American journal of clinical and experimental immunology最新文献

Background: IgA deficiency is the most common immunodeficiency disorder. Most affected individuals are asymptomatic, and since there are no routine diagnostic screening programs the prevalence of this disease has remained uncertain.

Methods and materials: Seven thousand blood donors who attended Fars Blood Transfusion Center, from September 2017 to March 2018, were selected randomly, and their serum IgA levels were checked by Immunoturbidimetry method. Cases with IgA levels <10 mg/dL were considered as serum IgA deficient patients. Serum IgM and IgG levels of IgA deficient cases were measured to determine selective IgA deficiency. The prevalent clinical findings of IgA deficiency were also investigated.

Results: Ten blood donors had selective IgA deficiency: 0.14% (CI 95%: 0.001, 0.002). All cases were male, with a mean age of 36.10±9.70 years. Investigating common clinical findings in the IgA deficient cases revealed the most prevalent symptoms were recurrent upper respiratory tract infections (50%) which were significantly higher in the study group compared to the control group (P-value =0.008) and allergic disorders (40%) with no statistical difference from the control cases.

Conclusion: The prevalence of selective IgA deficiency (SIgAD) among blood donors at Fars Transfusion Center was 0.14%. The most common clinical finding among the patients with SIgAD was recurrent upper respiratory infections, followed by allergic diseases.

Coronavirus 2019 (COVID-19) is an infection caused by the newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The innate system is the first line of defense against pathogens and diverse infectious agents. It has been suggested to play a key role in the development of the cytokine storm and promoting other severe forms of chronic inflammation. Toll-like receptors (TLRs) are crucial for the innate immune response to pathogens. TLR8 is expressed on myeloid cells and phagocytes, where it acts as an endosomal sensor of RNA degradation. The present study aimed to investigate whether the severity of COVID-19 symptoms could be associated with certain genetic variations of TLR8. We collected blood samples from 45 participants who had moderate to severe respiratory symptoms and a positive COVID-19 PCR test result within 3-5 days of sample collection. Genomic DNA was extracted from the blood samples, then exon 2 of the TLR8 gene was amplified with polymerase chain reaction (PCR), and PCR products were utilized for sequencing. DNA sequencing showed an average of 99.63% sequence homology in TLR8 across all samples. Base-pair homology analysis revealed variations in TLR8 at two positions: X:12937804 (rs5744080) and X:12937513 (rs2159377). The results revealed that these two mutations had no detrimental effect on symptoms in the target population. Our results show that specific SNPs did not affect the final receptor function of TLR8. This finding also indicates that the innate immune response, once activated, does not depend on the innate immune receptor's level of affinity for identifying their respective glycoprotein structures on the SARS-CoV-2 virus.

A scar is a local symptom, which results from severe physical, biological and chemical damage to human skin and soft tissue. Scars can affect both skin appearance and function. The affected skin or soft tissue cannot be completely repaired normally by itself and is replaced by formed fibrous tissue. Patients with scars can develop physical pain and mental conditions, especially those with scars left after burns, scalds and severe traumas. The scar proliferation phase can be up to several years which could be almost unbearable for patients. Also, the atrophic period afterwards makes the patient's face unrecognizable and dysfunctional, causing great physical and mental impairment. Therefore, scar repair is of great clinical importance for patients, and understanding the immunological mechanisms of scar repair is an important prerequisite for the effective treatment of scars. This study is a systematic review of current research advances about the immunological mechanisms of scar repair, so as to provide a reference for the selection of regimens in clinical treatment.

Background: Oral treatment of multiple sclerosis (MS) using disease-modifying therapies (DMTs) is a challenge worldwide. Fingolimod (FTY) and dimethyl fumarate (DMF) are two approved agents for oral treatment of MS with remarkable efficacy for relapse control and deceleration of disability progression. Therefore, the current study was done to compare disability control, lesions in magnetic resonance imaging (MRI), and adverse effects between the patients treated with FTY and DMF.

Methods: This randomized clinical trial (IR.MUI.REC.1396.3.786) was conducted on 60 patients who were randomly divided into two groups of treatment with 0.5 mg daily dose of FTY (n = 30) and 240 mg dose of DMF twice daily (n = 30). Disability of patients was assessed using the expanded disability status scale (EDSS) within 6 weeks, 12, and 24 months following treatment initiation and MRI was performed for all the patients prior to study initiation and within 24 months. Obtained data were compared between two study groups.

Results: There was no significant difference between two treatment groups based on EDSS scores, brain lesions in MRI, and newly formed plaques (P>0.05). Skin and gastrointestinal-related complaints were the most common adverse effects of DMF while the increase in liver enzyme level and thrombocytopenia were the most common complications of FTY, respectively (P-value = 0.22).

Conclusion: According to our findings, within 24-month follow-up, DMF was neither superior nor inferior to FTY comparing MRI lesions, EDSS scores, and adverse effects. Although, further evaluations with larger sample size are recommended.

The new emerging virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes a huge burden of morbidity and mortality worldwide. One of the predisposing factors which might increase the infection susceptibility and its complications can be the Inborn Errors of Immunity (IEI). One hundred and seventeen primary immunodeficient (PID) pediatric patients were monitored from March to December 2020 for any signs and symptoms of SARS-CoV-2 infection. Among them twenty-eight children were symptomatic and nineteen out of the twenty-eight patients took the coronavirus PCR test. Out of them, the PCR test results of 9 patients were positive. Herein, we report the nine cases of pediatric patients with IEI who were also infected with SARS-CoV-2 with a positive PCR test. We observed a variation in clinical manifestations, clinical courses, and outcomes among IEI pediatric patients affected with COVID-19. In our survey, prompt diagnosis and appropriate monitoring for possible complications were shown to be effective in reducing the mortality rate of the SARS-CoV-2 affected patients with IEI. Although there is no approved treatment for SARS-CoV-2 infection, supportive treatment might reduce the complications and lead to better outcomes. This study received approval from the Research Ethics Committee of Mashhad University of Medical Science with the ethics code of IR.MUMS.REC.1399.155. (https://ethics.research.ac.ir/EthicsProposalViewEn.php?id=129963).

[This corrects the article on p. 37 in vol. 10, PMID: 33815962.].

Objective: To investigate the efficacy of traditional Chinese medicine acupotomy combined with platelet-rich plasma (PRP) in the treatment of early and middle osteoarthritis.

Methods: Eighty cases of early and middle knee joint pain patients admitted in our hospital were selected in this retrospective study. They were divided into the control group and observation group according to treatment methods, with 40 cases in each group. The control group was treated with PRP, and the observation group was treated with acupotomy + PRP. Clinical response rate, visual analogue scale (VAS) pain score, Lequesne score, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and SF-36 quality of life score were compared between the two groups.

Results: The total clinical response rate in the observation group was higher than that in control group (P<0.01). VAS pain score, knee joint WOMAC index and Lequesne score in the two groups after treatment were lower than those before treatment, and those in the observation group were lower than those in the control group (all P<0.05). SF-36 quality of life score was significantly higher in the observation group than in the control group (all P<0.001).

Conclusion: Acupotomy combined with PRP in the treatment of early and middle osteoarthritis can relieve pain and improve joint function, which is worthy of clinical promotion.

Background: Leishmaniasis is one of the most important infectious illnesses around the world. Given the high commonness of this disease, specifically its skin type in Iran and due to the role of the Leishman bodies in diagnosis, the aim of present study was evaluating the expression of two CD1a and CD68 markers in cutaneous leishmaniasis lesions with and without Leishman bodies.

Methods: In this case-control study, 70 skin samples of patients with cutaneous leishmaniasis (35 patients with Leishman body as case group and 35 patients without Leishman boy as control group) were investigated during 2018-2019. The expression of CD1a and CD68 markers and immunohistochemistry staining (IHC) were investigated in this study.

Results: The expression of CD1a in the group with Leishman body was significantly higher than group without Leishman body (P=0.01), but there was no significant difference between groups as expression of CD68 (P=0.40). The frequency of hyperkeratosis, parakeratosis, exocytosis, acanthosis, spongiosis, hydropic degeneration of basal cell layer, lichenoid reaction, pseudoepitheliomatous hyperplasia, ulcer, thinning of the epidermis, mononuclear cells, and extension of inflammation into lower dermis in the group with Leishman body was higher than group without Leishman body (P<0.05).

Conclusion: The expression of CD1a and other morphological findings help to diagnose the difference between leishmaniasis with and without Leishman body.

Background: Food allergy which usually develops in the first year of life is a risk factor for persistent asthma in young children. Cow's milk has been demonstrated to be the most commonly identified food allergen in children. Considering the central role of non-IgE-mediated food allergies in the development of hidden gastroesophageal reflux and consequently asthma, we evaluated the effect of eliminating food allergens to better control asthma.

Method: A total of eighty infants and children up to the age of 12 referred to the Asthma Clinic of Mofid Children Hospital for a period of one year were enrolled in this study. In those patients whose asthma remained uncontrolled (Childhood Asthma Control Test ≤19) despite a 2-week period of treatment, we advocated a 2-week-diet based on eliminating cow's milk in conjunction with asthma conventional therapy. For breast-fed infants, mothers were requested to eliminate these products from their daily intake regimens and for formula-fed infants, the elemental based formula was started.

Results: Three of the patients were lost in follow-up and six of them were excluded from the study because of non-compliance. The Asthma Control Test score which was less than or equal to 19 in the entire study population, increased to 20 or more after we began a diet based on the elimination of cow's milk in all but 13 participants.

Conclusion: To conclude, the results were promising, demonstrating that a cow's milk protein elimination diet is a prudent approach in the management of patients with recalcitrant asthma, and can be considered as the missing link in asthma treatment.

Introduction-Objective: X-linked agammaglobulinemia (XLA) is a primary immunodeficiency disease predominantly with antibody deficiency and characterized by recurrent pyogenic infections, absence of B cells and agammaglobulinemia. In this study, it is aimed to review the demographic data of our XLA patients and examine the frequency of severe bacterial and mild infections and benefits of immunoglobulin replacement therapies to reduce the rate of infections. In addition, correlations between genotypic results and clinical and laboratory findings were searched.

Patients and methods: In this study, 20 patients who were followed-up between 1995-2019 and diagnosed with XLA by flow cytometric and genetic tests were included. Demographic data, symptoms at admission and follow-up, laboratory data and radiologic imaging findings, previous infections, immunoglobulin replacement treatments, and genetic analysis results of the patients were recorded.

Results: All patients in the study were male and the mean age of onset of symptoms was 60 months. The mean age at diagnosis was 72 months. A total of 19 different mutations were identified in the Bruton-tyrosine kinase gene, six of them were novel. Our eldest patient was 34 years old and the longest follow-up period was 24 years. Respiratory tract infections were the most common in the patients, only 35% of the causative agents were found in sputum cultures and H. influenzae type b (57.8%) was isolated most frequently. Both intravenous and subcutaneous immunoglobulin replacement therapies significantly reduced the number of severe bacterial infections and other mild infections.

Conclusion: XLA is a rare pediatric primary immunodeficiency disease and affected individuals require lifelong immunoglobulin replacement therapy. Immunoglobulin replacement prevents life-threatening infections and dramatically increases survival rates. The patients with regular treatment and follow-up, reach adulthood and has a high quality of life.