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STEVE GAFFIN: While the subject is mainly the problem of malnutrition and immunosuppression, among those tests that you have just described, are there any populations of humans in whom overstimulation of the immune system is observed, in whom there is immuno-activation, and through whom we could then search for dietary components to that, apart from genetic factors?

SUSANNA CUNNINGHAM-RUNDLES: This is not easy to do, but I would suggest using a model of chronic viral infections. We do have chronic activation of the immune system in those settings, in the development of cytokines that then eventually produce the loss of lean body mass. There are some good studies. I would very much approve of what Dr. Chandra said, for example, about parallels between HIV-associated malnutrition and protein calorie malnutrition. The problem is that HIV is such a hellish infection that you hesitate to extrapolate from that. But you could look at other chronic viral infections with that kind of evidence. You could look at autoimmune disease. But I personally think that autoimmune disease is a very unusual setting, and you would be on very shaky ground when you tried to apply it because you would have deregulation of the immune mechanisms. I am not sure that that would really apply to a healthy person under stress.

STEVE GAFFIN: I meant healthy people in different populations around the world. Are any of them relatively more resistant to certain infections, which might relate to that?

SUSANNA CUNNINGHAM-RUNDLES: That is true. Generally, however, those things appear to be somewhat more related to genetics. This actually is quite an interesting area to talk about. It is not easily addressed. But different MHC genes do affect response to particular stimulants, basically, most of the stimulants that we encounter. Personally, as a microbiologist, I believe it is all microbes. So I think that our response to microbes is extraordinarily fundamental. I do not know of anything that would exactly fit what you are looking for, though.

MELINDA BECK: We know that a lot of response to infection occurs locally and in the blood. What is your feeling about looking at, say, nasal lavage to study a respiratory infection?

SUSANNA CUNNINGHAM-RUNDLES: I really think that is very excellent and very much on target.



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