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ABSTRACT: This is an observational study with the primary objective to measure donor-specific immune responses by pediatric liver transplant (LT) recipients, using cell surface expression of lymphocyte activation markers and cytokine secretion in mixed lymphocyte reactions. The secondary objective was to demonstrate possible mechanism(s) involved in those who demonstrated donor-specific hyporesponsiveness. Study participants included 17 recipients, their respective parental donors, the non-donor parent, as well as unrelated third party individuals. Within the CD4(+) population, two distinct patterns of CD69 and CD71 expressions were observed: recipients who had a lower percentage of CD4(+)CD69(+) and CD4(+)CD71(+) cells after donor versus non-donor stimulation (therefore a donor/non-donor ratio <1); and recipients who had a higher percentage of CD4(+)CD69(+) and CD4(+)CD71(+) cells after donor versus non-donor stimulation (therefore a donor/non-donor ratio ≥1). Eight recipients had the above defined ratio of <1, with significantly decreased interferon-γ secretion after donor versus non-donor stimulation. CD4(+)CD25(hi.)CD127- regulatory T cells from these eight recipients suppressed donor and non-donor cell induced proliferation. Suppression of proliferation was partially abrogated by interleukin-2. In conclusion, CD69 and CD71 cell surface expression with interferon-γ secretion can be used to identify two distinct populations in pediatric LT recipients. Both active regulation and anergy underlie donor specific hyporesponsiveness.
Human immunology 02/2011; 72(5):392-7. · 2.55 Impact Factor
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ABSTRACT: The objective of this study was to retrospectively evaluate the utility of serum neopterin as a diagnostic marker of hemophagocytic lymphohistiocytosis (HLH). The medical records of patients diagnosed with HLH (familial and secondary) between January 2000 and May 2009 were reviewed retrospectively, and clinical and laboratory information related to HLH criteria, in addition to neopterin levels, was recorded. A group of 50 patients with active juvenile dermatomyositis (JDM) (who routinely have neopterin levels assessed) served as controls for the assessment of the accuracy, sensitivity, and specificity of neopterin as a diagnostic test for HLH. The Pearson correlation was used to measure the association between serum neopterin levels and established HLH-related laboratory data. Serum neopterin levels were measured using a competitive enzyme immunoassay. During the time frame of the study, 3 patients with familial HLH and 18 patients with secondary HLH were identified as having had serum neopterin measured (all HLH patients were grouped together). The mean neopterin levels were 84.9 nmol/liter (standard deviation [SD], 83.4 nmol/liter) for patients with HLH and 21.5 nmol/liter (SD, 10.13 nmol/liter) for patients with JDM. A cutoff value of 38.9 nmol/liter was 70% sensitive and 95% specific for HLH. For HLH patients, neopterin levels correlated significantly with ferritin levels (r = 0.76, P = 0.0007). In comparison to the level in a control group of JDM patients, elevated serum neopterin was a sensitive and specific marker for HLH. Serum neopterin has value as a diagnostic marker of HLH, and prospective studies are under way to further evaluate its role as a marker for early diagnosis and management of patients.
Clinical and vaccine immunology: CVI 01/2011; 18(4):609-14. · 2.37 Impact Factor
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ABSTRACT: The primary immunodeficiency diseases (PIDs) encompass an extremely large and diverse number of clinical disorders caused by mutations in genes that affect virtually every measurable component of our immune systems. Many of the genetic mutations lead to abnormalities that can be detected in circulating peripheral blood cells of suspected patients by flow cytometry and the appropriate combinations of reagents and in vitro manipulations. The flow cytometry procedures that have been developed to detect abnormalities in peripheral blood cells of primary immunodeficiency patients can barely be covered in an entire book, let alone one chapter. Instead of attempting to cover each disease with a specific assay or test, we review three procedures each covering a global aspect of the observed immune abnormality, i.e., detection of lymphocyte subset abnormalities, lymphocyte "marker" abnormalities, and leukocyte function abnormalities.
Methods in molecular biology (Clifton, N.J.) 01/2011; 699:317-35.
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ABSTRACT: Previous studies have reported that the adoption of a single-platform flow cytometry cell counting method resulted in lower interlaboratory variation in absolute T cell counts as compared to predicate dual-platform flow cytometry methods which incorporate independent automated lymphocyte counts (Schnizlein-Bick et al., Clin Diagn Lab Immunol 2000;7:336-343; Reimann et al., Clin Diagn Lab Immunol 2000;7:344-351). In the present study, we asked whether use of a single-platform method could reduce variation in absolute cell counts across the laboratories in the Multicenter AIDS Cohort Study (MACS) (n = 4), as suggested by the studies cited.
Identical study samples were shipped overnight to the MACS laboratories either by the National Institute of Allergy and Infectious Diseases, Division of AIDS Immunology Quality Assessment (NIAID- IQA) proficiency-testing program (n = 14), or by the Los Angeles site of the MACS (n = 10). For each sample, two tubes of blood were received; one was used for an automated complete blood count and differential, and the other for flow cytometry. The latter was performed using both our current dual-platform method (three-color CD45 gating and automated hematology) and the single-platform method (with TruCOUNT beads to generate the absolute counts).
The median percent coefficients of variation (%CVs) for the dual-platform and single-platform methods were 6.6 and 9.9, respectively, for CD4 T cell counts, and 5.9 and 8.5, respectively, for CD8 T cell counts (n = 24). These differences were not statistically significant. The differences in absolute T-cell counts between the MACS sites and the median of all laboratories participating in the NIAID-IQA were smaller for the dual-platform than for single-platform absolute count method.
In contrast to previous reports, we did not observe lower interlaboratory variation across the MACS sites for single-platform absolute lymphocyte subset counting relative to dual-platform methods. This result may be at least partly explained by the lower interlaboratory variation with the optimized dual-platform method in this study relative to the previous reports.
Cytometry Part B Clinical Cytometry 10/2009; 78(3):194-200. · 2.53 Impact Factor
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ABSTRACT: Probiotic nutrients have shown promise in therapy for the treatment of gastrointestinal inflammation, infection, and atopic disease. Intestinal dendritic cells (DC) play a critical role in shaping the intestinal immune response. In this study, we tested the effect of a probiotic preparation (VSL#3) on DC distribution and phenotypes within the intestinal mucosa using a lineage depletion-based flow cytometric analysis. In naïve C57BL/10J mice, intestinal mucosal DC were composed of plasmacytoid DC (pDC) and myeloid DC (mDC). The pDC were the dominant form in lamina propria and Peyer's patches, whereas mDC were the prevailing type in the mesenteric lymph nodes. Additional characterization of pDC and mDC with flow cytometry revealed that they expressed heterogeneous phenotypes in the intestinal mucosa. In mice gavaged with the probiotic VSL#3 for 7 d, the proportion of pDC within the lamina propria was >60% lower, whereas the pDC subset in the mesenteric lymph nodes was more than 200% greater than in sham-treated controls (P < 0.01). Within pDC, the proportion of functionally unique CX3CR1(+) DC was greater than in controls in both the lamina propria and the Peyer's patches (P < 0.01). In contrast to pDC, the mDC number was greater than in controls in all intestinal lymphoid tissue compartments in VSL#3-treated mice (P < 0.01). In conclusion, this study suggests that phenotypically and functionally distinct DC subsets are localized to specific lymphoid tissues within the intestinal mucosa and that the VSL#3 probiotic nutritional supplement alters the distribution of the DC subsets within the intestinal mucosa. These changes may be important in the alteration of mucosal immunity following probiotic VSL#3 therapy.
Journal of Nutrition 06/2009; 139(8):1595-602. · 3.92 Impact Factor
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Maurice R G O'Gorman
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ABSTRACT: The rapid increases in newly recognized primary immunodeficiency diseases (PIDs), including their clinical, genetic and laboratory-associated abnormalities, make staying abreast of the latest developments a challenge. This review provides an overview of current information directly and indirectly related to the laboratory diagnosis of PIDs.
The latest classification and several prevalence studies provide the framework for understanding the breadth, categories and incidence rates of over 120 recognized disease entities. The latter is followed by reviews of new information related to specific PIDs including new tests, new genetic associations and newly discovered laboratory-based abnormalities. The final section presents new PIDs and a discussion of the future potential of array-based technologies in the diagnosis of PIDs.
The information provided in this review will allow a new appreciation of previously underestimated PIDs' prevalence rates and the delay in their diagnosis. Understanding the molecular causes of PIDs will lead to earlier diagnoses and new targets for improved therapeutic intervention. The presentation of new diagnostic tests should encourage other laboratories to assess their potential in their own laboratories. Ultimately, this information will lead to an increase in the understanding of novel laboratory parameters associated with specific PID and should improve the time required to attain an accurate diagnosis.
Current opinion in pediatrics 01/2009; 20(6):688-97. · 2.01 Impact Factor
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ABSTRACT: Current approaches to the management of immunosuppression are largely empiric and reactive rather than proactive due to our inability to predict accurately how the recipient immune system will respond to a given organ allograft. The validation of simple, reliable, non-invasive assays exploring allogeneic anti donor responsiveness or donor specific non-responsiveness are of interest for several reasons: (i) it would allow for early and non-invasive detection of acute or chronic allograft rejection such that intervention could be initiated before effector mechanisms and organ destruction occur, (ii) it would allow for individual immunosuppressive drug therapy thereby avoiding the unwanted consequences of over immunosuppression, and (iii) the identification of the immunological phenotype related to operational tolerance could allow for the complete cessation of immunosuppressants. This review will summarize in vitro assays of T cell reactivity that reflect allo-antigen-specific responses.
Pediatric Transplantation 12/2008; 13(1):25-34. · 1.48 Impact Factor
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ABSTRACT: The measurement of both the percentage (in pediatric patients aged less than 5 or 6 years) and the absolute number of circulating CD4+ T cells remains the single most important parameter for establishing prognosis and determining when to treat HIV-1 infected infants. The predictive power of CD4+ T cell measurements in HIV-1 infected individuals has resulted in robust guidelines from numerous agencies on the use of CD4+ T cell measurements ranging from pretreatment evaluations to the initial assessment and monitoring of therapeutic responses and treatment failures. The increase in availability of HIV-1 antiretroviral drugs in resource limited setting has led to the urgent need to develop systems and technologies for the accurate and cost-effective measurement of CD4+ T cells. The establishment of standardized guidelines for antiretroviral therapy (including CD4 testing) along with significant advancements in the development of structured access to health care, centralized CD4 testing programs, improved quality assurance programs, and inexpensive CD4 measurement technologies are making CD4 testing more universally available. Recent evidence suggests that a CD4/CD8 ratio of less than 1 may provide a reliable marker of presumptive HIV-1 infection in HIV-1 exposed infants. This review will summarize the current guidelines for the use of CD4 testing in HIV-1 infected infants and the potential for the CD4:CD8 ratio to be used as a surrogate of HIV-1 infection in resource limited settings.
Cytometry Part B Clinical Cytometry 02/2008; 74 Suppl 1:S19-26. · 2.53 Impact Factor
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ABSTRACT: As part of the effort to promote elimination of global health care disparities, this special supplement compiled 19 articles about practical diagnostic cytometry to recognize the recent achievements of laboratory scientists working in the shadow of the HIV/AIDS epidemics in resource limited settings. First, the clinical significance, diagnostic utility (as governed by international guidelines), and the historical perspectives of CD4+ T cell enumeration are reviewed. Then successful large-scale implementations of cost-effective CD4 counting are described for parts of Africa, USA, and the Caribbean. These activities are linked with both the training of personnel in fledgling laboratories as well as with external quality assessment implementations. Some of the more recent solutions related to pediatric CD4 testing using CD4% values are covered. Nevertheless, the need for further simplification and parsimony is still immense, and the potential solutions are catalogued in the articles written by experts operating in truly challenging rural environments. Cytometry is considered to be an expandable flexible technology for other assays beyond CD4 assessment, particularly within organized laboratory services in the Third World. These include haematological measurements, CD38/CD8 lymphocyte activation for viral load-related assessments, diagnosis of active tuberculosis and malaria, and bead-based serological assays for a variety of infectious diseases. The development and support of these emerging technologies by affluent countries is not entirely altruistic but is likely to be beneficial for both the Third and the First Worlds.
Cytometry Part B Clinical Cytometry 02/2008; 74 Suppl 1:S1-3. · 2.53 Impact Factor
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Maurice R G O'gorman
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ABSTRACT: This presentation is organized according to the recent classification of primary immunodeficiencies published by the International Union of Immunological Societies Primary Immunodeficiency meeting. The diseases have been classified into eight groups. After each list, individual diseases that are amenable to assessment by flow cytometry are reviewed with a brief clinical description and a discussion of the appropriate flow cytometry application.
Clinics in Laboratory Medicine 10/2007; 27(3):591-626, vii. · 1.97 Impact Factor
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ABSTRACT: The continuous improvement and evolution of immune cell phenotyping requires periodic upgrading of laboratory methods and technology. Flow cytometry laboratories that are participating in research protocols sponsored by the NIAID are required to perform "switch" studies to validate performance before methods for T-cell subset analysis can be changed.
Switch studies were conducted among the four flow cytometry laboratories of the Multicenter AIDS Cohort Study (MACS), comparing a 2-color, lyse-wash method and a newer, 3-color, lyse no-wash method. Two of the laboratories twice failed to satisfy the criteria for acceptable differences from the previous method. Rather than repeating more switch studies, these laboratories were allowed to adopt the 3-color, lyse no-wash method. To evaluate the impact of the switch to the new method at these two sites, their results with the new method were evaluated within the context of all laboratories participating in the NIH-NIAID-Division of AIDS Immunology Quality Assurance (IQA) proficiency-testing program.
Laboratory performance at these two sites substantially improved relative to the IQA standard test results. Variation across the four MACS sites and across replicate samples was also reduced.
Although switch studies are the conventional method for assessing comparability of laboratory methods, two alternatives to the requirement of repeating failed switch studies should be considered: (1) test the new method and assess performance on the proficiency testing reference panel, and (2) prior to adoption of the new methods, use both the old and the new method on the reference panel samples and demonstrate that performance with the new method is better according to standard statistical procedures. These alternatives may help some laboratories' transition to a new and superior methodology more quickly than if they are required to attempt multiple, serial switch studies.
Cytometry Part B Clinical Cytometry 08/2007; 72(4):249-55. · 2.53 Impact Factor
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ABSTRACT: HIV-1 infection is characterized by an inverted CD4/CD8 T-cell ratio, but the distribution of inversions over time after seroconversion and whether delay of inversion is associated with a favorable prognosis are not known.
T-cell counts and clinical outcomes among men in the Multicenter AIDS Cohort Study who had incident HIV-1 infection before December 31, 1995 were analyzed by Kaplan-Meier and Cox proportional hazards methods. Results were also analyzed by time-dependent multivariate methods to adjust for CD4 lymphocyte counts, viral loads, age, race, and polymorphisms in host chemokine receptor genes (CCR5-Delta32 and CCR2-64I).
Among 424 cases whose date of seroconversion was known to within +/-4.5 months, 317, 52, and 55 inverted their CD4/CD8 ratio within less than 1, 1 to 2, and more than 2 years of seroconversion, respectively. Longer time to inversion was significantly associated with longer time to AIDS, even after adjusting for CD4 lymphocyte count and viral load at the first seropositive visit and over the first 3 seropositive visits. Of the 6 seroconverters who had more than 500 CD4 lymphocytes 10 years after seroconversion without receiving highly active antiretroviral therapy, 5 took more than 2 years to invert their CD4/CD8 ratio.
Time from HIV-1 seroconversion to inversion of the CD4/CD8 ratio independently predicted time to AIDS. Early measurements of the CD4/CD8 ratio until inversion occurs may identify people likely to become long-term nonprogressors or slow progressors, thus facilitating detailed studies of the mechanism of HIV-1 disease progression.
JAIDS Journal of Acquired Immune Deficiency Syndromes 09/2006; 42(5):620-6. · 4.43 Impact Factor
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Cytometry 05/2002; 50(2):46-52.
