1 6381 144 THE ROLE OF ONCOGENIC DNA VIRUSES IN PENILE CANCER DEVELOPMENT. PENILE CANCER IS A RELATIVELY RARE NEOPLASIA IN DEVELOPED COUNTRIES, WITH SIGNIFICANT MORBIDITY AND MORTALITY IN DEVELOPING COUNTRIES. PENILE CANCER CAN BE SUBDIVIDED INTO HUMAN PAPILLOMAVIRUS (HPV)-POSITIVE AND HPV-NEGATIVE CASES. WORLDWIDE, THE HPV PREVALENCE IN PENILE CANCER SAMPLES IS AROUND 50%, AND HPV16 IS THE MOST PREVALENT GENOTYPE. ALTHOUGH HPV IS AN IMPORTANT FACTOR FOR CANCER DEVELOPMENT, OTHER ONCOGENIC FACTORS MAY BE ASSOCIATED WITH CARCINOGENESIS. SOME OF THESE FACTORS CAN BE INFECTIOUS, SUCH AS THE EPSTEIN-BARR VIRUS (EBV), AS WELL AS THE MERKEL CELL POLYOMAVIRUS (MCPYV). THE PREVALENCE RATES OF NEARLY 50% FOR BOTH HPV AND EBV INFECTIONS INDICATE AN IMPORTANT ROLE OF THESE VIRUSES IN PENILE TISSUE MALIGNANCY, REINFORCING THE IDEA OF A MULTIFACTORIAL ETIOLOGY OF THE DISEASE. ALTHOUGH THE HPV ROLE IS BETTER UNDERSTOOD, EBV IS THOUGHT TO FACILITATE PERSISTENCE, INTEGRATION, AND MUTATIONS. RECENT STUDIES ON THE MERKEL CELL POLYOMAVIRUS HAVE NOT SHOWN A RELEVANT PREVALENCE IN PENILE CANCER SAMPLES, BUT ITS PRESENCE INDICATES THE OPPORTUNISTIC INFECTIOUS POTENTIAL OF THIS VIRUS. REGARDING HPV-NEGATIVE CASES, THE LITERATURE SUGGESTS A LINK WITH YOUNGER AGE AND EPIGENETIC ALTERATIONS, MAINLY THROUGH THE P16INK4A PATHWAY. RECENTLY, SEVERAL BIOMARKERS THAT MIGHT ACT AS PROGNOSTIC TOOLS (E.G., KI-67, SQUAMOUS CELL CARCINOMA ANTIGEN, AMONG OTHERS) HAVE BEEN PROPOSED, BUT THE RESULTS REMAIN CONTROVERSIAL. IN ADDITION, OTHER RISK FACTORS HAVE ALSO BEEN ASSOCIATED WITH PENILE CARCINOGENESIS, SUCH AS THE PRESENCE OF PHIMOSIS, NONCIRCUMCISION, CHRONIC INFLAMMATION, AND NUMBER OF SEXUAL PARTNERS. FURTHER STUDIES ARE NEEDED TO DEVELOP TOOLS FOR EARLY DETECTION AND EPIDEMIOLOGICAL SURVEILLANCE OF PENILE CANCER. 2019 2 6837 31 [INTERSTITIAL CYSTITIS: THE LATEST FINDINGS ON ITS AETIOPATHOGENESIS]. NEW FINDINGS PROVIDE PROGRESS IN THE UNDERSTANDING OF THE COMPLICATED AETIOPATHOGENESIS OF INTERSTITIAL CYSTITIS/BLADDER PAIN SYNDROME (IC/BPS), WHOSE CAUSALITIES HAVE ONLY BEEN DECIPHERED IN FRAGMENTS SO FAR. AN INCREASINGLY COMPLEX NETWORK OF PATHOMECHANISMS IS EMERGING, IN WHICH THE FREQUENTLY MENTIONED MAST CELLS AND UROTHELIAL CHANGES SEEM TO BE ONLY A FRAGMENT OF THE PATHOLOGICAL CHANGES. THE LATEST FINDINGS REGARDING A POSSIBLE GENETIC AND EPIGENETIC PREDISPOSITION ARE BASED ON PEDIGREE ANALYSES, DETECTION OF SINGLE NUCLEOTIDE POLYMORPHISMS AND SIGNIFICANT CHANGES IN DIFFERENTIALLY EXPRESSED GENES. MULTIPLE ALTERATIONS CAN BE DETECTED AT THE MOLECULAR LEVEL. PLATELET-ACTIVATING FACTOR, VEGF, CORTICOTROPIN-RELEASING HORMONE AND THE INFLAMMASOME ARE IMPORTANT PLAYERS IN UNDERSTANDING THE DISEASE, BUT THE PATHOMECHANISM UNDERLYING THE "ACTIVATION" OF IC REMAINS UNCLEAR. NEW STARTING POINTS COULD BE THE DETECTION OF VIRUSES (EPSTEIN-BARR VIRUS, BK POLYOMAVIRUSES) OR BACTERIAL INFLAMMATION BY PATHOGENS THAT CANNOT BE DETECTED IN STANDARD CULTURES. 2021 3 1006 41 CHRONIC VIRAL INFECTION AND PRIMARY CENTRAL NERVOUS SYSTEM MALIGNANCY. PRIMARY CENTRAL NERVOUS SYSTEM (CNS) TUMORS CAUSE SIGNIFICANT MORBIDITY AND MORTALITY IN BOTH ADULTS AND CHILDREN. WHILE SOME OF THE GENETIC AND MOLECULAR MECHANISMS OF NEURO-ONCOGENESIS ARE KNOWN, MUCH LESS IS KNOWN ABOUT POSSIBLE EPIGENETIC CONTRIBUTIONS TO DISEASE PATHOPHYSIOLOGY. OVER THE LAST SEVERAL DECADES, CHRONIC VIRAL INFECTIONS HAVE BEEN ASSOCIATED WITH A NUMBER OF HUMAN MALIGNANCIES. IN PRIMARY CNS MALIGNANCIES, TWO FAMILIES OF VIRUSES, NAMELY POLYOMAVIRUS AND HERPESVIRUS, HAVE BEEN DETECTED WITH VARIED FREQUENCIES IN A NUMBER OF PEDIATRIC AND ADULT HISTOLOGICAL TUMOR SUBTYPES. HOWEVER, ESTABLISHING A LINK BETWEEN CHRONIC VIRAL INFECTION AND PRIMARY CNS MALIGNANCY HAS BEEN AN AREA OF CONSIDERABLE CONTROVERSY, DUE IN PART TO VARIATIONS IN DETECTION FREQUENCIES AND METHODOLOGIES USED AMONG RESEARCHERS. SINCE A LATENT VIRAL NEUROTROPISM CAN BE SEEN WITH A VARIETY OF VIRUSES AND A WIDESPREAD SEROPOSITIVITY EXISTS AMONG THE POPULATION, IT HAS BEEN DIFFICULT TO ESTABLISH AN ASSOCIATION BETWEEN VIRAL INFECTION AND CNS MALIGNANCY BASED ON EPIDEMIOLOGY ALONE. WHILE DIRECT EVIDENCE OF A ROLE OF VIRUSES IN NEURO-ONCOGENESIS IN HUMANS IS LACKING, A MORE PLAUSIBLE HYPOTHESIS OF NEURO-ONCOMODULATION HAS BEEN PROPOSED. THE OVERALL GOALS OF THIS REVIEW ARE TO SUMMARIZE THE MANY HUMAN INVESTIGATIONS THAT HAVE STUDIED VIRAL INFECTION IN PRIMARY CNS TUMORS, DISCUSS POTENTIAL NEURO-ONCOMODULATORY MECHANISMS OF VIRAL-ASSOCIATED CNS DISEASE AND PROPOSE FUTURE RESEARCH DIRECTIONS TO ESTABLISH A MORE FIRM ASSOCIATION BETWEEN CHRONIC VIRAL INFECTIONS AND PRIMARY CNS MALIGNANCIES. 2010 4 1432 38 DIFFERENTIAL GENE HYPERMETHYLATION IN GENITAL LICHEN SCLEROSUS AND CANCER: A COMPARATIVE STUDY. AIMS: LICHEN SCLEROSUS (LS) IS A CHRONIC INFLAMMATORY DISEASE OF THE GENITAL SKIN OF UNKNOWN AETIOLOGY. THE ROLE OF LS IN PENILE SQUAMOUS CELL CARCINOGENESIS IS NOT WELL CHARACTERIZED. HPV HAS BEEN IMPLICATED IN BOTH, AS HAVE EPIGENETIC CHANGES. THE PRESENCE OF HPV AND HYPERMETHYLATION OF THE MGMT, P16, RASSF1, RASSF2, TSLC1 AND TSP1 GENES WERE STUDIED IN PENILE LS; MGMT, RASSF2 AND TSLC1 HYPERMETHYLATION IN PENILE CANCER AND TSLC1 HYPERMETHYLATION IN VULVAR LS AND CANCER EXTENDS PREVIOUS RESULTS REPORTED BY OUR GROUP. METHODS AND RESULTS: THIRTY-SEVEN HPV GENOTYPES AND HYPERMETHYLATION WERE EVALUATED BY PCR/REVERSE-LINE-BLOT AND METHYLATION-SPECIFIC PCR RESPECTIVELY, IN 27 PREPUTIAL LS, 24 PENILE SCC, 30 VULVAR SCC, 21 VULVAR LS AND 22 NORMAL SKIN CASES. HPV66 WAS PRESENT IN 3.7% OF PENILE LS CASES, AND P16 AND RASSF2 HYPERMETHYLATION WERE MORE FREQUENT IN PENILE CANCER THAN IN PENILE LS. P16, RASSF1, RASSF2 AND TSP1 HYPERMETHYLATION WERE SIMILAR IN PENILE AND VULVAR LS. CONCLUSIONS: GENE HYPERMETHYLATION IS A COMMON EVENT IN PENILE LS, AND OCCURS APPROXIMATELY AS FREQUENTLY AS IN VULVAR LS. CERTAIN GENES CAN BE HYPERMETHYLATED AS AN EARLY OR LATE EVENT IN LS OR CANCER, RESPECTIVELY. THIS SUGGESTS A POSSIBLE SEQUENTIAL ROLE FOR THESE ALTERATIONS IN THE TRANSITION FROM BENIGN TO MALIGNANT LESIONS. 2013 5 2662 48 EPSTEIN-BARR VIRUS AND MULTIPLE SCLEROSIS: A CONVOLUTED INTERACTION AND THE OPPORTUNITY TO UNRAVEL PREDICTIVE BIOMARKERS. SINCE THE EARLY 1980S, EPSTEIN-BARR VIRUS (EBV) INFECTION HAS BEEN DESCRIBED AS ONE OF THE MAIN RISK FACTORS FOR DEVELOPING MULTIPLE SCLEROSIS (MS), AND RECENTLY, NEW EPIDEMIOLOGICAL EVIDENCE HAS REINFORCED THIS PREMISE. EBV SEROCONVERSION PRECEDES ALMOST 99% OF THE NEW CASES OF MS AND LIKELY PREDATES THE FIRST CLINICAL SYMPTOMS. THE MOLECULAR MECHANISMS OF THIS ASSOCIATION ARE COMPLEX AND MAY INVOLVE DIFFERENT IMMUNOLOGICAL ROUTES, PERHAPS ALL RUNNING IN PARALLEL (I.E., MOLECULAR MIMICRY, THE BYSTANDER DAMAGE THEORY, ABNORMAL CYTOKINE NETWORKS, AND COINFECTION OF EBV WITH RETROVIRUSES, AMONG OTHERS). HOWEVER, DESPITE THE LARGE AMOUNT OF EVIDENCE AVAILABLE ON THESE TOPICS, THE ULTIMATE ROLE OF EBV IN THE PATHOGENESIS OF MS IS NOT FULLY UNDERSTOOD. FOR INSTANCE, IT IS UNCLEAR WHY AFTER EBV INFECTION SOME INDIVIDUALS DEVELOP MS WHILE OTHERS EVOLVE TO LYMPHOPROLIFERATIVE DISORDERS OR SYSTEMIC AUTOIMMUNE DISEASES. IN THIS REGARD, RECENT STUDIES SUGGEST THAT THE VIRUS MAY EXERT EPIGENETIC CONTROL OVER MS SUSCEPTIBILITY GENES BY MEANS OF SPECIFIC VIRULENCE FACTORS. SUCH GENETIC MANIPULATION HAS BEEN DESCRIBED IN VIRALLY-INFECTED MEMORY B CELLS FROM PATIENTS WITH MS AND ARE THOUGHT TO BE THE MAIN SOURCE OF AUTOREACTIVE IMMUNE RESPONSES. YET, THE ROLE OF EBV INFECTION IN THE NATURAL HISTORY OF MS AND IN THE INITIATION OF NEURODEGENERATION IS EVEN LESS CLEAR. IN THIS NARRATIVE REVIEW, WE WILL DISCUSS THE AVAILABLE EVIDENCE ON THESE TOPICS AND THE POSSIBILITY OF HARNESSING SUCH IMMUNOLOGICAL ALTERATIONS TO UNCOVER PREDICTIVE BIOMARKERS FOR THE ONSET OF MS AND PERHAPS FACILITATE PROGNOSTICATION OF THE CLINICAL COURSE. 2023 6 6355 38 THE ROLE OF HERPESVIRUS 6A AND 6B IN MULTIPLE SCLEROSIS AND EPILEPSY. HUMAN HERPESVIRUS 6A (HHV-6A) AND 6B (HHV-6B) ARE TWO CLOSELY RELATED VIRUSES THAT CAN INFECT CELLS OF THE CENTRAL NERVOUS SYSTEM (CNS). THE SIMILARITIES BETWEEN THESE VIRUSES HAVE MADE IT DIFFICULT TO SEPARATE THEM ON SEROLOGICAL LEVEL. THE BROAD TERM HHV-6 REMAINS WHEN REFERRING TO STUDIES WHERE THE TWO SPECIES WERE NOT DISTINGUISHED, AND AS SUCH, THE SEROPREVALENCE IS OVER 90% IN THE ADULT POPULATION. HHV-6B HAS BEEN DETECTED IN UP TO 100% OF INFANTS WITH THE PRIMARY INFECTION ROSEOLA INFANTUM, BUT LESS IS KNOWN ABOUT THE PRIMARY INFECTION OF HHV-6A. BOTH VIRUSES ARE NEUROTROPIC AND HAVE CAPACITY TO ESTABLISH LIFELONG LATENCY IN CELLS OF THE CENTRAL NERVOUS SYSTEM, WITH POTENTIAL TO REACTIVATE AND CAUSE COMPLICATIONS LATER IN LIFE. HHV-6A INFECTION HAS BEEN ASSOCIATED WITH AN INCREASED RISK OF MULTIPLE SCLEROSIS (MS), WHEREAS HHV-6B IS INDICATED TO BE INVOLVED IN PATHOGENESIS OF EPILEPSY. THESE TWO ASSOCIATIONS SHOW HOW NEUROLOGICAL DISEASES MIGHT BE CAUSED BY VIRAL INFECTIONS, BUT AS SUGGESTED HERE, THROUGH COMPLETELY DIFFERENT MOLECULAR MECHANISMS, IN AN AUTOIMMUNE DISEASE, SUCH AS MS, BY TRIGGERING AN OVERREACTION OF THE IMMUNE SYSTEM AND IN EPILEPSY BY HAMPERING INTERNAL CELLULAR FUNCTIONS WHEN THE IMMUNE SYSTEM FAILS TO ELIMINATE THE VIRUS. UNDERSTANDING THE VIRAL MECHANISMS OF PRIMARY INFECTION AND REACTIVATION AND THEIR SPECTRUM OF ASSOCIATED SYMPTOMS WILL AID OUR ABILITY TO DIAGNOSE, TREAT AND PREVENT THESE SEVERE AND CHRONIC DISEASES. THIS REVIEW EXPLORES THE ROLE OF HHV-6A AND HHV-6B SPECIFICALLY IN MS AND EPILEPSY, THE EVIDENCE TO DATE AND THE FUTURE DIRECTIONS OF THIS FIELD. 2020 7 6872 28 [POLYPHENOLS AS PROMISING BIOACTIVE COMPOUNDS]. POLYPHENOLS ARE DIVERSE AND WIDESPREAD BIOACTIVE PLANT-BASED COMPOUNDS. THESE COMPOUNDS ARE FOUND IN VARIOUS FOODS SUCH AS BERRIES, FRUITS, VEGETABLES, CEREALS, NUTS, COFFEE, CACAO, SPICES, SEEDS. THEY ARE DIVIDED INTO PHENOLIC ACIDS, STILBENES, FLAVONOIDS, LIGNANS DEPENDING ON THEIR MOLECULAR STRUCTURE. THEY ATTRACT THE ATTENTION OF RESEARCHERS DUE TO WIDE RANGE OF BIOLOGICAL EFFECTS ON HUMAN BODY. THE PURPOSE OF THIS WORK WAS TO ANALYZE MODERN SCIENTIFIC PUBLICATIONS ON THE BIOLOGICAL EFFECTS OF POLYPHENOLS. MATERIAL AND METHODS. THE REVIEW IS BASED ON PUBLICATIONS PRESENTED IN THE PUBMED, GOOGLE SCHOLAR, RESEARCHGATE, ELSEVIER, ELIBRARY, CYBERLENINKA DATABASES USING "POLYPHENOLS", "FLAVONOIDS", "RESVERATROL", "QUERCETIN", "CATECHINS" AS KEY WORDS. PREFERENCE WAS GIVEN TO ORIGINAL RESEARCHES OVER THE PAST 10 YEARS PUBLISHED IN REFEREED JOURNALS. RESULTS. OXIDATIVE STRESS, CHRONIC INFLAMMATION, MICROBIOME DISORDERS, INSULIN RESISTANCE, EXCESSIVE PROTEIN GLYCATION, AND GENOTOXIC EFFECTS ARE AT THE HEART OF THE PATHOGENESIS OF MANY DISEASES, INCLUDING THOSE ASSOCIATED WITH AGE. A LARGE AMOUNT OF MATERIAL HAS BEEN ACCUMULATED ON THE ANTIOXIDANT, ANTICARCINOGENIC, EPIGENETIC, METABOLIC, GEROPROTECTIVE, ANTI-INFLAMMATORY AND ANTIVIRAL EFFECTS OF POLYPHENOLS. THIS GIVES REASONS TO CONSIDER POLYPHENOLS AS VERY PROMISING MICRONUTRIENTS, WHICH INCLUSION IN THE DIET CAN REDUCE THE RISK OF DEVELOPING CARDIOVASCULAR, ONCOLOGICAL, NEURODEGENERATIVE DISEASES, DIABETES MELLITUS, OBESITY, METABOLIC SYNDROME, PREMATURE AGING, THAT IS, THE MAIN CAUSES OF DEATH, A DECREASE IN THE DURATION AND QUALITY OF LIFE OF A MODERN PERSON. CONCLUSION. EXPANDING THE RANGE OF PRODUCTS ENRICHED WITH POLYPHENOLS WITH THEIR HIGH BIOAVAILABILITY IS A PROMISING AREA OF SCIENTIFIC RESEARCH AND DEVELOPMENT OF PRODUCTION IN ORDER TO PREVENT SOCIALLY SIGNIFICANT AGE-ASSOCIATED DISEASES. 2023 8 6825 24 [GENETIC AND EPIGENETIC FACTORS OF POLYCYSTIC OVARY SYNDROME]. THE DEVELOPMENT OF POLYCYSTIC OVARY SYNDROME AND ITS EXACT PATHOPHYSIOLOGICAL MECHANISM IS STILL UNCLEAR, BUT ENVIRONMENTAL AND GENETIC FACTORS LIKELY PLAY A ROLE. EXPOSITION TO TERATOGENIC EFFECTS DURING THE PRENATAL DEVELOPMENT CAN LEAD TO CHRONIC DISEASES IN THE POSTNATAL PERIOD. THIS FINDING CONFIRMS THE COMMON FAMILIAL AGGREGATION AS WELL. A LITERATURE SEARCH WAS CONDUCTED UP TO JANUARY 1, 2016 FOR ARTICLES DEALING WITH THE GENETIC OR EPIGENETIC FACTORS OF POLYCYSTIC OVARY SYNDROME. THIS REVIEW WILL DISCUSS THE CURRENT UNDERSTANDING OF THE GENETIC BASIS AND CLINICAL PRESENTATION OF THIS DISEASE. ORV. HETIL., 2016, 157(32), 1275-1281. 2016 9 6254 31 THE MICROBIOME AND IRRITABLE BOWEL SYNDROME - A REVIEW ON THE PATHOPHYSIOLOGY, CURRENT RESEARCH AND FUTURE THERAPY. IRRITABLE BOWEL SYNDROME (IBS) IS A FUNCTIONAL DISORDER WHICH AFFECTS A LARGE PROPORTION OF THE POPULATION GLOBALLY. THE PRECISE ETIOLOGY OF IBS IS STILL UNKNOWN, ALTHOUGH CONSENSUS UNDERSTANDING PROPOSES IBS TO BE OF MULTIFACTORIAL ORIGIN WITH YET UNDEFINED SUBTYPES. GENETIC AND EPIGENETIC FACTORS, STRESS-RELATED NERVOUS AND ENDOCRINE SYSTEMS, IMMUNE DYSREGULATION AND THE BRAIN-GUT AXIS SEEM TO BE CONTRIBUTING FACTORS THAT PREDISPOSE INDIVIDUALS TO IBS. IN ADDITION TO FOOD HYPERSENSITIVITY, TOXINS AND ADVERSE LIFE EVENTS, CHRONIC INFECTIONS AND DYSBIOTIC GUT MICROBIOTA HAVE BEEN SUGGESTED TO TRIGGER IBS SYMPTOMS IN TANDEM WITH THE PREDISPOSING FACTORS. THIS REVIEW WILL SUMMARIZE THE PATHOPHYSIOLOGY OF IBS AND THE ROLE OF GUT MICROBIOTA IN RELATION TO IBS. CURRENT METHODOLOGIES FOR MICROBIOME STUDIES IN IBS SUCH AS GENOME SEQUENCING, METAGENOMICS, CULTUROMICS AND ANIMAL MODELS WILL BE DISCUSSED. THE MYRIAD OF THERAPY OPTIONS SUCH AS IMMUNOGLOBULINS (IMMUNE-BASED THERAPY), PROBIOTICS AND PREBIOTICS, DIETARY MODIFICATIONS INCLUDING FODMAP RESTRICTION DIET AND GLUTEN-FREE DIET, AS WELL AS FECAL TRANSPLANTATION WILL BE REVIEWED. FINALLY THIS REVIEW WILL HIGHLIGHT FUTURE DIRECTIONS IN IBS THERAPY RESEARCH, INCLUDING IDENTIFICATION OF NEW MOLECULAR TARGETS, APPLICATION OF 3-D GUT MODEL, GUT-ON-A-CHIP AND PERSONALIZED THERAPY. 2019 10 4509 35 MSELENI JOINT DISEASE: A POTENTIAL MODEL OF EPIGENETIC CHONDRODYSPLASIA. OBJECTIVE: IN THIS PAPER PAST RESEARCH ON THE NATURAL HISTORY OF MSELENI JOINT DISEASE, A CRIPPLING ENDEMIC OSTEOARTHRITIS, ITS SOCIO-ECONOMIC IMPACTS, THE DEMOGRAPHICS, DIET, GEOLOGY AND THE GENETIC BACKGROUND OF AFFECTED PEOPLE ARE REVIEWED. IN ADDITION, SOME NEW RESEARCH IDEAS ARE SUGGESTED TO CONTINUE THE SEARCH FOR ETIOLOGICAL AVENUES FOR THIS DISEASE SUCH AS STABLE ISOTOPE ANALYSIS AND EPIGENETIC MECHANISMS. RESULTS: MSELENI JOINT DISEASE IS A CHONDRODYSPLASIA FIRST DESCRIBED IN 1970. IT IS GEOGRAPHICALLY CONFINED TO A REMOTE AREA IN THE MAPUTALAND REGION IN NORTHERN KWAZULU NATAL, SOUTH AFRICA. THIS DISEASE AFFECTS MOST JOINTS BUT PRIMARILY THOSE OF THE HIP; IT IS A PROGRESSIVE CONDITION BEGINNING WITH PAIN AND STIFFNESS UNTIL THE PATIENT'S ABILITY TO WALK BECOMES COMPROMISED. MSELENI JOINT DISEASE IS CHARACTERIZED BY TWO DISTINCT ABNORMALITIES, PROTRUSIO ACETABULI THAT MAINLY AFFECTS FEMALES AND INCREASES IN FREQUENCY WITH AGE, AND HIP DYSPLASIA THAT IS MORE FREQUENT WITH AGE. MUCH RESEARCH HAS BEEN CONDUCTED ON THE PEOPLE WITH THE DISEASE AND THEIR SURROUNDING ENVIRONMENT. CONCLUSION: DESPITE INTENSIVE INVESTIGATIONS INTO THE ETIOLOGY OF MSELENI JOINT DISEASE, IT REMAINS UNKNOWN. AS A RESULT THE EXAMINATION OF EPIGENETIC MECHANISMS AND STABLE ISOTOPE ANALYSIS OF TEETH ARE SUGGESTED AS A MEANS OF PROVIDING INFORMATION ON THE ETIOLOGY OF THE DISEASE. THESE METHODS CAN ALSO BE APPLIED TO OTHER CHONDROPLASIAS OF UNKNOWN ETIOLOGY. 2010 11 4536 39 MULTIPLE SCLEROSIS - RISK FACTORS. MULTIPLE SCLEROSIS (MS) IS A CHRONIC AUTOIMMUNOLOGICAL CONDITION OF THE CENTRAL NERVOUS SYSTEM (CNS) AFFECTING MAINLY YOUNG ADULT INDIVIDUALS. THE PREVALENCE RANGES APPROXIMATELY BETWEEN 50 AND 300 PER 100000 INDIVIDUALS. IT IS CHARACTERIZED BY AN INFLAMMATORY PROCESS, DEMYELINATION AND AXONAL LOSS. IMMUNOLOGICAL MECHANISMS RESULTING IN THE DAMAGE TO THE MYELIN SHEATH EFFECTING THEN IN IMPAIRED NERVE IMPULSE CONDUCTION HAVE THE KEY ROLE IN MS PATHOGENESIS. THE ROLE OF INFLAMMATORY FACTORS HAS ALSO BEEN PROVED. HOWEVER, IT HAS NOT BEEN EXPLICITLY SHOWN WHETHER SUCH AN INFLAMMATORY PROCESS IS THE TRIGGERING FACTOR OR SECONDARY TO A YET UNKNOWN INFECTIOUS FACTOR OR A DEGENERATIVE PROCESS OF THE CNS. THEREFORE, RECOGNITION OF THE EPIGENETIC RISK FACTORS, SUCH AS: GEOGRAPHICAL LATITUDE, VITAMIN D LEVEL, HYGIENE HYPOTHESIS, EPSTEIN-BARR VIRUS (EBV) INFECTION AND OTHERS MAY CONTRIBUTE TO BETTER UNDERSTANDING OF THE MECHANISM UNDERLYING MULTIPLE SCLEROSIS. ADDITIONALLY, THEY MAY PROVIDE GUIDELINES FOR MORE EFFICIENT THERAPIES AND BETTER PREVENTION OF THE DISEASE. AIM OF THIS REVIEW IS TO PRESENT MOST CURRENT DATA ON MULTIPLE SCLEROSIS RISK FACTORS, CONSIDERING THOSE LESS KNOWN. 2020 12 3900 40 LATEST INSIGHTS INTO PATHOGENESIS OF MYCOSIS FUNGOIDES AND CUTANEOUS T-CELL LYMPHOMA. CUTANEOUS T-CELL LYMPHOMA (CTCL) IS A RARE BUT INCREASING MALIGNANCY WHOSE PROTEAN MANIFESTATIONS NECESSARILY PRESENT IN THE INTEGUMENT, BUT CAN ALSO SPREAD TO INVOLVE BLOOD, LYMPH NODES AND INTERNAL ORGANS. WE HAVE DEVELOPED EFFICACIOUS AND VARIED THERAPIES TO TREAT EARLY AND ADVANCED STAGE DISEASE, BUT THERE ARE STILL MANY WHO SUFFER TREMENDOUSLY FROM THIS ILLNESS. ALTHOUGH THE PATHOGENESIS OF THIS CANCER REMAINS FRUSTRATINGLY ELUSIVE, OVER THE LAST 200 YEARS WE HAVE GENERATED A ROBUST BODY OF EVIDENCE THAT POINTS TOWARD POSSIBLE SINGULAR AS WELL AS MULTIFACTORIAL ETIOLOGIES. COMBINING THE HISTORICAL HYPOTHESES WHICH HAVE FOCUSED UPON THE CONCEPT OF INFECTIOUS CAUSES, INCLUDING CARCINOGENIC GENOMIC VIRAL INTEGRATION AND BACTERIAL SUPERANTIGENIC CHRONIC STIMULATION AS WELL AS INDUSTRIAL/OCCUPATIONAL EXPOSURE, ALONG WITH THE MORE RECENT REVELATIONS OF BOTH GENETIC AND EPIGENETIC ALTERATION AND IMMUNE DYSREGULATION, WE ARE CLOSER THAN EVER TO UNDERSTANDING THE ETIOLOGY OF CTCL. IT IS THROUGH THIS KNOWLEDGE AND CONTINUED RESEARCH EFFORTS THAT WE WILL BE ABLE TO BETTER DIAGNOSE, TREAT, AND POTENTIALLY PREVENT OR CURE CTCL. 2017 13 6141 43 THE ETIOLOGY OF PEYRONIE'S DISEASE: PATHOGENESIS AND GENETIC CONTRIBUTIONS. INTRODUCTION: PEYRONIE'S DISEASE (PD) IS A CHRONIC FIBROSING CONDITION THAT CONTRIBUTES TO PENILE DEFORMITY, CURVATURE, AND PAIN. INITIAL FAMILIAL STUDIES DEMONSTRATED POTENTIAL GENETIC LINKS TO PD. SINCE THAT TIME, VERY FEW INVESTIGATIONS HAVE SIGNIFICANTLY ADVANCED THE SCIENCE IN THIS AREA. HENCE, THERE IS A LARGE OPPORTUNITY AND SIGNIFICANT NEED TO BETTER STUDY THE UNDERLYING GENOMICS AND PATHOGENESIS OF PD. AIM: TO SUMMARIZE THE CURRENT GENOMIC LITERATURE RELEVANT TO PD. METHODS: A REVIEW WAS PERFORMED OF ALL PUBMED-INDEXED LITERATURE FROM 1970-2018 RELATING TO THE PATHOPHYSIOLOGY AND GENETICS OF PD. KEY FINDINGS WERE CATEGORICALLY SUMMARIZED TO INCLUDE EPIDEMIOLOGY, RISK FACTORS, INHERITANCE PATTERNS, CHROMOSOMAL INSTABILITY, GENETIC ASSOCIATIONS, EPIGENETICS, DIFFERENTIAL GENE EXPRESSION, AND PRECLINICAL MODELS OF PD. MAIN OUTCOME MEASURES: SUMMARY OF THE CURRENT LITERATURE ON THE GENETICS OF PD. RESULTS: PD IS A COMMON CONDITION AND HAS SEVERAL KNOWN RISK FACTORS AND COMORBID DISEASE ASSOCIATIONS. ALTHOUGH MEN WITH PD ARE BELIEVED TO BE GENETICALLY PREDISPOSED, THERE ARE LIKELY SEVERAL SUBTYPES OF THE CONDITION, EACH WITH VARIED PATHOPHYSIOLOGICAL DISORDERS AND CONTRIBUTING FACTORS. AVAILABLE DATA SUGGEST THAT PD IS ASSOCIATED WITH UNDERLYING GENETIC INSTABILITY, INCLUDING DYSREGULATION OF GENES RELATING TO FIBROSIS AND CELLULAR DEGRADATION, THUS, RESULTING IN ABNORMAL PLAQUE DEVELOPMENT AND PENILE DEFORMITY. PRECLINICAL MODELS, INCLUDING CELL CULTURES AND RAT MODELS, DEMONSTRATE SEVERAL CONSISTENCIES WITH PD CLINICAL AND HISTOPATHOLOGIC CHARACTERISTICS; HOWEVER, AN IDEAL MODEL WITH SPONTANEOUS DEVELOPMENT OF PD IS LACKING. CONCLUSION: BASED ON LIMITED DATA, PD LIKELY REPRESENTS A HETEROGENEOUS CONDITION, WITH BOTH HERITABLE AND ENVIRONMENTALLY-DRIVEN EPIGENETIC FACTORS CONTRIBUTING TO ITS DEVELOPMENT AND PROGRESSION. HOWEVER, THERE REMAINS A SIGNIFICANT GAP IN THE LITERATURE ON THE UNDERLYING CAUSE AND PATHOPHYSIOLOGY OF THE CONDITION, SUGGESTING A SUBSTANTIAL NEED FOR FURTHER INVESTIGATION AND STUDY. SHARMA KL, ALOM M, TROST L. THE ETIOLOGY OF PEYRONIE'S DISEASE: PATHOGENESIS AND GENETIC CONTRIBUTIONS. SEX MED REV 2020;8:314-323. 2020 14 5213 32 PRESYMPTOMATIC RISK ASSESSMENT FOR CHRONIC NON-COMMUNICABLE DISEASES. THE PREVALENCE OF COMMON CHRONIC NON-COMMUNICABLE DISEASES (CNCDS) FAR OVERSHADOWS THE PREVALENCE OF BOTH MONOGENIC AND INFECTIOUS DISEASES COMBINED. ALL CNCDS, ALSO CALLED COMPLEX GENETIC DISEASES, HAVE A HERITABLE GENETIC COMPONENT THAT CAN BE USED FOR PRE-SYMPTOMATIC RISK ASSESSMENT. COMMON SINGLE NUCLEOTIDE POLYMORPHISMS (SNPS) THAT TAG RISK HAPLOTYPES ACROSS THE GENOME CURRENTLY ACCOUNT FOR A NON-TRIVIAL PORTION OF THE GERM-LINE GENETIC RISK AND WE WILL LIKELY CONTINUE TO IDENTIFY THE REMAINING MISSING HERITABILITY IN THE FORM OF RARE VARIANTS, COPY NUMBER VARIANTS AND EPIGENETIC MODIFICATIONS. HERE, WE DESCRIBE A NOVEL MEASURE FOR CALCULATING THE LIFETIME RISK OF A DISEASE, CALLED THE GENETIC COMPOSITE INDEX (GCI), AND DEMONSTRATE ITS PREDICTIVE VALUE AS A CLINICAL CLASSIFIER. THE GCI ONLY CONSIDERS SUMMARY STATISTICS OF THE EFFECTS OF GENETIC VARIATION AND HENCE DOES NOT REQUIRE THE RESULTS OF LARGE-SCALE STUDIES SIMULTANEOUSLY ASSESSING MULTIPLE RISK FACTORS. COMBINING GCI SCORES WITH ENVIRONMENTAL RISK INFORMATION PROVIDES AN ADDITIONAL TOOL FOR CLINICAL DECISION-MAKING. THE GCI CAN BE POPULATED WITH HERITABLE RISK INFORMATION OF ANY TYPE, AND THUS REPRESENTS A FRAMEWORK FOR CNCD PRE-SYMPTOMATIC RISK ASSESSMENT THAT CAN BE POPULATED AS ADDITIONAL RISK INFORMATION IS IDENTIFIED THROUGH NEXT-GENERATION TECHNOLOGIES. 2010 15 6711 51 VIRTUES AND WEAKNESSES OF DNA METHYLATION AS A TEST FOR CERVICAL CANCER PREVENTION. EPIGENETICS IS THE STUDY OF HERITABLE AND NON-HERITABLE GENETIC CODING THAT IS ADDITIVE TO INFORMATION CONTAINED WITHIN CLASSICAL DNA BASE PAIR SEQUENCES. DIFFERENTIAL METHYLATION HAS A FUNDAMENTAL ROLE IN THE DEVELOPMENT AND OUTCOME OF MALIGNANCIES, CHRONIC AND DEGENERATIVE DISEASES AND AGING. DNA METHYLATION CAN BE MEASURED ACCURATELY AND EASILY VIA VARIOUS MOLECULAR METHODS AND HAS BECOME A KEY TECHNOLOGY FOR RESEARCH AND HEALTHCARE DELIVERY, WITH IMMEDIATE ROLES IN THE ELUCIDATION OF DISEASE NATURAL HISTORY, DIAGNOSTICS AND DRUG DISCOVERY. THIS REVIEW FOCUSES ON CANCERS OF THE LOWER GENITAL TRACT, FOR WHICH THE MOST EPIGENETIC INFORMATION EXISTS. DNA METHYLATION HAS BEEN PROPOSED AS A TRIAGE FOR WOMEN INFECTED WITH HUMAN PAPILLOMAVIRUS (HPV) AND MAY EVENTUALLY DIRECTLY COMPLEMENT OR REPLACE HPV SCREENING AS A ONE-STEP MOLECULAR DIAGNOSTIC AND PROGNOSTIC TEST. METHYLATION OF HUMAN GENES IS STRONGLY ASSOCIATED WITH CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN) AND CANCER. OF THE MORE THAN 100 HUMAN METHYLATION BIOMARKER GENES TESTED SO FAR IN CERVICAL TISSUE, CLOSE TO 20 HAVE BEEN REPORTED IN DIFFERENT STUDIES, AND APPROXIMATELY 10 HAVE BEEN REPEATEDLY SHOWN TO HAVE ELEVATED METHYLATION IN CERVICAL CANCERS AND HIGH-GRADE CIN (CIN2 AND CIN3), MOST PROMINENTLY CADM1, EPB41L3, FAM19A4, MAL, MIR-124, PAX1 AND SOX1. OBTAINING CONSISTENT PERFORMANCE DATA FROM THE LITERATURE IS QUITE DIFFICULT BECAUSE MOST METHYLATION STUDIES USED A VARIETY OF DIFFERENT ASSAY METHODOLOGIES AND HAD INCOMPLETE AND/OR BIASED CLINICAL SPECIMEN SETS, VARYING ASSAY THRESHOLDS AND DISPARATE TARGET GENE REGIONS. THERE HAVE BEEN RELATIVELY FEW VALIDATION STUDIES OF DNA METHYLATION BIOMARKERS IN LARGE POPULATION-BASED SCREENING STUDIES, BUT AN ENCOURAGING DEVELOPMENT MORE RECENTLY IS THE EXECUTION OF WELL-DESIGNED STUDIES TO TEST THE TRUE PERFORMANCE OF THE MARKERS IN REAL-WORLD SETTINGS. METHYLATION OF HPV GENES, ESPECIALLY HPV16, HPV18, HPV31, HPV33 AND HPV45, IN DISEASE PROGRESSION HAS BEEN A MAJOR FOCUS OF RESEARCH. ELEVATED METHYLATION OF THE HPV16 L1 AND L2 OPEN READING FRAMES, IN PARTICULAR, IS ASSOCIATED WITH CIN2, CIN3 AND INVASIVE CANCER. ESSENTIALLY ALL CANCERS HAVE HIGH LEVELS OF METHYLATION FOR HUMAN GENES AND FOR DRIVER HPV TYPES, WHICH SUGGESTS THAT QUANTITATIVE METHYLATION TESTS MAY HAVE UTILITY IN PREDICTING CIN2 AND CIN3 THAT ARE LIKELY TO PROGRESS. IT IS STILL EARLY IN THE PROCESS OF DEVELOPMENT OF METHYLATION BIOMARKERS, BUT ALREADY THEY ARE SHOWING STRONG PROMISE AS A UNIVERSAL AND SYSTEMATIC APPROACH TO MOLECULAR TRIAGE, APPLICABLE TO ALL CANCERS, NOT JUST CANCER OF THE CERVIX. DNA METHYLATION TESTING IS BETTER THAN HPV GENOTYPING TRIAGE AND IS COMPETITIVE WITH OR COMPLEMENTARY TO OTHER APPROACHES SUCH AS CYTOLOGY AND P16 STAINING. GENOME-WIDE STUDIES ARE UNDERWAY TO SYSTEMATICALLY EXPAND METHYLATION CLASSIFIER PANELS AND FIND THE BEST COMBINATIONS OF BIOMARKERS. METHYLATION TESTING IS LIKELY TO SHOW BIG IMPROVEMENTS IN PERFORMANCE IN THE NEXT 5 YEARS. 2016 16 1892 27 ENDOMETRIOSIS: EPIDEMIOLOGY, CLASSIFICATION, PATHOGENESIS, TREATMENT AND GENETICS (REVIEW OF LITERATURE). ENDOMETRIOSIS IS A "MYSTERIOUS" DISEASE AND ITS EXACT CAUSE HAS NOT YET BEEN ESTABLISHED. AMONG THE ETIOLOGICAL FACTORS, CONGENITAL, ENVIRONMENTAL, EPIGENETIC, AUTOIMMUNE AND ALLERGIC FACTORS ARE LISTED. IT IS BELIEVED THAT THE PRIMARY MECHANISM OF THE FORMATION OF ENDOMETRIOSIS FOCI IS RETROGRADE MENSTRUATION, I.E., THE PASSAGE OF MENSTRUAL BLOOD THROUGH THE FALLOPIAN TUBES INTO THE PERITONEAL CAVITY AND IMPLANTATION OF EXFOLIATED ENDOMETRIAL CELLS. HOWEVER, SINCE THIS MECHANISM IS ALSO OBSERVED IN HEALTHY WOMEN, OTHER FACTORS MUST ALSO BE INVOLVED IN THE FORMATION OF ENDOMETRIOSIS FOCI. ENDOMETRIOSIS IS IN MANY WOMEN THE CAUSE OF INFERTILITY, CHRONIC PAIN AND THE DETERIORATION OF THE QUALITY OF LIFE. IT ALSO REPRESENTS A SIGNIFICANT FINANCIAL BURDEN ON HEALTH SYSTEMS. THE ARTICLE PRESENTS A REVIEW OF THE LITERATURE ON ENDOMETRIOSIS-A DISEASE AFFECTING WOMEN THROUGHOUT THE WORLD. 2021 17 3258 34 HEPATITIS C AND INTERFERON INDUCED THYROIDITIS. AUTOIMMUNE THYROID DISEASES (AITDS) ARE COMPLEX DISEASES THAT DEVELOP AS A RESULT OF INTERACTIONS BETWEEN GENETIC, EPIGENETIC, AND ENVIRONMENTAL FACTORS. SIGNIFICANT PROGRESS HAS BEEN MADE IN OUR UNDERSTANDING OF THE GENETIC AND ENVIRONMENTAL TRIGGERS CONTRIBUTING TO AITD. THE MAJOR ENVIRONMENTAL TRIGGERS OF AITD INCLUDE IODINE, SMOKING, MEDICATIONS, PREGNANCY, AND POSSIBLY STRESS. IN THIS REVIEW WE WILL FOCUS ON TWO WELL-DOCUMENTED ENVIRONMENTAL TRIGGERS OF AITD, HEPATITIS C VIRUS (HCV) INFECTION AND INTERFERON ALPHA (IFNA) THERAPY. CHRONIC HCV INFECTION HAS BEEN SHOWN TO BE ASSOCIATED WITH INCREASED INCIDENCE OF CLINICAL AND SUBCLINICAL AUTOIMMUNE THYROIDITIS (I.E. THE PRESENCE OF THYROID ANTIBODIES IN EUTHYROID SUBJECTS). MOREOVER, IFNA THERAPY OF CHRONIC HCV INFECTION IS ASSOCIATED WITH SUBCLINICAL OR CLINICAL THYROIDITIS IN UP TO 40% OF CASES WHICH CAN BE AUTOIMMUNE, OR NON-AUTOIMMUNE THYROIDITIS. IN SOME CASES INTERFERON INDUCED THYROIDITIS (IIT) IN CHRONIC HCV PATIENTS MAY RESULT IN SEVERE SYMPTOMATOLOGY NECESSITATING DISCONTINUATION OF THERAPY. WHILE THE EPIDEMIOLOGY AND CLINICAL PRESENTATION OF HCV AND INTERFERON INDUCED THYROIDITIS HAVE BEEN WELL CHARACTERIZED, THE MECHANISMS CAUSING THESE CONDITIONS ARE STILL POORLY UNDERSTOOD. 2010 18 5482 25 RETHINKING GENETIC MODELS OF ASTHMA: THE ROLE OF ENVIRONMENTAL MODIFIERS. ASTHMA IS A COMMON, CHRONIC DISEASE WITH A COMPLEX ETIOLOGY. TO DATE, MORE THAN 35 GENES HAVE BEEN ASSOCIATED WITH ASTHMA OR RELATED PHENOTYPES IN MULTIPLE POPULATIONS, BUT NONE OF THEM HAS BEEN SHOWN TO CONTRIBUTE TO RISK IN ALL POPULATIONS STUDIED. WE SUGGEST THAT GENETIC SUSCEPTIBILITY IS BOTH CONTEXT DEPENDENT AND DEVELOPMENTALLY REGULATED, AND THAT IGNORING THE ENVIRONMENTAL CONTEXT WILL MISS MANY IMPORTANT ASSOCIATIONS AND CLUES TO PATHOGENESIS. WE DEFINE 'ENVIRONMENT' BROADLY TO INCLUDE THE IN UTERO ENVIRONMENT, MATERNAL AFFECTION STATUS AND SEX, AND PROPOSE THAT EPIGENETIC MECHANISMS ARE THE LINK BETWEEN OUR GENES AND OUR ENVIRONMENT. 2005 19 2865 32 FUNCTIONAL ABDOMINAL PAIN DISORDERS IN CHILDREN. CHRONIC ABDOMINAL PAIN IS A COMMON PROBLEM IN PEDIATRIC PRACTICE. THE MAJORITY OF CASES FULFILL THE ROME IV CRITERIA FOR FUNCTIONAL ABDOMINAL PAIN DISORDERS (FAPDS). AT TIMES, THESE DISORDERS MAY LEAD TO RATHER SERIOUS REPERCUSSIONS. AREA COVERED: WE HAVE ATTEMPTED TO COVER CURRENT KNOWLEDGE ON EPIDEMIOLOGY, PATHOPHYSIOLOGY, RISK FACTORS RELATED TO PATHOPHYSIOLOGY, CLINICAL EVALUATION AND MANAGEMENT OF CHILDREN WITH FAPDS. EXPERT COMMENTARY: FAPDS ARE A WORLDWIDE PROBLEM WITH A POOLED PREVALENCE OF 13.5%. THERE ARE A NUMBER OF PREDISPOSING FACTORS AND PATHOPHYSIOLOGICAL MECHANISMS INCLUDING STRESSFUL EVENTS, CHILD MALTREATMENT, VISCERAL HYPERSENSITIVITY, ALTERED GASTROINTESTINAL MOTILITY AND CHANGE IN INTESTINAL MICROBIOTA. IT IS POSSIBLE THAT THE ENVIRONMENTAL RISK FACTORS INTRICATELY INTERACT WITH GENES THROUGH EPIGENETIC MECHANISMS TO CONTRIBUTE TO THE PATHOPHYSIOLOGY. THE DIAGNOSIS MAINLY DEPENDS ON CLINICAL EVALUATION. COMMONLY USED PHARMACOLOGICAL INTERVENTIONS DO NOT PLAY A MAJOR ROLE IN RELIEVING SYMPTOMS. CENTRALLY DIRECTED, NONPHARMACOLOGICAL INTERVENTIONS SUCH AS HYPNOTHERAPY AND COGNITIVE BEHAVIORAL THERAPY HAVE SHOWN BOTH SHORT AND LONG TERM EFFICACY IN RELIEVING PAIN IN CHILDREN WITH FAPDS. HOWEVER, THESE INTERVENTIONS ARE TIME CONSUMING AND NEED SPECIALLY TRAINED STAFF AND THEREFORE, NOT CURRENTLY AVAILABLE AT GRASS ROOT LEVEL. CLINICIANS AND RESEARCHERS SHOULD JOIN HANDS IN SEARCHING FOR MORE PRAGMATIC AND EFFECTIVE THERAPEUTIC MODALITIES TO IMPROVE OVERALL CARE OF CHILDREN WITH FAPDS. 2018 20 6877 32 [REASONS FOR THE DEVELOPMENT OF ALLERGIES IN CHILDREN]. ALLERGIES ARE ONE OF THE MOST COMMON CHRONIC DISEASES IN CHILDHOOD, CONTRIBUTING TO A TREMENDOUS MEDICAL AND ECONOMICAL BURDEN IN HEALTH CARE SYSTEMS OF MOST INDUSTRIALIZED COUNTRIES. THE DEVELOPMENT OF ALLERGIES IS DEPENDENT ON A COMPLEX INTERACTION OF-AMONG OTHERS-ENVIRONMENTAL FACTORS, NUTRITION, GENETIC AND EPIGENETIC MECHANISMS AS WELL AS THE MICROBIOME. THESE DIVERSE FACTORS CAN INFLUENCE EARLY LIFE IMMUNE REGULATION INCLUDING INNATE AND ADAPTIVE IMMUNE MECHANISMS IN A COMPLEX FASHION. IN CASE OF ANY CHILDHOOD ALLERGIES HAVE INCREASED SIGNIFICANTLY IN PAST DECADES. IN ADDITION TO ENVIRONMENTAL FACTORS AND NUTRITION, GENETIC AND EPIGENETIC MECHANISMS AS WELL AS THE MICROBIOME OF CHILDREN PLAY AN IMPORTANT ROLE. OF RELEVANCE IS THE WAY IN WHICH THESE DIVERSE FACTORS INFLUENCE EARLY IMMUNE DEVELOPMENT OF THE INNATE AND ADAPTIVE IMMUNE SYSTEMS OF CHILDREN. THEIR COMPLEX REGULATION IS DECISIVE FOR WHETHER OR NOT A CHILD DEVELOPS AN ALLERGY THAT MANIFESTS IN MOST CASES AS ATOPIC DERMATITIS, BRONCHIAL ASTHMA, OR ALLERGIC RHINO CONJUNCTIVITIS, OR WHETHER A CHILD DEVELOPS AN IMMUNE TOLERANCE. THESE INFLUENCES CAN BEGIN PRENATALLY, ALREADY SETTING THE COURSE FOR LATER IMMUNE SYSTEM DEVELOPMENT AND OCCURRENCE OF DISEASE. 2019