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Early Surgical Management of Thermal Airway Injury: A Case Series.
Jayawardena A, Lowery AS, Wootten C, Dion GR, Summitt JB, McGrane S, Gelbard A
(2019) J Burn Care Res 40: 189-195
MeSH Terms: Adrenal Cortex Hormones, Adult, Anti-Bacterial Agents, Azithromycin, Burns, Inhalation, Cicatrix, Humans, Immunity, Mucosal, Interleukin-17, Laryngoscopy, Male, Reconstructive Surgical Procedures, Skin Transplantation, Stents, Tracheostomy
Show Abstract · Added July 30, 2020
Inhalation injury is an independent risk factor in burn mortality, imparting a 20% increased risk of death. Yet there is little information on the natural history, functional outcome, or pathophysiology of thermal injury to the laryngotracheal complex, limiting treatment progress. This paper demonstrates a case series (n = 3) of significant thermal airway injuries. In all cases, the initial injury was far exceeded by the subsequent immune response and aggressive fibroinflammatory healing. Serial examination demonstrated progressive epithelial injury, mucosal inflammation, airway remodeling, and luminal compromise. Histologic findings in the first case demonstrate an early IL-17A response in the human airway following thermal injury. This is the first report implicating IL-17A in the airway mucosal immune response to thermal injury. Their second and third patients received Azithromycin targeting IL-17A and showed clinical responses. The third patient also presented with exposed tracheal cartilage and underwent mucosal reconstitution via split-thickness skin graft over an endoluminal stent in conjunction with tracheostomy. This was associated with rapid abatement of mucosal inflammation, resolution of granulation tissue, and return of laryngeal function. Patients who present with thermal inhalation injury should receive a thorough multidisciplinary airway evaluation, including early otolaryngologic evaluation. New early endoscopic approaches (scar lysis and mucosal reconstitution with autologous grafting over an endoluminal stent), when combined with targeted medical therapy aimed at components of mucosal airway inflammation (local corticosteroids and systemic Azithromycin targeting IL-17A), may have potential to limit chronic cicatricial complications.
© American Burn Association 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Antibody-functionalized peptidic membranes for neutralization of allogeneic skin antigen-presenting cells.
Wen Y, Liu W, Bagia C, Zhang S, Bai M, Janjic JM, Giannoukakis N, Gawalt ES, Meng WS
(2014) Acta Biomater 10: 4759-4767
MeSH Terms: Amino Acid Sequence, Animals, Antibodies, Antigen-Presenting Cells, Cell Membrane, Computer Systems, Emulsions, Female, Graft Rejection, Immobilized Proteins, Immunoglobulin G, Interferon-gamma, Lymph Nodes, Mice, Inbred BALB C, Mice, Inbred C57BL, Molecular Sequence Data, Nanoparticles, Neutralization Tests, Peptides, Skin, Skin Transplantation, Spectroscopy, Near-Infrared, T-Lymphocytes, Transplantation, Homologous
Show Abstract · Added April 2, 2019
We report herein application of an in situ material strategy to attenuate allograft T cell responses in a skin transplant mouse model. Functionalized peptidic membranes were used to impede trafficking of donor antigen-presenting cells (dAPCs) from skin allografts in recipient mice. Membranes formed by self-assembling peptides (SAPs) presenting antibodies were found to remain underneath grafted skins for up to 6 days. At the host-graft interface, dAPCs were targeted by using a monoclonal antibody that binds to a class II major histocompatibility complex (MHC) molecule (I-A(d)) expressed exclusively by donor cells. Using a novel cell labeling near-infrared nanoemulsion, we found more dAPCs remained in allografts treated with membranes loaded with anti-I-A(d) antibodies than without. In vitro, dAPCs released from skin explants were found adsorbed preferentially on anti-I-A(d) antibody-loaded membranes. Recipient T cells from these mice produced lower concentrations of interferon-gamma cultured ex vivo with donor cells. Taken together, the data indicate that the strategy has the potential to alter the natural course of rejection immune mechanisms in allogeneic transplant models.
Copyright © 2014 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.
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Blockade of GITR-GITRL interaction maintains Treg function to prolong allograft survival.
Kim JI, Sonawane SB, Lee MK, Lee SH, Duff PE, Moore DJ, O'Connor MR, Lian MM, Deng S, Choi Y, Yeh H, Caton AJ, Markmann JF
(2010) Eur J Immunol 40: 1369-74
MeSH Terms: Adoptive Transfer, Animals, Antibodies, Monoclonal, Antigen-Presenting Cells, Binding, Competitive, CD40 Ligand, Glucocorticoid-Induced TNFR-Related Protein, Graft Survival, Histocompatibility Antigens Class I, Humans, Immune Tolerance, Immunosuppressive Agents, Mice, Mice, Inbred BALB C, Mice, Inbred C57BL, Mice, Transgenic, Minor Histocompatibility Antigens, Receptors, Nerve Growth Factor, Receptors, Tumor Necrosis Factor, Recombinant Fusion Proteins, Skin Transplantation, T-Lymphocytes, Regulatory, Transplantation, Homologous, Tumor Necrosis Factor Inhibitors, Tumor Necrosis Factors
Show Abstract · Added October 24, 2013
Involvement of Treg in transplant tolerance has been demonstrated in multiple models. During the active process of graft rejection, these regulatory cells are themselves regulated and inactivated, a process termed counter-regulation. We hypothesize that ligation of the costimulatory molecule glucocorticoid-induced TNF receptor-related protein (GITR) on Treg inhibits their ability to promote graft survival, and by blocking GITR ligation graft survival can be prolonged. To this aim, we have designed a soluble GITR fusion protein (GITR-Fc), which binds GITR ligand and inhibits activation of GITR. Here, we show that GITR-Fc prolonged mouse skin graft survival, and this prolongation is dependent on Treg. In a full MHC-mismatched skin graft setting, GITR-Fc significantly improved graft survival when used in combination with MR1, anti-CD40L, while GITR-Fc alone did not demonstrate graft prolongation. These results demonstrate that disruption of binding of GITR with GITR ligand may be an important strategy in prolonging allograft survival.
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GITR Blockade Facilitates Treg Mediated Allograft Survival.
Sonawane SB, Kim JI, Lee MK, Lee SH, Duff PE, Moore DJ, Lian MM, Deng S, Choi Y, Yeh H, Caton AJ, Markmann JF
(2009) Transplantation 88: 1169-77
MeSH Terms: Animals, CD4-Positive T-Lymphocytes, Crosses, Genetic, Epitopes, Flow Cytometry, Glucocorticoid-Induced TNFR-Related Protein, Graft Survival, Humans, Immunosuppression, Inflammation, Lymphocytes, Mice, Mice, Inbred BALB C, Mice, Transgenic, Receptors, Nerve Growth Factor, Receptors, Tumor Necrosis Factor, Signal Transduction, Skin Transplantation, Survival Rate, T-Lymphocytes, Regulatory, Transplantation, Homologous, Tumor Necrosis Factors
Show Abstract · Added October 24, 2013
BACKGROUND - Many models of transplant tolerance have been found to depend on the induction of regulatory T cells (Tregs). Innate immune signals are known to suppress Tregs thereby augmenting immunity by abrogating Treg function. Such signals may also provide a barrier to transplantation tolerance mediated by Tregs. A number of cell surface molecules expressed by Tregs have been found to inhibit Treg activity, the best characterized of which is the glucocorticoid-induced tumor necrosis factor receptor-related (GITR) protein.
METHODS - By using an adoptive transfer model of allograft rejection, we can study the effects of inflammation and antigen-specific Tregs on graft survival. Inflammation resulting from the transplant procedure counter-regulates the suppressor activity of Tregs. To assess whether Treg activity could be enhanced by blocking GITR signaling, we compared the capacity of Tregs to prolong the survival of grafts in the presence or absence of activation-inducible TNF receptor (AITRL)-Fc, a novel construct that binds GITR.
RESULTS - We report that interruption of GITR-GITR ligand (GITRL) binding by AITRL-Fc resulted in long-term Treg-dependent acceptance of skin grafts in the setting of innate immune signals that otherwise interfere with Treg activity.
CONCLUSIONS - Inflammation and other innate immune signals may activate antigen presenting cells to upregulate GITRL. GITR-GITRL interaction is one pathway by which antigen presenting cells may enhance the adaptive response to foreign antigen by counter-regulating Tregs and by costimulating effector T cells. By blocking this interaction with AITRL-Fc, one can sustain the benefit conferred by graft-protective Tregs.
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22 MeSH Terms
Regulatory T-cell counter-regulation by innate immunity is a barrier to transplantation tolerance.
Kim JI, Lee MK, Moore DJ, Sonawane SB, Duff PE, O'Connor MR, Yeh H, Lian MM, Deng S, Caton AJ, Markmann JF
(2009) Am J Transplant 9: 2736-44
MeSH Terms: Animals, Antigen-Presenting Cells, Forkhead Transcription Factors, Graft Rejection, Immune Tolerance, Immunity, Innate, Inflammation, Mice, Mice, Transgenic, Skin Transplantation, T-Lymphocytes, Regulatory
Show Abstract · Added October 24, 2013
Innate immune signals foster adaptive immunity through activation of antigen-presenting cells. Recent in vitro evidence suggests that innate signaling may also contribute to immunity by countering the effects of regulatory T cells (T-regs), counter-regulation. We present in vivo evidence using a transgenic skin allograft model that the function of T-regs is lost in the setting of acute skin transplantation but remains intact when grafts were transplanted 1 month prior to allow surgery-induced inflammation to abate. Our findings identify T-reg counter-regulation as a naturally occurring process that accompanies transplantation and an important barrier to T-reg-mediated tolerance. Our finding further highlights the central role of regulatory cell deactivation in the initiation of the immune response.
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11 MeSH Terms
A direct comparison of rejection by CD8 and CD4 T cells in a transgenic model of allotransplantation.
Porrett PM, Lee MK, Lian MM, Wang J, Caton AJ, Deng S, Markmann JF, Moore DJ
(2008) Arch Immunol Ther Exp (Warsz) 56: 193-200
MeSH Terms: Animals, CD4-Positive T-Lymphocytes, CD8-Positive T-Lymphocytes, Graft Rejection, Graft Survival, Hemagglutinins, Mice, Mice, Inbred BALB C, Mice, Transgenic, Receptors, Antigen, T-Cell, Skin Transplantation, Transplantation, Homologous
Show Abstract · Added October 24, 2013
INTRODUCTION - The relative contributions of CD4+ and CD8+ T cells to transplant rejection remain unknown. The authors integrated a previous model of CD4-mediated graft rejection with a complementary model of CD8-mediated rejection to directly compare the function of graft-reactive CD4+ and CD8+ lymphocytes in vivo in a model where rejection requires transgenic T cells. These studies allow direct comparison of CD4 and CD8 T cell responses to the same antigen without the confounding effects of T cell depletion or homeostatic proliferation.
MATERIALS AND METHODS - Clone 4 and TS1 mice possess MHC class I- and II-restricted CD8+ and CD4+ T cells, respectively, which express transgenic T cell receptors that recognize the influenza hemagglutinin antigen (HA). We compared the in vivo response of CFSE-labeled, HA-specific transgenic CD8+ and CD4+ T cells after adoptive transfer into syngeneic BALB/c mice grafted with HA-expressing skin.
RESULTS - As in the authors' CD4+ model, HA104 skin was consistently rejected by both Clone 4 mice (n=9, MST: 14.2) and by 5 x 10(5) Clone 4 lymphocytes transferred to naive BALB/c hosts that do not otherwise reject HA+ grafts. Rejection correlated with extensive proliferation of either graft-reactive T cell subset in the draining lymph nodes, and antigen-specific CD4+ and CD8+ cells acquired effector function and proliferated with similar kinetics.
CONCLUSIONS - These data extend the authors' unique transgenic transplantation model to the investigation of CD8 T cell function. The initial results confirm fundamental functional similarity between the CD4 and CD8 T cell subsets and provide insight into the considerable redundancy underlying T cell mechanisms mediating allograft rejection.
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12 MeSH Terms
Prevention of allograft tolerance by bacterial infection with Listeria monocytogenes.
Wang T, Chen L, Ahmed E, Ma L, Yin D, Zhou P, Shen J, Xu H, Wang CR, Alegre ML, Chong AS
(2008) J Immunol 180: 5991-9
MeSH Terms: Animals, Bacterial Toxins, Bystander Effect, Graft Rejection, Heart Transplantation, Heat-Shock Proteins, Hemolysin Proteins, Humans, Immunologic Memory, Interferon Type I, Interleukin-1, Interleukin-18, Isoantigens, Listeria monocytogenes, Listeriosis, Mice, Mice, Inbred BALB C, Mice, Knockout, Myeloid Differentiation Factor 88, Signal Transduction, Skin Transplantation, Toll-Like Receptors, Transplantation Tolerance, Transplantation, Homologous
Show Abstract · Added December 10, 2013
Exposure to certain viruses and parasites has been shown to prevent the induction of transplantation tolerance in mice via the generation of cross-reactive memory T cell responses or the induction of bystander activation. Bacterial infections are common in the perioperative period of solid organ allograft recipients in the clinic, and correlations between bacterial infections and acute allograft rejection have been reported. However, whether bacterial infections at the time of transplantation have any effect on the generation of transplantation tolerance remains to be established. We used the Gram-positive intracellular bacterium Listeria monocytogenes (LM) as a model pathogen because its effects on immune responses are well described. Perioperative LM infection prevented cardiac and skin allograft acceptance induced by anti-CD154 and donor-specific transfusion in mice. LM-mediated rejection was not due to the generation of cross-reactive T cells and was largely independent of signaling via MyD88, an adaptor for most TLRs, IL-1, and IL-18. Instead, transplant rejection following LM infection was dependent on the expression of the phagosome-lysing pore former listeriolysin O and on type I IFN receptor signaling. Our results indicate that bacterial exposure at the time of transplantation can antagonize tolerogenic regimens by enhancing alloantigen-specific immune responses independently of the generation of cross-reactive memory T cells.
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Chemical burn induced by cutaneous exposure to a concentrated sodium hypochlorite and alkyl sulfate solution.
Piggott CD, Hayes B, Robb CW, Thomas L, Creech CB, Smith ML
(2007) Cutan Ocul Toxicol 26: 189-94
MeSH Terms: Acute Disease, Adolescent, Anti-Infective Agents, Local, Burns, Chemical, Dermatitis, Irritant, Detergents, Diagnosis, Differential, Female, Humans, Silver Sulfadiazine, Skin, Skin Transplantation, Sodium Hypochlorite, Sulfuric Acid Esters, Therapeutic Irrigation, Wound Healing
Show Abstract · Added February 3, 2014
BACKGROUND - Acute irritant contact dermatitis induced by cutaneous exposure to chemicals is a common dermatologic problem in the workplace. In severe cases, irritant contact responses can result in a caustic burn. Chemical burn induced by concentrated sodium hypochlorite (the active ingredient in bleach) has been reported infrequently in the literature, with no previously reported cases of chemical burn due to an alkyl sulfate (a common surfactant in cleaning fluids). Here we describe a chemical burn in a 16-year-old girl resulting from exposure to a solution of concentrated sodium hypochlorite and alkyl sulfate applied as a sanitizer to the interior of roller skates worn at work.
OBSERVATIONS - The diagnosis was made on the basis of the patient's exposure history, clinical appearance, and laboratory results. On physical examination, the erythematous plaque, located at the site of chemical exposure, had intact skin lines, surrounding edema, and decreased sensitivity to touch. The peripheral white blood cell count was within normal limits and bacterial and fungal cultures from the lesion were negative.
CONCLUSIONS - The irritant effect of exposure to chemicals, including those that usually are not major irritants, and the possible additive effect of simultaneous exposure to different chemicals, should be considered in the differential diagnosis of acute dermatitis of unknown etiology. Moreover, increased reporting of cases of chemical-induced acute irritant contact dermatitis will help lead to crucial early and appropriate treatment.
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16 MeSH Terms
Prolongation of skin graft survival by exogenous ubiquitin.
Earle SA, El-Haddad A, Patel MB, Ruiz P, Pham SM, Majetschak M
(2006) Transplantation 82: 1544-6
MeSH Terms: Animals, Dermatologic Surgical Procedures, Graft Survival, Immunosuppression, Immunosuppressive Agents, Lymphocyte Culture Test, Mixed, Mice, Skin, Skin Transplantation, Ubiquitin
Show Abstract · Added June 14, 2016
Recently, it was shown that exogenous ubiquitin has anti-inflammatory actions in vivo and that the ubiquitin-decapeptide 50-59 has immunosuppressive effects similar to cyclosporine. Immunosuppressive effects of the native ubiquitin molecule and its therapeutic potential in transplantation are unknown. We tested the hypothesis that ubiquitin inhibits alloreactivity and increases allograft survival in a murine model of skin transplantation in fully mismatched strain combinations (C3H/HEJ-DBA2). Ubiquitin dose-dependently inhibited mixed leukocyte reaction in C3H/HEJ splenocytes in vitro. Intraperitoneal ubiquitin administration (25 microg/h for 14 days) was well-tolerated, dose-dependently increased ubiquitin serum concentrations and median allograft survival from 10 days (with albumin; control) to 17 days in DBA2 mice (survival ratio: 1.7, 95% confidence interval: 1.266-2.134; P=0.0005). The in vivo effects in this study combined with our previous work strongly indicate that ubiquitin is a potent immune modulator with broad therapeutic potential. Ubiquitin treatment could be a novel strategy to improve immunosuppressive regimens in transplantation.
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10 MeSH Terms
Lipid defect underlies selective skin barrier impairment of an epidermal-specific deletion of Gata-3.
de Guzman Strong C, Wertz PW, Wang C, Yang F, Meltzer PS, Andl T, Millar SE, Ho IC, Pai SY, Segre JA
(2006) J Cell Biol 175: 661-70
MeSH Terms: Animals, Animals, Newborn, Base Sequence, Binding Sites, Cell Differentiation, Cell Proliferation, Embryo, Mammalian, Embryonic Development, Epidermis, Exons, GATA3 Transcription Factor, Gene Deletion, Immunity, Innate, Introns, Keratin-13, Kruppel-Like Transcription Factors, Lipid Metabolism, Mice, Molecular Sequence Data, Protein Binding, Skin Transplantation, Transcription, Genetic
Show Abstract · Added January 30, 2013
Skin lies at the interface between the complex physiology of the body and the external environment. This essential epidermal barrier, composed of cornified proteins encased in lipids, prevents both water loss and entry of infectious or toxic substances. We uncover that the transcription factor GATA-3 is required to establish the epidermal barrier and survive in the ex utero environment. Analysis of Gata-3 mutant transcriptional profiles at three critical developmental stages identifies a specific defect in lipid biosynthesis and a delay in differentiation. Genomic analysis identifies highly conserved GATA-3 binding sites bound in vivo by GATA-3 in the first intron of the lipid acyltransferase gene AGPAT5. Skin from both Gata-3-/- and previously characterized barrier-deficient Kruppel-like factor 4-/- newborns up-regulate antimicrobial peptides, effectors of innate immunity. Comparison of these animal models illustrates how impairment of the skin barrier by two genetically distinct mechanisms leads to innate immune responses, as observed in the common human skin disorders psoriasis and atopic dermatitis.
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22 MeSH Terms