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Disseminated infection with Phialemonium obovatum in a German shepherd dog.

A 4-year-old spayed female German Shepherd Dog was evaluated because of left forelimb lameness. A fungal granuloma on the distal portion of the radius was determined to be the cause of the lameness; the infecting organism was identified as Phialemonium obovatum. Despite aggressive treatment with amphotericin B, itraconazole, and ketoconazole and curettage of the local area, the dog developed systemic disease and was euthanatized 5 months after initial evaluation. Immune dysfunction may have played a role in development of disseminated disease, because although serum concentrations of total IgG, IgA, and IgM were within or greater than reference ranges, results of lymphocyte proliferation assays were abnormal, which indicated cellular immune dysfunction. Infection with Phialemonium obovatum should be considered as a differential diagnosis when branching fungal organisms are detected during histologic, cytologic, or microbiologic evaluation of tissue specimens.

Animals↗

Human leptin deficiency caused by a missense mutation: multiple endocrine defects, decreased sympathetic tone, and immune system dysfunction indicate new targets for leptin action, greater central than peripheral resistance to the effects of leptin, and spontaneous correction of leptin-mediated defects.

We have previously demonstrated that genetically based leptin deficiency due to a missense leptin gene mutation in a highly consanguineous extended Turkish pedigree is associated with morbid obesity and hypogonadism. We have now performed detailed assessments of endocrine, sympathetic, and immune function. We have also identified a new adult female homozygous patient in this extended family who is severely obese and amenorrheic. In this family all wild-type and heterozgous individuals have normal body weight. Seven obese members of this family, whom we presume to have been leptin deficient, died during childhood. There are several findings that indicate potentially novel targets for leptin action in humans. Four homozygous patients (1 adult male, 2 adult females, and 1 child) have sympathetic system dysfunction, whereas all heterozygous subjects have normal sympathetic system function. Despite sympathetic system dysfunction and postural hypotension, 1 of 3 homozygous adult patients has impaired renin-aldosterone function. The patients also exhibit alterations in GH and PTH-calcium function, and 1 of them has decreased bone mineral density. Despite their obesity, these patients do not have risk factors for cardiovascular disease, such as hypertension, impairments in lipid metabolism, or hyperleptinemia [corrected]. These data support the hypothesis that the obese may have central, but not peripheral, resistance to the effects of leptin and that hyperleptinemia [corrected] may mediate the cardiovascular morbidity of the obese who are not leptin deficient. Furthermore, these data indicate that there may be several new targets for leptin action in human physiology. Such new targets may lead to novel pharmacological strategies for the use of leptin agonists and antagonists in the treatment of human disease. All 19 normal weight individuals in this family are alive, whereas 7 of 11 obese individuals died in childhood after infections. The odds ratio for mortality in the context of this obesity phenotype is 25.4, indicating that this mutation severely impairs key biological functions during childhood, negatively impacting on survival. We found that only the obese child in this family had thyroid function abnormalities. The oldest homozygous female patient started to menstruate, albeit with a luteal phase defect, 7 months ago, after a delay of over 20 yr, whereas the younger adult subjects are still hypogonadic. Thus, we conclude that due to their long life span, humans who survive the negative effects of leptin deficiency during childhood can, in contrast to ob/ob mice, over decades compensate some of the effects of leptin deficiency on immunity and endocrine function through mechanisms that remain to be elucidated.

Adult↗

Selenium supplementation decreases coxsackievirus heart disease during murine AIDS.

Coxsackievirus B3 (CVB3) induces myocarditis, especially in the immunodeficient or immature. To investigate whether CVB3 induced pronounced cardiomyopathy during the severe immune dysfunction of murine acquired immunodeficiency syndrome (AIDS), female C57BL/6 mice were infected with LP-BM5 retrovirus and then coinfected with CVB3. C57BL/6 mice, essentially resistant to CVB3-induced cardiomyopathy, became susceptible to this cardiomyopathy because of the immune dysfunction caused by murine AIDS. This susceptibility suggests that retrovirus infection causes conditions favoring the CVB3 induction of cardiac lesions. Mice were fed a diet supplemented with selenium (Se) at nine times the recommended daily dose for mice (0.933 mg/ kg of diet). Heart tissues were analyzed histopathologically 12 d after CVB3 challenge. Mice experiencing concurrent retrovirus and CVB3 infection had a high degree of cardiac lesions that were consistent with myopathy compared to that in uninfected mice (p < 0.05). Se supplementation during murine retrovirus infection significantly diminished the pathogenesis caused by concurrent CVB3 infection in mice that had murine AIDS. There was a significant increase in the survival of dually retrovirus and CVB3-infected mice that were fed Se, compared to that of identically treated mice that were not fed Se. Hepatic lipid peroxides were significantly diminished in the Se-supplemented mice as compared to those in immunodeficient mice without supplementation (p <F 0.1). Increased oxidation occurred in mice that had murine AIDS, which was also shown by reduced tissue vitamin E. Therefore, the reduction of retrovirally induced oxidation and inflammation by Se produced conditions that improved the survival of mice during CVB3 infection.

Animals↗

[Study of the relation of the typology of nephrotic syndrome and red cell C3b receptor, T cell function].

This paper reports the determined results of rosette rates of red cell C3b receptor and active rosette (Ea) rates of T lymphocyte in 39 cases of nephrotic syndrome. Typology of nephrotic syndrome according to TCM differentiation symptoms, all the 39 cases were divided into three types: (1) 13 cases of deficiency of Qi of the Spleen with stagnancy of dampness; (2) 9 cases of deficiency of Yang of the Spleen and Kidney; (3) 17 cases of deficiency of Yin of the Liver and Kidney. The results showed that the red cell C3b receptor rosette rate and Ea rosette rate in 39 cases of nephrotic syndrome were significantly lower than those in the control. The difference between the two groups was very obvious (P less than 0.001) among the three types. The rosette rates of both in the deficiency of Qi of the Spleen and deficiency of Yang of the Spleen and Kidney were markedly decreased than those in the control (P less than 0.001). Whereas, the red cell C3b receptor rosette rate was lower than that in the control (P less than 0.01), and T cell Ea rosette rate showed no statistical difference (P greater than 0.05) in the deficiency of Yin of the Liver and Kidney. There was a close relationship between the immune dysfunction of red cell and the pathogenesis in nephrotic syndrome. There was markedly relationship between the pathogenesis of deficiency of Yang of the Spleen and Kidney and deficiency of Qi of Spleen with stagnancy of dampness and T cell immune dysfunction. While the Ea level in deficiency of Yin of the Liver and Kidney was closely correlated with the control. Probably this type was nephrotic nephrosis which had been treated with TCM-WM.

Adolescent↗

Cigarette smoke as a trigger for the dioxin receptor-mediated signaling pathway.

Dioxins and dioxin-like chemicals cause a wide range of pathologies including carcinogenesis, immune dysfunction, and developmental/reproductive abnormalities. Most of these toxic effects are mediated by aryl hydrocarbon receptor (AhR; also called the dioxin receptor), a ligand-activated transcription factor. Constitutive activation of AhR via genetic manipulation causes development of cancers, inflammation and immune abnormality in mice even without exposure to xenobiotic ligands. Recent investigation disclosed that cigarette smoke contains high levels of agonists for AhR and strongly activates the dioxin signaling pathway. In this review, we describe and discuss possible roles of AhR activation in cigarette smoke-related pathologies, especially focusing on carcinogenesis, inflammation, atherosclerosis, immune dysfunction and teratogenesis.

Animals↗

Immunologic abnormalities and their significance in sinus histiocytosis with massive lymphadenopathy.

In a computerized case registry, containing 220 cases of sinus histiocytosis with massive lymphadenopathy (SHML), 23 patients were identified with clinical or routine laboratory findings suggestive or diagnostic of immune dysfunction. We divided the abnormalities into hematologic autoantibodies (nine patients), glomerulonephritis (three patients), Wiskott-Aldrich syndrome (two patients), joint disease (nine patients), unusual infections (three patients), and miscellaneous (six patients). Nine of the patients had more than one finding prompting inclusion in this study. In five patients, at least one abnormality preceded the onset of SHML. A major difference between this subgroup of 23 patients and the remaining registry population was the mortality rate. Ten of the 23 patients have died, and in many cases the cause of death could be linked to the immunologic abnormality. This study establishes an association between SHML and clinically significant immune dysfunction and provides further evidence that this frequently multisystemic disease may be one manifestation of disordered immunity.

Adolescent↗

Age-associated deficiency in activation-induced up-regulation of telomerase activity in CD4+ T cells.

For lymphocytes, the ability to undergo clonal expansion is crucial for effective immune function. Telomerase activity compensates for telomere erosion during cell division and contributes to the capability of lymphocytes to maintain cellular proliferation. In addition, telomerase activity may have a fundamental role in cell growth and survival. To determine whether age-related immune dysfunction is associated with an abnormality in telomerase activity, we investigated telomerase activity in T cell populations from young adult and aged mice. Our data show that the ability of T cells from aged mice to up-regulate telomerase activity after activation was significantly diminished. This age-related deficiency in telomerase induction is restricted to CD4(+) T cells, as CD8(+) T cells retain the capability to up-regulate telomerase activity. These findings reinforce the notion that age-related immune dysfunction results mainly from impairment of helper T cells, and may have important implications for designing novel means to improve immune responses in aged individuals by enhancing CD8(+) T cell functions, which are crucial in both viral and tumour immunity.

Aging↗

Apoptosis of leukocytes: basic concepts and implications in uremia.

Circulating blood leukocytes have short life expectancies and end their lives by committing programmed cell death or apoptosis. Apoptosis is an active form of cell death that is initiated by a number of stimuli and is intricately regulated. Apoptosis in both excessive and reduced amounts has pathological implications. Evidence suggests that apoptosis may play a role in the pathophysiology of immune dysfunction in uremia. Indeed, accelerated programmed cell death has been observed in lymphocytes, monocytes, and polymorphonuclear leukocytes among patients with chronic renal failure. This may be due in part to the retention of uremic toxins. The aim of this article is to review the evidence for accelerated leukocyte apoptosis, key regulatory apoptotic pathways, and the possible role of this highly organized process in the pathogenesis of immune dysfunction in uremia.

Apoptosis↗

Is vitamin E supplementation a useful agent in AIDS therapy?

Acquired immune deficiency syndrome (AIDS) is a clinical disorder caused by a retrovirus infection, representing the end point in a progressive sequence of immunosuppressive changes. The literature is briefly summarized as to immunological, nutritional and other pathological modifications caused by AIDS, and properties of immunoenhancing, anti-oxidant and undernutrition-restoration of vitamin E supplementation. All these abnormalities in AIDS are similar to those that are stimulated or restored by intake of high doses of vitamin E. The drawbacks of pharmacological therapy like zidovudine (AZT), e.g. deleterious toxic side effects, inability to improve the immune dysfunctions and undernutrition initiated by the retrovirus infection, and finding of AZT-resistant HIV strains, necessitate new strategies for the clinical trials of novel therapies to treat AIDS with the existing medical therapies. Low toxicity nutritional agents with immunoenhancing and antioxidant activities like vitamin E may help to normalize retrovirus-induced immune dysfunctions, undernutrition and other pathological symptoms, thereby retarding the progression of the disease to AIDS. To address this vitamin E therapeutic role in HIV-positive individuals, This paper presents a review of vitamin E-related therapeutic roles in animals and humans, thereby showing why vitamin E supplementation could be used as a useful therapeutic agent in human AIDS therapy. Since there is a paucity of information available regarding the nutritional therapy in AIDS individuals, our purpose is to provide evidence from animal models or humans of the potential therapeutic role of vitamin E supplementation in the treatment of AIDS individuals.

Acquired Immunodeficiency Syndrome↗

Immune depression in polymicrobial sepsis: the role of necrotic (injured) tissue and endotoxin.

OBJECTIVE: Recent studies suggest immune dysfunction seen after the onset of polymicrobial sepsis, as produced by cecal ligation and puncture (CLP), is not caused by endotoxin (ETX) alone, but may be caused by the combined effect of the necrotic tissue (cecal ligation, [CL]) and other microbial components. Thus, the objective of this study was to assess the ability of necrotic tissue, in the presence or absence of low-dose endotoxin, to induce changes in the capacity of immune cells to produce proinflammatory or anti-inflammatory cytokines approximating those seen in CLP. DESIGN: Experimental, prospective study. SETTING: A hospital laboratory in the Center for Surgical Research. SUBJECTS: Male C3H/HeN mice. INTERVENTIONS: Mice were subjected to a CL and saline infusion (CL/Sal), CL in combination with low-dose ETX infusion (CL/ETX) (0.025 mg ETX/25 g body weight/24 hrs by a peritoneally implanted osmotic mini-pump), ETX infusion alone, saline infusion alone (Sal), CLP, or sham-CLP (Sham). Splenocytes, splenic macrophage and peritoneal macrophage were harvested from these animals 24 hrs (late) after being subjected to the above protocols. Splenocyte and macrophage inducible cytokine release was assessed by ELISA/bioassay. Survival over a 7-day period was also examined in additional groups. MEASUREMENTS AND MAIN RESULTS: Our results indicate a marked decrease in splenic interleukin (IL)-2. In addition, peritoneal or splenic macrophage IL-6 productive capacity was depressed in cells from animals subjected to CL/ETX or CLP. Alternatively, CL, in the presence or absence of ETX, induced a marked change in macrophage cytokine release capacity comparable to that seen in CLP, ie, decreased IL-12 release and increased IL-10 secretion. To the extent these cellular alterations contribute to an increase in mortality rate, we observed in subsequent survival studies that neither CL alone nor ETX produced mortality. However, the combination of CL/ETX markedly increased 7-day mortality rate (approximately 33%), although not to the same extent as CLP (80%). CONCLUSIONS: These results collectively suggest that the response to devitalized tissue produced by cecal ligation may predispose the host to the induction of a suppressive macrophage phenotype. The subsequent exposure of these animals to microbial agents induces immune dysfunction, as well as mortality seen after such a polymicrobial septic challenge.

Animals↗

Zinc in growth and development and spectrum of human zinc deficiency.

Growth retardation is seen in experimental animals as a result of severe dietary restriction of several essential trace elements. However, in humans, the effect of zinc deficiency is most pronounced. Growth failure and hypogonadism in males, related to a deficiency of zinc, have been recognized in many developing countries. A mild deficiency of zinc, affecting growth and development in children and adolescents, has been reported from developed countries as well. Zinc deficiency in humans may manifest as severe, moderate, or mild. The manifestations of severe zinc deficiency include bullous pustular dermatitis, alopecia, diarrhea, emotional disorder, weight loss, intercurrent infections due to cell-mediated immune dysfunctions, hypogonadism in males, neurosensory disorders, and problems with healing of ulcers. This condition can be fatal. A moderate level of zinc deficiency has been reported in a variety of conditions. Clinical manifestations include growth retardation and male hypogonadism in adolescence, rough skin, poor appetite, mental lethargy, delayed wound healing, cell-mediated immune dysfunctions, and abnormal neurosensory changes. A mild level of zinc deficiency may manifest with decreased serum testosterone level and oligospermia in males, decreased lean body mass, hyper-ammonemia, neurosensory changes, anergy, decreased serum thymulin activity, and decreased IL-2 activity. Although the clinical aspects of severe and moderate levels of zinc deficiency are well known, the recognition of mild levels of zinc deficiency has been difficult. Currently plasmas zinc appears to be the most widely used parameter for assessment of human zinc status, and it is known to be decreased in cases of severe and moderate deficiency of zinc.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Impaired natural immunity, cognitive dysfunction, and physical symptoms in patients with chronic fatigue syndrome: preliminary evidence for a subgroup?

OBJECTIVE: The diagnostic criteria of chronic fatigue syndrome (CFS) define a heterogeneous population composed of several subgroups. Past efforts to identify subgroup markers have met with mixed success. This study was designed to examine natural killer cell activity (NKCA) as a potential subgroup marker by comparing the clinical presentations of CFS patients with and without clinically reduced NKCA. METHODS: Forty-one female CFS patients were classified into having either low or normal NKCA levels. These subgroups were then compared on objective measures of cognitive functioning and subjective assessments of fatigue, vigor, cognitive impairment, and daytime dysfunction. RESULTS: Relative to CFS patients in the normal-NKCA subgroup, low-NKCA patients reported less vigor, more daytime dysfunction, and more cognitive impairment. In addition, low-NKCA patients performed less on objective measures of cognitive functioning relative to normal-NKCA patients. CONCLUSIONS: The results are offered as preliminary evidence in support of using NKCA as an immunological subgroup marker in CFS. Findings are also discussed in terms of known associations between dysregulated immune functions, somatic symptoms, and psychological stress.

Adolescent↗

Macrophage-tropic HIV-1 variants: initiators of infection and AIDS pathogenesis?

The importance of macrophage-tropic HIV-1 variants in AIDS pathogenesis becomes increasingly clear. Macrophage-tropic HIV-1 variants initiate infection, predominate in the asymptomatic phase, and persist throughout infection, even after the emergence of preferential T cell-tropic HIV-1 variants. HIV-1 infection of macrophages may contribute to the overall immune dysfunction observed in AIDS pathogenesis. Here, our knowledge of the biological variability of HIV-1, and specifically macrophage-tropic HIV-1 variants, is reviewed. Moreover, hypotheses about the mechanism of selection for macrophage-tropic variants in transmission, the mechanism by which these variants selectively persist in the asymptomatic phase, and how they may contribute to the general immune dysfunction are presented.

Acquired Immunodeficiency Syndrome↗

Simultaneous development of Crohn's disease and myelodysplastic syndrome progressing to acute myelocytic leukemia in a patient with a normal karyotype.

A 28-year-old man developed Crohn's disease and myelodysplastic syndrome concurrently. Chromosomal analysis of the bone marrow revealed a normal male karyotype. Subsequently, the myelodysplastic syndrome progressed to acute myelocytic leukemia. Several causes, including the medical treatment for Crohn's disease, chromosomal abnormalities, and a common underlying immune dysfunction, have been proposed as pathogenetic factors in the association with Crohn's disease of hematologic malignancies. This case suggests that neither medical treatment for Crohn's disease nor chromosomal abnormalities are inevitable causes of the development of hematologic malignancies associated with Crohn's disease. At present, the cause of the association remains unclear, although the idea of a common immune dysfunction is attractive.

Adult↗

Effect of graft-versus-host disease on anti-tumor immunity.

BCL1, a spontaneous B cell leukemia of BALB/c origin, is rejected by C.B-20 (Ighb, H-40b) but not BALB/c (Igha, H-40a) mice. Adoptive transfer of C.B-20 anti-BCL1 effector cells specific for the minor histocompatibility Ag H-40a protects irradiated C.B-20 but not BALB/c recipients. Because C.B-20 donor cells could potentially generate graft-vs-host disease (GVHD) in BALB/c recipients, we investigated the possibility that GVHD prevents the anti-tumor effect. GVHD was induced in (C.B-20 X B10.D2)F1 [H-2d, H-40b X H-2d,H-40b] recipients after injection of B10.D2-primed C.B-20 donor cells. GVHD was indicated by the histologic appearance of tissue sections from C.B-20----F1 livers, target organs of GVHD, which showed a marked mononuclear cell infiltrate around the portal tracts and central veins. In addition, splenic lymphocytes from these mice had altered CD4/CD8 ratios and were unable to respond to the polyclonal activators Con A and LPS. The mitogen unresponsiveness was at least partially due to the presence of a suppressor cell, because proliferation of normal spleen cells to Con A and LPS was suppressed upon addition of C.B-20----F1 spleen cells. Further immune dysfunction was evident by the inability of T cells from mice with GVHD to generate a CTL response to H-2 alloantigens. Addition of C.B-20----F1 spleen cells to F1 responder cells at the induction of culture did not prevent generation of CTL, indicating that a suppressor cell was not responsible for the lack of CTL activity. In this setting of GVHD, F1 recipients were able to reject BCL1 upon adoptive transfer of C.B-20 anti-BCL1 effector cells. These data indicate that GVHD-induced immune dysfunction does not inhibit the activity of antileukemia T cells.

Animals↗

Lymphoproliferative disorders: CT findings in immunocompromised children.

OBJECTIVE: The objective was to evaluate the CT imaging appearance, distribution of disease, type of immunocompromised state, and outcome of children with Epstein-Barr virus-induced lymphoproliferative disorders. MATERIALS AND METHODS: Medical records and imaging studies (from four tertiary children's medical centers) were reviewed for pathologically proven cases of lymphoproliferative disorders in patients less than 20 years old. Trends between the CT imaging appearance, distribution, and type of immunocompromised state and prognosis were noted and analyzed with Fisher's exact test. RESULTS: Twenty-seven cases were identified (mean age, 7 years 8 months). Eighteen children had undergone solid organ transplantation (heart, n = 9; liver, n = 7; kidney, n = 2), and four had undergone bone marrow transplantation. Five patients had primary immunodeficiencies. The CT appearance of lymphoproliferative disorders varied and included lymphadenopathy, focal mass or masses, and diffuse infiltration and enlargement of organs without focal mass. The distribution of disease included abdomen (n = 17), chest (n = 10), neck (n = 8), and brain (n = 1). In eight of nine heart transplant recipients, the disease predominantly involved the chest and neck, whereas in all seven liver transplant recipients, the disease was isolated to the abdomen (p = .001). The overall mortality rate of 44% was less related to anatomic extent (multiorgan, 46%; localized, 43%) than to type of immune dysfunction (p = .001): bone marrow transplantation (100%), primary immunodeficiency (80%), heart transplantation (55%), liver transplantation (0%), and kidney transplantation (0%). CONCLUSION: Lymphoproliferative disorders in children had a variable distribution, imaging appearance, and outcome. However, in recipients of solid organ transplants, the disease tended to occur in the anatomic region of the transplant. Mortality rates were more closely related to the type of underlying immune dysfunction than to distribution of disease.

Bone Marrow Transplantation↗

Thymic atrophy in the mouse is a soluble problem of the thymic environment.

Age related deterioration in the function of the immune system has been recognised in many species. The clinical presentations of such immune dysfunction are an age-related increased susceptibility to certain infections, and an increased incidence of autoimmune disease and certain cancers. Laboratory investigations reveal a reduced ability of the cells from older individuals, compared with younger individuals, to perform in functional in vitro assays. These manifestations are thought to be causally linked to an age associated involution of the thymus, which precedes the onset of immune dysfunction. Hypotheses to account for the age-related changes in the thymus include: (i) an age related decline in the supply of T cell progenitors from the bone marrow (ii) an intrinsic defect in the marrow progenitors, or (iii) problems with rearrangement of the TCR beta chain because of a defect in the environment provided by the thymus. We have analysed these possible options in normal mice and also in mice carrying a transgenic T cell receptor. The results from these studies reveal no age related decline either in the number of function of T cell progenitors in the thymus, but changes in the thymic environment in terms of the cytokines produced. We have shown that specific cytokine replacement therapy leads to an increase in thymopoiesis in old animals.

Aging↗

Comparison of the plaque microflora in immunodeficient and immunocompetent dental patients.

The nature and extent of the immune dysfunctions in 20 immunodeficient patients, as well as the immunocompetence of 22 control subjects, were verified by cell-mediated responsiveness and immunoglobulin quantitations. Comparisons of the microbial composition of supragingival plaque between the two populations showed that a greater number of immunodeficient than control subjects harbored Candida sp. and Staphylococcus sp. Conversely, a lower number of immunodeficient than control subjects harbored Streptococcus mutans. Also, patients with immune dysfunctions had a lower dental caries experience than their immunocompetent counterparts.

Antibody Formation↗