Les douleurs abdominales chroniques, souvent associées à une hypersensibilité viscérale d’origine colique (HSVC), sont l’un des symptômes majeurs constatés lors du syndrome de l’intestin irritable (SII). Le SII est une colopathie chronique fonctionnelle touchant environ 11% de la population mondiale et altérant significativement la qualité de vie des patients. L’étiologie multifactorielle de cette pathologie rend la physiopathologie complexe. Les gastroentérites infectieuses ont été décrites comme l’un des facteurs de risque dans le développement du SII-post-infectieux (SII-PI). Le SII-PI survient en effet dans 4 à 31% des cas suite à une gastroentérite aigüe d’origine bactérienne, virale ou parasitaire. Ces infections peuvent avoir de nombreuses répercussions et en particulier sur l’intégrité de la barrière épithéliale intestinale, le système immunitaire ou encore sur le microbiote intestinal. Par ailleurs, suite à une infection parasitaire, le risque de développer un SII est de 40% contre seulement 14% suite à une infection bactérienne.Blastocystis est le parasite intestinal le plus fréquemment retrouvé chez l’Homme. Néanmoins, malgré de récentes études épidémiologiques rapportant une plus forte prévalence de ce parasite chez les patients atteints de SII, son rôle en santé humaine reste débattu. De plus, d’autres études rapportent que les individus porteurs de ce parasite présentent des douleurs abdominales et sont atteints d’une dysbiose intestinale. Actuellement, l’absence d’un modèle animal d’infection par Blastocystis reproductible ne permet pas d’étudier les mécanismes physiopathologiques liés à l’infection et donc d’explorer la contribution éventuelle de ce parasite dans le SII.Les objectifs de ce travail de thèse étaient tout d’abord de mettre en place un modèle murin d’infection expérimentale par Blastocystis pour dans un deuxième temps évaluer si ce parasite est capable d’induire une HSVC et une dysbiose intestinale avec l’objectif d’établir un nouveau modèle de SII d’origine infectieuse chez le rat. Pour répondre au premier objectif, le pouvoir infectieux de différents sous-types et différentes formes du parasite (formes vacuolaires ou kystes), isolés de cultures axéniques ou purifiés à partir de selles de patients et d’animaux a été évalué chez des animaux de laboratoire (rats et souris). Nous avons ainsi réussi à établir un modèle reproductible d’infection chronique par Blastocystis chez le rat de laboratoire à l’aide de kystes purifiés à partir de selles humaines.L’utilisation de ce modèle in vivo, nous a permis de mettre en évidence que le sous-type 4 (ST4) de Blastocystis induit une HSVC sans origine inflammatoire chez les rats expérimentalement infectés. De plus, les animaux développent un comportement type anxio-dépressif corrélé à l’HSVC. La dysbiose intestinale associée à l’infection se caractérise par une augmentation de la richesse bactérienne et une diminution du ratio Firmicutes/Bacteroidetes. Par ailleurs, nous avons corrélé l’HSVC à l’augmentation de l’abondance relative du genre Bacteroides et la diminution de l’abondance relative de la famille des Clostridiaceae, bactéries productrices d’acides gras à chaine courte (AGCC). Une diminution des taux d’AGCC fécaux a d’ailleurs été constatée chez les rats infectés. De plus, nous avons mis en évidence une augmentation de l’activité de protéases à sérine dans les fèces des animaux infectés pouvant expliquer l’HSVC.Ces données suggèrent qu’une infection gastro-intestinale par Blastocystis serait associée à une hypersensibilité viscérale d’origine colique (HSVC) et à un déséquilibre de la flore intestinale (dysbiose). Ainsi, ce nouveau modèle d’infection pourrait être un bon modèle de SII d’origine infectieuse et pourrait donc contribuer à un meilleur diagnostic et au développement de nouvelles stratégies thérapeutiques pour des pathologies chroniques de l’intestin chez certains individus. / Chronic abdominal pain often associated with colonic hypersensitivity (CHS) is one of the major symptoms of irritable bowel syndrome (IBS). IBS is a functional chronic disorder affecting ~11% of worldwide population and disturbing patients’ quality of life. Etiology is multifactorial and thus pathophysiology is complex and remains poorly understood. Infectious gastroenteritis has been described as one of the risk factors for development of post-infectious IBS (PI-IBS). PI-IBS can occur in 4-31% of patients following acute gastroenteritis of bacterial, viral or parasitic origin. Numerous studies support a role for pathogen-mediated modifications in the resident intestinal microbiota, epithelial barrier integrity and immune activation in PI-IBS. Interestingly, the risk of IBS is highest with protozoal enteritis, with ~40% of individuals developing IBS against ~14% following bacterial infection. Blastocystis is the most common intestinal parasite found in human intestinal tract. Nevertheless, clinical relevance remains controversial, despite recent epidemiological studies showing a higher prevalence of this parasite in IBS patients. Interestingly, studies report that individuals carrying Blastocystis display abdominal pain and intestinal dysbiosis. Currently, the lack of reproducible animal model of Blastocystis infection does not allow to study the pathological mechanisms related to infection and thus to explore the potential contribution of this parasite in IBS.The aims of this study were first to develop a murine model of Blastocystis infection and then to investigate whether this parasite could lead to the development of intestinal dysbiosis associated CHS with the aim of developing a new PI-IBS rat model.The first aim was to evaluate the infectivity of different parasitic subtypes and stages (vacuolar and cystic forms) isolated from axenic cultures or purified from human or animal feces, into laboratory animals (rats and mice). Interestingly, we succeeded in the development of a reproducible model of chronic infection by Blastocystis in laboratory rats using cysts purified from human stool.Using this animal model, we found that Blastocystis ST4 induced non inflammatory CHS in infected rats. In addition infected rats developed anxiety- and depressive-like behavior correlated with CHS. Infection associated intestinal dysbiosis was characterized by increased bacterial richness and decreased Firmicutes/Bacteroidetes ratio. Interestingly, we correlated CHS with the increase in the relative abundance of genus Bacteroides and the decrease in the relative abundance of the family Clostridiaceae, some bacteria producing Short Chain Fatty Acids (SCFAs). Indeed, fecal SCFAs levels were decreased in infected rats. These decreases were correlated with the relative abundance of genus Oscillospira which was also described increased in Blastocystis individual carriers. In addition, we have demonstrated an increase in fecal serine protease activity in infected animals that may explain development of CHS.These data suggest that a gastrointestinal infection with Blastocystis may be associated with the establishment of intestinal dysbiosis associated CHS. Thus, this new infectious model could be a good model of PI-IBS and could therefore contribute to a better diagnosis and development of new therapeutic strategies for chronic bowel diseases.

The aim of the study was to investigate if PRIMA-1, a drug that reactivate the tumour suppressor gene p53, will have a synergistic effect when used in combination with γ-irradiation in a human small cell lung cancer cell line (U-1690), which show a low-dose hypersensitivity in clonogenic survival experiments. Clonogenic cell survival after incubation with PRIMA-1 alone in concentrations from 0.1 to 30 µM or in combination with γ-irradiation with a 137Cs source was performed. The standard LQ model, and the repairable-conditionally repairable damage model, the RCR model, were fitted to the experimental data. PRIMA-1 showed a time and concentration dependent cytotoxic, and 10 µM killed 60 % of cells during 72 hours incubation. The cells show low-dose hypersensitivity calculated with the RCR model. The combined treatment with 8 µM PRIMA-1 had a synergistic effect with irradiation doses from 2 Gy and above. The overall conclusion is that a combination with PRIMA-1 and irradiation is beneficial to achieve the best effect.

Objective: While most allergic responses to food are directed against protein epitopes and occur within 30 minutes of ingesting the allergen, recent studies suggest that delayed reactions may occur, sometimes mediated by IgE antibodies directed against carbohydrate moieties. The objective of this review is to summarize the clinical features and management of delayed hypersensitivity reactions to mammalian meat mediated by IgE antibodies to galactose-alpha 1,3-galactose (alpha-gal), an oligosaccharide.Methods: A PubMed search was conducted with MeSH terms: galactosyl-(1,3) galactose, oligosaccharides, cetuximab, allergy/hypersensitivity, and anaphylaxis. Reported cases with alpha-gal-mediated reactions were reviewed. This research study was approved by the Institutional Review Board of East Tennessee State University.Results: Thirty-two cases of adults presenting with red-meat induced allergy thought to be related to oligosaccharides have been reported in the literature so far, making this a rare and evolving syndrome. Most of these patients demonstrated delayed reactions to beef, as was seen in the case reported by us in this manuscript. IgE specific to alpha-gal was identified in most patients with variable response to skin testing with beef and pork. Inhibition studies in some cases showed that the IgE antibodies to beef were directed towards alpha-gal in the meat rather than the protein. The patients often reported history of tick bites, the significance of which is unclear at present. Reactions to cetuximab, a monoclonal antibody, are mediated by a similar mechanism, with IgE antibodies directed against an alpha-gal moiety incorporated in the drug structure.Conclusion: Alpha-gal is an oligosaccharide recently incriminated in delayed anaphylactic reactions to mammalian meats such as to beef, pork, and lamb. It appears that anaphylactic reactions to the anti-cancer biological agent, cetuximab, may be linked mechanistically to the same process. More studies are required to understand the underlying molecular basis for these delayed reactions in specific, and their broader implications for host defense in general.

Edema or tissue swelling is exacerbated during inflammation due to increased leukocyte infiltration and vascular permeability, after which resolution returns the tissue to homeostasis. In acute inflammatory reactions, upregulated levels of vascular endothelial growth factor (VEGF) is shown to increase vascular permeability. Vascular endothelial cells (EC) form a selective barrier regulating the degree of microvascular exchange and permeability in normal physiological and pathological settings. Vascular EC express pro-permeability VEGF receptors and neuropilin co-receptors that can mediate both stimulatory and inhibitory signals. Secreted class 3 semaphorin-3F (SEMA3F) is a high affinity ligand for the NRP2 receptor and has been shown to be anti-angiogenic through its ability to inhibit cell migration and attachment. Importantly, SEMA3F has been shown to compete for binding with VEGF to the NRP2 receptor. However, the role, if any, of SEMA3F in inflammation has yet to be fully elucidated. We hypothesize that SEMA3F reduces edema by inhibiting vascular permeability thereby promoting a quickened resolution of inflammation. To generate inflammatory lesions, delayed-type hypersensitivity cutaneous reactions were induced on the ear skin of C57BL/6 mice through topical applications of oxazolone. Total ear thickness as a readout of tissue swelling was compared to baseline (Day 0). To determine the effects of depleting SEMA3F during inflammation, ear thickness was measured after SEMA3F antibody or control IgG intraperitoneal injection into Nrp2+/- mice. To assess the effects of increased systemic SEMA3F on edema, ear thickness was measured after intravenous delivery of SEMA3F adenovirus (Ad-3F) or control adenovirus into wild-type mice. We report that SEMA3F depletion via SEMA3F antibodies led to significantly prolonged edema compared to controls. Ad-3F treated mice exhibit lower levels of inflammatory edema compared to control. We demonstrate that the SEMA3F signaling cascade is a key mediator of fluid homeostasis in inflammation. Likely, SEMA3F serves as an anti-inflammatory mechanism preventing excessive edema. / 2020-02-20T00:00:00Z

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24133号 / 医博第4873号 / 新制||医||1059(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 生田 宏一, 教授 濵﨑 洋子, 教授 森信 暁雄 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Although glucocorticoids are often used as an adjunct to epinephrine to treat anaphylactic shock, glucocorticoids can also be a rare cause of anaphylactic shock. Only through the administration of a challenge dose of different glucocorticoids and different substrates that glucocorticoids are delivered in can the determination be made about which glucocorticoid or accompanying solvent may be the culprit which caused the anaphylactic reaction. These challenge tests should only be performed in a controlled environment as repeat anaphylaxis is a risk, especially if the patient has a history of glucocorticoid-induced anaphylaxis.

INTRODUCTION: Acute infusion reactions from antineoplastic agents can include hypersensitivity reactions, anaphylaxis, and cytokine release infusion reactions. Severe acute infusion reactions happen in about 5% of the oncology patient population and nurses are responsible for assessment and management of the reaction. This is a high-stress task for a nurse magnified by the lack of exposure. This project explores nursing knowledge and perceived comfort level of acute infusion reactions caused by antineoplastic agents. METHODOLOGY: An original survey was created to test nursing knowledge and assess comfort level. Nursing knowledge was broken down into six subscales: general knowledge of acute infusion reactions, signs and symptoms of hypersensitivity, anaphylaxis, and cytokine release infusion reaction, and drugs most likely to cause hypersensitivity and anaphylactic reactions and cytokine release infusion reactions. Comfort questions were asked on a 6-point Likert scale from extremely uncomfortable to extremely comfortable. There was an additional section in the survey related to nurses’ distress and support in situations with acute infusion reactions. The questions were presented using a 6-point Likert scale ranging from strongly disagree to strongly agree. There were two open-ended questions that were designed to allow the nurses to share any additional information about their experiences with acute infusion reactions. Oncology nurses working with adults and pediatric populations were invited to participate. Descriptive statistics were used to analyze the survey results. T tests were used to compare groups and Pearson R statistics were used to examine relationships between total knowledge, knowledge subscale score, and comfort level. RESULTS: 20 nurses completed the survey. 12 were from the adult nurse population and 8 were from the pediatric nurse population. The typical participant was forty-four years of age, had sixteen years experience as a Registered Nurse, and thirteen years experience in the oncology setting. The average total knowledge score was a 56% based on 84 possible points. The basic knowledge section and the anaphylactic signs and symptoms were the highest scoring subscales, both scoring a 62%. Cytokine release infusion reaction signs and symptoms was the lowest scoring subscale with a 45%. There were no significant differences in knowledge between groups. The nurses chose an overwhelming agree/strongly agree when asked to choose the signs and symptoms related to each type of infusion reaction. The total comfort level score indicated that nurses were very comfortable managing acute reactions. There was no significant difference between the adult and pediatric setting comfort level scores. There was no statistically significant relationship between total knowledge score and total comfort level score. DISCUSSION: The knowledge score showed knowledge deficits while the comfort score indicated confidence in management of acute infusion reactions. The high frequency of agree/strongly agree for all three subscales of signs and symptoms indicates that the nurses at least know what to look for even if they cannot assign the specific sign and symptom to the type of infusion reaction. Knowledge about signs of specific types of drug reactions may not be necessary as long as a basic understanding of what to look for and how to manage a reaction is present.

No description available.

This research is based on semi-structured interviews with thirty-two people who understand themselves to be suffering from health problems called ecological illness, or environmental hypersensitivity. The research examines the experience of ecological illness. Given that the medical status of ecological illness is controversial, and that troubles considered to be ecological illness are typically vague and non-specific, the study focuses on meanings and interpretive frameworks that are applied in the definition of such troubles; by those affected, by significant others, and by physicians. The analysis examines the nature and course over time of definitions of trouble-related identity and the social psychological and practical consequences of such definitions for respondents' illness experience. Because respondents largely define their troubles as physical health problems, a central issue in the analysis is the medical and social legitimation of illness claims. The research found that, in the course of seeking medical treatment and legitimation for their problems, people's experiences of trouble were typically discredited. They were long unable to resolve conflicts between a self-identity as sick and others' assessments of them as "not sick" or psychologically troubled. While the eventual diagnosis of hypersensitivity was a profound relief to people in many respects, it was often not recognized and accepted by others as a basis for informal or "official'' sick role considerations. Because of scepticism toward the concept of multiple sensitivities, many people continued to feel stigmatized by their problems. The study illustrates the impact and significance of controversies within medicine for the experience of certain kinds of health problems. / Thesis / Master of Arts (MA)

The present study examined adverse effects of sunlight exposure (mimicked by intradermal cis-urocanic acid, cUCA) on local and systemic immune responses, with or without co-exposure to the immunotoxic insecticide permethrin. A single exposure to cUCA caused diminished splenic macrophage phagocytosis that was persistent up to 30 days post-exposure. Five-day exposure to cUCA subtly increased splenocyte proliferation in response to the T cell mitogen Concanavalin A. Four-week exposure to cUCA caused increased splenic lymphocyte cellularity, thymic hypocellularity, and enhanced hydrogen peroxide production by splenic leukocytes. Single exposure to topical permethrin resulted in decreased thymic and splenic weight and cellularity, and inhibited antibody production by splenic B cells. cUCA worsened the negative effect of permethrin on both thymic weight and cellularity, and depressed splenocyte blastogenesis, hydrogen peroxide production, and antibody production. Five-day exposure to either cUCA or permethrin also caused persistent decreased contact hypersensitivity responses, an effect that became more than additive when the chemicals were administered concurrently. Defects in antigen processing and presentation by cutaneous Langerhans cells were evaluated as possible contributing mechanisms to the cutaneous immunosuppression, using mice with deleted genes. Vehicle-exposed IFNg knockout mice displayed approximately a 22.1% depression in the ear swelling response as compared to control C57BL/6N mice, suggesting that this cytokine may be required for mounting a control-level hypersensitivity response. Ear swelling in cUCA-exposed IFNg knockout mice displayed a 21.4% depressed response as compared to cUCA-exposed wild-type C57BL/6N mice, again suggesting that IFNg is an important cytokine in the contact hypersensitivity (CH) response. TNFaR knockout mice exposed to cUCA displayed 33.9% greater ear swelling than cUCA-exposed wild-type C57BL/6N mice, suggesting that increased TNFa may be involved in inhibited CH by cUCA. TNFaR knockout mice exposed to permethrin displayed 33.9% greater ear swelling than permethrin-exposed C57BL/6N mice, suggesting that increased TNFa may also be involved in inhibited CH by permethrin. C57BL/6N mice exposed to cUCA + permethrin displayed severe reduction of the CH response to 8.7% of the control level. IFNg knockout mice exposed to permethrin + cUCA showed essentially identical depression of the CH response as IFNg knockout mice exposed to either permethrin or cUCA alone. These results suggest that IFNg is required for the greater than additive immunotoxic effect that occurred when these two agents were co-administered. TNFaR knockout mice exposed to cUCA + permethrin displayed 8.7 fold greater ear swelling than similarly exposed C57BL/6N mice, again suggesting that increased TNFa is involved in inhibited CH by both cUCA and permethrin. / Ph. D.