MAL protein controls protein sorting at the supramolecular activation cluster of human T lymphocytes.

T cell membrane receptors and signaling molecules assemble at the immunological synapse (IS) in a supramolecular activation cluster (SMAC), organized into two differentiated subdomains: the central SMAC (cSMAC), with the TCR, Lck, and linker for activation of T cells (LAT), and the peripheral SMAC (pSMAC), with adhesion molecules. The mechanism of protein sorting to the SMAC subdomains is still unknown. MAL forms part of the machinery for protein targeting to the plasma membrane by specialized mechanisms involving condensed membranes or rafts. In this article, we report our investigation of the dynamics of MAL during the formation of the IS and its role in SMAC assembly in the Jurkat T cell line and human primary T cells. We observed that under normal conditions, a pool of MAL rapidly accumulates at the cSMAC, where it colocalized with condensed membranes, as visualized with the membrane fluorescent probe Laurdan. Mislocalization of MAL to the pSMAC greatly reduced membrane condensation at the cSMAC and redistributed machinery involved in docking microtubules or transport vesicles from the cSMAC to the pSMAC. As a consequence of these alterations, the raft-associated molecules Lck and LAT, but not the TCR, were missorted to the pSMAC. MAL, therefore, regulates membrane order and the distribution of microtubule and transport vesicle docking machinery at the IS and, by doing so, ensures correct protein sorting of Lck and LAT to the cSMAC.

Effects of manidipine and its combination with an ACE inhibitor on insulin sensitivity and metabolic, inflammatory and prothrombotic markers in hypertensive patients with metabolic syndrome: the MARCADOR study.

BACKGROUND AND OBJECTIVE: Metabolic syndrome is common in patients with hypertension and increases the risk of developing diabetes mellitus. The objective of this study (the MARCADOR study) was to compare the effects of manidipine 20 mg with the extemporary combination of manidipine 10 mg/lisinopril 10 mg, amlodipine 10 mg and telmisartan 80 mg on insulin sensitivity, as well as metabolic, inflammatory and prothrombotic markers, in hypertensive non-diabetic patients with metabolic syndrome. METHODS: This study had a prospective, randomized, open-label, blinded endpoint (PROBE) design. A total of 120 patients aged 35-75 years with stage I-II essential hypertension (systolic blood pressure [BP] 140-179 mmHg, diastolic BP 90-109 mmHg) and metabolic syndrome were recruited from general practitioner clinics in Northern Gran Canaria Island, Spain and randomized to receive amlodipine 10 mg (n = 30), telmisartan 80 mg (n = 30), manidipine 20 mg (n = 30) or (low-dose) manidipine 10 mg/lisinopril 10 mg (n = 30), all administered once daily. At baseline and after 14 weeks of treatment, BP, insulin sensitivity, lipid profile, and albumin and metanephrin excretion as well as several other metabolic, inflammatory, prothrombotic and growth/adhesion markers were measured. The primary endpoint was the change in insulin sensitivity. RESULTS: A total of 115 patients completed the study. All treatments significantly lowered BP from baseline. Compared with amlodipine, manidipine had significantly superior effects (p < 0.05) on insulin resistance (-26.5% vs -3.0%), albumin/creatinine ratio (-28.2% vs -3.6%), low-density lipoprotein (LDL) cholesterol (-6.8% vs +1.7%), and several other metabolic, inflammatory and prothrombotic markers. Manidipine was associated with a slightly greater increase in insulin sensitivity than manidipine/lisinopril, but manidipine/lisinopril was significantly more effective than manidipine and telmisartan for improving a number of metabolic, inflammatory, prothrombotic and growth/adhesion markers. Amlodipine was associated with a significantly greater incidence of adverse effects compared with telmisartan, manidipine and manidipine/lisinopril (26.7% vs 3.3%, 3.3% and 13.3%, respectively). CONCLUSION: In patients with hypertension and metabolic syndrome, manidipine, both alone and in combination with the ACE inhibitor lisinopril, is significantly superior to amlodipine for improving insulin sensitivity as well as several metabolic, inflammatory and prothrombotic markers. Furthermore, the combination of manidipine and lisinopril appears to have greater efficacy than manidipine alone and telmisartan with respect to the improvement of metabolic, inflammatory and prothrombotic markers.

MT1-MMP collagenolytic activity is regulated through association with tetraspanin CD151 in primary endothelial cells.

MT1-MMP plays a key role in endothelial function, as underscored by the angiogenic defects found in MT1-MMP deficient mice. We have studied the molecular interactions that underlie the functional regulation of MT1-MMP. At lateral endothelial cell junctions, MT1-MMP colocalizes with tetraspanin CD151 (Tspan 24) and its associated partner alpha3beta1 integrin. Biochemical and FRET analyses show that MT1-MMP, through its hemopexin domain, associates tightly with CD151, thus forming alpha3beta1 integrin/CD151/MT1-MMP ternary complexes. siRNA knockdown of HUVEC CD151 expression enhanced MT1-MMP-mediated activation of MMP2, and the same activation was seen in ex vivo lung endothelial cells isolated from CD151-deficient mice. However, analysis of collagen degradation in these experimental models revealed a diminished MT1-MMP enzymatic activity in confined areas around the cell periphery. CD151 knockdown affected both MT1-MMP subcellular localization and its inclusion into detergent-resistant membrane domains, and prevented biochemical association of the metalloproteinase with the integrin alpha3beta1. These data provide evidence for a novel regulatory role of tetraspanin microdomains on the collagenolytic activity of MT1-MMP and indicate that CD151 is a key regulator of MT1-MMP in endothelial homeostasis.

Comparison of two recombinant erythropoietin formulations in patients with anemia due to end-stage renal disease on hemodialysis: a parallel, randomized, double blind study.

BACKGROUND: Recombinant human erythropoietin (EPO) is used for the treatment of last stage renal anemia. A new EPO preparation was obtained in Cuba in order to make this treatment fully nationally available. The aim of this study was to compare the pharmacokinetic, pharmacodynamic and safety properties of two recombinant EPO formulations in patients with anemia due to end-stage renal disease on hemodialysis. METHODS: A parallel, randomized, double blind study was performed. A single 100 IU/Kg EPO dose was administered subcutaneously. Heberitro (Heber Biotec, Havana, formulation A), a newly developed product and Eprex (CILAG AG, Switzerland, formulation B), as reference treatment were compared. Thirty-four patients with anemia due to end-stage renal disease on hemodialysis were included. Patients had not received EPO previously. Serum EPO level was measured by enzyme immunoassay (EIA) during 120 hours after administration. Clinical and laboratory variables were determined as pharmacodynamic and safety criteria until 216 hours. RESULTS: Both groups of patients were similar regarding all demographic and baseline characteristics. EPO kinetics profiles were similar for both formulations; the pharmacokinetic parameters were very close (i.e., AUC: 4667 vs. 4918 mIU.h/mL; Cmax: 119.1 vs. 119.7 mIU/mL; Tmax: 13.9 vs. 18.1 h; half-life, 20.0 vs. 22.5 h for formulations A and B, respectively). The 90% confidence intervals for the ratio between both products regarding these metrics were close to the 0.8-1.25 range, considered necessary for bioequivalence. Differences did not reach 20% in any case and were not determined by a formulation effect, but probably by a patients' variability effect. Concerning pharmacodynamic features, a high similitude in reticulocyte counts increments until 216 hours and the percentage decrease in serum iron until 120 hours was observed. There were no differences between formulations regarding the adverse events and their intensity. The more frequent events were pain at injection site (35.3%) and hypertension (29%). Additionally, further treatment of the patients with the study product yielded satisfactory increases in hemoglobin and hematocrit values. CONCLUSION: The formulations are comparable. The newly developed product should be acceptable for long-term application.

Efectividad y seguridad del uso de ior® EPOCIM en pacientes en prediálisis Ensayo clínico / Effectiveness and safety in the use of ior® EPOCIM in predialysis patients:Clinical trial

Introducción: El ior® EPOCIM (eritropoyetina humana recombinante) es un medicamento cubano que se produce en el Centro de Inmunología Molecular, el cual ha resultado ser seguro y no se han reportado eventos adversos graves asociados a su uso en pacientes dialíticos; sin embargo, en pacientes en prediálisis la información divulgada sobre su uso es insuficiente. Objetivo: Evaluar la efectividad y seguridad de ior® EPOCIM en pacientes con Enfermedad Renal Crónica en prediálisis, estadios 3 y 4: Material y Métodos: Se realizó un ensayo clínico multicéntrico, abierto, no aleatorizado, fase IV, que incluyó una muestra de 242 pacientes con y sin anemia. Durante 12 meses se evaluó el tratamiento con iorâ EPOCIM, dosis inicial de 30 U/Kg/dosis e incrementó según respuesta hematológica hasta 150 U/Kg/dosis, para lograr estabilización de la hemoglobina entre 10,5-12,5 g/dl y/o hematocrito entre 33-36 por ciento. Resultados: La hemoglobina inicial promedio fue 10 ± 1,5 g/dl, se incrementó rogresivamente hasta el cuarto mes, estabilizando su valor en 11,7 ± 1,2 g/dl, y el hematocrito tuvo similar comportamiento. La función renal se mantuvo estable; la calidad de vida mejoró; hubo mayor beneficio en las escalas de rol físico y salud general. Se reportaron 147 eventos adversos; tuvieron alguna relación causal 13,6 por ciento. El evento más frecuente fue la hipertensión arterial. Ninguna muerte estuvo relacionada con el producto. Conclusiones: El ior® EPOCIM fue seguro y efectivo en los pacientes estudiados con Enfermedad Renal Crónica en prediálisis, estadios 3 y 4(AU)

Introduction: The ior® EPOCIM (human recombinant erythropoietin) is a Cuban medicament produce by the Molecular Immunology Center, which result safety, not being adverse results associated to its use in dialytic patients, but regarding predialysis patients the disclosed information is not enough. Objective: To evaluate effectiveness and safety of ior® EPOCIM in patients with Chronic Kidney Disease (CKD) in pre-dialysis, stages 3 and 4. Material and Methods: Was performed a multicenter, opened, non-randomized phase IV clinical trial, which included 242 patients with and without anemia. During a 12 months period was evaluated the treatment with iorâ EPOCIM, with an initial dose of 30 U/kg/dose; and them increase according to the hematologic response up to a dose of 150 U/Kg/ to achieve the hemoglobinas stabilization between 10.5-12.5 g/dL and/or hematocrit between 33-36 percent. Results: The initial mean value for hemoglobin was 10 (SD ± 1.5 g / dl) it gradually increased until the 4th month stabilizing its value in 11.7 (SD ± 1.2 g / dl); hematocrit had similar behavior. Renal function remained stable. The life quality improved, was a greater benefit in the scale of the physical role and general health. 147 adverse events were reported; they had some causal relationship 13.6 percent. The most frequent event was hypertension (44.9 percent). No death was related with the product. Conclusions: ior® EPOCIM was safe and effective in this population(AU)

Duración de lactancia materna exclusiva, estado nutricional y dislipidemia en pacientes pediátricos / Duration of the exclusive breastfeeding, the nutritional status and dyslipidemia seen in pediatric patients

INTRODUCCIÓN: el abandono precoz de la lactancia materna exclusiva trae complicaciones a corto y largo plazo. OBJETIVO: determinar el estado nutricional y las alteraciones lipídicas en pacientes pediátricos según la duración de la lactancia materna exclusiva. MÉTODOS: estudio descriptivo de corte transversal en 50 pacientes, de edades comprendidas entre 1 y 18 años, con diferente tiempo de duración de la lactancia materna exclusiva, pertenecientes al consultorio médico 25, del área de salud del policlínico "Carlos Manuel Portuondo", en el período comprendido desde noviembre de 2012 a noviembre de 2013. Se estudiaron las variables edad, sexo, estado nutricional, tiempo de lactancia materna exclusiva, colesterol y triglicéridos. Los datos fueron incluidos en una base de datos automatizada con la hoja de cálculo electrónica Excel 2003, y resumidos y representados en tablas estadísticas y expresados textualmente. Se utilizó la estadística descriptiva. RESULTADOS: de los 42 pacientes que abandonaron precozmente la lactancia materna exclusiva, el 81 % presentó malnutrición, y el 74 % hipertrigliceridemia. CONCLUSIONES: resulta insuficiente la promoción de la lactancia materna exclusiva, expresada por la sustitución artificial de esta a medida que el niño transcurre por los primeros 6 meses de vida.

INTRODUCTION: the early cessation of exclusive breastfeeding brings short- and long term complications. OBJECTIVE: to determine the nutritional status and lipid alterations in pediatric patients according to the duration of exclusive breastfeeding. METHODS: descriptive and cross-sectional study of 50 patients aged one to 18 years and with varied lengths of time of exclusive breastfeeding, who were seen at the doctor's office no. 25 of "Carlos Manuel Portuondo" polyclinics in the period of November 2012 through November 2013. The study variables were age, sex, nutritional status, duration of exclusive breastfeeding, and cholesterol and triglyceride levels. The collected data were introduced into a database with electronic Excel 2003 spreadsheet and summarized and shown in statistical tables and textually expressed. Summary statistics were used. RESULTS: out of 42 patients who were early weaned, 81% presented with malnutrition and 74% with hypertriglyceridemia. CONCLUSIONS: promotion of the use of exclusive breastfeeding is poor since the mother's milk is replaced in the course of the first 6 months of life of the child.

An essential role for the MAL protein in targeting Lck to the plasma membrane of human T lymphocytes.

The MAL protein is an essential component of the specialized machinery for apical targeting in epithelial cells. The src family kinase Lck plays a pivotal role in T cell signaling. We show that MAL is required in T cells for efficient expression of Lck at the plasma membrane and activation of IL-2 transcription. To investigate the mechanism by which MAL regulates Lck targeting, we analyzed the dynamics of Lck and found that it travels to the plasma membrane in specific transport carriers containing MAL. Coimmunoprecipitation experiments indicated an association of MAL with Lck. Both carrier formation and partitioning of Lck into detergent-insoluble membranes were ablated in the absence of MAL. Polarization of T cell receptor for antigen (TCR) and microtubule-organizing center to immunological synapse (IS) were also defective. Although partial correction of the latter defects was possible by forced expression of Lck at the plasma membrane, their complete correction, formation of transport vesicles, partitioning of Lck, and restoration of signaling pathways, which are required for IL-2 transcription up-regulation, were achieved by exogenous expression of MAL. We concluded that MAL is required for recruitment of Lck to specialized membranes and formation of specific transport carriers for Lck targeting. This novel transport pathway is crucial for TCR-mediated signaling and IS assembly.

Eficacia y seguridad de la eritropoyetina en la anemia de la prematuridad / Efficacy and safety of erythropoietin for anemia of prematurity

Introducción: la eritropoyetina alfa recombinante forma parte del tratamiento de la anemia de la prematuridad. En Cuba su uso ha sido limitado y controvertido en cuanto a esquema y dosis empleada. Métodos: ensayo clínico prospectivo, multicéntrico, no aleatorizado, de eficacia y seguridad de eritropoyetina en la disminución de transfusiones en el recién nacido pretérmino de muy bajo peso. Se incluyeron 72 neonatos con edad gestacional menor de 34 semanas posmenstruales, y peso al nacer menor o igual a 1 500 g, con más de 7 días posnatales e ingesta de 50 mL/kg/día. Resultados: todos recibieron eritropoyetina 300 U/kg, subcutánea, 3 veces/semana, hasta las 40 semanas de edad gestacional y suplemento de hierro y vitaminas. La eritropoyetina fue muy segura, solo se notificó con relación posible una retinopatía de la prematuridad, ligera y recuperada. Conclusiones: se transfundieron 7 pacientes (9,7 por ciento) en el curso del estudio. El uso tardío de eritropoyetina en el pretérmino de muy bajo peso confirma su eficacia y seguridad

Introduction: recombinant alpha erythropoietin is part of the treatment for anemia of prematurity. The use of this one in Cuba has been restricted and controversial as to schedule and dose. Methods: prospective, non-randomized multicenter assay on the safety and efficacy of erythropoietin in the reduction of blood transfusion in very-low-weight preterm newborn. Seventy two neonates with gestational age under 34 post-menstruation weeks, weighing equal or less than 1 500 g, over 7 days of life after birth and fed on 50 mL/kg/day were included in the study. Results: all of them received 300 U/kg erythropoietin by subcutaneous administration three times a week up to reaching 40 weeks of gestational age and an iron and vitamin supplement. Erythropoietin is very safe; it was just possibly related to slight retinopathy of prematurity, but overcome. Conclusions: seven patients were transfused (9.7 percent ) in the course of study. The late use of erythropoietin in very-low-weight preterm child confirms its efficacy and safety

Recruitment of transferrin receptor to immunological synapse in response to TCR engagement.

T cell receptor engagement by an APC induces the formation of a highly organized complex of surface receptors and intracellular signaling molecules, known as the immunological synapse, at the site of cell-cell contact. The transferrin receptor (TfR, CD71) is normally present in the plasma membrane and recycling endosomes. In this study, we show that, although the TfR is typically absent from lipid rafts at steady state, stimulation with a mitogenic mixture of anti-CD3 Abs of human Jurkat T cells leads to a rapid compartmentalization of the TfR into lipid rafts accompanying that of CD3epsilon and activated Lck. This change occurs very rapidly and is accompanied by an increase in the surface expression of the TfR, probably by translocation from an internal endosomal pool. TfR recruitment to lipid rafts was also observed in primary T cells treated with mitogenic anti-CD3 Abs and in Jurkat T cell-APC conjugates. The use of beads coated with Abs indicates that the surface and endosomal TfR pools redistribute to the contact site region in response to engagement of CD28 and CD3. In T cell-APC conjugates, the T cell TfR endosomal pool relocates beneath the contact site, whereas surface TfR localizes to the peripheral ring of the immunological synapse. In the presence of specific anti-TfR Abs, the total number of T cell-APC contacts and the percentage of conjugates with CD3 and Lck translocated to the contact site were reduced. Our results therefore suggest the involvement of the TfR in the formation of the immunological synapse.