A very late onset AChR and MuSK double positive myasthenia gravis: a case description and literature review

AChR and MuSK double positive myasthenia gravis has been rarely reported. Generally, it occurs in children and adults after thymectomy or immunotherapy. Furthermore, in a few patients with bulbar or respiratory involvement, MuSK antibodies might be detected after clinical deterioration. We report a man with a very late onset myasthenia gravis (86-year-old) and the coexistence of both antibodies at the time of the diagnosis. Despite the presence of MuSK antibodies, he manifested no bulbar symptoms and had a favorable clinical outcome. However, side effects related to low dose pyridostigmine were evident. Hence, double positivity can also occur in elderly and in more benign forms of myasthenia gravis. Other cases of AChR and MuSK double positive myasthenia gravis could allow a better definition of this condition.

Effectiveness of vortioxetine in real-world clinical practice: Italian cohort results from the global RELIEVE study

Introduction

Major depressive disorder (MDD) is a debilitating disease in Italy affects 5.4% of people over 15 and 11.6% for the elderly. Efficacy of vortioxetine in adult patients with MDD was demonstrated in randomised controlled trials, there is a need for data on treatment in daily practice in Italy.

Objectives

To present the effectiveness and safety data of vortioxetine in real-world setting from patients enrolled from Italy in the RELIEVE study.

Methods

RELIEVE was a prospective, multi-national, observational study of outpatients initiating vortioxetine treatment for MDD at physician’s discretion. Data and outcomes of treatment of patients were collected at routine clinical visits. The primary outcome was functioning measured by SDS. Secondary outcomes included depressive symptoms measured by PHQ-9, cognitive funcion measured by PDQ-5, quality of life measured by EQ-5D-5L. Changes from baseline to month 6 were estimated with a linear mixed model of repeated measures approach.

Results

A total of 231 patients (mean age, 55.5 years, 27.3% over 65 years, 62% female) were enrolled from Italy and included in the analysis. Mean(SD) SDS total score, PHQ-9, PDQ-5 scores at baseline were 17.8(7.58), 15.7(5.97) and 9.8(4.99), the scores(SE) decreased by 6.6(0.64), 5.9(0.47) and 3.6(0.36) from baseline to last visit. Mean(SE) EQ-5D-5L utility index increased by 0.13(0.01). Safety and tolerability profile of vortioxetine was in line with the established profile.

Conclusions

Improvements in overall functioning, depressive symptoms, cognitive function and quality of life were observed in patients treated with vortioxetine, including a wide proportion of elderly patients in a real-world setting.

Disclosure

A. Pugliese is an employee of Lundbeck Italy. K. Simonsen and H. Ren are employees of H. Lundbeck A/S.

SUIHTER: a new mathematical model for COVID-19. Application to the analysis of the second epidemic outbreak in Italy

The COVID-19 epidemic is the latest in a long list of pandemics that have affected humankind in the last century. In this paper, we propose a novel mathematical epidemiological model named SUIHTER from the names of the seven compartments that it comprises: susceptible uninfected individuals (S), undetected (both asymptomatic and symptomatic) infected (U), isolated infected (I), hospitalized (H), threatened (T), extinct (E) and recovered (R). A suitable parameter calibration that is based on the combined use of the least-squares method and the Markov chain Monte Carlo method is proposed with the aim of reproducing the past history of the epidemic in Italy, which surfaced in late February and is still ongoing to date, and of validating SUIHTER in terms of its predicting capabilities. A distinctive feature of the new model is that it allows a one-to-one calibration strategy between the model compartments and the data that are made available daily by the Italian Civil Protection Department. The new model is then applied to the analysis of the Italian epidemic with emphasis on the second outbreak, which emerged in autumn 2020. In particular, we show that the epidemiological model SUIHTER can be suitably used in a predictive manner to perform scenario analysis at a national level.

Prevalence, molecular characterization, and clinical relevance of sensitization to Anisakis simplex in children with sensitization and/or allergy to Dermatophagoides pteronyssinus

Summary

Prevalence of the Anisakis Simplex's (AS) sensitization in children sensitized to Dermatophagoides pteronissynus (DP) is not known, neither it is to which percentage it might be due to cross-reactivity. The primary objective of the present retrospective cross-sectional study is to evaluate the prevalence of sensitization to AS in children sensitized or allergic to DP. Secondary outcomes were the prevalence of cross-reactivity and clinical relevance of the condition. The prevalence of sensitization to AS differs significantly among patients sensitized and not to DP (13.43% vs. 3.80%; p=0.019). The higher prevalence is mainly due to cross-reactivity with Der p10 (OR=8.86; 95% CI=4.33-40.74; p=0.0001). Currently, the sensitization to AS seems to have no clinical relevance in the pediatric population.

Improved Physicochemical and Structural Properties of Blueberries by High Hydrostatic Pressure Processing

The use of high pressure on fruits and vegetables is today widely studied as an alternative to the traditional thermal preservation techniques, with the aim of better preserving nutritional and organoleptic properties. The use of high hydrostatic pressures (400–600 MPa; 1–5 min; room temperature) was tested on the physicochemical and structural properties of blueberries, in comparison to raw and blanched samples. High hydrostatic pressures led to higher tissue damages than blanching, related to the intensity of the treatment. The cellular damages resulted in leakage of intracellular components, such as bioactive molecules and enzymes. As a consequence, among the high pressure treatments, the resulting antioxidant activity was higher for samples treated for longer times (5 min). Pectinmethyl esterase (PME), deactivated by blanching, but strongly barotolerant, was more active in blueberries treated with the more intense high pressure conditions. Blueberry texture was better retained after high pressure than blanching, probably because of the PME effect. Blueberry color shifted towards purple tones after all of the treatments, which was more affected by blanching. Principal component analysis revealed the mild impact of high pressure treatments on the organoleptic properties of blueberries.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Low-Dose Anti-Thymocyte Globulin (ATG) Preserves β-Cell Function and Improves HbA1c in New-Onset Type 1 Diabetes

OBJECTIVE

A pilot study suggested that combination therapy with low-dose anti-thymocyte globulin (ATG) and pegylated granulocyte colony-stimulating factor (GCSF) preserves C-peptide in established type 1 diabetes (T1D) (duration 4 months to 2 years). We hypothesized that 1) low-dose ATG/GCSF or 2) low-dose ATG alone would slow the decline of β-cell function in patients with new-onset T1D (duration <100 days).

RESEARCH DESIGN AND METHODS

A three-arm, randomized, double-masked, placebo-controlled trial was performed by the Type 1 Diabetes TrialNet Study Group in 89 subjects: 29 subjects randomized to ATG (2.5 mg/kg intravenously) followed by pegylated GCSF (6 mg subcutaneously every 2 weeks for 6 doses), 29 to ATG alone (2.5 mg/kg), and 31 to placebo. The primary end point was mean area under the curve (AUC) C-peptide during a 2-h mixed-meal tolerance test 1 year after initiation of therapy. Significance was defined as one-sided P value < 0.025.

RESULTS

The 1-year mean AUC C-peptide was significantly higher in subjects treated with ATG (0.646 nmol/L) versus placebo (0.406 nmol/L) (P = 0.0003) but not in those treated with ATG/GCSF (0.528 nmol/L) versus placebo (P = 0.031). HbA_1c was significantly reduced at 1 year in subjects treated with ATG and ATG/GCSF, P = 0.002 and 0.011, respectively.

CONCLUSIONS

Low-dose ATG slowed decline of C-peptide and reduced HbA_1c in new-onset T1D. Addition of GCSF did not enhance C-peptide preservation afforded by low-dose ATG. Future studies should be considered to determine whether low-dose ATG alone or in combination with other agents may prevent or delay the onset of the disease.

A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk

OBJECTIVE

We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals.

RESEARCH DESIGN AND METHODS

We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables.

RESULTS

Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002).

CONCLUSIONS

The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.

Insights into the Analysis of Phenolic Secoiridoids in Extra Virgin Olive Oil

Extra virgin olive oils (EVOOs) containing more than 5 mg/20 g tyrosol, hydroxytyrosol, and their secoiridoids can be recognized by health claims related to the protection of blood lipids from oxidative stress. Therefore, a reliable, accurate, and standardized analytical procedure is needed to determine these markers of EVOO quality. In order to overcome the limitations of current methods, a detailed investigation of sample preparation and chromatographic conditions was performed by UHPLC-UV-HRMS. The use of a C18 fused-core column and nonacidified gradient elution provided single, sharp peaks for oleocanthal and oleacein, allowing their reliable quantitation in UV profiles. Positive- and negative-UHPLC-HRMS/MS characterization of methanolic extracts revealed the presence of dimethyl acetal, methyl hemiacetal, and monohydrate derivatives of all secoiridoids. These artifacts were formed in aqueous methanol, which is usually employed to extract and analyze EVOO phenols, making the HPLC profiles more complex and the measurements less accurate and reproducible. Acetonitrile proved to be a suitable solvent to avoid the formation of secoiridoid dimethyl acetals and methyl hemiacetals and to efficiently extract EVOO bioactive phenols. Finally, the phenolic contents of Italian EVOO samples were determined by UHPLC-UV analysis of acetonitrile extracts before (direct method) and after acid hydrolysis (indirect method). The results indicated that the use of tyrosol and hydroxytyrosol as reference standards allowed more accurate quantitative data to be obtained. Direct and indirect methods provided comparable levels of EVOO phenols, highlighting the usefulness of acid hydrolysis in routine analyses. The improved procedure defines the most reliable conditions to provide an analytical method with suitable accuracy and repeatability in the analysis of healthy and functional EVOO phenols.

Enhancement of Methotrexate Cytotoxicity by Modulation of Proliferative Activity in Normal and Neoplastic t Lymphocytes and in a Myeloid Leukemia Cell Line

Recent advances in the modulation of cell kinetics with growth factors suggest that the effect of cyclespecific cytostatic drugs can be enhanced by combination with such factors. The truth of this hypothesis was investigated by studying the effect of phytohemoagglutinin and/or interlenkin 2 on the sensitivity to methotrexate (MTX) of normal T lymphocytes and of lymphoblastis of a patient with acute T-cell lymphoid leukemia. In both cases, inhibition of proliferation by MTX was increased from less than 30% in resting cells or those sub-optimally stimulated, in the case of leukemic blasts, to 68-83% in maximally stimulated cells. Similar results were observed when the AML 193 human myeloid leukemia line was stimulated with human recombinant granulocyte macrophage colony stimulation factor (GM-CSF). Under basal proliferation conditions, the addition of 1 μg/ml and 10 (μ/ml MTX was followed by 48% and 72% inhibition respectively. When 1 ng/ml GM-CSF (40 I.U./ml) was present, these figures rose to 89% and 91%. It is thus clear that growth factor-induced cell proliferation increases sensitivity to cyclespecific cytostatic agents. There is thus a biological premise for new perspectives in antineoplastic therapy.

Application and optimisation of air-steam cooking on selected vegetables: impact on physical and antioxidant properties

BACKGROUND

Several studies investigated the impact of different cooking techniques on the quality of vegetables. However, the use of the combined air-steam cooking is still scarcely debated, despite the advantages informally referred by professional catering workers. In this study, its optimisation was studied on Brussels sprouts and pumpkin cubes to obtain the best physical (texture, colour) and antioxidant (FRAP, total phenols) response, in comparison to a conventional steaming treatment.

RESULTS

Increasing the strength of the air-steam treatment, Brussels sprouts resulted to be softer, less green (higher a* value), richer in phenols and exhibited lower FRAP values than the steamed ones. The air-steamed pumpkin cubes exhibited an equivalent softening degree to that of steamed ones and, under the strongest cooking conditions, a higher antioxidant quality and a yellow darkening (lower b* value). Varying the cooking time and/or temperature, a linear change of force/compression hardness and a* (negative a*: greenness) for Brussels sprouts, b* (yellowness) and total phenol content for pumpkin cubes was observed. A predictive model for these variables was obtained by response surface methodology. The best process conditions to achieve the optimal desirability were also identified.

CONCLUSION

The application of air-steam cooking under suitable time/temperature conditions could be proposed as an alternative method to a traditional steam cooking on Brussels sprouts and pumpkin cubes, being able to preserve or improve their quality. The best air-steam cooking conditions were 25 min at 90 °C for Brussels sprouts and 10 min at 110 °C for pumpkin. © 2017 Society of Chemical Industry.

POSEIDON study: a pilot, safety and feasibility trial of high-dose omega3 fatty acids and high-dose cholecalciferol supplementation in type 1 diabetes

The anti-inflammatory and immunomodulatory properties of high-dose omega-3 fatty acids and Vitamin D, and the initial encouraging results from case reports on the use of this supplementation in new-onset Type 1 Diabetes (T1D), support further testing of this combination strategy. This intervention appears to be well tolerated, affordable, and sufficiently safe to be further tested in randomized prospective trials to determine whether this combination therapy may be of assistance to halt progression of autoimmunity and/or preserve residual beta-cell function in subjects with new onset and established T1D of up to 10 years duration. In addition, the 1st PreDiRe T1D conference (Preventing Disease and its Recurrence in Type 1 Diabetes - see Editorial in this issue) was organized to discuss initial results and possible alternative/complementary strategies, for collaborative international expansion of these trials, to include strategies for disease prevention. Our POSEIDON clinical trial will test the use of high dose vitamin D3 and highly purified Omega-3 fatty acids in new onset and established T1D. The draft of the study protocol, in addition to the informed consent and assent, is now shared open access to facilitate its international implementation by interested physicians and centers that would like to further test this approach through clinical trials.

Chemical Profile and Antioxidant Properties of Extracts and Essential Oils from Citrus × limon (L.) Burm. cv. Femminello Comune

Citrus × limon cv. Femminello Comune (Rutaceae) from Rocca Imperiale (Italy), one of the six Protected Geographical Indication (PGI) Italian lemon crops, has been recently received renewed interest. In this work, fresh and dried peels and leaves were extracted by hydrodistillation, supercritical fluid extraction (SFE), and Soxhlet apparatus. Chemical profile was assessed by gas chromatography (GC) and gas chromatography/mass spectrometry (GC/MS). Except for leaves extracts obtained by Soxhlet apparatus, the monoterpene hydrocarbons fraction dominated. Limonene, γ-terpinene, and β-pinene were the main identified compounds. The antioxidant activity was investigated using different in vitro assays namely 2,2-diphenyl-1-picrylhydrazyl (DPPH), ABTS, ferric reducing ability power (FRAP), and β-carotene bleaching test. In DPPH test, the essential oil obtained by hydrodistillation of fresh peel exhibited the highest activity (IC50 of 1.17 mg/ml). Leaves extracted by SFE showed a good activity in both DPPH and β-carotene bleaching test with IC50 values of 2.20 and 6.66 mg/ml, respectively. Monoterpene hydrocarbons fraction exhibited a positive Pearson's correlation coefficient with all antioxidant assays. Leaves, often considered waste material, should be considered from a different point because they represent a matrix of indisputable interest.

Correlation between collective and molecular dynamics in pH-responsive cyclodextrin-based hydrogels

The joint use of UV Raman and Brillouin scattering experiments is employed to explore phase evolutions in pH-responsive polysaccharide hydrogels.

Validation of a rapid type 1 diabetes autoantibody screening assay for community-based screening of organ donors to identify subjects at increased risk for the disease

The Network for Pancreatic Organ donors with Diabetes (nPOD) programme was developed in response to an unmet research need for human pancreatic tissue obtained from individuals with type 1 diabetes mellitus and people at increased risk [i.e. autoantibody (AAb)-positive] for the disease. This necessitated the establishment of a type 1 diabetes-specific AAb screening platform for organ procurement organizations (OPOs). Assay protocols for commercially available enzyme-linked immunosorbent assays (elisas) determining AAb against glutamic acid decarboxylase (GADA), insulinoma-associated protein-2 (IA-2A) and zinc transporter-8 (ZnT8A) were modified to identify AAb-positive donors within strict time requirements associated with organ donation programmes. These rapid elisas were evaluated by the international islet AAb standardization programme (IASP) and used by OPO laboratories as an adjunct to routine serological tests evaluating donors for organ transplantation. The rapid elisas performed well in three IASPs (2011, 2013, 2015) with 98-100% specificity for all three assays, including sensitivities of 64-82% (GADA), 60-64% (IA-2A) and 62-68% (ZnT8A). Since 2009, nPOD has screened 4442 organ donors by rapid elisa; 250 (5·6%) were identified as positive for one AAb and 14 (0.3%) for multiple AAb with 20 of these cases received by nPOD for follow-up studies (14 GADA+, two IA-2A(+) , four multiple AAb-positive). Rapid screening for type 1 diabetes-associated AAb in organ donors is feasible, allowing for identification of non-diabetic, high-risk individuals and procurement of valuable tissues for natural history studies of this disease.

Effect of different cooking methods on structure and quality of industrially frozen carrots

The effect of boiling, steaming and microwaving on microstructure, texture and colour of raw and industrially frozen carrots was investigated. The raw carrots, after cooking, showed dehydrated and separated cells with swollen walls. The carrots subjected to blanching, freezing and followed by frozen storage exhibited marked tissue damages indicating deep oriented fissures. Cooking caused cellular dehydration and separation in the tissue, with the same intensity between raw and frozen carrots and independently from the cooking treatment applied. Among different cooking methods, microwaving showed better retention of the initial texture and colour quality for both raw and frozen carrots. On the other hand, the steamed carrots revealed the highest degree of softening and colour differences from the control for both raw and frozen carrots, despite the worst tissue conditions were observed for the boiled carrots.

Risk Factors for Type 1 Diabetes Recurrence in Immunosuppressed Recipients of Simultaneous Pancreas-Kidney Transplants

Patients with type 1 diabetes (T1D) who are recipients of pancreas transplants are believed to rarely develop T1D recurrence in the allograft if effectively immunosuppressed. We evaluated a cohort of 223 recipients of simultaneous pancreas-kidney allografts for T1D recurrence and its risk factors. With long-term follow-up, recurrence was observed in approximately 7% of patients. Comparing the therapeutic regimens employed in this cohort over time, lack of induction therapy was associated with recurrence, but this occurs even with the current regimen, which includes induction; there was no influence of maintenance regimens. Longitudinal testing for T1D-associated autoantibodies identified autoantibody positivity, number of autoantibodies, and autoantibody conversion after transplantation as critical risk factors. Autoantibodies to the zinc transporter 8 had the strongest and closest temporal association with recurrence, which was not explained by genetically encoded amino acid sequence donor-recipient mismatches for this autoantigen. Genetic risk factors included the presence of the T1D-predisposing HLA-DR3/DR4 genotype in the recipient and donor-recipient sharing of HLA-DR alleles, especially HLA-DR3. Thus, T1D recurrence is not uncommon and is developing in patients treated with current immunosuppression. The risk factors identified in this study can be assessed in the transplant clinic to identify recurrent T1D and may lead to therapeutic advances.

Clinical Nutrition in Gerontology: Chronic Renal Disorders of the Dog and Cat

The recent advances in the nutrition of companion animals has resulted in a longer possible life-span for dogs and cats and an improvement in their quality of life. Numerous studies about geriatric animals show that an aging dog or cat requires a specific nutritional formulation that considers the metabolic changes associated with age. A correct diet plays an important role in the treatment of some chronic pathologies in aging animals, particularly those for which the aging process modifies the organ function. A correct diet can provide therapeutic support to the administration of drugs that can sometimes compromise organ function. In the present study, we identify key aspects of the clinical nutrition during chronic renal disorders of dogs and cats, diseases with an elevated incidence and a major cause of mortality in geriatric animals. The aim of nutritional treatment for dogs and cats affected by chronic renal disorders is to improve the quality and length of life, assuring an adequate amount of energy and slowing the progression of renal failure. To improve treatment efficacy it is necessary to prepare different dietary rations during the various stages of disease, on the basis of clinical signs and laboratory data.

Edible Flowers: A Rich Source of Phytochemicals with Antioxidant and Hypoglycemic Properties

Edible flowers are receiving renewed interest as rich sources of bioactive compounds. Ethanol extracts of eight edible flowers were phytochemically characterized and investigated for their bioactivity. Rutin, quercetin, luteolin, kaempferol, and myricetin were selected as standards and quantified by HPLC. The fatty acid profile was analyzed by GC and GC-MS. Antioxidant properties were evaluated by using different in vitro tests. The hypoglycemic effects were investigated via the inhibition of α-amylase and α-glucosidase. Sambucus nigra exhibited the highest radical-scavenging activity (IC50 of 1.4 μg/mL), followed by Hedysarum coronarium (IC50 of 1.6 μg/mL). Both species contained high quercetin and rutin contents. S. nigra extract exerted the highest activity in preventing lipid oxidation. Malva sylvestris extract inhibited both α-amylase and α-glucosidase with IC50 values of 7.8 and 11.3 μg/mL, respectively. These findings support the consumption of edible flowers as functional foods and their use as sources of natural antioxidants by the food industry.

The role of heterogeneity on the invasion probability of mosquito-borne diseases in multi-host models

Heterogeneity in transmission and stochastic events can play a significant role in shaping the epidemic dynamics of vector-borne infections, especially in the initial phase of an outbreak. In this work, by using multi-type branching process methodologies, we assess how heterogeneities in transmission among a large number of host groups can affect the invasion probabilities of a mosquito-borne disease. We show with both analytical and numerical methods that heterogeneities in transmission can shape the invasion probabilities differently from how they affect the basic reproduction number (R0). In particular, we find that, while R0 always increases with the heterogeneity, the invasion probability after the introduction of infected hosts can decrease with the increase of transmission heterogeneity, even approaching zero when the number of host groups is very large. In addition, we show that the invasion probability via infected vectors is always larger than via infected hosts when heterogeneous transmission is sufficiently high. Our findings suggest that, for multi-species infections (e.g. West Nile fever and Rift Valley fever) or for single-species infections with patchy host distribution, the introduction of primary infected vectors may represent a higher risk for major outbreaks occurrence than introductions of infected hosts.

Crocus cancellatus subsp. damascenus stigmas: chemical profile, and inhibition of α-amylase, α-glucosidase and lipase, key enzymes related to type 2 diabetes and obesity

Spices are appreciated for their medicinal properties besides their use as food adjuncts to enhance the sensory quality of food. In this study, Crocus cancellatus subsp. damascenus was investigated for its antioxidant activities employing different in vitro systems. Stigma extract demonstrated a radical scavenging activity against both 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) (ABTS) radicals with IC50 values of 34.6 and 21.6 µg/mL and a good ferric reducing ability (53.9 µM Fe(II)/g). In order to clarify the potential functional properties of this spice, the carbohydrate-hydrolysing enzymes and pancreatic lipase inhibitory properties were investigated. Crocus cancellatus subsp. damascenus extract inhibited α-amylase and α-glucosidase with IC50 values of 57.1 and 68.6 µg/mL, respectively. The bioactivity was discussed in terms of phytochemicals content. The obtained results may be of interest from a functional point of view or as food additive and to promote the revalorization of this species.

Effect of bioclimatic area on the composition and bioactivity of Tunisian Rosmarinus officinalis essential oils

The chemical composition of eight Tunisian Rosmarinus officinalis L. populations (A-H) from different bioclimatic areas has been examined by gas chromatography (GC) and GC-mass spectrometry. The essential oils are characterised by high amounts of oxygenated monoterpenes (58.2-71.7%) followed by monoterpene hydrocabons (15.1-26.7%). 1,8-Cineole, camphor, α-pinene and borneol are the main representative components. The antioxidant activity was investigated by 2,2-diphenyl-1-picrylhydrazyl radical (DPPH), ferric reducing ability power assay and β-carotene bleaching test. Samples showed antiradical activity by inhibiting DPPH radical with IC50 values ranging from 375.3 to 592.8 μg mL(- 1) for samples F and A, respectively. Sample A also showed the most promising activity in β-carotene bleaching test (IC50 of 31.9 μg mL(- 1)). The essential oils were also screened for acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) inhibitory activity. Sample G showed the highest activity against AChE (IC50 of 64.7 μg mL(- 1)) while sample D (IC50 of 29.5 μg mL(- 1)) exhibited the most potent activity against BChE.

Chemical composition and bioactivity of dried fruits and honey of Ficus carica cultivars Dottato, San Francesco and Citrullara

BACKGROUND

The aim of this study is to evaluate, for the first time, the chemical profile, antioxidant properties and cholinesterase inhibitory activity of dried fruits and honey of Ficus carica (fig) cultivars Dottato, Citrullara, and San Francesco.

RESULTS

Gas chromatography-mass spectrometry (GC-MS) analysis of fig extracts identified terpenes, sterols and fatty acids as major constituents. The aroma profile of honey obtained from a mixture of the three cultivars was investigated by solid-phase micro-extraction/GC-MS. 5-(Hydroxymethyl)-2-furancarboxaldehyde, 2,3-dihydro-3,5-dihydroxy-6-methyl-4H-pyran-4-one and 1,3-dihydroxy-2-propanone were the main compounds. Total phenol, flavonoid and anthocyanin content are also reported. The San Francesco cultivar is characterised by the highest phenol and flavonoid content, while Dottato showed the major anthocyanin content. The Dottato cultivar exhibited the best radical scavenging activity against both 2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid) and 2,2-diphenyl-1-picrylhydrazyl radicals (IC50 values of 5.4 and 22.6 µg mL(-1) , respectively). This cultivar also showed the highest inhibitory activity against both acetylcholinesterase and butyrylcholinesterase, with IC50 values of 26.9 and 31.8 µg mL(-1) , respectively.

CONCLUSION

Dried figs are a convenient source of bioactive compounds that demonstrated potential neuroprotection and antioxidant effects. Therefore, the addition of figs to the human diet should be recommended by dieticians and nutritionists.

In vitro assessment of the bioaccessibility of carotenoids from sun-dried chilli peppers

Chilli peppers have been recognized as an excellent source of antioxidants as they are rich in bioactive phytochemicals such as carotenoids which are known to exert various beneficial effects in vivo. Absorption is an important factor in the determination of the potential biological effects of carotenoids. The bioaccessibility of a food constituent such as a carotenoid represents its potential to be absorbed in humans. There is very limited information in the literature regarding the content and bioaccessibility of carotenoids from dried peppers. Therefore, the objectives of the present study were: first, to determine the carotenoid content of 20 varieties of red, orange or yellow coloured sun-dried chilli peppers belonging to either of four Capsicum species (annuum, baccatum, chinense and chacoense); and second, to quantify the carotenoid micellarization (bioaccessibility) following an in vitro digestion procedure. Red peppers had a higher carotenoid content and bioaccessibility than either the orange peppers or yellow pepper. Xanthophylls showed greater bioaccessibility than carotenes. Our findings confirm that dried chilli peppers are a good source of carotenoids.

Chemical profiling and in vitro biological effects of Cardiospermum halicacabum L. (Sapindaceae) aerial parts and seeds for applications in neurodegenerative disorders

Cardiospermum halicacabum is widely used in traditional medicine. Previous studies have focused on the aerial parts, while the seeds have been poorly investigated. This work aimed to analyse the chemical composition of extracts from aerial parts and seeds obtained using Naviglio and Soxhlet (PN, PS, and SN, SS, respectively), the inhibitory properties against tyrosinase, acetylcholinesterase (AChE), and butyrylcholinesterase (BChE) and the antioxidant effects. PN total extract showed significant anti-tyrosinase activity (IC50 value of 10.8 µg/mL). After partitioning with n-hexane, an HPLC method for analysing chemical constituents was established. Apigenin, luteolin, and apigenin-7-O-glucoside are the predominant constituents. SN n-hexane fraction was the most active inhibitor of BChE (IC50 of 57.9 µg/mL). Gas chromatography-mass spectrometry analysis revealed fatty acids, including eicosanoic acid, methyl 11-eicosenoate and oleic acid, as the major constituents. These findings suggest the potentiality of both seeds and aerial parts of C. halicacabum in the treatment of neurological disorders.

In vitro investigation of the bioaccessibility of carotenoids from raw, frozen and boiled red chili peppers (Capsicum annuum)

BACKGROUND

Carotenoid-rich foods are associated with antioxidant activity and the ability to alleviate chronic diseases.

PURPOSE

The present study investigated the effect of processing on the content and bioaccessibility of carotenoids from 13 cultivars of red chili pepper (Capsicum annuum).

METHODS

Carotenoids in chili peppers were analyzed before an in vitro digestion process. The portion of carotenoid transferred to the micelle fraction (bioaccessibility) was also quantified.

RESULTS

β-Carotene, β-cryptoxanthin, capsanthin and antheraxanthin were the most abundant carotenoids. Zeaxanthin, violaxanthin, neoxanthin and lutein were detected at lower concentrations. In general, freezing and boiling reduced carotenoid contents. Capsanthin and zeaxanthin had the highest bioaccessibility at an average value from 36 to 40%, followed by antheraxanthin (26%). Bioaccessibility of β-cryptoxanthin, violaxanthin and β-carotene was lower, averaging 6.1, 4.8 and 4.0%, respectively. Neoxanthin and lutein were not detected in micelles. Freezing increased the bioaccessibility of capsanthin, zeaxanthin, antheraxanthin, β-cryptoxanthin and violaxanthin; β-cryptoxanthin bioaccessibility increased and capsanthin and zeaxanthin bioaccessibility decreased following boiling.

CONCLUSIONS

Differences in the contents and bioaccessibility of carotenoids in 13 C. annuum cultivars and between the processed methods were herein evidenced.

The multiple origins of Type 1 diabetes

It is widely accepted that Type 1 diabetes is a complex disease. Genetic predisposition and environmental factors favour the triggering of autoimmune responses against pancreatic β-cells, eventually leading to β-cell destruction. Over 40 susceptibility loci have been identified, many now mapped to known genes, largely supporting a dominant role for an immune-mediated pathogenesis. This role is also supported by the identification of several islet autoantigens and antigen-specific responses in patients with recent onset diabetes and subjects with pre-diabetes. Increasing evidence suggests certain viruses as a common environmental factor, together with diet and the gut microbiome. Inflammation and insulin resistance are emerging as additional cofactors, which might be interrelated with environmental factors. The heterogeneity of disease progression and clinical manifestations is likely a reflection of this multifactorial pathogenesis. So far, clinical trials have been mostly ineffective in delaying progression to overt diabetes in relatives at increased risk, or in reducing further loss of insulin secretion in patients with new-onset diabetes. This limited success may reflect, in part, our incomplete understanding of key pathogenic mechanisms, the lack of truly robust biomarkers of both disease activity and β-cell destruction, and the inability to assess the relative contributions of various pathogenic mechanisms at various time points during the course of the natural history of Type 1 diabetes. Emerging data and a re-evaluation of histopathological, immunological and metabolic findings suggest the hypothesis that unknown mechanisms of β-cell dysfunction may be present at diagnosis, and may contribute to the development of hyperglycaemia and clinical symptoms.

Advantage of rapamycin over mycophenolate mofetil when used with tacrolimus for simultaneous pancreas kidney transplants: randomized, single-center trial at 10 years

Simultaneous pancreas kidney transplantation (SPKT) is the treatment of choice for patients with type 1 diabetes and end-stage renal disease. Rapamycin and mycophenolate mofetil (MMF) have been used for maintenance immunosuppression with tacrolimus in SPKT; however, long-term outcomes are lacking. From September 2000 through December 2009, 170 SPKT recipients were enrolled in a randomized, prospective trial receiving Rapamycin (n = 84) or MMF (n = 86). All patients received dual induction therapy with thymoglobulin and daclizumab, and low-dose maintenance tacrolimus and corticosteroids. Compared to MMF, rates of freedom from first biopsy-proven acute kidney or pancreas rejection were superior for Rapamycin at year 1 (kidney: 100% vs. 88%; P = 0.001; pancreas: 99% vs. 92%; P = 0.04) and at year 10 (kidney: 88% vs. 71%, P = 0.01; pancreas: 99% vs. 89%, P = 0.01). The higher rates of rejection were associated with withholding MMF (vs. Rapamycin, p = 0.009), generally for gastrointestinal or bone marrow toxicity. There was no significant difference in creatinine, proteinuria, c-peptide, viral infections, lymphoproliferative disorders or posttransplant diabetes. HbA1C and lipid levels were normal in both groups, although higher in the Rapamycin arm. There were no significant differences in patient or allograft survival. In this 10-year SPKT study, Rapamycin in combination with tacrolimus was better tolerated and more effective than MMF. Overall, the patient and allograft survival were equivalent.

On the formulation of epidemic models (an appraisal of Kermack and McKendrick)

The aim of this paper is to show that a large class of epidemic models, with both demography and non-permanent immunity incorporated in a rather general manner, can be mathematically formulated as a scalar renewal equation for the force of infection.

Chelating, antioxidant and hypoglycaemic potential of Muscari comosum (L.) Mill. bulb extracts

The metal chelating activity, antioxidant properties and the effect on carbohydrate-hydrolysing enzyme inhibition of Muscari comosum extracts have been investigated. M. comosum bulbs contain a total amount of the phenols with a value of 56.6 mg chlorogenic acid equivalent per gram of extract and a flavonoid content of 23.4 mg quercetin equivalent per gram of extract. In order to evaluate the non-polar constituents, n-hexane extract was obtained. Gas chromatography-mass spectrometry analysis revealed the presence of fatty acids and ethyl esters as major constituents, with different aldehydes and alkanes as minor components. Ethanolic extract had the highest ferric-reducing ability power (66.7 μM Fe(II)/g) and DPPH scavenging activity with a concentration giving 50% inhibition (IC₅₀) value of 40.9 μg/ml. Moreover, this extract exhibited a good hypoglycaemic activity with IC₅₀ values of 81.3 and 112.8 μg/ml for α-amylase and α-glucosidase, respectively. In conclusion, M. comosum bulbs show promising antioxidant and hypoglycaemic activity via the inhibition of carbohydrate digestive enzymes. These activities may be of interest from a functional point of view and for the revalorization of this ancient non-cultivated vegetable of Mediterranean traditional gastronomy.

Dimorphic histopathology of long-standing childhood-onset diabetes

AIMS/HYPOTHESIS

Childhood diabetes is thought to usually result from autoimmune beta cell destruction (type 1A) with eventual total loss of beta cells. Analysis of C-peptide in children characterised at diabetes onset for autoantibodies shows heterogeneous preservation of insulin secretion in long-standing diabetes. The aim of this study was to characterise the pancreases of childhood-onset diabetes in order to define the pathological basis of this heterogeneity.

METHODS

We evaluated 20 cadaveric organ donor pancreases of childhood-onset long-term patients for disease heterogeneity and obtained corresponding C-peptide measurements.

RESULTS

Pancreases from the majority of cadaveric donors contained only insulin-deficient islets (14 of 20). The remaining six patients (30%) had numerous insulin-positive cells within at least some islets, with two different histological patterns. Pattern A (which we would associate with type 1A diabetes) had lobular retention of areas with 'abnormal' beta cells producing the apoptosis inhibitor survivin and HLA class I. In pattern B, 100% of all islets contained normal-appearing but quantitatively reduced beta cells without survivin or HLA class I.

CONCLUSIONS/INTERPRETATION

Our data demonstrate that C-peptide secretion in long-standing diabetic patients can be explained by two different patterns of beta cell survival,possibly reflecting different subsets of type 1 diabetes.

Modelling the spatial spread of H7N1 avian influenza virus among poultry farms in Italy

We analysed the between-farm transmission of the H7N1 highly pathogenic avian influenza virus that disrupted the Italian poultry production in the 1999-2000 epidemic with a SEIR model with a spatial transmission kernel, accounting for the containment measures actually undertaken. We found significant differences in susceptibility between species and a reduction in transmissibility after the first phase. We performed simulations to assess the effectiveness of the implemented and new control measures. The most effective measure was the ban on restocking. An earlier start of pre-emptive culling promotes eradication; restricted pre-emptive culling delays eradication but causes lower losses.

The Type I Diabetes Genetics Consortium 'Rapid Response' family-based candidate gene study: strategy, genes selection, and main outcome

Candidate gene studies have long been the principal method for identification of susceptibility genes for type I diabetes (T1D), resulting in the discovery of HLA, INS, PTPN22, CTLA4, and IL2RA. However, many of the initial studies that relied on this strategy were largely underpowered, because of the limitations in genomic information and genotyping technology, as well as the limited size of available cohorts. The Type I Diabetes Genetic Consortium (T1DGC) has established resources to re-evaluate earlier reported genes associated with T1D, using its collection of 2298 Caucasian affected sib-pair families (with 11 159 individuals). A total of 382 single-nucleotide polymorphisms (SNPs) located in 21 T1D candidate genes were selected for this study and genotyped in duplicate on two platforms, Illumina and Sequenom. The genes were chosen based on published literature as having been either 'confirmed' (replicated) or not (candidates). This study showed several important features of genetic association studies. First, it showed the major impact of small rates of genotyping errors on association statistics. Second, it confirmed associations at INS, PTPN22, IL2RA, IFIH1 (earlier confirmed genes), and CTLA4 (earlier confirmed, with distinct SNPs) loci. Third, it did not find evidence for an association with T1D at SUMO4, despite confirmed association in Asian populations, suggesting the potential for population-specific gene effects. Fourth, at PTPN22, there was evidence for a novel contribution to T1D risk, independent of the replicated effect of the R620W variant. Fifth, among the candidate genes selected for replication, the association of TCF7-P19T with T1D was newly replicated in this study. In summary, this study was able to replicate some genetic effects, reject others, and provide suggestions of association with several of the other candidate genes in stratified analyses (age at onset, HLA status, population of origin). These results have generated additional interesting functional hypotheses that will require further replication in independent cohorts.

Insulin2 gene (Ins2) transcription by NOD bone marrow-derived cells does not influence autoimmune diabetes development in NOD-Ins2 knockout mice

Insulin is a critical autoantigen for the development of autoimmune diabetes in non-obese diabetic (NOD) mice. About 80% of NOD females and 30-40% of NOD males develop diabetes. However, Insulin2 (Ins2) knockout NOD mice develop autoimmune diabetes with complete penetrance in both sexes, at an earlier age, and have stronger autoimmune responses to insulin. The severe diabetes phenotype observed in NOD-Ins2-/- mice suggests that lack of Ins2 expression in the thymus may compromise immunological tolerance to insulin. Insulin is a prototypical tissue specific antigen (TSA) for which tolerance is dependent on expression in thymus and peripheral lymphoid tissues. TSA are naturally expressed by medullary thymic epithelial cells (mTEC), stromal cells in peripheral lymphoid tissues and bone marrow (BM)-derived cells, mainly CD11c(+) dendritic cells. The natural expression of TSA by mTEC and stromal cells has been shown to contribute to self-tolerance. However, it is unclear whether this also applies to BM-derived cells naturally expressing TSA. To address this question, we created BM chimeras and investigated whether reintroducing Ins2 expression solely by NOD BM-derived cells delays diabetes development in NOD-Ins2-/- mice. On follow-up, NOD-Ins2-/- mice receiving Ins2-expressing NOD BM cells developed diabetes at similar rates of those receiving NOD-Ins2-/- BM cells. Diabetes developed in 64% of NOD recipients transplanted with NOD BM and in 47% of NOD mice transplanted with NOD-Ins2-/- BM (P = ns). Thus, NOD-Ins2-/- BM did not worsen diabetes in NOD recipients and Ins2 expression by NOD BM-derived cells did not delay diabetes development in NOD-Ins2-/- mice.

Insulin protein and proliferation in ductal cells in the transplanted pancreas of patients with type 1 diabetes and recurrence of autoimmunity

AIM/HYPOTHESIS

We investigated whether beta cell neoformation occurs in the transplanted pancreas in patients with type 1 diabetes who had received a simultaneous pancreas-kidney transplant (SPK) and later developed recurrence of autoimmunity.

METHODS

We examined pancreas transplant biopsies from nine SPK patients with or without recurrent autoimmunity or recurrent diabetes and from 16 non-diabetic organ donors. Tissues were analysed by immunohistochemistry and immunofluorescence.

RESULTS

Numerous cytokeratin-19 (CK-19)(+) pancreatic ductal cells stained for insulin in six SPK recipients with recurrent autoimmunity, in five of whom diabetes requiring insulin therapy recurred. These cells also stained for the transcription factor pancreatic-duodenal homeobox-1 (Pdx-1), which is implicated in pancreatic development and beta cell differentiation. The number of insulin(+) ductal cells varied, being highest in the patient with the most severe beta cell loss and lowest in the normoglycaemic patient. In the patient with the most severe beta cell loss, we detected insulin(+)CK-19(+)Pdx-1(+) cells staining for the proliferation-related Ki-67 antigen (Ki-67), indicating proliferation. We were unable to detect Ki-67(+) beta cells within the islets in any SPK patient. Some insulin(+)CK-19(-) ductal cells contained chromogranin A, suggesting further endocrine differentiation. Insulin(+) cells were rarely noted in the pancreas transplant ducts in three SPK patients without islet autoimmunity and in six of 16 non-diabetic organ donors; these insulin(+) cells were never CK-19(+).

CONCLUSIONS/INTERPRETATION

Insulin(+) pancreatic ductal cells, some apparently proliferating, were found in the transplanted pancreas with recurrent islet autoimmunity/diabetes. Replicating beta cells were not detected within islets. The observed changes may represent attempts at tissue remodelling and beta cell regeneration involving ductal cells in the human transplanted pancreas, possibly stimulated by hyperglycaemia and chronic inflammation.

Combined islet and hematopoietic stem cell allotransplantation: a clinical pilot trial to induce chimerism and graft tolerance

To prevent graft rejection and avoid immunosuppression-related side-effects, we attempted to induce recipient chimerism and graft tolerance in islet transplantation by donor CD34+hematopoietic stem cell (HSC) infusion. Six patients with brittle type 1 Diabetes Mellitus received a single-donor allogeneic islet transplant (8611 +/- 2113 IEQ/kg) followed by high doses of donor HSC (4.3 +/- 1.9 x 10(6) HSC/kg), at days 5 and 11 posttransplant, without ablative conditioning. An 'Edmonton-like' immunosuppression was administered, with a single dose of anti-TNFalpha antibody (Infliximab) added to induction. Immunosuppression was weaned per protocol starting 12 months posttransplant. After transplantation, glucose control significantly improved, with 3 recipients achieving insulin-independence for a short time (24 +/- 23 days). No severe hypoglycemia or protocol-related adverse events occurred. Graft function was maximal at 3 months then declined. Two recipients rejected within 6 months due to low immunosuppressive trough levels, whereas 4 completed 1-year follow-up with functioning grafts. Graft failure occurred within 4 months from weaning (478 +/- 25 days posttransplant). Peripheral chimerism, as donor leukocytes, was maximal at 1-month (5.92 +/- 0.48%), highly reduced at 1-year (0.20 +/- 0.08%), and was undetectable at graft failure. CD25+T-lymphocytes significantly decreased at 3 months, but partially recovered thereafter. Combined islet and HSC allotransplantation using an 'Edmonton-like' immunosuppression, without ablative conditioning, did not lead to stable chimerism and graft tolerance.

Type 1 diabetic serum interferes with pancreatic beta-cell Ca2+-handling

The aim of this study was to clarify the frequency of patients with type 1 diabetes that have serum that increases pancreatic beta-cell cytoplasmic free Ca(2+) concentration, [Ca(2+)](i), and if such an effect is also present in serum from first-degree relatives. We also studied a possible link between the serum effect and ethnic background as well as presence of autoantibodies. Sera obtained from three different countries were investigated as follows: 82 Swedish Caucasians with newly diagnosed type 1 diabetes, 56 Americans with different duration of type 1 diabetes, 117 American first-degree relatives of type 1 diabetic patients with a mixed ethnic background and 31 Caucasian Finnish children with newly diagnosed type 1 diabetes. Changes in [Ca(2+)](i) , upon depolarization, were measured in beta-cells incubated overnight with sera from type 1 diabetic patients, first-degree relatives or healthy controls. Our data show that there is a group constituting approximately 30% of type 1 diabetic patients of different gender, age, ethnic background and duration of the disease, as well as first-degree relatives of type 1 diabetic patients, that have sera that interfere with pancreatic beta-cell Ca(2+)-handling. This effect on beta-cell [Ca(2+)](i) could not be correlated to the presence of autoantibodies. In a defined subgroup of patients with type 1 diabetes and first-degree relatives a defect Ca(2+)-handling may aggravate development of beta-cell destruction.