There is evidence that ACEi are efficacious at reducing BP and subsequent CVD and all-cause mortality in patients with mild, moderate and severe renal impairment. There is currently little evidence about the comparative effectiveness of other agents in preventing cardiovascular mortality and morbidity in this patient population. Post-hoc analyses of ACEi trials have shown that the treatment effects of ACEi on cardiovascular outcomes are consistent in patients with and without CKD.

ACEi appear therefore a reasonable first choice for prevention of CVD in this population. The evidence about the cardiovascular protective effects of ARB in CKD patients is scarce. However, they have been shown to confer renal protection in patients with diabetic nephropathy

and are therefore a sensible alternative if ACEi are not tolerated in this population. Head to head studies Alvelestat solubility dmso have reported similar cardiovascular outcomes with different classes of agents in people with CKD, although the power to detect meaningful https://www.selleckchem.com/products/icg-001.html differences is limited. ACEi, ARB, CCB and diuretics are therefore all reasonable choices for people with CKD. Renin angiotensin system blockade with ACEi or ARB is likely to have renal benefits in people with proteinuria and should therefore be preferred in this population (see separate guideline). There is little evidence about the efficacy in preventing CVD of different combinations of BP-lowering drugs in people with CKD. If BP targets are not met, the choice of a second agent should be based on individual patient factors, tolerability, and side-effects. a. We recommend that an ACEi or angiotensin receptor antagonist be prescribed for patients with CKD (or kidney transplant) and heart failure (1B). d. We suggest that patients receiving dialysis who have heart failure should be prescribed an ACEi or angiotensin receptor antagonist many (2D). For patients with CKD (or kidney transplant) symptomatic on the recommended agents, the following therapies could be considered as a third

agent (ungraded): Aldosterone antagonists have mortality benefit in people without CKD, but this may be attenuated in CKD and offset by greater toxicity Angiotensin receptor antagonist added to the ACEi reduces hospitalization but not mortality in people without CKD, but there are no data in CKD and potential increased toxicity Polyunsaturated fatty acid (PUFA), vasodilators and digoxin have all been studied in heart failure patients, but there is insufficient data to recommend for or against their use in heart failure patients with CKD receiving ACEi and beta-blocker therapy Diuretic therapy should be prescribed as required to control volume state with careful monitoring of kidney function and electrolytes (ungraded).

1) according to site of injury along the pedicle path, each yielding different surgical strategies as follows. Type A includes injuries within 2 cm from its origin; type B includes injuries from 2 cm below DNA Damage inhibitor its origin up to TD gives off the serratus branch; type C includes injuries between the level of the serratus branch and the neurovascular hilus, while type D injuries are intramuscular damages involving both horizontal and descending

branches. Whenever possible, primary anastomosis is the treatment of choice. This method is suited for type A without vessel tissue loss and B injuries that involve sharp lacerations of the pedicle with minimal (about 1 cm) or without vessel tissue loss. After locating proximal parts of artery and vein, the stumps are dissected free of surrounding tissue to provide for a tension-free coaptation. Whenever vessel tissue loss involves proximal segment up to the branch of the serratus or whether TD pedicle is cauterized about 1 cm in its length or not, direct anastomosis is not recommended. The need to refresh vessels’ edges and the shortening of proximal stump can

lead to excessive size discrepancy with unsafe anastomosis and limit the useful arch of rotation on the chest. The flap should be Decitabine revascularized by end-to-end anastomoses to circumflex scapular (CS) vessels so to compensate vessel shortness and diameter difference. In type C that involves sharp lacerations with minimal (about 1 cm) or without vessel tissue loss direct microsurgical anastomosis can be still performed between proximal and distal stumps. This method is not appropriate whether the proximal segment of neurovascular hilus is Cytidine deaminase involved or TD pedicle is cauterized about 1 cm in its length. In that case, the axillary vessels should not be used because of insufficient length of CS vessels and calibre

discrepancy to allow proper flap insetting and safe anastomosis. The flap can be revascularized by end-to-end anastomosis with serratus branch if intact. Whenever it is damaged as well as in all cases of LD pedicle’s avulsion and in type D lesions, a pedicled-to-free flap conversion to IMV recipient vessels at the third/fourth intercostal junction would be required. In attempt to spare IMV for possible future life-saving procedures, the wiser option is to dissect the ascending/descending branch of TD pedicle and prepare either IMV-perforators or the pectoral branch of the thoracocromial artery as recipient vessels. Since the ascending branch parallels the upper/medial LD border, anastomoses to IMV-perforators are suggested providing a free-tension horizontal insetting of the flap. For the same reason, since the descending branch parallels the lateral border of the muscle anastomoses to the pectoral branch should be performed with oblique insetting of the flap. The implant positioning under the muscle is not recommended because it can strain the anastomosis and consequently lead to arterial or vein impairment or both.

Further studies will need to address why the TREM-2/DAP12 receptor complex may sometimes Selleck PD0325901 inhibit and other times activate DC function. We speculate that direct activation of TREM-2/DAP12, such as with cross-linking antibody or with Sema6D/PlexinA1, leads to activation of DC cytokine production, but that the constitutive TREM-2/DAP12 signal present in DCs and

macrophages in conjunction with a TLR response leads to inhibition. This inhibition may be caused by a constitutive signal downstream of the DAP12 ITAM and Syk, the sequestration of signaling components by constitutive signaling through DAP12 and Syk, or by the induction of negative regulators of the TLR signal transduction pathway 13. TREM-2/DAP12 signaling also plays a positive role in phagocytosis 25, 27, 42. Knockdown of TREM-2 or DAP12 in microglia reduced the phagocytosis of apoptotic neurons, whereas overexpression of TREM-2 increased phagocytosis 42. Apoptosis has been shown to induce expression of an unknown TREM-2 ligand on the surface

of several cell types, including neurons 24, 25. These facts suggest that microglia recognize and phagocytose apoptotic neurons via TREM-2 ligation. This TREM-2 ligation upon phagocytosis of apoptotic cells may help protect against any inadvertent TLR-induced inflammatory response to self-DNA released from the apoptotic neurons. Consistent with this idea, knockdown of TREM-2 in microglia

causes an increase in TNF and NOS2 buy STA-9090 transcription when the cells are exposed to apoptotic neurons 42. Interestingly, TREM-2 can also recognize and bind to several species of bacteria and fungi 26–28 and is involved in phagocytosis of these bacteria 27. These observations indicate that TREM-2 binds both endogenous and exogenous ligands to induce phagocytosis. Our data demonstrate that TREM-2 negatively regulates DC and macrophage function in the presence of TLR ligands derived from bacteria and viruses, such as LPS and CpG DNA. TREM-2 also inhibited DC responses to the fungal particle Zymosan, which contains ligands for the TLR2/TLR6 heterodimer as well as ligands for additional receptors such as dectin-1 and Nod2 18, 19, 43. We propose that DCs require continuous TREM-2 ligation Interleukin-3 receptor for suppression of TLR responses to keep immune responses in check. The same endogenous and exogenous ligands that induce phagocytosis may also be able to cause the inhibitory signals we describe here, though these ligands have not been characterized at a molecular level. Indeed, though we have detected TREM-2 Fc binding to BMDCs, we have no direct evidence that the putative TREM-2 ligands bound by TREM-2 Fc participate in inhibitory signaling through TREM-2. Current studies in our laboratory aim to identify the endogenous TREM-2 ligands that cause inhibitory signals.

These findings were similar to previous findings in individual donors [7]. CD25 is expressed on activated effector T cells and, at higher levels, on CD4+ regulatory T cells (Tregs) [23]. Indeed, a small minority of the CD146+CD4+ T cells was CD25high (Fig. 4a, left)

and expressed the Treg transcription factor, FoxP3 (Supporting information, Fig. S3). On most CD146+CD4+ T cells, however, CD25 expression was low (Fig. 4a, left). Other T cell activation antigens [OX40 (Fig. 5) and CD69 (Fig. 6), but not major histocompatibility complex (MHC) class II (Supporting information, Fig. S4) or CD70 (Supporting information, Fig. S5)] were also over-represented systematically within the CD146+ population of the CD4+ T cell subset in HDs (a,b, left). (Only a subset of HDs was analysed for all activation markers; the trend for OX40 was consistent but did not reach statistical significance.)

Of these activation markers, only CD69 was Erlotinib in vivo over-represented consistently in HD CD146+ CD8 cells (Figs 4-6, Supporting information, Figs S5 and S6, A and C, left panels). Thus, CD146 was associated with recent T cell activation, although none of the markers exhibited perfect overlap and the association was less marked in CD8 cells. In CTD patients, deviations from these normal patterns were uncommon, as described further below. CD45RO is expressed following priming of naive T cells and persists www.selleckchem.com/products/bay-57-1293.html in central and effector memory T cells; chronically stimulated cells may re-express the CD45RA isoform [24, 25]. As reported previously in individual donors [7], CD146 expression on HD CD4 T cells was confined to CD45RO+ cells (Fig. 7a,b, left panels). However, within the CD8 subset, both CD45RO+ and RO− cells expressed CD146 (Fig. 7c, left). RO+ cells were enriched among CD146+ CD8 cells, but this trend was far less pronounced than in CD4 cells. Ribonucleotide reductase CD45RA was

analysed in some HDs and patients with SLE, showing reciprocal patterns to those observed with the RO isoform (Supporting information, Fig. S6). CD27 and CD28 are down-regulated sequentially upon chronic stimulation of T cells [26-28]. CD4+ T cells lacking CD28 have been implicated in atherogenesis [29]; CD28-negative CD8 cell expansion is associated with persistent herpesvirus infections. Both CD27+ and CD27–CD4 and CD8 T cells expressed CD146 (Fig. 8). Within the CD4, but not the CD8 subset, CD146+ cells were enriched for cells that had lost CD27. In most HDs, CD4+CD28− T cells were a small minority; virtually all CD146+ cells retained CD28 expression (Fig. 9). CD28 loss was more extensive in the CD8 subset and CD28–CD146+ CD8 cells were detectable (Fig. 9c), yet CD146 expression on CD8 cells was associated statistically with retention of CD28. In conclusion, CD146 is expressed by both early (CD27+) and late (CD27–) memory/effector CD4 T cells, but not by proatherogenic, ‘senescent’ CD28–CD4+ cells.

Interestingly, several pieces

of evidence support the idea that the cytokine milieu greatly affects Treg-cell response to OX40 triggering. We have previously shown that OX86 reverses Treg-cell suppression in graft versus host disease (GVHD) 54 and in tumors 3, while others have reported that OX86 administration to naïve mice promotes Treg-cell expansion, thus reinforcing suppression 55. Therefore, the outcome of OX40 stimulation may vary depending on microenvironmental cues. Conversely, OX40 may affect Treg-cell response to cytokine stimulation. Indeed, OX40 signal Opaganib supplier supports Treg-cell susceptibility to IL-2 by sustaining miR155 expression and restraining SOCS1 availability 56. These data highlight the importance of understanding how different microenvironments influence

Treg-cell behavior and how to take advantage of Treg-cell plasticity for the development of efficient cancer immunotherapies. The strictly Treg-cell-intrinsic modifications CH5424802 detected in the transcriptome of sorted Treg cells, treated or not with OX40 agonist Ab, were relatively few and of limited extent (all modulations were below 1.8-fold). However, according to the above considerations about OX40 tuning cytokine susceptibility, far wider effects may be elicited by OX40 stimulation in Treg cells embedded in a complex microenvironment and exposed to a panoply of signals. Among downregulated genes, beside Irf1, attention should be paid to Igtp and Iigp2 (also called Irgm2), belonging to p47-GTPase family that, like Irf1, are downstream IFN-γ

during the immune responses to pathogens 57. Again, the expression levels of both Igtp and Irgm2 were particularly high in Treg cells derived from lamina propria 45. Other modifications induced in Treg-cell transcriptome by OX40 triggering seemed to affect Treg-cell homing or Treg-cell ability to recruit other cells: Ccr8 and Itgae (encoding for CD103) were increased, Ccl4 and Xcl1 were decreased. A general interpretation of these changes is complex. CD103 is an integrin dictating gut homing, and OX40 is required for Treg-cell accumulation in the colon 58. However, in a model of PJ34 HCl T-cell transfer-induced colitis, OX40-deficient Treg cells expressed normal levels of CD103 and properly accumulated in the lamina propria 56. Contrary to Treg cells, effector T cells express OX40 only upon activation 11, 59. We found that Tem cells, representing the most abundant TIL subset, highly expressed OX40. This class of memory lymphocytes was reported to constitutively express CD40L at sufficient levels to induce DC activation 17. We hypothesized that, at the tumor site, the presence of immune-suppressive elements could render the basal CD40/CD40L-mediated interaction insufficient for optimal DC stimulation by Tem cells, and that OX40 triggering may supply to Tem cells the adequate boost.

Here, we report that PstS1 exclusively activated memory T cells but did not stimulate naïve cells. Thus, the ability of PstS1 to induce expression of co-stimulatory molecules and/or release of IL-6 and IL-1β by DCs, as better discussed below, may account for the Ag-independent activation of memory T lymphocytes. However, although unlikely, a contribution for TCR cross-reactivity, which may exist even between apparently unrelated peptide Ag [35] cannot

be excluded. Activation of T lymphocytes by unrelated Ags occurs frequently during infectious processes but the significance of this phenomenon is still a matter of debate. It is thought to be involved in homeostatic turnover, maintenance of immunological memory, or amplification of inflammatory responses [36]. PstS1 is released by replicating Mtb, especially during the acute phase of infection, as indicated by increased levels of anti-PstS1 mAbs in the sera of Imatinib mouse most patients with multibacillary or advanced pulmonary TB [37, 38]. Therefore, PstS1

released by Mtb may be exploited by the bacterium itself to facilitate inflammation during active TB disease. It may promote IFN-γ, IL-17, and IL-22 release by memory T cells specific for other Mtb Ags, such as Ag85B and Ag85A. IFN-γ and IL-17 are induced during primary TB [2-6] and are both capable of inducing chemokines that promote cell recruitment and granuloma organization throughout infection [39]. While many clinical and experimental data indicate a central role for the IFN-γ response in protection selleck chemicals llc against Mtb infection, the role of IL-17 is not yet fully elucidated. Th17 cells per se may contribute to the early control of Mtb infection, although they may increase tissue damage [4, 5]. Similarly, IFN-γ-producing T cells may directly cause lung damage and may alter the efficacy of protective TB

immunity unless tightly controlled [9, 10, 40], suggesting that excessive activation of IFN-γ response may be deleterious for the host. Thus, during TB infection, a balance between Th1 and Th17 responses Thiamet G needs to be achieved so as to control bacterial growth and limit immunopathology. Recently, a growing body of evidences suggests a role for IL-22 in TB. In healthy humans exposed to mycobacteria, IL-22-expressing CD4+ T cells were reported as being distinct from Th17 and Th1 cells [41]. Moreover, unlike IL-17, IL-22 was found in BALF of TB patients, suggesting that these two cytokines may have distinct roles in TB infection and disease outcome [41, 42]. Nevertheless, considering that the amplification of IFN-γ, IL-17, and IL-22 responses are a double-edge sword for the host [6-10, 42], further investigations are required to determine whether PstS1 release during infection is of benefit to the host or the mycobacteria. Moreover, it remains to be elucidated whether induction and amplification of Ag-unrelated memory Th1 or Th17/22 responses mediated by PstS1 are short term or long lasting.

Tbet was expressed at a significantly higher level in the colons from the Aire-group (Fig. 4B). No differences were found in the expression of other T helper cell (Th) cell lineage genes GATA3 and

RORγT. Finally, as a systemic marker of ongoing inflammation and colitis [40] we measured the concentration of acute IWR-1 purchase phase protein serum amyloid protein (SAP) in the recipient mice. Compared with both Aire−/− and Aire+/+ control animals without cell transfers, both groups of recipients had elevated plasma levels of SAP, but there was no statistically significant difference between the groups (Fig. 4C). The surprising lack of clinical disease, despite autoantibodies and other signs of autoreactivity in the Aire-group, prompted us to look at Tregs in the recipients. One month after the cell transfer, the proportion of circulating Foxp3+ cells among all CD4+ cells was comparable in both groups (control-group 6.2 ± 2.0% and Aire-group 4.7 ± 0.9%, difference not significant). At the time of termination, the frequency of circulating Foxp3+ cells remained similar in both recipient groups (Fig. 5A). However, the frequency of Ribociclib purchase circulating Foxp3+ cells expressing the cell cycle marker Ki-67 was significantly higher in the Aire group (Fig. 5B). To test whether this higher rate of proliferation resulted in increased accumulation of Treg cells

in the Aire group we then analysed the frequency of Foxp3+ cells in the recipients’ lymphoid tissues. In spleen, the frequency was similar in both groups (16.6 ± 4.1% and 17.5 ± 6.1% in the control and Aire group, respectively). In the mesenteric lymph nodes, in contrast, the frequency of both Foxp3+ cells, and the fraction of Treg

cells expressing Ki-67, was much higher in the Aire group (Fig. 5C,D). Moreover, the amount of Foxp3 mRNA in the colon tissue, normalized against TCR Cα mRNA, was higher in the Aire group recipients (Fig. 5E). Together, these data indicate that Treg cells hyperproliferated in the Aire group recipients, Montelukast Sodium accumulating in higher numbers to potential sites of inflammation. The importance of Aire to the development of central tolerance is clearly established [17, 20], but there is also increasing evidence that Aire is needed for maintaining peripheral tolerance [23, 24, 41]. Our model of LIP allowed us to determine how much of the Aire−/− phenotype is duplicated, when T cells that have matured in the absence of Aire are exposed to autoimmunity-provoking signals within an Aire-sufficient peripheral environment. Adoptive cell transfers have previously been carried out both using bulk lymphocytes and selected subsets of T cells. In our experiments, we chose to do the former. In several murine models of autoimmunity, such bulk transfers to lymphopenic recipients have been reported to successfully transfer the disease [28, 42–44], and in some models, the co-transfer of B and T cells are indeed required to trigger autoimmunity [45].

In none of the groups reported here were we able to score arthritis above the baseline, suggesting that peripheral tolerance Selleck CB-839 is intact in all groups (data not shown). This further emphasizes the conclusion that clonal deletion is not a critical contributor to the development of such tolerance in the case of chronic peripheral self-antigen stimulation. The absence of clonal deletion in the lower frequency group, prompted us to examine if the other major mechanisms of peripheral tolerance are intact in the model — namely anergy and conversion to a Treg-cell fate. We examined the latter by staining for the canonical marker Foxp3 and did not find significant conversion in the chronic hosts (Fig. 3A, closed bars in 3B) with

only a minimal conversion in the acute hosts (Fig. 3A, open bars in 3B). While this argues against skewing of the autoreactive T cell itself, it does not, of course, rule out the possibility that endogenous Treg cells

participate in the peripheral tolerance process. Finally, we tested if the T cells that persist for such extended periods in the presence of chronic antigen, are in fact anergic. The in vivo parallel of anergy, known as adaptive tolerance, is typically marked by a severe blunting of the signaling cascades downstream of the TCR leading to a reduction in the ability of the T cell to secrete cytokines such as IL-2 [18]. Consistent with this, 5C.C7 T cells recovered 13 days later from 103 injected PCC-transgenic mice failed to make IL-2 (detected by capture assay as shown in Figure 3C). This contrasted with the robust IL-2 detected in similar CP-690550 chemical structure cells that were acutely immunized with PCC in antigen deficient mice (open bar Methane monooxygenase in Figure 3D). Therefore, in this model, at near physiological precursor frequencies, the induction of anergy seems to operate but without

the accompaniment of clonal deletion or the conversion to a regulatory Foxp3 lineage. These results are strikingly similar to the fate of the T cells in a lymphopenic model where we observe anergy but no deletion or suppression [19]. In this context, however, it must be emphasized that the choice of a nondeletional tolerance mechanism is not simply restricted to anergy. In fact, in similar models, under lymphopenic conditions, T cells have been shown to develop anergy in concert with a suppressive phenotype [7]. The variables that allow this phenotype to develop in specific models may relate to TCR affinity, antigen presentation, etc., but are not well understood. The mechanisms controlling T-cell numbers in vivo remains an enduring mystery. Recent work suggests that clonal competition regulates the pool of memory T cells generated after acute immunization. We suggest that it seems to be less of a factor in the case T cells responding to chronic, self-antigens. Interestingly, these T cells can also persist in vivo for extended periods with no evidence of clonal deletion or conversion to Treg cells.

The authors have IWR1 no conflict of interests to declare. “
“Invasive fungal infections from febrile neutropenia are associated with significant cost and mortality. The mainstay of treatment

has been liposomal amphotericin B, however, echinocandins and azoles have shown promise as alternative treatments. Data on clinical efficacy exist, however, data incorporating pharmacoeconomic considerations are required in Turkey. The aim of this study was to investigate the cost effectiveness of caspofungin vs. voriconazole in empiric treatment of febrile neutropenia in Turkey. A decision analytic model was utilised, built upon two randomised-controlled trials and supplemented with expert panel input from clinicians in Turkey. A five-point composite outcome measure was utilised and sensitivity analyses were performed to demonstrate the robustness of the model. The base case scenario resulted in caspofungin being preferred by TL2,533, TL29,256 and TL2,536 per patient treated, successfully treated this website patient and patient survival, respectively (approx. USD1414, 16 328 and 1415); sensitivity analyses did not change the outcome. Monte Carlo simulation highlighted a 78.8% chance

of favouring caspofungin. The result was moderately sensitive to treatment duration and acquisition cost of the antifungal agents compared. This is the first pharmacoeconomic study comparing caspofungin to voriconazole within Turkey, resulting in an advantage towards caspofungin. The study will aid in formulary decision-making based on the clinical and economic consequences of each agent in the Turkish health care setting. “
“Eine frühe antimykotische Intervention kann helfen, invasive Mykosen erfolgreich zu therapieren.1 Für eine Gruppe von Patienten mit hohem Risiko für eine Pilzinfektion wurde in den letzten Jahren eine Aspergillus-wirksame antimykotische Prophylaxe etabliert. Ebenso wurden die diagnostischen Möglichkeiten verbessert. Die Sensitivität des Galactomannan (GM)-Tests wurde verbessert, und auch zum Nachweis von Glucan, einem Polysaccharid der Pilzzellwand, steht mittlerweile ein Testverfahren

zur Verfügung. Dies kann helfen, frühe, diagnostisch gestützte Therapieansätze zu entwickeln. Die Aspergillus-PCR, eine weitere sensitive Methode, wird nun international standardisiert und ob ihres sinnvollen Einsatzes Histamine H2 receptor geprüft. Weiterhin findet die Strategie der empirischen Therapie bei Fieber in Neutropenie häufig Anwendung, wenn kein Keimnachweis möglich ist. Sowohl diese empirische Strategie als auch die diagnostisch gestützte antimykotische Therapie tragen dazu bei, den Einsatz von Antimykotika gezielter zu steuern. Diese Strategien stellen Alternativen zu einer prophylaktischen, und damit sehr frühen und breiten Anwendung systemischer Antimykotika dar. Die Möglichkeiten und die aktuelle Studienlage zur empirischen und diagnostisch gesteuerten Therapie sollen im Folgenden dargestellt werden.

The cytokines were measured in the cell culture supernatants; TNF-α after 4 h incubation at 37°C and IL-6, IL-10 and IL-12 after 18 h incubation at 37°C using commercial ELISA kits (Milenyi Biotec Thermo Scientific). The cytokine responses were measured without (spontaneous) and after stimulation and the values of the spontaneous secretion were deducted from the challenge values to allow for comparison with other, similar studies (e.g. [20]). Counting of white blood cells showed only minor differences in the monocyte/lymphocyte ratio between controls

and subjects with sarcoidosis. The participants GSK458 were supplied with a pump and filter holders preloaded with cellulose acetate filters (Mixed Cellulose Esters, 25 mm PCM Casettes, 0·8 µm pore size; Zeflon International Inc., Ocala, FL, USA). The subjects turned on the pump and sampling was performed for about 4 h. The exact volume sampled was read from a volume meter attached to the pump and was usually

MLN0128 about 2·5 m3. The filters were analysed for their content of N-acetylhexosaminidase (NAHA) using an enzyme technique [10,21]. One ml of a fluorogenic enzyme substrate (4-methylumbelliferyl N-acetyl-β-D-glucosaminide; Mycometer A/S, Copenhagen, Denmark) was added to the filter, followed by 2 ml of a developer after an incubation period of around 30 min, determined by the room temperature. The liquid was sucked out through the filter and placed in a cuvette. The fluorescence in the cuvette was read in a fluorometer (Picofluor; Turner Designs, Sunnyvale, CA, USA). To decrease the variance induced by methodological variations in the analysis technique, the fluorescence values were divided by 10 and rounded off to the nearest whole number to express NAHA activity in units Erastin (NAHA U/m3). Values in the different groups were calculated using spss version 17–W7 and expressed as mean and standard error of the mean. Differences between groups were evaluated using the Mann–Whitney

test and the intercorrelations assessed using Spearman’s-test. A P-value of < 0·05 was considered statistically significant. The spontaneous secretion of different cytokines from PBMC is reported in Table 1. The spontaneous secretion of all cytokines was higher from PBMC from subjects with sarcoidosis with significant differences for TNF-α and IL-12. Table 2 reports the secretion of cytokines after incubation with different FCWA and LPS. After stimulation with S-glucan the secretion of TNF-α was significantly higher among subjects with sarcoidosis, but there were no differences for the other cytokines. Stimulation with P-glucan caused a high secretion of all cytokines, which was significantly higher among subjects with sarcoidosis. Chitin was a comparatively weak inducer of cytokines in both groups except for IL-6, and no differences were found between controls and sarcoidosis.