Alteration of the structural integrity of TLR signalling componen

Alteration of the structural integrity of TLR signalling components is often associated with profound clinical outcome and susceptibility to various infections or autoimmune disorders. During conditions of floral translocation, peripheral TLR-9 signalling is a crucial mediator of polymicrobial sepsis. Moreover, in other conditions in which bacterial translocation occurs [for example, during irradiation and human immunodefiency virus (HIV) infection] peripheral find protocol TLR-4 signals enhance the activation status of both CD4+ and CD8+ T cells [10]. However, under most circumstances

the tissues of the GI tract are exposed constantly to TLR ligands harboured by the commensal gut flora. Mice deficient MK-1775 in vivo in TLR-9 display increased frequencies of Tregs within intestinal effector sites and reduced levels of constitutive interleukin (IL)-17- and interferon (IFN)-γ-producing effector T cells [9]. Complementing this, lamina propria dendritic cells (DCs) lacking exposure to gut flora DNA, induce Treg conversion in vitro. Furthermore, Tregversus effector T cell disequilibrium in TLR-9−/− mice restricts immune responses to oral infection with the pathogen Encephalitozoon cuniculi.

Impaired intestinal immune responses were recapitulated in mice treated with antibiotics and were reversible after reconstitution with gut flora DNA [9]. Thus, signals derived from the gut flora act as adjuvants of immune responses for priming intestinal responses against

oral pathogens via modulation of the equilibrium between Treg and effector T cells. Intestinal epithelial cell (IEC) expression of TLRs has also Liothyronine Sodium proved to be important in maintaining the homeostatic host–microbiome relationship, and to involve unexpected subtleties. For example, TLR-9 is expressed on both the apical (luminal-facing) and basolateral surfaces of the epithelial cell layer, but only basolateral ligation triggers an inflammatory signal, while apical binding is inhibitory [11]. The capacity of IECs to control immune responsiveness extends to the production of thymic stromal lymphopoietin (TSLP) and IL-25, influencing the Th phenotype balance in a manner which can make or break effective immunity [12]. The structure and composition of the gut flora reflect natural selection at both the microbial and host levels, and show perturbations in GI dysfunction. For example, modified gut floral composition is found in inflammatory bowel disease (IBD) patients [13]. Furthermore, the presence of certain bacteria can aggravate small intestinal immunopathology following oral infection.

26 IFN-α and TNF-α have been shown to accelerate the loss of CD27

26 IFN-α and TNF-α have been shown to accelerate the loss of CD27 and CD28 in both CD4+15,37,38 and CD8+39 T cells in humans. However, the induction of IFN-α may also lead to the secondary secretion of other cytokines such as IL-15,40,41 which may induce homeostatic proliferation and CD45RA re-expression during CMV-specific CD8+ T-cell activation.20,42–44 It is currently not known whether IFN-α can also induce IL-7 secretion by leucocytes or stromal DNA Damage inhibitor cells but this is under investigation.

These observations suggest that the accumulation of highly differentiated CD45RA− CD27− and CD45RA+ CD27− CD4+ T cells in CMV-infected individuals may be related in part to the cytokines that are secreted either as a direct or indirect consequence of CMV re-activation in vivo. There has been controversy about the extent to which CMV re-activation occurs in seropositive individuals. Earlier studies did not find increased CMV DNA in the blood of older humans.45 However, a recent study confirmed that while CMV viral DNA is undetectable in the blood of healthy old volunteers, it is significantly increased in the urine of

these individuals Selleck Doramapimod compared with a younger cohort of CMV-seropositive subjects.46 This indicates that the ability to control CMV re-activation may be compromised during ageing and that this may lead to increased activation of CMV-specific T cells in older subjects.46 Therefore, the increased CMV-specific T-cell re-activation together with secretion of Urease differentiation-inducing cytokines such as IFN-α,15,37,39 may culminate in the highly differentiated memory T-cell repertoire that is found in older CMV-infected humans. Previous reports on CD8+ T cells that re-express CD45RA have described them as terminally differentiated and exhausted.21,22 However, we and others have shown that CD45RA+ CD27− CD8+

T cells can be re-activated to proliferate and exhibit effector functions in vitro,20,25,32 indicating that they are functional and retain replicative potential and are an important memory subset.47 We now extend these observations by showing that the same applies to CD45RA+ CD27− cells within the CD4+ T-cell population that secrete multiple cytokines as efficiently as the CD45RA− CD27− population and more efficiently than the naive CD45RA+ CD27+ and CD45RA− CD27+ subsets after T-cell receptor activation. In addition, the CD45RA+ CD27− and CD45RA− CD27− CD4+ T-cell populations that accumulate in CMV-seropositive donors also have cytotoxic potential but it is not clear what their target population may be. In addition to their functionality, the ability of CD45RA− CD27− and CD45RA+ CD27− T cells to proliferate and survive after T-cell receptor or homeostatic cytokine stimulation is crucial for their role in immunity. We showed that not only CD45RA− CD27− but especially CD45RA+ CD27− CD4+ T cells have reduced levels of Bcl-2 and impaired Akt phosphorylation.

This guideline was written in

2000 International Guideli

This guideline was written in

2000. International Guidelines:No recommendation. Imaging modalities, especially MRI, are advancing rapidly in technological terms. This guideline is very likely to be out of date within 3 years and should be reviewed at the latest by Selleck Barasertib 2011. Stephen Munn has no relevant financial affiliations that would cause a conflict of interest according to the conflict of interest statement set down by CARI. “
“Aim:  To investigate whether the presence of multiple renal arteries in the remnant kidney has implications for lower renal function or increased incidence of hypertension. Methods:  We reviewed the intraoperative and follow-up data of 101 live kidney donors who underwent nephrectomies at our institution. Sixty-nine donors (68.3%) had single artery in the remnant kidney (Group A), while 32 donors (31.7%) had multiple renal arteries in the remnant kidney

(Group B). We compared the demographic and intraoperative Epigenetics inhibitor data between the two groups. The follow-up data of donors in each group were divided into three subgroups based on the length Carbachol of the follow-up period (12–24 months, 24–48 months and ≥48 months). Subgroups were created based on blood pressure and serum creatinine level. The δblood pressure (follow-up blood pressure minus preoperative blood pressure) and

δserum creatinine (follow-up serum creatinine minus preoperative serum creatinine) in each subgroup in Group A were compared with the counterparts in Group B. Results:  Renal arterial stenosis and calcification of renal arterial wall were not observed in all donors. There were no significant differences in the intraoperative characteristics (e.g. age, body mass index, operative duration and estimated blood loss) between the two groups. In addition, the blood pressure and serum creatinine level among subgroups within each group were similar. Furthermore, significant differences in δblood pressure and δserum creatinine were not observed between subgroups within the same follow-up period. Recipient survival rate and serum creatinine level were similar and acceptable in both groups. Conclusions:  The presence of multiple renal arteries in the remnant kidney does not have additional negative influence on kidney donors after kidney donation.

The consistent above average home dialysis rates witnessed in New

The consistent above average home dialysis rates witnessed in New South Wales appear to be the result of renal unit culture, education strategies and policies that support ‘home dialysis first’. “
“Aim:  Hyperphosphataemia is almost inevitable in end stage renal disease (ESRD) patients and is associated with increased morbidity

and mortality. In this study we examined whether oral activated charcoal (oAC) reduces serum phosphate level in haemodialysis patients. Methods:  This was an open-label, prospective, uncontrolled study. One hundred and thirty-five haemodialysis patients were included in this study, with cessation of treatment with any phosphate binders during a 2 week washout period. Patients with serum phosphate levels greater than 5.5 mg/dL during the washout period were included for Venetoclax nmr treatment with oAC. oAC was started at a dose of 600 mg three times per day with meals and was administered for 24 weeks. oAC dose was titrated up during the 24 week period to achieve phosphate control (3.5–5.5 mg/dL). A second 2 week washout period followed the end of oAC treatment. Results:  In the 114 patients who successfully completed the trial, the mean dose of activated charcoal was MK 1775 3190 ± 806 mg/day. oAC reduced

mean phosphate levels to below 5.5 mg/dL, with mean decreases of 2.60 ± 0.11 mg/dL (P < 0.01) and 103 (90.4%) of the patients reached the phosphate target. After the second washout period the phosphate levels increased to 7.50 ± 1.03 mg/dL (P < 0.01). Serum intact parathyroid hormone (iPTH) levels declined from 338.75 ± 147.77 pg/mL to 276.51 ± 127.82 pg/mL (P < 0.05) during the study. oAC had Ribose-5-phosphate isomerase no influence on

serum prealbumin, total cholesterol, triglycerides, serum ferritin, haemoglobin or platelet levels and the levels of 1,25-dihydroxyvitamin D were stable during the study. Conclusion:  In this open-label uncontrolled study, oAC effectively controls hyperphosphataemia and hyperparathyroidism in haemodialysis patients. The safety and efficacy of oAC needs to be assessed in a randomized controlled trial. “
“Currently available calcium and aluminium based phosphate binders are dose limited because of potential toxicity, and newer proprietary phosphate binders are expensive. We examined phosphate-binding effects of the bile acid sequestrant colestipol, a non-proprietary drug that is in the same class as sevelamer. The trial was an 8-week prospective feasibility study in stable hemodialysis patients, using colestipol as the only phosphate binder, preceded and followed by a washout phase of all other phosphate binders. The primary study endpoint was weekly measurements of serum phosphate. Secondary endpoints were serum calcium, lipids, and coagulation status. Analyses used random effects mixed models. 30 patients were screened for participation of which 26 met criteria for treatment. At a mean dose of 8.8g/24h of colestipol by study end, serum phosphate dropped from 2.24mmol/L to 1.

Volume and pressures were recorded at various sensations up to ma

Volume and pressures were recorded at various sensations up to maximal capacity (MCC). Maximal capacity was considered a volume with strong feeling of fullness in lower ICG-001 purchase abdomen or filling pressure of 30 cmH2O, whichever was reached earlier. At the end of the filling phase, the patient was asked to void in the uroflowmeter. He was encouraged to void with pelvic-floor relaxation along with Crede’s maneuver/straining. The following definitions were used: (i) Pouch compliance = MCC/end.fill.Ppouch; (ii) MCC = voided volume + PVR. This definition was used rather

than “volume filled” to account for the urine production during the study; (iii) clinically significant incontinence = leakage of over a few drops of urine. Urethral pressure profilometry was performed after filling 100 mL infusate into the pouch. The catheter was pulled at a constant rate (2 mm/sec) using motor-driven automated catheter puller and urethral pressures were recorded. The above evaluation was conducted initially at least 6 weeks after surgery and later at least 3 months after the initial

evaluation. All patients were counseled and trained to void on schedule by sphincter relaxation along with Crede’s maneuver Selleckchem PD0325901 if required. The pelvic floor strengthening exercises were started in the preoperative period and continued thereafter. Pelvic floor rehabilitation was initiated just before removal of catheter. Data were analyzed using statistical package for social science (SPSS, version 17, Chicago, IL, USA). Normality of data were checked using one sample Kolmogorov–Smirnov test. The before-and-after comparisons were made using paired t-test (parametric), Wilcoxon signed rank test (non-parametric) or McNemar test (dichotomous categorical).

Correlations between clinical/QOL and urodynamic parameters were made using Pearson’s correlation (parametric) or Spearman’s rank correlation (non-parametric). Factors predicting continence status were examined using Mann–Whitney U-test (non-parametric dataset). Binominal logistic regression and stepwise linear regression analyses were conducted as appropriate. Total 17 patients with mean age 52.7 ± 11.3 years and body mass index 22.7 ± 3.3 kg/m2 were evaluated. All patients underwent cystoprostatectomy (radical in 16 patients with Chloroambucil bladder cancer and simple in one patient with genitourinary tuberculosis) and construction of orthotopic neobladder (ONB) with ileum of mean length 48 ± 7 cm (range 40–60 cm). Three patients of bladder cancer developed recurrence; one in corpus cavernosus of penis, one in the pelvis and one in both. All were treated with systemic chemotherapy and the latter two with pelvic radiotherapy in addition. The former patient had a complete remission of disease; the latter two succumbed to progressive disease and hence were excluded.

Renovascular hypertension (RVHT) is systemic hypertension due to

Renovascular hypertension (RVHT) is systemic hypertension due to haemodynamically significant RAS of the main renal artery or its proximal branches.1 From a haemodynamic point of view, a stenosis is significant when there is a demonstrable pressure gradient. The pressure drop beyond the stenosis triggers intrarenal

adaptive mechanisms leading to renal ischaemia and hypertension.2 At least a 50% narrowing is necessary to produce such a pressure gradient, as shown by a study combining three-dimensional MRA and direct measurements across a stenotic lesion.3 Therefore, despite lack of consensus, most authors use a reduction in luminal diameter of 50% as a cut-off point, to define the presence of haemodynamically significant RAS.4 Atherosclerosis accounts for 70–90% of cases of RAS and usually involves the ostium and proximal third of the main renal artery.5,6 FMD is a collection of vascular diseases that affects either intima, media or adventitia and is responsible for 10–30% of cases of RAS.5,7 The prevalence of RAS in an unselected hypertensive population varies between 1% and 5%.8 This increases to 20–40% in patients who exhibit specific clinical symptoms buy LY2157299 or signs of RVHT.6 The IA-DSA is regarded as the gold standard for diagnosis of RAS. However, it is invasive, does not establish the functional nature of the stenotic lesion and is subject to substantial inter-observer

variations.9,10 Conventional IA-DSA is hazardous, especially in those patients most likely to be studied, where co-existing aortic disease may result in athero-embolic complications and therefore clinicians will continue to rely on non-invasive methods as initial diagnostic steps.11 These guidelines are an attempt to provide an overview of diagnostic accuracy and reproducibility of three contemporary imaging modalities: duplex ultrasound, CTA and contrast-enhanced magnetic resonance

angiography (CE-MRA) for the detection of RAS in patients with clinically suspected RVHT. Functional tests of the renin-angiotensin system, including Lenvatinib molecular weight captopril renography, are not included in these guidelines. They are not recommended in elderly atherosclerotic patients because hypertension in these patients is not renin-dependent and the results do not reliably predict the course of hypertension after revascularization.5 Databases searched: The terms used to define arterosclerotic renovascular disease were ‘renal artery obstruction’ (as a MeSH term and text word) and ‘renal artery stenosis’, ‘renovascular disease$’ and ‘renal artery occlusion$’ as text words were combined with relevant MeSH terms and text words for diagnosis. The search was performed in Medline (1950 to April 2009). The Cochrane Renal Group Trials Register was also searched for trials not indexed in Medline. Date of searches: 2 April 2009.

A statistical test of heterogeneity tells us whether such differe

A statistical test of heterogeneity tells us whether such differences in treatment effects within a meta-analysis are due to study characteristics (heterogeneity), which need to be explored and explained, or are

due to chance alone. The test for heterogeneity is called the Cochran’s Q. This is similar to a chi-squared test for which the P-value can be interpreted (P < 0.05 indicates presence of heterogeneity). Statistical evaluation of heterogeneity is also expressed as the I2 statistic where, simply put, an I2 = 0% is no heterogeneity and increasing values to a maximum 100% is evidence of increasing heterogeneity. Higgins et al. defined low, moderate and high levels of heterogeneity as 25%, 50% and 100%, respectively.18 We note in Figure 2 that while five of eight trials appear to give Opaganib molecular weight similar RR for mortality

comparing higher and lower haemoglobin target values, three SRT1720 purchase trials (Levin et al.,19 Rossert et al.,20 and Parfrey et al.21) differ in the direction of treatment effect from the rest – and show higher risks of death with a lower haemoglobin target. The authors of this systematic review report no significant heterogeneity in this analysis (χ2 = 9.59, P = 0.213, I2 = 27%), suggesting that variability in effect size observed between studies might be due to chance alone. Once heterogeneity is identified using medroxyprogesterone formal statistical analysis, a preliminary approach to its interpretation is the visual analysis of the forest plot. Heterogeneity may be due to differences in studies including variations in the patient population, the intervention (including dose, route, frequency of administration) and study quality. In the example in Figure 2, we can ask how do the studies of Levin et al. Rossert et al. and Pafrey et al. differ from the others in the plot; did

they have differing event rates; were they conducted in different populations; were they of different method quality; or were they significantly smaller or larger studies (or other similar questions). When high-level or significant heterogeneity is identified, the causes of heterogeneity can be explored by subgroup analyses, by meta-regression or by qualitative assessment. Subgroup analysis pools similar studies together to allow the systematic reviewer to examine an effect estimate within subgroups of studies. This could be, for example, separating high-quality from low-quality studies into differing subgroups and summarizing treatment effects of each individual subgroup. It should be noted, however, that any reduction in heterogeneity achieved by dividing studies into such subgroups might simply reflect a loss of power to discern important variability that still remains between studies within a single subgroup.


In selleck inhibitor this paper, the information that is required for determining the sample size is described. The primary aim is to demystify the sample size section in published clinical trials. Some of the difficulties in determining the sample size correctly are also highlighted and some good practices recommended. “
“To explore the relationship between metabolic syndrome (MS) and risk for chronic kidney disease (CKD) in a Southern Chinese population. A cross-sectional study was conducted in 1724 community-based Southern Chinese participants from June to October 2012. The prevalence of MS (as defined by the International Diabetes Federation) and CKD

(defined as an estimated glomerular filtration rate of <60 mL/min per 1.73 m2 and/or albuminuria) was determined. The association between MS and CKD was then analyzed using STATA software. Metabolic syndrome was significantly associated with CKD (P < 0.001) in the unadjusted analyses as well as after adjustment for potential confounders. The unadjusted odds ratio and adjusted odds ratio for MS were 3.53 (95% confidence interval (CI) 2.62 to 4.75, P < 0.001) and 2.52 (95% CI 1.84 to 3.54, P < 0.001). When further adjusted for diabetes

and hypertension, the association of MS and CKD was significant (odds ratio (OR) 1.63, 95% CI 1.15 to 2.32, P = 0.006). After adjustment for potential confounders, mTOR inhibitor three components and four/five components were associated with CKD. The OR for three components and four/five components were 2.90 (95% CI 1.70 to 4.96, P < 0.001) and 3.64(95% CI 1.95 to 6.80, P < 0.001), when compared with those without components. High blood pressure, high serum triglyceride level, elevated fasting glucose level and central obesity were associated with CKD (P < 0.05). The odds ratios for elevated blood pressure, elevated serum triglyceride levels, elevated fasting glucose and central obesity were 1.80 (95% CI 1.25 to 2.62, P = 0.002), for 1.56 (95% CI 1.14 to 2.14, P = 0.006), 2.54 (95% CI 1.82 to 3.57, P < 0.001), and 1.50 (95% CI 1.10 to 2.07,

P = 0.01), respectively. These findings suggest that MS is associated with CKD in Southern Chinese population, which may provide important information for the overall control of these diseases. “
“The aim of this study was to investigate the effects of high-load resistance training on the rate of force development and neuromuscular function in patients undergoing dialysis. Twenty-nine patients were tested before and after 16 weeks of resistance training. The rate of force development was tested using the Good Strength dynamometer chair. Muscle strength and neuromuscular function in the m. Vastus lateralis was estimated using electromyography in a one repetition maximum test during dynamic knee extension and during a 20 s isometric knee extension with 50% of the one repetition maximum load. Muscle biopsies from the m. Vastus lateralis were analysed for morphologic characteristics.

Analysis was performed with IDEAS software (Amnis) Jurkat cells

Analysis was performed with IDEAS software (Amnis). Jurkat cells were labeled with DDAO selleck chemicals llc (Life Technologies) according to the manufacturer’s instruction, treated with 2.5 μg/mL Cycloheximide (Sigma-Aldrich) for 2 h, and added to CpG-activated (6 h) or resting CAL-1-NAB2, CAL-1-NAB2E51K, or CAL-1-EV in a ratio 25:1. For TRAIL blocking, 10 μg/mL anti-TRAIL (2E5; Enzo Life Sciences) was added to CAL1 cells 30 min prior to coculture with Jurkat

cells. After 20 h, apoptosis was measured with AnnexinV-PE staining (BD Biosciences) or with CaspGLOW Red Active Caspase-3 Staining Kit (BioVision) according to the manufacturers’ protocols. Total RNA was isolated with TRIZOL (Invitrogen). cDNA was generated with SuperScript RT II (Invitrogen) using Random Primers (Promega). Real-time RT-PCR was performed with ABsolute QPCR SYBR Green mix (Abgene) or SyBR Green Master Mix (Applied Biosystems) using the CFX96 (Bio-Rad) or Step One Plus (Applied Biosystems). Staurosporine in vivo The following primers were used for analysis: TRAIL (5′-ATGGCTATGATGGAGGTCCAG-3′;

5′-TTGTCCTGCATCTGCTTCAGC-3′), NAB2 (5′-CCCGAGAGAGCACCTACTTG-3′; 5′-GGGTGACTCTGTTCTCCAACC-3′), CD40 (5′-CGGCTTCTTCTCCAATGTGT-3′; 5′-ACCAAGAGGATGGCAAACAG-3′), IFN-β (5′-GAGCTACAACTTGCTTGGATTCC-3′; 5′- CAAGCCTCCCATTCAATTGC-3′), MXA (5′-TCCAGCCACCATTCCAAG-3′; 5′-CAACAAGTTAAATGGTATCACAGAGC-3′). 18s (5′-AGACAACAAGCTCCGTGAAGA-3′; 5′-CAGAAGTGACGCAGCCCTCTA-3′) was used as reference gene. The relative mRNA expression was calculated with the comparative CT (DDCT) method. Cell pellets were resuspended in 5× sample buffer or NP-40 lysis buffer containing protease inhibitors, and denaturated at 95°C. For NAB2 detection, cells were sonicated for 20 s prior to denaturation. SDS gels were transferred to nitrocellulose (Amersham Biosciences) or PVDF (Invitrogen) membranes, blocked with 5% nonfat milk or 4% BSA. Membranes were incubated with anti-NAB2 (1C4; Santa Cruz Biotechnologies), or anti-Actin (I-19; Santa Cruz Biotechnologies),

anti-Akt, anti-phospo-Akt, p38MAPK, anti-phospo-p38MAPK (Cell Signaling Technology), Adenosine triphosphate anti-NF-kB p65 (Santa Cruz Biotechnologies), anti-phospo-NF-kB p65 (Cell Signaling Technology), or anti-RhoGDI (BD Transduction Laboratories). Protein expression was revealed with HRP-conjugated secondary antibodies and assessed with ECL Plus Western Blot Detection Reagents (Amersham Biosciences or Thermo Scientific). TNF-α and IL-6 expression was measured in supernatants with the Cytometric Bead Array, according to the manufacturer’s protocol (CBA, Human Inflammation Kit, BD Biosciences). Data are represented as mean ± standard deviation (SD), and evaluated using a two-tailed, paired Student’s t-test (Geo MFI expression data), or a two-tailed, unpaired Student’s t-test (RT-PCR data and Apoptosis assay) unless stated otherwise. A probability value of p < 0.05 was considered statistically significant. We thank Dr. T.

Similarly, Th2 cells fit the description of a prime suspect durin

Similarly, Th2 cells fit the description of a prime suspect during the development of atopy and subsequent allergic reactions, but their sole involvement and subsequent targeting for allergy therapy (which has only achieved modest success9) is unlikely.

Hence, neither the Th2 cell, at a particular snapshot in time of analysis, or its associated cytokine profile after unphysiological stimulation in vitro, should be thought of alone, but rather in the context in which it is acting. These rather obvious reminders are often not observable during in vitro Th2 experiments or are not reported buy ABT-263 during complex in vivo studies. Yet to accurately report a Th2-dependent gene, to hypothesize and test the function of Th2 features and to ascribe some relevant meaning requires an appropriate environment. Th2 cells and their responses are often vaguely described as type 2 microenvironments, expanding the single Th2 cell to a multi-cytokine and multi-cell mélange including alternatively activated macrophages, eosinophils, basophils, mast cells and recently described innate-like cells. We will attempt to strip down these broad interpretations and draw attention

to what we know and do not know about the type-2 namesake, αβ+ CD4+ Th2 cells. The activation of the il4 gene in CD4+ Th cells is the conventional marker for Th2 differentiation similar to the activation of the ifng gene for Th1 differentiation (Fig. 1). These markers have LDK378 supplier been used to identify the specific requirements

for Th2, or Th1, differentiation in vitro, in vivo, in situ and ex vivo. Most of our current understanding of Th2 differentiation is therefore based upon the activation of this single gene. What about cells that do not activate il4, either naturally or through genetic manipulation of the il4 gene or il4 receptor, but display other Th2 markers? Are they still Th2 cells? Indeed, IL-4-independent Th2 differentiation has been reported10–12 and will be discussed in more detail below. Reductionist Protein kinase N1 in vitro experiments have been invaluable, forging ahead and undressing Th2 (and other CD4+ Th) cell differentiation down to three essential signals, (i) TCR engagement, (ii) appropriate co-stimulation, and (iii) cytokine receptor ligation (Fig. 2). Needless to say, discrepancies exist between in vitro and in vivo requirements for each Th subset. T-cell receptor engagement, activating nuclear factor of activated T cell (NFAT) and GATA-binding protein-3 (GATA 3)13 may be the first signal to nudge CD4+ Th cells down a Th2 path. In seminal studies by Constant et al.12 and Hosken et al.