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Aging people living with HIV (PWH) frequently manifest impaired antibody (Ab) responses to seasonal flu vaccination which has been attributed to ongoing inflammation and immune activation. We have recently reported a similar scenario in old simian immunodeficiency virus (SIV) infected rhesus macaques (RM) with controlled viremia and have been able to compensate for this deficiency by immunotherapy with interleukin (IL)‐21‐IgFc. To understand the underlying mechanisms of IL‐21‐induced immunomodulation leading to enhanced flu vaccine response in aging and SIV, we have investigated draining lymph node (LN) cells of IL‐21‐treated and ‐untreated animals at postvaccination. We observed IL‐21‐induced proliferation of flu‐specific LN memory CD4 T cells, expansion of B cells expressing IL‐21 receptor (IL‐21R), and modest expansion of T follicular helper cells (Tfh) co‐expressing T‐cell immunoreceptor with Ig and ITIM domains (TIGIT) and DNAX accessory molecule (DNAM‐1). Transcriptional analysis of LN cells of IL‐21‐treated animals revealed significant inhibition of germinal center (GC) Tfh and B‐cell interferon signaling pathways along with enhanced B‐cell development and antigen presentation pathways. We conclude that IL‐21 treatment at the time of flu vaccination in aging SIV‐infected animals modulates the inductive LN GC activity, to reverse SIV‐associated LN Tfh and B‐cell dysfunction. IL‐21 is a potential candidate molecule for immunotherapy to enhance flu vaccine responses in aging PWH who have deficient antibody responses. [ABSTRACT FROM AUTHOR]

Background: Although massage is one of the most popular complementary and alternative medical (CAM) treatments for anxiety, its effectiveness has never been rigorously evaluated for a diagnosed anxiety disorder. This study evaluates the effectiveness of therapeutic massage for persons with generalized anxiety disorder (GAD). Methods: Sixty-eight persons with GAD were randomized to therapeutic massage (n=23), thermotherapy (n=22), or relaxing room therapy (n=23) for a total of 10 sessions over 12 weeks. Mean reduction in anxiety was measured by the Hamilton Anxiety Rating Scale (HARS). Secondary outcomes included 50% reduction in HARS and symptom resolution of GAD, changes in depressive symptoms (Patient Health Questionnaire (PHQ-8)), worry and GAD-related disability. We compared changes in these outcomes in the massage and control groups posttreatment and at 6 months using generalized estimating equation (GEE) regression. Results: All groups had improved by the end of treatment (adjusted mean change scores for the HARS ranged from -10.0 to -13.0; P<.001) and maintained their gains at the 26-week followup. No differences were seen between groups (P=.39). Symptom reduction and resolution of GAD, depressive symptoms, worry and disability showed similar patterns. Conclusions: Massage was not superior to the control treatments, and all showed some clinically important improvements, likely due to some beneficial but generalized relaxation response. Because the relaxing room treatment is substantially less expensive than the other treatments, a similar treatment packaged in a clinically credible manner might be the most cost effective option for persons with GAD who want to try relaxation-oriented CAM therapies. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]