Effect of fresh frozen plasma on the in vitro activation of U937 monocytes: a potential role for the age of blood donors and their underlying cytokine profile.

BACKGROUND: Fresh frozen plasma (FFP) administration may increase the risk of nosocomial infections in parallel with the development of immune modulation. This could be driven by soluble mediators, possibly influencing the in vitro activation of human U937 monocyte cells, in a manner dependent on the age of the donors. METHODS: FFP donors were stratified into groups of 19-30 years, 31-40 years or 41-50 years, and U937 cells were cultured with FFP (alone or plus lipopolysaccharide-LPS) for 24 h. Both in FFP and supernatants, TNF, IL-1ß, IL-6, and IL-10 levels were measured by ELISA. Additionally, CD11B, TLR2, and CASP3 gene expression were measured by qtPCR in U937 cells. Total phagocytic activity was also assayed. RESULTS: Elevated IL-10, but low TNF and IL-1ß levels were measured in FFP from individuals aged 19-40 years, whereas in individuals aged 41-50 years FFP were characterized by equalized TNF and IL-10 levels. Elevated IL-6 levels were found in all FFP samples, especially in those from the oldest individuals. FFP stimulation was associated with striking modifications in cytokine production in an age-dependent way. Exposure to FFP attenuates the response to LPS. TLR2 and CD11B expression were enhanced regardless of the age of plasma donors, although CASP3 expression was increased only when FFP from individuals aged 19-40 years were tested. Phagocytosis decreased after exposure to FFP regardless of donor age. CONCLUSION: Our results suggest that soluble mediators in FFP may modulate the functioning of monocytes. Interestingly, this effect appears to be partially influenced by the age of donors.

Adrenal Medullary Hyperplasia: An Under the Radar Cause of Endocrine Hypertension.

Adrenal medullary hyperplasia is a cause of increased secretion of catecholamines by the adrenal gland that is rarely considered among the differential diagnoses of endocrine hypertension. We report the case of a 48-year-old Hispanic woman who presented for evaluation of resistant hypertension with several episodes of hypertensive crisis. The clinical presentation, biochemical results, and abdominal computed tomography scan suggested the possibility of a pheochromocytoma; however, an iodine-123-meta-iodobenzylguanidine (123I-MIBG) uptake study combined with single-photon emission computed tomography (SPECT) and computed tomography (CT) scan showed diffusely increased metabolic activity in both adrenal glands. The patient underwent left adrenalectomy, and the pathology study revealed the presence of adrenal medullary hyperplasia. After surgery, blood pressure control was achieved with one antihypertensive drug, and the patient did not have recurrent hypertensive crisis. Relevant findings obtained from a whole genomic sequence done on a whole blood DNA sample from the patient are discussed.

Duodenal somatostatinoma presenting as obstructive jaundice with the coexistence of a gastrointestinal stromal tumour in neurofibromatosis type 1: a case with review of the literature.

Somatostatinomas are rare neuroendocrine tumours, mostly located in the pancreas or duodenum, with an estimated incidence of 1 in 40 million. Duodenal somatostatinomas (DSs) are usually found in association with neurofibromatosis type 1 (NF1), tuberous sclerosis and Von Hippel-Lindau syndrome. Gastrointestinal stromal tumours (GIST) have also been described in NF1, but the association with somatostatinoma is very uncommon. We report the case of a patient with NF1 who presented with obstructive jaundice due to multiple firm nodules around the ampulla of Vater. A pancreaticoduodenectomy was performed and revealed a 1 cm duodenal/ampullary mass which stained positive for somatostatin, together with a GIST also found on the duodenal wall. Despite its rarity, ampullary somatostatinomas should be considered in the differential diagnosis of biliary tract dilation in patients with NF1.

The Evaluation of Flow-Mediated Vasodilation in the Brachial Artery Correlates With Endothelial Dysfunction Evaluated by Nitric Oxide Synthase Metabolites in Marfan Syndrome Patients.

Marfan syndrome (MS) is of the most common connective tissue disorders. Although most patients have mutations in the fibrillin-1 gene (FBN1) and more than 1,700 mutations have been described, there are no mutations in less than 10% of patients. Aortic dilation is the most important complication; it involves chronic inflammatory processes and endothelial dysfunction. Prospective study from March 2015 to January 2017, in a cohort of 32 patients of MS confirmed by Ghent criteria and 35 controls of both genders, with a median age of 26 years (18-56). Patients had no comorbidities such as diabetes, hypertension, and/or neoplasms. They were not being treated with statin, NSAIDs, calcium antagonists, oral nitrates, and/or beta-blockers during 7 days prior to the study and patients with smoking history in the last 4 years. Controls were matched by age and gender. We analyzed endothelial dysfunction by flow-mediated vasodilation in the brachial artery, determining the maximum peak flow in the reactive hyperemia phase with a Philips Envisor device with Doppler capability. Its correlation with serum levels of biological markers that could participate in endothelial dysfunction pathways such as NO3-/NO2- ratio, NO2- , citrulline, TNFα, IL-1, IL-6, IL-10, IL-8, osteopontin, ICAM, VCAM, and NO3-/NO2- was determined. Endothelial dysfunction was found in 21 MS patients (65%). The aortic annulus (AAo) was of 27 mm (22-40) and 24 mm (22-30) (p = 0.04) in MS patients with and without dysfunction. The level of NO3-/NO2- ratio, was of 108.95 ± 12.05 nM/ml in controls vs. 170.04 ± 18.76 nM/ml in MS (p = 0.002), NO2- was of 33.78 ± 3.41 vs. 43.95 ± 2.59 nM/ml (p = 0.03), citrulline 62.65 ± 3.46 vs. 72.81 ± 4.35 µMol/ml (p = 0.06). VCAM median was 39 pg/ml (0-86) vs. 32 pg/ml (11-66) (p = 0.03), respectively. The correlation of VCAM with triglycerides (TG) was of 0.62 (p = 0.005). There were no differences in TNFα, IL-1, IL-6, IL-8, IL-10, and osteopontin. MS endothelial dysfunction is related to aortic diameters, and increased levels of VCAM, L-citrulline and NO3-/NO2- ratio, NO2- . VCAM-1 has a significant correlation with TG and could play a significant role in endothelial dysfunction.

Effect of fresh frozen plasma on the in vitro activation of U937 monocytes: a potential role for the age of blood donors and their underlying cytokine profile

BACKGROUND: Fresh frozen plasma (FFP) administration may increase the risk of nosocomial infections in parallel with the development of immune modulation. This could be driven by soluble mediators, possibly influencing the in vitro activation of human U937 monocyte cells, in a manner dependent on the age of the donors. METHODS: FFP donors were stratified into groups of 19-30 years, 31-40 years or 41-50 years, and U937 cells were cultured with FFP (alone or plus lipopolysaccharide-LPS) for 24 h. Both in FFP and supernatants, TNF, IL-1ß, IL-6, and IL-10 levels were measured by ELISA. Additionally, CD11B, TLR2, and CASP3 gene expression were measured by qtPCR in U937 cells. Total phagocytic activity was also assayed. RESULTS: Elevated IL-10, but low TNF and IL-1ß levels were measured in FFP from individuals aged 19-40 years, whereas in individuals aged 41-50 years FFP were characterized by equalized TNF and IL-10 levels. Elevated IL-6 levels were found in all FFP samples, especially in those from the oldest individuals. FFP stimulation was associated with striking modifications in cytokine production in an age-dependent way. Exposure to FFP attenuates the response to LPS. TLR2 and CD11B expression were enhanced regardless of the age of plasma donors, although CASP3 expression was increased only when FFP from individuals aged 19-40 years were tested. Phagocytosis decreased after exposure to FFP regardless of donor age. CONCLUSION: Our results suggest that soluble mediators in FFP may modulate the functioning of monocytes. Interestingly, this effect appears to be partially influenced by the age of donors.

Design and implementation of the TRACIA: intracoronary autologous transplant of bone marrow-derived stem cells for acute ST elevation myocardial infarction.

OBJECTIVE: To describe the design of a protocol of intracoronary autologous transplant of bone marrow-derived stem cells for acute ST-elevation myocardial infarction (STEMI) and to report the safety of the procedure in the first patients included. METHODS: The TRACIA study was implemented following predetermined inclusion and exclusion criteria. The protocol includes procedures such as randomization, bone marrow retrieval, stem cells processing, intracoronary infusion of stem cells in the infarct-related artery, preand- post MRI, pre-and-post SPECT with radioisotope ventriculography, and clinical follow-up at 6 months. RESULTS: Eight patients with a diagnosis of acute STEMI and duration of symptoms of ?24 hours that were perfused successfully through primary percutaneous coronary intervention (PPCI) with a LVEF of ?45% were assigned randomly to two groups (n = 4 each). One group treated with stem cells and the other corresponded to the control group. Neither death, re-infarction, no need for revascularization or thrombosis of the stent were observed at follow-up. CONCLUSIONS: The initial experience at the Instituto Nacional de Cardiología Ignacio Chávez in the treatment of acute STEMI by means of autologous transplantation of bone marrow-derived stem cells is encouraging. Implementation was possible in the first eight patients with no complications.

Altered flow-mediated vasodilatation, low paraoxonase-1 activity, and abnormal high-density lipoprotein subclass distribution in Takayasu's arteritis.

BACKGROUND: Takayasu's arteritis (TA) is an idiopathic chronic inflammatory disease that causes occlusion of large arteries, but little is known about whether affected patients are characterized by endothelial dysfunction, different high-density lipoproteins (HDL) subclasses and paraoxonase-1 (PON1) activity. METHODS AND RESULTS: In the present study, 30 patients with TA, 30 age- and gender-matched volunteers (controls) and 15 patients with essential hypertension were studied. Flow-mediated vasodilation (FMD) and maximal blood flow velocity, assessed in the brachial artery by high-resolution ultrasound, were significantly lower in patients. HDL subclass distribution was determined by polyacrylamide gradient gel electrophoresis. HDL-cholesterol, HDL3b subclass and PON1 activity, assessed spectrophotometrically using phenylacetate as the substrate, were also lower in patients compared with controls. In a multiple regression analysis, the use of prednisone and systolic blood pressure were independent variables that predicted the FMD. CONCLUSIONS: A low FMD, abnormal size distribution of HDLs, and low PON1 activity are observed in TA patients. These abnormalities appear independently and constitute a cluster that may contribute to the vascular dysfunction of TA arteritis.

Design and implementation of the TRACIA: intracoronary autologous transplant of bone marrow-derived stem cells for acute ST elevation myocardial infarction / Diseño e implementación del estudio TRACIA: Trasplante intracoronario Autológo de Células madre para Infarto Agudo del miocardio con elevación de segmento ST

Objective: To describe the design of a protocol of intracoronary autologous transplant of bone marrow-derived stem cells for acute ST-elevation myocardial infarction (STEMI) and to report the safety of the procedure in the first patients included. Methods: The TRACIA study was implemented following predetermined inclusion and exclusion criteria. The protocol includes procedures such as randomization, bone marrow retrieval, stem cells processing, intracoronary infusion of stem cells in the infarct-related artery, pre-and-post MRI, pre-and-post SPECT with radioisotope ventriculography, and clinical follow-up at 6 months. Results: Eight patients with a diagnosis of acute STEMI and duration of symptoms of <24 hours that were perfused successfully through primary percutaneous coronary intervention (PPCI) with a LVEF of <45% were assigned randomly to two groups (n = 4 each). One group treated with stem cells and the other corresponded to the control group. Neither death, re-infarction, no need for revascularization or thrombosis of the stent were observed at follow-up. Conclusions: The initial experience at the Instituto Nacional de Cardiología Ignacio Chávez in the treatment of acute STEMI by means of autologous transplantation of bone marrow-derived stem cells is encouraging. Implementation was possible in the first eight patients with no complications.

Objetivo: Describir el diseño y la implementación de un protocolo de transplante autólogo intracoronario de células madre derivadas de médula ósea en infarto agudo al miocardio con elevación del ST y reportar la seguridad del procedimiento en los primeros pacientes incluidos. Métodos: El estudio TRACIA se implementó con base en criterios de inclusión y exclusión predeterminados. El protocolo incluye la aleatorización, obtención de médula ósea, procesamiento de células madre, infusión intracoronaria de células madre, RM basal y al seguimiento, SPECT con ventriculografía radioisotópica basal y post-procedimiento, y seguimiento clínico a seis meses. Resultados: Ocho pacientes con diagnóstico de infarto agudo del miocardio con elevación del ST y duración de síntomas <24 horas que fueron reperfundidos exitosamente con angioplastia primaria y con fracción de expulsión <45%, fueron aleatorizados a dos grupos; uno de ellos fue tratado con células madre y el otro grupo permaneció como control. No se observó muerte, re-infarto, necesidad de revascularización o trombosis del Stent durante el seguimiento. Conclusiones: La experiencia inicial en el Instituto Nacional de Cardiología Ignacio Chávez en el tratamiento del infarto agudo del miocardio con elevación del ST mediante trasplante autólogo de células madre derivadas de médula ósea, es alentadora. La implementación sin complicaciones fue posible en los primeros ocho pacientes.

Efecto del inhibidor de fosfodiesterasa tipo 4 —rolipram, sobre la maduración in vitro de oocitos bovinos / Efeito do inibidor de fosfodiesterasa tipo 4 —rolipram, sobre a maturação in vitro de oocitos bovinos / Effect of phosphodiesterase type 4-inhibitor rolipram on in vitro maturatrion of bovine oocytes

Durante el proceso de maduración in vitro de oocitos, las gonadotropinas FSH y LH inducen la producción de AMPc. El AMPc tiene efecto dual, donde los altos niveles de AMPc intraoocitario mantienen su bloqueo meiótico, mientras que en las células de la granulosa inducen la maduración del oocito. Los niveles de AMPc son regulados por hidrólisis mediada por fosfodiesterasas (PDE), las cuales presentan expresión específica en el folículo, el oocito expresa la PDE 3, mientras que las células de la granulosa PDE 4. Con el objetivo de evaluar el efecto del rolipram, un inhibidor específico de PDE 4, sobre el porcentaje de maduración nuclear in vitro (MNIV) de oocitos bovinos, 629 complejos cúmulo oocito (CCO) fueron cultivados a 38.5 ºC/5% CO2/24 h, en medio TCM-199 con la adición de pFSH y hrLH, o rolipram. Los grupos experimentales fueron: adición de gonadotropinas, rolipram (25, 50 ó 75 M), rolipram 50 M + gonadotropinas, o control sin estímulo. Los oocitos fueron teñidos con DAPI y evaluados bajo fluorescencia para determinar el porcentaje de maduración nuclear por la expulsión del primer cuerpo polar. El rolipram 50M estimuló la maduración nuclear de oocitos bovinos de una manera similar a la obtenida con las gonadotropinas (76.83 vs 79.46%, p>0.05), pero en mayor medida que la observada con rolipram 25 y 75 M (31.25, y 28.61%, respectivamente). Los CCOs cultivados en presencia de rolipram 50 M+Gonadotropinas maduraron en menor proporción (63.74%) comparada con gonadotropinas (p<0.01) o rolipram 50 M (p<0.05). Los resultados permiten concluir que el porcentaje de maduración nuclear in vitro de oocitos bovinos depende de la dosis de rolipram utilizada, donde la concentración de rolipram 50 M presentó un comportamiento similar a las gonadotropinas en la maduración del oocito...

Gonadotropic follicle stimulating hormone (FSH) and lutenizing hormone (LH) induce intracellular cyclic AMP (cAMP) production during the in vitro maturation (IVM) of bovine oocytes. Cyclic AMP exerts a dual effect, where high intraoocyte cAMP levels are responsible for oocyte meiotic blockage, while high cAMP levels into the granulose cells induce oocyte maturation. Intracellular cAMP levels are regulated by phosphodiesterases (PDE)-mediated hydrolysis, enzymes having a specific follicle expression pattern. Oocyte expresses typo 3 PDE (PDE 3), while granulose cells expresses type 4 PDE (PDE 4). With the aim to test the effect of the specific PDE 4 inhibitor rolliprom on percentage in vitro nuclear maturation (IVNM) of bovine oocytes, 629 cumulus-oocyte complexes (COC) were cultured at 38.5 ºC/CO2 5%/24 h on TCM-199 medium with pFSH and hrLH with or without rolipram. Experimental groups were: gonadotrophins alone, gonadotropins + rolipram (25, 50, or 75 M), rolipram 50 M + gonadotrophins, and control (media without stimulus). In order to determinate the nuclear maturation percentage by the first polar body expulsion, oocytes were dyed with DAPI and evaluated by fluorescence. Rolipram 50 M stimulated bovine oocyte nuclear maturation in a similar way to gonadotrophins stimulus (76.83 vs. 79.46%, p>0.05) did, but in a higher way than rolipram 25 M (31.25%) or 75 M (28.61%). The COC cultured with rolipram 50 M+gonadotrophins maturated in a lower proportion (63.74%) than did with gonadotropins (p<0.01) or rolipram 50 M (p<0.05). A dose-dependent response of percentage of IVNM of bovine oocytes was detected. Thus rolipram 50 M, exerts a similar effect of gonadotropins on oocyte maturation...

Durante o processo de maturação in vitro de oocitos, as gonadotrofinas FSH e LH induzem a produção de AMPc. O AMPc tem duplo efeito, pois os altos níveis de AMPc intraoocitario mantém o bloqueio meiótico, enquanto que nas células da granulosa induzem a maturação do oocito. Os níveis de AMPc são regulados pela hidrólise mediada das fosfodiesterasas (PDE), as quais apresentam expressão específica no folículo, o oocito expressa a PDE 3, enquanto que as células da granulosa PDE 4. Com o objetivo de avaliar o efeito do rolipram, um inibidor específico de PDE 4, sobre a percentagem de maturação nuclear in vitro (MNIV) de oocitos bovinos, 629 complexos cúmulo oocito (CCO) foram cultivados a 38.5 ºC/5% CO2/24 h, em meio TCM-199 com a adição de pFSH e hrLH, o rolipram. Os grupos experimentais foram: adição de gonadotrofinas, rolipram (25, 50 ó 75 M), rolipram 50 M + gonadotrofinas, ou controle sem estímulo. Os oocitos foram tingidos com DAPI e avaliados sob fluorescência para determinar a percentagem de maturação nuclear pela expulsão do primeiro corpo polar. O rolipram 50M estimulou a maturação nuclear de oocitos bovinos de maneira similar a obtida com as gonadotrofinas (76.83 vs 79.46%, p>0.05), porém em maior medida que a observada com rolipram 25 y 75 M (31.25, y 28.61%, respectivamente). Os CCOs cultivados na presença de rolipram 50 M+Gonadotrofinas maturaram em menor proporção (63.74%) quando comparado com gonadotrofinas (p<0.01) ou rolipram 50 M (p<0.05). Os resultados permitem concluir que a percentagem de maturação nuclear in vitro de oocitos bovinos depende da doses de rolipram utilizada, sendo que a concentração de rolipram 50 M apresentou um comportamento similar às gonadotrofinas na maturação do oocito...