Knowledge of sexual consent as a protective factor against sexual violence perpetration among first-year college men: a moderation analysis

This study examined whether knowledge of sexual consent buffers the relationship between risk factors for sexual violence (SV) and SV perpetration among first-year college men. The study data were drawn from a longitudinal study with 1144 first-year college men. A series of generalized linear models were conducted to examine whether knowledge of sexual consent moderated the relationship between SV risk factors and SV perpetration. Knowledge of sexual consent moderated the effect of hypermasculinity (P < 0.001), binge drinking (P < 0.001), rape-supportive social norms (P = 0.007) and peer support for SV (P < 0.001) such that there was a positive association between risk factors and SV perpetration among those with lower, but not higher, knowledge of sexual consent. Knowledge of sexual consent did not significantly moderate the relationship between SV perpetration and outcome expectancies for non-consensual sex (P = 0.387) and pornography use (P = 0.494). Knowledge of sexual consent may counteract risk factors for SV perpetration among young college men. The findings highlight the need for consent education to be incorporated in youth comprehensive sexual education to increase knowledge of sexual consent prior to college and campus-based SV prevention programming delivered to college students.

Can machine learning augment clinician adjudication of events in cardiovascular trials? A case study of major adverse cardiovascular events (MACE) across CVRM trials

Background and introduction

Accurate identification of clinical outcome events is critical to obtaining reliable results in cardiovascular outcomes trials (CVOTs). Current processes for event adjudication are expensive and hampered by delays. As part of a larger project to more reliably identify outcomes, we evaluated the use of machine learning to automate event adjudication using data from the SOCRATES trial (NCT01994720), a large randomized trial comparing ticagrelor and aspirin in reducing risk of major cardiovascular events after acute ischemic stroke or transient ischemic attack (TIA).

Purpose

We studied whether machine learning algorithms could replicate the outcome of the expert adjudication process for clinical events of ischemic stroke and TIA. Could classification models be trained on historical CVOT data and demonstrate performance comparable to human adjudicators?

Methods

Using data from the SOCRATES trial, multiple machine learning algorithms were tested using grid search and cross validation. Models tested included Support Vector Machines, Random Forest and XGBoost. Performance was assessed on a validation subset of the adjudication data not used for training or testing in model development. Metrics used to evaluate model performance were Receiver Operating Characteristic (ROC), Matthews Correlation Coefficient, Precision and Recall. The contribution of features, attributes of data used by the algorithm as it is trained to classify an event, that contributed to a classification were examined using both Mutual Information and Recursive Feature Elimination.

Results

Classification models were trained on historical CVOT data using adjudicator consensus decision as the ground truth. Best performance was observed on models trained to classify ischemic stroke (ROC 0.95) and TIA (ROC 0.97). Top ranked features that contributed to classification of Ischemic Stroke or TIA corresponded to site investigator decision or variables used to define the event in the trial charter, such as duration of symptoms. Model performance was comparable across the different machine learning algorithms tested with XGBoost demonstrating the best ROC on the validation set for correctly classifying both stroke and TIA.

Conclusions

Our results indicate that machine learning may augment or even replace clinician adjudication in clinical trials, with potential to gain efficiencies, speed up clinical development, and retain reliability. Our current models demonstrate good performance at binary classification of ischemic stroke and TIA within a single CVOT with high consistency and accuracy between automated and clinician adjudication. Further work will focus on harmonizing features between multiple historical clinical trials and training models to classify several different endpoint events across trials. Our aim is to utilize these clinical trial datasets to optimize the delivery of CVOTs in further cardiovascular drug development.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): AstraZenca Plc

Myeloid cell interferon responses correlate with clearance of SARS-CoV-2

The emergence of mutant SARS-CoV-2 strains associated with an increased risk of COVID-19-related death necessitates better understanding of the early viral dynamics, host responses and immunopathology. While studies have reported immune profiling using single cell RNA sequencing in terminal human COVID-19 patients, performing longitudinal immune cell dynamics in humans is challenging. Macaques are a suitable model of SARS-CoV-2 infection. We performed longitudinal single-cell RNA sequencing of bronchoalveolar lavage (BAL) cell suspensions from adult rhesus macaques infected with SARS-CoV-2 (n=6) to delineate the early dynamics of immune cells changes. The bronchoalveolar compartment exhibited dynamic changes in transcriptional landscape 3 days post- SARS-CoV-2-infection (3dpi) (peak viremia), relative to 14-17dpi (recovery phase) and pre-infection (baseline). We observed the accumulation of distinct populations of both macrophages and T-lymphocytes expressing strong interferon-driven inflammatory gene signature at 3dpi. Type I IFN response was highly induced in the plasmacytoid dendritic cells. The presence of a distinct HLADR+CD68+CD163+SIGLEC1+ macrophage population exhibiting higher angiotensin converting enzyme 2 (ACE2) expression was also observed. These macrophages were significantly recruited to the lungs of macaques at 3dpi and harbored SARS-CoV-2, while expressing a strong interferon-driven innate anti-viral gene signature. The accumulation of these responses correlated with decline in viremia and recovery. The recruitment of a myeloid cell-mediated Type I IFN response is associated with the rapid clearance of SARS-CoV-2 infection in macaques.

0374 Decline in Habitual Sleep Duration Over 10 Years and Worsening Sleep Disparities: Data From NHIS (2006-2015)

Introduction

Despite claims in the media, evidence that habitual sleep has declined in recent years is scant. Few data sources exist that systematically document sleep duration in a nationally representative sample, in the same way, over several years.

Methods

Data from 10 years of the National Health Interview Survey were used (N=305,555). During all years, habitual sleep duration, age, sex, race/ethnicity, and height/weight were recorded in the same way. Weighted regression analyses examined sleep duration as the outcome, year as linear predictor, and sociodemographics as covariates. Then, interaction terms examined whether the linear change associated with years was differentially experienced by different sociodemographic groups.

Results

The linear trend of sleep duration over the past 10 years is a loss of 0.78 minutes per year (95%CI -0.91,-0.64; p&lt;0.0001). After adjustment for age, sex, race/ethnicity and BMI, this remained relatively unchanged at 0.86 minutes (95%CI -0.99,-0.73; p&lt;0.0001). A year-by-race/ethnicity interaction was observed (p&lt;0.05). In stratified analyses, Non-Hispanic Whites showed a loss of 0.68 minutes per year (95%CI -0.84,-0.52, p&lt;0.0001). This was 1.33 minutes/year in Blacks/African-Americans (95%CI -1.74,-0.92; p&lt;0.0001), 1.57 minutes/year in Mexican-Americans (95%CI -1.98,-1.16; p&lt;0.0001), 0.99 minutes/year in other Hispanics/Latinos (95%CI -1.51,-0.47; p&lt;0.0001), 0.74 minutes/year in Asians (95%CI -1.24,-0.25; p=0.003), and 1.80 minutes/year in American Indians/Alaskan Natives (95%CI -3.57,-0.03, p=0.046).

Conclusion

On average, the US population has lost 47 seconds of nightly sleep per year over a 10-year period, equating to about 4.7 hours of sleep per year, but racial/ethnic groups were impacted differently. Compared to Non-Hispanic Whites, Blacks/African-Americans lost 96% more sleep, Mexicans lost 131% more sleep, other Hispanics/Latinos lost 46% more sleep, Asians lost 9% more sleep, and American Indians lost 165% more sleep. Thus, sleep disparities may be widening.

Support

Dr. Grandner is supported by R01MD011600

C-C motif chemokine receptor 2 drives protective immunity by mediating alveolar macrophage localization in tuberculosis granulomas

C-C motif chemokine receptor 2 (CCR2) axis is a major chemokine axis that recruits myeloid cells including monocytes and macrophages. Thus far, CCR2−/− mice have not been found to be more susceptible to infection with Euro-American lineage 4 strains of Mycobacterium tuberculosis (Mtb). Here, using a prototype W-Beijing family lineage 2 clinical Mtb strain, HN878, we show that CCR2−/− mice exhibit increased susceptibility to tuberculosis (TB). Following exposure to Mtb HN878, alveolar macrophages (AMs) are amongst the earliest cells infected. Using a novel labeling technique, we show that AMs accumulate early in the airways following Mtb HN878 infection and express CCR2. During disease progression, CCR2-expressing AMs exit the airways and localize within the TB granulomas to mediate protective immunity. RNA-sequencing of sorted airway and non-airway AMs show distinct gene expression profiles, suggesting that upon exit from airways, AMs become classically activated. Furthermore, absence of CCR2+ cells specifically at the time of AM egress from the airways resulted in enhanced susceptibility to Mtb infection, increased accumulation of neutrophils, and loss of Mtb control. Interestingly, we provide new evidence that infection with an Mtb strain HN878 mutant lacking phenolic glycolipid (PGL) expression still resulted in increased susceptibility in CCR2−/− mice. Together, our data provide novel evidence for a critical protective role for CCR2 in AM localization within the TB granulomas to mediate protective immunity against clinically relevant and emerging Mtb infections.

Yin and yang of interleukin-17 in host immunity to infection

The interleukin-17 (IL-17) family cytokines, such as IL-17A and IL-17F, play important protective roles in host immune response to a variety of infections such as bacterial, fungal, parasitic, and viral. The IL-17R signaling and downstream pathways mediate induction of proinflammatory molecules which participate in control of these pathogens. However, the production of IL-17 can also mediate pathology and inflammation associated with infections. In this review, we will discuss the yin-and-yang roles of IL-17 in host immunity to pathogens.

Itaconate Links Inhibition of Succinate Dehydrogenase with Macrophage Metabolic Remodeling and Regulation of Inflammation

Remodeling of the tricarboxylic acid (TCA) cycle is a metabolic adaptation accompanying inflammatory macrophage activation. During this process, endogenous metabolites can adopt regulatory roles that govern specific aspects of inflammatory response, as recently shown for succinate, which regulates the pro-inflammatory IL-1β-HIF-1α axis. Itaconate is one of the most highly induced metabolites in activated macrophages, yet its functional significance remains unknown. Here, we show that itaconate modulates macrophage metabolism and effector functions by inhibiting succinate dehydrogenase-mediated oxidation of succinate. Through this action, itaconate exerts anti-inflammatory effects when administered in vitro and in vivo during macrophage activation and ischemia-reperfusion injury. Using newly generated Irg1(-/-) mice, which lack the ability to produce itaconate, we show that endogenous itaconate regulates succinate levels and function, mitochondrial respiration, and inflammatory cytokine production during macrophage activation. These studies highlight itaconate as a major physiological regulator of the global metabolic rewiring and effector functions of inflammatory macrophages.

Mucosal vaccination with an attenuated strain of Mycobacterium tuberculosis induces a strong central memory response and protects non-human primates against lethal challenge (VAC4P.1104)

There is an urgent need for new vaccine(s) that protect efficiently against Mycobacterium tuberculosis (Mtb), as well as, to better understand the correlates of a protective host response to Mtb infection. Aerosol infection of macaques with the redox-stress deficient mutant, Mtb:Δ-sigH, resulted in the recruitment of significantly more inducible bronchus-associated lymphoid tissue, which is associated with protection from Mtb infection in mice, macaques, and humans. We therefore hypothesized that vaccination with Mtb:Δ-sigH could protect against a lethal Mtb challenge significantly better than a comparable Bacille Calmette-Guerin (BCG) vaccination. A single vaccination of the aerosol delivered, live-attenuated strain completely protected macaques from lethal Mtb challenge. Protection was associated with three-to-four log lower bacterial burden, significantly reduced granulomatous pathology and clinical features of Mtb infection, as well as, a strong T cell central memory response when compared to BCG-vaccinated animals. A higher magnitude, as well as, breadth of polyfunctional T cell responses was detected in the Mtb:Δ-sigH vaccinated animals. This includes an increased recruitment and turnover of central and effector T cells in the lung post vaccination compared to BCG-vaccinated animals. These results point to the protective qualities induced by a live-attenuated mucosal vaccine for protection against lethal Mtb challenge, and its future in TB vaccine initiatives.

Safety and efficacy of biphasic insulin aspart 30 in type 2 diabetes patients switched from either biphasic or basal human insulin: results from the Gulf cohort of the A1 chieve study

AIM

The 24-week, international, non-interventional A1 chieve study aimed to evaluate the safety and efficacy of insulin analogues in type 2 diabetes (T2D) in different countries. This sub-analysis reports results for T2D patients who switched from either biphasic human insulin (BHI) or human neutral protamine Hagedorn (NPH) insulin to biphasic insulin aspart 30 (BIAsp 30) in the Gulf cohort.

METHODS

Gulf patients with T2D who switched to BIAsp 30 from either BHI or NPH insulin were included. Safety and efficacy measurements were made by the physicians as part of routine clinical care.

RESULTS

A total of 1486 patients switched from BHI to BIAsp 30 (BIP group) and 232 patients switched from NPH insulin to BIAsp 30 (NEU group). Baseline glycated haemoglobin A1c (HbA₁c ) was poor in patients in the BIP and NEU groups (mean value ± SD: 9.4 ± 1.8% and 9.7 ± 1.5%, respectively). Significant reductions in the proportion of patients reporting hypoglycaemia (overall, major, minor and nocturnal) were noted in the BIP group after 24 weeks of BIAsp 30 therapy (p < 0.001). No major hypoglycaemic events were reported at Week 24 in the NEU group. In both groups, the mean HbA1c , fasting plasma glucose and postprandial plasma glucose improved significantly after 24 weeks of BIAsp 30 therapy (p < 0.001). The mean body weight, lipid parameters and systolic blood pressure also improved significantly in both groups (p < 0.05).

CONCLUSION

BIAsp 30 therapy enhanced glycaemic control over 24 weeks and was well-tolerated in T2D patients poorly controlled on prestudy BHI or NPH insulin.

MDSC-derived and TIL-endogenous NO plays a crucial role in the induction and stability of Th17 cells in human ovarian cancer (TUM4P.915)

Intratumoral Th17 numbers and local production of IL-17 have been shown to positively correlate with survival of ovarian cancer (OvCa) patients. We demonstrate that the tumor-associated expression of IL-17A in OvCa patients positively correlates with the expression of NOS-2. Our data indicate that the nitric oxide synthase-2 (NOS2/iNOS)- driven NO produced by patients’ myeloid-derived suppressor cells (MDSCs) promotes the development of RORgt(Rorc)+IL-23R+IL-17+ Th17 cells. In addition to the positive impact of the exogenous (MDSC-produced) NO, we show that the development of Th17 cells from naive-, memory-, or tumor-infiltrating CD4+ T cells, driven by IL-1β/IL-6/IL-23/NO-producing MDSCs or by recombinant cytokines (IL-1β/IL-6/IL-23), is associated with the induction of endogenous NOS2 and NO production, and critically depends on NOS2 activity within CD4+ T cells. Inhibition of NOS2 activity or the canonical cGMP/cGK pathway of NO signaling abolishes the de novo induction of Th17 cells and selectively suppresses IL-17 production by established Th17 cells isolated from OvCa patients. The current results provide rationale for targeting NO, NOS2, cGMP, and cGK as new targets to manipulate Th17 responses in cancer.

Induction and stability of human Th17 cells require endogenous NOS2 and cGMP-dependent NO signaling

Nitric oxide (NO) is a ubiquitous mediator of inflammation and immunity, involved in the pathogenesis and control of infectious diseases, autoimmunity, and cancer. We observed that the expression of nitric oxide synthase-2 (NOS2/iNOS) positively correlates with Th17 responses in patients with ovarian cancer (OvCa). Although high concentrations of exogenous NO indiscriminately suppress the proliferation and differentiation of Th1, Th2, and Th17 cells, the physiological NO concentrations produced by patients’ myeloid-derived suppressor cells (MDSCs) support the development of RORγt(Rorc)+IL-23R⁺IL-17⁺ Th17 cells. Moreover, the development of Th17 cells from naive-, memory-, or tumor-infiltrating CD4+ T cells, driven by IL-1β/IL-6/IL-23/NO-producing MDSCs or by recombinant cytokines (IL-1β/IL-6/IL-23), is associated with the induction of endogenous NOS2 and NO production, and critically depends on NOS2 activity and the canonical cyclic guanosine monophosphate (cGMP)–cGMP-dependent protein kinase (cGK) pathway of NO signaling within CD4⁺ T cells. Inhibition of NOS2 or cGMP–cGK signaling abolishes the de novo induction of Th17 cells and selectively suppresses IL-17 production by established Th17 cells isolated from OvCa patients. Our data indicate that, apart from its previously recognized role as an effector mediator of Th17-associated inflammation, NO is also critically required for the induction and stability of human Th17 responses, providing new targets to manipulate Th17 responses in cancer, autoimmunity, and inflammatory diseases.

CXCR5-CXCL-13-pathway in protective immunity to tuberculosis (P3190)

One third of the world’s population is infected with Mycobacterium tuberculosis (Mtb). Although most infected people remain asymptomatic, they have a 10% lifetime risk of developing active tuberculosis (TB). Thus, the current challenge is to identify immune parameters that distinguish individuals with latent TB from those with active TB. Using human and experimental models of Mtb infection, we show that organized ectopic lymphoid structures containing CXCR5+ T cells are found in Mtb-infected lungs. In addition, we show that in experimental Mtb infection models, the presence of CXCR5+ T cells inside ectopic lymphoid structures are associated with immune control. Furthermore, in a mouse model of Mtb infection, we show that activated CD4+ CXCR5+ T cells accumulate in Mtb-infected lungs, and produce proinflammatory cytokines. Absence of CXCR5 results in increased susceptibility to TB due to defective T cell localization within the lung parenchyma. We show that CXCR5 expression on T cells mediates correct T cell localization within TB granulomas, efficient macrophage activation, promoting protection against Mtb infection and facilitating lymphoid follicle formation. We also show that inducing T helper 17 (Th17) memory responses using mucosal immunization strategies improves vaccine-induced immunity against TB highlighting the potential use of IL-17-CXCR5-CXCL-13 axis in future TB vaccine design and therapy.

Th17 cells confer long-term adaptive immunity to oropharyngeal candidiasis (P3308)

Oropharyngeal candidiasis (OPC) is an opportunistic infection of the oral cavity caused primarily by Candida albicans. OPC particularly afflicts HIV+ patients with low CD4 counts, suggesting a role for CD4+ T cells in host defense. Experimental models of OPC have strongly suggested that immunity to OPC is IL-17-dependent, and humans with rare genetic defects that result in Th17 deficiency are associated with the development of OPC. However, other sources of IL-17 have been described, particularly in the innate compartment, but the relative contribution of adaptive and innate sources of IL-17 during OPC has not been well articulated. Here, we showed that development of adaptive immune responses in OPC results in a ~1 log decrease in fungal burden, tightly associated with an increased frequency of antigen-specific CD4+IL-17+ (Th17) cells. Importantly, adoptive transfer of Candida-primed Th17 cells into Rag1-/- mice resulted in protection from disease. Surprisingly, however, CD4-/- mice were resistant to OPC, which was linked, at least in part, with compensatory IL-17 production by both CD8+ and double-negative (DN) T cells. The adoptive transfer of CD8+IL-17+ or DN cells into Rag1-/- mice resulted in protection from OPC. Therefore, Th17 cells contribute to C. albicans clearance but their absence can be compensated by alternative sources of IL-17. These findings implicate CD8+IL-17+ and DN cells as vaccine targets in immunocompromised populations.

Normative data and psychometric properties of short form 36 health survey (SF-36, version 1.0) in the population of north Jordan

This study aimed to assess the psychometric properties of the short form 36 health survey (SF-36, version 1.0) and to establish SF-36 population norms among the general population of north Jordan. A systematic sample of 157 households was selected from 6 districts in Irbid governorate in north Jordan. A total of 511 people aged 18 years or more agreed to participate. The reliability of the instrument using the Arabic version of SF-36 was satisfactory: Cronbacha o alphas for all 8 SF-36 scales exceeded 0.70. All items passed the tests for item internal consistency and item discriminant validity. SF-36 population norms amongthe general population of north Jordan were established. The highest mean was for social functioning (66.8) among men and for physical functioning (69.8) among women. The lowest mean was for vitality (55.8) among men and bodily pain (54.6) among women. The SF-36 is a valid and reliable instrument for measuring quality of life among Jordanians.

IL-23 is required for long-term control of Mycobacterium tuberculosis and B cell follicle formation in the infected lung. (150.1)

IL-23 is required for effective IL-17 responses to aerosol infection with Mycobacterium tuberculosis (Mtb), however it does not appear to impact early control of bacterial growth in the lung. By extending the time course of infection using mice deficient for the p19 component of the IL-23 cytokine, we report that there is increased bacterial growth in the lungs of these mice compared to wild type infected mice. This increased bacterial growth is associated with decreased maintenance of B cell follicles within lungs of infected mice. While mRNA expression for molecules associated with limiting bacterial growth such as Interferon gamma (IFNγ) were equivalent between wild type and IL-23p19 deficient mice, reduced expression of both IL-17 and IL-22 mRNA was observed in IL-23p19 deficient Mtb-infected lungs. Importantly, we show that in mice deficient for IL-23p19, B cell follicle size was reduced during chronic Mtb infection and this was temporally associated with the increased bacterial burden. In mice deficient in the IL-17 receptor (IL-17R), B cell follicle generation was affected early in infection whereas the absence of IL-22 influenced the size of B cell follicles in the mid-term. Interestingly, the absence of IL-22 or IL-17R alone did not impact bacterial control. Thus, we show novel data that while IL-23 is required for long term control of Mtb growth in the lung, there is a compensatory effect of IL-22 and IL-17 during tuberculosis.

Interleukin-17 overcomes inhibition of Th1 immune responses following mycobacterial exposure (168.2)

Tuberculosis (TB) caused by the intracellular pathogen Mycobacterium tuberculosis, remains a worldwide health problem. Generation of effective T helper cell type 1 (Th1) responses are required for immunity against intracellular bacteria. However, multiple bacteria successfully inhibit the direct pathway of induction of Th1 responses, promoting the production of factors such as prostaglandin E2 (PGE2) and interleukin (IL-10), that suppress IL-12 and interferon gamma (IFNγ) production. Here, in a model of Mycobacterium bovis Bacille Calmette Guerin (BCG) vaccination, we demonstrate that a nominal Th1-suppresive factor, PGE2, can promote an alternative pathway of induction of Th1 immunity that is mediated by IL-23-dependent IL-17 induction. We show that PGE2 limits early Th1 responses via IL-10 production but also drives Th17 responses via IL-23 production. IL-17 then functions to overcome PGE2-IL-10-mediated Th1 inhibition and drive Th1 immunity following BCG exposure. Therefore, we demonstrate that PGE2-induced IL-17 response allows overcoming BCG-induced PGE2- and IL-10-mediated inhibition of IL-12 production and Th1 responses. The currently described alternative IL-17-dependent pathway of induction of Th1 immunity helps to understand the complex role of PGE2 in the regulation of immune responses and helps to design new therapeutic approaches in chronic intracellular infections.

The compositional organization of Mycobacterium tuberculosis granulomas is analogous to ectopic lymphoid organs (40.2)

Secondary lymphoid organs (SLOs) are integral in generating an effective adaptive immune response. Homing of cells to SLOs is a result of homeostatic chemokines, such as CXCL13. CXCL13, the ligand for CXCR5, is responsible for the recruitment of germinal center cells including B cells, T follicular helper (Tfh) cells and follicular dendritic cells (FDCs). Recently, CXCL13 has been reported in the lungs of mice following infection with Mycobacterium tuberculosis (Mtb). We found CXCL13 to be localized within the granuloma in both mice and human lungs as early as day 22 post infection in mice. In addition, we found Tfh cells, B cells, and FDCs localized within the granuloma of mice and humans. Recruitment of Tfh cells was seen in the draining lymph nodes by day 15 with accumulation in the lung by day 21 in Mtb infected mice. Infiltration of Tfh cells in the lung coincided with an increase in mRNA for known Tfh factors such as ICOS, BCL-6, IL-6 and IL-21, which followed upregulation of CXCL13 at day 18. Interestingly, another CXCR5+ population infiltrated the lung prior to accumulation of Tfh cells. These cells accumulate at day 12 and express surface markers suggestive of a monocyte lineage. Further, CXCR5-/- mice are more susceptible to Mtb infection by day 21. Our data suggest that the Mtb granuloma may function as an ectopic lymphoid organ, which may require involvement of CXCR5+ cells to elicit protective immunity.

IL-17 is critical for the generation of protective Th1 immunity against intracellular pathogens (45.1)

The importance of T helper type 1 (Th1) cell immunity in host resistance to the intracellular pathogens is well established. However, the relative roles of Interleukin (IL)-12-Th1 and IL-23-T helper type 17 (Th17) cell responses in immunity to intracellular pathogens is not well described. The IL-23-Th17 pathway is critical for protective immunity against extracellular bacterial infections. In contrast, the IL-23-Th17 pathway is dispensable for protection against intracellular pathogens such as Mycobacterium tuberculosis and Listeria. However, our data suggest that IL-17 regulates the Th1 pathway and is required for protective immunity against some intracellular pathogens such as Francisella tularensis Live Vaccine Strain and M.bovis BCG. IL-23-dependent IL-17 induces IL-12 in myeloid cells and is required for the generation of IFNγ producing adaptive immune responses. These findings illustrate a novel biological function for IL-17 in regulating IL-12-Th1 immunity and host responses against intracellular pathogens.

Novel IL-17–producing memory cells are key to vaccine-based protective immunity against M.tuberculosis challenge (45.12)

Interferon-gamma (IFNγ) is essential for limiting Mycobacterium tuberculosis infection. Using the mouse model, we have recently shown that vaccination triggered accelerated Interleukin-17 (IL-17) and IFNγ responses by CD4+ T cells in the lung during M. tuberculosis aerosol challenge. We propose that vaccination induces IL-17- producing CD4+ T cells that populate the lung and, after challenge, trigger the production of chemokines. The induction of chemokines results in recruitment of IFNγ-producing CD4+ T cells from the lymphoid compartment and ultimately restricts bacterial growth. The differential ability of IL-17-producing memory cells to populate the lung compared to the IFN-γ-producing cells suggests that these two cell types differ in their ability to migrate in response to chemokines. In support of this, our data using adoptive transfer models and chemotaxis assays suggests that differential responsiveness to chemokines and retention in different organs may provide the basis for the differential tissue distribution of these two cell types. During progression from effector to memory T cells, we also show differential expression of activation markers on IL17-producing and IFNγ-producing T cells. This information will lead us to determine whether altering the nature of the lung-resident IL-17 producing population impacts protective efficacy of the recall response to M.tuberculosis challenge.

This work was supported by AI075106-01 and Children's Hospital of Pittsburgh.

Stroke rehabilitation: application and analysis of the modified Barthel index in an Arab community

PURPOSE

The primary aim was to provide experience with a functional evaluation instrument (modified Barthel index MBI) that assures the quality of work and identify its deficiencies, familiarize our staff with the feasibility of its application on our local inpatients and educate our personnel in the field of stroke rehabilitation. The secondary aim was to collect data that are measurable and reproducible, identify specific local factors that adversely affect outcomes and serve as a feedback system to our national organizations.

METHODS

In this prospective/retrospective study we evaluated 80 hemiplegic patients with completed stroke, admitted to hospital during the year 1989 1990. They were assessed by a neurologist, physiatrist and physiotherapist on admission and discharge using the MBI. All patients received comprehensive inpatient rehabilitation. The study was interrupted at the beginning of the Gulf crisis. However, the data were revived and retrospectively studied in the year 1994-1995.

RESULTS

The MBI proved to be fully acceptable and easily applicable in our community. The rehabilitation staff became rapidly familiarized with its application and the reproduction of its data. The goals of rehabilitation were achieved through the reduction in the number of individuals in the more severe MBI scores and the increase in the number of individuals in the less severe ones. Significant improvements occurred in dressing of the upper and lower body, washing, grooming, care of perineum, transfer chair, toilet and walking on a level of 50 yards (p < or = 0.0005).

CONCLUSIONS

We conclude that MBI is simple, convenient, efficient, gives exact and accurate information about daily activities and ambulation and could be used in inpatient follow up sittings, in the Arab and culturally similar Middle East countries.

Metabolism of twelve herbicides by Streptomyces

Experiments were conducted to assess the ability of Streptomyces (strain PS1/5) to metabolize twelve herbicides representing several different classes including: acetanilides, triazines, ureas, uracils, and imidazoles. Incubations in aqueous culture with dextrin as carbon source and either ammonium or Casamino acids as nitrogen source resulted in transformations (> 50%) of eight of the herbicides tested: alachlor, metolachlor, atrazine, prometryne, ametryne, linuron, tebuthiuron, and bromacil; the remaining four herbicides (cyanazine, diuron, metribuzin, and imazapyr) were also transformed, but to a lesser extent. In most instances, biotransformations occurred concurrently with growth and results were consistent regardless of the nitrogen source (ammonium vs. Casamino acids). However, in some instances there were differences in rates of biotransformation as a consequence of the nitrogen source (e.g. alachlor, metribuzin), suggesting the selective induction of certain metabolic enzymes; in other instances biotransformations were not associated with growth, suggesting secondary metabolism. An experiment was also conducted to assess the ability of Streptomyces (strain PS1/5) to metabolize atrazine contaminated soil. Inoculation of soil amended with 20 micrograms/g of atrazine and 5% chitin as carbon source resulted in ca. 78% removal of atrazine within 28 days. These data suggest that Streptomyces species may be potential candidates for soil inoculation to bioremediate herbicide contaminated soils.