HMGN1 down-regulation in the diabetic kidney attenuates tubular cells injury and protects against renal inflammation via suppressing MCP-1 and KIM-1 expression through TLR4

BACKGROUND

Renal tubular injury, accompanied by damaging inflammation, has been identified to drive diabetic kidney disease (DKD) toward end-stage renal disease. However, it is unclear how damage-associated molecular patterns (DAMPs) activate innate immunity to mediate tubular epithelial cell (TEC) injury, which in turn causes with subsequent sterile inflammation in diabetic kidneys. High mobility group nucleosome-binding protein 1 (HMGN1) is a novel DAMP that contributes to generating the innate immune response. In this study, we focused on determining whether HMGN1 is involved in DKD progression.

METHODS

Streptozotocin (STZ)-induced diabetic mice model was established. Then we downrergulated HMGN1 expression in kidney with or without HMGN1 administration. The renal dysfunction and morphological lesions in the kidneys were evaluated. The expressions of KIM-1, MCP-1, F4/80, CD68, and HMGN1/TLR4 signaling were examined in the renal tissue. In vitro, HK2 cells were exposed in the high glucose with or without HMGN1, and further pre-incubated with TAK242 was applied to elucidate the underlying mechanism.

RESULTS

We demonstrated that HMGN1 was upregulated in the tubular epithelial cells of streptozotocin (STZ)-induced type 1 and type 2 diabetic mouse kidneys compared to controls, while being positively correlated with increased TLR4, KIM-1, and MCP-1. Down-regulation of renal HMGN1 attenuated diabetic kidney injury, decreased the TLR4, KIM-1, and MCP-1 expression levels, and reduced interstitial infiltrating macrophages. However, these phenotypes were reversed after administration of HMGN1. In HK-2 cells, HMGN1 promoted the expression of KIM-1 and MCP-1 via regulating MyD88/NF-κB pathway; inhibition of TLR4 effectively diminished the in vitro response to HMGN1.

CONCLUSIONS

Our study provides novel insight into HMGN1 signaling mechanisms that contribute to tubular sterile injury and low-grade inflammation in DKD. The study findings may help to develop new HMGN1-targeted approaches as therapy for immune-mediated kidney damage rather than as an anti-infection treatments.

Outcomes of Trainee-performed MIGS at Parkland Memorial Hospital: A Retrospective Cohort Study

Aims and background

As the use of minimally invasive or microinvasive glaucoma surgery (MIGS) continues to expand, it is important to look at its outcomes in the hands of trainees. This study aims to examine the efficacy and safety of Kahook Dual Blade (KDB) goniotomy and endocyclophotocoagulation (ECP) with cataract extraction (CE) done by residents and fellows.

Methods

All cases of KDB or ECP performed with CE between 2012 and 2020 at Parkland were reviewed, excluding cases with multiple MIGS procedures or other procedures.

Results

A total of 153 eyes of 136 patients who underwent KDB and 125 eyes of 124 patients who underwent ECP were included. Mean intraocular pressure (IOP) decreased from 17.2 ± 5.2 at baseline to 15.4 ± 5.5 mm Hg at postoperative (post-op) month (POM) 12 in the KDB group (p = 0.02) and from 18.6 ± 6.3 at baseline to 15.1 ± 4.9 mm Hg at POM12 in the ECP group (p < 0.001), with wide variation in IOP change among subjects for both. The mean change in IOP across all time points was statistically significant for both groups. Medication counts were reduced from baseline at POMs 1, 3, and 6, but not 12, in both the KDB and ECP groups (p = 0.43 and p = 0.35, respectively). The rate of serious complications was very low; the most common complication was cystoid macular edema (CME) (six cases) and active inflammation beyond POM1 (15 cases) for KDB and ECP, respectively.

Conclusion

Combined CE/MIGS procedures performed by trainees were safe but less efficacious in lowering IOP and medications compared to literature reporting outcomes of attending surgeons, apart from ECP/MIGS with regards to IOP lowering, which was found to be similarly efficacious.

Clinical significance

Cataract extraction (CE) combined with KDB or ECP in the hands of trainees decreased mean IOP from baseline and was safe. IOP and medication reduction of MIGS/CE in the hands of trainees were overall lesser than reported values by attending surgeons.

How to cite this article

Da J, Gillings M, Kamat S, et al. Outcomes of Trainee-performed MIGS at Parkland Memorial Hospital: A Retrospective Cohort Study. J Curr Glaucoma Pract 2023;17(3):134-140.

Comparison of Patient-Reported Functional Recovery From Different Types of Ophthalmic Surgery

PURPOSE

To characterize and compare patient-reported recovery of function after cataract or glaucoma surgery using a novel visual analog scale.

DESIGN

Prospective observational cohort study.

METHODS

Daily for 2 weeks and weekly thereafter, patients recovering from trabeculectomy, tube shunt implantation, or cataract extraction (CE) completed a diary-style questionnaire including visual analog scales (VASs; scored 0-100) grading pain and global function. Clinical examination data and medical histories were collected. Generalized estimating equation models evaluated associations between VAS function scores and pain or visual acuity (VA) and compared scores between surgery types.

RESULTS

Among 51 participants followed for 12 weeks, tube shunt placement reduced postoperative day 1 (POD1) function by 47 of 100 points vs CE (P = .006), while trabeculectomy did not reduce POD1 function vs CE (P = .33). After CE, trabeculectomy, and tube shunt placement, average VAS function scores increased 13.94 per week for 2 weeks (P < .001), 4.18 per week for 4 weeks (P = .02), and 7.76 per week for 7 weeks (P < .001), respectively. After those timepoints, there was no further significant change. Beyond 2 weeks, pain levels plateaued, and VA returned to baseline across surgery types; function was inversely related to pain or VA only for the first 2 or 4 weeks, respectively.

CONCLUSIONS

Patients recovering from cataract and glaucoma surgery report reduced function in the postoperative period. Tube shunt implantation causes greater morbidity than trabeculectomy, and both are associated with slower improvement than CE. Early postoperative function is associated with VA and pain, but neither fully explains reported impairment. A VAS for function may efficiently capture postoperative recovery.

Evidence-Based Criteria for Determining Peripapillary OCT Reliability

PURPOSE

To assess the impact of OCT signal strength (SS) and artifact on retinal nerve fiber layer (RNFL) measurement reliability and to understand whether glaucoma severity modifies this relationship.

DESIGN

Retrospective, longitudinal cohort study.

PARTICIPANTS

Two thousand nine hundred ninety-two OCT scans from 474 eyes of 241 patients with glaucoma or glaucoma suspect status.

METHODS

We extracted mean RNFL thickness and SS and manually graded scans for artifact. To analyze the effect of SS and artifact on OCT reliability, we (1) created a multilevel linear model using measured RNFL thickness values and demographic and clinical data to estimate the true (predicted) RNFL thickness, (2) calculated model residuals (ΔRNFL) as our reliability measure, and (3) created a second multilevel linear model with splines and interaction terms that modeled overall and quadrant specific reliability (ΔRNFL) as the outcome, using SS and artifact as predictors.

MAIN OUTCOME MEASURES

Impact of SS and artifact on ΔRNFL.

RESULTS

For SS between 10 and 3, the impact of decreases in SS on OCT reliability is modest (-0.67 to -1.25 ΔRNFL per 1-point decrease in SS; P < 0.05). But at less than 3, changes in SS have a large impact on reliability (-15.70 to -16.34 ΔRNFL per 1-point decrease in SS; P < 0.05). At SS between 10 and 3, decreases in SS tend to have a larger impact on reliability in eyes with severe glaucoma (-1.25 per 1-point decrease in SS; P < 0.05) compared with eyes with mild or moderate glaucoma (-0.67 to -0.75 per 1-point decrease in SS; P < 0.05). The presence of artifact has a significant impact on OCT reliability independent of the effects of SS (-4.76 ΔRNFL; P < 0.05). Artifact affects reliability solely in the quadrant in which it occurs, with artifact in one quadrant showing no impact on ΔRNFL in the opposite quadrant (P > 0.05).

CONCLUSIONS

Signal strength decreases down to 3 have relatively mild impacts on OCT reliability. At less than 3, the impact of further decreases in SS on reliability are substantial. The effect of SS on reliability is greater in severe glaucoma. Artifacts result in a decrease in reliability independent of the effect of SS. We propose evidence-based guidelines to guide physicians on whether to trust the results of an OCT scan.

Functional Loss of ATRX and TERC Activates Alternative Lengthening of Telomeres (ALT) in LAPC4 Prostate Cancer Cells

A key hallmark of cancer, unlimited replication, requires cancer cells to evade both replicative senescence and potentially lethal chromosomal instability induced by telomere dysfunction. The majority of cancers overcome these critical barriers by upregulating telomerase, a telomere-specific reverse transcriptase. However, a subset of cancers maintains telomere lengths by the telomerase-independent Alternative Lengthening of Telomeres (ALT) pathway. The presence of ALT is strongly associated with recurrent cancer-specific somatic inactivating mutations in the ATRX-DAXX chromatin-remodeling complex. Here, we generate an ALT-positive adenocarcinoma cell line following functional inactivation of ATRX and telomerase in a telomerase-positive adenocarcinoma cell line. Inactivating mutations in ATRX were introduced using CRISPR-cas9 nickase into two prostate cancer cell lines, LAPC-4 (derived from a lymph node metastasis) and CWR22Rv1 (sourced from a xenograft established from a primary prostate cancer). In LAPC-4, but not CWR22Rv1, abolishing ATRX was sufficient to induce multiple ALT-associated hallmarks, including the presence of ALT-associated promyelocytic leukemia bodies (APB), extrachromosomal telomere C-circles, and dramatic telomere length heterogeneity. However, telomerase activity was still present in these ATRX^KO cells. Telomerase activity was subsequently crippled in these LAPC-4 ATRX^KO cells by introducing mutations in the TERC locus, the essential RNA component of telomerase. These LAPC-4 ATRX^KO TERC^mut cells continued to proliferate long-term and retained ALT-associated hallmarks, thereby demonstrating their reliance on the ALT mechanism for telomere maintenance. IMPLICATIONS: These prostate cancer cell line models provide a unique system to explore the distinct molecular alterations that occur upon induction of ALT, and may be useful tools to screen for ALT-specific therapies.

Comparison of different approaches to the surgical treatment of penile fractures: quicker return to sexual function with longitudinal incisions

The objective of this study was to compare the long-term clinical outcomes from longitudinal incisions and subcoronal circumferential degloving incisions in the surgical treatment of penile fractures. From July 2001 to July 2014, 23 patients were identified with penile fractures. Fourteen patients underwent longitudinal incisions after ultrasound localization; nine patients underwent subcoronal circumferential degloving incisions. Sexual function was evaluated preoperatively and postoperatively using an abridged International Index of Erectile Function (IIEF) questionnaire. The mean (±s.d.) operative time was 19.1 (±3.9) min in the longitudinal incision group and was 45.1 (±6.5) min in the subcoronal circumferential degloving incision group (P<0.05). The mean (±s.d.) times required to recover sexual function were 35.6 (±6.0) days in the longitudinal incision group and 54.0 (±5.8) days in the circumferential incision group (P<0.05). Six months postoperatively, the erectile functions of all cases were comparable to the level preoperatively except three patients. One patient from each group reported symptoms associated with mild ED, but they experienced satisfying sexual orgasms after psychotherapy for 2 months. Another patient's score on the IIEF-5 declined from 25 to 24 points in the circumferential incision group 10 months postoperatively, and this was associated with maintaining an erection after vaginal penetration. In conclusion, the longitudinal incision may allow quicker return to sexual function but not necessarily improved the long-term clinical outcomes. Furthermore, postoperative psychosocial nursing and psychotherapy should receive more attention.

Primary clear cell adenocarcinoma of the peritoneum presents as Sister Mary Joseph's nodule: a case report and literature review

BACKGROUND

Sister Mary Joseph's nodule (SMJN) is a raised nodule around the umbilicus and is often a clinical sign of metastatic malignancy with poor prognosis. Primary clear cell adenocarcinoma of the peritoneum is rare. Herein the authors describe a case of primary peritoneal clear cell adenocarcinoma presenting with SMJN as an initial sign.

CASE

A 59-year-old woman was admitted into the present hospital complaining of an enlarged, painful umbilical nodule, and increasing abdominal distention. After the biopsy of the peritoneal nodule, primary clear cell adenocarcinoma of the peritoneum was diagnosed. The patient underwent multiple courses of aggressive chemotherapy combined with radiotherapy and surgery and has survived for more than four years.

CONCLUSION

Considering that SMJN is a rare sign of visceral malignancies, clinicians should be aware of this rare clinical sign when determining the differential diagnosis. Umbilical metastasis is usually indicates a poor prognosis. However, the present case suggests that long-term survival is possible.

Antiproliferative activity and toxicity of 2-methoxyestradiol in cervical cancer xenograft mice

2-methoxyestradiol (2-ME) is considered to be an effective anticancer compound for many types of tumors. We have previously demonstrated that 2-ME inhibits the growth of human cervical cancer HeLaS3 cells in vitro. In this study, we investigated the antitumoral effects of 2-ME on human cervical carcinoma in severe combined immune deficient (SCID) mice. The potential side effects of 2-ME on the SCID mice were also investigated. SCID mice were injected with HeLaS3 cells (3 x 10(6) to 4 x 10(6)/mouse) and a 15-day administration of 2-ME followed after a 1-week cell implantation. Tumor weight, volume, body weight, and blood chemistry were determined. Tumor tissues were examined with an antibody against the proliferative cell nuclear antigen and terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) staining. Liver, spleen, kidney, heart, and lung were screened by pathologic examinations. 2-ME (75 mg/kg p.o.) inhibited growth of human cervical carcinoma by 34% (P < 0.05) as compared with control. Necrosis was found in both 2-ME-treated and untreated tumor tissues, but the necrotic area was larger in 2-ME-treated mice. A low expression of proliferative cell nuclear antigen and an increased number of apoptotic cells were found in 2-ME-treated tumor sections as compared to those in controls. No significant difference was detected in blood chemistry. In addition, the liver showed hyperplastic Kupffer cells, hydropic swelling of hepatocytes, and liquefactive necrosis. The spleen showed an increased number of megakaryocytes and apoptotic cells after 2-ME treatment. Thus, 2-ME has an antitumor effect on human cervical carcinoma, and it is toxic to liver and spleen in this mouse model.

Antiproliferative activity and toxicity of 2-methoxyestradiol in cervical cancer xenograft mice

2-Methoxyestradiol (2-ME) is considered to be an effective anticancer compound for many types of tumors. We have previously demonstrated that 2-ME inhibits the growth of human cervical cancer HeLaS3 cells in vitro. In this study, we investigated the antitumoral effects of 2-ME on human cervical carcinoma in severe combined immune deficient (SCID) mice. The potential side effects of 2-ME on the SCID mice were also investigated. SCID mice were injected with HeLaS3 cells (3 × 106 to 4 × 106/mouse) and a 15-day administration of 2-ME followed after a 1-week cell implantation. Tumor weight, volume, body weight, and blood chemistry were determined. Tumor tissues were examined with an antibody against the proliferative cell nuclear antigen and terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) staining. Liver, spleen, kidney, heart, and lung were screened by pathologic examinations. 2-ME (75 mg/kg p.o.) inhibited growth of human cervical carcinoma by 34% (P < 0.05) as compared with control. Necrosis was found in both 2-ME–treated and untreated tumor tissues, but the necrotic area was larger in 2-ME–treated mice. A low expression of proliferative cell nuclear antigen and an increased number of apoptotic cells were found in 2-ME–treated tumor sections as compared to those in controls. No significant difference was detected in blood chemistry. In addition, the liver showed hyperplastic Kupffer cells, hydropic swelling of hepatocytes, and liquefactive necrosis. The spleen showed an increased number of megakaryocytes and apoptotic cells after 2-ME treatment. Thus, 2-ME has an antitumor effect on human cervical carcinoma, and it is toxic to liver and spleen in this mouse model.

[Significance on expressions of Annexin-I and its correlative gene proteins in endometrial hyperplasia, atypical hyperplasia and endometrial carcinoma]

OBJECTIVE

To investigate expression of Annexin-I in various endometrial lesions and its significance in differential diagnosis of endometrial borderline lesions.

METHODS

We collected 37 specimens with different endometrial lesions, and reclassified them according to China and FIGO's standard, which included 12 cases of endometrial hyperplasia (EH), 10 cases of atypical hyperplasia (ATH) and 15 cases of endometrial carcinoma (EC). Immunohistochemical staining for AX-I, c-erbB-2, p53 protein, ER, PR, EGF and IGF were performed by LSAB.

RESULTS

The results showed that for AX-I, 1 cases of EH was weakly positive and others were negative; 9 cases of ATH showed strong positivity in the cytoplasm and the cell membrane, and 1 weakly positive; 7 cases of EC were positive and 8 negative. c-erbB-2 was expressed in 9 cases of ATH and 1 was negative. Expressions of EGFR, ER and PR were strong in all cases, but IGFR was negative in almost all cases. P53 expression was higher in EC than in ATH.

CONCLUSIONS

AX-I expression suggests that (1) AX-I protein may play an important role in the pathogenesis of cancer, the expression decreased and disappeared after malignant change. (2) High expression for AX-I can be used to differentiate ATH and EC. In addition, c-erbB-2 expression appeared to parallel the expression of AX-I in both ATH and EC, but in ATH it was higher than that in EC.

[Mycobacterium vaccae influences the kinetics of Th1/Th2 cells and expression of iNOS in a marine model of experimental tuberculosis]

OBJECTIVE

To investigate the immunoregulative mechanism of Mycobacterium vaccae by way of molecular pathology.

METHODS

BALB/C mice were randomly divided into three groups: tuberculosis model (A); mice were challenged with H37Rv by their tail veins and then immunized by M. vaccae (B); control mice (N). Immunohistochemistry and pathological slices stained with HE were evaluated to investigate the correlation between the expression of IFN-gamma, IL-4 and iNOS and the type and magnitude of tissue injury.

RESULTS

A predominance of Th1 cells was observed manifested by a high percentage of IFN-gamma positive cells in the inflammatory infiltrate and granulomas demonstrated by immunohistology peaked 6 weeks after infection (0.058 +/- 0.010), and there was a significant increase compared with N group (0.005 +/- 0.020, P < 0.01). This was followed by a chronic advanced phase characterized by pneumonia local necrosis with a Tho balance due to an equivalent proportion of IFN-gamma and IL-4 positive cells in the lung lesions. The iNOS expression was increased in acute phase and decreased in chronic phase. B group had localized lung lesions, proliferate and lymphoid nodules were predominant, there was less necrostic change. A predominance of Th1 cells was observed during the infection changed over time and there was no Tho balance phase occurred. iNOS expression had a higher level during the wholecourse of infection.

CONCLUSION

M. vaccae can enhance the protective immunological response by inducing Th1 response and inhibiting Th2 response.

[Thyroid squamous-cell carcinoma showing thymus-like element (CASTLE): a report of eight cases]

OBJECTIVE

To report 8 cases of squamous-cell carcinoma showing thymus-like element (CASTLE) of the thyroid.

METHODS

Clinical data and pathological sections were retrospectively reviewed.

RESULTS

CASTLE of the thyroid differed from ordinary squamous-cell carcinoma (SCC) in that it not only presented typical squamous pattern of differentiation, but also admixed with thymic architecture, such as Hassall's corpuscles, lymphoepithelial-like structure and mature lymphocyte infiltration in the stroma. CASTLE of the thyroid and much better prognosis than that of the ordinary SCC of the thyroid with a median survival time of 10.5 year. Histogenesis of CASTLE was discussed.

CONCLUSION

Thyroid CASTLE is of rare occurrence. It should be distinguished from SCC of thyroid in order to treat such patients adequately.

[A study on p53 gene mutation, protein expression and relationship with clinico-pathological status in large cell carcinoma of the lung]

Immunohistochemistry and in situ hybridization techniques were used to investigate the correlation between p53 gene mutation and the clinico-pathological status as well as prognosis of large cell carcinoma of the lung. p53 expression was found in 40% of the cases by immunohistochemistry and p53 gene mutation was found in 53.3% by in situ hybridization. The concordance ratio was 73.3% between gene mutation and protein expression. No statistically significant correlation was found between p53 gene mutation, its protein expression and sex, age, smoking, histological type, tumor size or lymph node involvement. A significant correlation was found between p53 gene mutation (or its protein expression) and mitotic index. The result of in situ hybridization demonstrated that there was a statistically significant correlation between p53 gene mutation and a poor prognosis. It was found that p53 gene mutation was associated with fast growth of the tumor. Therefore p53 gene mutation is probably an indicator of poor prognosis for large cell carcinoma of the lung.

Expression of tissue-type plasminogen activator in smooth muscle cells of injured iliac arteries in rabbits

In this experiment, expression of tissue-type plasminogen activator (t-PA) in smooth muscle cells (SMCs) was measured at different intervals after the arterial injury. In the normal iliac arteries, only low levels of t-PA activity were estimated. t-PA activity in extracts of the iliac arteries increased significantly at the 4th day after the injury, equivalent to the process that SMCs migrated from the media to the intima, and the t-PA activity was then decreased approximately to the normal level at the 7th day. Coexistent to the above data, results from in situ hybridization showed that the expression of t-PA mRNA in the intima as well as media increased also significantly at the 4th day after the arterial injury, and at the 7th day, t-PA mRNA was detected only in those SMCs locating closely adjacent to the internal elastic lamina. These results suggest that t-PA might play an important role in SMC migration following endothelial injury, and antagonism of t-PA expression and/or activity within the vessel wall might be helpful in intervening the development of restenosis following angioplasty.

[Human papillomavirus infection and p53 gene mutation in primary lung cancer]

Surgical samples from 40 cases of primary lung cancer were studied by in situ hybridization and polymerase chain reaction (PCR) to detect HPV-DNA in different types of lung cancer. In addition, PCR-RFLP was used to examine mutation of p53 exon 7. The results showed that HPV-DNA positive rate in lung cancer was 55% (22/40 cases), including SCLC (9/9 cases), squamous cell carcinomas (8/16 cases), and adenocarcinomas (5/12 cases). Amplification of p53 exon 7 was seen in 5 of 22 HPV-DNA positive cases. RFLP analysis showed that p53 exon 7 mutation was present in two cases with gene amplification. In HPV-DNA negatives there was only one case with exon 7 amplification but no mutation. SCLC and squamous carcinoma had higher HPV infection rate than other types of lung cancer. The results suggest some relation between HPV infection and p53 gene mutation.