Lipocalin-2 expression identifies an intestinal regulatory neutrophil population during acute graft-versus-host disease

Acute graft-versus-host disease (aGVHD) is a life-threatening complication of allogeneic hematopoietic cell transplantation (allo-HCT), for which therapeutic options are limited. Strategies to promote intestinal tissue tolerance during aGVHD may improve patient outcomes. Using single-cell RNA sequencing, we identified a lipocalin-2 (LCN2)-expressing neutrophil population in mice with intestinal aGVHD. Transfer of LCN2-overexpressing neutrophils or treatment with recombinant LCN2 reduced aGVHD severity, whereas the lack of epithelial or hematopoietic LCN2 enhanced aGVHD severity and caused microbiome alterations. Mechanistically, LCN2 induced insulin-like growth factor 1 receptor (IGF-1R) signaling in macrophages through the LCN2 receptor SLC22A17, which increased interleukin-10 (IL-10) production and reduced major histocompatibility complex class II (MHCII) expression. Transfer of LCN2-pretreated macrophages reduced aGVHD severity but did not reduce graft-versus-leukemia effects. Furthermore, LCN2 expression correlated with IL-10 expression in intestinal biopsies in multiple cohorts of patients with aGVHD, and LCN2 induced IGF-1R signaling in human macrophages. Collectively, we identified a LCN2-expressing intestinal neutrophil population that reduced aGVHD severity by decreasing MHCII expression and increasing IL-10 production in macrophages. This work provides the foundation for administration of LCN2 as a therapeutic approach for aGVHD.

MDM2 Inhibition Enhances Immune Checkpoint Inhibitor Efficacy by Increasing IL15 and MHC Class II Production

The treatment of patients with metastatic melanoma with immune checkpoint inhibitors (ICI) leads to impressive response rates but primary and secondary resistance to ICI reduces progression-free survival. Novel strategies that interfere with resistance mechanisms are key to further improve patient outcome during ICI therapy. P53 is often inactivated by mouse-double-minute-2 (MDM2), which may decrease immunogenicity of melanoma cells. We analyzed primary patient-derived melanoma cell lines, performed bulk sequencing analysis of patient-derived melanoma samples, and used melanoma mouse models to investigate the role of MDM2-inhibition for enhanced ICI therapy. We found increased expression of IL15 and MHC-II in murine melanoma cells upon p53 induction by MDM2-inhibition. MDM2-inhibitor induced MHC-II and IL15-production, which was p53 dependent as Tp53 knockdown blocked the effect. Lack of IL15-receptor in hematopoietic cells or IL15 neutralization reduced the MDM2-inhibition/p53-induction-mediated antitumor immunity. P53 induction by MDM2-inhibition caused anti-melanoma immune memory as T cells isolated from MDM2-inhibitor-treated melanoma-bearing mice exhibited anti-melanoma activity in secondary melanoma-bearing mice. In patient-derived melanoma cells p53 induction by MDM2-inhibition increased IL15 and MHC-II. IL15 and CIITA expressions were associated with a more favorable prognosis in patients bearing WT but not TP53-mutated melanoma.

IMPLICATIONS

MDM2-inhibition represents a novel strategy to enhance IL15 and MHC-II-production, which disrupts the immunosuppressive tumor microenvironment. On the basis of our findings, a clinical trial combining MDM2-inhibition with anti-PD-1 immunotherapy for metastatic melanoma is planned.

Targeting MDM2 enhances antileukemia immunity after allogeneic transplantation via MHC-II and TRAIL-R1/2 upregulation

Patients with acute myeloid leukemia (AML) often achieve remission after allogeneic hematopoietic cell transplantation (allo-HCT) but subsequently die of relapse driven by leukemia cells resistant to elimination by allogeneic T cells based on decreased major histocompatibility complex II (MHC-II) expression and apoptosis resistance. Here we demonstrate that mouse-double-minute-2 (MDM2) inhibition can counteract immune evasion of AML. MDM2 inhibition induced MHC class I and II expression in murine and human AML cells. Using xenografts of human AML and syngeneic mouse models of leukemia, we show that MDM2 inhibition enhanced cytotoxicity against leukemia cells and improved survival. MDM2 inhibition also led to increases in tumor necrosis factor-related apoptosis-inducing ligand receptor-1 and -2 (TRAIL-R1/2) on leukemia cells and higher frequencies of CD8+CD27lowPD-1lowTIM-3low T cells, with features of cytotoxicity (perforin+CD107a+TRAIL+) and longevity (bcl-2+IL-7R+). CD8+ T cells isolated from leukemia-bearing MDM2 inhibitor-treated allo-HCT recipients exhibited higher glycolytic activity and enrichment for nucleotides and their precursors compared with vehicle control subjects. T cells isolated from MDM2 inhibitor-treated AML-bearing mice eradicated leukemia in secondary AML-bearing recipients. Mechanistically, the MDM2 inhibitor-mediated effects were p53-dependent because p53 knockdown abolished TRAIL-R1/2 and MHC-II upregulation, whereas p53 binding to TRAILR1/2 promotors increased upon MDM2 inhibition. The observations in the mouse models were complemented by data from human individuals. Patient-derived AML cells exhibited increased TRAIL-R1/2 and MHC-II expression on MDM2 inhibition. In summary, we identified a targetable vulnerability of AML cells to allogeneic T-cell-mediated cytotoxicity through the restoration of p53-dependent TRAIL-R1/2 and MHC-II production via MDM2 inhibition.

Emotional Stress and Subjective Body Experience of Heart Transplantation Candidates

We studied subjective complaints, psychological symptoms, and subjective appraisal of their body of 54 heart transplantation candidates at the time of admission to the waiting list using standardized psychological tests (GBB24, SCL-90-R, FBeK). The results of GBB24 and SCL90-R indicated high scores of strain before transplantation. In the FbeK, patients assessed their own body as worse than the normal population on all scales. Male patients displayed significantly higher scores of strain than women, but there was no difference in assessing their own bodies. The considerable scores of strain indicate the need for psychosomatic and psychotherapeutic interventions in a significant subgroup of patients.

[Predictors and mechanisms of tinnitus distress - a longitudinal analysis]

BACKGROUND

The available cross-sectional and retrospective evidence does not provide a clear answer to the question whether the multiple psychological problems and disturbances found in patients with chronic decompensated tinnitus are cause or consequence of the tinnitus. The present research took a longitudinal approach to examine this question.

METHOD

Psychopathological symptoms, personality, socio-demographical variables and otological features were assessed in 48 patients which had suffered from tinnitus for a period of no longer than 4 weeks. Six months after first assessment 92 % of the original sample (n = 44) were re-examined. 34 of these patients displayed chronic tinnitus. Univariate and multiple regression analyses were conducted in order to identify variables at first assessment which predicted tinnitus distress at second assessment for the 34 patients with chronic tinnitus.

RESULTS

Tinnitus attributed sleep disturbance, anxiousness, and life satisfaction, each assessed at first investigation, independently predicted tinnitus distress at second assessment six months later. These three variables together predicted 56 % of the variance of tinnitus distress at second assessment.

CONCLUSIONS

Our results support the model that the symptom tinnitus may develop on the basis of an enhanced psychophysiological tension and become a condensational core of preexisting psychological distress as a facilitatory process. Our results suggest that early psychotherapeutic interventions in patients at risk may prevent decompensation.

[Patients' subjective experiences after liver transplantation]

AIM

To study prospectively a cohort of patients in the first year after liver transplantation (LTx) with respect to their subjective experiences and their clinical condition.

METHODS

Sixteen non-selected, consecutive patients (9 male) of the Clinic of Visceral Surgery of Cologne University were interviewed between 4 and 12 months after orthotopic LTx by narrative interviews. The interviews were audiotaped and transcribed according to standard international rules. We analysed the content of the interviews according to Grounded Theory and performed an ideal type analysis based on case comparison.

RESULTS

Nine patients (56.25 %) had a mental disorder according to ICD-10. Patients' subjective experiences of the transplantation could be grouped into five ideal types: the successful, the grateful, the help-seeking, the vulnerable, and the special patient. These ideal types were found to be of a dimensional pattern when re-assessed at single-case level, i. e. individual patients fulfilled criteria of these ideal types to different degrees.

CONCLUSIONS

Our patients perceive LTx predominantly as successful therapy for terminal liver disease. They use different coping strategies to come to terms with the considerable impact of transplantation. Each strategy implies specific risk profiles which have to be kept in mind when dealing clinically with LTx patients.

[Eating disorders: anorexia nervosa, bulimia, binge eating]

We present an overview of three different eating disorders which seem to have an increasing prevalence, especially among young women between 12 and 20 years of age. Anorexia and bulimia nervosa are "threshold disorders" which usually become manifest for the first time during the transition from childhood to early adult life. Eating disorders are chronic disorders and often take a course of 6 or more years. Remission, improvements and symptom change can be expected even after many years of the disorder. Psychiatric comorbidity which occurs in more than 50% of eating disordered patients is of prime importance for prognosis. Depression, anxiety disorders, obsessive-compulsive disorders, and personality disorders are most common. There is a variety of complex in- and outpatient treatments with different components which have to be chosen according to the individual case.

Observation levels in acute psychiatric admissions

It was our objective to compare the influence of patients' variables and circumstances of admission on the use of observation levels in acute psychiatric admissions in a British mental health unit. We performed a prospective case note survey of all acute psychiatric admissions during 28 consecutive days in June and July 1991 within a large teaching hospital and a traditional psychiatric hospital in Nottingham, England. We compared, the demographic characteristics of 88 consecutive admissions, admission procedures, clinical data, initial observation levels and changes in observation levels. As for the results, most patients were admitted outside of regular working hours (weekends or after 5 p.m.). Most patients were placed on intermediate (close) observation. The most important factor associated with the choice of observation level was the legal status of the patient (chi2 = 14.79, df = 2, p < 0.001, Fisher's exact test p < 0.0001). There were significantly fewer incidents (chi2 = 7.72, df= 2, p < 0.05, Fisher's exact test p < 0.01) on the highest (special) category of observation. The observation policy of the unit was not followed consistently. The number of factors contributing to the choice of observation levels reflects the complexity of the task facing the staff. Special observation is an effective method of managing acutely disturbed patients. The time of admission of most patients implies that more trained staff should be provided outside of regular hours. Clinical staff should be regularly trained in the use of observation procedures. It should be a regular topic in clinical audit.

Curriculum Issues Related to Nurse Turnover

The problem of turnover rates among registered nurses has implications for nursing curriculum and for continuing education programs. After a brief presentation of turnover issues, curriculum implications will be discussed under three broad areas: (a) content about turnover included in nursing management textbooks; (b) nursing curriculum issues that influence the survivability of graduates of schools of nursing and thereby affect turnover rates; and (c) continuing education needs of registered nurses. This paper is not a summary of solutions for turnover. The problem of turnover is complex and poorly understood. The curricular issues provide challenges to traditional nursing education that would increase the likelihood of the development of "hardy" nurse graduates who have survival skills for the practice environment.

The value of different neuro-imaging methods in the diagnosis of a congenital, spinal, epidural meningeal cyst

Congenital, spinal, epidural cysts are rare causes of transverse or radicular spinal lesions. Usually these cysts are located in the thoracal region, are oblong-shaped, and extend over several segments dorsally to the cord. Frequently, they cause no symptoms for years. They are fairly accessible to diagnostics by modern neuro-imaging methods. We report on a 15 year old girl with paraparesis, which showed a slow progression over two years, short-term remissions, and finally impairment of bladder function. Myelogram, computer-assisted tomography and nuclear magnetic resonance tomography showed a large space-occupying mass from D8 to L1 epidural and dorsal of the myelon. Operation disclosed an epidural cyst from D10 to L2. Histologically, the removed material was classified as a meningeal cyst. Post-operatively the girl's condition improved under intensive physio-therapy. For the diagnosis of this spinal dysrhapic disorder CT scanning after intrathecal application of contrast medium and magnetic resonance imaging were most valuable.

Oklahoma pharmacists' explanations of professional satisfaction and dissatisfaction

This study examined whether the theoretical constructs of role conflict and incomplete professionalization serve as valid explanations of pharmacists' professional satisfaction or dissatisfaction. A sample of registered pharmacists in Oklahoma responded to a mail-out questionnaire containing indicies designed to measure job satisfaction and professional satisfaction. The questionnaire also included a satisfaction inventory of 17 facets considered to characterize pharmacy as a profession. From the questionnaire respondents, samples of pharmacists demonstrating extreme professional satisfaction and extreme dissatisfaction were randomly selected for telephone interviews. This study found pharmacists' professional satisfaction to be significantly less than satisfaction with their job. The study results would indicate that incomplete professionalization and internalized career goals rather than role conflicts are significantly related to pharmacist professional satisfaction.

The leakage of serum proteins across the blood-nerve barrier in hereditary and inflammatory neuropathies. An immunohistochemical and morphometric study

The leakage of eight different serum proteins and immunoglobulins across the blood-nerve barrier (BNB) was studied by means of the peroxidase-antiperoxidase method in hereditary and inflammatory neuropathies and graded semiquantitatively with respect to endoneurial staining intensity and distribution. These data were compared with the degree of alterations of the myelinated nerve fibre population evaluated by morphometric analysis. Our series of 18 human sural nerve biopsies included seven hereditary neuropathies (three HMSN I, two HMSN II, two tomaculous neuropathies), nine inflammatory neuropathies (seven polyneuritis, two hypertrophic neuritis) and two normal controls. In HMSN II and in tomaculous neuropathy there was no enhanced endoneurial staining for serum proteins despite of a severe nerve fibre loss, whereas in HMSN I a rise of serum proteins of small and moderate molecular size like albumin and IgG was demonstrated in the endoneurial space indicating an impaired BNB function. Qualitative changes of the BNB with leakage also of high molecular weight proteins were observed in polyneuritis and hypertrophic neuritis, irrespective of the degree of nerve fibre changes. Our results show that fibre loss and alteration of the BNB are not correlated. The unselective leakage of serum proteins through the BNB appears to be a characteristic change in inflammatory neuropathies leading to proteinous edema. With regard to the subperineurial accentuation of the endoneurial edema it will be discussed that the vascular diffusion barrier is more fragile than the perineurial diffusion barrier.