Objetivo: Avaliar as concentrações séricas do CA-125 e do CD-23 solúvel, durante dois períodos do ciclo menstrual (primeiro, segundo ou terceiro dia e o sétimo, oitavo ou nono dia), correlacionando-as a queixas clínicas, local de doença, estadiamento pela American Society for Reproductive Medicine e classificação histológica da endometriose pélvica. Pacientes e Métodos: No período de junho de 2007 a outubro de 2009, em estudo transversal, 102 mulheres, com queixas de infertilidade, dor pélvica refratária às terapêuticas clínicas, ou desejando laqueadura tubária, foram avaliadas por videolaparoscopia e divididas em um grupo caso, com endometriose (n=44), e outro controle, sem endometriose (n=58). Todas as pacientes foram submetidas a anamnese para investigação dos sintomas associados a endometriose e, antecedendo em até três meses da videolaparoscopia, a duas coletas de sangue venoso periférico para determinação da concentração do CA-125 e do CD-23 solúvel, por enzima-imunoensaio. Foram empregados os testes de Qui quadrado ou exato de Fisher para comparação de variáveis qualitativas. O teste t de Student, com análise de variância de Levene para amostras independentes, foi usado para diferença das médias de idade, intensidade dolorosa aferida pela escala visual analógica e concentrações dos marcadores, admitindo-se nível de significância igual a 0,05, para todos os testes. Resultados: Observamos que as concentrações médias do CA-125 foram significantemente maiores no grupo caso do que no grupo controle, em ambas as coletas na presença de dismenorréia severa e na ausência de infertilidade e de queixas urinárias cíclicas, mas apenas na segunda coleta naquelas com queixa de dor pélvica crônica e dispareunia de profundidade, permitindo diferenciação quando da presença de endometriose ovariana, grau III ou IV e padrões histológicos estromal ou glandular bem diferenciado. O CD-23 solúvel apresentou concentrações médias menores em pacientes com endometriose quando comparadas a mulheres sem a doença, porém sem atingir significância estatística, bem como essas concentrações foram menores na segunda coleta em pacientes sem endometriose com queixa de alterações intestinais cíclicas. Conclusões: Maiores concentrações do CA-125 em pacientes com endometriose reforçaram a afirmação de que esse marcador pode ser útil no diagnóstico e no manejo dessa doença. No entanto não se identificaram diferenças significantes na concentração desse marcador, em ambas as fases do ciclo menstrual, entre pacientes com endometriose em estádio inicial ou avançado, assim como entre aquelas com lesões histologicamente classificadas como diferenciadas ou indiferenciadas. O presente estudo trouxe uma análise diferenciada das concentrações médias do CD-23 solúvel e de suas associações com sintomas e local de doença / Objective: To evaluate serum concentrations of CA-125 and soluble CD-23, during two periods of the menstrual cycle (first, second or third day and the seventh, eighth or ninth day), correlating them to clinical complaints, site of disease, staging by the American Society for Reproductive Medicine and histological classification of pelvic endometriosis. Patients and Methods: From June 2007 to October 2009, within a cross-sectional study, 102 women with complaints of infertility, pelvic pain refractory to clinical therapies, or desiring for tubal ligation, were evaluated by videolaparoscopy and were divided into a case group, with endometriosis (n = 44), and a control group without endometriosis (n = 58). All patients underwent anamnesis for investigation of symptoms associated with endometriosis and, prior to three months to videolaparoscopy, they were submitted to two peripheral venous blood samples to measure CA-125 and soluble CD-23 concentrations by enzyme-linked immunosorbent assay. We utilized Chi square or Fisher exact test to compare qualitative variables. The t Student test, with Levene\'s variance analysis for independent samples, was used for mean difference in age, pain intensity measured by visual analogue scale and concentrations of markers, assuming a significance level of 0.05, for all tests. Results: We observed that average concentrations of CA-125 were significantly higher in case group than in control group in both samples, in the presence of severe dysmenorrhea and absence of infertility and cyclical urinary complaints, but only in the second collection, for women with chronic pelvic pain and deep dyspareunia, enabling differentiation in the presence of ovarian endometriosis grade III or IV and stromal or glandular well differentiated histological patterns. The soluble CD-23 showed lower average concentrations in patients with endometriosis compared to women without this disease, without statistical significance, and these concentrations were lower in the second collection for patients without endometriosis with complains of cyclical intestinal disorders. Conclusions: Higher concentrations of CA-125 in patients with endometriosis have reinforced the statement that this marker may be useful in the diagnosis and management of this disease. However we did not identify significant differences in concentration of this marker, in both phases of the menstrual cycle, between patients with endometriosis in early or advanced stage, and between those with lesions histologically classified as differentiated or undifferentiated. This study brought a differentiated analysis of the average concentrations of soluble CD-23, and of their associations with symptoms and site of disease.

Charles University Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Author: Bc. Petra Porubová Supervisor: prof. RNDr. Ctirad Andrýs, Ph.D. Title of diploma thesis: Allergic phenotypes in patients with respiratory allergy evaluated by microchip ISAC technique Key words: allergic inflammation, allergen specific IgE, component resolved diagnostics, microchip, ISAC Background: The aim of this diploma thesis was to evaluate the sensitization profile in the group of pacients with allergic rhinitis and/or bronhial asthma and to identify possible differences between patients with different disease severity. Methods: ImmunoCAP ISAC was used to determine specific IgE antibodies against 112 allergen components. The evaluated group included 152 patients (57.9 % women) from the allergology outpatient office of the Department of Clinical Immunology and Allergology, University Hospital Hradec Králové. Results: The most common allergens in this group of patients were the components Phl p 1 (68,4 %) and Bet v 1 (65,1 %). Differences in the number of positive and negative reactions were demonstrated between patients with different severity of allergic rhinitis. Correlations were found between the number of positive/negative reactions and the severity of bronchial asthma. And the...

Allergien sind häufige Erkrankungen in vielen industrialisierten Ländern. Ihre Entstehung beruht auf einem komplexen Zusammenspiel von genetischen und umweltassoziierten Einflüssen. Eine Vielzahl möglicher Faktoren ist beschrieben, die das Auftreten von AllerT gien beeinflussen können, etwa das Alter oder das Geschlecht. Es gibt allerdings nur sehr wenige Daten zur Verbreitung allergischer Erkrankungen in der älteren Bevölkerung. Das Ziel der vorliegenden Arbeit ist es, eine Übersicht zur Prävalenz allergischer ErkranT kungen und Sensibilisierungen in einer Stichprobe der 40T79Tjährigen Bevölkerung Leipzigs zu geben. Hierzu wurden insgesamt 4088 Probanden der zweiten ZwischenausT wertung (1. November 2011 bis 12. Juni 2013) der LIFETStudie untersucht. LIFE (Leipziger Forschungskomplex für Zivilisationserkrankungen) ist eine Kohortenstudie zur Erfassung von lebensstilT und umweltassoziierten Erkrankungen, beispielsweise Allergien, und mögT lichen Einflussfaktoren. In der vorliegenden Arbeit werden allergische Erkrankungen (alT lergische Rhinitis, Asthma bronchiale, atopisches Ekzem, Urtikaria, Anaphylaxie, NahT rungsmittelT und Insektengiftallergien) anhand eines AllergieTInterviews erfragt; SensibiliT sierungen werden mittels IgETDiagnostik für InhalationsT (SX1T) und NahrungsmittelallerT gene (FX5TScreeningtest) bzw. mittels Hautpricktest (Birke, Wiesenlieschgras, Beifuß, Dermatophagoides pteronyssinus, Alternaria alternata und Ambrosia) erfasst, weiterhin wird das GesamtTIgE bestimmt. Als mögliche Einflussfaktoren werden das Geschlecht, das Alter, der sozioökonomische Status und die allergologische Familienanamnese unterT sucht, hierzu werden neben den Prävalenzen auch OddsTRatios berechnet. Allergien sind häufige Erkrankungen in vielen industrialisierten Ländern. Ihre Entstehung beruht auf einem komplexen Zusammenspiel von genetischen und umweltassoziierten Einflüssen. Eine Vielzahl möglicher Faktoren ist beschrieben, die das Auftreten von Allergien beeinflussen können, etwa das Alter oder das Geschlecht. Es gibt allerdings nur sehr wenige Daten zur Verbreitung allergischer Erkrankungen in der älteren Bevölkerung. Das Ziel der vorliegenden Arbeit ist es, eine Übersicht zur Prävalenz allergischer Erkrankungen und Sensibilisierungen in einer Stichprobe der 40-79-jährigen Bevölkerung Leipzigs zu geben. Hierzu wurden insgesamt 4088 Probanden der zweiten Zwischenauswertung (1. November 2011 bis 12. Juni 2013) der LIFE-Studie untersucht. LIFE (Leipziger Forschungskomplex für Zivilisationserkrankungen) ist eine Kohortenstudie zur Erfassung von lebensstil- und umweltassoziierten Erkrankungen, beispielsweise Allergien, und möglichen Einflussfaktoren. In der vorliegenden Arbeit werden allergische Erkrankungen (allergische Rhinitis, Asthma bronchiale, atopisches Ekzem, Urtikaria, Anaphylaxie, Nahrungsmittel- und Insektengiftallergien) anhand eines Allergie-Interviews erfragt; Sensibilisierungen werden mittels IgE-Diagnostik für Inhalations- (SX1-) und Nahrungsmittelallergene (FX5-Screeningtest) bzw. mittels Hautpricktest (Birke, Wiesenlieschgras, Beifuß, Dermatophagoides pteronyssinus, Alternaria alternata und Ambrosia) erfasst, weiterhin wird das Gesamt-IgE bestimmt. Als mögliche Einflussfaktoren werden das Geschlecht, das Alter, der sozioökonomische Status und die allergologische Familienanamnese untersucht, hierzu werden neben den Prävalenzen auch Odds-Ratios berechnet. Insgesamt zeigt sich, dass allergische Erkrankungen und Sensibilisierungen in der untersuchten Stichprobe häufig sind. Die Einflussfaktoren zeigen unterschiedliche Effekte für das Risiko einer Allergie. Beispielsweise geht eine positive allergologische Familienanamnese mit einem erhöhten Risiko einher. Die möglichen Ursachen für Prävalenzunterschiede bei den allergischen Erkrankungen im Vergleich mit der Literatur und das Verhalten der Einflussfaktoren werden, ebenso wie die bestehenden Limitationen von LIFE, kritisch diskutiert. In der vorliegenden Arbeit wird erstmalig der Status quo von allergischen Erkrankungen in einer Probandengruppe der älteren Leipziger Bevölkerung gezeigt. Allergien sind bei den älteren Teilnehmern weniger häufig als bei den jüngeren, aber immer noch weit verbreitet. Weitere Untersuchungen sind notwendig, um mögliche Prävalenzänderungen zu dokumentieren und weitere Einflussfaktoren zu untersuchen. LIFE und seine geplanten Nachuntersuchungen bieten hierfür passende Möglichkeiten.

Le cetuximab (CTX) est un anticorps monoclonal anti-EGFR indiqué dans les cancers ORL dont les modalités de prescription pourraient être améliorées. Après chimiothérapie d’induction (étude Tremplin), en comparaison au cisplatine, il était moins toxique mais sans améliorer la préservation laryngée. À la première injection, le CTX peut déclencher un choc anaphylactique lié à la préexistence d’IgE anti-αGal. Des tests prédictifs détectant ces IgE ont été développés et réalisés chez 41 patients avec une sensibilité et une valeur prédictive négative de 100%. La relation entre concentrations sériques et efficacité/toxicité a été étudiée chez 34 patients. La pharmacocinétique a été décrite à l’aide d’un modèle combinant des mécanismes d’élimination non saturable (CL) et saturable (k0). La clairance globale du CTX, reflet de l’exposition des patients, était reliée aux survies sans progression et globale (SG). Le grade de radiodermite était associé à la SG. Une simulation pharmacocinétique suggère, qu’en comparaison à l’injection standard de CTX, une injection toutes les trois semaines entrainera des AUC proches mais des concentrations résiduelles différentes. / Cetuximab (CTX) is an anti-EGFR monoclonal antibody approved in head and neck cancer, which prescription modalities may be improved. After induction chemotherapy (Tremplin study), compared to cisplatin, CTX was less toxic but did not improve larynx preservation. During first infusion, CTX can induce an anaphylaxis reaction due to the presence of preexisting anti-αGal IgE. Predictive assays detecting these IgE were developed and tested in 41 patients, with sensitivity and negative predictive values of 100%. Relationship between serum concentrations and efficacy/toxicity was studied in 34 patients. CTX pharmacokinetics was described using a model combining non-saturable (CL) and saturable (k0) eliminations. Global clearance, which reflects patient exposure, was related to progression free and overall (OS) survivals. Severe radiation dermatitis was also associated with OS. A pharmacokinetic simulation suggests that, in comparison to standard CTX infusion, an infusion every three weeks will lead to similar AUC but to different residual concentrations.

p. 1-157 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-24T21:12:07Z No. of bitstreams: 1 22222222222tttt.pdf: 2420212 bytes, checksum: d208a267b6fe5b14ae33b31fc9319a4a (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T17:08:10Z (GMT) No. of bitstreams: 1 22222222222tttt.pdf: 2420212 bytes, checksum: d208a267b6fe5b14ae33b31fc9319a4a (MD5) / Made available in DSpace on 2013-05-04T17:08:10Z (GMT). No. of bitstreams: 1 22222222222tttt.pdf: 2420212 bytes, checksum: d208a267b6fe5b14ae33b31fc9319a4a (MD5) Previous issue date: 2011 / O objetivo deste estudo foi investigar a influência de fatores ambientais, antropométricos e de estilo de vida em asma e atopia em uma área rural do Equador. Foi conduzido um estudo transversal, a partir do qual foram identificadas crianças e adolescentes, com e sem chiado no peito no ultimo ano, para serem incluídas no estudo caso-controle. Inicialmente, um estudo exploratório foi realizado para identificar se diferentes fatores (sócioeconômicos, ambientais, famíliares, estilo de vida, infecção por helmintos) estariam associados com sibilo atópico e não-atópico na área rural. Os resultados mostraram que sibilo não-atópico foi o fenótipo mais comum nesta área, e foi observado um padrão diferente de fatores de risco para sibilância atópica e não-atópica, o que pode sugerir que diferentes mecanismos podem estar envolvidos. Vários estudos nas áreas rurais e urbanas pobres na América Latina têm reportado que a asma não é atribuída a atopia. Da mesma forma, uma dissociação entre a IgE específica e reatividade ao teste cutâneo tem sido observada. Assim, testamos a hipótese de que na nossa população, infecções por helmintos, poderiam estar modificando estas associações. Os resultados mostram uma relação complexa entre helmintos, asma e atopia. Notou-se que a associação entre os marcadores de atopia foi mais débil nos indivíduos com presença de sensibilização para Ascaris, e a associação entre o teste cutâneo e sibilo, foi atenuada em indivíduos com infecção ativa com Ascaris e / ou Trichuris. Adicionalmente a IgE anti-Ascaris, mas não infecção ativa, incrementou o risco de sibilo, independentemente de IgE específica a alérgenos. Finalmente, uma nova hipótese sugere que a adoção de novos estilos de vida estaria conduzindo a um aumento da asma e atopia. Assim, estudou-se excesso de peso, por ser considerado um marcador de recentes mudanças nos padrões de vida e que, por sua vez, estaria associado com asma e atopia. A presença de teste cutâneo e IgE específica a alérgenos foi de 1,85 e 2,20 vezes maior em crianças com excesso de peso do que em crianças eutróficas/déficit, respectivamente. No entanto, o efeito em sibilo foi decorrente de um mecanismo não-atópico. Embora esses resultados precisem ser confirmados por estudos longitudinais, certamente contribuirão para uma melhor compreensão dos mecanismos da asma não-atopica nas aéreas rurais, que tem sido muito pouco compreendidos. / Salvador

This study aimed to evaluate laboratory aspects (total IgE and eosinophils) in patients with Schistosoma mansoni and geohelminths in three localities in Rio Largo, Alagoas. Coprological survey was conducted in 3030 subjects and examined two slides for each stool sample by the Kato-Katz technique, blood count to determine the absolute and relative number of eosinophilic and quantification of serum total IgE using the automated chemiluminescence system (Automated Chemiluminescence Systems) ACS: 180 SIEMENS, adapted to the System II and MAGIC LITE using commercial kits in 547 individuals from three localities infested by the snail Biomphalaria glabrata, close to the river Mundaú and environmental similarities. The subjects were divided into four groups, G1 (co-infected with S. mansoni and geohelminths): n = 115 (21.02%) with mean age 21.18 ± 13.08 years, G2 (infected only by S. mansoni): n = 127 (23.22%) with mean age 29.59 ± 16.54 years; G3 (infected only by geohelminths): n = 149 (27.24%) with mean age 23.99 ± 15.52 years and G4 (negative for S. mansoni and geohelminths, the control group): n = 156 (28.52%) with mean age 25.44 ± 14.60 years. The parasitic load of S. mansoni was quantified and classified according to intensity of infection by the number of eggs per gram of feces detected. The study was approved by the Ethics Committee of the Federal University of Alagoas and implemented in accordance with the resolution MS-CNS 196/96. For processing and data analysis used the software SPSS 11.5. In all analysis was considered the 5% level of significance. The descriptive statistical analysis of qualitative and quantitative variables were performed by the distribution of relative frequencies and absolute position measurements (mean) and dispersion (standard deviation). He applied the normality test, t test, analysis of variance oneway (ANOVA), chi-square test, Fisher exact test, Pearson and Spearman correlation and linear regression. Of the 3030 samples, 1,209 (39.90%) were positive for any helminth, and 679 (22.41%) positive for A. lumbricoides, 546 (18.02%) for T. Trichiura, 220 (7.26%) to Ancyostomatidae and 242 (8.0%) for S. mansoni. There was no statistically significant difference (p>0.05) of individuals positive for S. mansoni separated by gender, age and locality, the mean parasite burden was moderate and 111 epg (minimum 24 and maximum of 4,080 epg). Eosinophils increased significantly with increasing parasite load (p<0.05). The absolute and relative eosinophilia appear to have greater significance in relation to group coinfected, because presented more frequently than the other groups. There were no significant differences (p>0.05) between worm burden of S. mansoni and total IgE levels, nor between serum total IgE and age. Thus the total IgE test was not considered relevant to the diagnosis of Schistosomiasis mansoni. There was no correlation between markers of total IgE and geohelminth infections, whether they are co-infected with S. mansoni. The results suggest the importance of including eosinophil counts in epidemiological surveys, the complementation of the findings and parasitological diagnosis of schistosomiasis, contributing to more precise investigations focused on the control of schistosomiasis in endemic areas. / Este estudo objetivou avaliar aspectos laboratoriais (IgE total e eosinófilos) em portadores de Schistosoma mansoni e geohelmintos em três localidades no município de Rio Largo, Alagoas. Foi realizado inquérito coprológico em 3.030 indivíduos e analisadas duas lâminas para cada amostra de fezes pela técnica de Kato-katz, hemograma para determinar o número absoluto e relativo de eosinífilos e quantificação sérica de IgE total utilizando o sistema de quimioluminescência automatizado (Automated Chemiluminescence Systems) ACS: 180 da SIEMENS, adaptado ao Sistema MAGIC LITE II e usando kits comerciais em 547 indivíduos de três localidades infestadas pelo molusco Biomphalaria glabrata, próximas ao rio Mundaú e com semelhanças ambientais. Os indivíduos foram divididos em 4 grupos, G1 (co-infectados por S. mansoni e geohelmintos): n=115 (21,02%) com média de idade 21,18 ± 13,08 anos; G2 (infectados apenas por S. mansoni): n=127 (23,22%) com média de idade 29,59 ± 16,54 anos; G3 (infectados exclusivamente por geohelmintos): n=149 (27,24%) com média de idade 23,99 ± 15,52 anos e G4 (negativos para S. mansoni e geohelmintos, considerado grupo controle): n=156 (28,52%) com média de idade 25,44 ± 14,60 anos. A carga parasitária do S. mansoni foi quantificada e classificada de acordo com a intensidade da infecção pelo número de ovos por grama de fezes detectados. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Alagoas e executado de acordo com a resolução CNS-MS 196/96. Para o processamento e análise dos dados utilizou-se o software SPSS 11.5. Em todas as análises foi considerado o nível de 5% de significância. A análise estatística descritiva das variáveis qualitativas e quantitativas foram realizadas através da distribuição de freqüências relativas e absolutas, medidas de posição (média aritmética) e dispersão (desvio padrão). Aplicou-se teste de normalidade, teste t, análise de variância one-way (ANOVA), teste do quiquadrado de Pearson, teste exato de Fisher, correlação de Pearson e Spearman e regressão linear simples. Das 3.030 amostras, 1.209 (39,90%) estavam positivas para algum helminto, sendo 679 (22,41%) positivas para A. lumbricoides , 546 (18,02%) para T. Trichiura, 220 (7,26%) para Ancyostomatidae e 242 (8,0%) para S. mansoni. Não houve diferença estatisticamente significante (p>0,05) dos indivíduos positivos para S. mansoni separados por gênero, faixa etária e localidades, a média da carga parasitária foi moderada e de 111 opg (mínimo de 24 e máximo de 4.080 opg). Os eosinófilos aumentavam significantemente conforme o aumento da carga parasitária (p<0,05). As eosinofilias absoluta e relativa parecem ter maior significado em relação ao grupo de co-infectados, pois apresentram maior frequência em relação aos demais grupos. Não foram observadas diferenças significantes (p>0,05) entre carga parasitária de S. mansoni e níveis de IgE total, nem entre níveis séricos de IgE total e faixa etária. Desta forma o teste de IgE total não foi considerado relevante para o diagnóstico de esquistossomose mansoni. Não houve correlação entre os marcadores de IgE total e as infecções geohelmínticas, independente de estarem co-infectados por S. mansoni. Os resultados sugerem a importância da inclusão de contagem de eosinófilos em inquéritos epidemiológicos, na complementação dos achados parasitológicos e no diagnóstico da esquistossomose, contribuindo para investigações mais precisas voltadas para o controle da esquistossomose mansônica nas áreas endêmicas.

Allergi förekommer hos cirka 20 % av befolkningen i Sverige. Av de 20 % bedöms 40 % vara allergiska mot pollen. Allergi uppstår då en individ upprepade gånger exponeras för ett allergiframkallande ämne sk allergen. IgE-antikroppar bildas och binder till basofila granulocyter och mastceller. Den allergiska reaktionen eller överkänslighetsreaktionen av typ I uppkommer när ett allergen exempelvis pollen, kommer i direkt kontakt med IgE-antikroppar på mastceller eller basofila granulocyter. Allergiska individer har högre koncentration av IgE-antikroppar i blodet än icke allergiska. Normal koncentration av IgE i serum hos icke allergiker är &lt;0.35 kU/L. Syftet med studien var att genom analys av serumprover från 50 patienter jämföra två immunokemiska metoder på analysinstrumenten, Siemens immulite® 2000 XPi och Thermo Fisher Phadia® 250, för detektion av IgE-antikroppar riktade mot en inhalationspanel respektive björkpollen. Immulite® 2000 XPi användes som referensmetod. Jämförelsen gjordes för att bedöma om metoderna gav överensstämmande resultat och om Phadia® 250 skulle kunna användas som ett alternativ till rutinmetoden. Studiematerialet bestod av 50 patienter i åldrarna 18–80 år, 17  män (34 %) och 33 kvinnor (66 %). Resultatet visade att metoderna överlag gav överrensstämmande resultat med avseende på positiva och negativa IgE-värden, men att de uppmätta värdena för metoderna saknade överrensstämmelse. Analysresultaten från de båda metoderna gav överlag god korrelation vid analys av specifikt IgE mot björk (R=0,977) men en svagare korrelation vid analys av inhalationspanel (R=0,609). Med hjälp av Man-Whitney u-test sågs en signifikant skillnad vid IgE-analys mot björk (p= 0,0006) däremot sågs inte en signifikant skillnad mellan metodernas IgE-värden mot inhalationspanelerna (p=0,2398). För att kunna utvärdera om Phadia® 250 skulle kunna användas som ett alternativ till rutinmetoden, krävs en större population av prover samt fler analystillfällen. / Allergy is nowadays a public health problem that’s affecting 20 % of the Swedish population. A very common allergen that is related to 40% of all the allergic cases is pollen. Allergic reactions occur when an  individual is repeatedly exposed to an allergenic substance called allergene. IgE antibodies then form and bind to basophilic granulocytes and mast cells. The allergic reaction or type I hypersensitivity reaction, occurs when an allergen such as pollen comes into direct contact with IgE antibodies on mast cells or basophilic granulocytes. IgE is produced by plasma cells under the influence of CD4+ T lymphocytes. The IgE antibodies synthesized then sensitize the mast cells and basophilic granulocytes which are the most active cell types involved in allergic reactions. Allergic individuals have a higher concentration of IgE antibodies in the blood than non-allergic. Normal serum IgE concentration in non-allergic patients is &lt;0.35 kU / L. The aim of the study was to compare two immunochemical instruments, Siemens Immulite® 2000 XPi and Thermo Fisher Phadia® 250, by analyzing 50 serum samples to detect possible presence of IgE antibodies directed against an inhalation panel and a single allergen (IgE against birch). The study material consisted of 50 patients between the ages of 18-80, 17 men (34%) and 33 women (66%). The results showed that overall the two methods yielded consistent results due to positive and negative IgE values, but the measured values of the methods lacked concordance. The analysis results from the two methods generally yielded good correlation in the analysis of specific IgE against birch (R = 0.977) but a weaker correlation in the inhalation panel analysis (R = 0.609). Man-Whitney u-test showed a significant difference in IgE analysis against birch (p = 0.0006). However, a significant difference between the IgE values of the methods against the inhalation panels (p = 0.22398) was not observed. To be able to evaluate whether Phadia® 250 could be used as an alternative to the routine method, a larger population of samples and more analytical occasions is required.

Tesis por compendio / [EN] About 10 % of all adverse drug reactions are due to allergies, with ß-lactam antibiotics causing the majority of the episodes. Although the actual incidence remains unknown, individuals suspected of being allergic to a drug end up being prescribed with other medications that are less effective, more expensive or harmful. Consequently, a correct diagnosis is key to reduce the derived economic costs and proceed to an adequate 'delabeling' of the population. At present, clinical approaches to diagnose allergies to ß-lactam antibiotics are based on in vivo and in vitro tests. These tests present limited clinical performances since they are invasive, dangerous, and provide false positives and/or negatives. Moreover, the diagnostic sensitivity is far from what is expected, possibly because the epitopes that cause the allergic episodes are still not well detected. In this respect, the preparation of antigens has commonly been determined by the direct attachment of antibiotics to carrier molecules through the formation of an amide bond between amino lysine groups of the carrier molecule and the carboxylate group of the antibiotic. Even so, specific IgE are barely detected with such antigens. This dissertation addresses the synthesis of haptens and the generation of antigens to ß-lactam antibiotics, which develop a more reliable in vitro diagnosis of allergies to these drugs. The evaluation of the antigens has been carried out by means of multiplex in vitro tests based on compact disc technology. This research begins by focusing on the synthesis and preparation of penicillin antigens. To this end, first, the effect of the incorporation of aliphatic spacer arms in the chemical structure of penicillin has been approached, considering the possibility that a better molecular recognition is obtained by moving the hapten away from the carrier protein. Thirteen haptens derived from benzylpenicillin and amoxicillin were synthesized in order to prepare antigens with human serum albumin. The evaluation of the antigens revealed that even though they were immunogenic and were detected by the raised IgG antibodies, they were not detected by specific IgE from allergic patients. Additionally, the next approach considered the cationization of the carrier proteins, human serum albumin and histone. The modification of carboxylate groups of the protein to amino groups allow for an increase of the molar hapten/protein ratio. This strategy led to the generation of five antigens, four of which (only those histone-based antigens), did increase the sensitivity of the assay. Concretely, specific IgE has been determined in sera from allergic patients at low concentrations (LOD = 0.07 IU/mL) with a diagnostic specificity of 100 % and a sensitivity of 60 and 31 % for benzylpenicillin and amoxicillin, respectively. That means a 60 % improvement in the diagnostic sensitivity when compared to the in vitro reference test. Subsequently, the idea of preparing minor antigens based on penicillin metabolites was approached. Penicilloic, penilloic, penicillic, and 6-aminopenicillanic acids, together with penicillamine, were therefore conjugated to the carrier proteins human serum albumin and histone. Except penilloic acid, the rest of antigens were selectively detected when testing a set of serum samples from allergic patients. The diagnostic specificity obtained was 100 %, 94 % in the case of penicillic acid, and the sensitivity was between 67 and 100 %. Another approach was focused on the production of antigens for other families of ß-lactam antibiotics. The generation of antigens for cephalosporins, carbapenems, monobactams or ß-lactam inhibitors is essential, since in vitro tests for the detection of allergies to these antibiotics are not commercially available. Therefore, the results obtained after the preparation of major and minor antigens for the antibiotics cefuroxime, cefotaxime, ceftriaxone, meropenem, and aztreonam were evaluated. / [ES] Alrededor del 10 % de las reacciones adversas a medicamentos son debidas a alergias, siendo los antibióticos ß-lactámicos los que más episodios alérgicos ocasionan. Aunque la incidencia real sigue siendo desconocida, los individuos sospechosos de presentar alergia a algún medicamento acaban siendo prescritos con otros medicamentos, menos efectivos, más caros o perjudiciales. Así pues, un correcto diagnóstico resulta clave para disminuir los costes económicos derivados y proceder a un adecuado 'desetiquetado' de la población. En la actualidad, las pruebas de diagnóstico de alergias a antibióticos ß-lactámicos se basan en ensayos in vivo e in vitro. Estos ensayos muestran bajas prestaciones, ya que son invasivos y peligrosos y proporcionan falsos positivos y/o negativos. Además, la sensibilidad diagnóstica está lejos de ser la esperada, posiblemente porque aún no se ha conseguido reconocer todos los epítopos causantes de los episodios alérgicos. En este sentido, la preparación de antígenos se ha basado hasta el momento, en mayor medida, en la unión directa de los antibióticos a las moléculas portadoras mediante la formación de un enlace amida entre los grupos amino de las lisinas de la molécula portadora y el grupo carboxilato del antibiótico. Aun así, las IgE específicas son vagamente detectadas con estos antígenos. En esta tesis se ha abordado la síntesis de haptenos y la generación de determinantes antigénicos a antibióticos ß-lactámicos con los que poder realizar un diagnóstico in vitro más fiable de alergias a estos fármacos. La evaluación de los mismos se ha llevado a cabo mediante ensayos in vitro multiplex basados en tecnología de disco compacto. Esta investigación comienza centrándose en la síntesis y preparación de antígenos de penicilina. Para ello, en una primera fase se ha estudiado el efecto de la incorporación de brazos espaciadores alifáticos en la generación de antígenos, considerando la posibilidad de que se obtenga un mejor reconocimiento molecular al alejar el hapteno de la proteína portadora. Se sintetizaron trece haptenos derivados de bencilpenicilina y amoxicilina con los que se prepararon antígenos con la proteína albumina de suero humano. La evaluación de los antígenos reveló que a pesar de ser suficientemente inmunogénicos y ser reconocidos por anticuerpos IgG de conejo, éstos no fueron reconocidos por IgE específicas de muestras de pacientes alérgicos. Así bien, por otro lado, la estrategia de cationización de las proteínas albumina de suero humano e histona fue abordada teniendo en cuenta que la modificación de grupos carboxilatos de la proteína a grupos amino aumenta la relación molar hapteno/proteína. Esta estrategia permitió la generación de 5 antígenos, 4 de los cuales (los antígenos de histona), esta vez sí, incrementaron la especificidad de la respuesta inmunológica obtenida, reconociendo IgE específicas. Concretamente, se han determinado IgE específicas en suero de pacientes alérgicos a bajas concentraciones (LOD = 0.07 IU/mL) con una especificidad diagnóstica del 100 % y una sensibilidad del 60 y 31 % para bencilpenicilina y amoxicilina, respectivamente, mejorando la sensibilidad un 60 % en comparación con el ensayo in vitro de referencia. A pesar de las mejoras obtenidas con las estrategias llevadas a cabo, se estudiaron otras vías no clásicas para la síntesis de nuevos haptenos con mayor diversidad química. Este enfoque se basa en la generación de antígenos en librerías químicas de compuestos con diversidad estructural para encontrar nuevos haptenos biológicamente activos. Dichas estrategias, hasta el momento, no han sido empleadas para la generación de antígenos y el análisis de muestras de suero de pacientes alérgicos. Con el fin de incorporar diversidad estructural, se sintetizaron, mediante la técnica combinatoria diversity-oriented synthesis, 22 compuestos de los precursores de las penicilinas y cefalosporinas, ácido 6-aminopenicilánico y ácido 7-amino-desacetoxicefalosporánico, respectivamente, y de los antibióticos amoxicilina y ampicilina. Su evaluación con el inmunoensayo in vitro basado en disco compacto ha demostrado que la incorporación de diversidad permite el reconocimiento de epítopos causantes de episodios alérgicos. Concretamente, se observó que estos antígenos eran capaces de detectar anticuerpos tipo IgG e IgE específicos procedentes de suero de conejos inmunizados y de suero humano de pacientes alérgicos, siendo especialmente selectivos los determinantes de amoxicilina y ampicilina. Concretamente, se obtuvo una sensibilidad diagnóstica del 79 % y una especificidad diagnóstica del 100 % / [CA] Al voltant del 10% de les reaccions adverses a medicaments són degudes a al·lèrgies, sent els antibiòtics ß-lactàmics aquells que més episodis al·lèrgics ocasionen. Encara que la incidència real continua sent desconeguda, els individus sospitosos de presentar al·lèrgia a algun medicament acaben sent prescrits amb altres medicaments, menys efectius, més cars o perjudicials. Així doncs, un correcte diagnòstic resulta clau per a disminuir els costos econòmics derivats i procedir a un adequat 'desetiquetatge' de la població. En l'actualitat, les proves de diagnòstic d'al·lèrgies a antibiòtics ß-lactàmics es basen en assaigs in vivo i in vitro. Aquests assaigs mostren baixes prestacions, ja que són invasius i perillosos i proporcionen falsos positius i/o negatius. A més a més, la sensibilitat diagnòstica està lluny de ser l'esperada, possiblement perquè encara no s'ha aconseguit reconéixer tots els epítopes causants dels episodis al·lèrgics. En aquest sentit, la preparació d'antígens s'ha basat fins al moment, en major mesura, en la unió directa dels antibiòtics a les molècules portadores mitjançant la formació d'un enllaç amida entre els grups amino de les lisines de la molècula portadora i el grup carboxilat de l'antibiòtic. Així i tot, les IgE específiques són vagament detectades amb aquests antígens. En aquesta tesi s'ha abordat la síntesi d'haptens i la generació de determinants antigènics a antibiòtics ß-lactàmics amb els quals poder realitzar un diagnòstic in vitro més fiable d'al·lèrgies a aquests fàrmacs. La seua avaluació s'ha dut a terme mitjançant assaigs in vitro multiplex basats en tecnologia de disc compacte. Aquesta investigació comença centrant-se en la síntesi i preparació d'antígens de penicil·lina. Per a això, en una primera fase s'ha estudiat l'efecte de la incorporació de braços espaiadors alifàtics en la generació d'antígens, considerant la possibilitat que s'obtinga un millor reconeixement molecular en allunyar l'haptè de la proteïna portadora. Es van sintetitzar tretze haptens derivats de bencilpenicil·lina i amoxicil·lina amb els quals es van preparar antígens amb la proteïna albúmina de sèrum humà. L'avaluació dels antígens va revelar que malgrat ser prou immunogènics i ser reconeguts per anticossos IgG de conill, aquests no van ser reconeguts per IgE específiques de mostres de pacients al·lèrgics. Així bé, d'altra banda, l'estratègia de cationització de les proteïnes albúmina de sèrum humà i histona va ser abordada tenint en compte que la modificació dels grups carboxilats de la proteïna a grups amino augmenta la relació molar hapten/proteïna. Aquesta estratègia va permetre la generació de 5 antígens, 4 dels quals (els antígens d'histona), aquesta vegada sí, van incrementar l'especificitat de la resposta immunològica obtinguda, reconeixent IgE específiques. Concretament, s'han determinat IgE específiques en sèrum de pacients al·lèrgics a baixes concentracions (LOD = 0.07 IU/mL) amb una especificitat diagnòstica del 100 % i una sensibilitat del 60 i 31 % per a bencilpenicil·lina i amoxicil·lina, respectivament, millorant la sensibilitat un 60 % en comparació amb l'assaig in vitro de referència. Malgrat les millores obtingudes amb les estratègies dutes a terme, es van estudiar altres vies no clàssiques per a la síntesi de nous haptens amb major diversitat química. Aquest enfocament es basa en la generació d'antígens en llibreries químiques de compostos amb diversitat estructural per a trobar nous haptens biològicament actius. Aquestes estratègies, fins al moment, no han sigut emprades per a la generació d'antígens i l'anàlisi de mostres de sèrum de pacients al·lèrgics. Amb la finalitat d'incorporar diversitat estructural, es van sintetitzar, mitjançant la tècnica combinatòria diversity- oriented synthesis, 22 compostos dels precursors de les penicil·lines i cefalosporines, àcid 6-aminopenicilànic i àcid 7-amino-desacetoxicefalosporànic, respectivament, i dels antibiòtics amoxicil·ina i ampicil·lina. La seua avaluació amb l'immunoassaig in vitro basat en disc compacte ha demostrat que la incorporació de diversitat permet el reconeixement d’epítops causants d'episodis al·lèrgics. Concretament, es va observar que aquests antígens eren capaços de detectar anticossos tipus IgG i IgE específics procedents de sèrum de conills immunitzats i de sèrum humà de pacients al·lèrgics, sent especialment selectius els determinants d’amoxicil·lina i ampicil·lina. Concretament, es va obtindre una sensibilitat diagnòstica del 79 % i una especificitat diagnòstica del 100 %. / This work was supported by the H2020 program (project COBIOPHAD, grant agreement No. 688448 awarded to A.M.), being an initiative of the Photonics Public Private Partnership; Agencia Estatal de Investigación Agencia Estatal de Investigación (CTQ2016-75749-R, FEDER) (PID2019-110713RB-I00, FEDER) awarded to S.M.; Generalitat Valenciana (PROMETEO/2020/094 awarded to A.M. & S.M.); program UPV-La FE 2019 (P105 VALBIOAL awarded to S.M & E. I-E.); and the National Institute of General Medical Sciences (GM-1R35GM127045 awarded to S.L.S.). E.P.M. was supported by a FPU fellowship from the Ministerio de Educación, Cultura y Deporte (FPU15/01738 and EST18/00360). B.K.H. was supported by a fellowship from the National Science Foundation (DGE1144152 and DGE1745303). The authors acknowledge the Instituto de Investigación Sanitaria La Fe, Valencia, Spain, which provided the samples from both allergic patients and controls. / Peña Mendizabal, E. (2022). Synthesis and Evaluation of Antigenic Determinants for ß-lactam Allergy Diagnosis [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/182979 / Compendio

Der globale Prävalenzanstieg allergischer Erkrankungen wird mit der westlichen Ernährung und einem sich ändernden Fettsäurespektrum assoziiert. Die omega-3 Fettsäure Docosahexaensäure (DHA) wurde bereits bei verschiedenen chronisch-entzündlichen Erkrankungen erfolgreich therapeutisch eingesetzt. Die dabei zugrunde liegenden Wirkmechanismen sind jedoch nicht vollständig geklärt. Deshalb wurde hier der molekulare Mechanismus der DHA-vermittelten Hemmung der IgE-Produktion in humanen B-Zellen sowie der verminderten Differenzierung IgE-produzierender Plasmazellen in vitro untersucht. Analysen der beteiligten Signaltransduktionswege offenbarten eine Reduktion der IL-4-abhängigen STAT6-Phosphorylierung und der CD40-vermittelten NFkappaB-Translokation, was zu einer Inhibition des IgE-Klassenwechsels auf dem Niveau des epsilon-Keimbahntranskriptes sowie der Aktivierungsinduzierten Desaminase führte. Weiterhin wurde in einer randomisierten, kontrollierten Doppelblindstudie die Supplementierung mit hochdosierter DHA bei Patienten mit atopischem Ekzem hinsichtlich klinischer und immunologischer Parameter geprüft. Dabei führte DHA zu einer Reduktion des Schweregrades der Erkrankung und zu einer verminderten IgE-Produktion anti-CD40/IL 4-stimulierter Blutzellen ohne Beeinflussung des Serum-IgE-Spiegels. Schließlich wurden die lokalen Prozesse nach DHA-Verabreichung in einem Mausmodell für proteininduzierte Dermatitis analysiert. Dabei war die Reduktion der klinischen Ekzemausprägung mit der verminderten Zahl dermaler CD8+ T-Zellen verbunden. Andere histologische Parameter und das Serum-IgE blieben jedoch unbeeinflusst. Durch die Fähigkeit von DHA, in den IgE-Klassenwechsel in B-Zellen einzugreifen, stellt die Supplementierung mit DHA somit eine mögliche präventive Maßnahme gegen allergische Erkrankungen dar. Ebenso ist DHA in der Lage, den Schweregrad des atopischen Ekzems durch die positive Beeinflussung lokaler inflammatorischer Prozesse signifikant zu verbessern. / The prevalence of allergic diseases has increased worldwide. Westernised diet with its changing polyunsaturated fatty acid (PUFA) proportions is considered to contribute to this development. The omega-3 PUFA Docosahexaenoic acid (DHA) has been reported to be antiinflammatory, but its way of action is not completely understood. Initially, the molecular mechanisms of DHA impact on IgE production in human B cells were examined in vitro. Thereby, DHA inhibited IgE production and the differentiation of IgE secreting cells. This was mediated through direct inhibition of the immunoglobulin isotype switching process by decreasing epsilon germline transcript and activation induced desaminase transcription. Analysis of involved signalling pathways revealed an inhibition of IL-4 driven STAT6 phosphorylation and a reduced NFkappaB translocation into nucleus upon CD40 ligation. Next, in a randomised, double bind, controlled clinical study the efficacy of high-dose DHA supplementation in atopic eczema was determined by investigating the impact on clinical and immunological parameters. In the DHA, but not in control group a clinical improvement of atopic eczema and a reduction of CD40/IL-4 mediated IgE synthesis of peripheral blood cells were observed whereas serum IgE levels remained unchanged. Finally, in a mouse model the impact of oral DHA application on allergen induced dermatitis as well as the underlying local mechanisms were investigated. Thereby, the DHA mediated reduction of clinical skin score was associated with decreased dermal CD8+ T cell numbers, whereas other histological parameters or serum IgE values were not affected. In summary the results indicate that dietary DHA may be effective in prevention of allergic diseases by interference with the IgE switching process and improve the clinical outcome of atopic eczema by its positive impact on local inflammatory processes.

IgE ist das Schlüsselmolekül Typ-I allergischer Erkrankungen.. Die Produktion von IgE wird durch die Interaktion des Oberflächenmoleküls CD40 auf B-Zellen mit seinem Liganden (CD40L), dass von aktivierten T-Zellen exprimiert wird, sowie über Signale durch die Zytokine IL-4 oder IL-13 von B-Zellen produziert. Die CD40/IL-4-abhängige IgE-Produktion in vitro kann einerseits als Modell zum Verständnis der Entstehung allergischer Erkrankungen eingesetzt werden; andererseits können potenziell therapeutisch wirksame Substanzen untersucht werden. Untersuchungen zum Verständnis allergischer Erkrankungen zeigen, dass LTa nach CD40/IL-4-Stimulation von humanen B-Zellen vermehrt produziert wird und dies in autokriner Weise zu einer Steigerung der CD40/IL-4-vermittelten Proliferation und IgE-Produktion führt. Darüberhinaus wurde eine vermehrte Produktion von LTa bei allergischen Patienten nachgewiesen, so dass eine funktionelle Relevanz von LTa in der Pathogenese allergischer Erkrankungen zu vermuten ist. Die Arbeiten zu den intrazellulären Mechanismen der LTa-Induktion nach CD40/IL-4-Stimulation demonstrieren, dass sowohl der Transkriptionsfaktor NF-kB als auch verschiedene Proteinkinasen hier eine wesentliche Rolle spielen. Untersuchungen mit Hilfe des CD40/IL-4-abhängigen Systems bei humanen B-Zellen, die einen therapeutischen Einsatz zur Behandlung allergischer Erkrankungen haben könnten, zeigen, dass Retinoide aber auch Vitamin D zu einer erheblichen Hemmung der IgE-Produktion in- vitro führen. / IgE plays a key role for the development of type I related allergic diseases. Production of IgE by B cells is induced by the interaction of the surface molecule CD40 with its natural ligand (CD40L), which is expressed on activated T cells and signals which are provided by the cytokines IL-4 or IL-13. This model can be used for studies either to understand the development of allergic diseases or to investigate novel therapeutic approaches. In the context of the understanding the development of allergic diseases the present work shows that LTa is produced by B cells after CD40+IL-4 stimulation and that increased production of LTa results in enhanced CD40+IL-4 mediated B cell proliferation and IgE synthesis. Furthermore an increased production of LTa was shown in allergic patients indicating the potential role of LTa in allergic diseases. Analysis of the gene regulation of LTa after CD40 stimulation revealed an important role of the transcription factor NF-kB and showed the role of different protein kinases at the intracellular level. Studies using the CD40+IL-4 system in vitro which may have a therapeutical impact revealed that vitamin A and vitamin D are potent inhibitors of IgE production in vitro. Taken together the present work shows new mechanisms of CD40+IL-4 mediated IgE synthesis and also offers new potential therapeutical approaches of allergic diseases.