Cullin 3 RING E3 ligase inactivation causes NRF2-dependent NADH reductive stress, hepatic lipodystrophy, and systemic insulin resistance

Cullin RING E3 ligases (CRL) have emerged as key regulators of disease-modifying pathways and therapeutic targets. Cullin3 (Cul3)-containing CRL (CRL3) has been implicated in regulating hepatic insulin and oxidative stress signaling. However, CRL3 function in liver pathophysiology is poorly defined. Here, we report that hepatocyte Cul3 knockout results in rapid resolution of steatosis in obese mice. However, the remarkable resistance of hepatocyte Cul3 knockout mice to developing steatosis does not lead to overall metabolic improvement but causes systemic metabolic disturbances. Liver transcriptomics analysis identifies that CRL3 inactivation causes persistent activation of the nuclear factor erythroid 2-related factor 2 (NRF2) antioxidant defense pathway, which also reprograms the lipid transcriptional network to prevent TG storage. Furthermore, global metabolomics reveals that NRF2 activation induces numerous NAD+-consuming aldehyde dehydrogenases to increase the cellular NADH/NAD+ ratio, a redox imbalance termed NADH reductive stress that inhibits the glycolysis-citrate-lipogenesis axis in Cul3 knockout livers. As a result, this NRF2-induced cellular lipid storage defect promotes hepatic ceramide accumulation, elevates circulating fatty acids, and worsens systemic insulin resistance in a vicious cycle. Hepatic lipid accumulation is restored, and liver injury and hyperglycemia are attenuated when NRF2 activation and NADH reductive stress are abolished in hepatocyte Cul3/Nrf2 double-knockout mice. The resistance to hepatic steatosis, hyperglycemia, and NADH reductive stress are observed in hepatocyte Keap1 knockout mice with NRF2 activation. In summary, our study defines a critical role of CRL3 in hepatic metabolic regulation and demonstrates that the CRL3 downstream NRF2 overactivation causes hepatic metabolic maladaptation to obesity and insulin resistance.

Deletion of hepatocyte cysteine dioxygenase type 1, a bile acid repressed gene, enhances glutathione synthesis and ameliorates acetaminophen hepatotoxicity

Liver is a major organ that metabolizes sulfur amino acids cysteine, which is the substrate for the synthesis of many essential cellular molecules including GSH, taurine, and coenzyme A. Bile acid-activated farnesoid x receptor (FXR) inhibits cysteine dioxygenase type 1 (CDO1), which mediates hepatic cysteine catabolism and taurine synthesis. To define the impact of bile acid inhibition of CDO1 on hepatic sulfur amino acid metabolism and antioxidant capacity, we developed hepatocyte-specific CDO1 knockout mice (Hep-CDO1 KO) and hepatocyte specific CDO1 transgenic mice (Hep-CDO1 Tg). Liver metabolomics revealed that genetic deletion of hepatic CDO1 reduced de novo taurine synthesis but had no impact on hepatic taurine abundance or bile acid conjugation. Consistent with reduced cysteine catabolism, Hep-CDO1 KO mice showed increased hepatic cysteine abundance but unaltered methionine cycle intermediates and coenzyme A synthesis. Upon acetaminophen overdose, Hep-CDO1 KO mice showed increased GSH synthesis capacity and alleviated liver injury. In contrast, hepatic CDO1 overexpression in Hep-CDO1 Tg mice stimulated hepatic cysteine to taurine conversion, resulting in reduced hepatic cysteine abundance. However, Hep-CDO1 Tg mice and WT showed similar susceptibility to acetaminophen-induced liver injury. Hep-CDO1 Tg mice showed similar hepatic taurine and coenzyme A compared to WT mice. In summary, these findings suggest that bile acid and FXR signaling inhibition of CDO1-mediated hepatic cysteine catabolism preferentially modulates hepatic GSH synthesis capacity and antioxidant defense, but has minimal effect on hepatic taurine and coenzyme A abundance. Repression of hepatic CDO1 may contribute to the hepatoprotective effects of FXR activation under certain pathologic conditions.

Search for Heavy Neutral Leptons in Electron-Positron and Neutral-Pion Final States with the MicroBooNE Detector

We present the first search for heavy neutral leptons (HNLs) decaying into νe^{+}e^{-} or νπ^{0} final states in a liquid-argon time projection chamber using data collected with the MicroBooNE detector. The data were recorded synchronously with the NuMI neutrino beam from Fermilab's main injector corresponding to a total exposure of 7.01×10^{20} protons on target. We set upper limits at the 90% confidence level on the mixing parameter |U_{μ4}|^{2} in the mass ranges 10≤m_{HNL}≤150  MeV for the νe^{+}e^{-} channel and 150≤m_{HNL}≤245  MeV for the νπ^{0} channel, assuming |U_{e4}|^{2}=|U_{τ4}|^{2}=0. These limits represent the most stringent constraints in the mass range 35 Collapse

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Affiliation(s)

P Abratenko Tufts University, Medford, Massachusetts 02155, USA
O Alterkait Tufts University, Medford, Massachusetts 02155, USA
D Andrade Aldana Illinois Institute of Technology (IIT), Chicago, Illinois 60616, USA
L Arellano The University of Manchester, Manchester M13 9PL, United Kingdom
J Asaadi University of Texas, Arlington, Texas 76019, USA
A Ashkenazi Tel Aviv University, Tel Aviv, Israel, 69978
S Balasubramanian Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
B Baller Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
G Barr University of Oxford, Oxford OX1 3RH, United Kingdom
D Barrow University of Oxford, Oxford OX1 3RH, United Kingdom
J Barrow Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts 02139, USA Tel Aviv University, Tel Aviv, Israel, 69978
V Basque Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
O Benevides Rodrigues Illinois Institute of Technology (IIT), Chicago, Illinois 60616, USA
S Berkman Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA Michigan State University, East Lansing, Michigan 48824, USA
A Bhanderi The University of Manchester, Manchester M13 9PL, United Kingdom
A Bhat University of Chicago, Chicago, Illinois 60637, USA
M Bhattacharya Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
M Bishai Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
A Blake Lancaster University, Lancaster LA1 4YW, United Kingdom
B Bogart University of Michigan, Ann Arbor, Michigan 48109, USA
T Bolton Kansas State University (KSU), Manhattan, Kansas 66506, USA
J Y Book Harvard University, Cambridge, Massachusetts 02138, USA
M B Brunetti University of Warwick, Coventry CV4 7AL, United Kingdom
L Camilleri Columbia University, New York, New York 10027, USA
Y Cao The University of Manchester, Manchester M13 9PL, United Kingdom
D Caratelli University of California, Santa Barbara, California 93106, USA
F Cavanna Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
G Cerati Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
A Chappell University of Warwick, Coventry CV4 7AL, United Kingdom
Y Chen SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
J M Conrad Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts 02139, USA
M Convery SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
L Cooper-Troendle University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
J I Crespo-Anadón Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas (CIEMAT), Madrid E-28040, Spain
R Cross University of Warwick, Coventry CV4 7AL, United Kingdom
M Del Tutto Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
S R Dennis University of Cambridge, Cambridge CB3 0HE, United Kingdom
P Detje University of Cambridge, Cambridge CB3 0HE, United Kingdom
A Devitt Lancaster University, Lancaster LA1 4YW, United Kingdom
R Diurba Universität Bern, Bern CH-3012, Switzerland
Z Djurcic Argonne National Laboratory (ANL), Lemont, Illinois 60439, USA
R Dorrill Illinois Institute of Technology (IIT), Chicago, Illinois 60616, USA
K Duffy University of Oxford, Oxford OX1 3RH, United Kingdom
S Dytman University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
B Eberly University of Southern Maine, Portland, Maine 04104, USA
P Englezos Rutgers University, Piscataway, New Jersey 08854, USA
A Ereditato University of Chicago, Chicago, Illinois 60637, USA Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
J J Evans The University of Manchester, Manchester M13 9PL, United Kingdom
R Fine Los Alamos National Laboratory (LANL), Los Alamos, New Mexico 87545, USA
O G Finnerud The University of Manchester, Manchester M13 9PL, United Kingdom
W Foreman Illinois Institute of Technology (IIT), Chicago, Illinois 60616, USA
B T Fleming University of Chicago, Chicago, Illinois 60637, USA
D Franco University of Chicago, Chicago, Illinois 60637, USA
A P Furmanski University of Minnesota, Minneapolis, Minnesota 55455, USA
F Gao University of California, Santa Barbara, California 93106, USA
D Garcia-Gamez Universidad de Granada, Granada E-18071, Spain
S Gardiner Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
G Ge Columbia University, New York, New York 10027, USA
S Gollapinni Los Alamos National Laboratory (LANL), Los Alamos, New Mexico 87545, USA
E Gramellini The University of Manchester, Manchester M13 9PL, United Kingdom
P Green University of Oxford, Oxford OX1 3RH, United Kingdom
H Greenlee Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
L Gu Lancaster University, Lancaster LA1 4YW, United Kingdom
W Gu Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
R Guenette The University of Manchester, Manchester M13 9PL, United Kingdom
P Guzowski The University of Manchester, Manchester M13 9PL, United Kingdom
L Hagaman University of Chicago, Chicago, Illinois 60637, USA
O Hen Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts 02139, USA
C Hilgenberg University of Minnesota, Minneapolis, Minnesota 55455, USA
G A Horton-Smith Kansas State University (KSU), Manhattan, Kansas 66506, USA
Z Imani Tufts University, Medford, Massachusetts 02155, USA
B Irwin University of Minnesota, Minneapolis, Minnesota 55455, USA
M Ismail University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
C James Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
X Ji Nankai University, Nankai District, Tianjin 300071, China
J H Jo Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
R A Johnson University of Cincinnati, Cincinnati, Ohio 45221, USA
Y-J Jwa Columbia University, New York, New York 10027, USA
D Kalra Columbia University, New York, New York 10027, USA
N Kamp Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts 02139, USA
G Karagiorgi Columbia University, New York, New York 10027, USA
W Ketchum Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
M Kirby Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
T Kobilarcik Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
I Kreslo Universität Bern, Bern CH-3012, Switzerland
M B Leibovitch University of California, Santa Barbara, California 93106, USA
I Lepetic Rutgers University, Piscataway, New Jersey 08854, USA
J-Y Li University of Edinburgh, Edinburgh EH9 3FD, United Kingdom
K Li Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
Y Li Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
K Lin Rutgers University, Piscataway, New Jersey 08854, USA
B R Littlejohn Illinois Institute of Technology (IIT), Chicago, Illinois 60616, USA
H Liu Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
W C Louis Los Alamos National Laboratory (LANL), Los Alamos, New Mexico 87545, USA
X Luo University of California, Santa Barbara, California 93106, USA
C Mariani Center for Neutrino Physics, Virginia Tech, Blacksburg, Viriginia 24061, USA
D Marsden The University of Manchester, Manchester M13 9PL, United Kingdom
J Marshall University of Warwick, Coventry CV4 7AL, United Kingdom
N Martinez Kansas State University (KSU), Manhattan, Kansas 66506, USA
D A Martinez Caicedo South Dakota School of Mines and Technology (SDSMT), Rapid City, South Dakota 57701, USA
S Martynenko Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
A Mastbaum Rutgers University, Piscataway, New Jersey 08854, USA
I Mawby University of Warwick, Coventry CV4 7AL, United Kingdom
N McConkey University College London, London WC1E 6BT, United Kingdom
V Meddage Kansas State University (KSU), Manhattan, Kansas 66506, USA
J Micallef Massachusetts Institute of Technology (MIT), Cambridge, Massachusetts 02139, USA Tufts University, Medford, Massachusetts 02155, USA
K Miller University of Chicago, Chicago, Illinois 60637, USA
A Mogan Colorado State University, Fort Collins, Colorado 80523, USA
T Mohayai Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA Indiana University, Bloomington, Indiana 47405, USA
M Mooney Colorado State University, Fort Collins, Colorado 80523, USA
A F Moor University of Cambridge, Cambridge CB3 0HE, United Kingdom
C D Moore Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
L Mora Lepin The University of Manchester, Manchester M13 9PL, United Kingdom
M M Moudgalya The University of Manchester, Manchester M13 9PL, United Kingdom
S Mulleriababu Universität Bern, Bern CH-3012, Switzerland
D Naples University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
A Navrer-Agasson The University of Manchester, Manchester M13 9PL, United Kingdom
N Nayak Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
M Nebot-Guinot University of Edinburgh, Edinburgh EH9 3FD, United Kingdom
J Nowak Lancaster University, Lancaster LA1 4YW, United Kingdom
N Oza Columbia University, New York, New York 10027, USA
O Palamara Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
N Pallat University of Minnesota, Minneapolis, Minnesota 55455, USA
V Paolone University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
A Papadopoulou Argonne National Laboratory (ANL), Lemont, Illinois 60439, USA
V Papavassiliou New Mexico State University (NMSU), Las Cruces, New Mexico 88003, USA
H B Parkinson University of Edinburgh, Edinburgh EH9 3FD, United Kingdom
S F Pate New Mexico State University (NMSU), Las Cruces, New Mexico 88003, USA
N Patel Lancaster University, Lancaster LA1 4YW, United Kingdom
Z Pavlovic Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
E Piasetzky Tel Aviv University, Tel Aviv, Israel, 69978
I Pophale Lancaster University, Lancaster LA1 4YW, United Kingdom
X Qian Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
J L Raaf Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
V Radeka Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
A Rafique Argonne National Laboratory (ANL), Lemont, Illinois 60439, USA
M Reggiani-Guzzo University of Edinburgh, Edinburgh EH9 3FD, United Kingdom The University of Manchester, Manchester M13 9PL, United Kingdom
L Ren New Mexico State University (NMSU), Las Cruces, New Mexico 88003, USA
L Rochester SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
J Rodriguez Rondon South Dakota School of Mines and Technology (SDSMT), Rapid City, South Dakota 57701, USA
M Rosenberg Tufts University, Medford, Massachusetts 02155, USA
M Ross-Lonergan Los Alamos National Laboratory (LANL), Los Alamos, New Mexico 87545, USA
C Rudolf von Rohr Universität Bern, Bern CH-3012, Switzerland
I Safa Columbia University, New York, New York 10027, USA
G Scanavini Wright Laboratory, Department of Physics, Yale University, New Haven, Connecticut 06520, USA
D W Schmitz University of Chicago, Chicago, Illinois 60637, USA
A Schukraft Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
W Seligman Columbia University, New York, New York 10027, USA
M H Shaevitz Columbia University, New York, New York 10027, USA
R Sharankova Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
J Shi University of Cambridge, Cambridge CB3 0HE, United Kingdom
E L Snider Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
M Soderberg Syracuse University, Syracuse, New York 13244, USA
S Söldner-Rembold The University of Manchester, Manchester M13 9PL, United Kingdom
J Spitz University of Michigan, Ann Arbor, Michigan 48109, USA
M Stancari Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
J St John Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
T Strauss Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
A M Szelc University of Edinburgh, Edinburgh EH9 3FD, United Kingdom
W Tang University of Tennessee, Knoxville, Tennessee 37996, USA
N Taniuchi University of Cambridge, Cambridge CB3 0HE, United Kingdom
K Terao SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
C Thorpe Lancaster University, Lancaster LA1 4YW, United Kingdom The University of Manchester, Manchester M13 9PL, United Kingdom
D Torbunov Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
D Totani University of California, Santa Barbara, California 93106, USA
M Toups Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
Y-T Tsai SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
J Tyler Kansas State University (KSU), Manhattan, Kansas 66506, USA
M A Uchida University of Cambridge, Cambridge CB3 0HE, United Kingdom
T Usher SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
B Viren Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
M Weber Universität Bern, Bern CH-3012, Switzerland
H Wei Louisiana State University, Baton Rouge, Louisiana 70803, USA
A J White University of Chicago, Chicago, Illinois 60637, USA
S Wolbers Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
T Wongjirad Tufts University, Medford, Massachusetts 02155, USA
M Wospakrik Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
K Wresilo University of Cambridge, Cambridge CB3 0HE, United Kingdom
W Wu University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
E Yandel University of California, Santa Barbara, California 93106, USA
T Yang Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
L E Yates Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
H W Yu Brookhaven National Laboratory (BNL), Upton, New York 11973, USA
G P Zeller Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
J Zennamo Fermi National Accelerator Laboratory (FNAL), Batavia, Illinois 60510, USA
C Zhang Brookhaven National Laboratory (BNL), Upton, New York 11973, USA

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[Secondary non-tuberculous mycobacterium infection in patients with bronchiectasis caused by Marfan syndrome]

In this article, we reported a 28-year-old female patient who presented with intermittent hemoptysis, cough, and sputum production. Laboratory tests showed no abnormalities in the blood counts or inflammatory markers, and the sputum cultures were negative. A chest computed tomography scan showed bronchiectasis associated with infection in the middle and lower lobes of the right lung and right pleural thickening. We performed bronchoalveolar lavage by bronchoscopy in the dorsal segment of the right lower lobe and found Mycobacterium avium intracellulare complex (MAC) by Next Generation Sequencing (NGS) of bronchoalveolar lavage fluid (BALF). The patient's symptoms improved significantly after anti-mycobacterium treatment and the extent of infection was reduced on imaging. To further identify the cause of bronchiectasis, the patient is tall and thin, with slender limbs. Cardiac color ultrasound showed the widening of aortic sinus. Her genetic testing of blood samples revealed the gene mutation in the FBN1 gene (c.4349G>A). Based on these results, she was diagnosed with Marfan syndrome.

[Serology and genomic analysis of para-Bombay individuals in a hospital in Hunan Province]

To investigate the serological and genetic characteristics of para-Bombay patients in a hospital in Hunan Province. A retrospective analysis was conducted on the blood type results of 175 439 hospitalized patients born in Hunan Province from the Third Xiangya Hospital, Central South University from 2016 to 2021. Phenotypes of ABO blood group was analyzed by blood group serology, and molecular biological methods were used to analyze the genotype, including ABO genotyping by polymerase chain reaction-sequence specific primers (PCR-SSP) and fucosyltransferase 1 (FUT1) and fucosyltransferase 2 (FUT2) gene sequencing. The results showed that 3 cases of Ah and 1 case of Bh were detected. FUT1 sequencing showed that there were 2 cases of h3h3, 1 case of h1h1 and 1 case of h302h1, of which h302 (c.302C>T) was the first discovered mutation. FUT2 sequencing revealed that 4 cases were all Se357Se357. The pedigree study showed that the inheritance of para-Bombay blood group was consistent with autosomal dominant inheritance. In conclusion, the FUT1 gene mutations leading to para-Bombay blood group mainly include h3, h1 and h302, of which h3 mutation is the most common.

Baseline anxiety disorders are associated with progression of diabetic kidney disease in type 2 diabetes

BACKGROUND

Diabetic kidney disease (DKD) is a leading cause of kidney failure worldwide. Anxiety has been associated with disease progression in non-diabetes patients. We aimed to examine the prospective association between anxiety and progression of DKD in type 2 diabetes.

METHODS

We conducted a prospective cohort study of 2040 participants with type 2 diabetes at the Diabetes Center of Shanghai General Hospital between May 2017 and June 2020. Anxiety disorders at baseline were diagnosed by a structured clinical interview based on the 10th Revision of International Classification of Disease (ICD). Progression of DKD was identified as the transition from one urinary albumin excretion rate (AER) stage to the next or the development of kidney failure during the follow-up period.

RESULTS

At baseline, 403 (19.8%) had a diagnosis of anxiety disorders, of whom 107 (26.6%) also received a depression diagnosis. During a median follow-up time of 3.2 years, deterioration of the kidney status occurred in 340 (16.7%) individuals. After adjustment for potential confounders including depression or an anxiety × depression interaction term, anxiety disorders were independently related to an increased risk of progression of DKD (HR 1.539, 95% CI 1.130-2.095, p = 0.006; HR 1.536, 95% CI 1.111-2.122, p = 0.009, respectively).

CONCLUSIONS

Anxiety disorders at baseline, independent of possible confounders, were associated with the progression of DKD in type 2 diabetes. Whether therapeutic interventions for anxiety reduce the risk needs to be investigated.

Association of serum thymosin β4 with malnutrition-inflammation-atherosclerosis syndrome in peritoneal dialysis patients: a cross-sectional study

BACKGROUND

Malnutrition-inflammation-atherosclerosis (MIA) syndrome may worsen the prognosis of peritoneal dialysis (PD) patients. Serum thymosin β4 (sTβ4) protects against inflammation, fibrosis and cardiac dysfunction.

OBJECTIVES

The present study aimed to characterize the association between sTβ4 and MIA syndrome as well as to investigate the potential of regulating sTβ4 to improve the prognosis of PD patients.

METHODS

We performed a cross-sectional, single-center pilot study involving 76 PD patients. Demographic characteristics, clinical characteristics, nutritional profiles, inflammatory mediators, atherosclerosis-related factors and sTβ4 levels were collected and subjected to association analysis for sTβ4 and MIA syndrome.

RESULTS

sTβ4 levels did not significantly vary with sex or primary disease in PD patients. Ages and PD features did not vary between patients with different levels of sTβ4. PD patients with higher levels of sTβ4 had significantly higher levels of nutritional indicators, including subjective global nutritional assessment (SGA) (p < 0.001) and serum albumin (ALB) (p < 0.001) but lower levels of inflammatory and atherosclerotic indicators, including serum C reaction protein (CRP) (p = 0.009), the right common carotid artery (RCCA) intimal thickness (p < 0.001) and the left common carotid artery (LCCA) intimal thickness (p = 0.02). Correlation analysis showed that sTβ4 was positively associated with SGA (p < 0.001) and serum ALB (p < 0.001) but negatively associated with CRP (p = 0.020), RCCA intimal thickness (p < 0.001) and LCCA intimal thickness (p = 0.033). In multiple adjusted models, the prevalence of MIA syndrome was significantly decreased in PD patients with increased levels of sTβ4 when patients without MIA syndrome were compared to those with all indicators of MIA syndrome (OR = 0.996, 95% CI 0.993-0.999, p = 0.003) or those with at least one indicator of MIA syndrome (OR = 0.997, 95% CI 0.995-0.998, p < 0.001).

CONCLUSIONS

The sTβ4 level decreases in PD patients with MIA syndrome. The prevalence of MIA syndrome decreases significantly as the level of sTβ4 increases in PD patients.

Identification and adaptive evolution analysis of glutaredoxin genes in Populus spp

Glutaredoxin (GRX) is a class of small redox proteins widely involved in cellular redox homeostasis and the regulation of various cellular processes. The role of GRX gene in the differentiation of Populus spp. is rarely reported. We compared the similarities and differences of GRX genes among four sections of poplar using bioinformatics, corrected the annotations of some GRX genes, and focused on analysing their transcript profiling and adaptive evolution in Populus spp. A total of 219 GRX genes were identified in four sections of poplar, among which annotations for 13 genes were corrected. Differences in GRX genes were found between sect. Turanga, represented by P. euphratica, and other poplar sections. Most notably, P. euphratica had the smallest number of duplication events for GRX genes (n = 9) and no tandem duplications, whereas there were >25 duplication events for all other poplars. Furthermore, we detected 18 pairs of GRX genes under positive selection pressure in various sections of poplar, and identified two groups of GRX genes in the Salicaceae that potentially underwent positive selection. Expression profiling results showed that the PtrGRX34 and its orthologous genes were upregulated under stress treatments. In summary, the GRX gene family underwent expansion during poplar differentiation, and some genes underwent rapid evolution during this process, which may be beneficial for Populus spp. to adapt to environmental changes. This study may provide more insights into the molecular mechanisms of Populus spp. adaptation to environmental changes and the adaptive evolution of GRX genes.

[Molecular epidemiology and clinical characteristics of six cases of CA-MRSA pneumonia after influenza]

Objective: To summarize and analyze the strains' molecular epidemiology and clinical characteristics of 6 strains of post-influenza community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) pneumonia. Methods: Six cases of CA-MRSA pneumonia after influenza from 2014 to 2022 were retrospectively collected and CA-MRSA strains from each patient were cultured. Then, SCCmec typing, MLST typing, and spa typing were performed on the samples, which also included the procedures for the detection of virulence factors. Antibiotic susceptibility test was then performed on all 6 strains. Results: ST59-t437-Ⅳ was the predominant type in all the strains of CA-MRSA(2/6). Leukocidin (PVL) was detected in 5 cases, and hemolysin α (HLAα) and phenol soluble regulatory protein α (PSMα) were detected in 6 cases. Five of the cases included in this study were diagnosed with severe pneumonia. In terms of treatment, 4 cases received antiviral therapy, and 5 patients with severe pneumonia received anti-infection treatment with vancomycin as the first choice and were discharged after improvement of their condition. Conclusions: The molecular types and virulence factors of CA-MRSA after influenza infection could vary considerably. Our experiments also showed that secondary CA-MRSA infection after influenza was more common in young people with no underlying diseases and could cause severe pneumonia. Vancomycin and linezolid were the first-line drugs for treating CA-MRSA infection and were highly effective in improving the condition of diagnosed patients. We highlighted the importance of referring patients with severe pneumonia after influenza for etiological tests to determine whether they had CA-MRSA infection, so that they could be properly treated with anti-influenza agents and receive appropriate anti-CA-MRSA infection treatment.

Glycine-β-Muricholic Acid Improves Liver Fibrosis and Gut Barrier Function by Reducing Bile Acid Pool Size and Hydrophobicity in Male Cyp2c70 Knockout Mice

Cyp2c70 knockout mice lack the enzyme that produces muricholic acids and show a "human-like" hydrophobic bile acid pool-induced hepatobiliary injury. In this study, we investigated the potential anti-cholestasis effect of glycine-conjugated β muricholic acid (G-β-MCA) in male Cyp2c70 KO mice based on its hydrophilic physiochemical property and signaling property as an farnesoid X receptor (FXR) antagonist. Our results showed that G-β-MCA treatment for 5 weeks alleviated ductular reaction and liver fibrosis and improved gut barrier function. Analysis of bile acid metabolism suggested that exogenously administered G-β-MCA was poorly absorbed in the small intestine and mostly deconjugated in the large intestine and converted to taurine-conjugated MCA (T-MCA) in the liver, leading to T-MCA enrichment in the bile and small intestine. These changes decreased the biliary and intestine bile acid hydrophobicity index. Furthermore, G-β-MCA treatment decreased intestine bile acid absorption via unknown mechanisms, resulting in increased fecal bile acid excretion and a reduction in total bile acid pool size. In conclusion, G-β-MCA treatment reduces the bile acid pool size and hydrophobicity and improves liver fibrosis and gut barrier function in Cyp2c70 KO mice.

Impact of the degree of worsening renal function and B-type natriuretic peptide on the prognosis of patients with acute heart failure

Background

The impact of the degree of worsening renal function (WRF) and B-type natriuretic peptide (BNP) on the prognosis of patients with acute heart failure (AHF) is still debatable. The present study investigated the influence of different degrees of WRF and BNP levels at discharge on 1-year all-cause mortality in AHF.

Methods

Hospitalized AHF patients diagnosed with acute new-onset/worsening of chronic heart failure (HF) between January 2015 and December 2019 were included in this study. Patients were assigned into high and low BNP groups based on the median BNP level at discharge (464 pg/ml). According to serum creatinine (Scr) levels, WRF was divided into non-severe WRF (nsWRF) (Scr increased ≥0.3 mg/dl and &lt;0.5 mg/dl) and severe WRF (sWRF) (Scr increased ≥0.5 mg/dl); non-WRF (nWRF) was defined as Scr increased of &lt;0.3 mg/dl). Multivariable cox regression was used to evaluate the association of low BNP value and different degrees of WRF with a all-cause death, as well as testing for an interaction between the two.

Results

Among 440 patients in the high BNP group, there was a significant difference in WRF on mortality (nWRF vs. nsWRF vs. sWRF: 22% vs. 23.8% vs. 58.8%, P &lt; 0.001). Yet, mortality did not significantly differ across the WRF subgroups in the low BNP group (nWRF vs. nsWRF vs. sWRF: 9.1% vs. 6.1% vs. 15.2%, P = 0.489). In multivariate Cox regression analysis, low BNP group at discharge (HR, 0.265; 95%CI, 0.162–0.434; P &lt; 0.001) and sWRF (HR, 2.838; 95%CI, 1.756–4.589; P &lt; 0.001) were independent predictors of 1-year mortality in AHF.There was a significant interaction between low BNP group and sWRF(HR, 0.225; 95%CI, 0.055–0.918; P &lt; 0.05).

Conclusions

nsWRF does not increase the 1-year mortality in AHF patients, whereas sWRF does. A low BNP value at discharge is associated with better long-term outcomes and mitigates the adverse effects of sWRF on prognosis.

A single-arm, multicenter, phase II trial of osimertinib in patients with epidermal growth factor receptor exon 18 G719X, exon 20 S768I, or exon 21 L861Q mutations

BACKGROUND

For patients with stage IV non-small-cell lung cancer with epidermal growth factor receptor (EGFR) exon 19 deletions and exon 21 L858R mutations, osimertinib is the standard of care. Investigating the activity and safety of osimertinib in patients with EGFR exon 18 G719X, exon 20 S768I, or exon 21 L861Q mutations is of clinical interest.

PATIENTS AND METHODS

Patients with stage IV non-small-cell lung cancer with confirmed EGFR exon 18 G719X, exon 20 S768I, or exon 21 L861Q mutations were eligible. Patients were required to have measurable disease, an Eastern Cooperative Oncology Group performance status of 0 or 1, and adequate organ function. Patients were required to be EGFR tyrosine kinase inhibitor-naive. The primary objective was objective response rate, and secondary objectives were progression-free survival, safety, and overall survival. The study used a two-stage design with a plan to enroll 17 patients in the first stage, and the study was terminated after the first stage due to slow accrual.

RESULTS

Between May 2018 and March 2020, 17 patients were enrolled and received study therapy. The median age of patients was 70 years (interquartile range 62-76), the majority were female (n = 11), had a performance status of 1 (n = 10), and five patients had brain metastases at baseline. The objective response rate was 47% [95% confidence interval (CI) 23% to 72%], and the radiographic responses observed were partial response (n = 8), stable disease (n = 8), and progressive disease (n = 1). The median progression-free survival was 10.5 months (95% CI 5.0-15.2 months), and the median OS was 13.8 months (95% CI 7.3-29.2 months). The median duration on treatment was 6.1 months (range 3.6-11.9 months), and the most common adverse events (regardless of attribution) were diarrhea, fatigue, anorexia, weight loss, and dyspnea.

CONCLUSIONS

This trial suggests osimertinib has activity in patients with these uncommon EGFR mutations.

A new prognostic model for brain metastases of specific primary tumors with stereotactic radiotherapy

PURPOSE

Stereotactic radiotherapy (SRT) was widely used in brain metastases (BM), especially in oligometastases. It is imperative to develop a new prognostic score to predict the overall survival (OS) of brain metastases based on prognostic factors for specific primary tumors.

MATERIAL AND METHOD

One hundred and ninety-seven patients were involved in the training cohort to develop a new prognostic score to predict the overall survival (OS) of brain metastases for specific primary tumors. Independent prognostic factors were confirmed using a Cox regression model. The score was developed based on clinical prognostic factors of OS with Cox proportional hazards model. The result was validated in another cohort with 56 participants to evaluate the performance of the score.

RESULTS

One hundred and ninety-seven patients with 329 brain metastases received SRT. For NSCLC, the significant prognostic factors were extracranial metastases, target therapy and number of brain metastases. For gastrointestinal cancer, the significant prognostic factors were target therapy and number of brain metastases.

CONCLUSION

The prognostic factors scores were varied by the histologic types which can be used to efficiently stratify for selected patients with brain-metastasis.

Combining ASBT inhibitor and FGF15 treatments enhances therapeutic efficacy against cholangiopathy in female but not male Cyp2c70 KO mice

Therapeutic reduction of hydrophobic bile acids exposure is considered beneficial in cholestasis. The Cyp2c70 KO mice lack hydrophilic muricholic acids and have a human-like hydrophobic bile acid pool resulting in hepatobiliary injury. This study investigates if combining an apical sodium-dependent bile acid transporter inhibitor GSK2330672 (GSK) and fibroblast growth factor-15 (FGF15) overexpression, via simultaneous inhibition of bile acid synthesis and gut bile acid uptake, achieves enhanced therapeutic efficacy in alleviating hepatobiliary injury in Cyp2c70 KO mice. The effects of GSK, adeno-associated virus (AAV)-FGF15, and the combined treatment on bile acid metabolism and cholangiopathy were compared in Cyp2c70 KO mice. In female Cyp2c70 KO mice with more severe cholangiopathy than male Cyp2c70 KO mice, the combined treatment was more effective in reversing portal inflammation, ductular reaction, and fibrosis than AAV-FGF15, while GSK was largely ineffective. The combined treatment reduced bile acid pool by ∼80% compared to ∼50% reduction by GSK or AAV-FGF15, and enriched tauro-conjugated ursodeoxycholic acid in the bile. Interestingly, the male Cyp2c70 KO mice treated with AAV-FGF15 or GSK showed attenuated cholangiopathy and portal fibrosis but the combined treatment was ineffective despite reducing bile acid pool. Both male and female Cyp2c70 KO mice showed impaired gut barrier integrity. AAV-FGF15 and the combined treatment, but not GSK, reduced gut exposure to lithocholic acid and improved gut barrier function. In conclusion, the combined treatment improved therapeutic efficacy against cholangiopathy than either single treatment in the female but not male Cyp2c70 KO mice by reducing bile acid pool size and hydrophobicity.

EZH2 promotes angiogenesis in peritoneal dialysis by epigenetically activating SP4 expression in the IL-6/sIL-6R signalling pathway

Background: Interleukin-6 (IL-6)/soluble IL-6 receptor (sIL-6R) promotes peritoneal angiogenesis by stimulating SP4-mediated vascular endothelial growth factor (VEGF) production in peritoneal dialysis (PD). Moreover, histone methyltransferase enhancer of zeste homologue 2 (EZH2) is involved in IL-6/sIL-6R signalling via the acceleration of vascular endothelial growth factor (VEGF)-induced angiogenesis. However, the molecular mechanism underlying how EZH2 epigenetically activates VFGF expression in IL-6/sIL-6R signalling during PD is still unclear. Methods and Results: In this study, we measured the expression of EZH2, DNMT3B and SP4 in human peritoneal mesothelial cells (HPMCs) treated with IL-6/sIL-6R stimulation and/or EZH2 overexpression, silencing or inhibition. Methylation of the CpG site in the SP4 promoter region and VEGF production were measured under these treatments in HPMCs. Moreover, tube formation in human umbilical vein endothelial cells (HUVECs) was detected following treatment with conditioned media from these stimulated HPMCs. The 5/6 nephrectomy (5/6Nx) rat model was established, and the rats were injected with peritoneal dialysate. EZH2, DNMT3B and SP4 expression and microvessels were analysed in 5/6Nx + PD rats treated with IL-6/sIL-6R and EZH2 overexpression. The results showed that IL-6/sIL-6R and EZH2 overexpression enhanced the expression of EZH2, DNMT3B and SP4, but EZH2 silencing/inhibition reduced these expression levels. The results for VEGF production and tube formation in vitro followed the same trend. IL-6/sIL-6R and EZH2 overexpression increased the methylation percentage of the -170 bp CpG site in the SP4 promoter region in HPMCs. Moreover, IL-6/sIL-6R and EZH2 overexpression stimulated EZH2, DNMT3B and SP4 expression and promoted angiogenesis in 5/6Nx + PD rats. Conclusions: Thus, this study indicated that EZH2 is involved in IL-6/sIL-6R signalling and epigenetically regulates SP4 expression, thereby stimulating VEGF production and angiogenesis in PD. Targeting EZH2 is expected to be a novel therapeutic approach for end-stage renal disease (ESRD) patients with PD treatment.

Effects of apical sodium-bile acid transporter inhibitor and obeticholic acid co-treatment in experimental non-alcoholic steatohepatitis

Background and aims

Several bile acids-based monotherapies have been developed for non-alcoholic steatohepatitis (NASH) treatment but clinical trial findings suggest that they do not satisfactorily improve NASH and liver fibrosis in many patients. Recently, we have shown that combining a gut-restricted apical sodium-bile acid transporter (ASBT) inhibitor GSK2330672 (GSK) with adeno-associated virus (AAV)-mediated liver fibroblast growth factor 15 (FGF15) overexpression provides significantly improved efficacy than either single treatment against NASH and liver fibrosis in a high fat, cholesterol, and fructose (HFCFr) diet-induced NASH mouse model. The beneficial effects of the combined treatment can be attributed to the markedly reduced bile acid pool that reduces liver bile acid burden and intestinal lipid absorption. The aim of this study is to further investigate if combining GSK treatment with the orally bioavailable obeticholic acid (OCA), which induces endogenous FGF15 and inhibits hepatic bile acid synthesis, can achieve similar anti-NASH effect as the GSK+AAV-FGF15 co-treatment in HFCFr-diet-fed mice.

Materials and methods

Male C57BL/6J mice were fed HFCFr diet to induce NASH and liver fibrosis. The effect of GSK, OCA, and GSK+OCA treatments on NASH development was compared and contrasted among all groups.

Results

Findings from this study showed that the GSK+OCA co-treatment did not cause persistent reduction of obesity over a 12-week treatment period. Neither single treatment nor the GSK+OCA co-treatment reduce hepatic steatosis, but all three treatments reduced hepatic inflammatory cytokines and fibrosis by a similar magnitude. The GSK+OCA co-treatment caused a higher degree of total bile acid pool reduction (~55%) than either GSK or OCA treatment alone. However, such bile acid pool reduction was insufficient to cause increased fecal lipid loss. The GSK+OCA co-treatment prevented GSK-mediated induction of hepatic cholesterol 7alpha-hydroxylase but failed to induce ileal FGF15 expression. GSK did not reduce gallbladder OCA amount in the GSK+OCA group compared to the OCA group, suggesting that ASBT inhibition does not reduce hepatic OCA distribution.

Conclusions

Unlike the GSK+AAV-FGF15 co-treatment, the GSK+OCA co-treatment does not provide improved efficacy against NASH and liver fibrosis than either single treatment in mice. The lack of synergistic effect may be partly attributed to the moderate reduction of total bile acid pool and the lack of high level of FGF15 exposure as seen in the GSK+AAV-FGF15 co-treatment.

TFEB regulates sulfur amino acid and coenzyme A metabolism to support hepatic metabolic adaptation and redox homeostasis

Fatty liver is a highly heterogenous condition driven by various pathogenic factors in addition to the severity of steatosis. Protein insufficiency has been causally linked to fatty liver with incompletely defined mechanisms. Here we report that fatty liver is a sulfur amino acid insufficient state that promotes metabolic inflexibility via limiting coenzyme A availability. We demonstrate that the nutrient-sensing transcriptional factor EB synergistically stimulates lysosome proteolysis and methionine adenosyltransferase to increase cysteine pool that drives the production of coenzyme A and glutathione, which support metabolic adaptation and antioxidant defense during increased lipid influx. Intriguingly, mice consuming an isocaloric protein-deficient Western diet exhibit selective hepatic cysteine, coenzyme A and glutathione deficiency and acylcarnitine accumulation, which are reversed by cystine supplementation without normalizing dietary protein intake. These findings support a pathogenic link of dysregulated sulfur amino acid metabolism to metabolic inflexibility that underlies both overnutrition and protein malnutrition-associated fatty liver development.

Low protein diet supplemented with ketoacids on muscle wasting in chronic kidney disease: A clinical trial

Aim

Nutrition is an important part of the care of patients with chronic kidney disease (CKD). However, there is limited clinical research on the skeletal muscle nutrition of patients with CKD. We carried out this study to find out whether a low-protein diet supplemented with ketoacids (LPD + KA) could improve muscle wasting in patients with CKD.

Methods

Patients were enrolled in this non-blind, parallel-group, randomized trial assessing the nutritional status of CKD, randomly assigned to either the LPD + KA group or conventional LPD group. Blood samples such as Hemoglobin, Cystatin C, Creatinine, BUN, Albumin, Pre- Albumin, Glycerin Trilaurate, and Cholesterol were measured at baseline and every 3 months. The parameters of skeletal muscle and other body composition were assessed before and after dietary intervention for 12 months.

Results

A total of 58 patients with CKD completed the study and were available for further analysis. The hemoglobin and albumin were observed to be markedly improved in the LPD + KA group during the follow-up as compared to baseline. Body mass index and total body water index of both groups were increased upon follow-up but the increase in the LPD + KA group was comparatively higher. Moreover, an increase in body fat%, skeletal muscle mass index, and appendicular skeletal muscle mass index was observed in both groups between baseline and follow-up, but it was statistically insignificant.

Conclusion

This study did not find a significant improvement of KAs on muscle wasting, and a long time or more indices study may need to find the effects of the LPD + KA diets.

Clinical trial registration

[www.ClinicalTrials.gov], identifier [NCT02568020].

Retention of Intrafibrillar Minerals Improves Resin-Dentin Bond Durability

The concept of extrafibrillar demineralization involves selective removal of apatite crystallites from the extrafibrillar spaces of mineralized dentin without disturbing the intrafibrillar minerals within collagen. This helps avoiding activation of endogenous proteases and enables air-drying of partially demineralized dentin without causing collapse of completely demineralized collagen matrix that adversely affects resin infiltration. The objective of the present study was to evaluate the potential of quaternized carboxymethyl chitosan (QCMC)-based extrafibrillar demineralization in improving resin-dentin bond durability. Isothermal titration calorimetry indicated that QCMC synthesized by quaternization of O-carboxymethyl chitosan had moderate affinity for Ca²⁺ (binding constant: 8.9 × 10⁴ M^-1). Wet and dry bonding with the QCMC-based demineralization produced tensile bond strengths equivalent to the phosphoric acid (H₃PO₄)-based etch-and-rinse technique. Those bond strengths were maintained after thermocycling. Amide I and PO₄^3- mappings of QCMC-conditioned dentin were performed with atomic force microscope-infrared spectroscopy (AFM-IR). Whereas H₃PO₄-etched dentin exhibited an extensive reduction in PO₄^3- signals corresponding to apatite depletion, QCMC-conditioned dentin showed scattered dark areas and bright PO₄^3- streak signals. The latter were consistent with areas identified as collagen fibrils in the amide I mapping and were suggestive of the presence of intrafibrillar minerals in QCMC-conditioned dentin. Young's modulus mapping of QCMC-demineralized dentin obtained by AFM-based amplitude modulation-frequency modulation recorded moduli that were the same order of magnitude as those in mineralized dentin and at least 1 order higher than H₃PO₄-etched dentin. In situ zymography of the gelatinolytic activity within hybrid layers created with QCMC conditioning revealed extremely low signals before and after thermocycling, compared with H₃PO₄-etched dentin for both wet and dry bonding. Confocal laser scanning microscopy identified the antibacterial potential of QCMC against Streptococcus mutans and Enterococcus faecalis biofilms. Taken together, the QCMC-based demineralization retains intrafibrillar minerals, preserves the elastic modulus of collagen fibrils, reduces endogenous proteolytic activity, and inhibits bacteria biofilms to extend dentin bond durability.

Chchd10 is dispensable for myogenesis but critical for adipose browning

The Chchd10 gene encodes a coiled-coil-helix-coiled-coil-helix-domain containing protein predicted to function in the mitochondrion and nucleus. Mutations of Chchd10 are associated with ALS, dementia and myopathy in humans and animal models, but how knockout of Chchd10 (Chchd10^KO) affects various tissues especially skeletal muscle and adipose tissues remains unclear. Here we show that Chchd10 expression increases as myoblasts and preadipocytes differentiate. During myogenesis, CHCHD10 interacts with TAR DNA binding protein 43 (TDP-43) in regenerating myofibers in vivo and in newly differentiated myotubes ex vivo. Surprisingly, Chchd10^KO mice had normal skeletal muscle development, growth and regeneration, with moderate defects in grip strength and motor performance. Chchd10^KO similarly had no effects on development of brown and white adipose tissues (WAT). However, Chchd10^KO mice had blunted response to acute cold and attenuated cold-induced browning of WAT, with markedly reduced UCP1 levels. Together, these results demonstrate that Chchd10 is dispensable for normal myogenesis and adipogenesis but is required for normal motility and cold-induced, mitochondrion-dependent browning of adipocytes. The data also suggest that human CHCHD10 mutations cause myopathy through a gain-of-function mechanism.

TLR13 contributes to skeletal muscle atrophy by increasing insulin resistance in chronic kidney disease

Objectives

Insulin resistance in chronic kidney disease (CKD) stimulates muscle wasting, but the molecular processes behind the resistance are undetermined. However, inflammation in skeletal muscle is implicated in the pathogenesis of insulin resistance and cachexia. Toll‐like receptors (TLRs) are known to regulate local innate immune responses, and microarray data have shown that Tlr13 is upregulated in the muscles of mice with CKD, but the relevance is unknown.

Materials and Methods

We performed in vitro experiments in C2C12 myotubes and constructed a CKD murine model using subtotal nephrectomy to conduct experiments in vivo.

Results

Tlr13 expression was stimulated in C2C12 myotubes treated with uremic serum. The expression of Tlr13 was also upregulated in the tibialis anterior muscles of mice with CKD. Tlr13 knockdown with siRNAs in skeletal muscle cells decreased insulin resistance despite the inclusion of uremic serum. This led to increased levels of p‐AKT and suppression of protein degradation. Using immunofluorescence staining and coimmunoprecipitation assay, we found that TLR13 recruits IRF3, which activates Irf3 expression, resulting in decreased AKT activity. Moreover, insulin resistance and proteolysis are re‐induced by Irf3 overexpression under Tlr13 deletion.

Conclusions

Our results indicate that TLR13 is involved in CKD‐mediated insulin resistance in muscle. In catabolic conditions where insulin signaling is impaired, targeting TLR13 may improve insulin sensitivity and prevent muscle atrophy.

Lipid droplet dynamics regulate adult muscle stem cell fate

The lipid droplet (LD) is a central hub for fatty acid metabolism in cells. Here we define the dynamics and explore the role of LDs in skeletal muscle satellite cells (SCs), a stem cell population responsible for muscle regeneration. In newly divided SCs, LDs are unequally distributed in sister cells exhibiting asymmetric cell fates, as the LDLow cell self-renews while the LDHigh cell commits to differentiation. When transplanted into regenerating muscles, LDLow cells outperform LDHigh cells in self-renewal and regeneration in vivo. Pharmacological inhibition of LD biogenesis or genetic inhibition of LD catabolism through knockout of Pnpla2 (encoding ATGL, the rate-limiting enzyme for lipolysis) disrupts cell fate homeostasis and impairs the regenerative capacity of SCs. Dysfunction of Pnpla2-null SCs is associated with energy insufficiency and oxidative stress that can be partially rescued by antioxidant (N-acetylcysteine) treatment. These results establish a direct link between LD dynamics and stem cell fate determination.

[Clinical characteristics of human adenovirus infection in hospitalized children with acute respiratory infection in Beijing]

Objective: To compare the clinical characteristics of different types of human adenovirus (HAdV) infection in hospitalized children with acute respiratory infection in Beijing, and to clarify the clinical necessity of adenovirus typing. Methods: In a cross-sectional study, 9 022 respiratory tract specimens collected from hospitalized children with acute respiratory infection from November 2017 to October 2019 in Affiliated Children's Hospital, Capital Institute of Pediatrics were screened for HAdV by direct immunofluorescence (DFA) and (or) nucleic acid detection. Then the Penton base, Hexon and Fiber gene of HAdV were amplified from HAdV positive specimens to confirm their HAdV types by phylogenetic tree construction. Clinical data such as laboratory results and imaging data were analyzed for children with predominate type HAdV infection using t, U, or χ² test. Results: There were 392 cases (4.34%) positive for HAdV among 9 022 specimens from hospitalized children with acute respiratory infection. Among those 205 cases who were successfully typed, 131 were male and 74 were female, age of 22.6 (6.7, 52.5) months,102 cases (49.76%) were positive for HAdV-3 and 86 cases (41.95%), HAdV-7, respectively, while 17 cases were confirmed as HAdV-1, 2, 4, 6, 14 or 21. In comparison of clinical characteristics between the predominate HAdV type 7 and 3 infection, significant differences were shown in proportions of children with wheezing (10 cases (11.63%) vs. 25 cases (24.51%)), white blood cell count >15 ×10⁹/L (4 cases (4.65%) vs.14 cases (13.73%)), white blood cell count <5×10⁹/L (26 cases (30.23%) vs.11 cases (10.78%)), procalcitonin level>0.5 mg/L (43 cases (50.00%) vs. 29 cases (28.43%)), multilobar infiltration (45 cases (52.33%) vs.38 cases (37.25%)), pleural effusion (23 cases (26.74%) vs. 10 cases (9.80%)), and severe adenovirus pneumonia (7 cases (8.14%) vs. 2 cases (1.96%)) with χ²=5.11, 4.44, 11.16, 9.19, 4.30, 9.25, 3.91 and P=0.024, 0.035, 0.001, 0.002, 0.038, 0.002, 0.048, respectively, and also in length of hospital stay (11 (8, 15) vs. 7 (5, 13) d, Z=3.73, P<0.001). Conclusions: HAdV-3 and 7 were the predominate types of HAdV infection in hospitalized children with acute respiratory tract infection in Beijing. Compared with HAdV-3 infection, HAdV-7 infection caused more obvious inflammatory reaction, more severe pulmonary symptoms, longer length of hospital stay, suggesting the clinical necessity of further typing of HAdVs.

Effects of Non-Invasive Brain Stimulation on Alzheimer's Disease

BACKGROUND

Previous meta-analyses did not explore the immediate and long-term effect of non-invasive brain stimulation (NIBS) on different cognitive domains in Alzheimer's disease (AD). The meta-analysis aimed to assess the therapy effect of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) on different cognitive domains in AD in randomized controlled trials (RCTs).

METHODS

Studies published before December 2021 and exploring therapy effect of rTMS, tDCS on different cognitive domains in AD were searched in the following databases: PubMed and Web of Science. We used STATA 12.0 software to compute the standard mean difference (SMD) and a 95% confidence interval (CI).

RESULTS

The present study included 16 articles (including 372 AD patients treated with rTMS and 310 treated with sham rTMS) for rTMS and 11 articles (including 152 AD patients treated with tDCS and 134 treated with sham tDCS) for tDCS. The present study showed better immediate and long-term general cognitive function increase effects in AD given rTMS, compared to those given sham rTMS with random effects models (immediate effect: SMD = 2.07, 95% CI = 0.37 to 3.77, I2 = 97.8%, p < 0.001; long-term effect: SMD = 5.04, 95% CI = 2.25 to 7.84, I2 = 97.8%, p < 0.001). The present study showed no significant immediate and long-term effects of rTMS on attention, executive, language and memory functions. In addition, the present study showed no significant difference in immediate or long-term effects of tDCS on general cognitive function, attention, language or memory functions between tDCS group and sham tDCS group.

CONCLUSIONS

RTMS was an effective treatment technique for general cognitive function in AD, whereas tDCS showed no significant therapy effect on cognitive function in AD. More large-scale studies were essential to explore the effect of NIBS on various cognitive function in AD.

Prostacyclins and pulmonary arterial hypertension in children

OBJECTIVE

Despite its low incidence, pulmonary hypertension in children places a substantial burden on families and society because survival can be shorter than 10 months and treatment options are limited and ineffective. Drugs to treat pulmonary hypertension include endothelin antagonists, phosphodiesterase type 5 inhibitors and prostacyclin, which is the most widely used to treat pediatric pulmonary hypertension. The main aim of this study was to provide a comprehensive overview of the advantages and disadvantages of prostacyclin and its analogs for treating pulmonary hypertension in children.

MATERIALS AND METHODS

To retrieve a thorough collection of studies, we performed a search in PubMed using the following combination of keywords: (Prostacyclins) or (Epoprostenol) or (Iloprost) or (Treprostinil) or (Beraprost), (children) and (pulmonary arterial hypertension). The time limits used for the search were December 1983 to May 2021.

RESULTS

The search retrieved a total of 238 articles. Titles and abstracts of articles were screened for relevance, and all relevant articles published in English were included.

CONCLUSIONS

Epoprostenol can be effective against severe pulmonary hypertension. Iloprost can treat severe persistent pulmonary hypertension in newborns and inhaled iloprost can be used in pulmonary vasoreactivity testing. Treprostinil is a long-acting prostacyclin analog, and it shows the highest antiproliferative activity among prostacyclins. Beraprost may be effective in premature infants, but available evidence comes from only one patient, so more clinical testing is needed.

[Current status and research advances on the use of assisted traction technique in endoscopic full-thickness resection]

Endoscopic full-thickness resection (EFTR) allows completely resecting deep submucosal tumors (SMTs) in the gastrointestinal wall, which has a broad application prospect in clinic. However, its application and promotion are limited by complex surgical procedures and high surgical risk. Various auxiliary traction techniques are expected to reduce the operation difficulty and risk of EFTR and improve its operative success rate. To provide a reference for clinicians, we summarize various auxiliary traction techniques in EFTR in this article. The clip-with-line method is simple to operate and widely used, whereas its traction is limited and there is a risk of clip falling off. The snare traction method and the clip-snare traction method has advantage of large traction force, but its thrust is affected by the hardness of snare. The traction point of the grasping forceps traction method is flexible and easy to adjust. Nevertheless, it requires the use of a dual-channel upper endoscope, which is difficult to operate. The transparent cap traction method and the full-thickness resection device traction method takes a short time and is easy to promote, whereas the resectable lesion is limited, and the size of the lesion may affect the success rate. In contrast, the suture loop needle-T-tag tissue anchors assisted method has a large resection range, but the operation is complicated and the feasibility has not been verified. The robot-assisted method has flexible operation and excellent visualization, whereas it is expensive and difficult to operate. There is no report of the application of magnetic anchor technology in EFTR, but it may have good application prospects in the auxiliary traction of EFTR.

Dynamic contrast-enhanced magnetic resonance imaging: A novel approach to assessing treatment in locally advanced esophageal cancer patients

Aims

This study aims to investigate the potential application of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to predict concurrent chemoradiation (CRT) in locally advanced esophageal carcinoma.

Patients and Methods

This study involved 33 patients with locally advanced esophageal cancer and treated with CRT. The patients underwent DCE-MRI before CRT (pre) and 3 weeks after starting CRT (mid). The patients were categorized into two groups: complete response (CR) and non-complete response (non-CR) after 3 months of treatment. The quantitative parameters of DCE-MRI (K^trans, Kep, and Ve), the changes and ratios of parameters (ΔK^trans, ΔKep, ΔVe, rΔK^trans, rΔKep, and rΔVe), and the relative ratio in the tumor area and a normal tube wall (rK^trans, rKep, and rVe) were calculated and compared between two timeframes in two groups, respectively. Moreover, the receiver operating characteristics (ROC) statistical analysis was used to assess the above parameters.

Results

We divided 33 patients into two groups: 22 in the CR group and 11 in the non-CR group. During the mid-CRT phase in the CR group, both K^trans and Kep rapidly decreased, while only Kep decreased in the non-CR group. The pre-K^trans and pre-Kep in the CR group were substantially higher compared to the non-CR group. Moreover, the rK^trans was also apparently observed as higher at pre-CRT in the CR group compared to the non-CR group. The ROC analysis demonstrated that the pre-K^trans could be the best parameter to evaluate the treatment performance (AUC = 0.74).

Conclusion

Pre-K^trans could be a promising parameter to forecast how patients with locally advanced esophageal cancer will respond to CRT.

Skeletal remodeling of chalcone-based pyridinium salts to access isoindoline polycycles and their bridged derivatives

Simultaneous deconstructive ring-opening and skeletal reconstruction of an inert, aromatic pyridinium ring is of great importance in synthetic communities. However, research in this area is still in its infancy. Here, a skeletal re-modeling strategy was developed to transform chalcone-based pyridinium salts into structurally intriguing polycyclic isoindolines through a dearomative ring-opening/ring-closing sequence. Two distinct driving forces for the deconstruction of the pyridinium core were involved in these transformations. One was the unprecedented harnessing of the instability of in situ generated cyclic β-aminoketones, and the other was the instability of the resultant N,N-ketals. The desired isoindoline polycycles could undergo the Wittig reaction with various phosphorus ylides to achieve structural diversity and complexity. Notably, by tuning the Wittig conditions by addition of one equivalent of base, an additional bridged ring was introduced. A plausible mechanism was proposed on the basis of control experiments and theoretical calculations.

[Clinical characteristics of children infected with different subtypes/genotypes of human respiratory syncytial virus in Beijing from 2009 to 2017]

Objective: To explore the different clinical characteristics of children infected with different subtype/genotype of human respiratory syncytial virus (HRSV) in Beijing. Methods: Respiratory specimens for positive HRSV were randomly collected from children with acute respiratory tract infection (ARTI) in the epidemic season of HRSV from November of each year to January of the next year during 2009 and 2017. G genes of HRSV were amplified and sequenced for subtyping and genotyping by bioinformatics analysis. Clinical data were collected and analyzed. Results: Out of 590 children, 376 (63.7%) with subtype A, and 214 (36.3) with subtype B. The annual dominant subtypes of HRSV from 2009 to 2017 were B-A-A-B-AB-A-A-B-A, respectively, whilst a total of 10 genotypes were detected with 95.8% assigned to genotype ON1 and NA1 of subtype A, and genotype BA9 of subtype B. Children infected with subtype B (96 cases, 44.9%) were more likely aged 0-3 month old than those with subtype A (118 cases, 31.4%) (P=0.001), and more likely to be admitted to Intensive Care Unit(ICU) ((124 cases, 57.9%) than those with subtype A (172 cases, 45.7%)) (P=0.005). Statistical significance were shown among children infected with genotype ON1, NA1 or BA9, in the possibility of infection in children aged 0-3 month (P=0.003), proportion of admission into ICU (P=0.007), length of stay in hospital (P=0.001), and clinical outcome (P=0.001), respectively. Conclusion: Children infected with different subtype or genotype of HRSV have different clinical characteristics, which stresses the important role of the monitoring HRSV subtypes and genotypes among children.

Thalidomide Suppresses Angiogenesis Through the Signal Transducer and Activator of Transcription 3/SP4 Signaling Pathway in the Peritoneal Membrane

Peritoneal angiogenesis is the key pathophysiological factor that limits peritoneal ultrafiltration during peritoneal dialysis (PD) in uremic patients. Thalidomide has been confirmed to inhibit angiogenesis by inhibiting the secretion of vascular endothelial growth factor (VEGF), but the exact mechanism by which thalidomide inhibits vascular proliferation during PD is still unclear. Here, the objective of the present study was to investigate whether the reduction in VEGF production by human peritoneal mesothelial cells (HPMCs) was controlled by thalidomide. Stimulation of HPMCs with IL-6 in combination with soluble IL-6 receptor (sIL-6R) promoted VEGF expression and secretion, but these effects were attenuated by thalidomide treatment through a transcriptional mechanism that involved signal transducer and activator of transcription 3 (STAT3) and SP4. Conditioned medium from HPMCs cultured with thalidomide inhibited angiogenic endothelial tube formation, which could be further blocked by silencing SP4 and promoted by overexpressing SP4. In vivo, induction of peritoneal angiogenesis in sham rats, sham+PD rats, 5/6 nephrectomy (5/6Nx) rats, 5/6Nx+PD rats, and 5/6Nx+PD rats intraperitoneally treated with thalidomide showed that thalidomide was involved in the control of several key endothelial-specific targets, including VEGFR2, VEGFR3, SP4, and STAT3 expression and new vessel formation, confirming the role of thalidomide and STAT3/SP4 signaling in these processes. Taken together, these findings identify a novel mechanism that links thalidomide, STAT3/SP4 signaling, and angiogenesis in the peritoneal membrane.

Diastereoselective trifunctionalization of pyridinium salts to access structurally crowded azaheteropolycycles

A highly diastereoselective dearomative trifunctionalization of pyridinium salts with multifunctional o-hydroxyl aromatic azomethine ylides has been established, which not only provided a convenient and rapid method to assemble challenging and architecturally crowded chroman-pyrrolidine-hydrogenated pyridine fused pentacycles, but also represented a rare successful example of the higher-order multifunctionalization of pyridiniums.

Ultra-low-dose estradiol and dydrogesterone: a phase III study for vasomotor symptoms in China

OBJECTIVE

This study aimed to evaluate the efficacy and safety of ultra-low-dose estradiol plus dydrogesterone for vasomotor symptoms in postmenopausal women in China (trial registration CTR20160689).

METHODS

A total of 332 patients were randomized to continuous combined estradiol 0.5 mg + dydrogesterone 2.5 mg or placebo for 12 weeks. The primary efficacy endpoint was change in the number of hot flushes per day from baseline to end of treatment. Secondary efficacy endpoints included change in the number of moderate-to-severe hot flushes per day, menopausal symptoms from baseline and quality of life.

RESULTS

Between baseline and end of treatment, change in the mean number of hot flushes per day was -5.9 (95% confidence interval [CI] - 6.6, -5.2) with estradiol + dydrogesterone and -4.5 (95% CI -5.1, -3.8) with placebo, with a mean difference of -1.4 hot flushes per day (95% CI -2.2, -0.7; p < 0.001). Significant differences in favor of estradiol + dydrogesterone were also observed in several secondary efficacy endpoints. The study treatment was well tolerated.

CONCLUSION

Continuous combined estradiol 0.5 mg + dydrogesterone 2.5 mg reduced hot flushes in postmenopausal women in China. This ultra-low-dose regimen provides an additional option for women experiencing the vasomotor symptoms of menopause. These data are consistent with previous results in other populations.

MiR-29ab1 Cluster Resists Muscle Atrophy Through Inhibiting MuRF1

Skeletal muscle has great plasticity. An increase in protein degradation can cause muscle atrophy. Atrogin-1 and muscle ring finger-1 (MuRF1) are dramatically upregulated in various muscle atrophy. Inhibition of Atrogin-1 and MuRF1 protects against muscle atrophy. MiR-29 plays an important regulatory role in skeletal muscle development. However, the function of miR-29 in skeletal muscle protein metabolism is not clear. To investigate the function of miR-29, we generated miR-29 knockout mice and the miR-29ab1 cluster overexpression mice. The disruption of miR-29 led to severe atrophy of skeletal muscle during puberty, and the muscle-specific overexpression of the miR-29ab1 cluster protected against denervation-induced and fasting-induced muscle atrophy. Furthermore, the overexpression of miR-29a, b mimics in myotubes resisted the muscle atrophy. MuRF1 was the direct target gene of miR-29a, b. These results demonstrate that miR-29ab1 cluster plays a critical role in the maintenance of skeletal muscle. MiR-29ab1 cluster is the excellent inhibitor of MuRF1, ultimately indicating that miR-29ab1 cluster is good therapeutic molecule candidate for adulthood.

[Incidence and risk factors of anastomotic leak after transanal total mesorectal excision in China: a retrospective analysis based on national database]

Objective: Transanal total mesorectal excision (taTME) was a very hot topic in the first few years since its appearance, but now more introspections and controversies on this procedure have emerged. One of the reasons why the Norwegian Ministry of Health stopped taTME was the high incidence of postoperative anastomotic leak. In current study, the incidence and risk factors of anastomotic leak after taTME were analyzed based on the data registered in the Chinese taTME Registry Collaborative (CTRC). Methods: A case-control study was carried out. Between November 15, 2017 and December 31, 2020, clinical data of 1668 patients undergoing taTME procedure registered in the CTRC database from 43 domestic centers were collected retrospectively. After excluding 98 cases without anastomosis and 109 cases without complete postoperative complication data, 1461 patients were finally enrolled for analysis. There were 1036 males (70.9%) and 425 females (29.1%) with mean age of (58.2±15.6) years and mean body mass index of (23.6±3.8) kg/m(2). Anastomotic leak was diagnosed and classified according to the International Study Group of Rectal Cancer (ISREC) criteria. The risk factors associated with postoperative anastomotic leak cases were analyzed. The impact of the cumulative number of taTME surgeries in a single center on the incidence of anastomotic leak was evaluated. As for those centers with the number of taTME surgery ≥ 40 cases, incidence of anastomic leak between 20 cases of taTME surgery in the early and later phases was compared. Results: Of 1461 patients undergoing taTME, 103(7.0%) developed anastomotic leak, including 71 (68.9%) males and 32 (31.1%) females with mean age of (59.0±13.9) years and mean body mass index of (24.5±5.7) kg/m(2). The mean distance between anastomosis site and anal verge was (2.6±1.4) cm. Thirty-nine cases (37.9%) were classified as ISREC grade A, 30 cases (29.1%) as grade B and 34 cases (33.0%) as grade C. Anastomotic leak occurred in 89 cases (7.0%,89/1263) in the laparoscopic taTME group and 14 cases (7.1%, 14/198) in the pure taTME group. Multivariate analysis showed that hand-sewn anastomosis (P=0.004) and the absence of defunctioning stoma (P=0.013) were independently associated with anastomotic leak after taTME. In the 16 centers (37.2%) which performed ≥ 30 taTME surgeries with cumulative number of 1317 taTME surgeries, 86 cases developed anastomotic leak (6.5%, 86/1317). And in the 27 centers which performed less than 30 taTME surgeries with cumulative number of 144 taTME surgeries, 17 cases developed anastomotic leak (11.8%, 17/144). There was significant difference between two kinds of center (χ(2)=5.513, P=0.019). Thirteen centers performed ≥ 40 taTME surgeries. In the early phase (the first 20 cases in each center), 29 cases (11.2%, 29/260) developed anastomotic leak, and in the later phase, 12 cases (4.6%, 12/260) developed anastomotic leak. The difference between the early phase and the later phase was statistically significant (χ(2)=7.652, P=0.006). Conclusion: The incidence of anastomotic leak after taTME may be reduced by using stapler and defunctioning stoma, or by accumulating experience.

[Diagnosis and treatment of Chlamydia psittaci pneumonia: experiences of 8 cases]

Objective: In order to improve the understanding and clinical treatment of Chlamydia psittaci pneumonia, we analyzed the clinical manifestations, laboratory test results and imaging features of 8 patients. Methods: We collected the clinical data of 8 patients with Chlamydia psittaci pneumonia diagnosed by metagenomic next-generation-sequencing (mNGS) from November 2018 to February 2020, including clinical features, chest CT scan, pathological features and antibiotic use. Results: A total of one male and 7 females, aged from 45 to 85 years(median 62 years), were included in this study. All the patients had high fever, cough and most had expectoration (6/8). The leukocyte count and PCT level were mostly normal (7/8). However, we observed decreased lymphocyte count(5/8), elevated C-reactive protein in all patients, and increased ESR in most patients (7/8). The chest CT of all the patients showed large patchy consolidation, with one case having pleural effusion. The pathological manifestations were nonspecific, showing infiltration of inflammatory cells and exudation. Moxifloxacin and/or doxycycline were administered after diagnosis, and the course of treatment lasted from 14 to 21 days.Chest CT showed absorption of lesions following treatment Conclusions: Chlamydia psittaci pneumonia showed certain characteristics, including high fever with pulmonary patchy consolidation, and normal white blood cell count. Molecular diagnostic methods such as mNGS could lead to rapid diagnosis and treatment which can shorten the course of hospitalization and thus improve prognosis.

[Risk factors and clinical prognosis analysis of carbapenem-resistant Enterobacterales bacteria nosocomial infection]

Objective: To explore the risk factors for carbapenem-resistant Enterobacterales (CRE) infection and death. Methods: A case-control analysis of 482 inpatients in 18 secondary or tertiary hospitals in Beijing in 2018 was conducted. Patients infected by CRE were selected as the case group (n=247), and infected by carbapenem susceptible Enterobacterales (CSE) as the control group (n=235). The risk factors and clinical prognosis of CRE infection were analyzed by single factor analysis and multivariate logistic regression analysis. Results: CRE were resistant to most antimicrobials, but were highly sensitive to colistin and tigecycline, with sensitivity of 94.0% and 99.5%, respectively. Multivariate analysis showed that prior 30-day tracheal intubation (OR=2.607, 95%CI: 1.655-4.108, P<0.001), empirical treatment using third or fourth generation cephalosporins (OR=2.339, 95%CI: 1.438-3.803, P=0.001), carbapenems (OR=2.468, 95%CI: 1.610-3.782, P<0.001) and quinolones (OR=2.042, 95%CI: 1.268-3.289, P=0.003) were independent risk factors for CRE infection. Mechanical ventilation (OR=3.390, 95%CI: 1.454-7.904, P=0.005), heart failure (OR=4.679, 95%CI: 1.975-11.083, P<0.001), moderate or severe liver disease (OR=3.057, 95%CI: 1.061-8.806, P=0.038), prior 30-day quinolones exposure (OR=2.882, 95%CI: 1.241-6.691, P=0.014) and septic shock (OR=7.772, 95%CI: 3.505-17.233, P<0.001) were independent risk factors for death after CRE infection. Conclusions: Reducing the use of antimicrobials and invasive procedures such as prior 30-day tracheal intubation may reduce the probability of CRE infection. Grading the severity of the underlying disease in patients with CRE infection, as well as predicting and preventing the occurrence of septic shock will help reduce the risk of death.

POS0776 CORRELATION OF PERIPHERAL CD4+GRANZB+CTLS WITH DISEASE SEVERITY IN PATIENTS WITH PRIMARY SJÖGREN’S SYNDROME

Background:

Sjögren’s syndrome (SS) is a chronic autoimmune disorder. The major histopathologic lesion of it is a focal lymphocytic infiltrate around ductal and acinar epithelial cells, which include a majority of CD4+T. Several studies have shown that the epithelial cells in SS present diverse phenomena, such as MHC class II overexpression. CD4+T cells with cytotoxic activity (CD4 CTL) have been detected in various immune responses. They are characterized by their ability to secrete perforin and granzyme B to kill the target cells in an MHC class II-restricted fashion.

Objectives:

So this study was to investigate the correlation of peripheral CD4+GranzB+CTLs with disease severity and organ involvement in patients with primary Sjögren’s syndrome.

Methods:

We recruited 116 pSS patients and 46 healthy controls using flow cytometry to examine proportion of CD4+GranzB+CTLs in their peripheral blood, and immunofluorescence to test the expression of CD4+GranzB+CTLs in labial gland. The correlations of CD4+GranzB+CTLs and the relevant clinical data were analyzed.

Results:

We analyzed the percentage of CD4+GranzB+cytotoxic T cells in peripheral blood mononuclear cells (PBMCs) by flow cytometry. Frequency of peripheral CD4+GranzB+CTLs were measured in 116 patients with pSS and 46 healthy controls matched for age and sex. The percentage of CD4+GranzB+CTLs were significantly up-regulated in pSS patients than healthy controls (7.1%±4.9% vs 3.1%±1.9%, p <0.0001) and positive correlation with ESSDAI in pSS patients(r = 0.6332, p<0.001). The percentage of CD4+GranzB+CTLs were markedly higher in pSS patients with extraglandular manifestations. Moreover, CD4+GranzB+CTLs were observed in the lymphocytic foci and periductal areas of the LSGs and were elevated with increased foci index (FI). After excluding the other risk factors associated with pSS, CD4+GranzB+CTLs were still related to ESSDIA and extraglandular manifestations independently(p<0.05). ROC curve analysis indicated that the area under the curve (AUC) of CD4+GranzB+CTLs was 0.796 to predict the activity of pSS, and 0.851 to presume extraglandular manifestations. The best diagnostic cut-off point was 4.865 for pSS patients.

Conclusion:

In this study, We provide new evidence indicating involvement of CD4+GranzB+CTLs over activation in the disease pathophysiology of pSS, which may serve as a new biomarker to evaluate the activity and severity of pSS.

References:

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Table 1.

Multivariate analysis of CD4+GranzB+CTLs influenced by pSS-related factors

regression coefficientstandard errort-statisticsp value95%CICD8+GranzB+CTLs(%)0.1440.0334.3346.9E-50.077, 0.211ESSDAI0.2560.1222.0950.0410.011, 0.502extraglandular manifestations2.6121.2682.0590.0450.065, 5.158Figure 1.

Receiver operating characteristic (ROC) curve of the frequency of CD4+GranzB+CTLs to predict ESSDAI and extraglandular manifestations response

Disclosure of Interests:

None declared

Choosing an appropriate glomerular filtration rate estimating equation: role of body mass index

Background

We aimed to investigate the accuracy of different equations in evaluating estimated glomerular filtration rate (eGFR) in a Chinese population with different BMI levels.

Methods

A total of 837 Chinese patients were enrolled, and the eGFRs were calculated by three Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, three full-age spectrum (FAS) equations and two Modification of Diet in Renal Disease (MDRD) equations. Results of measured GFR (mGFR) by the 99Tcm-diathylenetriamine pentaacetic acid (99Tcm-DTPA) renal dynamic imaging method were the reference standards. According to BMI distribution, the patients were divided into three intervals: below 25th(BMI_P25), 25th to 75th(BMI_P25–75) and over 75th percentiles (BMI_P75).

Results

The medium BMI of the three BMI intervals were 20.9, 24.8 and 28.9 kg/m², respectively. All deviations from mGFR (eGFR) were correlated with BMI (p < 0.05). The percentage of cases in which eGFR was within mGFR ±30% (P30) was used to represent the accuracy of each equation. Overall, eGFR_{FAS_Cr_CysC} and eGFREPI_Cr_2009 performed similarly, showing the best agreement with mGFR among the eight equations in Bland-Altman analysis (biases: 4.1 and − 4.2 mL/min/1.73m², respectively). In BMI_P25 interval, eGFR_{FAS_Cr} got − 0.7 of the biases with 74.2% of P30, the kappa value was 0.422 in classification of CKD stages and the AUC₆₀ was 0.928 in predicting renal insufficiency, and eGFREPI_Cr_2009 got 2.3 of the biases with 71.8% of P30, the kappa value was 0.418 in classification of CKD stages and the AUC₆₀ was 0.920 in predicting renal insufficiency. In BMI_P25–75 interval, the bias of eGFR_{FAS_Cr_CysC} was 4.0 with 85.0% of P30, the kappa value was 0.501 and the AUC₆₀ was 0.941, and eGFR_{FAS_Cr_CysC} showed balanced recognition ability of each stage of CKD (62.3, 63.7, 68.0, 71.4 and 83.3% respectively). In BMI_P75 interval, the bias of eGFR_{EPI_Cr_CysC_2012} was 3.8 with 78.9% of P30, the kappa value was 0.484 the AUC₆₀ was 0.919, and eGFR_{EPI_Cr_CysC_2012} equation showed balanced and accurate recognition ability of each stage (60.5, 60.0, 71.4, 57.1 and 100% respectively). In BMI_P75 interval, the bias of eGFR_{FAS_Cr_CysC} was − 1.8 with 78.5% of P30, the kappa value was 0.485, the AUC₆₀ was 0.922. However, the recognition ability of each stage of eGFR_{FAS_Cr_CysC} eq. (71.1, 61.2, 70.0, 42.9 and 50.0% respectively) was not as good as GFR_{EPI_Cr_CysC_2012} equation.

Conclusion

For a Chinese population, we tend to recommend choosing eGFR_{FAS_Cr} and eGFR_{EPI_Cr_2009} when BMI was around 20.9, eGFR_{FAS_Cr_CysC} when BMI was near 24.8, and eGFR_{EPI_Cr_CysC_2012} when BMI was about 28.9.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-021-02395-x.

Combined ASBT Inhibitor and FGF15 Treatment Improves Therapeutic Efficacy in Experimental Nonalcoholic Steatohepatitis

BACKGROUND & AIMS

Pharmacologic agents targeting bile acid signaling show promise for treating nonalcoholic steatohepatitis (NASH). However, clinical findings suggest that new treatment strategies with enhanced therapeutic efficacy and minimized undesired effects are needed. This preclinical study investigates whether combining an apical sodium-bile acid transporter (ASBT) inhibitor GSK233072 (GSK672) and fibroblast growth factor-15 (FGF15) signaling activation improves anti-NASH efficacy.

METHODS

Mice with high fat, cholesterol, and fructose (HFCFr) diet-induced NASH and stage 2 fibrosis are used as a NASH model. GSK672 or AAV8-TBG-FGF15 interventions are administered alone or in combination to HFCFr diet-fed mice.

RESULTS

The combined treatment significantly enhances therapeutic efficacy against steatosis, inflammation, ballooning, and fibrosis than either single treatment. Mechanistically, the synergistic actions of GSK672 and FGF15 on inhibiting gut bile acid reuptake and hepatic bile acid synthesis achieve greater magnitude of bile acid pool reduction that not only decreases bile acid burden in NASH livers but also limits intestinal lipid absorption, which, together with FGF15 signaling activation, produces weight loss, reduction of adipose inflammation, and attenuated hepatocellular organelle stress. Furthermore, the combined treatment attenuates increased fecal bile acid excretion and repressed bile acid synthesis, which underlie diarrhea and hypercholesterolemia associated with ASBT inhibition and FGF19 analogue, respectively, in clinical settings.

CONCLUSIONS

Concomitant ASBT inhibition and FGF15 signaling activation produce metabolic changes that partially mimic the bariatric surgery condition whereby lipid malabsorption and increased FGF15/19 signaling synergistically mediate weight loss and metabolic improvement. Further clinical studies may be warranted to investigate whether combining ASBT inhibitor and FGF19 analogue enhances anti-NASH efficacy and reduced treatment-associated adverse events in humans.

Short-term prognosis and influencing factors of patients with acute kidney injury treated with prolonged intermittent renal replacement therapy

BACKGROUND

Studies assessing prognosis after prolonged intermittent renal replacement therapy (PIRRT) for acute kidney injury (AKI) are scarce.

AIM

To assess the impact of PIRRT on AKI and factors associated with short-term prognosis.

METHODS

In this retrospective nested case-control study, AKI patients administered PIRRT in Shanghai General Hospital from 01/2012 to 10/2018 were assigned to the 30-day survivor and death groups. Surviving patients were further divided into the kidney recovery and non-recovery groups at 30 and 90 days post-discharge, respectively. Propensity score matching was performed.

RESULTS

Totally 576 patients were included in the non-matched study population, mortality and kidney recovery rates were 51.7% and 33.4%, respectively. After propensity score matching, there were 250 patients in each of the death and survival groups. Low PIRRT frequency (OR = 2.165, 95% CI = 1.178-3.978), infection (OR = 0.447, 95% CI = 0.251-0.795), number of damaged vital organs (OR = 0.478, 95% CI = 0.346-0.661), sodium (OR = 0.958, 95% CI = 0.928-0.988), total protein (OR = 1.047, 95% CI = 1.022-1.072), pre-dialysis thrombin time (TT; OR = 0.959, 95% CI = 0.936-0.983), pre-discharge glomerular filtration rate (GFR; OR = 1.024, 95% CI = 1.017-1.031) and admission ward [reference: renal ward; intensive care unit (OR = 0.042, 95% CI = 0.008-0.211); surgery (OR = 0.092, 95% CI = 0.018-0.465); medical (OR = 0.049, 95% C% CI = 0.009-0.259); other (OR = 0.097, 95% CI = 0.016-0.572)] independently predicted 30-day mortality. Peripherally inserted central catheter (OR = 13.970, 95% CI = 1.439-135.589), urea nitrogen (OR = 0.961, 95% CI = 0.933-0.990) and pre-discharge GFR (OR = 1.102, 95% CI = 1.067-1.137) independently predicted 30-day kidney recovery. Pre-dialysis Scr (OR = 0.997, 95% CI = 0.995-0.999), urea nitrogen (OR = 0.948, 95% CI = 0.912-0.986) and pre-discharge GFR (OR = 1.137 95% CI = 1.088-1.189) independently predicted 90-day kidney recovery.

CONCLUSIONS

PIRRT improves survival and kidney function recovery in AKI patients. In patients with previous GFR ≥ 30 mL/(min-1.73 m² ) and no prior maintenance dialysis, PIRRT at 3-5 sessions/week might be appropriate.

The value of 18F-FDG PET/CT imaging combined with detection of CA125 and HE4 in the diagnosis of recurrence and metastasis of ovarian cancer

OBJECTIVE

To explore the clinical application value of 18F-fluorodeoxyglucose (18F-FDG) PET/CT imaging combined with detection of serum tumor molecular markers (carbohydrate antigen 125 (CA 125) and human epididymis protein 4 (HE4)) in the diagnosis of recurrence and metastasis of ovarian cancer.

PATIENTS AND METHODS

Clinical data about 18F-FDG PET/CT imaging and serum CA125 and HE4 of 69 ovarian cancer patients after the first cytoreductive surgery and chemotherapy were retrospectively analyzed, and the clinical application value of 18F-FDG PET/CT imaging combined with detection of CA125 and HE4 in the diagnosis of recurrence and metastasis of ovarian cancer was evaluated.

RESULTS

The 18F-FDG PET/CT images of recurrence and metastasis of ovarian cancer showed hypermetabolism. The sensitivity, specificity, accuracy, predictive positive value, and predictive negative value of 18F-FDG PET/CT imaging for the diagnosis of recurrence and metastasis of ovarian cancer were 90.74%, 86.67%, 89.86%, 96.08%, and 72.22%, respectively; those of CA125 for the diagnosis of them were 77.78%, 86.67%, 79.71%, 95.45% and 52.00%, respectively, and those of HE4 for the diagnosis of them were 70.37%, 93.33%, 76.84%, 97.44%, and 48.39% respectively. In addition, the sensitivity and specificity of 18F-FDG PET/CT combined with detection of serum CA125 and HE4 for the diagnosis were 100.00% and 100.00%, respectively, significantly higher than those of separate 18F-FDG PET/CT imaging, detection of serum CA125, and detection of serum HE4 (c2 = 5.243, 13.500, 18.783, p = 0.022, 0.000, 0.000; c2 = 4.000, 8.525, 9.864, p = 0.046, 0.004, 0.002), and the accuracy of the combination use of them was 95.65%, also significantly higher than that of separate CA125 and HE4 (c2 = 8.118, 10.315, p = 0.004, 0.001, both p < 0.01). Furthermore, the maximum standardized uptake value (SUVmax) of 18F-FDG PET/CT imaging for recurrence and metastasis of ovarian cancer focuses was significantly positively correlated with serum CA125 and HE4 levels (r = 0.596, p = 0.000; r = 0.431, p = 0.002), and the serum CA125 level was also significantly positively correlated with serum HE4 level in patients with recurrent or metastasized ovarian cancer (r = 0.198, p = 0.043,).

CONCLUSIONS

18F-FDG PET/CT imaging combined with detection of serum CA125 and HE4 can significantly improve the diagnostic efficiency to recurrence and metastasis of ovarian cancer and is conducive to the early diagnosis of the recurrence and metastasis, which provides a basis for further clinical intervention.

Trimethylamine N-oxide mediated Y-box binding protein-1 nuclear translocation promotes cell cycle progression by directly downregulating Gadd45a expression in a cellular model of chronic kidney disease

AIMS

Cell cycle arrest plays critical roles in preventing renal tubular epithelial cell (RTEC) injury and maladaptation after the onset of chronic kidney disease (CKD), but the underlying mechanism governing this arrest has not been fully elucidated. This study was designed to determine the underlying role of YB-1 in promoting cell cycle progression and nuclear translocation in HK-2 cells induced by trimethylamine N-oxide (TMAO).

MAIN METHODS

YB-1 primarily accumulated in the cytoplasm in HK-2 cells after they were treated with TMAO for 30 min and 6 h. Gene expression was analysed using RNA sequencing in HK-2 cells treated with TMAO. Cell cycle progression was analysed via flow cytometry. Luciferase assay and ChIP-PCR were performed to determine the relationship between transcription factor YB-1 and Gadd45a promoter region. Additionally, mice were fed with TMAO to test renal dysfunction and measure the expression of YB-1, GADD45a and CCNA2 in the kidney sections through immunohistochemistry.

KEY FINDINGS

YB-1 primarily accumulated in the cytoplasm in HK-2 cells after they were treated with TMAO for 30 min and 6 h. RNA sequencing analysis showed that the cell cycle checkpoint genes growth arrest and DNA damage (Gadd)45a, Gadd45g, cyclin (Ccn)a2, Ccnb1, Ccne1 and Ccnf were differentially expressed in HK-2 cells after treated with 400 μM TMAO for 30 min. Flow cytometry results demonstrated that cell cycle progression was blocked at the G2/M checkpoint. In animal models, elevated dietary TMAO directly led to progressive renal tubulointerstitial dysfunction and inhibited the expression of YB-1 in kidney. Moreover, YB-1 was determined to regulate Gadd45a expression by directly binding to its promoter region. YB-1 expression was negatively correlated with the expression of Gadd45a and Gadd45g but positively correlated with Ccna2, Ccnb1, Ccne1 and Ccnf in CKD.

SIGNIFICANCE

YB-1 may be a reliable molecular target and an effective prognostic biomarker for CKD.

Bone marrow mesenchymal stem cell exosomes suppress phosphate-induced aortic calcification via SIRT6-HMGB1 deacetylation

Background

Vascular calcification associated with chronic kidney disease (CKD) can increase the risk of mortality. Elevated serum levels of high mobility group box 1 (HMGB1) promotes vascular calcification in CKD via the Wnt/β-catenin pathway. Sirtuin 6 (SIRT6) prevents fibrosis in CKD by blocking the expression of β-catenin target genes through deacetylation. This study aimed to investigate whether the inhibition of vascular calcification by bone marrow mesenchymal stem cell (BMSC)-derived exosomes is related to SIRT6 activity and assess the regulatory relationship between HMGB1 and SIRT6.

Methods

CKD characteristics, osteogenic markers, calcium deposition, and the differential expression of HMGB1 and SIRT6 have been measured in a 5/6 nephrectomized mouse CKD model fed a high-phosphate diet to induce aortic calcification. In vitro assays were also performed to validate the in vivo findings.

Results

High phosphate promotes the translocation of HMGB1 from the nucleus to the cytosol and induces the expression of Runx2, osteopontin, and Msx2. However, BMSC-derived exosomes were found to alleviate CKD-related fibrosis and the induction of osteogenic genes although less significantly when SIRT6 expression is suppressed. SIRT6 was found to modulate the cytosol translocation of HMGB1 by deacetylation in vascular smooth muscle cells.

Conclusion

Our results indicate that BMSC-derived exosomes inhibit high phosphate-induced aortic calcification and ameliorate renal function via the SIRT6–HMGB1 deacetylation pathway.

Continuous and discontinuous transitions in the depinning of two-dimensional dusty plasmas on a one-dimensional periodic substrate

Langevin dynamical simulations are performed to study the depinning dynamics of two-dimensional dusty plasmas on a one-dimensional periodic substrate. From the diagnostics of the sixfold coordinated particles P_{6} and the collective drift velocity V_{x}, three different states appear, which are the pinning, disordered plastic flow, and moving ordered states. It is found that the depth of the substrate is able to modulate the properties of the depinning phase transition, based on the results of P_{6} and V_{x}, as well as the observation of hysteresis of V_{x} while increasing and decreasing the driving force monotonically. When the depth of the substrate is shallow, there are two continuous phase transitions. When the potential well depth slightly increases, the phase transition from the pinned to the disordered plastic flow states is continuous; however, the phase transition from the disordered plastic flow to the moving ordered states is discontinuous. When the substrate is even deeper, the phase transition from the pinned to the disordered plastic flow states changes to discontinuous. When the depth of the substrate further increases, as the driving force increases, the pinned state changes to the moving ordered state directly, so that the disordered plastic flow state disappears completely.