To purify CMVpp65495–503-specific CD8+ T cells, purified total CD8+ T cells from CMVpent+ subjects were stained with the biotin mAb cocktail for CD8+ T-cell isolation and subsequently with Streptavidin-PE and CMVpent-APC (Proimmune). CMVpent+ cells were sorted in a FACSAria to 95% purity. Human neonatal CD8+ T cells from UCBMC were labeled with anti-CD8 microbeads (Miltenyi) and purified using Estrogen antagonist POSELD2 program (purity of CD3+CD8+≥90%). Purified

CD8+ T cells were cultured (5×105 cells/mL) with medium alone (RPMI-glutamax medium (Invitrogen) supplemented with 10% FCS (Sigma) and 1% penicillin/streptomycin (Invitrogen)) or medium containing IFN-α2b, IFN-α5, anti-CD3/CD28-Beads (Beads coated with anti-human CD3 and CD28 mAb)

(Invitrogen) alone or together with IFN-α (IFN-α2b or IFN-α5). The IFN-α dose was 500 IU/mL. Beads were used at a 1:10 Beads:cell ratio. Purified CMVpp65495–503-specific CD8+ T cells were left unstimulated or stimulated with anti-CD3/CD28-Beads alone or together this website with IFN-α, in IL-2-conditioned medium (50 IU/mL) (Peprotech). In some cases, previously to stimulation, CD8+ T cells were labeled with 1.25 μM of CFSE (Sigma-Aldrich). In some cases, freshly purified CD8+ T cells were directly co-cultured (4 h) (i) with control IgG- or anti-CD3 OKT3 mAb-loaded p815 target cells (E:T ratio=10:1) or with (ii) HLA-A2+ T2 cells (E:T=5:1) loaded with HLA-A2-restricted control peptide (Leukocyte Proteinase-3169–177) or CMV peptide (Proimmune), in the presence or absence of IFN-α. To facilitate

IFN-γ detection by intracellular staining, cells were cultured in the presence of Brefeldin A (10 μg/mL) (Sigma-Aldrich) for the last 6 h of culture or along the culture (in the case of 4 h short-term assay). For the detection of CD107a, cells were cultured in the presence of anti-human CD107a-PE mAb (H4A3) or mouse IgG1-PE (10 μg/mL) (BD Biosciences) and Monensine (1 μg/mL) (Sigma-Aldrich). Total C-X-C chemokine receptor type 7 (CXCR-7) RNA was extracted using the nucleic Acid Purification lysis solution and the semiautomated ABI Prism 6100 Nucleic Acid PrepStation system (Applied Biosystems). Total RNA was treated with DNase prior to RT with M-MLV reverse transcriptase in the presence of RNaseOUT (all from Invitrogen). Real-time RT-PCR was performed using the CFX96 Real-time system, the IQ SYBR Green Mix (BioRad) and specific primers for each gene (Supporting Information Table 3). Results were normalized to β-actin. The amount of each transcript was expressed by the formula: 2Δct [Δct=ct(β-actin)-ct(gene], with ct as the point at which fluorescence rises appreciably above background fluorescence. Cells stained with fluorochrome-labeled mAb and/or CFSE were acquired on a FACSCalibur (BD Biosciences) and analyzed using FlowJo (Tree Star). Fold expansion was calculated as the output/input ratio of the absolute numbers of cells determined using Trucount beads (BD Biosciences).

m. did induce Gag-specific gut-homing T cells [20]. Thus, in the BALB/c mice, triple regimens of DCM and OSI-906 DMC elicited robust CD8+ TEM cells early after vaccination, which converted into TCM and in the spleen maintained the markers for GALT homing. In the first part of this work, we rederived ChAdV-68 by inserting its whole genome into a BAC in a single step, which simultaneously generated a deletion at the E1 locus, for easy further manipulation using recombineering. This simplified cloning strategy paves a way for future derivation and exploration of other human and animal adenoviruses so far untested

for vaccine delivery [40]. The application of BAC recombineering also facilitates modulation of adenovirus immunogenic properties by rational activation of various innate pathways, which will in turn lead to functionally distinct properties of vaccine-elicited

adaptive responses. Clearly, not all the HIV-1-host interactions and workings of the immune system are yet completely understood to, on one hand, identify desired protective properties of vaccine-elicited T cells and, on the other hand, manipulate the intra- and intercellular signaling so as to bias the actively induced responses toward a desired type. Nevertheless, BAC-facilitated selleck kinase inhibitor genetic manipulation prepares the grounds for such future molecular manipulations. The AMQ epitope-mediated protection of BALB/c mice against EcoHIV/NDK infection [35] best approximates the clearance of HIV-1-infected cells during primary HIV-1 infection. For human vaccines, Gag is a suitable first-generation immunogen, to which broad and robust T-cell responses correlate with good control of chronic HIV-1 infection

[43]. For more efficient early protection particularly in humans, responses to conserved regions of HIV-1 [44, 45] that the virus cannot easily change without Interleukin-3 receptor a likely significant fitness cost and/or mosaic protein design [46] might be even more beneficial due to the increase coverage of HIV-1 variants and escape mutants. However, these are theoretical arguments: which vaccine design will induce the most effective T-cell responses can be only determined by protection of humans against acquisition of HIV-1 and/or decrease of virus load at set point, which in turn delays development of AIDS possibly without the need of antiretroviral drugs. While the HIV-1-derived Tg determines specificity of the vaccine-elicited T cells, route of immunization and choice of vaccine vector(s) determine the T-cell quality, tissue localization and longevity [47, 48]. In this respect, ChAdVs are gaining center stage as vectors for subunit vaccines against a number of challenging infections such are malaria, HCV, pandemic influenza virus, and HIV-1 [7].

Both examinations showed many abnormal processes in oligodendroglial-like cells with round nuclei. In contrast, few reactive astrocytes that demonstrated immunoreactivity for glial fibrillary acidic protein were found in this area. Tau accumulation

was present in 37% of cases. There was no correspondence with the regions showing increasing numbers of nestin or CD34-positive cells. There were no significant associations between epileptic GSK2126458 solubility dmso clinical parameters and the incidences of the abovementioned immunopositive cells. CD34-positive cells and nestin-positive cells are found as frequently as balloon cells and are associated with abnormal reconstitution of the cortex. These findings support the assertion that increases in the numbers of these cells might contribute to promoting epilepsy. In Bcl-2 inhibitor addition, these immunopositive cells

are valuable findings for the pathological identification of epileptogenic lesions. “
“One of the insidious biological features of gliomas is their potential to extensively invade normal brain tissue, yet molecular mechanisms that dictate this locally invasive behavior remain poorly understood. To investigate the molecular basis of invasion by malignant gliomas, proteomic analysis was performed using a pair of canine glioma subclones – J3T-1 and J3T-2 – that show different invasion phenotypes in rat brains but have similar genetic backgrounds. Two-dimensional protein electrophoresis of whole-cell lysates of J3T-1 (angiogenesis-dependent invasion phenotype) and J3T-2 (angiogenesis-independent invasion phenotype) was performed. Twenty-two distinct spots were recognized when significant alteration was defined as more than 1.5-fold change in spot intensity between J3T-1 and J3T-2. Four proteins that demonstrated increased expression in J3T-1, and 14 proteins that demonstrated increased expression in J3T-2 were identified using liquid chromatography-mass spectrometry analysis. One of the proteins

identified was annexin A2, which was expressed at higher levels in J3T-1 Loperamide than in J3T-2. The higher expression of annexin A2 in J3T-1 was corroborated by quantitative RT-PCR of the cultured cells and immunohistochemical staining of the rat brain tumors. Moreover, immunohistochemical analysis of human glioblastoma specimens showed that annexin A2 was expressed at high levels in the tumor cells that formed clusters around dilated vessels. These results reveal differences in the proteomic profiles between these two cell lines that might correlate with their different invasion profiles. Thus, annexin A2 may be related to angiogenesis-dependent invasion. “
“Calcium dyshomeostasis is implicated in the pathogenesis of several neurodegenerative disorders including Alzheimer’s disease. However, much of the previous research has focused on changes in neuronal calcium signalling.

Without close supervision,

many patients with TB are unable to complete a full course of medication, which results in relapse and acquired drug resistance [17]. China has the second highest burden of TB. The challenge we are facing for the control of TB is a dilemma because of the high incidence of MDR-TB and the lack of funding for the treatment with second-line anti-TB drugs. Previous studies demonstrate that DNA vaccine has a pronounced therapeutic action on TB in mice [8, 9]. In addition, immunotherapy with plasmid DNA encoding mycobacterial antigen in association with conventional chemotherapy is a more rapid and effective form of treatment on reactivation and reinfection of M. tb [10, 11]. In the present study, we test whether immunotherapy with DNA vaccine in combination with RFP or PZA result in effective treatment Ku-0059436 in vivo of MDR-TB in infected mice. Mycobacterium tuberculosis Ag85A DNA vaccine is a strong immunotherapeutic agent for MDR-TB [14] and TB [8–11]. Th2 response is abundant during M. tb infection; therefore, the therapeutic effect is associated with not only prompt Th1 response but also switching from an improper status to a protective one. In the current study, significantly Navitoclax in vivo more T cells that secrete IFN-γ are elicited by Ag85A DNA vaccination, and lower

amount of IL-4 are observed in Ag85A DNA vaccine immunized mice, suggesting a predominant Th1 immune response. RFP alone fails to kill the bacteria, but PZA alone is able to kill the bacteria, which suggest that MDR-TB model has been developed successfully. Vaccination with Ag85A DNA vaccine

associated with RFP reduces the pulmonary and splenic bacterial loads by 1.34 and 1.28 logs, respectively, compared with those of the RFP groups, which proves again that Ag85A DNA vaccine is the most efficient immunotherapy for MDR-TB in mice. This is consistent with our previous study [14]. Although Ag85A DNA vaccine associated with PZA treatment reduces the splenic infectious bacterial loads, it fails to reduce the pulmonary infectious bacterial loads when compared with the PZA alone groups. These results suggest that Ag85A DNA selleck inhibitor vaccine fails to strengthen the drug effect of PZA in killing infectious bacteria in lungs, but prevents haematogenous dissemination of M. tb to the spleens. Cai et al. [12] demonstrate that combined DNA vaccine may be a valuable adjunct to shorten the duration of antibacterial chemotherapy. The data of this study indicate that immunotherapy with RFP or PZA results in effective treatment of MDR-TB in infected mice. In conclusion, M. tb Ag85A DNA vaccine has obvious immunotherapeutic effect on TB and MDR-TB in mice. DNA vaccination associated with conventional chemotherapy may have synergistic effect for this treatment. The therapeutic Ag85A DNA vaccine and its combination with anti-TB drugs may be promising and affordable strategies for the treatment of MDR-TB disease in developing countries.

Seven months after implantation in October 2001, the knee prosthesis was finally removed after consent of the patient. Fungal and

bacterial cultures taken at this time remained negative. The patient showed a fast clinical improvement with a reduction of ESR and CRP to 23 and 16, respectively. Itraconazole therapy was continued with 400 mg day−1 for another 6 months. Serum levels were not measured during ITZ treatment. One Selleckchem Mitomycin C month after the termination of ITZ administration, the patient developed a recurrence of infection with a draining fistula close to the knee. Therefore, in March 2002, the patient was referred for a second opinion to a tertiary care orthopaedic reference centre. The consultant advised to amputate the leg just above the knee to allow the proper fitting of a limb prosthesis. The patient refused to follow the advice of limb amputation. But in September 2002 he agreed to an arthrodesis of the knee with an external fixation devise. Cultures taken during the arthrodesis were negative. Four months after placement, the external fixation devise was removed but in January 2003 (only 1 month after removal) the patient presented again with

pain, mild swelling, skin lesions and one pus-producing fistula in a scar above the proximal left tibia (Fig. 3). Magnetic resonance imaging selleck kinase inhibitor (MRI) showed a multi-loculated abscess on the anteromedial side of the left tibia and infiltration of the local tissue (Fig. 4a,b), while MRI of the upper leg was without pathological findings. During surgical exploration of the lower leg, several subcutaneous collections of fluid were excised and again P. apiosperma was cultured. In vitro Nintedanib (BIBF 1120) susceptibility testing according to CLSI 38A2 broth microdilution15 after almost 1 year of ITZ therapy showed that the causative P. apiosperma strain had high minimal inhibitory concentrations (MIC) of amphotericin B (16 mg l−1), ITZ (>16 mg l−1), and isavuconazole

(16 mg l−1). The lowest MICs/MECs (minimal effective concentrations) were found for voriconazole (VORI; 1 mg l−1), posaconazole (1 mg l−1), caspofungin (1 mg l−1), anidulafungin (0.5 mg l−1) and micafungin (0.125 mg l−1). Because VORI was just registered in the European Union in 2003, with the label to treat Scedosporium and Pseudallescheria infections and based on our in vitro susceptibility results, previous case reports with favourable outcome,16–18in vitro studies19,20 and in vivo results21,22 with Scedosporium strains, the antifungal therapy was changed from ITZ to oral VORI (loading dose: 2 dd 400 mg for two days, followed by 1 dd 400 mg). As the patient was not clinically improving and ulcerous skin lesions persisted, suggesting progression and spreading of the Scedosporium infection, an above knee amputation was carried out in April 2003, six weeks after initiation of VORI therapy.

UC manifests as a TH2 cytokine (IL-4, IL-5, and IL-13)-driven erosion of the intestinal epithelium 23, 24, 51–53. On the contrary, Crohn’s colitis is driven by TH1 and TH17 cytokines (IFN-γ, IL-17A/F) 3, 54. Although the etiology of UC remains unclear, recent studies

have focused on the role of IL-33, an IL-1 family cytokine that instructs type 2 inflammation 25. In human UC patients, IL-33 expression is highly upregulated within the intestinal mucosa and IL-33-deficient mice are protected from DSS-induced intestinal immunopathology 23, 24, 55. Our data show that CD68TGF-βDNRII mice produce high levels selleck chemical of IgE and IL-33 within the colon following DSS-induced gut injury. One source of IL-33 in CD68TGF-βDNRII mice was intestinal Mϕs, which demonstrates that TGF-β serves an important role in limiting intestinal inflammation through suppression of IL-33. This may be an important mechanism that could partially explain the reason how mutations in TGF-βRII

in humans are associated with increased risk for UC and UC-associated cancer 19, 20. Thus, it Napabucasin research buy is tempting to speculate that blockade of IL-33 during UC may help to reduce the severity of colitis in these patients. Overall, we demonstrate that mice engineered to have a specific impairment of TGF-β responsiveness in Mϕs develop increased severity of DSS-induced colitis during the resolution phase. This suggests that TGF-β-mediated regulation of Mϕs function serves an important role in the suppression of intestinal inflammation following acute injury. In this regard, it will be important to determine whether CD68TGF-βDNRII mice develop altered susceptibility or resistance to infectious diseases or show defects in tissue repair mechanisms in other model

systems. The Ribonucleotide reductase TGF-βDNRII construct was obtained from Dr. Chung Lee at Northwestern University in a plasmid that encodes the extracellular and transmembrane domains, but lacks the cytoplasmic region for human TGF-β receptor II (−5 to 553), which blocks TGF-β responsiveness in vivo 56. This region was subcloned into a modified pcDNA3.1™ (Invitrogen) using Not 1 and Xho 1. The 1 kb promoter sequence from human CD68 (macrosialin) including the 89 bp intronic enhancer (provided by Peter Murray at St. Jude Hospital) 26 was inserted 5′ to TGF-βDNRII as a BamH1-EcoRV fragment and confirmed by restriction digest and DNA sequencing. CD68TGF-βDNRII mice were generated by pronuclear injection of fertilized C57BL/6 oocytes at the University of Cincinnati Transgenic core facility. Offspring were analyzed for genotype by PCR using primers specific for CD68IVS1 and human TGF-β type II. All mice used in the study were age-matched male mice on a C57BL/6 background. All experiments were performed with age-/sex-matched nontransgenic littermates used as controls.

Assess the risk for CI-AKI using tools such as medical history, physical examination and, in higher risk groups, laboratory investigations in all patients who are considered for a procedure that requires intravascular learn more administration of iodinated contrast medium. The optimal imaging modality for the

likely diagnoses should always be considered. In patients at increased risk for CI-AKI, the balance of all risks and benefits of the imaging modality should be evaluated. Use the lowest possible dose of contrast medium in patients at risk for CI-AKI. During AKI we recommend commencing RRT using anticoagulation unless the risk is considered unacceptable. (1B) If a patient is receiving systemic anticoagulation, we Cobimetinib solubility dmso suggest that this may be sufficient for RRT. (2B) For anticoagulation in intermittent RRT, we recommend using either unfractionated or low molecular weight heparin, rather than other anticoagulants. (1C). For anticoagulation in CRRT, we recommend using either regional citrate anticoagulation, low dose unfractionated heparin, a protocol based heparin dose

targeting a systemic APTT or a weight based dose of low molecular weight heparin. The choice should be based on patient characteristics and local practices and resources. (1B) For CRRT in a patient with impaired coagulation or increased bleeding risk: it is reasonable to choose between no anticoagulation with attention to optimizing circuit function and regional anticoagulation either with UFH and protamine or citrate. (2C) In a patient with suspected heparin induced thrombocytopenia (HIT), all heparin must be stopped. We recommend using direct Nabilone thrombin inhibitors (such as argatroban)

or Factor Xa inhibitors (such as danaparoid or fondaparinux) rather than other or no anticoagulation during RRT. (1A) In a patient with HIT who does not have severe liver failure, we suggest using argatroban rather than other thrombin or Factor Xa inhibitors during RRT. (2C) We suggest that when a patient with AKI requires RRT, the decision to use anticoagulation for RRT is based on the risks and benefits of anticoagulation to the patient. Excessive clotting should be managed with attention to both anti-coagulant and non-anticoagulant factors. Dose and delivery of dialysis We recommend the following dose of dialysis should be prescribed/delivered in AKI patients: In AKI, peritoneal dialysis may be prescribed in order to achieve the goals of fluid, electrolyte and acid base balance, depending on local resources that are available. No recommendations or suggestions possible due to lack of evidence. R.G.

Agaricus blazei Murill, like Gf, is rich

in immunostimulatory mixture of β(1-3)-, β(1-4)- and β(1-6)-d-glucans with antitumour activity [4], probably secondary to modulation of NK-cells [5] and monocytes/macrophages of native MK-2206 cell line immunity [6–8]. In vitro AbM stimulates mononuclear phagocytes to secrete nitric oxide [9] and pro-inflammatory cytokines like IL-1β, IL-6 and TNF-α and chemokine IL-8 [9, 10]. Recently, the stimulatory effect of the AbM-based mushroom extract (AndoSan™; ACE Co. Ltd., Gifu, Japan) on cytokine production (TNF-α, IL-1β, IL-6, IL-8, G-CSF and MIP-1β) in monocyte-derived dendritic cells has also been demonstrated [11]. The effects are probably mediated by binding of sugars in AbM to Toll-like

receptor-2 (TLR-2) [12], but also to dectin-1 [13] and the lectin-binding site of CD11b/18 [14] and possibly CD11c/18 [15]. Gene microarray expression analysis of promonocytic THP-1 tumour cells [16] supported these results because stimulation with AbM strongly upregulated genes for IL-1β and IL-8, moderately for TLR-2 and co-operative molecule MyD88, but not for TLR-4. On the other hand, daily consumption of 60 ml of the current AbM-based extract for 7 days in patients with chronic hepatitis C [17] had no effect in vivo on the expression of these PLX-4720 chemical structure genes in blood cells. Recently, we reported that AbM stimulation of whole blood ex vivo [18] stimulated the release of all the 17 different cytokines, chemokines and leucocyte growth factors tested. The cytokines were pro-inflammatory (IL-1β, IL-6, TNF-α), anti-inflammatory (IL-10) and pleiotropic 4��8C (IL-7, IL-17) and of the Th1- (IFN-γ, IL-2, IL-12) and Th2 types (IL-4, IL-5, IL-13). In addition, chemokines IL-8, MIP-1β, MCP-1 and

leucocyte growth factors G-CSF and GM-CSF were also studied. On the other hand, when blood was collected from volunteers prior to and 12 days after their daily intake (60 ml) of AbM, there was in vivo either a significant reduction in cytokine levels for IL-1β, TNF-α, IL-6, IL-2 and IL-17 or unaltered levels of the remaining 12 factors. This pointed to a stabilizing and anti-inflammatory effect of AbM in vivo when given via the oral route. Patients with inflammatory bowel disease (IBD) like ulcerative colitis (UC) and Crohn’s disease (CD) have in the colon mucosa an unselective increase in chemokine expression including that of MIP1-β, MCP-1 and IL-8 [19] as well as cytokines IL-1β [20], IL-6 and TNF-α [21]. Cytokine levels in serum, however, are less extensively studied, but increased levels of IL-6 [22] and TNF-α [23, 24] have been detected in patients with UC and CD. Recently, increased serum levels of the chemokine MIP-1β were found in patients with UC [25]. The IBD, UC and CD are autoimmune diseases of Th2 and Th1 nature, respectively.

T-cell cultures differentiated in the presence of G-1 secreted threefold more IL-10, with no change in IL-17A, tumour necrosis factor-α, or interferon-γ. Moreover, inhibition of extracellular signal-regulated kinase (but not p38 or Jun N-terminal

kinase) signalling blocked the response, while analysis of Foxp3 and RORγt expression demonstrated increased numbers of IL-10+ cells in both the Th17 (RORγt+) and Foxp3+ RORγt+ hybrid T-cell compartments. Our findings translated in vivo as systemic treatment of male mice with G-1 led to increased IL-10 secretion from splenocytes following T-cell receptor cross-linking. These results demonstrate that G-1 acts directly on CD4+ T cells, and to our knowledge provide the first example of a synthetic small molecule capable of eliciting IL-10 expression in Th17 or hybrid T-cell populations. CD4+ helper T lymphocytes orchestrate adaptive immune responses to invading Metabolism inhibitor pathogens, and are critical to the pathogenesis Veliparib research buy of numerous disease processes, including autoimmunity and cancer. They are an attractive drug target because of their central role in immunity, and their implication in a wide variety of diseases. There are

several distinct lineages of CD4+ helper T cells, each specialized in enhancing specific branches of the immune system. The original paradigm described by Mossman and Coffmann1 divided Orotic acid CD4+ helper T lymphocytes into the T helper type 1 (Th1) and Th2 populations, with Th1 cells producing interferon-γ (IFN-γ) and coordinating

cellular immunity responses and Th2 cells secreting humoral immunity mediators such as interleukin-4 (IL-4), IL-5 and IL-13. In 2005, the Th1–Th2 paradigm was expanded as the Th17 population emerged as a third class of helper/effector T cell. Th17 cells are characterized by expression of the transcription factor RORγt,2,3 and secrete pro-inflammatory cytokines including IL-214 and IL-17A/F. These cells are important to controlling infections by extracellular pathogens, but also appear to play a deleterious role in human health by contributing to the pathogenesis of numerous autoimmune diseases.5 In mice, Th17 differentiation depends on transforming growth factor-β (TGF-β) and IL-6- or IL-21-mediated signal transducer and activator of transcription 3 (STAT3) activation,5 while IL-23 signalling plays a critical role in stabilizing the Th17 phenotype.6 Although Th1, Th2 and Th17 effector T cells coordinate a robust and diverse arsenal of adaptive immune responses necessary for the maintenance of human health, mechanisms of restraint must limit effector responses to protect the host from immune-mediated damage. A major breakthrough in elucidating the mechanisms of adaptive immune regulation emerged with the identification of an array of regulatory T (Treg) -cell populations.

Statistical analyses compared responses between (1) ESID and focused AAAAI respondents click here and (2) ESID and general AAAAI respondents. The comparison between focused and general AAAAI respondents has been reported previously [5]. Differences in responses between groups were assessed using χ2 and Fisher’s exact tests for categorical data where appropriate. All data were analysed using STATA version 11·0 (Stata Corp., College Station, TX, USA). Statistical significance was declared with P-values < 0·05. There were 123 responses to our questionnaire, which was a 27·3% response rate and therefore higher than the 13·5% response rate to the AAAAI survey, although the total number of respondents

was greater in the AAAAI survey, in keeping with the larger membership [5]. The higher response rate may be due, in part, to a smaller community of immunologists within ESID or a greater sense of commitment to PID among the ESID membership. In both instances, the questionnaires had relatively low response rates overall. This reflects the general finding that there are lower

responses to e-mail and internet surveys than postal mail surveys [6]. The covering letter from an organizational leader that accompanied the ESID survey may, in part, account for the higher response NVP-AUY922 cell line rate. The disadvantage of low response rates is the risk of substantial non-response bias, but this is likely to be the same for each group. In order to understand the nature of individual respondents generally, information on the length of time since medical graduation and on geographical location of respondents was requested. ESID

respondents Edoxaban had a very similar distribution to the AAAAI respondents (Table 1), in terms of age or length of medical practice. ESID is an international organization and although it was a requirement to be a member of ESID to participate in this questionnaire, there are ESID members located outside Europe. Among the 123 ESID respondents, 105 (85·4%) were located within Europe (Table 2 and Appendix B); the United Kingdom had the largest representation (26 respondents, 21·1%), reflecting the relatively high number of PID centres in the United Kingdom. In addition, six respondents (4·9%) were from the Middle East and 11 (8·9%) from other countries (Table 2 and Appendix B). Non-response bias is a limitation of this present study, as so few questionnaires were returned for analysis. We attempted to minimize response bias by ensuring anonymous responses, as respondents may have otherwise felt pressured to answer with the more ‘socially acceptable’ answer rather than their true beliefs, especially when it comes to patient care and following guidelines. Because the mode of administration was an internet questionnaire, it is conceivable that younger members might have been more apt to respond.