All tests were carried out using Statistica (Data Analysis Software System, version 7.1; Statsoft Inc., Tulsa, OK, USA). A P-value ≤ 0·05 was considered significant. Twenty-seven patients (13 men and 14 women, mean age 43·3, range 23–86 years) met the inclusion

Poziotinib mouse criteria. Seven had active CE1-2 cysts, six had CE3a and seven CE3b transitional cysts, and seven had inactive CE4-5 cysts. One patient, who was assuming ABZ for 20 days at the moment of serum collection, was included in the study because of the high percentage of cysts remaining active after one month of ABZ treatment (17). One patient with a history of surgery for CE was included in the study because of the considerable length of time (>10 years) since the operation. Patients’ data are summarized in Table 1. Percentages of samples with detectable

levels of cytokines and their median values are shown in Table 2. All subjects (100%) had detectable levels of TNFα, while positive Ceritinib datasheet samples for IL4, IL10 and IL12 were 27%, 39% and 80%, respectively. No statistically significant difference was found between the percentages of cytokine-positive samples of groups, with the exception of IL4 (P = 0·002). This was likely because of the high percentage (83%) of samples with detectable IL4 in CE3b patients when compared to only 50% in CE3a patients and the complete negativity of the other groups. Median levels of IL4 but not of the other cytokines were significantly different between groups (P = 0·002). Again, this was likely because of higher levels of IL4 in CE3b patients compared to the other groups (Figure 2). The low number of patients in each group prevented us from evaluating any between-groups

statistical differences. Eighty per cent (21/27) and 88·9% (24/27) of patients were positive for anti-Echinococcus Ab with IgG-ELISA test and with IHA, respectively. All seronegative patients had CE4-CE5 cysts. These figures Fossariinae are consistent with those reported in the literature (18,19). As expected (6,18–20), a statistically significant decrease in Ab titres was found passing from active (CE1-2) to inactive (CE4-5) cysts (Table 2) (P < 0·01 for IHA and P < 0·05 for IgG-ELISA test). No statistically significant correlation was found between any of the investigated cytokines and Ab levels. The aim of this study was to evaluate ex vivo the immune response in patients with CE infection with different cystic stage according to the WHO US classification of echinococcal cysts (Figure 1): CE1 and CE2 (active cysts), CE3 [transitional cysts, further divided into CE3a and CE3b subgroups (16)], and CE4 and CE5 (inactive cysts). Our findings confirm previous studies reporting a complex mixed Th1–Th2 immune response in patients with CE infection (6,13,14,18–24). A similar mixed pattern was found in controls, which is not surprising as serum cytokines are not antigen specific.