Small Intestinal Goblet Cells Control Humoral Immune Responses and Mobilization During Enteric Infection

Humoral immune responses within the gut play diverse roles including pathogen clearance during enteric infections, maintaining tolerance, and facilitating the assemblage and stability of the gut microbiota. How these humoral immune responses are initiated and contribute to these processes are well studied. However, the signals promoting the expansion of these responses and their rapid mobilization to the gut mucosa are less well understood. Intestinal goblet cells form goblet cell-associated antigen passages (GAPs) to deliver luminal antigens to the underlying immune system and facilitate tolerance. GAPs are rapidly inhibited during enteric infection to prevent inflammatory responses to innocuous luminal antigens. Here we interrogate GAP inhibition as a key physiological response required for effective humoral immunity. Independent of infection, GAP inhibition resulted in enrichment of transcripts representing B cell recruitment, expansion, and differentiation into plasma cells in the small intestine (SI), which were confirmed by flow cytometry and ELISpot assays. Further we observed an expansion of isolated lymphoid follicles within the SI, as well as expansion of plasma cells in the bone marrow upon GAP inhibition. S1PR1-induced blockade of leukocyte trafficking during GAP inhibition resulted in a blunting of SI plasma cell expansion, suggesting that mobilization of plasma cells from the bone marrow contributes to their expansion in the gut. However, luminal IgA secretion was only observed in the presence of S. typhimurium infection, suggesting that although GAP inhibition mobilizes a mucosal humoral immune response, a second signal is required for full effector function. Overriding GAP inhibition during enteric infection abrogated the expansion of laminar propria IgA+ plasma cells. We conclude that GAP inhibition is a required physiological response for efficiently mobilizing mucosal humoral immunity in response to enteric infection.

Commercial application of flow cytometry for evaluating bull sperm

Artificial insemination using semen from genetically superior sires remains one of the most effective biotechnologies ever commercialized for animal breeding purposes. Genetic progress, however, cannot begin until conception occurs. Processing laboratories that provide cryopreserved bull semen for commercial use depend on in vitro assays of semen quality to identify samples that are expected to result in less than desirable conception rates. These identified samples are discarded, rather than released to salable inventories, with the desired effect of minimizing variance in field fertility among both sires and individual collections. Although the industry was successfully founded on subjective assessment of motility and acrosome integrity, flow cytometric and computer-assisted sperm analysis offer more objective and repeatable measures of sperm quality attributes. Albeit more expensive to implement, the increased precision and repeatability when using these objective assays lends to greater confidence in the accuracy of decisions for individual collections and (or) bulls. The efficacy of a quality control program is evidenced by the range in sire fertility estimates calculated from field fertility data, which have historically indicated >90% of all sires achieve fertility deviation within ±3% points of the breed average. This impressive precedent implies somewhat limited opportunity for transition to objective assessments to have a meaningful impact on an already narrow range of fertility distributions. Nonetheless, flow cytometric assessments of novel attributes of sperm quality hold promise for detection of truly sub-fertile sires (deviations < -3) that presently elude detection with use of existing semen bioassays.

Emerging synthetic cannabinoids detected by a drug checking service in Toronto, Canada

BACKGROUND

Toronto's Drug Checking Service (DCS) provides people who use drugs with information on the chemical composition of their substances and conducts real-time monitoring of the unregulated drug supply. Presented are first known data of three newly detected synthetic cannabinoids (SCs) in Toronto, Ontario.

METHODS

The present data are from samples analyzed between April and November 2020. Samples were collected at partnering harm reduction agencies in Toronto and analyzed using gas or liquid chromatography-mass spectrometry. An intake survey queried about the sample characteristics on submission, including expected drug(s).

RESULTS

Samples were analyzed between 1 April and 20 November 2020 (N = 19), which marks the period immediately following imposed COVID-19 border and movement restrictions in Canada. The newly detected, unexpected SCs were ACHMINACA (n = 15), AB-FUBINACA (n = 3), and 4-fluoro-MDMB-BUTINACA (n = 1). Fentanyl was expected in 74% (n = 14). Most SCs were detected in samples containing fentanyl or related analogues (n = 18; 95%), or benzodiazepine-related drugs (i.e., etizolam and flualprazolam) (n = 15; 79%).

CONCLUSIONS

This information can inform overdose prevention efforts and drug market monitoring of SCs in Toronto and regions served by the same drug trafficking routes. The detection of SCs during a period marked by COVID-19-related restrictions can contribute to efforts to identify global drug market trends during this time.

Evaluating networked drug checking services in Toronto, Ontario: study protocol and rationale

BACKGROUND

The increasing incidence of fatal opioid overdose is a public health crisis in Canada. Given growing consensus that this crisis is related to the presence of highly potent opioid adulterants (e.g., fentanyl) in the unregulated drug supply, drug checking services (DCS) have emerged as part of a comprehensive approach to overdose prevention. In Canada's largest city, Toronto, a network of DCS launched in 2019 to prevent overdose and overdose-related risk behaviors. This network employs mass spectrometry technologies, with intake sites co-located with supervised consumption services (SCS) at three frontline harm reduction agencies. The protocol and rationale for assessing the impact of this multi-site DCS network in Toronto is described herein. The aims of this study are to (1) evaluate the impact of DCS access on changes in and factors influencing overdose and related risk behaviors, (2) investigate the perceived capacity of DCS to prevent overdose, and (3) identify composition (qualitative and quantitative) trends in Toronto's unregulated drug supply.

METHODS

We will use a parallel-mixed-methods design with complementary data sources (including data from chemical analysis of drug samples, quantitative intake and post-test surveys, SCS, coroners, paramedic services, and qualitative interviews), followed by a meta-inference process wherein results from analyses are synthesized.

RESULTS

Whereas most DCS globally target "recreational drug users," in Toronto, this networked DCS will primarily target marginalized people who use drugs accessing frontline services, many of whom use drugs regularly and by injection. This evolution in the application of DCS poses important questions that have not yet been explored, including optimal service delivery models and technologies, as well as unique barriers for this population. Increasing information on the unregulated drug supply may modify the risk environment for this population of people who use drugs.

CONCLUSIONS

This study addresses evidence gaps on the emerging continuum of overdose prevention responses and will generate critical evidence on a novel approach to reducing the ongoing high incidence of drug-related morbidity and mortality in Canada and elsewhere.

P3417Comparison of cardiometabolic profile and left ventricular systolic dysfunction amongst outpatients in a low-income Sub-Saharan African versus high-income European population; the MTIMA I study

Background

Most of the information on modifiable risk factors linked to cardiac dysfunction comes from high income countries and/or hospitalized patients. We sought to evaluate the challenge of non-communicable diseases (NCDs) in the community setting in Malawi, and to compare the cardiometabolic profile of these patients with age, sex and diabetes matched European participants.

Methods

MTIMA I is a prospective, observational, cohort study of community dwelling patients attending a NCD clinic in Malawi together with age, sex and diabetes matched European participants. All consenting patients were evaluated for clinical history, blood pressure, heart rate, body mass index (BMI), fasting glucose, left ventricular ejection fraction and medications.

Results

Amongst 251 sub-Saharan African patients and 502 age, sex and diabetes matched European patients, the average age was 61.8±10.6 years, 31% were male and 53% had diabetes and the majority had hypertension (80.0% and 70.7% in the African and European cohorts respectively, p=NS). The African population had poorer pressure control (147/90±21/13 mmHg vs 137/82±19/11 mmHg, p<0.0001) and higher heart rates (80.73±17.0 bpm vs 72.7±12.5 bpm, p<0.0001) than the European cohort. Use of antihypertensive agents per patient was lower in the African population (0.96±0.05 vs 1.22±0.05, p<0.001) and there was lower usage of renin-angiotensin-aldosterone-system modifying therapies. Reported smoking rates were lower in the African cohort (3% vs 16%, p<0.0001). Only 78 of the African cohort had lipids evaluated compared with all the European cohort and in this subset, while total cholesterol was lower (4.4±1.2, vs. 4.6±0.5 mmol/L, p<0.01), it was due to lower HDL (0.99±0.5 vs 1.3±0.2 mmol/L, p<0.001) as LDL cholesterol was similar (2.6±1.0, vs 2.5±0.5 mmol/L, p=ns). Statin usage was lower in the African cohort (1.6% vs 61.5%, p<0.0001). Surprisingly, the average body mass index did not differ between the populations (28.9±0.3 vs 29.2±1.5 kg/m2, p=NS) and there were similar proportions of obesity (31.1% vs 33.7%). Plasma glucose was higher in the African population (10.3±0.4 vs. 7.4±0.1 mmol/L, p<0.0001) despite similar usage of antidiabetic therapies. Average ejection fraction was significantly lower in the African cohort (49.8±8.6% vs 66.5±3.5%, p<0.0001). Left ventricular systolic dysfunction (<40%) was significantly more prevalent in the African cohort (21% vs 0.4%, p<0.0001).

Conclusions

The profile of cardiovascular risk factors, medications and cardiac dysfunction is different in community dwelling African and European patients with chronic cardiovascular disease. One in 5 African patients in our study has undiagnosed left ventricular systolic dysfunction reflecting the need for increased focus on non-communicable diseases and cardiovascular prevention. Further work on the pathophysiology of the high rate of LVSD noted and prevention strategies are required

3069Epigenetic changes in heart failure cohorts: novel insights into methylation changes of protein and RNA coding genes in human cardiac tissue

Background

Limited knowledge exists of the extent of epigenetic alterations, such as DNA methylation, in Heart Failure (HF). We conducted targeted DNA methylation sequencing to identify DNA methylation alterations in coding and non-coding RNA across different etiological sub-types of HF.

Methods and results

A targeted bisulfite sequence capture sequencing platform was applied to DNA extracted from cardiac interventricular septal tissue of 30 male HF patients encompassing etiologies including Hypertrophic Obstructive Cardiomyopathy (HOCM, n=12), Ischemic Cardiomyopathy (ISCM, n=9), Dilated Cardiomyopathy (DCM, n=9), and 9 control patients with non-failing hearts (NF). We detected 62,678 differentially methylated regions (DMR) in the studied HF cohort. By comparing each HF sub-group to the NF control group we identified 195 unique DMRs: 5 in HOCM, 151 in DCM, and 55 in ISCM. These translated to 4 genes/1 non-coding RNA (ncRNA) in HOCM, 131 genes/17 ncRNA in DCM, and 51 genes/5 ncRNA in ISCM. Subsequent gene/ncRNA expression analysis was assessed using qRT-PCR and revealed 6 genes: 4 hypermethylated (HEY2, MSR1, MYOM3, COX17), 2 hypomethylated (CTGF, MMP2); and 2 microRNA: 1 hypermethylated (miR-24–1), 1 hypomethylated (miR-155) with significantly up- or down-regulated expression levels consistent with the direction of methylation in the particular HF sub-group.

Conclusions

For the first time DNA methylation alterations and associated gene expression changes were identified in etiologically-variant pathological heart failure tissue. The methylation-sensitive and disease-associated genes/non-coding RNA identified from this study represent a unique cohort of loci that demonstrate a plausible potential as a novel diagnostic and/or therapeutic target in HF and warrant further investigation.

Acknowledgement/Funding

Enterprise Ireland; European Regional Development Fund under Ireland's European Structural and Investment Funds Programmes 2014-2020

P04.16 TP53 mutations in codon 273 is predictive of overall survival in astrocytoma patients

BACKGROUND

Tumour Protein 53 (TP53) is a tumour suppressor gene that is mutated in at least 50% of human malignancies. The prevalence of TP53 mutation is much higher in astrocytomas with reports of up to 75% TP53 mutant cases. Rare cases of TP53 mutation also exist in oligodendroglial tumours (10–13%). P53 pathway is therefore an important factor in low-grade glioma tumorigenesis. Although the prognostic impact of TP53 mutations has been studied previously, no concrete concordance were reached between the studies. In this study, we investigated the prognostic effects of TP53 mutation in astrocytoma and oligodendroglioma.

MATERIAL AND METHODS

A cohort of 65 matched primary and recurrent fresh frozen tumours were sequenced to identify hotspot exons of TP53 mutation. Exons 1 to 10 were sequenced and pathogenic mutations were mostly predominant between Exons 4 and 8. The cohort was further expanded with 78 low grade glioma fresh frozen tissues and hotspot exons were sequenced. Selecting only the primary tumour from 65 matched tumours, a total of 50 Astrocytoma cases and 51 oligodendroglioma cases were analysed for prognostic effects of TP53. Only pathogenic TP53 mutations confirmed through COSMIC and NCBI databases were included in the over survival and progression-free survival analysis.

RESULTS

62% (31/50) of astrocytomas and 16% (8/51) of oligodendrogliomas harboured pathogenic TP53 mutations. Pathogenic hotspot mutations in codon 273 (c.817 C>T and c.818 G>A) was prevalent in astrocytoma with 58% (18/31) of tumours with these mutations. TP53 mutation status was maintained between primary and recurrent tumours in 93% of cases. In astrocytoma, overall survival of TP53 mutant patients was longer compared to TP53 wild-type patients (p<0.01) but was not significant after adjusting for age, gender, grade and IDH1 mutation status. In contrast, astrocytoma patients with specific TP53 mutation in codon 273 showed significantly better survival compared to other TP53 mutant and TP53 wild-type patients combined (p<0.01) in our multivariate analysis. Time to first recurrence (progression-free survival) of TP53 mutant patients was significantly longer than TP53 wild-type patients (p<0.01) after adjustments were made, while TP53 mutation in codon 273 was not prognostic for progression-free survival. In oligodendroglioma patients, TP53 mutations did not significantly affect overall survival and progression-free survival.

CONCLUSION

In agreement with others, TP53 mutation is more prevalent in Astrocytoma and mutations in codon 273 are significantly associated with longer survival.

Candidaemia and a risk predictive model for overall mortality: a prospective multicentre study

Background

Candidaemia is associated with high mortality. Variables associated with mortality have been published previously, but not developed into a risk predictive model for mortality. We sought to describe the current epidemiology of candidaemia in Australia, analyse predictors of 30-day all-cause mortality, and develop and validate a mortality risk predictive model.

Methods

Adults with candidaemia were studied prospectively over 12 months at eight institutions. Clinical and laboratory variables at time of blood culture-positivity were subject to multivariate analysis for association with 30-day all-cause mortality. A predictive score for mortality was examined by area under receiver operator characteristic curves and a historical data set was used for validation.

Results

The median age of 133 patients with candidaemia was 62 years; 76 (57%) were male and 57 (43%) were female. Co-morbidities included underlying haematologic malignancy (n = 20; 15%), and solid organ malignancy in (n = 25; 19%); 55 (41%) were in an intensive care unit (ICU). Non-albicans Candida spp. accounted for 61% of cases (81/133). All-cause 30-day mortality was 31%. A gastrointestinal or unknown source was associated with higher overall mortality than an intravascular or urologic source (p < 0.01). A risk predictive score based on age > 65 years, ICU admission, chronic organ dysfunction, preceding surgery within 30 days, haematological malignancy, source of candidaemia and antibiotic therapy for ≥10 days stratified patients into < 20% or ≥ 20% predicted mortality. The model retained accuracy when validated against a historical dataset (n = 741).

Conclusions

Mortality in patients with candidaemia remains high. A simple mortality risk predictive score stratifying patients with candidaemia into < 20% and ≥ 20% 30-day mortality is presented. This model uses information available at time of candidaemia diagnosis is easy to incorporate into decision support systems. Further validation of this model is warranted.

Electronic supplementary material

The online version of this article (10.1186/s12879-019-4065-5) contains supplementary material, which is available to authorized users.

Intestinal Goblet cells and Goblet Cell Associated Antigen Passages regulate the balance between Tregs and Th17

Tolerance towards dietary antigens and luminal microbes is essential to maintain homeostasis, the breakdown of which results in development of inflammatory bowel disease (IBD). T-helper 17 (Th17) and T-regulatory (Treg) cells are abundant in the intestinal mucosa, where they function to protect the host from pathogens and to restrain excessive effector T-cell responses, respectively. How the balance and switch between Treg and Th17 responses is maintained in the steady state to promote tolerance and how this balance becomes altered to favor Th17 responses in the setting of IBD is not known. We have identified that intestinal goblet cell (GC) associated antigen passages (GAPs), are a major pathway for steady-state luminal antigen transfer to lamina propria - dendritic cells (LP-DCs). In addition, GAPs are necessary for the imprinting of LP-DCs with tolerogenic properties, for the de novo induction of Tregs specific for dietary antigens, and the maintenance of pre-existing LP Tregs. Moreover, GAP inhibition results in the expansion of Th17 cells in the small intestine LP. Consistent with this, single cell profiling of intestinal lymphocytes revealed enhanced Th17 pathway gene signatures in mice lacking GCs. These observations strongly support that GCs/GAPs have a previously unappreciated role in maintaining the functional balance between Treg and Th17 cell.

Abstract B146: The tumor necrosis factor superfamily member RANKL suppresses effector cytokine production in group 3 innate lymphoid cells

While signals that activate group 3 innate lymphoid cells (ILC3s) have been described, the factors that negatively regulate these cells are less well understood. Here we found that the tumor necrosis factor (TNF) superfamily member receptor activator of nuclear factor κB ligand (RANKL) suppressed ILC3 activity in the intestine. Deletion of RANKL in ILC3s and T-cells increased C-C motif chemokine receptor 6 (CCR6)+ ILC3 abundance and enhanced production of interleukin-17A (IL-17A) and IL-22 in response to IL-23 and during infection with the enteric murine pathogen Citrobacter rodentium. Additionally, CCR6+ ILC3s produced higher amounts of the master transcriptional regulator RORγt at steady state in the absence of RANKL. RANKL-mediated suppression was independent of T-cells, and instead occurred via interactions between CCR6+ ILC3s that expressed both RANKL and its receptor, RANK. Thus, RANK-RANKL interactions between ILC3s regulate ILC3 abundance and activation, suggesting that cell clustering may control ILC3 activity.

Citation Format: Jennifer Kaoru Bando, Susan Gilfillan, Christina Song, Keely McDonald, Stanley C-C. Huang, Rodney D. Newberry, Yasuhiro Kobayashi, David S.J. Allan, James R. Carlyle, Marina Cella, Marco Colonna. The tumor necrosis factor superfamily member RANKL suppresses effector cytokine production in group 3 innate lymphoid cells [abstract]. In: Proceedings of the Fourth CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; Sept 30-Oct 3, 2018; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2019;7(2 Suppl):Abstract nr B146.

Aiming for elimination: Outcomes of a consultation pathway supporting regional general practitioners to prescribe direct-acting antiviral therapy for hepatitis C

To increase access to treatment, the Australian government enabled general practitioners (GPs) to prescribe direct-acting antivirals (DAAs) to treat hepatitis C virus (HCV)-in consultation with a specialist if inexperienced in HCV management. This study describes the establishment and outcomes of a remote consultation pathway supporting GPs to treat HCV. Key stakeholders from primary and tertiary healthcare services in the Barwon South Western region developed and implemented an HCV remote consultation pathway. Pharmaceutical Benefits Schedule prescription data were used to evaluate GP DAA prescription 12 months pre-and post- pathway implementation. A retrospective review of patients referred for remote consultation for 12 months post- pathway inception was undertaken to determine the care cascade. HCV treatment initiation by GPs increased after implementation of the remote consultation pathway. In the 12-month study period, 74 GPs referred 169 people for remote consultation; 114 (67%) were approved for GP DAA treatment; 48 (28%) were referred for specialist assessment. In total, 119 (71%) patients commenced DAA; 69 were eligible for SVR12 assessment. Post-treatment HCV RNA data were available for 52 (75%) people; 37 achieved SVR12; 15 achieved SVR ranging from week 5 to 11 post-treatment. No treatment failure was detected. Collaborative development and implementation of a remote consultation pathway has engaged regional GPs in managing HCV. Follow-up post-treatment could be improved; however, no treatment failure has been documented. To eliminate HCV as a public health threat, it is vital that specialists support GPs to prescribe DAA.

Complex history of dog (Canis familiaris) origins and translocations in the Pacific revealed by ancient mitogenomes

Archaeological evidence suggests that dogs were introduced to the islands of Oceania via Island Southeast Asia around 3,300 years ago, and reached the eastern islands of Polynesia by the fourteenth century AD. This dispersal is intimately tied to human expansion, but the involvement of dogs in Pacific migrations is not well understood. Our analyses of seven new complete ancient mitogenomes and five partial mtDNA sequences from archaeological dog specimens from Mainland and Island Southeast Asia and the Pacific suggests at least three dog dispersal events into the region, in addition to the introduction of dingoes to Australia. We see an early introduction of dogs to Island Southeast Asia, which does not appear to extend into the islands of Oceania. A shared haplogroup identified between Iron Age Taiwanese dogs, terminal-Lapita and post-Lapita dogs suggests that at least one dog lineage was introduced to Near Oceania by or as the result of interactions with Austronesian language speakers associated with the Lapita Cultural Complex. We did not find any evidence that these dogs were successfully transported beyond New Guinea. Finally, we identify a widespread dog clade found across the Pacific, including the islands of Polynesia, which likely suggests a post-Lapita dog introduction from southern Island Southeast Asia.

Knife to Skin Time in Orthopaedics- A New Sub-Speciality Selection Tool

Several selection methods have been used to aid selection into orthopaedic training programs but no process exists to aid in sub-speciality selection. A process which is continuous, unbiased and encompasses technical skill and decision making would be the gold standard. This paper analyses the use of a daily clinical task that assesses many of the desirable traits of a prospective trainee. A retrospective review of 13,474 orthopaedic procedures was under taken. The results showed a clear distinction between orthopaedic sub-specialities in time taken to perform this task. The authors suggest that this could provide a low cost insight into the appropriate subspecialty for orthopaedic trainees.

Microbial and Maternal Factors Control the Development of RORγt+ Regulatory T Cells Promoting Durable Tolerance and Preventing Allergy

Mounting evidence emphasizes the importance of exposure to food allergens and gut microbes in early life to promote tolerance and reduce the risk of food allergy. Indeed the NIAID recently recommended early introduction of dietary peanut to reduce peanut allergy in at risk children. The mechanisms promoting tolerance during early life are incompletely understood, but potentially relate to a population of long-lived RORγt+ inducible regulatory T cells (iTregs) which prevent the development of food-specific Th2 responses throughout life. The optimal time for exposure to environmental antigens for the development of these RORγt+ iTregs, where in the gut protective exposures occur, and how the immune system’s contact with these antigens is controlled in early life remain unknown. We identified a window of time in early life in which luminal antigens are shunted to the colonic lamina propria (LP) and delivered to colonic LP antigen presenting cells by goblet cell-associated antigen passages (GAPs), correlating to an expansion of colonic LP RORγt+ iTregs. GAP formation was regulated by goblet cell sensing of breast milk epidermal growth factor and the blooming gut microbiota. Disruption of the gut microbiota or GAP formation and antigen delivery during early life abrogated tolerance to dietary antigens, decreased RORγt+ iTregs, and induced a skewing of the immune system toward systemic Th2 (allergic) responses. We propose the gut microbiota, in concert with maternal factors, control antigen delivery and the induction of RORγt+ iTregs during infancy. These mechanisms allow for proper education of the immune system against reaction to dietary and microbial antigens, a process that then suppresses inappropriate Th2 responses later in life.

A comparison of HFrEF vs HFpEF's clinical workload and cost in the first year following hospitalization and enrollment in a disease management program

BACKGROUND

Admission with heart failure (HF) is a milestone in the progression of the disease, often resulting in higher intensity medical care and ensuing readmissions. Whilst there is evidence supporting enrolling patients in a heart failure disease management program (HF-DMP), not all reported HF-DMPs have systematically enrolled patients with HF with preserved ejection fraction (HFpEF) and there is a scarcity of literature differentiating costs based on HF-phenotype.

METHODS

1292 consenting, consecutive patients admitted with a primary diagnosis of HF were enrolled in a hospital based HF-DMP and categorized as HFpEF (EF≥45%) or HFrEF (EF<45%). Hospitalizations, primary care, medications, and DMP workload with associated costs were evaluated assessing DMP clinic-visits, telephonic contact, medication changes over 1year using a mixture of casemix and micro-costing techniques.

RESULTS

The total average annual cost per patient was marginally higher in patients with HFrEF €13,011 (12,011, 14,078) than HFpEF, €12,206 (11,009, 13,518). However, emergency non-cardiovascular admission rates and average cost per patient were higher in the HFpEF vs HFrEF group (0.46 vs 0.31 per patient/12months) & €655 (318, 1073) vs €584 (396, 812). In the first 3months of the outpatient HF-DMP the HFrEF population cost more on average €791 (764, 819) vs €693 (660, 728).

CONCLUSION

There are greater short-term (3-month) costs of HFrEF versus HFpEF as part of a HF-DMP following an admission. However, long-term (3-12month) costs of HFpEF are greater because of higher non-cardiovascular rehospitalisations. As HFpEF becomes the dominant form of HF, more work is required in HF-DMPs to address prevention of non-cardiovascular rehospitalisations and to integrate hospital based HF-DMPs into primary healthcare structures.

Combining PARP inhibitors with radiation therapy for the treatment of glioblastoma: Is PTEN predictive of response?

Glioblastoma (GBM) is fatal. The standard radiotherapy and chemotherapy (temozolomide) followed by an adjuvant phase of temozolomide provide patients with, on average, a 2.5 months benefit. New treatments that can improve sensitivity to the standard treatment are urgently needed. Herein, we review the mechanisms and utility of poly (ADP-ribose) polymerase inhibitors in combination with radiation therapy as a treatment option for GBM patients and the role of phosphatase and tensin homologue mutations as a biomarker of response.

Microgeographic Proteomic Networks of the Human Colonic Mucosa and Their Association With Inflammatory Bowel Disease

BACKGROUND & AIMS

Interactions between mucosal cell types, environmental stressors, and intestinal microbiota contribute to pathogenesis in inflammatory bowel disease (IBD). Here, we applied metaproteomics of the mucosal-luminal interface to study the disease-related biology of the human colonic mucosa.

METHODS

We recruited a discovery cohort of 51 IBD and non-IBD subjects endoscopically sampled by mucosal lavage at 6 colonic regions, and a validation cohort of 38 no-IBD subjects. Metaproteome data sets were produced for each sample and analyzed for association with colonic site and disease state using a suite of bioinformatic approaches. Localization of select proteins was determined by immunoblot analysis and immunohistochemistry of human endoscopic biopsy samples.

RESULTS

Co-occurrence analysis of the discovery cohort metaproteome showed that proteins at the mucosal surface clustered into modules with evidence of differential functional specialization (eg, iron regulation, microbial defense) and cellular origin (eg, epithelial or hemopoietic). These modules, validated in an independent cohort, were differentially associated spatially along the gastrointestinal tract, and 7 modules were associated selectively with non-IBD, ulcerative colitis, and/or Crohn's disease states. In addition, the detailed composition of certain modules was altered in disease vs healthy states. We confirmed the predicted spatial and disease-associated localization of 28 proteins representing 4 different disease-related modules by immunoblot and immunohistochemistry visualization, with evidence for their distribution as millimeter-scale microgeographic mosaic.

CONCLUSIONS

These findings suggest that the mucosal surface is a microgeographic mosaic of functional networks reflecting the local mucosal ecology, whose compositional differences in disease and healthy samples may provide a unique readout of physiologic and pathologic mucosal states.

Derivation of the clinical grade human embryonic stem cell line RCe013-A (RC-9)

The human embryonic stem cell line RCe013-A (RC-9) was derived under quality assured compliance with UK regulation, European Union Directives and International guidance for tissue procurement, processing and storage according to Good Manufacturing Practice (GMP) standards. The cell line was derived from a failed to fertilise oocyte voluntarily donated as unsuitable and surplus to fertility requirements following informed consent. RCe013-A (RC-9) shows normal pluripotency marker expression and differentiation to the three germ layers in vitro and in vivo. It has a normal 46XY male karyotype and microsatellite PCR identity, HLA and blood group typing data are available.

Disruption of the gut microbiota by antibiotics exposure during early life promotes spontaneous Th2 responses and loss of tolerance to dietary antigens

Allergic disorders, manifest by T helper 2 (Th2) type immune responses to environmental antigens, are rapidly increasing in children. Regulatory T cells (Tregs) limit Th2 responses, and Treg deficiencies are seen in children with allergic disorders, implying that Treg deficiencies or dysfunction underlie the pathogenesis of Th2 mediated disease. What incurs Treg deficiency and its relationship to the increasing incidence of allergy is unknown, however, studies have shown that the intestinal microbiota plays an important role in regulating Treg differentiation during early life. With this in mind we explored whether oral exposure to specific antibiotics in early life altered Treg populations and predisposed to Th2 responses. We found that exposure of mice to a combination of broad spectrum oral antibiotics between days 10 and 20 of life abrogated tolerance to a dietary antigen, ovalbumin (Ova). Exposure of mice to single antibiotics of varying spectra between days 10 and 20 of life had a range of effects from abrogation of oral tolerance to the spontaneous development of Th2 responses manifested by increased levels of IL-13 in the serum in the absence of challenge. Ongoing studies are evaluating the effect of the respective antibiotic regimens on the intestinal microbial community using 16S bacterial DNA sequencing, with the aim to link alterations in the microbial composition to the immunological profile of the respective treatment groups. In summary, our results show that disruption of the intestinal microbiota by exposure to specific antibiotics during a period in early life results in loss of Tregs, promotes Th2 immunity, and impair establishment of oral tolerance to dietary antigen.

Maternal control of dietary and gut microbial antigen exposure promotes enhanced tolerance and prevents allergic responses

The incidence of allergic disorders is rapidly increasing in children in Western societies, and is linked to allergen avoidance diets and decreased exposure to microbes and microbial antigens in early life. Exposure to dietary antigens and the microbiota via the gastrointestinal tract early in life is associated with a reduced risk of allergic disorders, however the optimal time to introduce these antigens, where the immune system encounters these antigens, and what controls the immune systems exposure to define this time in early life is largely unknown. We identified a window of time in early life in which luminal antigens are shunted to the colonic lamina propria (LP) immune system to induce enhanced tolerogenic responses. Delivery of luminal antigens to the colonic immune system during this time in life was mediated by the formation of goblet cell-associated antigen passages (GAPs), which were regulated by goblet cell (GC) intrinsic sensing of breast milk derived epidermal growth factor (EGF) and the blooming gut microbiota. Disruption of GAP formation and antigen delivery during this time in early life abrogated tolerance to dietary antigens, decreased regulatory T cells, and induced a skewing of the immune system toward systemic Th2 responses. We propose that maternal control of antigen delivery during infancy allows for the proper education of the immune system against dietary and microbial antigens, and induction of regulatory T cells necessary to suppress inappropriate Th2 responses later in life.

Motivated to do well: an examination of the relationships between motivation, effort, and cognitive performance in schizophrenia

The uncertain relationship between negative symptoms, and specifically motivational deficits, with cognitive dysfunction in schizophrenia is in need of further elucidation as it pertains to the interpretation of cognitive test results. Findings to date have suggested a possible mediating role of motivational deficits on cognitive test measures, although findings from formal examinations of effort using performance validity measures have been inconsistent. The aim of this study was to examine the relationships between motivation, effort exerted during cognitive testing, and cognitive performance in schizophrenia. Sixty-nine outpatients with schizophrenia or schizoaffective disorder were evaluated for psychopathology, severity of motivational deficits, effort exerted during cognitive testing, and cognitive performance. Motivation and degree of effort exerted during cognitive testing were significantly related to cognitive performance, specifically verbal fluency, verbal and working memory, attention and processing speed, and reasoning and problem solving. Further, effort accounted for 15% of the variance in cognitive performance, and partially mediated the relationship between motivation and cognitive performance. Examining cognitive performance profiles for individuals exerting normal or reduced effort revealed significant differences in global cognition, as well as attention/processing speed and reasoning and problem solving. These findings suggest that cognitive domains may be differentially affected by impairments in motivation and effort, and highlight the importance of understanding the interplay between motivation and cognitive performance deficits, which may guide the appropriate selection of symptom targets for promoting recovery in patients.