Subdominant T-cell epitopes have previously been shown to mediate

Subdominant T-cell epitopes have previously been shown to mediate heterologous immunity in BAY 57-1293 the murine LCMV model, but immunodominant epitopes may also play a role. This has been suggested in studies of humans in whom immunodominant HLA-A2-restricted influenza M1-specific CD8+ T cells found to be cross-reactive to Epstein-Barr

virus BMLF-1 expand during acute infectious mononucleosis and are thought to contribute to lymphoproliferation 23. Similarly, in our model, CD8+ T cells specific for the immunodominant epitope are cross-reactive in both JEV and WNV-infected mice. In both JEV- and WNV-infected mice, higher frequencies of IFN-γ+ CD8+ T cells were Doxorubicin molecular weight detected compared

to frequencies of TNF-α+ CD8+ T cells on day 7 post-infection, as has been seen after acute LCMV infection, independent of stimulating peptide variant 24. However, we detected a significantly higher proportion of IFN-γ+TNF-α+ CD8+ T cells in mice infected with WNV compared with those immunized with both attenuated and pathogenic JEV strains (Fig. 2B–D), as well as higher TNF-α production on a per cell basis (Supporting Information Fig. 2). The role of TNF-α in WNV infection is pleiotropic and may lead to resolution of the infection or to immunopathology depending on the concentration of TNF-α. Wang et al. demonstrated decreased mortality from WNV infection in TLR3−/− mice, which they related to a decrease in TNF-α production and subsequent diminution in blood-brain

permeability resulting in reduced WNV neuroinvasion 25. However, Shrestha et al. demonstrated that neutralization of TNF-α in WNV-infected mice decreased their survival due to lower numbers of CD8+ T cells and macrophages trafficking to the brain 26. CD8+ T-cell production of TNF-α during acute WNV infection may contribute to their own trafficking into the central nervous system resulting in control of virus infection or increased immunopathology. The qualitative disparity in cytokine profiles during acute infection Reverse transcriptase with closely related viruses may be due to one of several factors: (i) differences in the kinetics of the response; (ii) differences in activation state in different virus infections; (iii) differences in viral burden and/or tissue tropism between attenuated JEV and WNV. To further delineate whether these differences are related to virus family versus viral virulence, we investigated responses to a pathogenic JEV virus strain, Beijing, at similar doses and clinical outcome to those of attenuated JEV SA14-14-2 and virulent WNV. At 1×103 pfu of JEV Beijing, no mortality was seen in 6- to 7-wk-old mice, which is similar to what was seen after the attenuated JEV SA14-14-2 at 1×106 pfu.

Urine protein excretion should be quantified by analysis of a 24-

Urine protein excretion should be quantified by analysis of a 24-hour urine collection or spot urine protein : creatinine ratio. Increased urine protein excretion usually excludes further consideration as a kidney donor. American Society of Transplantation Position Statement on the Medical Evaluation of Living Kidney Donors (2007): The following reasons will typically exclude a living donor

candidate from donating . . . ≥300 mg/day of proteinuria. 1 Conduct prospective, controlled studies on long-term living kidney donor outcomes. Include an assessment of the utility of urinary protein excretion compared with urinary albumin excretion; and outcomes of donors with isolated medical abnormalities. Both of the authors have no relevant financial affiliations that would cause a conflict of interest according to the conflict of interest statement Ulixertinib supplier set Apoptosis inhibitor down by CARI. “
“Aim:  Vancomycin and teicoplanin are the two most used glycopeptides for the treatment of methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin is suspected to have more nephrotoxicity but this has not been clearly established. The aim of this study was to assess its nephrotoxicity by a consensus definition of acute kidney injury (AKI): the risk (R), injury (I), failure (F), loss and end-stage renal disease

(RIFLE) classification. Methods:  Patients with MRSA bacteraemia who were prescribed either vancomycin or teicoplanin between 2003 and 2008 were classified. Patients who developed

AKI were classified by RIFLE criteria. click here Variables such as comorbidities, laboratory data and medical cost information were also obtained from the database. Outcomes determined were: (i) the rate of nephrotoxicity and mortality; and (ii) the association of nephrotoxicity with the length of hospital stay and costs. Results:  The study included 190 patients (vancomycin 33, teicoplanin 157). Fifteen patients on vancomycin and 27 patients on teicoplanin developed AKI (P = 0.0004). In the vancomycin group, four, eight and three patients were classified to RIFLE criteria R, I and F, respectively. In the teicoplanin group, 17, nine and one patient were classified to RIFLE criteria R, I and F, respectively. Kaplan–Meier analysis showed significant difference in time to nephrotoxicity for the vancomycin group compared to the teicoplanin group. No significant differences were found between the groups in terms of total mortality, length of hospital stay and costs. Conclusion:  The study data suggest that vancomycin is associated with a higher likelihood of nephrotoxicity using the RIFLE classification. “
“Aim:  Screening algorithms for chronic kidney disease have been developed and validated in American populations. Given the worldwide burden of kidney disease, developing algorithms for populations outside the USA is needed.

Even cross-presentation capacity, which has been attributed solel

Even cross-presentation capacity, which has been attributed solely to CD8+ cDCs and CD103+ mDDCs in many models, has also been observed in mLCs, CD11b+ mDDCs and/or CD11b+ cDCs [18-26]. In this review we will discuss how underlying limitations of murine experimental models may have led to these apparently contradictory findings. CD11b CD103+ CD11b+ CD103 CD11b CD103 DC subset function

is often inferred from ex-vivo assays that measure the response of antigen-specific T cells co-cultured with DC subsets purified from the draining LNs and/or spleens of immunized or infected mice. Additionally, lymphatic cannulation of larger mammals such as in rats, pigs, sheep and cattle has been used to recover migrating dendritic cells for ex-vivo phenotypical and functional studies PF-01367338 in vitro (reviewed in [27]). T cell proliferation and effector function in these ex-vivo assays generally reflect the extent of antigen presentation at the time of DC harvest, and thus provide an indirect measure of the efficiency of in-vivo antigen uptake and processing by a given DC subset. However, ex-vivo assays

can also be affected by changes in DC immunogenic properties resulting from the physical manipulation involved in DC isolation [28, 29]. In addition, co-culture overrides microanatomical factors that may constrain the probability of in-vivo contact between DCs and T cells within the T cell zones of lymphoid organs. For example, the majority of splenic CD11b+ cDCs are located outside the T cell zone in the steady state and would contact Proteasome inhibitor T cells only after Toll-like receptor (TLR)-dependent signals

drive their relocation into the T cell zone, yet they may still present antigen Nutlin3 to activate T cells in vitro [30]. In skin-draining LN, the peak arrival of mLCs after immunization is on day 4, compared with days 1–2 for mDDCs [6], so that assays performed on day 2 would not detect the capacity of mLCs migrating from the immunization site to present antigen [31]. Another major limitation of ex-vivo assays is that in-vitro T cell responses do not always mimic their in-vivo counterparts [3, 32, 33]. Effective concentrations of cytokines such as IL-2 are higher in vitro yet T cell division times are longer, and are accompanied by much higher rates of spontaneous cell death [33]. T cell cytokine production tends to be polarized more strongly in vitro than in vivo (reviewed in [34]). Long-term regulation of T cell effector and memory differentiation in vitro is also highly dependent on addition or withdrawal of exogenous cytokines. Most importantly, the conditions that induce T cell deletion in vivo are not replicated effectively in vitro. In-vivo tolerogenic responses to soluble peptide begin with a proliferative burst that is followed rapidly by deletion in the absence of effector cytokine production [33, 35].

Then we tested for acquired immunity by comparing worm burdens in

Then we tested for acquired immunity by comparing worm burdens in the immunized-challenged hamsters (Group 5) and the challenge controls (Group 4), with a specific prediction that Group 4 would have more worms than Group 5. The Mann–Whitney

U test was used post hoc in SPSS to explore differences in worm burden between specified groups. All other quantified parameters of the mucosal response to infection were examined by Omipalisib purchase general linear models (GLM) in SPSS (version 12.0.1 for Windows) fitting treatment (the five treatments) and time (days 73 and 94 of the experiment, excluding the values derived from Group 5 hamsters culled on days 80 and 87). Models were scrutinized carefully for approximately normal distribution of residuals. In Group 5 hamsters (primary + secondary infection), for which data were derived on four separate days (73, 80, 87 and 94 of the experiment), we additionally looked for changes over time. If the data appeared approximately linearly distributed, we employed parametric regression analysis (Pearson’s) in SPSS, with days of the experiment as the independent factor. For nonlinear trends, we fitted the best-fit curves in SPSS, and tested them for goodness of fit by F tests. The mean worm burden of each experimental

group at autopsy is shown in Table 2. Not surprisingly the naïve control group (Group 1), and the group treated with ivermectin on day 35 post-infection selleckchem (p.i.) (Group 3, primary abbreviated infection) were without worms at autopsy. Group 2 (primary continuous infection), had low worm burdens on days 73 and 94 p.i., with some adult worms still persisting from the original immunizing infection given on day 0, but representing a stable infection: there was no statistically significant difference between mean worm burdens in Group 2 hamsters Y-27632 2HCl on day 73 and 94 (Mann–Whitney U test, z = 0·7). The challenge control group (Group 4), given only the second

infection, had higher worm burdens than the immunized-challenged group (Group 5, primary + secondary infection; 2-way anova, confined to Groups 4 and 5, and days 10 and 31 post-challenge infection (p.c.), for the specific prediction, z = 2·72, P = 0·0033), indicating that Group 5 had expressed acquired resistance to challenge. The results are illustrated in Figure 1, and the statistical analysis is given in the legend. Naïve control hamsters (Group 1) maintained the height of villi between the two sampling points (Figure 1; days 73 and 94 from the start of the experiment) and the values recorded were within, albeit towards the lower end of, the normal range reported earlier from naive hamsters (20). Hamsters infected on day 0 of the experiment and sustaining a continuous infection throughout (Group 2, primary continuous infection), had villi with drastically reduced height on both days, with values not atypical of those reported by Alkazmi et al. (20).

This discovery transformed the management of two chronic relapsin

This discovery transformed the management of two chronic relapsing conditions from maintenance symptomatic therapies, and in some cases surgery, to curative treatment with targeted antibiotics. The possibility

that infections by other organisms from the genus Helicobacter are implicated in the pathogenesis of other human diseases is a tantalizing one. The inflammatory bowel diseases (IBD), Crohn’s disease (CD) and ulcerative colitis (UC), demonstrate many similarities to gastric and duodenal ulceration before the discovery of H. pylori, including unexplained onset in previously healthy hosts, a chronic relapsing disease course with no curative treatments, chronic gastrointestinal inflammation selleck kinase inhibitor and predisposition to malignant change. In this review, we shall consider the evidence supporting Helicobacter spp. as the pathogenic agents in IBD. We will discuss the relative incompatibility of H. pylori disease AZD2281 manufacturer and IBD, highlighted by the apparent protective effect of prior H. pylori infection on IBD disease risk. We shall review animal variants of IBD, which are both initiated by and associated with Helicobacter spp. infection. We will then review

the Helicobacter organisms associated with human gastrointestinal disease and the molecular evidence for Helicobacter organisms in human IBD. For the purpose of clarity, Helicobacter organisms associated primarily with gastritis or CYTH4 biliary disease are not covered within this article. More than 30 Helicobacter organisms have been described to date (see Fig. 1), but only H. pylori has been

proven to cause human disease. It is inconceivable that H. pylori is the only human pathogen within such a broad genus, and as described below, other candidates are already being investigated. IBD comprises two main conditions: CD and UC. The onset of both conditions occurs at all ages, but with a bimodal distribution with peaks in the late teenage/early adult years (particularly CD) and in late adulthood (particularly UC) (Koehoorn et al., 2006). CD is characterized by transmural inflammation of the gastrointestinal tract at any site from mouth to anus. The disease can affect the mucosa in continuity or include healthy areas between affected sites leading to so-called ‘skip lesions’. Such skip lesions are characteristic of CD and, in addition to the hallmark granuloma on biopsy, they are utilized in differentiating CD from UC. UC affects only the mucosal layer of the gastrointestinal tract and extends in continuity proximally from the rectum (Lennard-Jones, 1989). In UC, the colon is involved exclusively, although ‘backwash’ ileitis can be a feature of extensive disease. The aetiology of both conditions is poorly understood, but genetic, immunological and environmental factors all play a role.

Still, these findings indicate that the migration of Treg cells f

Still, these findings indicate that the migration of Treg cells from the gut or other peripheral tissues back into the draining LN might be a general feature of Treg-cell trafficking and have a profound role on the function of these cells. This is supported by findings suggesting that CCR7 is crucial to permit relocation of tissue-residing Treg cells to the draining LN [35]. There are compelling data supporting an important function of iTreg cells in intestinal tolerance since oral tolerance LY2157299 price against OVA does not require nTreg cells [22] but rather iTreg cells [23, 36]. Thus, at least in

the OVA model, iTreg cells but not nTreg cells are essential. However, it is conceivable that nTreg cells also survey the gut tissue as part of their body-wide task to protect the host from T-cell driven autoimmune responses. Beyond

this surveillance role, why should not nTreg cells participate in establishing tolerance to the gut-specific antigenic load in the form of food and microbial antigens? At least in an inflammatory context, this is indeed the case. In models of experimental colitis where Treg cells need to keep immune responses to a broad heterogeneity of PD-0332991 ic50 antigens in check, both nTreg- and iTreg-cell populations contribute in a nonredundant manner to protect from fatal disease outcomes [4, 5]. Therefore, the local condition and the nature of the antigenic compound — ranging from food constituents and self-antigen to PAMPs — may preferentially require either iTreg or nTreg cell-borne protection GABA Receptor and in many cases, successful Treg-cell responses might rely on the involvement of both Treg-cell subsets. Given that nTreg and iTreg

cells differ in their TCR repertoire and may also diverge in the mode/efficacy of their suppressive mechanisms [6], one advantage of recruiting both cell types to participate in immune inhibition would be the availability of a combined and thus broader repertoire of TCRs, as well as broader inhibitory tools. We hypothesize that both iTreg and nTreg cells can acquire LN- and tissue-specific homing patterns upon antigen contact, even at the subinflammatory levels that characterize the daily (nondiseased) situation [8, 23]. Typically, these migration patterns are not too restrictive but also permit organism-wide dissemination of Treg cells in order to communicate (and possibly coordinate) immune activities. The intestine stands out with respect to the load and diversity of antigens encountered by immune cells. Along the road to fully appreciate Treg-cell contributions to intestinal homeostasis, it will be important to collect data regarding the identity of antigenic epitopes recognized by nTreg and/or iTreg cells. Moreover, the importance of recirculation between LNs and the drained extra-lymphatic tissue for the shaping and function of Treg cells deserves more attention.

For in vitro NK-cell co-cultures,

FCS was replaced by 5%

For in vitro NK-cell co-cultures,

FCS was replaced by 5% normal human AB serum (NHS) (Nabi, Boca Raton, FL, USA). Recombinant human (rh)IL-12p70 and rhIL-18 were purchased from R&D Systems (Minneapolis, MN, USA) and from Bender MedSystems (Burlingame, CA, USA), respectively. Ficoll-Paque™ was obtained from Amersham Biosciences AB (Uppsala, Sweden). Monensin and Brefeldin A were purchased from eBioscience (San Diego, CA, USA) and Sigma (St. Louis, MO, USA), respectively. Autologous LCL was generated in our laboratory as previously described and was used as EBV+ stimulators in functional assays 38. NK-cell phenotype was determined by seven-color flow cytometric analysis as previously described 8. Briefly, 100 μL whole blood or 0.1×106 PBMC aliquots were incubated for 30 min at room temperature or 4°C, respectively, in the dark with different see more combinations

of fluorochrome-conjugated mAbs, such as anti-CD3, anti-CD19, anti-CD56, anti-CD16, anti-NKG2D and anti-PD-1 (all from e-Bioscience), anti-NKp46 (Miltenyi Biotech GmbH, Auburn CA, USA). Stained aliquots from whole blood were further incubated for 10 min at room temperature with PD98059 concentration 2 mL/tube of lysing buffer (BD Bioscience) to allow red blood cell lysis. All tubes were then washed twice with FACS buffer (PBS supplemented with 1% FCS, and 0.05% NaN3) and fixed with 2% paraformaldehyde-containing FACS buffer (Sigma). Appropriate isotype negative controls were always used to define background staining. Data acquisition was performed using an LSR II (BD Biosciences) and analyzed using the FlowJo software (Tree Star, Ashland OR, USA). Thawed PBMC (1×106 cells/mL) were plated in 48-well plates (Costar Corning, Corning, NY, USA) in the presence

of (i) hrIL-12p70 Orotidine 5′-phosphate decarboxylase (10 ng/mL)+hrIL-18 (20 ng/mL) or (ii) autologous LCL cells (at 5:1 NK:LCL ratio) for 18 h at 37°C, 5% CO2. PBMCs cultured in media alone were used as negative controls. In selected experiments, neutralizing antibodies against PD-1 (R&D Systems) were added at 20 μg/mL at co-culture initiation. NK-cell degranulation upon activation, as a direct measurement of cytotoxicity, was assessed by CD107a staining, as previously described 39. Briefly, anti-CD107a mAb (eBioscience) was added at co-culture initiation. During the last 4 h of co-culture, monensin (2 μM) and brefeldin A (15 μg/mL) were added to each condition according to the manufacturer instructions. Cells were then harvested, washed, surface stained and fixed as described above. NK-cell intracellular cytokine staining was detected simultaneously by further cell permeabilization with 2% saponin (Sigma) and intracellular staining with anti-IFN-γ mAb (eBioscience). Appropriate isotype negative controls were always used to define background staining.

23 Although the classification of CD+ve T-cells subsets has expan

23 Although the classification of CD+ve T-cells subsets has expanded to include TH17 and Treg, the TH1/TH2 paradigm has indelibly shaped our understanding cellular immune responses.24 The capability to study cytokine biology and T-cell effector function in sheep find more is improving because of an expanding portfolio of ruminant/ovine-specific immunological reagents.6 However, despite the availability of molecular probes and antibodies to ovine IFN-γ and IL-4, the TH1/TH2 paradigm has never been conclusively

demonstrated in sheep. This has principally been as a result of technical problems in the generation and maintenance of ovine T-cell clones. Furthermore, high variability in cellular immune responses at a polyclonal level in sheep can complicate data interpretation.25 Despite these difficulties, immunological correlates of protection against OEA have been identified at both the cellular and cytokine level and are important steps in our progress towards the development of new and improved disease control measures such as vaccination based on recombinant bacterial components. The knowledge that sheep acquire protective immunity to OEA after abortion

allows targeted dissection of that response (availability of immunological reagents AZD6244 cost permitting). We have previously reported that peripheral blood mononuclear cells (PBMC) from sheep experimentally infected with C. abortus before mid-pregnancy are primed to secrete

IFN-γ (but not IL-4) when mitogenically restimulated in vitro with concanavalin A (Con A). In those studies, the greatest amounts of IFN-γ were found in cultures of PBMC collected from sheep around the time of abortion or in cultures of PBMC collected STK38 from sheep after infection that did not abort, suggestive of a TH1-type protective immune response.21 However, the cellular source of this IFN-γ within the PBMC population has not yet been identified. The functional roles of specific cell subsets in host protection against chlamydial infections have only been conclusively identified to date in congenic mice using adoptive cell transfers, cell depletions or targeted gene knock-outs. However, these resources and techniques are not available in sheep, and thus the relative importance of CD4+ve T cells over other lymphocyte populations for host protection against OEA remains to be fully defined. However, the correlation between IFN-γ production and host immune control of C. abortus infection in sheep is more definitive than the identification of cell subsets producing the IFN-γ.

Results: Up to June, 2012, 15849 patients which came from 115 hem

Results: Up to June, 2012, 15849 patients which came from 115 hemodialysis facilities in Beijing Palbociclib were reported by the Beijing Hemodialysis Quality Control and Improvement Center(BJHDQCIC). Among them 9495 cases (male 4971, 52.4%; female 4524, 47.6%) have complete follow up records of clearly indentify categories demography, serum calcium, serum phosphate and iPTH. The survive rate is significant different among three groups (P < 0.0001). Using Cox hazards regression model analysis, we found the age is old or young apparently related the mortality when age >60 (HR = 2.572,95%CI 2.311,2.862); age < 40 (HR = 0.508,95%CI 0.384,0.572); age 40∼60, reference = 1.

The hemodialysis vintage 0.05). Conclusion: The risk of mortality was increased in senior hemodialysis patients with diabetic nephropathy or hypertensive nephropathy, hemodialysis time less than one year, lower serum calcium and lower PTH. Based on 2003 KDOQI guideline, the lowest survive rate in three groups is when iPTH < 150 pg/ml. The hemodialysis patients with iPTH > 300 pg/ml have the higher survive rate due to

calcitriol treatments and parathyroidectomy were applied during follow up. LEE check details YOUNG-KI, CHOI SUN RYOUNG, CHO AJIN, KIM JWA-KYUNG, CHOI MYUNG-JIN, KIM SOO JIN, YOON JONG-WOO, KOO JA-RYONG, KIM HYUNG JIK, NOH JUNG-WOO Department of Internal Medicine & Hallym Kidney Research Institute, Hallym University College of Medicine Introduction: Vascular calcification is thought to oxyclozanide be associated with a significant mortality and morbidity in patients with chronic kidney disease. It is well recognized that the prevalence of vascular calcification increases with progressively decreasing kidney function. Although the KDIGO recommended that a lateral abdominal radiograph be used to detect the presence or

absence of vascular calcification, the risk factors for progression of calcification are not clearly elucidated. Therefore, we investigate the predictors of vascular calcification progression in patients on maintenance hemodialysis. Methods: This study was prospective observational study. Lateral lumbar radiography of the abdominal aorta was used to evaluate the overall abdominal aorta calcification (AAC) score, which is related to the severity of calcific deposits at lumbar vertebral segments L1–L4. Lumbar radiography was performed at baseline and after 1 year, respectively. The progression of AAC score was defined by any increase in Δcalcification (the change of AAC score). Results: The subjects were 124 patients on maintenance hemodialysis. 68 (58.1%) were female. The mean age was 57.2 ± 10.9 years, and the vintage of dialysis was 56.7 ± 53.8 months. The underlying renal diseases were diabetes mellitus in 66 (56.4%) patients. The mean baseline AAC score of the study population was 6.2 ± 6.0. The independent risk factors of AAC were age, presence of cardiovascular diseases, and dialysis vintage.

, 2005) The influence of lactic acid on cytokine production by p

, 2005). The influence of lactic acid on cytokine production by peripheral blood mononuclear cells (PBMCs) has not Rapamycin been determined previously, and is the subject of this communication. The findings have biological relevance for an enhanced understanding of infection-related immune mechanisms operative in the lactic acid-dominated female lower genital tract. Venous blood was obtained from 10 healthy female and male volunteers and PBMCs isolated by Ficoll-Hypaque (GE Healthcare Biosciences, Piscataway, NJ) gradient centrifugation. The mononuclear

cell band was recovered, the cells were washed twice in RPMI 1640 culture medium (Invitrogen, Carlsbad, CA) and resuspended in RPMI to a final viable concentration of 1 × 106 cells mL−1. Viability was determined by trypan blue exclusion. The PBMCs were added to the wells of a sterile microtiter plate (1 × 105 cells per well) that contained RPMI medium±various concentrations

of l-lactic acid (Sigma-Aldrich, St. Louis, MO) or l-lactic acid that had been neutralized with sodium hydroxide to the pH of RPMI medium. In other experiments, hydrochloric acid (HCl) was added to RPMI medium to match the pH obtained by lactic acid addition. After incubation for 24 h in a 37 °C, 5% CO2 incubator, either lipopolysaccharide (50 ng mL−1Escherichia coli serotype 0111:B4, Sigma-Aldrich) or an equivalent volume of RPMI was added to quadruplicate wells and incubation LY2606368 supplier was continued for another 24 h. The culture supernatants were then collected by centrifugation and stored at −80 °C until assayed for cytokines. Cell viability as well as the pH in each well were checked at the conclusion of the experiment. All reagents were filter sterilized before use and a sterile technique was used throughout. The study was approved by

the institutional review board of the Weill Cornell Medical Center–New York Presbyterian Hospital and written informed consent was obtained from all participants. The culture supernatants were tested in duplicate for IL-23, IL-12, IL-10, IL-6 and tumor necrosis factor-α (TNF-α) using commercial enzyme-linked immunosorbent Elongation factor 2 kinase assay kits (ebioscience, San Diego, CA for IL-23 and IL-12; Invitrogen for IL-10 and TNF-α; R&D Systems, Minneapolis, MN for IL-6). Experimental values were averaged and converted to pg mL−1 by reference to a standard curve that was generated in parallel to the test samples. The lower limits of sensitivity were 15 pg mL−1 for IL-23, 4 pg mL−1 for IL-12, 0.2 pg mL−1 for IL-10, 9.4 pg mL−1 for IL-6 and 1.7 pg mL−1 for TNF-α. The associations between cytokine levels and incubation condition were analyzed using the Mann–Whitney test. A P value of<0.05 was considered significant. graph pad instat (Graft Pad Software, San Diego, CA) was utilized for the analysis. The addition of lactic acid to PBMCs incubated with lipopolysaccharide resulted in a marked increase in IL-23 secretion over that released in the presence of lipopolysaccharide alone (P=0.0068).