In the context of transplantation, dendritic cells (DCs) can sensitize alloreactive T cells via two pathways. The direct pathway is initiated by donor DCs presenting intact donor MHC molecules. The indirect pathway results from recipient DCs processing and presenting donor MHC as peptide. This simple dichotomy suggests that T cells with direct and indirect allospecificity cannot cross-regulate each other because distinct APCs are involved. In this study we describe a third, semidirect pathway of MHC alloantigen presentation by DCs that challenges this conclusion. Mouse DCs, when cocultured with allogeneic DCs or endothelial cells, acquired substantial levels of class I and class II MHC:peptide complexes in a temperature- and energy-dependent manner. Most importantly, DCs acquired allogeneic MHC in vivo upon migration to regional lymph nodes. The acquired MHC molecules were detected by Ab staining and induced proliferation of Ag-specific T cells in vitro. These data suggest that recipient DCs, due to acquisition of donor MHC molecules, may link T cells with direct and indirect allospecificity.
Maternal vitamin D insufficiency is not uncommon. Infants born to mothers who are deficient in vitamin D and or calcium, usually due to cultural modifications in their diets or clothing habits, and in addition are breastfed, are at risk of developing vitamin D deficiency and hypocalcaemia. We present a case of neonatal hypocalcaemic seizures secondary to vitamin D deficiency.Rickets in children resulting from vitamin D deficiency is well documented. It is also becoming clear that there is a positive correlation between maternal vitamin D status during pregnancy and lactation and the development of rickets both in infancy and childhood. The correlation between maternal vitamin D, neonatal vitamin D and hypocalcaemia is not well documented.
Food allergy quality of life questionnaires (FAQLQ) are the most common instruments used in food allergy research to assess health-related quality of life (HRQL). With the increase in food allergy treatment trials, it is important to determine which items within the FAQLQ are most and least useful in this context. We sought to assess which items of the FAQLQ-child form (CF) were most discriminative, using item response theory (IRT), which examines relations between item responses and underlying construct (in this case, HRQL). METHODS: PEPITES was a phase 3 randomised, placebo-controlled trial that studied the safety and efficacy of Viaskin Peanut 250 mg in children aged 4-11 years. Children who participated in PEPITES, aged ≥8 years, completed the FAQLQ-CF at baseline and at 12 months. FAQLQ-CF items were analysed using IRT, considering items' discrimination values, difficulty levels, and item information curve. RESULTS: 92 children (mean age 5 8.47 years, SD 1.7) completed the FAQLQ-CF. By IRT analysis, 14 of 30 total items contained in the FAQLQ presented very high discrimination levels (a > 1.7), with the highest levels relating to items that assessed 'fear'. All the items presented difficulty level within the recommended range (mean across b1-b6 < 2+1.5), being neither too easy, nor too difficult. CONCLUSIONS: We have identified 14 items contained within the FAQLQ-CF by IRT approach that best discriminate and assess HRQL in a treatment context. These findings may provide a novel and reliable framework for measurement of changes in HRQL in future food immunotherapy clinical trials.
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