Aeri Moon

Bio: Aeri Moon is an academic researcher from Harvard University. The author has contributed to research in topics: GERD & Population. The author has an hindex of 9, co-authored 11 publications receiving 951 citations. Previous affiliations of Aeri Moon include Albert Einstein College of Medicine & Partners HealthCare.

Iconographies supplémentaires de l'article : Mechanisms of nutrient modulation of the immune response

Abstract: Lack of adequate macronutrients or selected micronutrients, especially zinc, selenium, iron, and the antioxidant vitamins, can lead to clinically significant immune deficiency and infections in children. Undernutrition in critical periods of gestation and neonatal maturation and during weaning impairs the development and differentiation of a normal immune system. Infections are both more frequent and more often become chronic in the malnourished child. Recent identification of genetic mechanisms is revealing critical pathways in the gastrointestinal immune response. New studies show that the development of tolerance, control of inflammation, and response to normal mucosal flora are interrelated and linked to specific immune mechanisms. Nutrients act as antioxidants and as cofactors at the level of cytokine regulation. Protein calorie malnutrition and zinc deficiency activate the hypothalamic-pituitary-adrenal axis. Increased circulating levels of glucocorticoids cause thymic atrophy and affect hematopoiesis. Chronic undernutrition and micronutrient deficiency compromise cytokine response and affect immune cell trafficking. The combination of chronic undernutrition and infection further weakens the immune response, leading to altered immune cell populations and a generalized increase in inflammatory mediators. Obesity caused by excess nutrition or excess storage of fats relative to energy expenditure is a form of malnutrition that is increasingly seen in children. Leptin is emerging as a cytokine-like immune regulator that has complex effects in both overnutrition and in the inflammatory response in malnutrition. Because the immune system is immature at birth, malnutrition in childhood might have long-term effects on health.

Mechanisms of nutrient modulation of the immune response.

Abstract: Lack of adequate macronutrients or selected micronutrients, especially zinc, selenium, iron, and the antioxidant vitamins, can lead to clinically significant immune deficiency and infections in children. Undernutrition in critical periods of gestation and neonatal maturation and during weaning impairs the development and differentiation of a normal immune system. Infections are both more frequent and more often become chronic in the malnourished child. Recent identification of genetic mechanisms is revealing critical pathways in the gastrointestinal immune response. New studies show that the development of tolerance, control of inflammation, and response to normal mucosal flora are interrelated and linked to specific immune mechanisms. Nutrients act as antioxidants and as cofactors at the level of cytokine regulation. Protein calorie malnutrition and zinc deficiency activate the hypothalamic-pituitary-adrenal axis. Increased circulating levels of glucocorticoids cause thymic atrophy and affect hematopoiesis. Chronic undernutrition and micronutrient deficiency compromise cytokine response and affect immune cell trafficking. The combination of chronic undernutrition and infection further weakens the immune response, leading to altered immune cell populations and a generalized increase in inflammatory mediators. Obesity caused by excess nutrition or excess storage of fats relative to energy expenditure is a form of malnutrition that is increasingly seen in children. Leptin is emerging as a cytokine-like immune regulator that has complex effects in both overnutrition and in the inflammatory response in malnutrition. Because the immune system is immature at birth, malnutrition in childhood might have long-term effects on health.

Allergic gastroenteropathy in children.

Abstract: Objective: To review the pathogenesis, symptoms, and treatment of gastrointestinal disorders linked to immunopathologic reactions associated with the ingestion of food antigens in infancy and childhood. Data Sources: A computerized MEDLINE search was performed for the following topics: allergic colitis, allergic proctitis, eosinophilic gastroenteritis, eosinophilic colitis, cow milk intolerance, protein losing enteropathy, and malabsorption. This search was restricted to the English language and human subjects. Articles published between 1960 and 1993 were included as references. The textbooks which were used as references include: (1) Walker WA, et al, eds. Pediatric gastrointestinal disease; pathophysiology, diagnosis, management, Philadelphia: BC Decker, 1991; (2) Wyllie R, et al, eds. Pediatric gastrointestinal disease; pathophysiology, diagnosis, management, Philadelphia: WB Saunders, 1993; (3) Targan SR, et al, eds. Immunology & immunopathology of liver and gastrointestinal tract. Igaku-Shoin, 1991; (4) Goldman H, et al, eds. Pathology of the gastrointestinal tract. Philadelphia: WB Saunders, 1992. Conclusion: The symptoms of allergic gastroenteropathy may be those of classic allergic reactions or present as symptom complexes that may include diarrhea, malabsorption, and protein-losing enteropathy. The immunopathogenesis of allergic gastroenteropathy is complex and is still not clearly understood. As our understanding of the gastrointestinal mucosal system evolves, we should be able to manage and care for the infants and children who suffer from this group of disorders better

Positive Association between Helicobacter pylori and Gastroesophageal Reflux Disease in Children

Abstract: Objectives—The role of Helicobacter pylori (H. pylori) in gastroesophageal reflux disease (GERD) remains controversial, particularly in children, since there are limited published data. Adult studies suggested that H. pylori infection may protect against GERD by causing atrophic gastritis, which leads to reduced gastric acid secretion. The objective of our study was to determine the role of H. pylori infection in the development of GERD in a pediatric population. Methods—A retrospective analysis of 420 patients (M:F = 214:206) who underwent esophagogastroduodenoscopy (EGD) with biopsies between January 2000 and April 2006 was conducted. Patient demographics, clinical indications for EGD and the prevalence of reflux esophagitis (RE), the biomarker for GERD, in two groups, H. pylori positive and H. pylori negative, were reviewed. The prevalence of RE in the H. pylori positive and H. pylori negative groups was further analyzed based on gender and age ( 10 yrs). The mean age of the study population was 8.2 years (range 0 – 20 yrs). The clinical indications for EGD were as follows: recurrent abdominal pain (n = 186, 44%), malabsorption (n = 80, 19%), persistent vomiting (n = 80, 19%), suspected eosinophilic gastrointestinal disorders (n = 63, 15%) and others such as upper GI bleeding or IBD surveillance (n = 11, 3%). Statistical analysis was performed by using Chi-square test, Fisher’s exact test and multivariate logistical regression analysis. Results—Among the 420 patients, 16 patients (3.8%) were positive for H. pylori and 167 patients (39.8%) were found to have RE. Thirteen patients with H. pylori were found to have histologic evidence of RE. The prevalence of RE in the H. pylori positive population was 81.3% compared to 38.1% in the H. pylori negative population (p ≤ 0.05). There were no patients with H. pylori in the youngest age group. In the second age group (1–10 yrs), 100% of the H. pylori positive patients had RE while 44.6% of the H. pylori negative patients had RE (p ≤ 0.05). Both male and female patients with H. pylori had a higher prevalence of RE, 77.8% and 85.7% respectively. On a multivariate logistical regression, for the overall study cohort, H. pylori positive patients had an odds ratio of 5.79 of developing RE compared to H. pylori negative patients (p ≤ 0.05). Conclusions—Our study results indicate that there is a significantly higher prevalence of RE in an H. pylori- infected cohort independent of age or gender. The findings suggest that H. pylori infection in children is positively associated with RE.

Update on food allergy

Abstract: Tremendous progress has been made in our understanding of food-based allergic disorders over the past 5 years. Recent epidemiologic studies suggest that nearly 4% of Americans are afflicted with food allergies, a prevalence much higher than appreciated in the past. In addition, the prevalence of peanut allergy was found to have doubled in American children less than 5 years of age in the past 5 years. Many food allergens have been characterized at the molecular level, which has contributed to our increased understanding of the immunopathogenesis of many allergic disorders and might soon lead to novel diagnostic and immunotherapeutic approaches. The management of food allergies continues to consist of educating patients on how to avoid relevant allergens, to recognize early symptoms of an allergic reaction in case of an accidental ingestion, and to initiate the appropriate emergency therapy. However, the recent successful clinical trial of anti-IgE therapy in patients with peanut allergy and the number of immunomodulatory therapies in the pipeline provide real hope that we will soon be able to treat patients with food allergy.

Food allergy. Part 1: Immunopathogenesis and clinical disorders

Abstract: Up to 8% of children less than 3 years of age and approximately 2% of the adult population experience food-induced allergic disorders. A limited number of foods are responsible for the vast majority of food-induced allergic reactions: milk, egg, peanuts, fish, and tree nuts in children and peanuts, tree nuts, fish, and shellfish in adults. Food-induced allergic reactions are responsible for a variety of symptoms involving the skin, gastrointestinal tract, and respiratory tract and may be caused by IgE-mediated and non-IgE-mediated mechanisms. In part 1 of this series, immunopathogenic mechanisms and clinical disorders of food allergy are described.

Eosinophilic gastrointestinal disorders (EGID)

Abstract: Primary eosinophilic gastrointestinal disorders are defined as disorders that selectively affect the gastrointestinal tract with eosinophil-rich inflammation in the absence of known causes for eosinophilia (eg, drug reactions, parasitic infections, and malignancy). These disorders include eosinophilic esophagitis, eosinophilic gastritis, eosinophilic gastroenteritis, eosinophilic enteritis, and eosinophilic colitis and are occurring with increasing frequency. Significant progress has been made in elucidating that eosinophils are integral members of the gastrointestinal mucosal immune system and that eosinophilic gastrointestinal disorders are primarily polygenic allergic disorders that involve mechanisms that fall between pure IgE-mediated and delayed T(H)2-type responses. Preclinical studies have identified a contributory role for the cytokine IL-5 and the eotaxin chemokines, providing a rationale for specific disease therapy. An essential question is to determine the cellular and molecular basis for each of these clinical problems and the best treatment regimen, which is the main subject of this review.

Eosinophils: Biological Properties and Role in Health and Disease

Abstract: Eosinophils are pleiotropic multifunctional leukocytes involved in initiation and propagation of diverse inflammatory responses, as well as modulators of innate and adaptive immunity. In this review, the biology of eosinophils is summarized, focusing on transcriptional regulation of eosinophil differentiation, characterization of the growing properties of eosinophil granule proteins, surface proteins and pleiotropic mediators, and molecular mechanisms of eosinophil degranulation. New views on the role of eosinophils in homeostatic function are examined, including developmental biology and innate and adaptive immunity (as well as their interaction with mast cells and T cells) and their proposed role in disease processes including infections, asthma, and gastrointestinal disorders. Finally, strategies for targeted therapeutic intervention in eosinophil-mediated mucosal diseases are conceptualized.

Burn wound healing and treatment: review and advancements

Abstract: Burns are a prevalent and burdensome critical care problem. The priorities of specialized facilities focus on stabilizing the patient, preventing infection, and optimizing functional recovery. Research on burns has generated sustained interest over the past few decades, and several important advancements have resulted in more effective patient stabilization and decreased mortality, especially among young patients and those with burns of intermediate extent. However, for the intensivist, challenges often exist that complicate patient support and stabilization. Furthermore, burn wounds are complex and can present unique difficulties that require late intervention or life-long rehabilitation. In addition to improvements in patient stabilization and care, research in burn wound care has yielded advancements that will continue to improve functional recovery. This article reviews recent advancements in the care of burn patients with a focus on the pathophysiology and treatment of burn wounds.