Adjuvant effect of dendritic cells activator Imiquimod in genetic immunization with HIV-1 p55 Gag

Dendritic cells (DC) are important antigen-presenting cells that have abilities to induce and maintain T-cell immunity, or attenuate it during hyperimmunization. Additional activation of DCs may be useful for vaccination purposes. Imiquimod is known to be a specific agonist of the Toll-like receptors (TLR7), which are located mainly on DCs. To study the effect of DC stimulation on the effectiveness of an HIV-1 p55 gag DNA vaccine in a mice model, we employed 25, 50, and 100 nM of Imiquimod as an adjuvant. Subsequently, Western blot analysis was used to quantify p55 protein production after the immunization. To characterize T-cells immune response, both the frequency of IFN-γ -secreting cells and IFN-γ and IL-4 production were measured, via an ELIspot assay and ELISA, respectively. Low concentrations of Imiquimod were found to effectively stimulate Gag production and the magnitude of the T-cell immune response, whereas higher concentrations reduced vaccination effects. Our results show that the adjuvant effects of Imiquimod depend on concentration. The use of Imiquimod may be helpful to study DC to T cell communication, including possible induction of immunotolerance.

Soy and Frequent Dairy Consumption with Subsequent Equol Production Reveals Decreased Gut Health in a Cohort of Healthy Puerto Rican Women

The U.S. Hispanic female population has one of the highest breast cancer (BC) incidence and mortality rates, while BC is the leading cause of cancer death in Puerto Rican women. Certain foods may predispose to carcinogenesis. Our previous studies indicate that consuming combined soy isoflavones (genistein, daidzein, and glycitein) promotes tumor metastasis possibly through increased protein synthesis activated by equol, a secondary dietary metabolite. Equol is a bacterial metabolite produced in about 20-60% of the population that harbor and exhibit specific gut microbiota capable of producing it from daidzein. The aim of the current study was to investigate the prevalence of equol production in Puerto Rican women and identify the equol producing microbiota in this understudied population. Herein, we conducted a cross-sectional characterization of equol production in a clinically based sample of eighty healthy 25-50 year old Puerto Rican women. Urine samples were collected and evaluated by GCMS for the presence of soy isoflavones and metabolites to determine the ratio of equol producers to equol non-producers. Furthermore, fecal samples were collected for gut microbiota characterization on a subset of women using next generation sequencing (NGS). We report that 25% of the participants were classified as equol producers. Importantly, the gut microbiota from equol non-producers demonstrated a higher diversity. Our results suggest that healthy women with soy and high dairy consumption with subsequent equol production may result in gut dysbiosis by having reduced quantities (diversity) of healthy bacterial biomarkers, which might be associated to increased diseased outcomes (e.g., cancer, and other diseases).

Human megakaryocytes possess intrinsic antiviral immunity through regulated induction of IFITM3

Evolving evidence indicates that platelets and megakaryocytes (MKs) have unexpected activities in inflammation and infection; whether viral infections upregulate biologically active, antiviral immune genes in platelets and MKs is unknown, however. We examined antiviral immune genes in these cells in dengue and influenza infections, viruses that are global public health threats. Using complementary biochemical, pharmacological, and genetic approaches, we examined the regulation and function of interferon-induced transmembrane protein 3 (IFITM3), an antiviral immune effector gene not previously studied in human platelets and MKs. IFITM3 was markedly upregulated in platelets isolated from patients during clinical influenza and dengue virus (DENV) infections. Lower IFITM3 expression in platelets correlated with increased illness severity and mortality in patients. Administering a live, attenuated DENV vaccine to healthy subjects significantly increased platelet IFITM3 expression. Infecting human MKs with DENV selectively increased type I interferons and IFITM3. Overexpression of IFITM3 in MKs was sufficient to prevent DENV infection. In naturally occurring, genetic loss-of-function studies, MKs from healthy subjects harboring a homozygous mutation in IFITM3 (rs12252-C, a common single-nucleotide polymorphism in areas of the world where DENV is endemic) were significantly more susceptible to DENV infection. DENV-induced MK secretion of interferons prevented infection of bystander MKs and hematopoietic stem cells. Thus, viral infections upregulate IFITM3 in human platelets and MKs, and IFITM3 expression is associated with adverse clinical outcomes. These observations establish, for the first time, that human MKs possess antiviral functions, preventing DENV infection of MKs and hematopoietic stem cells after local immune signaling.

Use of adjuvant chemotherapy in patients with stage III colon cancer in Puerto Rico: A population-based study

Objective

This study aims to examine factors associated with the use of adjuvant chemotherapy and the use of oxaliplatin after curative resection in stage III colon cancer patients and assesses the effect of their use in three-year survival.

Methods

This retrospective cohort study was conducted using Puerto Rico Central Cancer Registry-Health Insurance Linkage Database. The study cohort consisted of stage III colon cancer patients with a curative surgery in the period 2008–2012. Multivariate logistic regression was used to estimate adjusted odds ratios. Kaplan-Meier methods and Cox proportional hazards models were used to assess the association between adjuvant chemotherapy and oxaliplatin use and overall survival and risk of death, respectively.

Results

Overall, 75% of the study population received adjuvant chemotherapy during the study period. Factors statistically associated with receiving adjuvant chemotherapy within four months after resection included being married (adjusted odds ratio [AOR] 1.64; 95% CI 1.18–2.28; p = 0.003), and being enrolled in Medicare (AOR 1.68; 95% CI: 1.03–2.75; p = 0.039) or Medicaid and Medicare dual eligible (AOR 1.66; 95% CI: 1.06–2.60; p = 0.028). However, patients aged ≥70 years were less likely to receive adjuvant chemotherapy (AOR 0.22; 95%CI 0.14–0.36; p<0.001).

Discussion

We observed a significant reduction in mortality in adjuvant chemotherapy treated patients. Similarly, patients <70 years treated with oxaliplatin had significantly lower risk of death than those who did not, although for patients ≥70 years no statistical significance was achieved. Future studies should assess effective interventions to reduce barriers to access guideline-based recommended colon cancer treatment.

Knowledge and implementation of the DNR in internal medicine teaching programs

BACKGROUND

The knowledge and implementation skills of the DNR (do not resuscitate) order amongst physicians in training appears to be quite variable.

METHODS

We constructed, validated and implemented an instrument which evaluates knowledge and implementation skills of medical residents regarding the DNR in the 8 accredited teaching hospitals in Puerto Rico.

RESULTS

Participation of 136 residents from 240 approved positions was seen. Most thought (93.3%) the DNR should be written in the medical record. And 88.1% thought appropriate to suggest a DNR to the patient or family for a terminally ill patient. For a patient with an uncertain prognosis who insisted on a DNR, 78.5% believed the attending physician and 21.5% thought the ethics committee was responsible for determining the propriety of the order. When the patient and the treating physicians agreed on the appropriateness of a DNR order most residents in the North of Puerto Rico thought the writing of the order was the purview of the resident while residents in the South-West thought this to be the responsibility of the attending physician. In the absence of a DNR order, more than 77.4% of the residents in the North and South would initiate CPR in a comatose patient with terminal cancer, multiple organ failure and sepsis in contrast to 15% of the residents in the West.

CONCLUSIONS

Implementation and knowledge skills of medical residents in the health regions of Puerto Rico differ. Knowledge and implementation of the DNR merits improvement in all training programs.

Factor V Leiden thrombophilia: presentation of three patients and a literature review

Hypercoagulable states represent a condition with multiple etiologies in which an interplay of acquired and congenital coagulation defects contribute to abnormal clotting. Several of the thrombophilic disorders are relatively prevalent; one person may have multiple defects, leading to thrombosis without obvious external stimuli. Factor V Leiden thrombophilia is the most common inherited form of thrombophilia and it is occasionally associated with the anomalous prothrombin G20210A mutations. We presents three puertorrican middle-aged females diagnosed with Factor V Leiden after debuting with abnormal clotting events. They shared the common traits of being female, having been born in Puerto Rico, and having parents of European descent. The first two cases presented with deep venous thrombosis of lower and upper extremities, and both had the association of Factor V Leiden and prothrombin G20210A mutation. The third case presented with a cerebrovascular accident, evidencing arterial thrombosis, after receiving estrogen replacement therapy. This report adds Factor V Leiden as a cause of hypercoagulable states in puertorrican patients.

Squamous cell carcinoma of the penis

Squamous cell carcinoma of the penis (CA Penis) is not a rare disease in P.R. We have reviewed all cases of CA penis diagnosed in our institution from Jan. 79-Jan. 89. Pathology and hospital records were audited. The survival data on all patients was updated via telephone or record review up to May 89. A total of 18 pts were seen in the last decade. Of these 11. (61%) were seen in the last four years. Four of 18 patients were excluded from analysis due to lack of staging and therapy data. The median age 54.9 y (range 23-82y). The following risk factors were identified: phimosis 12/14 (86%) p = .05, leukoplakia 8/14 (57%); prior venereal disease 1/14 (7%). The primary lesion appeared in the prepuce 8/14 (57%) and glans 6/14 (43%). TNM staging was done in all pts. Most pts presented with T3 or T4 disease 10/14 (71%) and palpable regional adenopathy (N1-N3) 9/14 (64%). Of the nine pts with palpable adenopathy, in 5 (56%) microscopic malignant disease was confirmed. A correlation between T3 or T4 disease and the presence of palpable adenopathy was seen (80%). The Stage at diagnosis of the 14 pts: I: 0/14 (29%), II: 5/14 (7%), III: 3/14 (21%), IV: 6/14; (43%). All pts were treated with partial penectomy and 7/14 had unilateral or bilateral inguinal lymphadenectomy. Long term survivors (LTS), greater than 12 mo., were seen 3/4 pts with Stage II disease, 1/3 Stage III, and 2/5 in Stage IV. The most important prognostic factor for LTS was malignant involvement of regional lymph nodes with 0/5 in this group.(ABSTRACT TRUNCATED AT 250 WORDS)