The Asthma, Allergic and Immunologic Disease Cooperative Research Center proposal at UCLA comprises a set of four interrelated research projects centered around the theme of the molecular aspects of regulation of allergic and immune mediated inflammation. Additionally the Demonstration and Education project focuses on developing a novel model for increasing satisfaction and thereby compliance in the management of asthma of children from the local working population. The individual research projects include molecular, biochemical and cellular investigations of inflammatory responses, with emphasis on the immune response related to mucosal surfaces (the airway and gastrointestinal tract) and the impact of environmental factors on these responses. These studies investigate #1) the induction/regulation of the inducible nitric oxide synthase and prostaglandin synthase genes in inflammatory cells. Their specific role of products of these enzymes (prostaglandins and nitric oxide) in inflammation in the airway and gastrointestinal tract are just being appreciated, since inducible isoforms of these two enzymes have only now been identified and cloned, #2) the control of B cell differentiation and IgE synthesis by receptors (CD40 and IL-6R) which activate tyrosine protein kinases and the mechanisms by which aromatic hydrocarbons modulate these pathways, #3) the modulation by polycyclic aromatic hydrocarbons of the quantity and isoforms of IgE produced via direct B cell effects as well as via alterations in the intercellular contact and soluble intercellular signals, and #4) the nature of the T cell repertoire expressed in inflammatory bowel disease, the modulatory effects of prostaglandins and the regulatory effects of bacterial superantigens on intestinal inflammation. The studies in this AAIDCRC combine, therefore, a theme of mucosal allergic/immune inflammation with the theme of modulation of the immune response by exogenous agents such as aromatic hydrocarbons and bacterial superantigens. The projects include 5 senior investigators from three departments. Each is an independently funded investigator in his/her own right. Four of these investigators are continuing participants from the predecessor CIRID grant. The Demonstration and Educational Intervention Project will test the hypothesis that improved patient satisfaction will result in improved adherence and care received by asthmatic children. A child-derived measure of """"""""satisfaction"""""""" with care received by children with asthma will be developed. Parental satisfaction with care will also be assessed as adherence to care is known to be related to levels of satisfaction. These instruments will be used with physician groups to determine sources of dissatisfaction. A controlled trial will then be undertaken assessing the effects on adherence with care resulting from providing skills training to physicians to reduce children's dissatisfaction with care.
