Sodium taurocholate co-transporting polypeptide deficiency

INTRODUCTION

Little is known about bile acid transporter defects on the basolateral side of hepatocytes. In 2015 Vaz et al. published a first case of SLC10A1 mutation causing Na-taurocholate Co-transporting Polypeptide deficiency with hypercholanemia and normal bilirubin and Autotaxin levels. The index patient presented with failure to thrive, but without pruritus or jaundice. Several new cases have been published since, but the full spectrum of clinical presentation of mutations in SLC10A is not known. The primary aim of this review is to report a patient with a novel homozygous mutation and discuss the findings in the light of all other reported cases to date.

MATERIAL AND METHODS

We describe the findings of a patient with a previously unreported homozygous mutation and review all published cases to date in English on PubMed.

RESULTS

Our female patient born in 2002 presented with a feeding disorder and failure to thrive akin to the first description by Vaz. Workup suggested underlying liver disease although she did not complain of pruritus. Serum levels of aminotransferases, alkaline phosphatase, gamma-glutamyl transferase and bilirubin were normal. Plasma bile acids were chronically elevated, up to 150-fold. A first liver biopsy performed at 2 years of age showed unspecific findings with focal steatosis. Ursodeoxycholic acid treatment was introduced and the liver panel monitored regularly. At age 14, a second biopsy was performed, and histology was within normal limits. At this time, serum Autotaxin levels were found to be in normal range. Finally, genetic analysis revealed a homozygous 5 bp deletion in the gene SLC10A1 resulting in a premature stop codon predicted to lead to a complete NTCP loss of function. Most other reported cases to date carry the c.800C>T (p.Ser267Phe) mutation and are asymptomatic.

DISCUSSION

NTCP deficiency appears to have a benign course as most patients are asymptomatic. Many patients seem to present with transient neonatal jaundice. Large variations in total plasma bile acid levels are observed between patients; they may be linked to the underlying genetic mutation or to yet uncharacterized compensatory mechanisms. Longer follow-up is needed to evaluate the long-term consequences of this newly identified inherited disease of bile acid transport.

Circulating immune cell populations related to primary breast cancer, surgical removal, and radiotherapy revealed by flow cytometry analysis

BACKGROUND

Advanced breast cancer (BC) impact immune cells in the blood but whether such effects may reflect the presence of early BC and its therapeutic management remains elusive.

METHODS

To address this question, we used multiparametric flow cytometry to analyze circulating leukocytes in patients with early BC (n = 13) at the time of diagnosis, after surgery, and after adjuvant radiotherapy, compared to healthy individuals. Data were analyzed using a minimally supervised approach based on FlowSOM algorithm and validated manually.

RESULTS

At the time of diagnosis, BC patients have an increased frequency of CD117⁺CD11b⁺ granulocytes, which was significantly reduced after tumor removal. Adjuvant radiotherapy increased the frequency of CD45RO⁺ memory CD4⁺ T cells and CD4⁺ regulatory T cells. FlowSOM algorithm analysis revealed several unanticipated populations, including cells negative for all markers tested, CD11b⁺CD15^low, CD3⁺CD4^-CD8^-, CD3⁺CD4⁺CD8⁺, and CD3⁺CD8⁺CD127⁺CD45RO⁺ cells, associated with BC or radiotherapy.

CONCLUSIONS

This study revealed changes in blood leukocytes associated with primary BC, surgical removal, and adjuvant radiotherapy. Specifically, it identified increased levels of CD117⁺ granulocytes, memory, and regulatory CD4⁺ T cells as potential biomarkers of BC and radiotherapy, respectively. Importantly, the study demonstrates the value of unsupervised analysis of complex flow cytometry data to unravel new cell populations of potential clinical relevance.

Navigating transdermal diffusion with multiphoton fluorescence lifetime imaging

We demonstrate the potential of fluorescence lifetime imaging by time-correlated single-photon counting as a method for monitoring the transdermal diffusion pathway and diffusion rate of pharmaceuticals in human skin. The current application relies on observing subtle changes in the fluorescence lifetime of the intrinsic fluorophores present in the intracellular region between corneocytes of the stratum corneum. We have comprehensively characterized the measured fluorescence lifetimes from intracorneocyte junctions in three skin section types (dermatomed skin, epidermal membranes and stratum corneum) revealing statistically significant differences of the short lifetime component between each of the types, which we attribute to the sample preparation and imaging method. We show using epidermal membrane sections that application of a drug/solvent formulation consisting of ethinyl estradiol and spectroscopic grade ethanol to the surface gives rise to a slight but statistically significant shortening of the fluorescence lifetime of the long-lived emitting species present in the sample, from approximately 2.8 ns to 2.5 ns. The method may be useful for future studies where the kinetics and pathways of a variety of applied formulations could be investigated.

Bar overdentures utilizing the Locator attachment

Implant-retained overdentures are a restorative option for both the fully and partially edentulous arches. A new attachment, the Locator, which features a reduced interarch requirement and the advantage of built-in guide planes providing precise insertion, is described. The Locator is an advancement in attachment technology, with an improved design combined from the best features of a ball attachment, an ERA attachment, and a cap attachment.

One step partial purification of beta-D-galactosidase from Kluyveromyces marxianus CDB 002 using STREAMLINE-DEAE

The intracellular enzyme beta-D-galactosidase provides interesting applications in the dairy industry, which are able to solve problems related to product processing, or can alleviate lactose intolerance in some populations. In order to obtain a technical enzyme, yeast cells of Kluyveromyces marxianus CDB 002 were disrupted by high pressure homogenization and an innovative chromatographic technique was tested for the recovery of beta-D-galactosidase. A STREAMLINE 25 column, containing 65 ml STREAMLINE-DEAE was equilibrated with 50 mM potassium phosphate buffer pH 7.5 at an upward flow of 250 cmh-1. 100-200 ml cell homogenate were applied onto the expanded gel. After unbound proteins and cellular debris were washed out, the bed was allowed to sediment and beta-D-galactosidase was eluted with a downward flow of 0.2 M NaCl in the same buffer. A 6-fold purification factor was achieved with 63% activity recovery, while removing cell debris at a single step, thus avoiding a centrifugation step. Concentration and volume of the applied sample affected purification and gel performance. The results presented show STREAMLINE-DEAE chromatography to be an interesting method for the production of beta-D-galactosidase as a technical enzyme, since it can also be applied on a large scale without much modification.

Use of guide planes and implant supported bar overdentures: a case report

A stable occlusal plane is achieved with the combination of two maxillary, implant-supported milled bars securing an overdenture and bilateral, mandibular-fixed partial dentures. Overdenture retention is enhanced with attachments. Guide planes assure proper alignment of the overdenture for easy patient insertion and improved prosthesis stability. A reliable technique for verifying the accuracy of the master cast is also presented.

Divalproate augmentation in lithium-resistant rapid cycling mania in four geriatric patients

This report describes four geriatric patients, with rapid cycling bipolar disorder, who were treated successfully with divalproex sodium in combination with lithium carbonate, noting that both drugs were necessary for clinical remission of symptoms. Divalproex sodium may actually enhance the sensitivity to lithium carbonate in this population, potentially leading to treatment with lower lithium concentrations. This strategy has an advantage in enabling a greater safety range in the use of lithium carbonate in elderly patients. This report further raises questions as to the nature of rapid cycling illness in the "old-old" population.

Technology assessment. An American Medical Association perspective

The contemporary practice of medicine depends on the use of a wide array of technologies that did not exist 40 years ago. An exponential increase in our scientific knowledge base, and the subsequent application of this new information to clinical practice, have dramatically extended longevity, enhanced the quality of life, and improved the overall health status of the American public. Clinical medicine has become "a set of technologies for diagnosis, prevention, treatment, and rehabilitation."

Experimental observations on peritoneal transport in rabbits

Peritoneal transfer kinetics of substances differing in molecular size and lipophilic properties were studied in anuric adult rabbits with ligated ureters. In conscious animals, the dialysate/plasma concentration ratios of creatinine (Cr) and inulin (In) rose exponentially up to 200 min of dwelling. Peritoneal CIn was 0.24 ml/min/kg, and CCr was 0.10 ml/min/kg of body wt. The transfer rate for dipropyl acetic acid (VPA) was higher than for its more lipophilic analogue dibutyl acetic acid (DBA); the apparent equilibrium of the dialysate/plasma concentration ratio for VPA was 0.3 to 0.6 and 0.15 to 0.20 for DBA. Correspondingly, the peritoneal CVPA was higher (0.08 to 0.16 ml/min/kg) than CDBA (0.04 to 0.05 ml/min/kg); peritoneal clearances were 8% vs. 1.5% of the plasma clearances. The addition of nitroglycerin, dopamine, isoprenalin, fenoterol, and nitroprusside sodium to the dialysate did not increase significantly the peritoneal CCr and CIn during 30-min cycles. In conclusion, the peritoneal transport kinetics of creatinine, inulin, and protein are qualitatively similar to clinical data, but of different magnitude. The efficiency of peritoneal dialysis depends on the lipophilic characteristics of the substance to be transferred. The vasoactive drugs studied seem not to be promising for increasing the efficiency of peritoneal transport.