Biallelic human SHARPIN loss of function induces autoinflammation and immunodeficiency

The linear ubiquitin assembly complex (LUBAC) consists of HOIP, HOIL-1 and SHARPIN and is essential for proper immune responses. Individuals with HOIP and HOIL-1 deficiencies present with severe immunodeficiency, autoinflammation and glycogen storage disease. In mice, the loss of Sharpin leads to severe dermatitis due to excessive keratinocyte cell death. Here, we report two individuals with SHARPIN deficiency who manifest autoinflammatory symptoms but unexpectedly no dermatological problems. Fibroblasts and B cells from these individuals showed attenuated canonical NF-κB responses and a propensity for cell death mediated by TNF superfamily members. Both SHARPIN-deficient and HOIP-deficient individuals showed a substantial reduction of secondary lymphoid germinal center B cell development. Treatment of one SHARPIN-deficient individual with anti-TNF therapies led to complete clinical and transcriptomic resolution of autoinflammation. These findings underscore the critical function of the LUBAC as a gatekeeper for cell death-mediated immune dysregulation in humans.

Does measuring the medial gap before bone resection in total knee arthroplasty provide optimum gap adjustment and prevent bone recutting?

This study aimed to demonstrate that measuring the medial gap before bone resection during total knee arthroplasty (TKA) provides an optimum gap adjustment in varus knees. In this study, patients were separated into two groups. Group 1 included patients whose medial joint gap was measured before bone resection and Group 2 included patients who underwent conventional technique without measuring. The medial joint gap was measured with a custom-made gap measuring device up to the point that the knee was corrected and aligned along its mechanical axis. Medial joint gap distances, distal medial femoral bone cut thicknesses, amounts of tibial resection calculated; gap internal distances measured after cutting and the thicknesses of the trial inserts were recorded. A comparison was made between the groups concerning the number of patients requiring an additional tibial bone cut and the distribution of insert thicknesses. Extra tibial bone resections were performed in two (5.7%) patients in Group 1 and 10 (28.6%) patients in Group 2. In Group 1, where the medial joint gap was measured, the need for an additional bone resection was statistically less (p=0.018). In comparing the distribution of insert size by group, the number of patients on whom an 8 mm insert had been used was significantly greater in Group 1 (p=0.024). The findings obtained in this study suggest that measuring the medial joint gap before bone resection in total knee arthroplasty may prevent repeated bone recutting and additional bone resections.

Stasis dermatitis: A skin manifestation of poor prognosis in patients with heart failure

BACKGROUND

 The relationship between stasis dermatitis (SD), clinical factors, and heart failure (HF) outcomes in outpatients has not been previously assessed.

METHODS

 This observational cross-sectional study evaluated 324 patients admitted to the HF outpatient clinic. A total of 158 HF outpatients (100 males and 58 females) were enrolled in the study and were divided into two groups depending on whether they were diagnosed with SD within six months before attending the outpatient clinic. Forty-one patients (26 %) diagnosed with SD in the preceding six months were designated group 1, and 117 (74 %) not diagnosed were designated group 2.

RESULTS

 Diabetes mellitus (DM) (OR =5.473, p <0.001), chronic obstructive pulmonary disease (COPD) (OR =2.623, p =0.039), and increased systolic pulmonary artery pressure (SPAP) (OR =1.061, p =0.001) values were independently associated with SD in multivariate logistic regression analysis. During the follow-up of 12 ± 4 months, no significant difference was documented between group 1 and group 2 regarding the death ratio (17 % vs. 19 %, p =0.991). In the multivariate Cox proportional-hazards model with a stepwise forward method, the presence of SD diagnosis [hazard ratio (HR) =2.933, 95 % Confidence Interval (CI): 1.660-5.181, p <0.001] and coronary artery disease (CAD) (HR=2.492, 95%CI: 1.238-5.018, p= 0.011) remained independently associated with the risk of HF-related hospitalization.

CONCLUSION

SD was found, for the first time, to be independently associated with DM, COPD, and increased SPAP values and determined as an independent predictor for HF-related hospitalization.HIPPOKRATIA 2022, 26 (1):13-18.

Effect of occlusal splint on interleukin 6, malondialdehyde and 8-hydroxydeoxyguanosine levels in the synovial fluid of patients with temporomandibular disorders

The actual role of splint therapy in preventing excessive loading of the temporomandibular joint (TMJ) is still debated. Lower intra-articular pressure levels have been measured in patients wearing occlusal splints, which may also reduce oxidative stress in the articular spaces. The aim of this study was to determine whether splint therapy reduces oxidative stress and inflammation in TMJ internal derangement patients by measuring interleukin 6 (IL-6), malondialdehyde (MDA), and 8-hydroxydeoxyguanosine (8-OHdG) levels in the synovial fluid (SF). Twenty-four patients with a temporomandibular disorder (TMD) were included in the study. TMJ SF samples were obtained prior to arthrocentesis. Twelve patients used a 2-mm hard acrylic, maxillary stabilization-type splint for 3 months after arthrocentesis. Twelve patients had no treatment after the SF aspiration. Second SF samples were obtained from all patients at 3 months post arthrocentesis. IL-6, MDA, and 8-OHdG levels in the samples were evaluated. All patients showed a significant symptomatic improvement after treatment (P < 0.005). No statistical correlation was found between the two groups concerning pre-treatment and 3-month SF levels of MDA, 8-OHdG, and IL-6. Although splint therapy was found to be successful in eliminating clinical symptoms of TMD, the results showed no beneficial effect on inflammation and oxidative stress markers in the synovial fluid.

First Report of Diplodia pinea on Pseudotsuga menziesii in Turkey

Diplodia pinea is a latent, opportunistic pathogen of Pinus and other coniferous species, including Pseudotsuga menziesii (3). The fungus causes twig blight, branch cankers, tree and seedling collar rot, root rot, and can also infect cones (1). D. pinea has often been reported causing tip and shoot blight on various Pinus spp. in different parts of Turkey. During disease surveys on Pinus spp. carried out in May 2012 in Izmit in the Marmara Region (37°36'54″N, 31°20'00″E), typical shoot blight symptoms of D. pinea infection were also observed on the neighboring P. menziesii trees. Shoots and cones of P. menziesii were investigated for the presence of D. pinea pycnidia. Pycnidia from cones and shoots were placed on potato dextrose agar (PDA) and incubated at 23°C. Three isolates were obtained from shoot and cone samples. Identification of the pathogen was based on morphological characteristics of the conidia and by PCR of the ITS region of nuclear rDNA. Colonies on PDA were woolly, whitish at first turning black, sometimes partly or entirely turning light gray. Micromorphological characteristics of the Diplodia isolates were similar to those described in (2): conidia width 18.4 μm (SD ± 2.8) (range 11 to 22 μm) × length 34.0 μm (SD ± 5.3) (range 20 to 41 μm) (n = 100). Conidia were at first hyaline, later becoming brown to dark brown, oblong ellipsoid, bicellular with a distinct septum. To confirm the identity of the isolates, genomic DNA was extracted and the internal transcribed spacer (ITS) region of the rDNA was amplified using primers ITS1 and ITS4 (4). Amplicons were 483 bp in length (GenBank Accession No. KF372874) and shared 98% nucleotide identity with HM100285.1 and 97% nucleotide identity with JX981458.1 of D. pinea. Inoculation tests were performed on 2-year-old P. menziesii seedlings by placing mycelial plugs of three isolates obtained from pycnidia on the main stem after wounding with a cork borer. Control seedlings were inoculated with PDA plugs without mycelium. All seedlings were incubated at 24°C for 3 weeks in a climate chamber. Following incubation, the seedlings displayed dark brown-to-black discoloration, measuring on average 10.7 ± 0.6 cm, of the bark and wood tissues around the inoculation points on the stems. The pathogen was successfully re-isolated from symptomatic stem tissues, thus fulfilling Koch's postulates. To our knowledge, this is the first report of P. menziesii as a host of D. pinea in Turkey. P. menziesii is not endemic to Turkey and to date has a limited distribution (approximately 140 ha), but it is an important fast growing tree species for new industrial plantations. References: (1) J. de Wet. PhD thesis, University of Pretoria, 2008. (2) J. de Wet et al. Plant Dis. 84:151, 2000. (3) G. Hausner et al. Can. J. Plant Pathol. 21:256, 1999. (4) T. J. White et al. PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, CA, 1990.