Results of the studies reported herein show that the in-vivo depletion of NK and NK T cells prior to immunization in this murine model of human PBC markedly delayed the generation of both anti-mitochondrial antibodies (AMA) and autoreactive T cell responses. Despite the reduction in the autoreactive T and B cell responses to mitochondrial autoantigens, the specific degree of portal selleckchem inflammation was unchanged, emphasizing the lack of an absolute requirement for the NK/NK T-associated innate immune effector mechanisms in the initiation of a breakdown of tolerance and a potential major role of a continued adaptive response

in the natural history of disease. Female C57BL/6J (B6) mice aged 8–9 weeks were obtained from Kyudo (Kumamoto, Japan) and maintained in ventilated cages under specific pathogen-free conditions. Each mouse was immunized intraperitoneally with a mixture of 2-octynoic acid-bovine serum albumin (2OA-BSA) conjugate (100 µg/25 µl) incorporated in complete Freund’s adjuvant (CFA; Sigma-Aldrich, St Louis, MO, USA) containing 10 mg/ml of Mycobacterium tuberculosis strain H37Ra. The mice CB-839 price subsequently received biweekly booster doses of 2OA-BSA incorporated in incomplete Freund’s adjuvant (IFA; Sigma-Aldrich), as reported previously [9]. Groups of these 2OA-BSA-immunized mice were either treated intravenously with 100 µg

of NK1·1 antibody (Cedarlane, Alexis, NC, USA) to deplete NK cells or NK T cells (group A, n = 32) or treated with control mouse immunoglobulin (group B, n = 32) every week before 2OA-BSA treatment and up to the time of killing. As negative controls, female B6 mice (group C, n = 12) were immunized with BSA incorporated in CFA (Sigma-Aldrich) and boosted using the same dose and schedule as the experimental mice. Sera and spleens were collected before and at every 6 weeks post-immunization to 24 weeks. Serological AMA was determined by enzyme-linked immunosorbent assay (ELISA) [10] Adenosine triphosphate and spleen mononuclear cells were isolated for detection of NK1·1-positive cells by flow cytometry and enzyme-linked immunospot (ELISPOT) assay. In a nested study, liver samples were collected from eight mice

from groups A and B and three mice from group C, each at 6, 12, 18 and 24 weeks, and subjected to histological analysis [11–13]. Two-colour flow cytometry was performed on cell suspensions using a fluorescence activated cell sorter (FACS)Caliber flow cytometer (BD Biosciences, San Jose, CA, USA), as described previously [14]. Cell surface monoclonal antibodies utilized included anti-CD3 and NK1·1 (BD Biosciences). Splenic mononuclear cells (2·5–5·0 × 105) were stained for cell surface antigen expression at 4°C in the dark for 30 min, washed twice in 2 ml phosphate-buffered saline containing 1% bovine serum albumin and 0·01% sodium azide, and were fixed in 200 µl of 1% paraformaldehyde. Isotype-matched control antibodies were used to determine the background levels of staining.

Twenty percent experienced worse symptoms during pregnancy with 53% happening in the third stage of pregnancy. Forty-two percent of the female patients had no pain during or after sexual intercourse, while 34%

experienced occasional pain and 24% had frequent pain. The location of post-sexual pain was lower abdomen (29%), vagina (30%), and back (3%). Twenty-nine percent of the female patients experienced flare-up symptoms related to their menstrual cycle. Twenty-six percent had frequency flare-up related to menstrual cycle, with 66% before menstrual cycle, 26% during menstrual cycle, and 8% after menstrual cycle. Fourteen percent of the female patients experienced selleck compound flare up of pain related to the menstrual cycle, with 73% before, 17% during, and 10% after menstrual cycle. The most frequently encountered problems indicated from the studied group were long travel (83%) and sleep (80%), working at position which patients were qualified to do (66%), short travel (58%), partner relationship (35%), family relationships and Opaganib clinical trial responsibilities (24%) (Table 5). Comparing our data with the data analyzed in some large-scale research outside Taiwan, we have the

following findings: The average age in the present study is the same as the age shown in ICDB, but is younger than that offered in the studies of Koziol et al.[12] This suggests that the average age of IC patients through clinical diagnosis has become younger with the increasing awareness of this disease in the field of medicine. Our patients reported that their first symptom occurred at the age of 38, but they did not get diagnosed until the age of 46. Thus, there is a difference of 8 years and it suggests that IC is not a disease that can be diagnosed at the early stage. Compared with the difference of 4–7 years documented in the studies outside Taiwan, the difference of 8 years in the present study implies that the understanding of IC in Taiwan is still not sufficient. In addition, the duration of frequency and urgency symptoms is longer than that

of pain symptoms (i.e. 62 months vs. 46 months). It might imply that the initial symptom of IC patients includes frequency and urgency, accompanied by the symptom of pain. Suffering from pain is then the Dichloromethane dehalogenase biggest factor that causes IC patients to become serious about clinical and medical assistance. Some research studies have found that patients who suffer from early symptoms are younger than patients who suffer from typical IC patients. Variability and progression is commonly seen in interstitial cystitis. Because typical symptoms such as frequency, urgency, pain, and nocturia might not occur simultaneously, the biggest challenge that clinicians encounter is how to diagnose the disease at the early stage and how to treat patients appropriately. We can tell the difference between chronic prostatitis and interstitial cystitis more precisely at present day..

In fact, recent studies have led to the realization that Th17 cells may represent a heterogeneous group of IL-17-producing cells that vary in their expression profile, effector functions, and pathogenicity BTK inhibition [10, 11]. The relative abundance of TGF-β and IL-23 has emerged as a major skewing factor between “classical” and “alternative” Th17 cells. Classical Th17 cells arise in an environment with relatively low amounts of IL-23 and appear to have a more regulatory phenotype,

with production of cytokines such as IL-10 and IL-21, than the more pathogenic alternative Th17 cells, which secrete IFN-γ and GM-CSF and are generated in the presence of IL-23 (reviewed in [12]). Although Th17 cells have been the focus of much attention in the past few years, mainly because of their involvement in autoimmune diseases, they are not the sole producers of IL-17. Indeed, CD4−CD8− double-negative (DN) T cells have been shown to secrete large amounts of IL-17 [13], and much of the IL-17 secreted during early inflammatory responses, for example following microbial infection, is produced by innate immune cells as discussed by Mills

and colleagues in an accompanying article in this Th17 review series in the European Journal of Immunology [14]. Such cells include γδT cells, lymphoid-tissue inducer-like cells, invariant natural killer (NK) T cells, NK cells, Selleckchem Epigenetics Compound Library and neutrophils (reviewed in [15]). Most of these cell types can be found in mucosal and epithelial barriers, for example in the gut, lungs, and skin, and have an important role in tissue surveillance. Mast cells have also been reported to secrete IL-17 in synovium from individuals with rheumatoid arthritis and in psoriatic lesions [16-18]. Emerging data suggest IL-17-producing cells may be central to the pathogenesis of systemic autoimmune diseases. Increased plasma levels of IL-17, as

well as an increased frequency of pheromone IL-17-producing T cells, have been reported in patients with SLE and have been shown to correlate with disease activity in some studies [13, 19-23]. Both Th17 and DN T-cell populations are expanded in patients with SLE as compared with healthy individuals. DN T cells were already known to be positively associated with lupus nephritis and to participate in the induction of anti-DNA autoantibody production some 20 years ago [24]; however, interest in their role in SLE pathogenesis has recently been renewed when they were found to be major producers of IL-17 in SLE and to infiltrate kidneys in patients with lupus nephritis [13]. Indeed, IL-17-producing T cells have been detected in the main target organs in SLE, such as skin, kidneys, and lungs, suggesting that IL-17 may play a role in local inflammation and resulting tissue damage [20, 25, 26]. Further supporting the presence of a Th17-biased environment in patients with SLE, increased plasma levels of IL-6, a crucial differentiating factor for Th17 cells, as well as IL-21, a Th17 cytokine, have been observed in such patients [22, 27-29].

In another study, a discrete subset of myeloid (CD11b+) DCs was the only cell type in spleen that transcribed IFN-β1 genes after systemic DNP Ponatinib in vitro treatment, though other cell types ingested DNPs and contained cargo DNA [33]. Thus it may not be a coincidence

that, in a recent study to examine antigen uptake in living lymphoid tissues using intra-vital techniques, CD11b+ DCs were shown to ingest particulate antigens rapidly [35]. Other spleen cells have also been shown to ingest DNPs rapidly. Marginal zone macrophages (MZMs; CD169+, F4/80neg) in mouse spleen ingested DNPs rapidly and avidly, but unlike CD11b+ DCs, no DNP cargo DNA was detected in MZMs [33], suggesting that MZMs ingest and degrade particulate material containing DNA such as chromatin, which resembles DNPs before DNA accesses the cytosol; this scenario is consistent with the ability of MZMs to remove blood-borne particulate

materials selleck kinase inhibitor in a way that does not incite autoimmunity [36]. Unlike MZMs, some splenic CD8α+ DCs and myeloid non-DCs (CD11b+CD11cneg) also ingested DNPs and retained cargo DNA but did not transcribe IFN-β1 genes [33], suggesting that cytosolic DNA sensing to activate the STING/IFN-β pathway may be defective in these cell types. Treating mice with cdiGMP elicited responses in the spleen that were remarkably similar to those induced by DNPs [33], reinforcing the conclusions that myeloid DCs are “first-responder cells” and are specialized to sense cytosolic DNA and CDNs, and that the DNA sensing STING/IFN-β pathway may be functionally defective in other “nonresponder” cells. DNP and cdiGMP treatments were also shown to induce comparable patterns of IL-1β transcription via a STING-independent pathway [33]; however, myeloid non-DCs (not myeloid DCs)

expressed the highest levels of IL-1β transcripts. Another recent report revealed that bacterial CDNs stimulate mucosal immunity in mice via a pathway dependent on STING and NFκB signaling but not IRF3 and IFN-αβ signaling to induce TNF-α [37]. In summary, responses to DNA by innate immune cells are surprisingly complex and functionally Exoribonuclease dichotomous, revealing tissue-, cell-type-, and pathway-specific differences in how innate immune cells respond to DNA. The molecular basis of such complex physiologic responses to DNA are poorly understood but are critically important for elucidating pivotal pathways that control downstream immune responses to DNA. Cytosolic DNA sensing to induce regulation via STING may be biologically significant for several reasons. Regulatory responses to DNA may help maintain self-tolerance during homeostasis and inflammation, thereby reducing the risk of inciting autoimmunity.

Thus, they suggest that γ-PGA might be used to treat Th17-driven autoimmune diseases. In the present study, we found that γ-PGA acting directly on

naive CD4+ T cells regulates reciprocally the mutually exclusive developmental pathways of Treg cells and Th17 cells. Upon TCR/CD28 stimulation in the absence of polarizing conditions, γ-PGA signalling, acting through a TLR-4/MyD88-dependent pathway, favours the induction of aTreg cells. However, in Th17-polarizing conditions it activates a TLR-4/MyD88-independent pathway inhibiting the BAY 57-1293 development of Th17 cells. These in vitro effects seem to also apply in vivo, as γ-PGA reduced the fraction of Th17 cells in the inflamed tissue of EAE mice. These findings reveal several novel features of γ-PGA action on CD4+ T cells: the existence of a TLR-4/MyD88-independent pathway of signalling and the novel function of γ-PGA in Treg/Th17 regulation. The TLR-4/MyD88-independent activity of γ-PGA implies the presence of a receptor(s) other than TLR-4. We suspected that TLR-3 was the putative receptor of γ-PGA, as it is the only member of the TLR family that does not signal via MyD88 and its ligands are highly polyanionic, such as γ-PGA [34]. However, this appears not to be the case, because we found that the TLR-3 ligand poly I:C did not affect the polarization

of Th17 cells (data not shown). Our data demonstrate clearly that the effects of γ-PGA signalling include inhibition of the IL-6-driven induction of Th17-specific factors, such as STAT-3, RORγt, IRF-4 and Ahr. Therefore, γ-PGA signals appear to induce BMS-777607 mw common inhibitory molecule(s) or co-repressor(s) which inhibit the expression of the above factors. Alternatively, γ-PGA may only target STAT-3, which would in turn affect the expression of genes

encoding RORγt, IRF-4 and Ahr. A recent report identifying these molecules as STAT-3 targets [32] supports this latter idea. Interestingly, unlike other IL-6 target molecules, IL-6-driven induction of SOCS3 was even up-regulated ZD1839 clinical trial by γ-PGA, suggesting that it is γ-PGA signalling that induces SOCS3 expression. Because SOCS3 specifically inhibits the STAT-3 activation that is critical for Th17 differentiation [35], it is also feasible that the γ-PGA effect on Th17 suppression is due, at least in part, to up-regulation of SOCS3. Conversely, γ-PGA-mediated down-regulation of STAT-3 might contribute to FoxP3 induction or vice versa, in view of the evidence that STAT-3 can inhibit the conversion of naive T cells to Treg cells in vivo[32]. In addition to this cross-regulatory pathway involving FoxP3 and STAT-3, we found evidence for a distinct pathway of Th17 suppression that is independent of FoxP3 activity. This γ-PGA signalling pathway is currently under investigation. We found that EAE suppression by γ-PGA was associated with a reduction in the number of Th17 cells in the CNS but not in the spleen.

1 μCi/106 cells of Na251CrO4 for 90 min at 37° and, where indicated, were pulsed for 45 min with 10−6 m of the different peptides at 37°. Cells were then washed,

and 4 × 103 cells were used as targets of each CTL at different effector to target ratios. The per cent specific lysis was calculated as 100 × [(c.p.m. sample)−(c.p.m. medium)/(c.p.m. Triton X-100)−(c.p.m. medium)], where c.p.m. represents counts/min. Spontaneous release was always < 20% in all cases. None of the tested peptides affected spontaneous release. Enzyme-linked immunosorbent spot-forming cell assay [ELISPOT; for interferon-γ (IFN-γ)] was carried out using commercially available kits (Becton-Dickinson, Franklin Lakes, NJ) according to the manufacturer’s instructions. Hormones antagonist Abiraterone In brief, 96-well nitrocellulose plates were coated with 5 μg/ml anti-IFN-γ, and maintained at 4° overnight. The following day the plates were washed four times with PBS and blocked for 2 hr with 10% fetal bovine serum-supplemented RPMI-1640 at 37°. The CTLs were added to the wells (in triplicate) at a ratio of 10 : 1 and incubated

with target cells at 37° for 24 hr. Controls were represented by cells incubated with concanavalin A (Sigma-Aldrich, St Louis, MO; 5 μg/ml) (positive control), or with the medium alone (negative control). Spots were read using an ELISPOT reader (A.EL.VIS GmbH, Hannover, Germany). Results are expressed as net number of spot-forming units/106 cells.15 Surface expression of HLA-ABC molecules was detected by indirect immunofluorescence using anti-human HLA-ABC mouse monoclonal antibody (BD Pharmingen, San Diego, CA). Mean logarithmic fluorescence intensity was determined by FACS analysis (Bryte HS; Bio-Rad, Milan, Italy).13 It has been previously demonstrated that the HPV epitope, derived from the EBNA1 antigen (amino acid 407–417) and presented by HLA-B35 and HLA-B53 alleles of the B5 cross-reactive group, is one of the targets of EBNA1-specific Demeclocycline CTL responses in healthy EBV-seropositive individuals.20 To identify specific responses to this epitope and to obtain HPV-specific CTL cultures for further evaluation, we investigated the presence of HPV-specific memory CTL responses in a panel of HLA-B35

healthy EBV-seropositive individuals. To this end, PBLs obtained from nine healthy HLA-B35 positive, EBV-seropositive donors (Table 1) were stimulated with the HPV peptide.24 As control, parallel stimulations were performed using the HLA-B35-presented YPL epitope derived from the EBNA3A antigen.5 The specificity of CTL cultures was tested after three stimulations using standard 51Cr-release assays against autologous PHA-blasts, pulsed or not with the relevant synthetic peptide. As shown in Fig. 1, HPV-pulsed PHA blasts were efficiently lysed by representative CTL cultures obtained from donors 5, 6, 7 and 8. Three of these donors also responded to the YPL epitope. Overall, these stimulations yielded HPV-specific CTL responses in six of the nine donors tested (Table 1).

From each animal, three flat sheets of unstripped ileum free of Peyer’s patches were placed in

Teflon holders and mounted in Ussing chambers within 5 min after being cut off from blood supply. Both sides of the sample (exposed area 0·2 cm2) were in contact with 1·6 mL Krebs–Ringer solution, stirred and gassed with humidified 95% O2 + 5% CO2 at 37°C. The transepithelial potential difference Vte MK0683 mouse (mV) was continuously monitored with Calomel electrodes connected to the chambers with Krebs–Ringer-agar bridges. Transepithelial electrical resistance R (Ω/cm2) was calculated from the voltage deflections induced by bipolar current pulses of 10 μA (every 30 s) applied through platinum wires. The potential and resistance data were stored on a PC using custom software (Natural Simstrument, Amsterdam, the Netherlands). During off-line data analysis, corrections were made for resistance of the solution and for potential differences between Calomel electrodes, measured both just before and immediately

after each experiment. The equivalent short-circuit Ku-0059436 chemical structure current Isc (μA/cm2) was calculated from the continuously monitored values of R and Vte. Reported values for the parameters Vte, R and Isc were obtained at the end of a 15- to 20-min equilibration period. Generally, these values were stable during the subsequent 1- or 2-h experiment. At the end of the experiment, the secretory capacity of the tissue segments was tested by measuring their response (Vte and Isc) to application of the secretagogue carbachol in the serosal compartment (10−4 M). In the Ussing chamber experiments, the measured transepithelial potential

(Vte) and equivalent short-circuit current (Isc) are indicative of the basal epithelial secretion, while the increase in these parameters (dVte and dIsc) in response to the secretagogue carbachol reflects the maximal secretory capacity. Paracellular mucosal-to-serosal permeability was determined using NaFl Casein kinase 1 as a model molecule (25). After the equilibration period, NaFl was added to the mucosal compartment (0·01 g/L) and 200-μL serosal samples were taken every 7·5 min and replaced by Krebs–Ringer. The concentration of NaFl was determined using a fluorimeter (Polarstar Galaxy fluorescence multi-well plate reader; BMG LabTech GmbH, Jena, Germany), with 485 nm and 530 nm as excitation and emission wavelengths respectively. Steady-state NaFl-flux was quantified and expressed as ng/cm2/h. For each animal, average values of electrophysiological parameters and NaFl-flux were calculated from simultaneous measurements of three ileal samples. Statistical analyses were performed using SPSS v.12·0 software (SPSS Inc., Chicago, IL, USA).

Relevant information was obtained from forms that were completed by the referring neurologists. The detailed clinical course of the patient who was ultimately diagnosed with EBV encephalitis was retrospectively determined by review of the medical record. DNA was extracted from 200 μl of CSF using a https://www.selleckchem.com/products/Dasatinib.html QIAamp Blood Kit (Qiagen, Chatsworth, CA, USA). After DNA extraction, DNA was eluted in 50 μl of elution buffer and stored at −20°C. Ten μl of DNA was used for real-time PCR analysis. Real-time PCR was performed to determine DNA copy numbers for varicella-zoster virus (7), EBV (8), cytomegalovirus,

HHV-6, HHV-7 (9), and HHV-8 (10). PCR reactions were performed using the TaqMan PCR Kit (PE Applied Biosystems, Foster City, CA, USA). For each

viral DNA assessment, standard curves were constructed using the CT values obtained from serial dilution of plasmid DNA containing the target sequences (10 to 106 gene copies/tube). CT values for each sample were plotted on a standard curve and Sequence Detector v1.6 software (PE Applied Biosystems) used to automatically selleck products calculate the sample DNA copy numbers. Detection limits of the all real-time PCR were 10 gene copies/reaction (250 gene copies/ml). Each sample was tested in duplicate, and the mean was used to determine the sample copy number. None of the CSF samples contained varicella zoster virus, cytomegalovirus, HHV-6, HHV-7, or HHV-8 DNA. EBV DNA was detected in only one of the 61 CSF samples, with a copy number of 1184 copies/ml. The clinical course of the patient who had high concentrations of EBV DNA in her CSF is shown in Figure 1. This 36-year-old female patient presented to her family

doctor with fever and severe headache, and was transferred to the university hospital because of mild somnolence. Although physical examination at the time of hospital admission (day 5 of the illness) revealed fever, mild somnolence, and a stiff neck, there were no signs or symptoms suggestive of infectious mononucleosis such as lymphadenopathy, hepatosplenomegaly or tonsillitis. The patient had mild pleocytosis and increased CSF protein concentrations. However, she did not have an increased number of atypical lymphocytes or hepatic impairment at the time of admission. A subsequent PCR analysis performed by a commercial laboratory did Dapagliflozin not detect HSV DNA in the CSF. Serological testing for EBV infection was not performed. The patient was suspected to have meningo-encephalitis and treated with acyclovir and antibiotics. Despite this treatment, her neurological symptoms persisted for 6 days after hospital admission. Moreover, short-term memory loss appeared on day 9 of the illness. Therefore, on day 11 of the illness, a spinal tap and MRI were performed to clarify the patient’s diagnosis. Pleocytosis with mildly elevated CSF protein concentrations were again observed.

The authors do not have any conflict of interest related to the topic of this study. “
“Photodynamic therapy (PDT) is a minimally invasive approach, in which a photosensitiser compound is activated by exposure to visible light. The activation of the sensitiser drug results in several chemical reactions, such as the production of oxygen reactive species and other reactive molecules, whose presence

in the biological site leads to the damage of target cells. Although PDT has been primarily developed to combat cancerous lesions, this therapy can be employed for the treatment of several conditions, including infectious diseases. learn more A wide range of microorganisms, including Gram positive and Gram negative bacteria, viruses, protozoa and fungi have demonstrated susceptibility to antimicrobial photodynamic therapy. This treatment might consist of an alternative to the management of fungal infections. Antifungal photodynamic therapy has been successfully employed against Candida albicans and other Candida species and also against dermatophytes. The strain-dependent antifungal effect selleck products and the influence of the biological medium are important issues to be considered. Besides, the choice of photosensitiser to be employed in PDT should consider the characteristics of the fungi and the medium to be treated, as

well as the depth of penetration of light into the skin. In the present review, the state-of-the-art of antifungal PDT is discussed and the photosensitiser characteristics are analysed. “
“Fifty-three soil samples were collected from various

sites click here in the vicinity of Vedanthangal Water Bird Sanctuary and screened for the presence of keratinophilic fungi using the hair baiting techniques for isolation. Twenty-eight isolates were recovered and identified by recognition of their macro- and micromorphological features. Seven species related to five genera were recorded viz. Auxarthron conjugatum (1.89%), Chrysosporium fluviale (3.77%), Chrysosporium indicum (20.75%), Chrysosporium tropicum (7.55%), Chrysosporium state of Ctenomyces serratus (5.66%), Gymnoascus petalosporus (1.89%) and Microsporum gypseum complex (11.32%). The study shows that migratory birds harbour a variety of keratinophiles and may be a potential source of transfer of these fungi from one location to another. “
“Candida albicans is the predominant causal agent of candidiasis. Its ability to form hyphae and biofilm has been suggested to be key virulence factors. In this study, we investigated the effect of major licorice compounds licochalcone A, glabridin and glycyrrhizic acid on growth, biofilm formation and yeast-hyphal transition of C. albicans. The synergistic effect of licorice compounds with the antifungal drug nystatin was also evaluated. Minimal inhibitory concentrations (MICs) for C.

In clinical studies of CGD [23–30], the disorder has presented most often with pneumonia, infectious dermatitis, osteomyelitis, and recurrent or severe abscess formation in the skin and organs of the reticuloendothelial buy DAPT system. Tissue examination typically shows microscopic granulomas [31]. Infections are caused generally by bacteria such as Staphylococcus aureus and gram-negative bacilli, and fungi such as Aspergillus and Candida [22, 29]. Unusual pathogens characteristic of CGD include Burkholderia cepacia, Chromobacterium violaceum, Nocardia and invasive Serratia marcescens.

The management of CGD includes prophylactic antibiotics, antifungals and IFN-γ, along with aggressive and prolonged treatment of infections as they occur [22, 32]. Prophylactic trimethoprim/sulfamethoxazole (5 mg/kg/day based on trimethoprim) reduces the frequency of major infections from about once every year to once every 3.5 years, preventing staphylococcal and

skin infections without increasing the frequency of serious fungal infections. Itraconazole prophylaxis showed marked efficacy in the prevention of fungal Inhibitor Library cell assay infection in CGD (100 mg daily for patients <13 years or <50 kg; 200 mg daily for those ≥13 years or ≥50 kg). IFN-γ reduces the frequency of severe infections and the length of hospitalization for infections and is well tolerated [33], although not all centres use the drug. Therefore, the current recommendations include prophylaxis with trimethoprim/sulfamethoxazole, itraconazole and IFN-γ (50 μg/m2) in CGD [22]. Bone marrow transplantation and gene therapy offer Mannose-binding protein-associated serine protease potential cure of CGD, although with considerable risk and toxicity. Several transplant approaches are in

use, ranging from full myeloablation resulting, when successful, in complete engraftment, to non-myeloablative conditioning regimens, leading to stable hematopoietic chimerism [22]. Gene therapy for CGD has shown marking of cells in the periphery for several months, but clinical benefit has been elusive, presumably because of the low numbers of corrected cells in the circulation (<0.01%). In contrast to severe combined immunodeficiency, where the growth advantage of corrected cells enables small numbers to fill the T-cell compartment, restoring the NADPH oxidase in neutrophils does not seem to offer any apparent selective growth advantage to these cells, making it more difficult for CGD gene therapy to achieve long-term correction [22]. However, even temporary correction of a small proportion of cells can provide short-term clinical benefit [34, 35]. A multinational group has achieved successful gene therapy in patients with X-linked CGD, using liposomal busulfan conditioning followed by infusion with autologous CD34+ peripheral blood stem cells transduced with a retroviral vector, in which gp91phox expression is driven by the spleen focus-forming virus long terminal repeat [36–38].