DR3 Regulates Intestinal Epithelial Homeostasis and Regeneration After Intestinal Barrier Injury

BACKGROUND & AIMS

Tumor necrosis factor (TNF) superfamily member tumor necrosis factor-like protein 1A (TL1A) has been associated with the susceptibility and severity of inflammatory bowel diseases. However, the function of the tumor necrosis factor-like protein 1A and its receptor death receptor 3 (DR3) in the development of intestinal inflammation is incompletely understood. We investigated the role of DR3 expressed by intestinal epithelial cells (IECs) during intestinal homeostasis, tissue injury, and regeneration.

METHODS

Clinical phenotype and histologic inflammation were assessed in C57BL/6 (wild-type), Tl1a-/- and Dr3-/- mice in dextran sulfate sodium (DSS)-induced colitis. We generated mice with an IEC-specific deletion of DR3 (Dr3ΔIEC) and assessed intestinal inflammation and epithelial barrier repair. In vivo intestinal permeability was assessed by fluorescein isothiocyanate dextran uptake. Proliferation of IECs was analyzed by bromodeoxyuridine incorporation. Expression of DR3 messenger RNA was assessed by fluorescent in situ hybridization. Small intestinal organoids were used to determine ex vivo regenerative potential.

RESULTS

Dr3-/- mice developed more severe colonic inflammation than wild-type mice in DSS-induced colitis with significantly impaired IEC regeneration. Homeostatic proliferation of IECs was increased in Dr3-/- mice, but blunted during regeneration. Cellular localization and expression of the tight junction proteins Claudin-1 and zonula occludens-1 were altered, leading to increased homeostatic intestinal permeability. Dr3ΔIEC mice recapitulated the phenotype observed in Dr3-/- mice with increased intestinal permeability and IEC proliferation under homeostatic conditions and impaired tissue repair and increased bacterial translocation during DSS-induced colitis. Impaired regenerative potential and altered zonula occludens-1 localization also were observed in Dr3ΔIEC enteroids.

CONCLUSIONS

Our findings establish a novel function of DR3 in IEC homeostasis and postinjury regeneration independent of its established role in innate lymphoid cells and T-helper cells.

Pointing in a different direction: a case of bilateral absence of extensor indicis

Understanding anatomical variations, as well as, normal anatomy of the muscles and tendons of the hand is vital for successful clinical evaluation and surgery. A number of extensor muscle and tendon variations have been reported in the literature including duplication, triplication, and absence. We report a rare anatomical variation that includes bilateral absence of the extensor indicis (EI) muscles and bilateral duplication of the extensor digitorum (ED) tendon to the second digit in the forearm of an 83-year-old male cadaver during routine upper limbs dissection. In the present case, only three muscles were present in the deep compartment: extensor pollicis longus (EPL), extensor pollicis brevis (EPB), and abductor pollicis longus (APL) with bilateral absence of EI. The reported prevalence of bilateral absence of EI muscle and tendon ranges from 0.5 to 3.5% [1, 26]. The prevalence of an additional index tendon arising bilaterally from the ED muscle belly is 3.2 % of the population [1]. Extension of the index finger is governed by the actions of EI and ED. However, the four tendons of ED are linked to each other by juncturae tendinum (JT), restricting independent extension of the digits in certain postures, e.g. when the hand is fisted. With fisted hand, EI controls extension of the index finger. Clinically, EI tendons are used for tendon reconstruction procedures to restore function to the hand and thumb after trauma or tendon rupture. This report highlights the importance of anticipating anatomical variations and conducting pre-operative evaluations to confirm the presence of EI when planning tendon transfer procedures.

Direct signaling of TL1A-DR3 on fibroblasts induces intestinal fibrosis in vivo

Tumor necrosis factor-like cytokine 1A (TL1A, TNFSF15) is implicated in inflammatory bowel disease, modulating the location and severity of inflammation and fibrosis. TL1A expression is increased in inflamed mucosa and associated with fibrostenosing Crohn's disease. Tl1a-overexpression in mice causes spontaneous ileitis, and exacerbates induced proximal colitis and fibrosis. Intestinal fibroblasts express Death-receptor 3 (DR3; the only know receptor for TL1A) and stimulation with TL1A induces activation in vitro. However, the contribution of direct TL1A-DR3 activation on fibroblasts to fibrosis in vivo remains unknown. TL1A overexpressing naïve T cells were transferred into Rag-/- , Rag-/- mice lacking DR3 in all cell types (Rag-/-Dr3-/-), or Rag-/- mice lacking DR3 only on fibroblasts (Rag-/-Dr3∆Col1a2) to induce colitis and fibrosis, assessed by clinical disease activity index, intestinal inflammation, and collagen deposition. Rag-/- mice developed overt colitis with intestinal fibrostenosis. In contrast, Rag-/-Dr3-/- demonstrated decreased inflammation and fibrosis. Despite similar clinical disease and inflammation as Rag-/-, Rag-/-Dr3∆Col1a2 exhibited reduced intestinal fibrosis and attenuated fibroblast activation and migration. RNA-Sequencing of TL1A-stimulated fibroblasts identified Rho signal transduction as a major pathway activated by TL1A and inhibition of this pathway modulated TL1A-mediated fibroblast functions. Thus, direct TL1A signaling on fibroblasts promotes intestinal fibrosis in vivo. These results provide novel insight into profibrotic pathways mediated by TL1A paralleling its pro-inflammatory effects.

Application of an Intermittency Model for Laminar, Transitional, and Turbulent Internal Flows

A turbulent transition model has been applied to fluid flow problems that can be laminar, turbulent, transitional, or any combination. The model is based on a single additional transport equation for turbulence intermittency. While the original model was developed for external flows, a slight modification in model constants has enabled it to be used for internal flows. It has been successfully applied to such flows for Reynolds numbers that ranged from 100 to 100,000 in circular tubes, parallel plate channels, and circular tubes with an abrupt change in diameters. The model is shown to predict fully developed friction factors for the entire range of Reynolds numbers as well as velocity profiles for both laminar and turbulent regimes.

Identification of a novel HLA-A*02 allele, HLA-A*02:01:01:32, in a deceased Caucasoid donor

HLA-A*02:01:01:32 differs from HLA-A*02:01:01:01 by a single nucleotide substitution (G→A) at position 2456.

Natural radioactivity content in soil and indoor air of Chellanam

Contribution of terrestrial radiation due to the presence of naturally occurring radionuclides in soil and air constitutes a significant component of the background radiation exposure to the population. The concentrations of natural radionuclides in the soil and indoor air of Chellanam were investigated with an aim of evaluating the environmental radioactivity level and radiation hazard to the population. Chellanam is in the suburbs of Cochin, with the Arabian Sea in the west and the Cochin backwaters in the east. Chellanam is situated at ∼25 km from the sites of these factories. The data obtained serve as a reference in documenting changes to the environmental radioactivity due to technical activities. Soil samples were collected from 30 locations of the study area. The activity concentrations of (232)Th, (238)U and (40)K in the samples were analysed using gamma spectrometry. The gamma dose rates were calculated using conversion factors recommended by UNSCEAR [United Nations Scientific Committee on the Effects of Atomic Radiation. Sources and effects of ionizing radiation. UNSCEAR (2000)]. The ambient radiation exposure rates measured in the area ranged from 74 to 195 nGy h(-1) with a mean value of 131 nGy h(-1). The significant radionuclides being (232)Th, (238)U and (40)K, their activities were used to arrive at the absorbed gamma dose rate with a mean value of 131 nGy h(-1) and the radium equivalent activity with a mean value of 162 Bq kg(-1). The radon progeny levels varied from 0.21 to 1.4 mWL with a mean value of 0.6 mWL. The thoron progeny varied from 0.34 to 2.9 mWL with a mean value of 0.85 mWL. The ratio between thoron and radon progenies varied from 1.4 to 2.3 with a mean of 1.6. The details of the study, analysis and results are discussed.

Fitzgerald Trait: Deficiency of a Hitherto Unrecognized Agent, Fitzgerald Factor, Participating in Surface-Mediated Reactions of Clotting, Fibrinolysis, Generation of Kinins, and the Property of Diluted Plasma Enhancing Vascular Permeability (PF/Dil)

The prolonged partial thromboplastin time observed in the plasma of a 71-yr-old asymptomatic man was related to the deficiency of a hitherto unrecognized agent. The patient's plasma also exhibited impaired surface-mediated fibrinolysis and esterolytic activity and impaired generation of kinins and of the property enhancing vascular permeability designated PF/Dil. The patient's plasma contained normal amounts of all known clotting factors except Fletcher factor (a plasma prekallikrein) which was present at a concentration of 10-15% of pooled normal plasma. Fletcher trait plasma, however, contained normal amounts of the agent missing from the patient's plasma and corrected the defects in clotting, fibrinolysis, and vascular permeability. Fletcher trait plasma was less effective in correcting generation of kinins and esterolytic activity, presumably because of the patient's partial deficiency of prekallikrein. The site of action of the factor deficient in the patient's plasma appeared to be subsequent to the activation of Hageman factor and plasma prekallikrein. A fraction of normal plasma, devoid of other clotting factors, corrected the defect in clotting in the patient's plasma; a similar fraction of the patient's plasma did not correct this abnormality. No evidence yet exists pointing to the familial nature of the patient's defect. Tentatively, the patient's disorder may be referred to by his surname as Fitzgerald trait, and the agent apparently deficient in his plasma as Fitzgerald factor.

Platelet function and structure in myeloproliferative disease, myelodysplastic syndrome, and secondary thrombocytosis

Platelet function and morphologic characteristics were evaluated in 43 patients with myeloproliferative disease (MPD), 5 patients with myelodysplastic syndrome (MDS), and 7 patients with secondary thrombocytosis (ST). Platelet Factor IV (PF4) and B-thromboglobulin (BTG) showed slight elevation in ST but significant elevation in all MPDs. They were either normal or slightly elevated in MDS. Defective platelet aggregation with one or more inducers was seen in 62% of all patients. An epinephrine-induced defect was the most consistent aggregation abnormality. Hyperaggregation and spontaneous aggregation were seen in 15% of patients. Of the eight patients who showed increased bleeding tendency, all eight showed defective aggregation with two or more inducers, five showed decreased surface activation response, as well as decreased or abnormal granules and dense tubular disarray in the transmission electron microscope (TEM) study. Seven patients had clinical evidence of recurrent arterial and venous thromboses. Five of these patients showed hyperaggregation response to adenosine diphosphate and collagen and abnormal Wu and Hoak platelet aggregate ratio. Four patients showed spontaneous aggregation on aggregometer. Surface activation response was significantly increased in five patients, and an increase in platelet granules by TEM study was seen in four patients. Primary thrombocythemia could be differentiated from secondary thrombocytosis (ST) by the presence of abnormal aggregation response and significantly increased PF4 and BTG in the former, and greatly elevated plasma fibrinogen and Factor VIII, as part of acute phase reactant response, in the latter.

Myelodysplasia with bone marrow lymphocytosis and fibrosis mimicking recurrent Hodgkin's disease

Myelodysplastic syndromes and acute leukemias after treatment for Hodgkin's disease (HD) are well recognized. Preleukemic changes are commonly seen. Three patients from the authors' files are found with myelofibrosis and bone marrow lymphocytosis after treatment for HD. Although somewhat unusual, the clinical impression initially was, in each case, isolated recurrence of HD involving the bone marrow, 6 to 11 years after initial diagnosis. In each case, after single or multiple marrow aspirates and biopsies were done, the differential between HD involving the marrow and myelodysplasia with myelofibrosis and lymphocytic infiltrates was made. The absence of diagnostic Reed-Sternberg (RS) cells was useful in diagnosing the latter. All three patients died of causes related to cytopenias, with two having progressed to overt acute nonlymphocytic leukemia. Myelofibrosis with lymphocytic infiltrates in the marrow, without diagnostic RS cells, in patients' status after treatment for HD, should alert one to the possibility of myelodysplasia.

Splenectomy in systemic lupus erythematosis

Of 860 patients with systemic lupus erythematosus (SLE) who were evaluated during a 25-year-period, 16 (1.9%) underwent splenectomy. Twelve of these patients had steroid resistant thrombocytopenia. An excellent long-term outcome occurred in eight (67%), significant improvement occurred in three (25%), and one patient died who also had chronic active hepatitis and portal hypertension. In two of three patients (67%) with autoimmune hemolytic anemia, the condition was corrected by splenectomy; in the third patient there was some improvement, but reduced doses of corticosteroids were required. One patient with severe neutropenia and recurrent bacterial infection obtained lasting benefit following splenectomy. Histologic examination of the removed spleen was not helpful in corroborating the diagnosis of SLE in these well established cases. Splenectomy had no adverse affect upon other aspects of SLE, in particular upon renal function. The authors conclude that the indications for splenectomy have proven to be of value in selected SLE patients with autoimmune or hypersplenic cytopenia.

Nonsecretory multiple myeloma with osteoporosis: immunocytologic and bone resorptive studies

Two patients, ultimately found to have advanced nonsecretory multiple myeloma, presented with skeletal pain, diffuse skeletal demineralization, and fractures. The correct diagnosis was initially obscured by the absence of typical hematologic findings and discrete lytic bone lesions. Bone marrow examination was diagnostic. Intracytoplasmic IgA or IgD kappa was demonstrated in the myeloma cells of each case. Decreased quantitative polyclonal serum immunoglobulins and hypercalcemia were important clinical clues. The demonstration of increased osteoclast activating factor (OAF) derived from the cultured myeloma cells from each case suggests that the secretion of OAF and immunoglobulin are unrelated.

High incidence of monoclonal proteins in the serum and urine of chronic lymphocytic leukemia patients

Chronic lymphocytic leukemia (CLL) is generally considered a nonsecretory B cell immunoproliferative disorder. Conventional electrophoretic and immunoelectrophoretic methods have revealed serum monoclonal proteins in less than 10% of these patients. However, there is increasing experimental evidence from in vitro studies demonstrating that CLL cells may secrete immunoglobulins, particularly free light chains. We examined the serum and urine of 36 consecutive CLL patients for monoclonal proteins using sensitive immunochemical methods (high resolution agarose gel electrophoresis combined with immunofixation). The results obtained were correlated with the Rai stage, quantitative immunoglobulin levels, and lymphocyte membrane immunoglobulin phenotype of the leukemic cells. Twenty-three monoclonal proteins were identified in the serum or urine of 22 patients, an incidence of 61%. Six patients had serum monoclonal proteins, seven had only urinary monoclonal proteins, and nine had monoclonal proteins in serum and urine. In every instance the monoclonal protein was the same light chain type as expressed on the leukemic cells. Our findings suggest that the monoclonal proteins observed in the serum or urine of CLL patients are secretory products of the tumor cells and that their discovery is a function of the sensitivity of the method used for their detection.

Multiple active X chromosomes in myelofibrosis with myeloid metaplasia

A woman with myelofibrosis and myeloid metaplasia had a karyotype of 47,X,del(X)(q22),+del(X)(q22) in unstimulated peripheral blood and bone marrow aspirate cultures. The normal X chromosome was late replicating, and the two deleted X chromosomes always replicated early and synchronously. The karyotype from phytohemagglutin-stimulated peripheral blood cultures was uniformly 46,XX. Structurally abnormal X chromosomes are exceedingly rare in myeloproliferative disease. The abnormal karyotype very likely reflects monoclonal proliferation of an abnormal myeloid cell line. The X chromosome inactivation process, which acts upon embryonic somatic cells of all mammals, apparently does not react to postembryonic nondisjunction of the active X chromosome.

Fitzgerald factor: a hitherto unrecognised coagulation factor

A newly recognised asymptomatic coagulation-factor deficiency is reported in a 71-year-old man. This factor seems to operate at an early stage in the intrinsic coagulation pathway and participates in other Hageman-factor-mediated biological reactions. The patient has an atypical cellular inflammatory response as observed by the skin-window technique.