Altogether these data suggest that RyR1 depletion in skeletal mus

Altogether these data suggest that RyR1 depletion in skeletal muscle is one of the pathophysiological mechanisms of the disease as already reported in recessive forms of RYR1-related congenital myopathy [19,28,38–40]. In conclusion, we have identified a specific clinical AZD0530 mw and histological phenotype

associated with recessive RYR1 mutations. Our data clearly show that in this group of patients, the histological phenotype shares features traditionally described in different forms of congenital myopathies, namely centronuclear and core myopathies. They strongly support the idea that the presence of disorganized myofibrillar areas with irregular borders in muscle biopsies from patients with clinical manifestations of congenital myopathy are likely to be due to RYR1 mutations, even in the presence of numerous fibres with internalized nuclei. Hence, this peculiar morphological pattern should be consistently associated with the subgroup of ‘congenital myopathies with cores’. This will improve molecular diagnosis and consequently, genetic counselling and the prognosis given to patients. We are grateful to Professor S. Lyonnet for giving us DNA samples of patient 1. We thank Dr Anna Buj-Bello; Dr R. Peat and Dr Y. Corredoira for proof-reading of the manuscript

and helpful advice and L. Manéré, G. Brochier, E. Lacène, M. Beuvin, M.T. Viou, P. Thérier and S. Drouhin for their excellent technical help. “
“R. Bolea, P. Hortells, I. Martín-Burriel, find more A. Vargas, B. Ryffel, M. Monzón and J. J. Badiola (2010) Neuropathology and Applied Neurobiology36, 300–311 Consequences of dietary manganese and copper imbalance on neuronal apoptosis in a selleck screening library murine model of scrapie Aims: Copper and manganese levels are altered in mice both lacking PrPc and prion-infected brains.

The aim of this study was to analyse the effects of manganese and copper imbalance on neuronal apoptosis in a scrapie-infected Tga20 mouse model. Methods: Immunoreactivities for the apoptotic proteins Bax and active caspase-3 were evaluated in nine regions of the brain of scrapie-infected and control Tga20 mice treated with one of several diets: depleted cooper (−Cu), loaded manganese (+Mn), depleted copper/loaded manganese (−Cu+Mn) and regular diet. Immunohistochemical determination of NeuN was used to detect possible neuronal loss. Results: Intracellular Bax detection was significantly decreased in animals fed with modified diets, particularly in those treated with copper-depleted diets. A decrease in active caspase-3 was primarily observed in animals fed with enhanced manganese diets. Our results show that the −Cu, −Cu+Mn and +Mn diets protected against apoptosis in scrapie-infected mice. However, NeuN immunolabelling quantification revealed that no diet was sufficient to arrest neuronal death.

[8, 9] The compound PGE2 is an arachidonic acid-derived lipid med

[8, 9] The compound PGE2 is an arachidonic acid-derived lipid mediator generated in abundance at sites of infection and inflammation as a result of the rapid up-regulation of cyclooxygenase-2 and microsomal PGE synthase-1 enzymes.[10] It is also an important hormonal regulator of reproduction that is generated in the uterus where it is involved in early and late processes ranging from implantation of the fertilized egg to parturition.[11]

PGE2 is a highly potent modulator of innate and adaptive immunity that influences cell behavior through the ligation of its four distinct G-protein-coupled E-prostanoid (EP) receptors, numbered EP1-4.[12, 13] Both EP2 and EP4 are potent immunoregulatory receptors that share the capacity to increase intracellular concentrations of cyclic adenosine monophosphate (cAMP) within seconds to minutes of PGE2 binding.[13, 14] PGE2-dependent increases in cAMP have been shown to impair the phagocytic ability of different macrophage Selleckchem Dasatinib types against a range of pathogens,[15-18] and it can be suggested that such effects might have evolved to limit the extent of host inflammatory responses or trigger the resolution of inflammation. However, in clinical situations such as pregnancy and the puerperium, where local and systemic PGE2 levels are elevated for physiological reasons,[19-21] the immunosuppressive effects of PGE2 might be maladaptive, particularly when an opportunistic selleck kinase inhibitor pathogen such as C. sordellii gains access

to the normally uninfected uterus (or surrounding soft tissue). The purpose of this study was to address the question of whether PGE2 and cAMP-signaling cascades could regulate the phagocytosis of C. sordellii by human macrophages

and to determine the involvement and mafosfamide relative importance of EP2 and EP4 receptors in such regulation. A better understanding of endogenous regulators of innate immunity will enhance efforts to develop better preventive and therapeutic options against reproductive tract infections. Phorbol-12-myristate-13-acetate (PMA)-differentiated THP-1 cells (a human macrophage-like cell line) were used in this study. These cells were obtained from the American Type Culture Collection (ATCC, TIB-202; Manassas, VA, USA) and cultured in RPMI 1640 (Invitrogen, Carlsbad, CA, USA) supplemented with 1% antibiotic-antimycotic (Invitrogen) and 10% charcoal-/dextran-treated fetal bovine serum (FBS; HyClone, Waltham, MA, USA), referred to as RPMI +/+. Cells were passaged every 2–4 days and were used through the 10th passage, at which time a new culture was started. THP-1 cells were matured into macrophages by culturing with 100 nm PMA (Sigma-Aldrich, St. Louis, MO, USA) in RPMI +/+ for 24 hr at 37°C with 5% CO2. Cells were detached from the flask with non-enzymatic cell dissociation solution (Sigma-Aldrich) and gentle scraping. Phorbol-12-myristate-13-acetate-activated THP-1 cells were used for all experiments presented here, unless otherwise noted.

β-hexosaminidase is a generally accepted marker for histamine rel

β-hexosaminidase is a generally accepted marker for histamine release, and so provides a convenient means of estimating mast cell degranulation (16). When human mast cells were reacted with live trichomonads, β-hexosaminidase release increased as a function of number of trichomonads, and TCM promoted β-hexosaminidase release with an efficiency similar to that observed with 5 × 106 live trichomonads (Figure 3). Furthermore, when mast cells were incubated with TCM

for 6 h, IL-8 and TNF-α production increased more than with CM (Figure 4a,b). Because of the possibility that these cytokines were present in the TCM, we also examined the production of cytokine mRNAs and found that IL-8 and TNF-α mRNA levels in the mast Stem Cell Compound Library in vivo cells were also increased preferentially by exposure to TCM (Figure 4c). Neutrophils are known to play an important role in inflammatory responses by virtue of their ability to perform a series of effector functions that collectively represent a major mechanism of innate immunity against injury or infection. Neutrophil infiltration is thought to be primarily responsible for the cytological changes observed

in trichomoniasis (12,17). We investigated whether culture supernatants buy PLX4032 of mast cells incubated with TCM for 6 h (M-TCM) had chemotactic activity for neutrophils. Medium alone (C), culture supernatant of mast cell alone (M) and culture supernatant of mast cell activated with CM (M-CM) had similar chemotactic activities. M-TCM stimulated neutrophil migration in a concentration-dependent manner, and M-TCM was more effective at each concentration than the corresponding TCM concentration (Figure 5), indicating that mast cells may play a role in neutrophil migration. Adhesion of T. vaginalis

to VECs is a prerequisite for the establishment of infection and plays an important role in the pathogenesis of trichomoniasis (2,3,9). Kucknoor et al. (9) examined transcriptional changes during the initial stage of T. vaginalis adhesion to VECs and showed upregulation of genes related to inflammation, such as IL-8, MCP-1, COX-2 and FN. Until now, it has not been known how these inflammatory mediators influence the inflammation caused by T. vaginalis. selleck kinase inhibitor Therefore, the aim of this study was to see whether supernatants of human vaginal epithelium cells incubated with live T. vaginalis (TCM) influenced inflammatory cell migration and activity. We indeed found that such culture supernatants attracted mast cells and stimulated them to release of β-hexosaminidase and cytokines, which could subsequently induce neutrophil migration. Mast cells are key effectors of allergic inflammation in peripheral tissues. However, because of the discovery that they play a critical role in protection during acute infection, they are now considered as primary inducers of both innate and adaptive immune responses (10,18). Mast cells are generally present in mucosal tissues, which are continuously exposed to foreign antigens including pathogens and allergens (19).


“Hereditary angiooedema (HAE) is a life-threatening diseas


“Hereditary angiooedema (HAE) is a life-threatening disease with poor clinical phenotype correlation with its causal mutation in the C1 inhibitor (SERPING1) gene. It is characterized by substantial symptom variability even in affected members of the same family. Therefore, it is likely that genetic factors outside the SERPING1 gene have an influence on disease manifestation. In this study, functional polymorphisms in genes with a possible disease-modifying effect, B1 and B2 bradykinin receptors (BDKR1, BDKR2), angiotensin-converting enzyme (ACE) and mannose-binding lectin (MBL2), were analysed in 36 unrelated HAE patients. The same analysis was carried out in 69 HAE patients regardless of their

familial relationship. No significant influence Selleckchem Pexidartinib of the studied polymorphisms in the BDKR1, BDKR2, ACE and MBL2 genes on GSK-3 inhibition overall disease severity, localization and severity of particular attacks, frequency of oedema episodes or age

of disease onset was detected in either group of patients. Other genetic and/or environmental factors should be considered to be responsible for HAE clinical variability in Caucasians. Hereditary angiooedema (HAE) results from a genetic deficiency of C1 inhibitor (C1 Inh). It is characterized by recurrent, acute attacks of localized subcutaneous or submucosal oedema [1]. The most severe clinical manifestations include potentially life-threatening laryngeal oedema and gastrointestinal symptoms that may imitate acute abdominal emergency. Subcutaneous limb and face tissue and, on rare

occasions, urogenital tract mucous membranes may also be affected. Markedly decreased expression of C1 Inh in the plasma is called type I HAE, while expression of a dysfunctional C1 Inh protein, together with decreased levels of normal protein, is termed type II HAE [2]. Even though the genetic basis of HAE has been clearly identified and almost CYTH4 200 mutations in the C1 inhibitor (SERPING1) gene have been described so far [3, 4] (http://hae.enzim.hu), oedema pathogenesis has not been yet fully understood. Patients usually become symptomatic during childhood or adolescence and demonstrate variability in the frequency and severity of oedema episodes. The frequency of attacks is neither correlated with the age of onset nor with their localization or severity and is highly variable even among family members carrying the same mutation in the SERPING1 gene [2, 5, 6]. The character and location of mutation can only provide evidence for HAE type I and II, but it provides no information on the clinical course of the disease. A limited genotype–phenotype correlation has been described in some splicing-defective mutations that seemed to be associated with a milder course of the disease. A recent family-based study indicated that the c.−21t/c polymorphic variant at the second base of exon 2 in the SERPING1 gene, when present in a non-mutated allele, may confer an increased risk of severe forms of the disease [7].

[52] Further support for this model is provided by kinetic stabil

[52] Further support for this model is provided by kinetic stability of pMHCII complexes in the presence of DM and the absence of an exchange peptide.[52, 57, 47] In consideration of the correlation between two-peptide intermediates and ‘open’ conformers, the observed DM-associated increase

in inter-peptide FRET has been interpreted as evidence that DM recognizes the ‘open’ MHCII resulting from the interaction with the two peptides. An important step in defining the two-peptide/MHCII intermediate and refining the exchange mechanism in general will be mapping the location where the exchange peptide interacts with the pre-bound peptide/MHCII complex. Exchange peptides with different chemistry need to be recognized, so one possibility is that the competitor peptide interacts with a distinct (presumably less Selleck Pexidartinib polymorphic) site present across MHCII alleles. Analysing the ‘peptide exchangeability’ of MHCII molecules carrying ad hoc mutations in the absence or presence of DM might be an approach to address these questions. Interestingly, the possibility GSK-3 activation that the two-peptide/MHCII intermediate and the push-off

mechanism occur both in the absence of DM at neutral pH and in the presence of DM at acid pH broadens the possibilities for loading MHCII molecules efficiently under different conditions. Consequently, the question arises as to whether a similar breadth of binding conditions also takes place in vivo and whether it might regulate alternative loading or recycling pathways of class II MHC molecules. The extensive

CYTH4 polymorphism characterizing MHCII molecules affects the stabilities of class II heterodimers and plays a role in determining the extent to which DM exerts its function. In vitro experiments have shown allele-dependent association of DM with empty class II.[32] Studies performed in transfected cells have identified the allele-specific requirement of DM during class II-restricted antigen presentation, however different groups reached contradictory conclusions.[61-64] It is likely that the complementation assays adopted in those works to investigate DM activity could be affected by additional experimental variables, such as abnormal expression levels and functional contributions by recipient cell lines, impairing our ability to evaluate the significance of these observations. To rectify these technique-related inconsistencies, mutant mice were generated expressing known ratios of different MHC class II alleles and Ii chain via homologous recombination in embryonic stem cells. Experiments conducted in these animals showed clear evidence for distinctive isotype-specific modes of peptide capture and dependence on DM.[65, 66] These studies led to an investigation of the possibility that human MHCII molecules also feature a diversified DM and/or Ii requirement for appropriate trafficking and antigen presentation.


“Blizard Institute, Barts and The London School


“Blizard Institute, Barts and The London School

selleck chemical of Medicine, Queen Mary University of London, London, UK Fluorochrome-conjugated peptide–major histocompatibility complex (pMHC) multimers are widely used for flow cytometric visualization of antigen-specific T cells. The most common multimers, streptavidin–biotin-based ‘tetramers’, can be manufactured readily in the laboratory. Unfortunately, there are large differences between the threshold of T cell receptor (TCR) affinity required to capture pMHC tetramers from solution and that which is required for T cell activation. This disparity means that tetramers sometimes fail to stain antigen-specific T cells within a sample, an issue that is particularly problematic when

staining tumour-specific, autoimmune or MHC class II-restricted T cells, which often display TCRs of low affinity for pMHC. Here, we compared optimized staining with tetramers and dextramers (dextran-based multimers), with the latter carrying greater numbers of both pMHC and fluorochrome per molecule. Most notably, we find that: (i) dextramers stain more brightly than tetramers; (ii) dextramers outperform tetramers when TCR–pMHC affinity is low; Fulvestrant cost (iii) dextramers outperform tetramers with pMHC class II reagents where there is an absence of co-receptor stabilization; and (iv) dextramer sensitivity is enhanced further by specific protein kinase inhibition. Dextramers are compatible with current state-of-the-art flow cytometry platforms and will probably find particular utility in the fields of autoimmunity and cancer immunology. “
“The 5th Congress of the Federation of Immunological Societies of Asia Oceania (FIMSA) was organized jointly with the 39th annual conference of the Indian Immunology Society (IIS) in New Delhi from March 14–17, 2012. Founded in 1992 as a non-profit scientific organization, the Federation currently has twelve immunology societies as its full members (Australia,

New Zealand, Japan, Korea, Thailand, Hong Thymidylate synthase Kong, Singapore, Taiwan, China, Sri Lanka, Iran, and India) and a few others as associate members. It is one of the four major Federations of the International Union of Immunological Societies (IUIS), the other three being the European Federation of Immunological Societies (EFIS), the Latin American Association of Immunology (ALAI: Asociación Latinoamericana de Inmunología), and the Federation of African Immunological Societies (FAIS). These Federations have played a key role in promoting collaboration and communication between immunologists through educational programs with the objective of advancing this science in Asia. The central theme of the FIMSA 2012 meeting was “Translational Immuno-logy in health and disease” with the focus of the main talks being applied research, broadly modeled on the bench-to-clinic theme.

Induced eosinophilia and mastocytosis are found in the intestinal

Induced eosinophilia and mastocytosis are found in the intestinal tract of IL-5 Tg mice undergoing a primary N. brasiliensis infection and relatively few larvae or worms can be recovered (69,75,76). The intestinal-stage parasites recovered from IL-5 Tg mice generally fail to localize in the preferred anterior third of the duodenum, are smaller than those from WT hosts and produce few eggs (64). Wild-type FVB/N mice also support few intestinal N. brasiliensis

larvae or worms at any stage of a primary infection (77). In none of the many host strains and genetic variants used in our studies have we seen strong inflammatory responses in the lungs 24–48 h pi., when most of the larvae are present (65,69,75,77). Intense inflammatory responses are evident 4–6 days post-primary infection and these may be focused on a few remaining larvae or larval sheaths, although a component of this inflammation may also reflect physical damage to the tissues caused by https://www.selleckchem.com/products/Erlotinib-Hydrochloride.html larval migration (65). Much has been made of this later response by other researchers, but it is important to understand that most larvae have migrated from the lungs to the gut by the end

of day 3 and Venetoclax concentration so at least in primary infections, it is not this stage of inflammation that is larvicidal or inhibitory to further development and colonization. Leucocytes are in fact very scarce in the lungs during the period when larvae are present, with just a small number of cells of macrophage-like appearance that are generally not closely associated with the parasite (65). The late pulmonary inflammatory response may be important for priming for adaptive

immunity and perhaps in limiting tissue damage, though the latter seems less likely. A strong inflammatory response with activation of potent effector cells in the lungs may be counterproductive for both parasite and host. It is worth noting that the means through which this early lung inflammation is prevented should provide for useful insights reaching beyond parasite immunology. We have some evidence that eosinophils and other leucocytes that accumulate in the gut may damage parasites at this site (69), but N. brasiliensis larvae are probably most vulnerable to attack earlier in the migratory pathway. In primary infections of IL-5 Tg (65) and WT FVB/N mice (77) and in secondary infections of WT CBA/Ca, BALB/c and C57BL/6 mice (69,75,76), larvae are trapped or damaged in the pre-lung phase of the migratory pathway. In primary infections of IL-5 Tg hosts, significant numbers of larvae are either trapped in the skin or migration to the lungs is prevented or delayed (65). Larvae that do manage to migrate to the lungs of IL-5 Tg mice are significantly smaller and paler than those recovered from WT mice (65). Conversely, more larvae can be recovered from the lungs of the IL-5−/− and ΔdblGATA deletion mutant strains in both primary and secondary infections (69).

44,45 GM-CSF requires signal transducer and activator of transcri

44,45 GM-CSF requires signal transducer and activator of transcription 5 (STAT5) to suppress Flt-3-driven pDC development.46 STAT5 activation by GM-CSF promptly reduces the expression of essential pDC-related genes in lin− Flt3+ haematopoietic

progenitor cell cultures in the presence of Flt3L.46 By contrast, STAT3 has been shown to be essential for the proliferation of bone marrow progenitors in response to Flt3L,46 and pDC and cDC numbers were shown to be reduced in STAT3-deficient mice. However, STAT3 was not shown to be required for the commitment or development of pDCs, because STAT3-deficient pDCs responded to CpG ODN by producing IFN-α, a characteristic of differentiated pDCs. Taken together, these data reveal a suppressive role for STAT5 and a proliferative role for STAT3 in regulating the production of pDCs. Further to this, studies have demonstrated that buy CCI-779 TLR9 ligation by CpG ODN MI-503 diminished STAT5 activation by IL-7,29 and LPS stimulation led to increased STAT3 activity in human immature monocyte-derived DCs.27 We therefore suggest that the mechanism driving pDC generation at the expense of BMDCs

in response to stimulation with LPS or CpG ODN involves reduced GM-CSF-mediated signalling as a result of decreased STAT5 activity. As Flt3L has been shown to be produced by human bone marrow stromal cells,47 we also suggest that Flt3L is secreted in response to the stimuli and that the signal provided by Flt3L is boosted by increased STAT3 activity.

This hypothesis could be tested by culturing bone marrow cells with GM-CSF in the presence or absence of LPS or CpG ODN and assessing the Flt3L-dependent production and phosphorylation of STAT3 and STAT5, and these experiments are under way. The authors report no conflict of interest. Figure S1. Daily addition of TNF-α does not reverse the effects of LPS or CpG on BMDC production. BALB/c bone marrow cells (5 × 105) were cultured for 6 days with GM-CSF in the presence or absence of LPS or CpG ODN in the presence or absence of daily additions of 20 mg/ml anti-TNF-α for 6 days. Surface markers were analysed by flow cytometry. Results are based on data for 10 000 gated events. Progesterone Data shown are representative of two similar experiments. “
“Chronic graft-versus-host disease (cGVHD) is characterised by a complex etiology of both alloimmune- and autoimmune-mediated disease progression and pathology, and is consequently difficult to control. The therapeutic potential of regulatory T (Treg) cells for cGVHD is currently being investigated; however, the relative ability of Treg cells with defined antigen specificities for auto- and alloantigen to prevent disease has not been previously examined.

The most striking and constant finding was the dramatic

d

The most striking and constant finding was the dramatic

decrease of dendritic (CD1a+CD2–CD3–) cells from early to late lesions, encompassed by an increase in the proportions of total T cells. These are the only statistically significant (PStudent’s t < 0·05) differences between the two groups of patients. The proportions of helper and cytotoxic T cells; B cells, activated cells and natural killer (NK) cells were not significantly different. In previous studies we have demonstrated that peripheral blood lymphocyte subsets are not different in patients with vitiligo than in normal individuals, despite the time of evolution of the disease; therefore, it seems that these changes are localized to the skin lesions and do not result from a central disorder. Also unexpected was the scant number of B cells check details in early stages of the disease and its practical absence in late stages of the disorder. The core finding of this study is suggestive of the possibility that the immune self-reactivity seen in vitililgo is antigen-driven, rather than spontaneous. For a long time it has been considered that triggering of autoimmune reactants, mainly

autoantibodies, does not follow the regular pathway as non-self-antigens. Anti-DNA antibodies, for instance, are not known to be produced Antiinfection Compound Library after DNA fragments are presented to T cells by major histocompatibility complex (MHC) molecules in antigen-presenting cells in patients with systemic lupus erythematosus, nor are rheumatoid factors believed to be produced after IgG molecules or immune complexes are presented to the immune system. For the vast majority of autoantibodies it is believed that autoreactive clones are ‘freed’ from regulatory mechanisms, thus

resulting in the spontaneous activation of such clones and the synthesis and Carnitine palmitoyltransferase II secretion of their autoantibody products [30]. Polyclonal activation, superantigens, equivocal co-operation and other mechanisms have been mentioned and proposed; however, it is thought generally that specific antigen-driven responses are not involved in autoimmune diseases [30]. The finding of abundant dendritic cells in infiltrates from early biopsies suggests strongly that an antigen-presentation process is taking place at this stage of the pathogenetic process. It is possible, therefore, to hypothesize that a primary non-autoimmune phenomenon causes the breakdown of melanocytes. This primary process, which could be traumatic, physical or infectious, might result in the exposure and uptake of intracellular melanocyte-associated antigens by professional antigen-presenting cells and – in individuals with genetic susceptibility – trigger a ‘traditional’ T cell-dependent immune response towards previously hidden self-antigenic structures.

When the target tooth was missing, the second molar in the same s

When the target tooth was missing, the second molar in the same side or the first incisor in the opposite side was examined. The deepest PPD was recorded for each tooth. Periodontal disease was defined as positive if a woman had at least one tooth with a PPD of 3.5 mm or deeper. Among the 1157 women, 131 cases of periodontal disease were identified using this definition. The 1026 remaining participants were eligible to serve as control subjects, but seven women were excluded because of missing

data on the factors under study; thus, 1019 women were classified as control subjects. In the baseline survey, each participant filled out a questionnaire and mailed it to the data management AZD3965 centre. Research technicians completed missing or illogical data by telephone interview. The questionnaire in the baseline survey included questions about smoking habits, household income, education, toothbrushing frequency and use of an interdental brush.

A history of smoking was defined as having smoked at least once per day for at least 1 year. Research technicians or subjects themselves collected buccal specimens with BuccalAmp swabs (Epicenter BioTechnologies, Madison, WI, USA). Genomic Inhibitor Library purchase DNA was extracted using a QIAmp DNA mini kit (Qiagen, Inc., Valencia, CA, USA). Genotyping of VDR SNPs was performed using TaqMan SNP Genotyping Assays on a StepOnePlus machine (Applied Biosystems, Foster City, CA, USA), according to the manufacturer’s instructions. Departures from Hardy–Weinberg equilibrium were tested among the control subjects using the Chi-square test. Linkage disequilibrium was examined using Haploview software version 4.2 (Broad Institute, Cambridge, MA, USA) [23]. Estimations of crude odds ratios (ORs) and 95% confidence intervals (CIs) for periodontal disease associated with the SNPs under

study Silibinin were made by means of logistic regression analysis, with the reference category being the homozygote of the major allele. Multiple logistic regression analysis was used to control for age at oral examination, region of residence, education, smoking, toothbrushing frequency and use of interdental brush. The statistical power calculation was performed using QUANTO version 1.2 [24]. Haplotypes and their frequencies were inferred according to the expectation maximization algorithm. For differences in haplotype frequency between the cases and control groups, crude ORs and 95% CIs were estimated based on the frequency of each haplotype relative to all other haplotypes combined. We examined multiplicative and additive interactions between the SNPs under study and smoking with regard to the risk of periodontal disease. The multiplicative interaction was estimated by introducing a multiplicative term into a multiple logistic regression model.