Collagenous colitis (CC) is an inflammatory bowel disease of unknown etiology. It is characterized by watery diarrhoea without blood, normal endoscopic findings but microscopically colonic mucosal inflammation and increased thickness of the subepithelial collagen band, the latter being a pathognomonic sign. The inflammatory infiltrate in the mucosa of CC contains lymphocytes, plasma cells, eosinophils, mast cells but few neutrophils. The pathophysiological roles of the thickened collagen band and the inflammatory infiltrate in CC are not fully understood. The aims of the present study were to develop a colonoscope based segmental perfusions technique and to analyze local intestinal secretion of inflammatory mediators: Eosinophilic Cationic Protein (ECP), Myeloperoxidase (MPO), Basic Fibroblast Growth Factor (bFGF), Vascular Endothelial Growth Factor (VEGF) and permeability marker albumin in CC patients without medication and also during steroid treatment. Furthermore, the colonic mucosal distribution of bFGF and VEGF were studied by immunohistochemical methods. Colonoscope-based segmental perfusions were performed in totally 22 patients and the success rate was 76% in both rectal and descending colon segments. The analysis showed high intraluminal concentrations of ECP, bFGF, VEGF and albumin in ten CC patients compared to 10 control patients. Further, albumin had correlations with ECP and VEGF. However, elevated concentrations of MPO, an important feature of ulcerative colitis, were only observed in a few CC patients. Immunohistochemistry visualized bFGF and VEGF in the colonic epithelium but also deeper in the lamina propria. The steroid treatment study (including 12 patients) showed that the perfusate concentrations of ECP, bFGF and VEGF declined significantly in parallel with decreased frequency of diarrhoea. In conclusion, a safe colonoscope-based, segmental perfusion technique was developed and perfusions of the rectum and descending colon were performed. CC patients had elevated perfusate concentrations of ECP, VEGF and bFGF. There was a marked reduction of these mediators during steroid treatment supporting the hypothesis that these inflammatory mediators separately or synergistically participate in the inflammatory reaction and tissue remodelling in CC patients. The finding of correlations between albumin and ECP or VEGF implies that permeability is increased in CC and may be triggered by ECP and VEGF.

This thesis describes studies in patients with inflammatory bowel disease (IBD) and collagenous colitis (CC). We investigated mucosal eosinophil and neutrophil granulocytes and T-cells involved in the inflammatory processes and aimed at determining whether these processes are reflected in the faecal (F) contents of specific proteins secreted by cells in the intestinal mucosa. Thus, we measured eosinophil cationic protein (ECP) and eosinophil protein X (EPX) and the neutrophil derived myeloperoxidase (MPO) and calprotectin (C); and in addition, chromogranin A (CgA), Chromogranin B (CgB) and secretoneurin (SN), derived from EEC cells and cells in the enteric nervous system. We found that a normalised FC level can serve as a surrogate marker for successful treatment in patients with IBD, but persistently high FC levels need further evaluation (study I). Furthermore, FC and F-MPO appear to relate better than F-EPX to treatment outcome in IBD. We evaluated F-ECP, F-EPX, F-MPO and FC as markers of disease activity and treatment outcome in patients with CC (study III) and concluded that F-ECP was the best discriminator of detecting active CC. Normalised F-ECP and F-EPX could serve as markers of successful treatment. We showed that the inflammation in CC is characterised by activated eosinophils, but that there is no neutrophil activity (study II). T-cells have a lower grade of activity in active CC than in control subjects. During budesonide treatment the normal activation of eosinophils and T-cells is restored, with concomitant clinical remission. The findings in studies II and III indicate that the eosinophils have an essential role in the pathophysiology of CC. Markedly higher values of F-CgA, F-CgB and F-SN were found in patients with CC than in those with IBD and controls (study IV) indicating a crucial role for the intestinal neuro-endocrine system in the pathogenesis of collagenous colitis.

In der vorliegenden Arbeit wurde Gewebe aus den Nasennebenhöhlen von Patienten mit Nasenpolypen untersucht. Außerdem wurden Zusammenhänge zwischen den Zellpopulationen und den Angaben zu allergischen Erkrankungen und wiederholtem Auftreten der Polypen analysiert. Es fand sich eine interindividuell unterschiedlich starke Infiltration mit eosinophilen Granulozyten. Es konnten keine Unterschiede in der prozentualen Verteilung von eosinophilen Granulozyten im Polypengewebe bei allergischen/ nichtallergischen Patienten oder Patienten mit/ ohne Rezidiv nachgewiesen werden. Die Untersuchungen erfolgten mit dem Laser Scanning Zytometer (LSC), das mit der Standardmethode, der Begutachtung mittels Lichtmikroskop, verglichen wurde. Mit der beschriebenen Methode erfolgte die Untersuchung von Polypengewebe nach einem speziell für diese Anwendung entwickelten Protokoll. Die Ergebnisse korrelierten gut mit den Ergebnissen der Lichtmikroskopie. Aufgrund der Weiterentwicklung des LSC und der ständig wachsenden Anzahl der Nachweismöglichkeiten der an der Polyposis nasi beteiligten Zytokine stellt das LSC eine ideale Methode für die Erforschung der Pathogenese von chronischen Entzündungen der Nasennebenhöhlen dar.

Background: According to recent studies in children, IgE sensitization not only against perennial allergens, but also against food allergens, is related to asthma risk and increased airway inflammation. During the last decade, a new technique for IgE determination based on allergen components has become available, but its use in epidemiological studies has been limited. Aims: To investigate the relationship between the pattern of IgE sensitization to allergen components and the prevalence of asthma, airway inflammation and hyperresponsiveness in a population-based setting. To examine the relationship of IgE sensitization to allergen extract, and airway inflammation, airway hyperresponsiveness and blood eosinophilia in asthmatics. To examine the natural history of IgE sensitization to food allergens in adults. To compare extract-based and component-based IgE measurements in relation with new-onset respiratory disease and airway inflammation and hyperresponsiveness. Methods: The present thesis is based on cross-sectional and longitudinal analyses of the adult, the population-based study ECRHS (European Community Health Survey) and a cross-sectional, observational study of young subjects with asthma. IgE sensitization was examined by means of both extract-based and component-based tests. Airway inflammation was assessed by exhaled NO and airway hyperresponsiveness with methacholine test. Results: IgE sensitization to food allergens independently related to increased airway inflammation in both a population-based study and a study of asthmatics. Furthermore, a relation was found with increased blood eosinophils in asthmatics. The decrease in prevalence of IgE sensitization against food allergens during a 9-year follow-up was larger than the decrease of aeroallergens. Subjects with IgE sensitization to both cat extract and components showed more frequent airway inflammation, greater bronchial responsiveness and higher likelihood of developing asthma and rhinitis than subjects with IgE sensitization only to cat extract. Conclusions: The presence of IgE antibodies against food allergens was independently associated with airway and systemic inflammation. Both aeroallergens and food allergens should be examined in order to understand the signaling of local and systemic inflammation in asthma. Prevalence of IgE sensitization to food decreased in adults to a larger extent than IgE sensitization against aeroallergens. Measurement of IgE sensitization to cat allergen components appears to have a higher clinical value than extract-based measurement

Allergic asthma is an immunological disease, mediated by CD4+ Th2 cells, and its prevalence has increased over recent decades. Features of allergic asthma include airway hyperresponsiveness (AHR), airway eosinophilia, excessive airway mucus production, and increased IgE and Th2 cytokine levels. Airway remodeling with pulmonary fibrosis is noted in the progress of asthma. In this thesis, a murine model of allergic asthma was used to investigate the effect of cyclophosphamide (CY) on asthma and the involvement of regulatory T cells (Treg), and the role of Granulocyte-macrophage colony stimulating-factor (GM-CSF) in allergic asthma by using GM-CSF knockout mice. CY is a cytotoxic agent, which paradoxically augments several immune responses. The first part of this thesis was aimed to study the effects of CY in a murine model of allergic airway inflammation. BALB/c mice were immunized with ovalbumin (OVA) on days 0 and 14, and challenged with aerosolized OVA from days 21 to 27. Some mice additionally received CY on days -2 and 12. In the CY-treated animals, pronounced worsening of inflammatory features was noted, including increases in eosinophil infiltration, epithelial thickness, mucus occlusion and eosinophil numbers in bronchoalveolar lavage fluid (BALF). Increased total and OVA-specific serum IgE were also noted in the CY-treated animals. In cell cultures from peritracheal lymph nodes, the Th2 cytokines IL-4 and IL-5 were elevated in animals treated with CY. It was hypothesized that the effects of CY could be caused by reduced immunosuppression mediated by Treg. mRNA expression of the immunosuppressive cytokines IL-10 and TGF-beta was reduced in the lungs of CY-treated mice. The expression of FoxP3, a marker of naturally occurring Treg, was significantly reduced in spleens, thymuses and peritracheal lymph nodes after the second injection of CY, and in the lung tissue after allergen challenge in CY-treated mice. Furthermore, lung IL-10-producing CD4+ T cells and CTLA-4+-bearing CD4+ T cells were reduced after allergen aerosol challenge in CY-treated mice. Thus CY worsened the features of allergic pulmonary inflammation in this model, in association with increased production of IgE and Th2 cytokines. The reduction in expression of FoxP3 and immunosuppressive cytokines by CY suggests that toxicity to Treg may contribute to the increased inflammation. GM-CSF plays a role in the growth, development, and maturation of bone marrow hemopoietic cells into mature blood cells, and has been proposed to be involved in potentiating the function of inflammatory cells in allergic inflammation. In the second part of this thesis, GM-CSF knockout (KO) mice were used to investigate the role of GM-CSF. In allergic KO mice, airway eosinophils were only shown in the perivascular, but not peribronchial areas in the lung, compared to the allergic wild-type (WT) mice in which eosinophil infiltration appeared in both areas. Eosinophil numbers were drastically reduced in the bronchoalveolar lavage fluid (BALF) of KO mice. IL-5 production in the lung tissue and BALF in allergic KO mice was reduced; similar results were also found in peritracheal draining lymph nodes after in vitro stimulation assays. However, IL-4 and IL-13 production, airway hyperresponsiveness (AHR), and serum IgE production were not affected in allergic KO mice. Surprisingly, lung IFN-gamma mRNA and BALF levels were increased in allergic KO mice. Lung mRNA levels of CCR3, a key chemokine receptor on eosinophils, were significantly reduced in allergic KO mice, whereas expression of the chemokines eotaxin and RANTES were at similar levels in allergic KO and WT mice. Lung mRNA levels of the IFN-gamma-inducible chemokines Mig (CXCL9) and IP-10 (CXCL10), which are antagonists of CCR3, and their receptor CXCR3 were increased in allergic KO mice, compared with allergic WT mice. Data obtained from flow cytometry showed more eosinophils survived in the lung of WT mice than KO mice. Another allergy model, a peritoneal allergy model was performed to investigate inflammation in a different model. Leukocyte subpopulations such as neutrophils, eosinophils, macrophages, and lymphocytes were reduced in the peritoneal lavage fluid of allergic KO mice. The findings revealed that GM-CSF is essential for IL-5 production, pulmonary airway eosinophilia and eosinophil survival. In the absence of GM-CSF, over-production of IFN-???? may induce chemokines, including Mig and IP-10, which are antagonists for CCR3 and may reduce airway eosinophil infiltration. In this thesis, a murine model of allergic asthma has been used to obtain novel findings on the regulation of allergic inflammation. The results with CY are relevant to the treatment of asthma patients with CY and other cytotoxic agents. The findings in the GM-CSF KO mice suggest that GM-CSF is a potential therapeutic target in asthma, and that in assessment of new therapeutic agents for asthma, effects on GM-CSF should be considered.

The formation of hypochlorous and hypobromous acids by heme peroxidases is a key property of certain immune cells. These products are not only involved in defense against pathogenic microorganisms and in regulation of inflammatory processes, but contribute also to tissue damage in certain pathologies. After a short introduction about experimental approaches for the assessment of the halogenating activity in vitro and in cell suspensions, we are focusing on novel applications of fluorescent dye systems to detect the formation of hypochlorous acid (HOCl) in leukocytes. Special attention is directed to properties and applications of the non-fluorescent dye aminophenyl fluorescein that is converted by HOCl, HOBr, and other strong oxidants to fluorescein. This dye allows the detection of the halogenating activity in samples containing free myeloperoxidase and eosinophil peroxidase as well as in intact granulocytes using fluorescence spectroscopy and flow cytometry, respectively.

In der vorliegenden Arbeit wurde Gewebe aus den Nasennebenhöhlen von Patienten mit Nasenpolypen untersucht. Außerdem wurden Zusammenhänge zwischen den Zellpopulationen und den Angaben zu allergischen Erkrankungen und wiederholtem Auftreten der Polypen analysiert. Es fand sich eine interindividuell unterschiedlich starke Infiltration mit eosinophilen Granulozyten. Es konnten keine Unterschiede in der prozentualen Verteilung von eosinophilen Granulozyten im Polypengewebe bei allergischen/ nichtallergischen Patienten oder Patienten mit/ ohne Rezidiv nachgewiesen werden. Die Untersuchungen erfolgten mit dem Laser Scanning Zytometer (LSC), das mit der Standardmethode, der Begutachtung mittels Lichtmikroskop, verglichen wurde. Mit der beschriebenen Methode erfolgte die Untersuchung von Polypengewebe nach einem speziell für diese Anwendung entwickelten Protokoll. Die Ergebnisse korrelierten gut mit den Ergebnissen der Lichtmikroskopie. Aufgrund der Weiterentwicklung des LSC und der ständig wachsenden Anzahl der Nachweismöglichkeiten der an der Polyposis nasi beteiligten Zytokine stellt das LSC eine ideale Methode für die Erforschung der Pathogenese von chronischen Entzündungen der Nasennebenhöhlen dar.

Submitted by PPG Pediatria e Sa?de da Crian?a (pediatria-pg@pucrs.br) on 2018-11-01T18:12:18Z No. of bitstreams: 1 disserta??o Josiane Silva Silveira vers?o final corrigida.pdf: 4036302 bytes, checksum: cdea806bf90b79da9a4047282152d203 (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-11-05T12:55:20Z (GMT) No. of bitstreams: 1 disserta??o Josiane Silva Silveira vers?o final corrigida.pdf: 4036302 bytes, checksum: cdea806bf90b79da9a4047282152d203 (MD5) / Made available in DSpace on 2018-11-05T13:36:59Z (GMT). No. of bitstreams: 1 disserta??o Josiane Silva Silveira vers?o final corrigida.pdf: 4036302 bytes, checksum: cdea806bf90b79da9a4047282152d203 (MD5) Previous issue date: 2018-10-26 / Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq / INTRODUCTION: asthma is a chronic inflammatory disease characterized by secretion of elevated levels of cytokines (interleukin (IL)-4, IL-5 and IL-13), reactive oxygen species (ROS), autophagy and eosinophil extracellular traps (EETs) release in airway. Moreover, respiratory syncytial virus (RSV) infection may facilitate allergic sensitization development as well as exacerbate asthma symptoms. Recently, studies have demonstrated an increase of autophagy in eosinophils of asthmatic patients, contributing to an increase in inflammatory response. In asthma, an increase in EETs release may cause tissue damage and an increase in mucus viscosity, which contribute to airway obstruction and reduction of lung function. However, the mechanism of EETs formation and its pathophysiologic role in asthma are poorly understood. OBJECTIVE: the aim of this dissertation was to elucidate some mechanisms involved in EETs release in asthma. We investigated whether the respiratory syncytial virus (RSV) could induce EETs in vitro in bronchoalveolar lavage fluid (BALF) eosinophils of an experimental asthma model. Moreover, we evaluated ROS and autophagy participation in mechanisms involved in EETs formation. METHODS: in order to perform the experimental model of asthma, BALB/cJ mice were sensitized with two subcutaneous injections of ovalbumin (OVA) on days 0 and 7, followed by three intranasal challenges with OVA on days 14, 15 and 16 of the protocol. In paper 1, BALF eosinophils of OVA group and control group were stimulated with RSV (103 PFU/mL) in vitro for 3 hours. After that, culture supernatant was collected in order to perform the analyses proposed in this study which were evaluated according to the specific objectives of this paper. In paper 2, during the experimental asthma protocol, mice were treated intranasally with a nicotinamide adenine dinucleotide phosphate oxidase (NDPH oxidase) inhibitor, diphenyleneiodonium (DPI), or a glutathione precursor, N-acetylcysteine (NAC). In paper 3, mice were treated intranasally with an autophagy inhibitor, 3-Methyladenine (3-MA). Treatments were performed 45 minutes before of the three intranasal administrations with OVA. At the end of the protocol, BALF and lung tissue were collected to perform the techniques discribed in each of the papers, according to their specific objectives. RESULTS: in paper 1, we verified an increase in EETs release in BALF eosinophils from OVA group stimulated with RSV in vitro. RSV in vitro decreased IFN-? in BALF cells when compared to the OVA group. In paper 2, we showed that in NAC-treated OVA group there was a decrease in the inflammatory cells in BALF and lung tissue. DPI or NAC treatments reduced EPO activity, goblet cells hyperplasia, inflammatory cytokines and NF?B p65 immunocontent in lung, and they helped in decreasing ROS production in lung. Furthermore, NAC increased catalase (CAT) activity in lung. However, only NAC treatment improved mitochondrial energy metabolism in lung. We showed that DPI or NAC reduced EETs formation in BALF from the OVA group. In paper 3, we showed that in 3-MA-treated OVA group there was a decrease in the inflammatory cells, EPO activity, goblet cells hyperplasia, inflammatory cytokines, NF?B p65 immunocontent, and oxidative stress in airway. Moreover, 3-MA was able to improve mitochondrial energy metabolism and increase Na+,K+-ATPase activity. We also demonstrated that 3-MA decreased light chain 3B (LC3B) in BALF cells and lung tissue as well as reduced EETs formation in BALF. CONCLUSION: our results verified an important role for RSV in the induction of EETs release. Moreover, DPI, NAC and 3-MA treatments decreased airway inflammation, oxidative stress and EETs release in asthma. Our data suggested that RSV, ROS and autophagy participate in the mechanisms for EETs release in asthma. Thus, identification of mechanisms that regulate EETs formation in asthma may contribute to a better understanding of the pathogenesis of this chronic inflammatory disease which damages patients? quality of life and is responsible for a high economic cost for the Brazilian Single Health System (SUS). / INTRODU??O: a asma ? uma doen?a inflamat?ria cr?nica caracterizada pela secre??o de elevados n?veis de citocinas do perfil T helper 2 (Th2) como interleucina (IL)-4, IL-5 e IL-13, esp?cies reativas de oxig?nio (EROs), aumento da autofagia e forma??o redes extracelulares de eosin?filos (EETs). A infec??o pelo v?rus sincicial respirat?rio (VSR) pode facilitar o desenvolvimento da sensibiliza??o al?rgica bem como exacerbar os sintomas da doen?a. Recentemente, estudos t?m demonstrado o aumento da autofagia em eosin?filos das vias de pacientes asm?ticos, contribuindo para o aumento da resposta inflamat?ria nas vias a?reas. Na asma, a produ??o excessiva de EETs pode causar dano tecidual e aumento da viscosidade do muco, podendo contribuir para o aumento da obstru??o da via a?rea e redu??o da fun??o pulmonar. Entretanto, os mecanismos de forma??o das EETs e seu papel fisiopatol?gico na asma s?o pouco compreendidos. OBJETIVO: esta disserta??o teve como objetivo elucidar alguns mecanismos envolvidos na libera??o de EETs na asma. Avaliamos a participa??o do VSR in vitro, das EROs e da autofagia nos mecanismos envolvidos na libera??o das EETs em eosin?filos do lavado broncoalveolar (LBA) em um modelo experimental de asma. METODOLOGIA: para o desenvolvimento do modelo experimental de asma, camundongos BALB/cJ foram sensibilizados com duas inje??es subcut?neas de ovalbumina (OVA) nos dias 0 e 7 seguidos por tr?s desafios intranasais com OVA nos dias 14, 15 e 16 do protocolo. No artigo cient?fico 1, eosin?filos do LBA de animais do grupo OVA e do grupo controle foram estimulados com VSR (103 PFU/mL) in vitro por 3 horas. Ap?s este per?odo, o sobrenadante da cultura foi coletado para a realiza??o das t?cnicas avaliadas conforme os objetivos espec?ficos deste artigo cient?fico. No artigo cientifico 2, durante o protocolo experimental de asma, os animais foram tratados via intranasal com um inibidor da nicotinamida adenina dinucleot?deo fosfato oxidase (NADPH oxidase), difenileno-iod?nio (DPI), ou com um precursor da glutationa, N-acetilciste?na (NAC), 45 minutos antes dos tr?s desafios intranasais com OVA. J? no artigo cientifico 3, os animais foram tratados via intranasal com um inibidor de autofagia, 3-metiladenina (3-MA), 45 minutos antes dos tr?s desafios intranasais com OVA. Ao final do protocolo o LBA e o tecido pulmonar foram coletados para a realiza??o das t?cnicas avaliadas em cada um dos artigos cient?ficos, conforme seus objetivos espec?ficos. RESULTADOS: no artigo cientifico 1, observamos um aumento na libera??o de EETs em eosin?filos do LBA de animais submetidos ao modelo experimental de asma e estimulados com VSR in vitro. Por outro lado, o VSR in vitro foi capaz de diminuir os n?veis de IFN-? no sobrenadante da cultura de eosin?filos do LBA. Em rela??o aos resultados do artigo cient?fico 2, verificamos que no grupo OVA tratado com NAC ocorreu uma diminui??o no n?mero de c?lulas inflamat?rias no LBA bem como uma redu??o no infiltrado inflamat?rio pulmonar. Al?m disso, os animais do grupo OVAM tratados com DPI ou NAC apresentaram uma redu??o da enzima EPO, hiperplasia de c?lulas caliciformes, citocinas inflamat?rias e da prote?na fator nuclear kappa B (NF?B p65). Os tratamentos com DPI ou NAC foram capazes de reduzir a forma??o de EROs, aumentar a atividade da enzima catalase antixidante (CAT). Por outro lado, par?metros do metabolismo energ?tico mitocondrial aumentaram somente com o tratamento com NAC. Por fim, demonstramos que os tratamentos com DPI ou NAC foram capazes de reduzir a forma??o de EETs do LBA. No artigo cient?fico 3, observamos que no grupo OVA tratado com o inibidor de autofagia, 3-MA, ocorreu uma diminui??o no n?mero de c?lulas inflamat?rias no LBA bem como uma redu??o do infiltrado inflamat?rio pulmonar. Al?m disso, os animais tratados com 3-MA apresentaram uma redu??o nos n?veis da enzima EPO, hiperplasia de c?lulas caliciformes, citocinas inflamat?rias e da prote?na NF?B p65. O tratamento com 3-MA foi capaz de reduzir a forma??o de EROs bem como aumentar os n?veis da enzima antioxidante CAT. O tratamento com 3-MA tamb?m melhorou par?metros do metabolismo energ?tico mitocondrial e a atividade da enzima Na+,K+ATPase. Demonstramos tamb?m que o tratamento com 3-MA diminuiu o imunoconte?do da prote?na light chain 3B (LC3B) em eosin?filos do LBA e no tecido pulmonar e reduziu a forma??o de EETs no LBA. CONCLUS?O: Nossos resultados demonstram um importante papel do VSR na indu??o da libera??o de EETs. Al?m disso, verificamos que os tratamentos com DPI, NAC e 3-MA foram capazes de reduzir a inflama??o das vias a?reas, o estresse oxidativo e a libera??o de EETs no LBA. Demonstramos que o VSR, as EROs e a autofagia participam dos mecanismos que regulam o processo de libera??o das EETs na asma. Assim, a identifica??o de alguns desses mecanismos envolvidos na libera??o de EETs na asma pode contribuir para uma melhor compreens?o da patog?nese desta doen?a inflamat?ria cr?nica que prejudica a qualidade de vida dos pacientes e ? respons?vel por um alto custo econ?mico para o Sistema ?nico de Sa?de (SUS).

<p>Hodgkin lymphoma (HL) is characterised histologically by a minority of malignant Hodgkin and Reed-Sternberg (HRS) cells surrounded by benign cells, and clinically by a relatively good prognosis. The treatment, however, leads to a risk of serious side effects. Knowledge about the biology of the disease, particularly the interaction between the HRS cells and the surrounding cells, is essential in order to improve diagnosis and treatment. </p><p>HL patients with abundant eosinophils in the tumours have a poor prognosis, therefore the eosinophil derived protein eosinophil cationic protein (ECP) was studied. Serum-ECP (S-ECP) was elevated in most HL patients. It correlated to number of tumour eosinophils, nodular sclerosis (NS) histology, and the negative prognostic factors high erythrocyte sedimentation rate (ESR) and blood leukocyte count (WBC). A polymorphism in the ECP gene (434(G>C)) was identified and the 434GG genotype correlated to NS histology and high ESR.</p><p>The poor prognosis in patients with abundant eosinophils in the tumours has been proposed to depend on HRS cell stimulation by the eosinophils via a CD30 ligand (CD30L)-CD30 interaction. However, CD30L mRNA and protein were detected in mast cells and the predominant CD30L expressing cell in HL is the mast cell. Mast cells were shown to stimulate HRS cell lines via CD30L-CD30 interaction. The number of mast cells in HL tumours correlated to worse relapse-free survival, NS histology, high WBC, and low blood haemoglobin. </p><p>Survival in patients with early and intermediate stage HL, diagnosed between 1985 and 1992, was generally favourable and comparatively limited treatment was sufficient to produce acceptable results for most stages. The majority of relapses could be salvaged. Patients treated with a short course of chemotherapy and radiotherapy had an excellent outcome.</p><p>In conclusion prognosis is favourable in early and intermediate stages and there are possibilities for further improvements based on the fact that mast cells and eosinophils affect the biology and prognosis of HL.</p>

Hodgkin lymphoma (HL) is characterised histologically by a minority of malignant Hodgkin and Reed-Sternberg (HRS) cells surrounded by benign cells, and clinically by a relatively good prognosis. The treatment, however, leads to a risk of serious side effects. Knowledge about the biology of the disease, particularly the interaction between the HRS cells and the surrounding cells, is essential in order to improve diagnosis and treatment. HL patients with abundant eosinophils in the tumours have a poor prognosis, therefore the eosinophil derived protein eosinophil cationic protein (ECP) was studied. Serum-ECP (S-ECP) was elevated in most HL patients. It correlated to number of tumour eosinophils, nodular sclerosis (NS) histology, and the negative prognostic factors high erythrocyte sedimentation rate (ESR) and blood leukocyte count (WBC). A polymorphism in the ECP gene (434(G&gt;C)) was identified and the 434GG genotype correlated to NS histology and high ESR. The poor prognosis in patients with abundant eosinophils in the tumours has been proposed to depend on HRS cell stimulation by the eosinophils via a CD30 ligand (CD30L)-CD30 interaction. However, CD30L mRNA and protein were detected in mast cells and the predominant CD30L expressing cell in HL is the mast cell. Mast cells were shown to stimulate HRS cell lines via CD30L-CD30 interaction. The number of mast cells in HL tumours correlated to worse relapse-free survival, NS histology, high WBC, and low blood haemoglobin. Survival in patients with early and intermediate stage HL, diagnosed between 1985 and 1992, was generally favourable and comparatively limited treatment was sufficient to produce acceptable results for most stages. The majority of relapses could be salvaged. Patients treated with a short course of chemotherapy and radiotherapy had an excellent outcome. In conclusion prognosis is favourable in early and intermediate stages and there are possibilities for further improvements based on the fact that mast cells and eosinophils affect the biology and prognosis of HL.