In contrast, IL-17A- and IL-22-secreting cells were more abundant

In contrast, IL-17A- and IL-22-secreting cells were more abundantly derived Doxorubicin price from lesional skin (Supporting Information

Fig. S3B). This observation led us to use such lesions as a source of T cells to generate CD4+ T-cell clones with various Th profiles, including Th17 and Th22 cells. Hierarchical cluster analysis performed on the cytokine pattern of skin-infiltrating T-cell clones obtained from two psoriasis patients yielded distance trees that highlighted their organization into five dominant groups, each characterized by a typical cytokine secretion profile (Fig. 3A and Supporting Information Fig. S4A). The number of clusters obtained was validated using the non-hierarchical cluster analysis (data not shown) with an excellent inter-classification comparison index (kappa agreement value κ=0.89 and 0.70 respectively). The inter-cluster differences were confirmed through the computation of the mean relative cytokine productions in each proposed cluster, followed by inter-cluster comparisons (Fig. 3B and Supporting Information Fig. S4B).

This analysis confirmed that IFN-γ was most increased in the first cluster, as compared with other clusters (p<0.0001 for both patients), IL-10 in the second cluster (p<0.0001), IL-4 (p=0.001 and p=0.0065, 1st and 2nd patient respectively) and IL-5 (p<0.0001) in the third, IL-17 selleck compound library in the fourth (p<0.0001) and IL-22 in the fifth (p<0.0001) (Fig. 3B and Supporting Information Fig. S4B). The clusters were therefore named Th1, Tr1, Th2, Th17 and Th22 respectively. Altogether, these data suggest that Th1, Th2, Tr1, Th17 and Th22 orientation can be

objectively distinguished by cluster analysis of cytokine production profiles. The Th22 subset should therefore clearly be distinguished from the previously recognized Th17 subset. We then used TCRα and TCRβ clonotypic analysis to assess whether the commitment Sclareol of these functionally distinct subsets of CD4+ T cells would be antigen-driven or TCR-independent. Surprisingly, only 45 different clonotypes were used by the 66 T-cell clones derived from the skin biopsy of a psoriasis patient. Eight different clonotypes were extensively shared between subsets and represented 39% of the T-cell infiltrate (Fig. 4). One clone was shared by four different subsets. TCR sharing between the Th17 and Th22 subset, with only one clone shared, was not more extensive than that between other subsets. TCR sharing between functionally distinct T-cell clones was confirmed in a skin biopsy from a second psoriasis patient. In this case, TCR sharing was less extensive, but clones overlapping between Th17 and Th22 as well as Th17 and Th2 were nonetheless identified among the 59 skin-derived T-cell clones analyzed (Supporting Information Fig. S4C). These results demonstrate that none of the five Th cell types use a strictly dedicated TCR repertoire.

Rapid progression of disease in Uganda is associated with TNF-α-m

Rapid progression of disease in Uganda is associated with TNF-α-mediated inflammatory pathology. Invasive pulmonary aspergillosis.  The role of TNF-α and lymphotoxin-alpha (LT-α) in fungal infection diseases has been reported [64]. The presence of polymorphism in TNF-α and LT-α genes or their receptors might increase the susceptibility of haematologic patients to develop invasive pulmonary aspergillosis (IPA). SNPs in TNF-α, LT-α and tumour necrosis factor receptor 2 (TNFR2) and a variable number of tandem repeats (VNTRs) in TNFR2 were investigated in haematologic patients and controls. Similar genotype and alleles frequencies were detected between patients

and controls. TNF-α and LT-α polymorphisms were not associated with the presence of IPA. A strong high throughput screening association of IPA with VNTR in the promoter region of the TNFR2 gene was found. Cancer is the major health problem and leading cause of death. Several genetic polymorphisms have been reported to associated with disease. The genetic factors play important role in the epidemiology and pathogenesis of cancer. TNF genetic polymorphism

can regulate gene expression and have been associated with inflammatory and malignant conditions. Azmy et al. [65] have been detected the role of TNF-α rs1800630 and rs361525 INCB024360 cost polymorphisms in breast cancer susceptibility and severity. Breast cancer cases and controls have shown similar allele frequencies for both polymorphisms. No association was found between rs1800629, rs361525 and susceptibility to breast cancer in North European population. Role of TNF rs361525 in breast cancer risk was investigated by Gaudet et al. [66], in breast cancer cases and controls, in European, from 30 studies in the Breast Cancer Association Consortium. Jung et al. [67] have detected 12 SNPs in 11 apoptosis-related next genes in the apoptosis pathway. Human papillomavirus (HPV) 16 infection is an important factor for cervical cancer. Alteration in local levels of TNF in the cervix may affect the immune response of an individual, hence affecting the persistence of HPV. Excess TNF-α can result in harmful inflammatory responses, whereas too little

can contribute to persistent infection. TNF-α is one of the primary cytokines released after HPV infection and upregulates the expression of antigen-processing and presentation pathway components for class I HLA. Eleven TNF SNPs were associated with susceptibility to HPV16-associated cervical cancer. A significant difference in genotype distribution of three SNPs between the cases and controls were reported. Haplotype distribution also showed a significant difference between cases and controls. A new association was reported between several TNF-SNPs and susceptibility to cervical cancer [68]. The associations between six TNF SNPs (rs1799964, rs1800630, rsl799724, rs1800629, rs361525 and rs1800610) and prostate cancer risk were investigated [69].

1D) This partial RING domain is insufficient to confer E3 ubiqui

1D). This partial RING domain is insufficient to confer E3 ubiquitin ligase activity on viral Pellino since a recombinant form of the latter failed to catalyse the in vitro generation of polyubiquitin chains in the presence of E1 and E2 enzymes, whereas the mammalian member Pellino3S shows strong catalytic activity (Fig.

1E). Western immunoblotting using an anti-myc Selleckchem BGB324 antibody shows that the lack of activity of viral Pellino relative to Pellino3 cannot be attributed to differences in protein quantity since both proteins show comparable levels of immunoreactivity. Interestingly, viral Pellino has a mobility corresponding to its predicted size of 25.4 kDa but it also shows a fainter immunoreactive band of slower electrophoretic mobility. The identity of this protein is unknown but its lack of reactivity with the anti-ubiquitin

antibody excludes https://www.selleckchem.com/products/Trichostatin-A.html the possibility of the protein being modified by ubiquitination. The above analysis suggests that viral Pellino resembles its mammalian counterparts in containing a core FHA domain but differs in lacking both a wing appendage to the FHA domain and a functional RING-like motif. The emerging roles of Pellino proteins in TLR signalling coupled to the discovery of a viral homolog prompted studies on the ability of viral Pellino to regulate TLR signal transduction. Viral Pellino is encoded by the genome of MsEPV and given that the natural host of MsEPV is insect cells, the highly AT-rich sequence of the viral Pellino gene reflects an adaptation to this environment. In order

to ensure expression of viral Pellino in both insect and human cells, a form of the gene was chemically synthesised with codon sequences optimised for recognition by human translation machinery. This involved replacing As or Ts in the third position of each codon with a G or C, without altering the amino acid sequence of the translated protein. Such an approach was previously shown to enhance expression of poxviral genes in human cells 24. We initially PLEKHB2 assessed the effects of viral Pellino on Toll signalling in macrophage-like Drosophila S2 cells. A myc-tagged version of the viral protein showed uniform cytoplasmic distribution after transfection in these cells (Fig. 2A). The effects of increasing levels of viral Pellino expression on signalling by the Toll ligand C-106 was then assessed (Fig. 2B). C-106 is the active C-terminal fragment of the Spätzle protein and induced activation of a firefly luciferase reporter under the control of the drosomycin promoter. Toll signalling can induce expression of this antimicrobial peptide through the Rel family transactivators Dorsal and Dif. Thus, the activation of the drosomycin promoter was an especially relevant readout for Toll signalling in the present studies in light of the demonstration that Drosophila Pellino plays a key role in driving expression of drosomycin 13.

These unexpected findings suggest that ILCs play a critical

These unexpected findings suggest that ILCs play a critical Cytoskeletal Signaling inhibitor role in autoimmune pathology. This hypothesis was corroborated by another study, in which lung natural helper cells, a population of type 2 ILCs (group 2 ILCs), were shown to participate substantially in allergen-induced airway inflammation, at least in the murine system [13]. Furthermore, it has been suggested that ILCs are able to influence adaptive immune responses in general via OX40 ligand signaling to memory T cells

[14, 15]. The development of autoimmune neuroinflammation in the murine system is critically dependent on the cytokine IL-23 [16, 17]. Mice lacking the genes of IL-23, namely Il23a and Il12b or components of the IL-23 receptor complex, are completely EAE resistant. However, even though

IL-23 had initially been described to polarize IL-17 secreting autoaggressive T cells [18], it became later clear that other factors initiate the differentiation of TH17 cells [19]. In fact, naïve buy Palbociclib T cells are unresponsive to IL-23, as they lack the appropriate receptor complex [20]. Hence, the actual function and cellular target of IL-23 in the context of neuroinflammatory disease remains a subject of some debate. In contrast to naïve Th cells, ILCs (as well as γδ T cells) are constitutively responsive to IL-23 signaling and thus among the first cells sensing IL-23. Indeed, some reports suggested that the immediate IL-23 responsiveness of γδ T cells can be a critical factor in models of autoimmune inflammation [21]. Thus, we hypothesized that ILCs could also play a role in initiating neuroinflammation. So far, outside of lymphoid organs the presence of ILCs has only been investigated in the skin, lung, and intestine [1]. We analyzed the central nervous system (CNS) of mice immunized with the immunodominant peptide of the myelin oligodendrocyte glycoprotein (MOG35–55) and indeed detected a significant population of lineage negative Thy1+ Sca1+ ILCs, which were able to produce both IFN-γ and IL-17. A small population of these

cells was also detectable in the CNS of naïve animals. Genetic fate-mapping revealed the mafosfamide major fraction of these cells belonging to the RORγt-dependent lineage (group 3 ILCs), but a minor fraction of CNS-infiltrating ILCs resembled a Thy1+ RORγt-independent lineage (group 2 ILCs). However, in vivo ablation of all Thy1+ ILCs demonstrated that these cells did not contribute significantly to disease progression, indicating that their presence in the CNS is a result of the inflammation dictated by adaptive immunity and that their contribution to the inflammatory process is negligible. Phenotypically, the ILC family has been characterized by a large variety of markers, which led to a plethora of subtypes and designations for ILCs [1].

In addition, the frequency of HBV-specific IL-21-secreting CD4+ T

In addition, the frequency of HBV-specific IL-21-secreting CD4+ T cells did not be detected in the Hu’s study, which could not

directly be involved in liver damage in HBV infection. In summary, the study presented here demonstrates that HBc-specific IL-21-producing CD4+ T cell response is decreased in patients with CHB than AHB. These data support the hypothesis that decreased IL-21 secreted from HBV-specific CD4+ T cells partly contributes to the exhaustion of specific cytotoxic CD8+ T cell response in chronic HBV infection. These findings provide clues for rational design of new therapeutic strategy against chronic HBV infection. This work was supported by the National Grand Program on Key Infectious Disease buy SCH772984 of China (Grant no. 2012ZX10002007) and Specialized Selleck RXDX-106 Research Fund for the Doctoral Program Construction of Higher Education in China (No 53410903). The authors who have taken part

in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript. “
“Early phases of human pregnancy are associated with the accumulation of a unique subset of natural killer (NK) cells in the maternal decidua. Decidual NK (dNK) cells that are devoid of cytotoxicity play a pivotal role in successful pregnancy. By secreting large amounts of cytokines/chemokines and angiogenic factors, dNK cells participate in all steps of placentation including trophoblast invasion into the maternal endometrium and vascular remodelling. In this review, we summarize some of dNK cell features and discuss more recent exciting data that challenge the conventional view of these cells. Our new data demonstrate that dNK cells undergo fine tuning or even subvert their classical inhibitory machinery and turn into a real defence force in Thiamet G order to prevent the spread of viruses to fetal tissue. Today it is not clear how these phenotypic and functional adaptations impact cellular cross-talk at the fetal–maternal interface and tissue homeostasis. Ultimately, precise understanding of the molecular mechanisms that govern dNK cell plasticity

during congenital human cytomegalovirus infection should lead to the design of more robust strategies to reverse immune escape during viral infection and cancer. Natural killer (NK) cells are large granular lymphocytes of the innate immune system and represent the first line in the host defence against invading pathogens.[1, 2] Unlike T cells, NK cells do not express an antigen-specific receptor but rather they express a large repertoire of activating and inhibitory receptors. Mature NK cells recirculate in the blood (pNK) where their number varies anywhere from 5 to 20% of total lymphocytes. Natural killer cells are also present in lymphoid and non-lymphoid tissues including the uterus where they are mainly CD56bright CD16neg.

[93] During infection, because of bacterial lysis, multiple patho

[93] During infection, because of bacterial lysis, multiple pathogen hsp will be visible

to the host in parallel. The identity of cargo proteins will depend upon the family and type of hsp chaperone.[40] The meningococcal stress protein MSP63, a member of the hsp60 family, has been shown in man to be immunogenic during natural meningococcal infection.[94] selleck kinase inhibitor Genes encoding hsp, including DnaK, GroEL, GroES, DnaJ, GrpE and ClpB, were shown by transcriptional profiling to be up-regulated several fold in N. meningitidis in human blood during bacteraemia.[95] The similarity of pathogen-derived hsp to human hsp raises the hypothetical possibility of enhanced self recognition induced by vaccines enriched for pathogen hsp. Theoretically, this could occur as a consequence of the presentation of host proteins to DC by vaccine-derived hsp and the induction of autoimmune responses induced by the vaccine hsp. The potential for antibodies produced in mice against Akt inhibitor plant

hsp70 to cross-react, either with murine hsp70 or human hsp70, has been investigated and found to be absent despite the significant structural similarities between the three isoforms.[86] Significantly, as a consequence of the manufacturing process, hsp are present in many marketed vaccines against infectious diseases, notably in whole cell vaccines and vaccines derived from cell extracts. The extensive, safe use of vaccines containing hsp therefore provides compelling evidence against safety concerns. For example, whole cell vaccines are used widely and possess acceptable safety profiles.[96] Antibodies to hsp65 were found in sera from children vaccinated

with DTP (diphtheria, tetanus, pertussis) vaccine administered extensively in Europe and the USA.[97] Antibodies against BCG hsp develop naturally in infants in 6–12 months, even without BCG vaccination.[98] The safety of human exposure to N. meningitidis hsp was obtained from administration of marketed vaccines that contain hsp.[99] Such vaccines have been used since the 1980s and the safety records are excellent. From the pioneering work of Benjamin Jesty and subsequent developments Gemcitabine nmr from Edward Jenner to the present day, vaccines have delivered and continue to deliver significant improvements to global health. Smallpox is eradicated, polio has been controlled and the frequency of childhood diseases such as measles has reduced. However, the most successful vaccines have been against diseases where the causal pathogen does not have major anti-immune defence mechanisms. Many pathogens, including hepatitis C and human immunodeficiency viruses, M. tuberculosis, Helicobacter pylori and Plasmodium falciparum have evolved complex immune evasion strategies and probably require high level effector T-cell activation for their eradication. So far, these pathogens have proved intractable to existing vaccination strategies.

1c)

In the case of IFNg, Kersh et al [22] determined tha

1c).

In the case of IFNg, Kersh et al.[22] determined that the promoter re-acquires a repressive DNA methylation, but can demethylate this region within 6 hr of TCR stimulation. Additionally the laboratories of both Turner and Shen revealed that the IFNg promoter obtained permissive histone modifications at the effector stage of differentiation which were maintained into the memory stage.[21, 26] These data demonstrate that the acquired ability of memory cells to rapidly recall cytokine production is coupled to modification of the epigenetic programme at these loci by establishing a poised transcriptional state. Moreover, these studies firmly establish epigenetic programming as a mechanism that adapts to TCR signalling. In addition to these important studies on transcriptional regulation of effector molecules, our BIBW2992 clinical trial laboratory has recently demonstrated that the promoter of the immuno-inhibitory molecule programmed death 1 (PD-1) undergoes dynamic epigenetic modifications during acute versus chronic viral infection.[27]

Our data demonstrated that epigenetic modification of the PD-1 promoter was tuned to the duration and or strength of the TCR signal.[27] A commonality among the effector molecules and immuno-inhibitory receptor is that their off-on-off pattern of gene expression during naive to effector to check details memory differentiation is regulated in part through epigenetic modifications at their promoters (Fig. 1c). Taken together, these studies demonstrate that epigenetic modifications are used to control immune function by not only directly regulating the expression of cytolytic

molecules, but also by controlling the sensitivity of the cell Plasmin to activating inhibitory signals. Indeed, the rapid recall of effector molecules is a defining feature of memory CD8 T cells, yet equally important is the ability of memory CD8 T cells to persist at a higher quantity relative to their naive counterparts in the absence of antigen. This acquired function is critical to the design of vaccines that generate life-long T-cell immunity. Importantly the dramatic increase in quantity of antigen-specific CD8 T cells at the memory stage of the response over the naive stage is in part achieved through up-regulation of pro-survival molecules in a subset of effector cells. Therapeutic strategies designed to enhance the quantity of effector cells that survive to the memory stage of the response following acute infection or vaccination through manipulation of pro-survival gene expression programmes in antigen-specific CD8 T cells is now the focus of intense investigation.[28] Support for this strategy has recently come from studies using rapamycin therapy. It was demonstrated that mice treated daily with rapamycin, the inhibitor of mammalian target of rapamycin (mTOR), during the course of acute lymphocytic choriomeningitis virus infection developed a greater quantity and quality of memory CD8 T cells.

Our results revealed that CML-specific CTL crucially contribute t

Our results revealed that CML-specific CTL crucially contribute to disease control and are characterized by high IL-7Rα expression. Interestingly, CML cells produced IL-7 that was crucial for the

maintenance of specific CTL. Therefore, CML maintains RAD001 mouse leukemia-specific CD8+ T-cell-mediated immunosurveillance by IL-7 signaling. Bone marrow was cotransduced with retroviral particles encoding for BCR/ABL and NUP98/HOXA9 and injected into irradiated syngeneic recipient mice. As shown previously, coexpression of BCR/ABL and NUP98/HOXA9 led to the development of CML and progression to blast crisis within several weeks 17. Granulocyte counts rose up to 9×107/mL (C57BL/6 control mice:<2×106 granulocytes/mL blood). Phenotypically, the leukemic cells consist of a population Selleckchem Pifithrin-�� of immature myeloid blasts (MAC-1+,

GR-1+ and c-kit+) of up to 10% and a majority of mature granulocytes 17. This cotransduction was chosen to model the transition from chronic phase to blast crisis. To study antigen-specific immune responses, H8 transgenic mice were chosen as bone marrow donors. In this experimental setup, all leukemia cells expressed the immunodominant CTL epitope gp33 of lymphocytic choriomeningitis virus (LCMV) on MHC class I molecules as a model leukemia antigen (H8-CML mice). To analyze the impact of CD8+ T cells on disease progression, H8-CML mice with high granulocyte counts (>5×107 granulocytes/mL blood) were depleted of CD8+ 2-hydroxyphytanoyl-CoA lyase T cells by monoclonal antibody or were left untreated. Depletion of CD8+ T cells

led to disease progression and death of 83% of the animals within 4–19 days (Fig. 1A). CML progression was significantly slower in untreated control mice and 50% of the mice survived up to 75 days. On the contrary, treatment with IgG from rat serum (as control for αCD8 antibody YTS169.4) did not prolong survival when compared with untreated mice (Supporting Information Fig. 1). These results suggest that CD8+ T cells are crucially involved in the control of CML disease progression. The fact that a minority of the CD8+ T-cell-depleted animals still could control CML suggests that other effector mechanisms may contribute to the immunosurveillance of CML. In agreement with our earlier results, in CML mice no gp33-specific CTL response was detectable in the blood by tetramer staining 17. Naïve C57BL/6 mice and LCMV-immune mice which had been infected 8 wk previously with 200 pfu LCMV-WE were used as controls (Fig. 1B and D). The absence of specific CD8+ T cells in blood of CML mice by tetramer staining was in contrast to the rapid leukemia progression in CD8+ T-cell-depleted animals. Using a dextramer enrichment approach, we could detect gp33-specific CTL in pooled spleens and lymph nodes of H8-CML animals above the background of naïve C57BL/6 mice (Fig. 1C and D and Supporting Information Fig. 2A and B) 18.

Tr1 cell clone administration was tolerated and showed dose-depen

Tr1 cell clone administration was tolerated and showed dose-dependent efficacy in patients

suffering from severe disease.62 These data represent the first bench-to-bedside test of Tregs as a therapy for IBD and set the stage for more comprehensive trials. Recent work in the field of transplantation and autoimmunity has shown that antigen-specific Tregs are much more effective at preventing graft rejection or diabetes than are polyclonal populations;16 significantly fewer antigen-specific Tregs are required to mediate potent suppression, and the delivery of antigen-specific Everolimus manufacturer cells decreases the risk of global immunosuppression and the possibility of increased risk of infection and cancer. Notably, antigen-specific Tregs can prevent colitis, as demonstrated by the adoptive transfer of OVA-specific Tregs64 or Tr1 cells,65 but because OVA is unlikely to be beta-catenin signaling a disease-driving antigen in IBD, the question of whether OVA-specific Tregs would be effective at suppressing established effector responses directed at pathogenic antigens remains outstanding. To develop antigen-specific Treg therapy at least some of the dominant antigens that perpetuate effector T-cell responses in the intestine need to be identified. Using T-cell clones isolated from IBD patients, Duchmann et al.66 found that many of the clones were specific for commensal gut flora, including species of Enterobacteriaceae, Bacteroides

and Bifidobacterium. Corroborating these data, Cong et al.67 found that T cells specific for enteric bacterial flora drive disease in spontaneously colitic C3H/HeJBir mice. It was subsequently demonstrated that

bacterial flagellin, a protein present on all flagellated bacteria including commensal species found in the gut, is a dominant antigen in these mice. In addition, flagellin expressed by a Clostridium species, known as CBir, is targeted by antibodies in colitic mice and humans,68 and transfer of CBir-specific CD4+ T-cell lines into immunodeficient mice causes severe colitis.68 Further evidence that T cells that recognize flagellin are relevant in colitis comes from studies with Escherichia coli-derived flagellin, the delivery of Y-27632 solubility dmso which exacerbates dextran sodium sulphate-induced colitis in a TLR5-independent manner.69,70 Although this is a new and rapidly evolving field, these data collectively suggest bacterial flagellin as a candidate antigen to target for Treg cellular therapy of IBD. Although dominant antigens that drive IBD are still being discovered, and there are likely to be many different disease-relevant antigens, antigen-directed Treg therapy could currently be tested in a chronic inflammatory gastrointestinal disease that shares similar defects in immune regulation to IBD. Coeliac disease is a chronic immune-mediated inflammatory disorder initiated by wheat gliadin and related proteins in barley and rye.

In addition, studies that did not specify women’s HIV infection s

In addition, studies that did not specify women’s HIV infection status and only mentioned investigating STIs in general as outcomes of interest in the abstract were excluded. In addition to the limitations of the review itself, there are important methodological limitations within the studies included in this review, which may have affected

their findings. Most studies utilised a cross-sectional design, which severely limits their ability to make causal inferences. None of the studies click here provided strong longitudinal, prospective information on the relationship between early sexual debut and women’s increased HIV risk, because a few cohort studies included in this review had short follow-up times or only included women in their sample who were already sexually active. In addition, asking women retrospectively about their age at their first sexual intercourse is prone to result in potential recall or response bias, especially given the potential sensitivity of the topic being explored, especially if first sexual debut was with a non-marital sexual

partner.[36] There may also potentially be variations in the quality of the research being presented, with a potential for bias being enhanced if surveys have not met standards of intensive interviewer Lenvatinib datasheet training, careful translation into local languages of terms such as sexual intercourse and sexual partners.[30] Only a few studies included in this review reported implementing strategies or measures to reduce recall and social desirability biases when asking women about their age at their sexual debut.[14] In the review, we were also not able to ensure comparability in the definitions of early sexual debut Terminal deoxynucleotidyl transferase across studies and instead had to compile evidence from studies that used differing definitions. In practice, the majority of studies reviewed compared rates of HIV infection among women who had started having

sex before the age of 15 to rates among women who had their first sex after the age of 15. However, a few studies also used other age cut-offs, and a number of studies used multiple age categories, which made the comparisons and interpretations difficult. For example, they compared early sexual debut before the age of 15 with first sex after the age of 20 or even 25, while the majority of women in most studies had their first sex between the ages of 16–20. Existing evidence on the developmental stages of adolescents[37] seems to suggest that an age cut-off for early first sex before the age of 15 is the most sensible; however, this should be determined according to the cultural background, as first sex may often coincide with cultural norms or legal marriage age. Whichever cut-off point is chosen, it should be accompanied by a justification, which was rarely given in the reviewed studies.