Serena Eccher, Marco Sposito, Ilaria Mariangela Scaglione, Luca Pasqualin, Michele Rota, Adele Bonato, Lucia Longo, Alice Avancini, Ilaria Trestini, Daniela Tregnago, Jessica Insolda, Michele Milella, Sara Pilotto, Lorenzo Belluomini
{"title":"Microbiome and <i>EGFR</i>-mutant non-small cell lung cancer: a complex interplay.","authors":"Serena Eccher, Marco Sposito, Ilaria Mariangela Scaglione, Luca Pasqualin, Michele Rota, Adele Bonato, Lucia Longo, Alice Avancini, Ilaria Trestini, Daniela Tregnago, Jessica Insolda, Michele Milella, Sara Pilotto, Lorenzo Belluomini","doi":"10.1080/1744666X.2026.2645844","DOIUrl":"10.1080/1744666X.2026.2645844","url":null,"abstract":"<p><strong>Introduction: </strong>Epidermal growth factor receptor (<i>EGFR</i>)-mutant non-small cell lung cancer (NSCLC) exhibits unique biological and therapeutic characteristics. Although <i>EGFR</i> tyrosine kinase inhibitors (<i>EGFR</i>-TKIs) offer substantial clinical benefits, resistance development and treatment-related toxicities remain major challenges. Emerging evidence indicates that the host microbiome may significantly influence the efficacy and tolerability of <i>EGFR</i>-targeted therapies.</p><p><strong>Areas covered: </strong>This review summarizes the main microbiome characteristics of <i>EGFR</i>-mutant NSCLC and discusses the interplay between gut, respiratory and intratumoral microbiome, and <i>EGFR</i>-TKI therapy in NSCLC, highlighting differential microbiome shifts associated with different TKIs and comparing the role of microbiome in modulating responses to <i>EGFR</i>-TKIs. The review also explores preclinical and early clinical strategies aimed at enhancing TKI efficacy and at, potentially, improving sensitivity of <i>EGFR</i>-mutant NSCLC to immunotherapy.</p><p><strong>Expert opinion: </strong>Despite its emerging role, microbiome research in <i>EGFR</i>-mutant NSCLC holds substantial potential to refine therapeutic outcomes. Microbiota-targeted interventions may improve TKIs efficacy, mitigate toxicity, and potentially expand immunotherapeutic options in this molecularly and immunologically 'cold' subgroup. Future integrative studies combining microbiome, metabolome, and immune profiling are essential to translate these insights into personalized clinical strategies.</p>","PeriodicalId":12175,"journal":{"name":"Expert Review of Clinical Immunology","volume":" ","pages":"295-306"},"PeriodicalIF":4.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147442899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Next-generation sequencing reveals genetic heterogeneity in <i>MEFV</i>-negative or heterozygous familial Mediterranean fever: a retrospective study.","authors":"Derya Karaer, Taner Durak, Leyla Rezan Aydin, Samet Türel, Pervin Elvan Tokgün, Gülşah Kilbaş, Semra Ayduran, Onur Tokgün, Selçuk Yüksel, Kadri Karaer","doi":"10.1080/1744666X.2026.2660767","DOIUrl":"10.1080/1744666X.2026.2660767","url":null,"abstract":"<p><strong>Background: </strong>Familial Mediterranean Fever (FMF) is traditionally linked to <i>MEFV</i> mutations. However, many patients remain genetically unexplained after routine screening. This study evaluates the utility of Next-Generation Sequencing (NGS) in patients with negative or heterozygous <i>MEFV</i> results from fragment analysis.</p><p><strong>Methods: </strong>We analyzed 320 patients clinically diagnosed with FMF who had either no mutations or a single heterozygous mutation based on traditional 16-variant screening. NGS was used to sequence the entire <i>MEFV</i> gene and 18 additional autoinflammatory genes.</p><p><strong>Results: </strong>NGS identified variants (pathogenic, likely pathogenic, or VUS) in 34% of cases. Crucially, NGS detected previously missed <i>MEFV</i> variants (e.g. c.380A > C, c.428 G > T) in 54 patients and identified compound heterozygosity in several others. Furthermore, 45 patients carried variants in non-<i>MEFV</i> genes, including <i>TNFRSF1A</i>, <i>NOD2</i>, and <i>PSTPIP1</i>, suggesting potential oligogenic or modifier effects. Clinical reevaluation of these cases revealed diverse phenotypes, including varying colchicine responses and associations with amyloidosis or neutrophilic dermatoses.</p><p><strong>Conclusions: </strong>NGS significantly increases the diagnostic yield in FMF-like presentations by detecting rare <i>MEFV</i> variants and identifying broader genetic heterogeneity. The transition from targeted screening to comprehensive NGS panels provides a deeper understanding of autoinflammatory phenotypes and supports individualized diagnostic and therapeutic strategies in clinical practice.</p>","PeriodicalId":12175,"journal":{"name":"Expert Review of Clinical Immunology","volume":" ","pages":"337-347"},"PeriodicalIF":4.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Should esophageal string test be used to monitor inflammation in EoE?","authors":"Anita M Husain, Colby Sharlin, Shauna Schroeder","doi":"10.1080/1744666X.2026.2659683","DOIUrl":"10.1080/1744666X.2026.2659683","url":null,"abstract":"","PeriodicalId":12175,"journal":{"name":"Expert Review of Clinical Immunology","volume":" ","pages":"251-252"},"PeriodicalIF":3.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147671599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seigo Okada, Pui Y Lee, Hiroki Yasudo, Yuji Ohnishi, Mary Beth F Son, Jane W Newburger, Shunji Hasegawa
{"title":"Interleukin-33/ST2 axis in Kawasaki disease: biology, vascular pathology, and future therapeutic strategies.","authors":"Seigo Okada, Pui Y Lee, Hiroki Yasudo, Yuji Ohnishi, Mary Beth F Son, Jane W Newburger, Shunji Hasegawa","doi":"10.1080/1744666X.2026.2655165","DOIUrl":"10.1080/1744666X.2026.2655165","url":null,"abstract":"<p><strong>Introduction: </strong>Kawasaki disease (KD) is an acute systemic vasculitis of childhood and the leading cause of acquired heart disease in developed countries. Coronary artery abnormalities (CAAs), the major clinical sequelae of KD, remain major clinical challenges, which highlights the need for deeper mechanistic insights.</p><p><strong>Areas covered: </strong>This review summarizes current knowledge of the interleukin-33 (IL-33)/suppression of tumorigenicity 2 (ST2) axis in the context of KD. We discuss the molecular biology of IL-33 and its receptors, downstream signaling pathways, and cell-type-specific immunological and vascular effects. Evidence from clinical studies, biomarker analyses, and experimental KD models is integrated to delineate the potential contribution of IL-33/ST2 signaling to coronary arteritis. Relevant literature was identified through comprehensive searches of major biomedical databases focusing on KD, vasculitis, IL-33, ST2, and related therapeutic strategies. Literature was identified via PubMed and ClinicalTrials.gov.</p><p><strong>Expert opinion: </strong>Current evidence supports the IL-33/ST2 axis as a plausible, context-dependent modulatory pathway linking tissue injury, innate immune activation, and vascular inflammation in KD. Soluble ST2 shows particular promise as a biomarker reflecting disease activity and cardiac stress. Targeted modulation of IL-33/ST2 signaling, guided by disease phase and biomarker profiles, could represent a next-generation therapeutic approach to prevent CAAs in KD.</p>","PeriodicalId":12175,"journal":{"name":"Expert Review of Clinical Immunology","volume":" ","pages":"275-293"},"PeriodicalIF":4.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Antonio L Teixeira, Debora P Maia, Maria Carmo Pereira Nunes, Gabriel A de Erausquin, Cristian P Zeni, Aline S Miranda
{"title":"Revisiting an immunoneuropsychiatry classic: Sydenham's chorea.","authors":"Antonio L Teixeira, Debora P Maia, Maria Carmo Pereira Nunes, Gabriel A de Erausquin, Cristian P Zeni, Aline S Miranda","doi":"10.1080/1744666X.2026.2660763","DOIUrl":"10.1080/1744666X.2026.2660763","url":null,"abstract":"<p><strong>Introduction: </strong>Sydenham chorea (SC) is the major neurologic manifestation of rheumatic fever. It is defined by characteristic involuntary movements and frequently associated with neuropsychiatric symptoms that may develop weeks or months following a Group A beta hemolytic streptococcal (GAS) infection.</p><p><strong>Areas covered: </strong>The authors searched PubMed database for recent original studies and systematic reviews on SC pathogenesis, clinical spectrum and therapeutic approaches.</p><p><strong>Expert opinion: </strong>Compelling evidence supports that autoantibodies targeting neuronal antigens underly the pathogenesis of SC. In the basal ganglia, autoantibodies react, among other epitopes, with dopamine type 2 (D2) receptors. The resulting dopaminergic signaling dysfunction leads to SC-related motor and neuropsychiatric symptoms. A key gap in the antibody-mediated hypothesis of SC lays on the limited understanding on how peripherally generated autoantibodies reach the basal ganglia. D2 antagonists and valproic acid are the main symptomatic therapeutic strategies for SC. The use of corticosteroids can accelerate the resolution of motor symptoms, and must be considered in severe cases, including <i>chorea paralytica</i>. Plasmapheresis and immunoglobulin have been considered investigational for SC.</p>","PeriodicalId":12175,"journal":{"name":"Expert Review of Clinical Immunology","volume":" ","pages":"263-273"},"PeriodicalIF":4.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147689101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ivan Foeldvari, Ameenat Solebo, Sheila T Angeles-Han, Agnes Galbo Brost, Joke de Boer, Jesus Díaz-Cascajosa, Mia Glerup, Helene Ingels, Jens Klotsche, Viera Koopman-Kalinina Ayuso, Ilaria Maccora, Stephanie Mata, Ellen Nordal, Nicolino Ruperto, Gabriele Simonini, Joost F Swart, Jan Titz, Charlotte L L I van Meerwij, Jordi Anton
{"title":"What is the best way to plan a 12-month clinical drug trial in JIA associated uveitis?","authors":"Ivan Foeldvari, Ameenat Solebo, Sheila T Angeles-Han, Agnes Galbo Brost, Joke de Boer, Jesus Díaz-Cascajosa, Mia Glerup, Helene Ingels, Jens Klotsche, Viera Koopman-Kalinina Ayuso, Ilaria Maccora, Stephanie Mata, Ellen Nordal, Nicolino Ruperto, Gabriele Simonini, Joost F Swart, Jan Titz, Charlotte L L I van Meerwij, Jordi Anton","doi":"10.1080/1744666X.2026.2659684","DOIUrl":"10.1080/1744666X.2026.2659684","url":null,"abstract":"<p><strong>Introduction: </strong>Juvenile idiopathic arthritis associated anterior uveitis (JIA-U) is the most common extraarticular manifestation of JIA. There are no published proposed criteria or outcome measures for a 12-month clinical trial for JIA-U.</p><p><strong>Areas covered: </strong>Our expert group, the Multinational Interdisciplinary Working Group for Uveitis in Childhood (MIWGUC), reviewed the previous trials, the quality-of-life instruments, biomarkers, and the patient perspective. Based on an expert consensus, a proposal for a future clinical trial was developed, to provide a foundation for the standardization of outcome measures and trial design in JIA-U. By integrating clinical, imaging, biomarker, and patient-reported outcomes into a unified framework, we aim to accelerate evidence-based therapeutic development and improve long-term care for children affected by anterior uveitis.</p><p><strong>Expert opinion: </strong>A key measure of primary outcome is the anterior chamber cell number, which has intra-observer and inter-observer variation. New techniques that are objective and decrease the variation of the assessment are emerging. Anterior Segmentation Optical Coherence Tomography (OCT) is an innovative imaging technology to assess the number of anterior chamber cells in OCT. The flare meter is an additional assessment, although not yet widely used.</p>","PeriodicalId":12175,"journal":{"name":"Expert Review of Clinical Immunology","volume":" ","pages":"323-336"},"PeriodicalIF":4.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zehra Genc Ozbay, Elif Soyak Aytekin, Saliha Esenboga, Deniz Cagdas
{"title":"Malignancies in the context of Inborn errors of immunity: an immunologist's view.","authors":"Zehra Genc Ozbay, Elif Soyak Aytekin, Saliha Esenboga, Deniz Cagdas","doi":"10.1080/1744666X.2026.2633137","DOIUrl":"10.1080/1744666X.2026.2633137","url":null,"abstract":"<p><strong>Introduction: </strong>Inborn errors of immunity (IEIs), also known as primary immunodeficiency diseases (PIDs) since 2017 Inborn Errors of Immunity Committee classification, comprise a heterogeneous group of genetic disorders resulting in impaired immune development and function. Malignancy is a major challenge in IEIs, particularly in those with defects in DNA repair, tumor suppression, immune surveillance, or chronic inflammatory control, highlighting the close interplay between immune dysfunction and oncogenesis.</p><p><strong>Areas covered: </strong>Hematologic malignancies, especially non-Hodgkin lymphomas, predominate in IEIs, though epithelial tumors also occur and present at younger ages with poorer outcomes. Both intrinsic factors - such as genomic instability and defective lymphocyte maturation - and extrinsic factors, including chronic inflammation, oncogenic viral infections, and iatrogenic exposures, contribute to cancer development. Subtypes such as ataxia-telangiectasia, Nijmegen breakage syndrome, Wiskott - Aldrich syndrome, and common variable immunodeficiency show particularly high malignancy rates. Defects in specific immune pathways, may predispose to organ-specific or virus-driven cancers.</p><p><strong>Expert opinion: </strong>Although hematopoietic stem cell transplantation remains curative for selective IEIs, post-transplant malignancy risk persists. A deeper understanding of shared molecular pathways linking immunodeficiency and cancer is essential to refine early diagnosis, risk stratification, and targeted management in this vulnerable population.</p>","PeriodicalId":12175,"journal":{"name":"Expert Review of Clinical Immunology","volume":" ","pages":"223-231"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146200597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samantha M Logan, Tina Henderson, Mehdi Hooshmandi, Luke Y C Chen, Kristi L Smiley, Rebecca Marsh, Lusia Sepiashvili
{"title":"Validation of a rapid fluorescence immunoassay for soluble interleukin-2 receptor α in a pediatric population.","authors":"Samantha M Logan, Tina Henderson, Mehdi Hooshmandi, Luke Y C Chen, Kristi L Smiley, Rebecca Marsh, Lusia Sepiashvili","doi":"10.1080/1744666X.2026.2637765","DOIUrl":"10.1080/1744666X.2026.2637765","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study was to assess the analytical performance of an automated fluorescence immunoassay (FIA) on the ProteinSimple Ella for rapid measurement of sIL-2 Rα in pediatrics.</p><p><strong>Research design and methods: </strong>Analytical performance evaluation included imprecision, linearity, accuracy, and reference interval establishment. Accuracy was evaluated via method comparison with a chemiluminescent immunoassay (CMIA) through split sampling of EDTA plasma (<i>n</i> = 28). Reference intervals were established per CLSI guidelines (EP28-A3) using plasma from 222 metabolically stable outpatients aged 0 to 19 years.</p><p><strong>Results: </strong>Imprecision at quality control concentrations of 34 and 1943 pg/mL was 5.0% and 6.9%, respectively. The method was linear across the analytical measuring range. A strong linear correlation between FIA and CMIA (slope: 0.99, bias: -10%, <i>R</i> = 0.99) was found. It was determined that the 2400 U/mL clinical cutoff is equivalent to 10,320 pg/mL. sIL-2 r concentrations were inversely correlated with age. Age-specific reference ranges were established: (1) 0 to <6 years: 1377 - 5022, (2) 6 to <14 years: 851 - 3288, and (3) 565-2499 pg/mL.</p><p><strong>Conclusions: </strong>Characterization of the analytical performance of the automated FIA for sIL-2 Rα measurement and establishment of age-specific reference ranges is expected to facilitate future investigations of this biomarker in children and adolescents.</p>","PeriodicalId":12175,"journal":{"name":"Expert Review of Clinical Immunology","volume":" ","pages":"243-248"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147283165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jan Hendrik Niess, Ashley Kimberley Heinsalo, Hassan Melhem
{"title":"Potential approaches in repairing the damaged epithelial barrier in eosinophilic esophagitis.","authors":"Jan Hendrik Niess, Ashley Kimberley Heinsalo, Hassan Melhem","doi":"10.1080/1744666X.2026.2641531","DOIUrl":"10.1080/1744666X.2026.2641531","url":null,"abstract":"<p><strong>Introduction: </strong>Eosinophilic esophagitis, or short EoE, is a chronic, food- and aeroallergen-driven type 2 inflammation strongly linked to epithelial barrier dysfunction, causing dysphagia and food impaction. We discuss the key question of whether barrier damage initiates the disease by allowing allergen penetration across the epithelium, or whether epithelial disruption results secondarily from inflammation.</p><p><strong>Areas covered: </strong>This review examines current evidence of structural and functional epithelial defects in EoE, including abnormalities in junctional proteins, impaired cell differentiation, and increased permeability, based on a literature search in PubMed and Google Scholar. These defects stem from environmental or dietary exposures in individuals with genetic susceptibility, as evidenced by genome-wide association studies that identify genes crucial for epithelial structure and regulation. It also assesses the extent to which barrier dysfunction is caused by inflammatory cytokines, especially IL-13 and other type 2 cytokines, which directly alter epithelial architecture. Lastly, we explore emerging strategies to strengthen or repair the epithelial barrier, ranging from dietary interventions and biologics to approaches targeting epithelial metabolism, protease balance, and hormonal pathways.</p><p><strong>Expert opinion: </strong>Maintaining epithelial integrity is essential for preventing and treating EoE. Future treatments should directly reinforce the epithelial barrier, unlike current treatment options that reduce type 2 inflammation.</p>","PeriodicalId":12175,"journal":{"name":"Expert Review of Clinical Immunology","volume":" ","pages":"145-154"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}