The Mexican Cavefish Mount a Rapid and Sustained Regenerative Response Following Skeletal Muscle Injury

Physical injury and tissue damage is prevalent throughout the animal kingdom, with the ability to quickly and efficiently regenerate providing a selective advantage. The skeletal muscle possesses a uniquely large regenerative capacity within most vertebrates, and has thus become an important model for investigating cellular processes underpinning tissue regeneration. Following damage, the skeletal muscle mounts a complex regenerative cascade centered around dedicated muscle stem cells termed satellite cells. In non-injured muscle, satellite cells remain in a quiescent state, expressing the canonical marker Pax7 (Chen et al. 2020). However, following injury, satellite cells exit quiescence, enter the cell cycle to initiate proliferation, asymmetrically divide, and in many cases terminally differentiate into myoblasts, ultimately fusing with surrounding myoblasts and pre-existing muscle fibers to resolve the regenerative process (Chen et al. 2020).

Cytokines and tryptophan metabolites can predict depressive symptoms in pregnancy

Depression during and after pregnancy affects up to 20% of pregnant women, but the biological underpinnings remain incompletely understood. As pregnancy progresses, the immune system changes to facilitate fetal development, leading to distinct fluctuations in the production of pro-inflammatory factors and neuroactive tryptophan metabolites throughout the peripartum period. Therefore, it is possible that depression in pregnancy could constitute a specific type of inflammation-induced depression. Both inflammatory factors and kynurenine metabolites impact neuroinflammation and glutamatergic neurotransmission and can therefore affect mood and behavior. To determine whether cytokines and kynurenine metabolites can predict the development of depression in pregnancy, we analyzed blood samples and clinical symptoms in 114 women during each trimester and the postpartum. We analyzed plasma IL-1β, IL-2, -6, -8, -10, TNF, kynurenine, tryptophan, serotonin, kynurenic- quinolinic- and picolinic acids and used mixed-effects models to assess the association between biomarkers and depression severity. IL-1β and IL-6 levels associated positively with severity of depressive symptoms across pregnancy and the postpartum, and that the odds of experiencing significant depressive symptoms increased by >30% per median absolute deviation for both IL-1β and IL-6 (both P = 0.01). A combination of cytokines and kynurenine metabolites in the 2nd trimester had a >99% probability of accurately predicting 3rd trimester depression, with an ROC AUC > 0.8. Altogether, our work shows that cytokines and tryptophan metabolites can predict depression during pregnancy and could be useful as clinical markers of risk. Moreover, inflammation and kynurenine pathway enzymes should be considered possible therapeutic targets in peripartum depression.

Associations between estrogen and progesterone, the kynurenine pathway, and inflammation in the post-partum

BACKGROUND

Depression during and after pregnancy is common, affecting at least 15% of women. Features of depression in pregnancy range from mild symptoms of disrupted mood and interest to severe depression and suicidal behavior. Previous studies suggest hormone- and immune dysregulations might contribute to post-partum depression, but consistent evidence is lacking.

METHODS

A total of 163 women were included in the study in the post-partum. Peri-partum depression (PPD) was diagnosed using SCID interviews and depressive symptoms were quantified using the Edinburgh Perinatal Depression Rating Scale (EPDS), retrospectively long-term, as well as acutely. Plasma estrogen, progesterone, pro- and anti-inflammatory cytokines and kynurenine metabolites were measured in the post-partum.

RESULTS

Higher estrogen and progesterone in the post-partum were linked to more severe depressive symptoms over pregnancy. In the post-partum, estrogen was positively correlated with the pro-inflammatory cytokine IL-6 and negatively correlated with kynurenine and picolinic acid. Conversely, progesterone was negatively correlated with IL-1β and several metabolites in the kynurenine pathway, including quinolinic acid.

LIMITATIONS

Associative study design, did not attempt to assess causality. Did not adjust hormone levels for medication effects.

CONCLUSIONS

Our study suggests that higher sex hormones in the post-partum are linked to depression severity over pregnancy. Estrogen was coupled with a pro-inflammatory profile and neurotoxic kynurenine metabolites, whereas progesterone was linked to an anti-inflammatory profile in the post-partum.

Project Solo: an independent practitioner initiative for confidential self-assessment of quality

Project Solo, a grassroots organization of independent physicians, has developed a unique method of confidential self-assessment of quality. Participating physicians can use the data to improve their own practices and to have a strong, credible voice for retaining and promoting the strengths of independent practices in providing medical care. In a pilot project, 56 independent physicians in Project Solo were given bar-coded, postage-paid survey forms of patient satisfaction to distribute to 100 patients. The population for this pilot study was the 35 physicians with patients returning at least one survey. A total of 1858 surveys (53% of surveys given to physicians) were returned, representing a variety of rural and urban practices in 19 states. The mean percentage of responses rated "excellent" to survey items from Project Solo physicians is similar to the percentages reported for this survey in other studies. We conclude that Project Solo serves as an effective and efficient model for gathering patient satisfaction data and can be further developed as a tool for gathering clinical outcome and other quality measurement data in the solo and small group practice setting.