood after 2 wk of exposure. In contrast, eosinophilia was markedly reduced by 3 wk and completely resolved by 4 wk of exposure, despite the continued presence of Ag. Decreases in airway eosinophilia were associated with a robust humoral response. We observed that levels of OVA-specific IgE, IgG1, and IgG2a increased during the course of exposure. To assess whether continuous exposure to Ag impacts the ability of the lung to respond to subsequent Ag challenge, mice were exposed to either 2 or 4 wk of OVA in the context of GM-CSF. All groups were then rested for 28 days and exposed to OVA on three consecutive days. We observed a significant decrease in airway eosinophilia and IL-5 expression in the bronchoalveolar lavage and serum in mice initially exposed to 4 wk of OVA, compared with animals exposed to 2 wk only. However, in both groups expression of B7.2 on dendritic cells as well as CD25, CD69, and T1/ST2 on CD4(+) T cells was enhanced, suggesting immune activation. Delivery of rGM-CSF fully restored airway eosinophilia. This study shows that exposure to innocuous Ag alone does not lead to persistent eosinophilic airway inflammation, but rather to abrogated eosinophilia. This suppression can be reversed by GM-CSF.
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Affiliation(s)
- Filip K Swirski
- Department of Pathology and Molecular Medicine, Division of Respiratory Diseases and Allergy and Center for Gene Therapeutics, McMaster University, Hamilton, Ontario, Canada
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Abstract
Smoking causes various changes in the lung. This report describes a case of cigarette smoke-induced acute eosinophilic pneumonia (CS-AEP) with neutrophilia in the blood. However, the precise mechanism is unknown, so we examined the effect of exposure to cigarette smoke extracts on the production of interleukin (IL)-4, IL-5, IL-8, IL-18, granulocyte macrophage-colony stimulating factor (GM-CSF), and vascular endothelial growth factor (VEGF) by human bronchial epithelial cells (HBECs) obtained from the patient. We found that IL-8 released from HBECs was involved in neutrophilia in the blood, and is a new factor in the development of AEP, especially in the early phase.
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Affiliation(s)
- Keisuke Miki
- Department of Internal Medicine, JA Kochi Hospital, Nankoku, Kochi
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26
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Philit F, Etienne-Mastroïanni B, Parrot A, Guérin C, Robert D, Cordier JF. Idiopathic acute eosinophilic pneumonia: a study of 22 patients. Am J Respir Crit Care Med 2002; 166:1235-9. [PMID: 12403693 DOI: 10.1164/rccm.2112056] [Citation(s) in RCA: 179] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Idiopathic acute eosinophilic pneumonia (IAEP) is characterized by acute febrile respiratory failure associated with diffuse radiographic infiltrates and pulmonary eosinophilia. We conducted a multicenter retrospective study to characterize this rare clinical entity further and to improve its diagnostic criteria. A total of 13 male and 9 female patients (mean age: 29 +/- 15.8 years) presented with severe hypoxemia (Pa(O2)/fraction of inspired oxygen ratio = 156 +/- 74.1) requiring mechanical ventilation in 14 cases. Bronchoalveolar lavage was performed on all patients and showed 54.4 +/- 19.2% eosinophils on differential cell count, but no open-lung biopsies were done. No clinical differences were found between patients seen at less than 7 days (n = 15) or at 7 to 31 days (n = 7) from the onset of IAEP. A total of 12 patients met the clinical criteria of acute lung injury, and eight of these patients met the criteria for acute respiratory distress syndrome. All patients recovered, either spontaneously (6) or on corticosteroid treatment (16). No relapses occurred. We conclude that: (1) diagnostic criteria of IAEP are compatible with a duration of symptoms for up to 1 month, but the response to corticosteroid treatment is not diagnostic because of possible spontaneous recovery; (2) IAEP should be considered as differential diagnosis of acute lung injury or acute respiratory distress syndrome; (3) bronchoalveolar lavage eosinophilia obviates the need for lung biopsy in IAEP.
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Affiliation(s)
- François Philit
- Service d'Assistance Respiratoire et Réanimation Médicale, Hôpital de la Croix Rousse, Paris, France
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Affiliation(s)
- Y Tanino
- First Department of Medicine, Hokkaido University School of Medicine, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan.
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Chapoval SP, Marietta EV, Smart MK, David CS. Requirements for allergen-induced airway inflammation and hyperreactivity in CD4-deficient and CD4-sufficient HLA-DQ transgenic mice. J Allergy Clin Immunol 2001; 108:764-71. [PMID: 11692102 DOI: 10.1067/mai.2001.118794] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Airway inflammation is central to the pathogenesis of allergic asthma, and molecules that mediate this process obviously represent targets for therapy. OBJECTIVE To study the role of CD4(+) T cells and/or HLA-DQ molecules in allergic asthma, we have generated and characterized models of short ragweed allergen (SRW)-induced inflammation using transgenic mice with HLA-DQ (DQ6 or DQ8), human CD4 (hCD4), or both on a genetic background that lacks mouse MHC II and CD4 (Abeta(0)/mCD4(0)). METHODS Mice were actively sensitized and later challenged intranasally with SRW allergenic extract. Bronchoalveolar lavage fluid composition, airway inflammation and hyperresponsiveness, blood eosinophil levels, and cell proliferation were examined. RESULTS In response to SRW treatment, both DQ6 and DQ8 transgenic mice expressing hCD4 developed pulmonary eosinophilia and associated lung tissue damage with increase in eosinophil peroxidase and T(H)2 cytokines in bronchoalveolar lavage fluid, strong airway hyperreactivity, and persistent blood eosinophilia. The response was independent of mast cells/histamine pathway and was mediated by DQ-restricted hCD4(+) T cells. Interestingly, lungs of CD4-deficient DQ6 transgenic mice showed an eosinophilic inflammation without local increase in cytokines and eosinophil peroxidase. The allergic reaction was absent in double-knockout mice and mice expressing either DQ8 or hCD4 alone. CONCLUSIONS DQ6 molecules are critical to SRW-induced allergy and can operate in the presence or absence of CD4. However, both DQ antigens and CD4 molecules are critical for full manifestation of allergen-induced asthma in transgenic mice.
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Affiliation(s)
- S P Chapoval
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
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Stelmach I, Jerzynska J, Kuna P. Markers of allergic inflammation in peripheral blood of children with asthma after treatment with inhaled triamcinolone acetonide. Ann Allergy Asthma Immunol 2001; 87:319-26. [PMID: 11686425 DOI: 10.1016/s1081-1206(10)62247-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND It is important to monitor inflammation regularly in asthma in addition to clinical symptoms, and there is a great need for noninvasive tests that could routinely be used in clinical practice. OBJECTIVE Our hypothesis was that the improvement of clinical parameters, together with decreased airway responsiveness, could be correlated with changes in the levels of serum markers of inflammation after a 4-week treatment with triamcinolone. METHODS In this double-blind, randomized, placebo-controlled trial, 48 children, aged 6 to 18 years, with mild to moderate atopic asthma, were randomly allocated to receive triamcinolone or matching placebo for 4 weeks. The following parameters were measured: the symptom score, forced expiratory volume in 1 second (FEV1), provocative concentration of histamine causing a 20% fall in FEV1 (PC20) for histamine and peripheral blood eosinophil count, serum levels of the inflammatory markers eosinophil cationic protein (ECP), soluble receptor of interleukin-2 (sIL-2R), interleukin-4, soluble intercellular adhesion molecule-1 before and after treatment. RESULTS The clinical parameters significantly improved after treatment with triamcinolone; the mean value of FEV1 changed from 74% of predicted value before, to 90% of predicted after treatment (P < 0.001). PC20 for histamine after treatment with triamcinolone increased significantly from the mean value 2.5 mg/mL to 4.7 mg/mL (P < 0.001). Treatment with triamcinolone significantly (P < 0.05) decreased serum levels of all the measured inflammatory markers. The mean concentration of eosinophil blood count was 380 and 261 cells/mm3; ECP, 83 and 58 ng/mL; serum sIL-2R, 734 and 487 pg/mL; soluble intercellular adhesion molecule-1, 266 and 210 ng/mL, before and after treatment, respectively. The values of interleukin-4 were low and close to the sensitivity of the assay. A significant correlation was found between ECP and sIL-2R levels before and after treatment with triamcinolone. CONCLUSIONS A significant decrease of all the measured serum parameters was observed after treatment with triamcinolone; however, no significant correlation was found among any of those parameters and clinical markers of disease severity (such as FEV1 or PC20H).
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Affiliation(s)
- I Stelmach
- M. Curie Hospital, Department of Pediatric and Allergy, Zgierz, Poland.
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Obase Y, Shimoda T, Mitsuta K, Matsuo N, Matsuse H, Kohno S. Correlation between airway hyperresponsiveness and airway inflammation in a young adult population: eosinophil, ECP, and cytokine levels in induced sputum. Ann Allergy Asthma Immunol 2001; 86:304-10. [PMID: 11289329 DOI: 10.1016/s1081-1206(10)63303-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Eosinophil counts and eosinophil cationic protein (ECP) levels in the airway are elevated in asthmatic patients. However, few studies have examined the correlation between various cytokines in the sputum and airway hyperresponsiveness (AHR) in young adults with or without asthma. OBJECTIVE We examined the correlation between AHR and eosinophil counts or ECP, and levels of several cytokines in the sputum. METHODS We studied 120 nonsmoker students (group 1: intermittent mild asthmatic patients; group 2: subjects with history of childhood asthma; group 3: subjects sensitized by Dermatophagoides farinae with atopic disease; group 4: normal subjects sensitized by D. farinae; group 5: subjects with cedar pollinosis; and group 6: normal subjects). In each subject, AHR and lung function tests were measured, together with eosinophil count, ECP, granulocyte-macrophage colony-stimulating factor, TNF-alpha, IL-5, and interleukin-1beta in induced sputum. RESULTS AHR in groups 1 and group 2 were high, in groups 5 and 6 low, and in groups 3 and 4 lower than in groups 1 and 2 but higher than groups 5 and 6. Percentages of eosinophils, ECP, and TNF-alpha in induced sputum in groups 1 and 2 were high, those in groups 5 and 6 were below detection limits, and those in groups 3 and 4 were lower than the percentages in groups 1 and 2. Granulocyte-macrophage colony-stimulating factor in the sputum was elevated only in group 1. The correlations between AHR and sputum eosinophil count, ECP, and TNF-alpha were significant, with the strongest correlation with TNF-alpha. CONCLUSIONS Our results suggest that TNF-alpha levels in the sputum play an important role in determining the severity of AHR in young individuals. Further once AHR develops, it does not disappear, and the severity of airway inflammation influences the extent of AHR.
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Affiliation(s)
- Y Obase
- The Second Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
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Abstract
To clarify the pathogenesis of chronic eosinophilic pneumonia (CEP), the apoptosis of eosinophils from bronchoalveolar lavage (BAL-Eos) was compared with that of eosinophils from peripheral blood (PB-Eos) in six cases of CEP. The survival rate of eosinophils and the percentage of apoptotic cells of both types of eosinophils were examined, and the effects of interleukin 5 (IL-5) were evaluated. The role of Fas expression in apoptosis of these eosinophils was also studied. The survival rate of BAL-Eos on the third day of culture was significantly higher than that of PB-Eos (p < 0.01). This was associated with a lower proportion of apoptotic cells in BAL-Eos than in PB-Eos; the percentages of apoptotic cells in PB-Eos and BAL-Eos after 24 h of incubation were 21.7 +/- 3.4% and 10.6 +/- 1.7% respectively. IL-5 suppressed apoptosis and increased the survival rate of both PB-Eos and BAL-Eos. It was found that the apoptotic character of BAL-Eos differed from that of PB-Eos in at least three ways. Firstly, the positive rate of Fas expression on PB-Eos was increased after 24 h of incubation, whereas that on BAL-Eos did not change. Secondly, the expression of Fas on PB-Eos was suppressed by IL-5 (18.5 +/- 4.2% - 8.3 +/- 3.2%, p < 0.05), whereas IL-5 failed to suppress Fas expression on BAL-Eos (3.3 +/- 1.6% - 3.6 +/- 1.0%). Lastly, binding of antibody to Fas antigen induced apoptosis of PB-Eos, but not of BAL-Eos. These data suggested that Fas seemed to be involved in the apoptosis of PB-Eos, whereas BAL-Eos were Fas-resistant in chronic eosinophilic pneumonia. In conclusion, apoptosis of eosinophils might be suppressed by proinflammatory cytokines such as IL-5 leading to their accumulation in the lung. Chronic stimulation of eosinophils in the alveolar space with IL-5 may play a crucial role chronic eosinophilic disorders.
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Affiliation(s)
- N Saita
- First Dept of Internal Medicine, Kumamoto University, School of Medicine, Japan
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32
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Bettiol J, Bartsch P, Louis R, De Groote D, Gevaerts Y, Louis E, Malaise M. Cytokine production from peripheral whole blood in atopic and nonatopic asthmatics: relationship with blood and sputum eosinophilia and serum IgE levels. Allergy 2000; 55:1134-41. [PMID: 11117270 DOI: 10.1034/j.1398-9995.2000.00711.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The cytokine network is thought to be essential in orchestrating airway inflammation in asthma. Although evidence has accumulated to suggest that atopic asthma is a Th2 disease, much less is known about nonatopic asthma. METHODS We have compared the production of IL-4, IL-6, IFN-gamma, and TNF-alpha from peripheral blood leukocytes between atopic (n=21) and nonatopic (n=22) asthmatics and healthy nonatopic subjects (n=20). Peripheral blood was incubated for 24 h either without stimulus or with LPS or PHA. Cytokines were measured by the immunotrapping technique (Dynamic Immunoassay). RESULTS When compared to healthy nonatopic subjects, both atopic and nonatopic asthmatics showed increased blood and sputum eosinophilia associated with raised total serum IgE levels. Similarly, both asthma groups displayed spontaneous, endotoxin-induced overproduction of IL-6. Enhanced spontaneous, endotoxin-induced release of IL-4 combined with reduced spontaneous IFN-gamma production was seen only in atopic asthma. In this group of patients, the production of IL-4 was related to the extent of blood and sputum eosinophilia. In nonatopic asthmatics, serum levels of IgE were inversely related to the production of IFN-gamma. CONCLUSIONS Both atopic and intrinsic asthma display raised blood and airway eosinophilia, raised total serum IgE, and overproduction of IL-6 from peripheral blood. Atopic asthma is also characterized by impaired spontaneous release of IFN-gamma and increased production of IL-4 that correlates with the magnitude of eosinophilic inflammation.
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Affiliation(s)
- J Bettiol
- Department of Pneumology, CHU Sart-Tilman, University of Liège, Belgium
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33
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Abstract
This study is an extended follow-up for 24 months of a 12-week trial to study the long-term clinical efficacy of low-dose inhaled budesonide (BUD) once or twice daily in children with mild asthma. A total of 122 children (mean age 9.7 years, girls/boys; 42/80) with mild asthma (FEV1 103.7% of predicted, reversibility in FEV1 3.5%, and fall in FEV1 after exercise 12.2%), not previously treated with inhaled steroids, were included in a double-blind, randomized, parallel-group study. The children were treated with inhaled BUD 100 or 200 microg administered via Turbuhaler once daily in the morning, 100 microg twice daily, or placebo for 27 months. Exercise and methacholine challenges were performed at 3-month intervals the first year and at 6-month intervals the second year, in a total of seven visits. A significant dose-response effect favoring BUD 200 microg daily (vs 100 microg daily) was found when comparing changes in FEV1, FEF25%, and FEV50%; the fall in FEV1 after an exercise test; and the effect on blood eosinophils. Bronchial hyperreactivity to methacholine decreased significantly on three visits in patients treated with BUD 200 microg daily compared to placebo. Growth rate was not significantly affected except in children aged 7-11 years at baseline after 12 months of treatment. In conclusion, 100 or 200 microg daily of inhaled BUD for 27 months is safe and effective in protecting against exercise-induced asthma and achieving nearly normal lung function. Baseline lung function was not significantly affected in this group of children with mild asthma.
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Affiliation(s)
- G Jónasson
- Paediatric Section for Allergy and Pulmonology, Ullevål Hospital, Oslo, Norway
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34
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Phunmanee A, Boonsawat W, Charoensiri DJ, Limkunacul C. Chronic eosinophilic pneumonia: a case report. J Med Assoc Thai 2000; 83:959-63. [PMID: 10998853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Chronic eosinophilic pneumonia (CEP) is a disorder, characterized by a history of pneumonia (> 2 months) and eosinophilic pulmonary infiltration without any organic causes. We describe a 28-year-old woman who presented with cough, dyspnea and fever for 2 months. She was diagnosed with mild asthma and allergic rhinitis 2 years before being diagnosed with CEP. For a period of 9 months she took no medication. Her chest roentgenogram at this admission revealed patchy infiltration in both upper lung fields. Laboratory data revealed blood eosinophilia (4,284/mm3), and her serum IgE was mildly elevated (245.8 IU/ml). A computerized tomography of the chest did not show bronchiectasis. CEP was diagnosed from significant eosinophilia in bronchoalveolar larvage fluid and transbronchial biopsy revealed eosinophilic infiltration without any demonstrable infectious agent. The patient was treated with prednisolone 45 mg/day. Her symptoms disappeared and her chest roentgenogram showed nearly complete resolution in 2 and 4 days, consecutively.
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Affiliation(s)
- A Phunmanee
- Department of Medicine, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Thailand
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35
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Zhao LL, Lindén A, Sjöstrand M, Cui ZH, Lötvall J, Jordana M. IL-12 regulates bone marrow eosinophilia and airway eotaxin levels induced by airway allergen exposure. Allergy 2000; 55:749-56. [PMID: 10955701 DOI: 10.1034/j.1398-9995.2000.00583.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Airway allergen exposure causes local eosinophilic cell infiltration. This cellular inflammatory response is likely to involve the release of eosinophils from peripheral storage pools, and possibly also regeneration of eosinophils in the bone marrow. IL-12 is an inhibitory cytokine in allergic inflammation, shown to reduce eosinophilic cell infiltration. The aim of the present study was to determine whether airway allergen exposure increases bone marrow eosinophil production, and, if so, whether IL-12 modulates this effect. METHODS Ovalbumin-sensitized C57BL/6 mice and IL-12 knockout (KO) mice were exposed to allergen via the airway route, and the inflammatory cell response was evaluated in bronchoalveolar lavage fluid, blood, and bone marrow. RESULTS Allergen instillation intranasally produced a dose-dependent inflammatory response in the lower airways of sensitized mice. This inflammatory response was dominated by eosinophils, but there were also increases of both lymphocytes and neutrophils. Sensitization and airway allergen exposure also increased the IL-5-dependent growth of bone marrow cells in vitro. The enhanced bone marrow responsiveness in vitro was paralleled by an increased number of bone marrow eosinophils in vivo. After sensitization and repeated allergen exposure, IL-12 KO mice showed higher eosinophil levels in both BAL and bone marrow than parallel wild-type control mice. Furthermore, BAL-eotaxin levels were increased in IL-12 KO mice as opposed to parallel wild-type controls after allergen exposure. CONCLUSIONS Airway allergen exposure induced systemic immunologic responses, including increased eosinophil numbers in both airways and bone marrow, and also enhanced IL-5 responsiveness in bone marrow cells. IL-12 may regulate airway eosinophilia at both the level of eosinophilopoiesis and the level of local recruitment of eosinophils into the airways.
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Affiliation(s)
- L L Zhao
- Department of Respiratory Medicine and Allergology, Göteborg University, Gothenburg, Sweden
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36
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Alvarez MJ, Olaguibel JM, Garcia BE, Tabar AI, Urbiola E. Comparison of allergen-induced changes in bronchial hyperresponsiveness and airway inflammation between mildly allergic asthma patients and allergic rhinitis patients. Allergy 2000; 55:531-9. [PMID: 10858983 DOI: 10.1034/j.1398-9995.2000.00534.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Bronchial eosinophilic inflammation and bronchial hyperresponsiveness (BHR) are the main features of allergic asthma (AA), but they have also been demonstrated in allergic rhinitis (AR), suggesting a continuity between both diseases. In spite of not fully reproducing natural allergenic exposure, the allergen bronchial provocation test (A-BPT) has provided important knowledge of the pathophysiology of AA. Our aim was to verify the existence of a behavior of AA and AR airways different from the allergen bronchial challenge-induced airway eosinophilic inflammation and BHR changes. We studied a group of 31 mild and short-evolution AA and 15 AR patients, sensitized to Dermatophagoides pteronyssinus. The A-BPT was performed with a partially biologically standardized D. pteronyssinus extract, and known quantities of Der p 1 were inhaled. Peripheral blood (eosinophils and ECP) and induced sputum (percentage cell counts, ECP, albumin, tryptase, and interleukin [IL]-5) were analyzed, before and 24 h after A-BPT. Methacholine BHR, assessed before and 32 h after the A-BPT, was defined by M-PD20 values and, when possible, by maximal response plateau (MRP). The A-BPT was well tolerated by all the patients. AA presented a lower Der p 1 PD20 and a higher occurrence of late-phase responses (LPR). M-PD20 values decreased in AA, but not in AR, patients. MRP values increased in both groups. Eosinophils numbers and ECP levels increased in blood and sputum from both AA and AR, but only the absolute increment of sputum ECP levels was higher in AA than AR patients (P = 0.025). The A-BPT induced no change in sputum albumin, tryptase, or IL-5 values. We conclude as follows: 1) In spite of presenting a lower degree of bronchial sensitivity to allergen, AR patients responded to allergen inhalation with an eosinophilic inflammation enhancement very similar to that observed among AA. 2) MRP levels increased in both AA and AR patients after allergen challenge; however, M-PD20 values significantly changed only in the AA group, suggesting that the components of the airway response to methacholine were controlled by different mechanisms. 3) It is possible that the differences between AR and AA lie only in the quantitative bronchial response to allergen inhalation.
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Affiliation(s)
- M J Alvarez
- Servicio de Alergología, Hospital de León, Spain
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37
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Abstract
We report a case of acute eosinophilic pneumonia (AEP). Although the patient had been a habitual cigarette smoker for over 4 months, he had had not any respiratory distress. After he inhaled smoke from fireworks for 3 consecutive nights, the patient began to complain of cough, fever and dyspnea. He showed leukocytosis of 16,200/microl and hypoxemia of 58.1 torr. Chest radiograph showed bilateral infiltrates with Kerley A and B lines. The bronchoalveolar lavage fluid revealed 38.5% eosinophils. He was diagnosed as AEP. In this patient, inhaling of smoke from fireworks was clinically suspected to be associated with the induction of AEP.
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Affiliation(s)
- K Hirai
- Department of Internal Medicine, Nagano Municipal Hospital
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38
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Maeno T, Maeno Y, Sando Y, Takahashi T, Yarita H, Tsukagoshi M, Suga T, Kurabayashi M, Nagai R. Nuclear hypersegmentation precedes the increase in blood eosinophils in acute eosinophilic pneumonia. Intern Med 2000; 39:157-9. [PMID: 10732836 DOI: 10.2169/internalmedicine.39.157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
In this case of acute eosinophilic pneumonia (AEP), eosinophils with hypersegmented nuclei emerged in the blood before the increase of eosinophil count. An 18-year-old woman complaining of fever, cough and dyspnea was admitted because of diffuse ground-glass opacities in her chest roentgenogram. On admission, her blood cell count revealed a marked increase of neutrophils. Although the number of eosinophils was normal, some of them contained three- or four-lobed nuclei. She was diagnosed to have AEP through bronchoalveolar lavage and transbronchial lung biopsy. The combination with acute clinical course, pulmonary infiltration and the presence of hypersegmented eosinophils in blood may imply the diagnosis of AEP.
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Affiliation(s)
- T Maeno
- Second Department of Internal Medicine, Gunma University, Maebashi
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39
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Saita N, Yamanaka T, Kohrogi H, Ando M, Hirashima M. Difference in apoptotic function between eosinophils from peripheral blood and bronchoalveolar lavage in chronic eosinophilic pneumonia. Int Arch Allergy Immunol 1999; 120 Suppl 1:91-4. [PMID: 10529613 DOI: 10.1159/000053603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We compared apoptosis in eosinophils from bronchoalveolar lavage (BAL-Eos) with that in eosinophils from peripheral blood (PB-Eos) of 4 patients with chronic eosinophilic pneumonia (CEP). The survival rate of the BAL-Eos on the 3rd day of the culture was significantly higher than that of the PB-Eos (39.1 vs. 1.3%). The percentage of apoptotic cells in the PB-Eos after a 24-hour incubation was higher than that in the BAL-Eos (21.7 vs. 10.6%) according to an analysis with annexin V. We further found that ECF-PI9, an eosinophil chemotactic factor (ECF) derived from an established T cell line (STO-2), significantly suppressed the apoptosis of both PB-Eos and BAL-Eos and prolonged their survival. The expression of Fas on PB-Eos was significantly suppressed by ECF-PI9 (18.5 to 7.37%, p < 0. 05), whereas ECF-PI9 failed to suppress the Fas expression on BAL-Eos (3.3 to 3.6%). In addition, an ECF with similar physicochemical properties and biological functions was isolated from the BAL fluid of patients with CEP. These data demonstrate differences between PB-Eos and BAL-Eos, and indicate that ECF-PI9 is involved in the pathogenesis of CEP.
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Affiliation(s)
- N Saita
- First Department of Internal Medicine, Kumamoto University, School of Medicine, Kumamoto, Japan
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40
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Thuy GN, Cuguilliere A, Arteaga C, Miltgen J, Bonnet D. [Idiopathic chronic eosinophilic pneumonia]. Med Trop (Mars) 1999; 58:455-8. [PMID: 10410365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Idiopathic chronic eosinophilic pneumonia is a rare disease first described by Carrington 30 years ago. The cause is unknown. As illustrated by the case described in this report, most cases occur in asthmatic patients in the fifth decade of life. Cardinal features are respiratory symptoms, altered general status, laboratory evidence of inflammation, blood eosinophilia in most cases, and x-ray images showing the presence of infiltrates in both lungs. Diagnosis can be confirmed by detection of eosinophils in broncho-alveolar lavage fluid. Extrapulmonary involvement is uncommon and is suggestive of Churg and Strauss syndrome. In atypical cases, diagnosis requires histological study demonstrating infiltration of interstitial tissue and alveolar spaces. Differential diagnosis can be difficult since several disorders identified within the last 10 years are nosologically similar, e.g. acute eosinophilic pneumonia. In many cases, diagnosis is based on response to corticosteroid treatment which is highly effective on idiopathic chronic eosinophilic pneumonia. Frequent recurrence leads to corticosteroid dependence in 20 to 30% of cases.
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Affiliation(s)
- G N Thuy
- Service de Pneumologie, Hôpital d'Instruction des Armées Laveran, Marseille, France
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41
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Arunthathi S, Raju S. Dapsone induced pulmonary eosinophilia without cutaneous allergic manifestations--an unusual encounter--a case report. Acta Leprol 1998; 11:3-5. [PMID: 9693685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Dapsone is a drug of choice in the treatment of leprosy. In addition it is very useful in the treatment of many other dermatological conditions. The "dapsone-induced hypersensitivity" is not unknown. However, to the best of our knowledge, pulmonary eosinophilia induced by dapsone without any cutaneous allergic manifestation has not been reported in leprosy patients. Pulmonary eosinophilia (Loeffler's syndrome) induced by dapsone without cutaneous manifestation has been reported in a non leprosy patient by Janier et al. We report a case of pulmonary eosinophilia associated with dapsone therapy in a patient with lepromatous leprosy without allergic cutaneous manifestations and our experience in the management of this patient.
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Affiliation(s)
- S Arunthathi
- Department of Medicine, Schieffelin Leprosy Research and Training Center, Karigiri, Tamil Nadu, India
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42
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Tani K, Kashio M, Sano N, Nakamura Y, Ogushi F, Sone S. A case of sarcoidosis associated with chronic eosinophilic pneumonia. J Med Invest 1998; 45:131-6. [PMID: 9864974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
A 38-year-old man was hospitalized in our university hospital because of pulmonary opacities with bilateral hilar and mediastinal lymphadenopathy seen on chest radiograph. Eosinophilia was observed in the circulation and bronchoalveolar lavage (BAL) fluid. Histological examination revealed noncaseating epithelioid granulomas and eosinophilic infiltration in the lung. Based on these findings, a diagnosis of sarcoidosis combined with chronic eosinophilic pneumonia was made. The infiltrates on chest radiograph and BAL eosinophilia were promptly reduced with corticosteroid therapy, but only mild reduction was observed in diffuse nodular shadows and hilar and mediastinal lymphadenopathy, and high amounts of lymphocytes in BAL fluid remained. Increased IFN-gamma, IL-4 and IL-5 were detected in the BAL fluid, and corticosteroid therapy reduced IL-4 and IL-5 (Th-2 cytokines) but not IFN-gamma (Th-1 cytokine). These cytokine levels in BAL fluid were intimately correlated with the clinical course of sarcoidosis and chronic eosinophilic pneumonia.
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Affiliation(s)
- K Tani
- Third Department of Internal Medicine, University of Tokushima School of Medicine, Japan
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43
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Enrique E, Aguilar X, Magarolas R. [Cavitated chronic eosinophilic pneumonia with increased serum IgE. Is its differentiation from Churg-Strauss vasculitis possible?]. Arch Bronconeumol 1998; 34:364-5. [PMID: 9762401 DOI: 10.1016/s0300-2896(15)30407-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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44
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Feldmesser M, Kress Y, Casadevall A. Effect of antibody to capsular polysaccharide on eosinophilic pneumonia in murine infection with Cryptococcus neoformans. J Infect Dis 1998; 177:1639-46. [PMID: 9607844 DOI: 10.1086/515314] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The effect of the murine IgG1 monoclonal antibody (MAb) 2H1, which binds to Cryptococcus neoformans glucuronoxylomannan (GXM), on pulmonary infection in immunocompetent C57Bl/6 mice was examined. C57Bl/6 mice develop eosinophilic pneumonia in response to pulmonary cryptococcal infection. Survival, organ fungus burden, serum anticapsular antibody levels, and histopathology by light and electron microscopy were studied. MAb administration prior to infection prolonged survival without reducing the number of yeast in the lung or extrapulmonary sites. Compared with uninfected mice, occasional control and MAb-treated mice produced more IgM antibody to GXM or low levels of GXM-binding IgG1, IgG2b, or IgG3 antibodies. MAb-treated mice had fewer granules per eosinophil, indicating alteration in eosinophil physiology or degranulation (or both). Our results provide additional evidence that antibody administration can produce quantitative and qualitative changes in the inflammatory response to a pathogen.
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MESH Headings
- Animals
- Antibodies, Fungal/immunology
- Antibodies, Fungal/pharmacology
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/pharmacology
- Antigens, Fungal/immunology
- Colony Count, Microbial
- Cryptococcosis/blood
- Cryptococcosis/immunology
- Cryptococcosis/pathology
- Cryptococcosis/prevention & control
- Cryptococcus neoformans/immunology
- Disease Models, Animal
- Female
- Immunization, Passive
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Polysaccharides/immunology
- Pulmonary Eosinophilia/blood
- Pulmonary Eosinophilia/immunology
- Pulmonary Eosinophilia/pathology
- Pulmonary Eosinophilia/prevention & control
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Affiliation(s)
- M Feldmesser
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
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45
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Okubo Y, Horie S, Hachiya T, Momose T, Tsukadaira A, Takashi S, Suzuki J, Isobe M, Sekiguchi M. Predominant implication of IL-5 in acute eosinophilic pneumonia: comparison with chronic eosinophilic pneumonia. Int Arch Allergy Immunol 1998; 116:76-80. [PMID: 9623513 DOI: 10.1159/000023928] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute eosinophilic pneumonia (AEP) is a rare disease with unknown etiology. To examine pathophysiology of AEP we measured the cell number of eosinophils and eosinophil active cytokines in the peripheral blood and bronchoalveolar lavage fluid (BALF) of AEP patients and compared the levels with those measured in chronic eosinophilic pneumonia (CEP) patients. METHODS Cell number of eosinophils in peripheral blood and BALF from patients with AEP (n = 3) and CEP (n = 3) were measured. Eosinophil active cytokines in serum and BALF from the patients were measured using ELISA. RESULTS Eosinophil cell number in peripheral blood was 274-1,377/mm3 in AEP and 526-2,500/mm3 in CEP. The percentages of BALF eosinophils were high in AEP and CEP. Eosinophilia disappeared after methylprednisolone pulse therapy (1 g for 3 days) in AEP, however the cell number of eosinophils gradually increased after methylprednisolone pulse therapy and then spontaneously decreased to within normal range without any further medication. The concentrations of IL-5 in AEP were very high in serum and in BALF, however the concentrations in CEP were low in serum and BALF. CONCLUSION AEP is a disease in which eosinophil active cytokine IL-5 is predominantly involved; CEP is not. The factors involving eosinophil infiltration to inflammatory loci differ between AEP and CEP.
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Affiliation(s)
- Y Okubo
- First Department of Internal Medicine, Shinshu University School of Medicine, Asahi, Matsumoto, Japan
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46
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Palmantier R, Rocheleau H, Laviolette M, Mancini J, Borgeat P. Characteristics of leukotriene biosynthesis by human granulocytes in presence of plasma. Biochim Biophys Acta 1998; 1389:187-96. [PMID: 9512647 DOI: 10.1016/s0005-2760(97)00149-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The formation of leukotriene B4 (LTB4) by neutrophils stimulated with the ionophore A23187 or physiological stimuli in heparinized plasma was investigated. In comparison with neutrophils stimulated (A23187) in a protein-free buffered salt solution, neutrophils stimulated in plasma produced only trace amounts of LTB4. The addition of human recombinant LTA4-hydrolase or erythrocytes to plasma prior to A23187 stimulation strongly and selectively stimulated (> 4-fold) the formation of LTB4 supporting that neutrophils activated in plasma with A23187 release in the extracellular milieu most of LTA4 formed by the cells, and indicating that plasma proteins drastically slow down the further metabolism of LTA4 released by neutrophils. The formation of LTB4 was then investigated in GM-CSF-primed neutrophils stimulated with fMLP in plasma; levels of synthesis were very low and the addition of erythrocytes prior to stimulation strongly enhanced LTB4 synthesis, demonstrating that agonist-stimulated neutrophils also release most of LTA4 generated in the extracellular milieu. Investigations on the fate of LTA4 in plasma revealed that LTA4 was slowly degraded through an unknown process, i.e. not through the previously described non-enzymic hydrolysis resulting in the formation of dihydroxy derivatives of LTA4. Using neutrophils labeled with tritiated arachidonate, we also demonstrated that neutrophils stimulated in plasma with fMLP or A23187, almost exclusively use endogenous arachidonate, as opposed to plasma arachidonate, to generate 5-lipoxygenase products. Finally, experiments performed with purified eosinophils indicated that contrary to neutrophils, the eosinophils do not release LTA4, but directly release LTC4.
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Affiliation(s)
- R Palmantier
- Centre de Recherche en Rhumatologie et Immunologie, CHUL, Québec, Canada
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47
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Cottin V, Deviller P, Tardy F, Cordier JF. Urinary eosinophil-derived neurotoxin/protein X: a simple method for assessing eosinophil degranulation in vivo. J Allergy Clin Immunol 1998; 101:116-23. [PMID: 9449510 DOI: 10.1016/s0091-6749(98)70202-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Eosinophil-derived neurotoxin/protein X (EDN/EPX), one of the cationic granule proteins released by polymorphonuclear eosinophils, can be detected in human urine. OBJECTIVE We sought to evaluate whether the urinary release of EDN/EPX was dependent on the blood eosinophil cell count, the bronchoalveolar eosinophil cell count, or both and on the clinical diagnosis. We also attempted to determine the precise kinetics of decrease of EDN excretion and eosinophil counts after the onset of corticosteroid treatment. METHODS Daily urinary release of EDN/EPX was measured by radioimmunoassay in 28 patients with high hypereosinophilia (group 1), 32 patients with moderate hypereosinophilia (group 2), 26 patients without hypereosinophilia at the time of the study but with a known pulmonary disease involving eosinophils (group 3), and 13 control patients (group 4). RESULTS The urinary excretion of EDN/EPX was significantly higher in patients from groups 1 or 2 than in patients from groups 3 or 4. Particularly high levels of EDN/EPX excretion were observed in patients from groups 1 or 2 with chronic eosinophilic pneumonia (chronic eosinophilic pneumonia: 4.7 +/- 8.1 mg/day, control subjects: 0.39 +/- 0.33 mg/day, p < 0.001). Urinary excretion of EDN/EPX was significantly correlated with blood (r = 0.66, p < 0.001) and differential bronchoalveolar (r = 0.62, p = 0.04) eosinophil cell counts in patients from group 1 but not from the other groups. Corticosteroid treatment was followed by a significant decrease in EDN/EPX excretion. The kinetics of decrease in EDN/EPX were delayed as compared with the dramatic drop in peripheral eosinophil counts. Distinct kinetics between urinary EDN/EPX and eosinophil counts differentiated the recurrence of chronic eosinophilic pneumonia from an asthma attack in one patient. CONCLUSION Measurement of urinary EDN/EPX excretion may be a useful indicator of eosinophil degranulation in vivo.
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Affiliation(s)
- V Cottin
- Service de Pneumologie, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Université Claude Bernard, Lyon, France
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Abstract
To identify the problems involved in the diagnosis of chronic eosinophilic pneumonia (CEP), clinical findings were analysed for 43 patients diagnosed clinically or pathologically with CEP during the past 10 years. About 28% of patients showed peripheral blood eosinophilia and a typical pattern of pulmonary oedema on chest X-ray at initial examination. Eosinophilia was demonstrated in peripheral blood in 86% of patients, in bronchoalveolar lavage (BAL) in 100%, and in transbronchial lung biopsy (TBLB) specimens in 64% of patients. Peripheral blood tests, BAL, and TBLB were all positive for eosinophilia in 60% of patients. BAL was the single test most likely to be positive among the diagnostic tests used in the present study. When CEP is suspected clinically, an understanding of which site is examined by each of the diagnostic tests and of the likelihood of a positive result in each test will facilitate the selection of the most appropriate tests for individual patients.
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Affiliation(s)
- H Matsuse
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Japan
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Hamada H, Sakatani M, Nishioka M, Akira M, Yamamoto S, Ueda E, Okano Y, Nakamura Y, Sone S. [Chronic eosinophilic pneumonia successfully treated with suplatast tosilate]. Nihon Kyobu Shikkan Gakkai Zasshi 1997; 35:692-7. [PMID: 9294307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The patient was a 45-year-old woman in whom a chest X-ray film obtained on admission showed bilateral infiltrative shadows. A chest CT scan revealed areas of consolidation and ground-glass opacities. Examination of bronchoalveolar lavage fluid revealed many eosinophils, and specimens obtained by transbronchial lung biopsy showed thickened alveolar septa with infiltration of eosinophils. The numbers of eosinophils and the level of IgE in blood were low. The radiographic appearance improved after administration of suplatast tosilate. The level of interleukin 5 was high both in plasma and in bronchoalveolar lavage fluid before treatment, but the level of IL-5 in plasma was low after suplatast tosilate was given. Suplatast tosilate, which suppresses the production of cytokines, may be useful in patients with chronic eosinophilic pneumonia.
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Affiliation(s)
- H Hamada
- Department of Internal Medicine, National Kinki-chuo Hospital for Chest Diseases, Osaka, Japan
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50
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Golstein MA, Steinfeld S. Chronic eosinophilic pneumonia followed by Churg-Strauss syndrome. Rev Rhum Engl Ed 1996; 63:624-8. [PMID: 8938874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Chronic eosinophilic pneumonia and Churg-Strauss syndrome are two uncommon conditions of unknown etiology that share similar pulmonary manifestations. Whereas chronic eosinophilic pneumonia mainly targets the lung, Churg-Strauss syndrome is a systemic diseases. We report three patients who developed Churg-Strauss syndrome about eight years after being diagnosed with chronic eosinophilic pneumonia. Hypereosinophilia and high IgE levels were present in both conditions. Elevation of IgA levels was consistently demonstrated at the time of the diagnosis of Churg-Strauss syndrome. IgA elevation may be useful as a marker for progression of chronic eosinophilic pneumonia to Churg-Strauss syndrome.
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Affiliation(s)
- M A Golstein
- Rheumatology Department, Caesar De Paepe Hospital Center, Brussels, Belgium
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