PTX3 as a novel inflammatory biomarker in patients with myocarditis

Background

Pentraxin-3 (PTX3) is an acute phase protein, which plays pivotal roles in innate immunity and inflammation. Among cardiovascular diseases, PTX3 was found to be elevated in acute myocardial infarction, chronic heart failure, and cardiac arrest. So far, however, PTX3 has never been investigated in the context of myocarditis.

Purpose

To evaluate PTX3 as a circulating marker of inflammation in patients with suspected myocarditis.

Methods

We enrolled 30 consecutive inpatients with new diagnosis of myocarditis, proven both by the updated Lake Louise criteria on cardiac magnetic resonance (CMR), and by the Dallas criteria on endomyocardial biopsy (EMB) (100%). Circulating serum PTX3 was assessed at the time of EMB, by ELISA technique using a commercial kit. Normal values for PTX3 were considered as <2 ng/mL, as in previous studies. A normal control group (n=10) was used for results validation of PTX3.

Results

In our cohort (77% males, age 50±18 y; median left ventricle ejection fraction [LVEF] 50%, IQR 30–59%), PTX3 levels were assessed in 30 patients. PTX3 levels were elevated in 26/30 (87%) patients with myocarditis (median 4,36 ng/mL, IQR 2,44–6,72, range 1,20–40,0), and in none (0/10) among healthy controls (median 1,28 ng/mL, IQR 1,04–1,36, range 0,77–1,94) (p=0,001). In the study group, the yield of other cardiac biomarkers was lower: 12/30 (40%) for C-reactive protein, 23/30 (77%) for T-troponin, and 20/30 (67%) for NTproBNP. PTX3 was constantly elevated in patients presenting with heart failure (HF) (16/16, 100%), compared with those presenting with acute coronary syndrome-like (8/10, 80%), or arrhythmias (2/4, 50%) (p=0,024). In particular, elevated PTX3 was associated with systolic dysfunction (LVEF <50%) at discharge (16/16 vs. 10/14, p=0,022).

Conclusion

Our preliminary data suggest PTX3 as a novel biomarker with potential diagnostic and prognostic value for myocarditis and inflammatory cardiomyopathy.

Funding Acknowledgement

Type of funding sources: None.

AB0154 MERTK AND THE RESOLUTION OF INFLAMMATION IN IGG4-RELATED DISEASE

Background:

IgG4-Related Disease (IgG4-RD) is characterized by fibrotic lesions, serum IgG4 elevation, and prompt response to glucocorticoids. B and T lymphocytes are considered the initiators of tissue inflammation in IgG4-RD, but the prominent stromal reaction observed at disease sites suggest that a dysregulation of processes involved in the resolution of inflammation could be pathologically relevant as well. Mer receptor tyrosine kinase (MerTK) and its ligands protein S (Pros1) have a pivotal role in the resolution of inflammation through the activation of a well-characterized signaling pathway that ultimately dampens the immune response and promotes the recovery of tissue function. MerTK and the processes involved in the resolution of inflammation have never been addressed in IgG4-RD.

Objectives:

To investigate MerTK involvement in the pathogenesis of IgG4-RD by evaluating (a) the expression of MerTK and of its endogenous ligands in IgG4-RD tissues; (b) the presence of circulating precursors of MerTK+ cells infiltrating IgG4-RD lesions in the peripheral blood of IgG4-RD patients; (c) the effects of immunosuppressive therapies on MerTK expression in IgG4-RD tissues.

Methods:

Three distinct cohorts of IgG4-RD patients were included in this study. 8 active patients were used for immunohistochemistry studies for MerTK expression. 16 IgG4-RD and 14 Sjögren syndrome patients, together with 6 control tonsils, were used for multicolor immunofluorescence studies and TissueQuest software quantification of the expression of MerTK, CD68, CD163, Pros1, Gas6, CD4, SLAMF7, CD19, IgG4, cleaved caspase-3. 10 untreated IgG4-RD patients were used to evaluate MerTK expression in circulating monocytes subsets and fibrocytes by flow cytometry.

Results:

MerTK was highly expressed in IgG4-RD affected organs. MerTK+ cells accounted on average for 16% (range 5-35%) of all cells in the tissue, and the majority of them expressed CD68,reflecting a monocyte-macrophage origin. 33.5 % (interquartile range (IQR) 26-41%) of MerTK+ cells co-expressed CD68 and CD163, while 30.5% (IQR 19-41.5%) expressed CD68 but not CD163. CD68+MerTK+ cells displayed two main morphological appearances, compatible with those of macrophages and of myofibroblasts. In addition, MerTK+ cell number was significantly increased in salivary glands from IgG4-RD patients compared to Sjögren syndrome (p < 0.0001). Circulating precursors of CD68+MerTK+ cells infiltrating IgG4-RD lesions were identified by flow cytometery in the peripheral blood of patients with active IgG4-RD as MerTK+ populations of intermediate monocytes, nonclassical monocytes and collagen expressing fibrocytes. MerTK ligand Pros1 was exposed on 52% (IQR 42-57%) of infiltrating B lymphocytes, 74% (IQR 54-89%) of infiltrating T lymphocytes, and, likely, on apoptotic cells that were detected in IgG4-RD tissues. CD68+MerTK+ cells were found in physical contact with Pros1+ cells in IgG4-RD lesions and their number decreased by 56% after successful treatment with rituximab.

Conclusion:

MerTK is abundant in IgG4-RD affected organs and is preferentially expressed on CD68+ macrophages and myofibroblasts that infiltrate IgG4-RD lesions. MerTK+ cells might interact with apoptotic cells and Pros1 expressing T and B lymphocytes in IgG4-RD tissues, leading to the persistent activation of processes involved in the resolution of inflammation and promoting the development of tissue fibrosis.

Disclosure of Interests:

None declared

Vessel-associated myogenic precursors control macrophage activation and clearance of apoptotic cells

Swift and regulated clearance of apoptotic cells prevents the accumulation of cell remnants in injured tissues and contributes to the shift of macrophages towards alternatively activated reparatory cells that sustain wound healing. Environmental signals, most of which are unknown, in turn control the efficiency of the clearance of apoptotic cells and as such determine whether tissues eventually heal. In this study we show that vessel-associated stem cells (mesoangioblasts) specifically modulate the expression of genes involved in the clearance of apoptotic cells and in macrophage alternative activation, including those of scavenger receptors and of molecules that bridge dying cells and phagocytes. Mesoangioblasts, but not immortalized myoblasts or neural precursor cells, enhance CD163 membrane expression in vitro as assessed by flow cytometry, indicating that the effect is specific. Mesoangioblasts transplanted in acutely or chronically injured skeletal muscles determine the expansion of the population of CD163(+) infiltrating macrophages and increase the extent of CD163 expression. Conversely, macrophages challenged with mesoangioblasts engulf significantly better apoptotic cells in vitro. Collectively, the data reveal a feed-forward loop between macrophages and vessel-associated stem cells, which has implications for the skeletal muscle homeostatic response to sterile injury and for diseases in which homeostasis is jeopardized, including muscle dystrophies and inflammatory myopathies.

Acid sphingomyelinase determines melanoma progression and metastatic behaviour via the microphtalmia-associated transcription factor signalling pathway

Melanoma is a rapidly growing and highly metastatic cancer with high mortality rates, for which a resolutive treatment is lacking. Identification of novel therapeutic strategies and biomarkers of tumour stage is thus of particular relevance. We report here on a novel biomarker and possible candidate therapeutic target, the sphingolipid metabolising enzyme acid sphingomyelinase (A-SMase). A-SMase expression correlates inversely with tumour stage in human melanoma biopsies. Studies in a mouse model of melanoma and on cell lines derived from mouse and human melanomas demonstrated that A-SMase levels of expression actually determine the malignant phenotype of melanoma cells in terms of pigmentation, tumour progression, invasiveness and metastatic ability. The action of A-SMase is mediated by the activation of the extracellular signal-regulated kinase, the subsequent proteasomal degradation of the Microphtalmia-associated transcription factor (Mitf) and inhibition of cyclin-dependent kinase 2, Bcl-2 and c-Met, downstream targets of Mitf involved in tumour cell proliferation, survival and metastatisation.

Characterization of innate responses elicited by neoadjuvant radio-chemotherapy for rectal cancer

e15044

Background: The neoadjuvant chemo-radiotherapy (CT-RT) has improved the treatment of locally advanced rectal cancer reducing the local recurrence. However a survival benefit has not been reached yet. In order to increase the rate of pathological complete remissions in our Institution we intensified both the CT schedule adding oxaliplatin to 5-FU and the RT program with tomotherapy. The aim of this study was to verify: whether the pattern of innate response elicited by the neoadjuvant CT-RT is heterogeneous among pts and whether this information can be used to identify which pts will benefit from the treatment. Methods: We collected samples of T3N+M0 rectal cancer pts before, during and after neoadjuvant CT-RT (3 cycles of oxaliplatin + 5-FU; 45 Gy). At each time point we characterized circulating monocytes by flow cytometry, infiltrating macrophages by immunoistochemistry (IHC) and selected inflammatatory molecules by ELISA.Results: We recruited so far 25 pts, of whom 10 have reached the surgery with three pathological complete remission and four down staging. No substantial changes were detectable in the number of circulating monocytes. In contrast we observed a clear expansion of CD14/CD86 and CD14/CD163 double positive subsets. This event was transient and apparently causally related to the treatment since it abated at the later time point. Moreover, it correlated with sensitivity to the treatment: 5/7 pts who underwent disease regression had an early and transitory increase of the number of CD14/CD86 and CD14/CD163 positive cells, which was absent or negligible in non responder pts. The IHC study revealed a massive tumoral infiltration by macrophages which displayed clear features of alternative M2 polarization as assessed by expression of the CD163 and 206 scavenger receptors. A subset of pts had elevated PTX3 and low CRP concentration at the onset of treatment. PTX3 concentration abated after the first CT cycle. Conclusions: These data suggest that neoadjuvant CT-RT modulates the cellular components of innate immune responses, that could represent valuable predictive factors.

No significant financial relationships to disclose.

Pigment identification on "Pietà" of Barletta, example of Renaissance Apulian sculpture: a Raman microscopy study

A study of the original painting layer of the "Pietà" of Barletta, a polychrome statue, important example of Renaissance Apulian sculpture, was performed by mu-Raman spectroscopy. Vermilion was identified in the original layer of the blood drops on Jesus knee. Lazurite was identified as the original blue pigment on Our Lady's veil and lace, currently a yellow ochre-like color. The use of lazurite demonstrates the historical-artistic importance of this polychrome statue, and supports the hypothesis that this artwork was probably commissioned by Our Lady's devotees to itinerant artists inspired by the more precious Vesperbilder model.

Attentional demands reflect learning-induced alterations of bimanual coordination dynamics

This study aimed to investigate the effects of practice on bimanual coordination dynamics and attentional demands. Participants were asked to perform a dual-task associating a cyclic antiphase bimanual pattern and a discrete reaction time task. A pretest determined each individual critical transition frequency. In the training session, participants practised 120 trials. They were instructed to maintain the antiphase coordination pattern at the critical transition frequency. The training session was interrupted and followed by an intermediate test (after 60 trials) and a post-test (30 min after 120 trials), respectively. A retention test was performed 7 days after the end of the training session. Results showed that: (i) the number of transitions decreased as a consequence of practice; and (ii), subjects were able to maintain the antiphase pattern at a higher frequency than in the pretest. Analysis of the trade-off between relative phase variability and reaction time showed that participants were able to maintain a higher level of stability at the same (intermediate and post-test) or a lower attentional cost (retention test). These findings show that phase transition dynamics and pattern stability can be significantly modified as a result of practice. Changes in the trade-off between pattern stability and cost with learning confirm that the attentional cost incurred by the central nervous system to maintain pattern stability decreased with practice. In line with recent neurobiological studies, the present study provides new insights regarding relationships between brain processes, attentional demands and coordinated behaviour in learning bimanual patterns.

A dynamical framework to understand performance trade-offs and interference in dual tasks

This study demonstrated that the dynamic pattern approach may reconcile resource and outcome conflict theories to explain performance in dual tasks. Participants performed a bimanual coordination task and a reaction time task with different conditions of attentional priority. Results showed a trade-off between pattern variability and reaction time when priority was given to the coordination task. Such a trade-off was indicative of resource allocation. An analysis of perturbation in the bimanual coordination revealed interference, a reputed sign of outcome conflict. Moreover, interference diminished substantially when priority was given to the bimanual task. The coexistence of performance trade-off and outcome conflict suggests that these two phenomena are not mutually exclusive. Rather, both may follow from modifying the coupling between the limbs through attention.

Shared dynamics of attentional cost and pattern stability

This paper examines the informational activity devoted by the CNS to couple oscillating limbs in order to sustain and stabilize bimanual coordination patterns. Through a double-task paradigm associating a bimanual coordination task and a reaction time (RT) task, we investigated the relation between the stability of preferred bimanual coordination patterns and the central cost expended by the CNS for their stabilization. Ten participants performed in-phase and anti-phase coordination patterns in a dual task condition (coordination + RT) at several frequencies (0.5, 0.75, 1.0, 1.5, and 2.0 Hz), thereby decreasing the stability of the bimanual patterns. Results showed a U-shaped evolution of pattern stability and attentional cost, as a function of oscillation frequency, exhibiting a minimum value at the same frequency. These findings indicate that central cost and pattern stability covary and may share common, high order dynamics. Moreover, the attentional focus given to the bimanual coordination and the RT task was also manipulated by requiring either shared attention or priority to the coordination task. Such a manipulation led to a tradeoff between pattern stability and RT performance: The more stable the pattern, the more costly it is to stabilize. This suggests that stabilizing a coordination pattern incurs a central cost that depends on its intrinsic stability. Conceptual consequences of these results for understanding the relationship between attention and coordination are drawn, and the mechanisms putatively at work in dual tasks are discussed.

Effects of attention on phase transitions between bimanual coordination patterns: a behavioral and cost analysis in humans

The present study aimed to obtain a behavioral analysis of the effects of attentional focus on the dynamics of phase transitions in bimanual coordination and to evaluate the central cost expended by the central nervous system to maintain and stabilize such coordination patterns before and after the transition. Eight subjects were asked to execute an anti-phase coordination pattern (180 degrees of relative phase), while gradually increasing the frequency of oscillation. The central cost was assessed using a dual-task paradigm associating the bimanual coordination task with a reaction time task. Results showed that: (1) the transition process was significantly altered by focusing attention on the bimanual coordination task; and (2) the cost involved in sustaining the bimanual patterns was determined by their coordination dynamics.

Electrical kindling is associated with a lasting increase in the extracellular levels of kynurenic acid in the rat hippocampus

Endogenous kynurenic acid (KYNA), an excitatory amino acid receptor antagonist with antineurotoxic and anticonvulsant activity, was assessed by microdialysis in the hippocampus of kindled rats. One week after the completion of amygdala or hippocampal kindling (stage 5), the dialysate concentration of KYNA in the hippocampus of both hemispheres was 1.7 +/- 0.1-fold higher than in shams (P < 0.01). Veratridine (50 microM), applied through the probe, reduced extracellular KYNA by 28% within 1 h in controls (P < 0.05), but was ineffective in stage 5 kindled rats. At the preconvulsive stage 2, dialysate KYNA concentration and the effect of veratridine were similar to controls. The activity of KYNA's biosynthetic enzyme, kynurenine aminotransferase, did not change in the hippocampus 1 week after stage 5 seizures. These data indicate an enhanced liberation of KYNA in teh hippocampus of fully kindled animals due to an impairment of normal regulatory mechanisms. This may be of relevance for the control of hippocampal excitability during epileptogenesis.

Extracellular glutamate levels in the hypothalamus and hippocampus of rats after acute or chronic oral intake of monosodium glutamate

Using brain microdialysis we studied the effect of high doses of monosodium glutamate (MSG) on the extracellular concentration of glutamate in the hypothalamus and in the hippocampus of freely moving rats. MSG at 4 g/kg (40% solution) given by gavage caused a significant increase in plasma (5.3 +/- 0.4-fold, P < 0.01) and extracellular glutamate in the hippocampus (4.2 +/- 0.6-fold, P < 0.01) and in the hypothalamus (8.9 +/- 1.7-fold, P < 0.01) compared to control rats receiving a 40% sucrose solution (10 ml/kg). The peak increase was found within 40 min after MSG administration then declining to baseline in the next 80 min. No changes were found in glutamate tissue concentrations. Twenty-one days after ad libitum MSG intake with the diet (approximately 4 g/kg) no changes were found, in plasma, in extracellular and tissue concentration of glutamate in the hypothalamus compared to rats fed with a normal diet. Glutamate release induced by 200 mM KCl was not modified as well. Histological analysis of Nissl-stained brain tissue slices did not reveal any obvious cell loss in the hippocampus after acute or chronic MSG administration.

Enhanced neuropeptide Y release in the hippocampus is associated with chronic seizure susceptibility in kainic acid treated rats

We measured the release of neuropeptide Y (NPY) from hippocampal slices of rats at various times after limbic seizures induced by a subcutaneous injection of 12 mg/kg kainic acid (KA). Two days after KA, 100 mM KCl induced a 1.6 +/- 0.2-fold increase in NPY release compared to saline-injected rats (P < 0.05), while spontaneous and 50 mM KCl-induced release were unchanged. Thirty days after KA, the spontaneous and 100 mM KCl-induced efflux of NPY was enhanced 2-fold on average (P < 0.01) compared to controls, while no significant differences were found using 50 mM KCl. Tissue concentration of NPY was raised 2.2 +/- 0.2 times (P < 0.01) 30 days after KA. Thirty days after KA, the rats showed enhanced susceptibility to tonic-clonic seizures, assessed using a normally subconvulsive dose of pentylenetetrazol (PTZ; 30 mg/kg). A selective antibody (Ab) raised against NPY in a rabbit was infused bilaterally for three days in the CA3 area and dentate gyrus (DG) of the dorsal hippocampus of rats treated 30 days before with KA. This significantly reduced (P < 0.05) the number of animals with tonic-clonic seizures induced by 30 mg/kg PTZ, compared to KA treated rats which received the inactivated Ab. The Ab was ineffective in naive rats injected with a full convulsive dose of PTZ (55 mg/kg). The present results show that neuronal release of NPY is enhanced in the hippocampus after limbic seizures induced in rats by KA. This effect persists for at least 30 days and may contribute to the chronically enhanced susceptibility to seizures after injection of this toxin.

Electrical kindling of the hippocampus is associated with functional activation of neuropeptide Y-containing neurons

The release of neuropeptide Y (NPY) was measured from hippocampal slices of rats at stage 2 (preconvulsive stage) and stage 5 (full seizure expression) of electrical kindling of the dorsal hippocampus (upper blade of the dentate gyrus). Spontaneous release in naive rats (9.0 +/- 0.8 fmol/ml every 10 min) was independent of external Ca2+ but was reduced by 38 +/- 3.6% (P < 0.05) during 20 min incubation with 5 microM tetrodotoxin. Spontaneous efflux in naive rats did not differ from that in shams (implanted with electrodes but not stimulated) or in rats kindled to stage 2 and stage 5. Twenty-five, 50 and 100 mM KCl induced a concentration-dependent release of NPY (P < 0.05 and P < 0.01 at 25 and 50-100 mM respectively) from slices of shams. The effect of 100 mM KCl was reduced by 94 +/- 1% (P < 0.01) in the absence of Ca2+. Two days after the last stage 2 stimulation and 1 week after the last stage 5 seizure, NPY release was significantly larger than in shams at all KCl concentrations in the stimulated and contralateral hippocampus (P < 0.05 and P < 0.01). Forty-eight hours after one single after-discharge and 1 month after the last stage 5 seizure, 50 mM KCl induced a significantly larger release of NPY in the stimulated and contralateral hippocampus (P < 0.01 and P < 0.05), although the effect was less than during kindling.(ABSTRACT TRUNCATED AT 250 WORDS)

Extracellular somatostatin measured by microdialysis in the hippocampus of freely moving rats: evidence for neuronal release

Intracerebral microdialysis combined with a sensitive and specific radioimmunoassay was used to monitor the neuronal release of somatostatin (somatostatin-like immunoreactivity, SLI) in the dorsal hippocampus of freely moving rats. The sensitivity of the radioimmunoassay was optimized to detect < 1 fmol/ml. The basal concentration of SLI in 20-min dialysate fractions (5 microliters/min) collected 24 h after probe implantation was stable over at least 200 min. The spontaneous efflux dropped by 54 +/- 6.4% (p < 0.05) when Ca2+ was omitted and 1 mM EGTA added to the Krebs-Ringer solution and by 65.5 +/- 3.2% (p < 0.05) in the presence of 1 microM tetrodotoxin. Depolarizing concentrations of the Na+ channel opener veratridine (6.25, 25, 100 microM) induced 11 +/- 2 (p < 0.05), 17 +/- 2 (p < 0.05), and 21 +/- 5 (p < 0.01) fold increase in SLI concentration, respectively, during the first 20 min of perfusion. The effect of 100 microM veratridine was blocked by coperfusion with 5 microM tetrodotoxin (p < 0.01) and reduced by 79% (p < 0.01) in the virtual absence of Ca2+. Neuronal depolarization by 20 min of perfusion with Krebs-Ringer solution containing 25 and 50 mM KCl and proportionally lowered Na+ increased the dialysate SLI 4.4 +/- 1 (p < 0.05) and 17 +/- 3 (p < 0.01) fold baseline, respectively. Ten micromolar ouabain, a blocker of Na+,K(+)-ATPase, increased the dialysate SLI 15-fold baseline, on average (p < 0.05), during 80 min of perfusion. The results demonstrate the suitability of brain microdialysis for monitoring the neuronal release of SLI and for studying its role in synaptic transmission.

Anti-somatostatin antibody enhances the rate of hippocampal kindling in rats

A somatostatin-specific antibody (Ab) (1:250) was continuously infused into the stimulated dorsal hippocampus of rats from 4 days before to 26 days after the beginning of kindling or until the first stage 5. Controls received boiled Ab. The number of stimulations to the first stage 5 were reduced by 41 +/- 4% (P < 0.01, Student's t-test) in animals infused with the Ab compared to controls. The cumulative after-discharge in the stimulated hippocampus was slightly, although not significantly, reduced. Kindling was not affected when the Ab was infused only during the first 10 stimulations (stage 2). Histological analysis showed no neurotoxic effects in the hippocampus as a consequence of Ab infusion.

Somatostatin release is enhanced in the hippocampus of partially and fully kindled rats

The release of somatostatin (somatostatin-like immunoreactivity) from hippocampal slices during the development of hippocampal kindling in rats was measured under resting and depolarizing conditions. Preliminary experiments in naive rats showed that the spontaneous efflux of somatostatin (4.0 +/- 0.3 fmol/ml every 10 min) was independent of external Ca2+ but was reduced to 71.5 +/- 6% of baseline (P < 0.05) during 20 min incubation with 5 microM tetrodotoxin. Neuronal depolarization with 25, 50 and 100 mM KCl induced a Ca(2+)-dependent somatostatin release, respectively 4.3 +/- 0.4, 16.7 +/- 1.6 and 22.0 +/- 1.3 times baseline (P < 0.01). Veratridine caused a dose-dependent Ca2+ and tetrodotoxin (5 microM) sensitive release ranging from 6.5 +/- 0.1 to 13.0 +/- 1.4 times baseline at 1.4 microM and 50 microM respectively (P < 0.01). One week after the last of three consecutive stage 5 seizures (full seizure expression) or 48 h after the last stage 2 stimulation (preconvulsive stage), 50 mM KCl-induced somatostatin release was significantly higher (1.8 +/- 0.1, P < 0.01) than in shams (animals implanted with electrodes but not stimulated) in the stimulated and contralateral hippocampus. Somatostatin release measured under resting conditions was increased by 1.5 times in the stimulated hippocampus at stage 2 (P < 0.05) and by 2.2 and 1.7 times in both hippocampi at stage 5 (P < 0.01). Forty-eight hours after the induction of a single afterdischarge no significant changes were found in either spontaneous or 50 mM KCl-induced release of somatostatin.(ABSTRACT TRUNCATED AT 250 WORDS)