Study protocol P-MAPS: microbiome as predictor of severity in acute pancreatitis-a prospective multicentre translational study.

BACKGROUND: Acute pancreatitis (AP) is an inflammatory disorder that causes a considerable economic health burden. While the overall mortality is low, around 20% of patients have a complicated course of disease resulting in increased morbidity and mortality. There is an emerging body of evidence that the microbiome exerts a crucial impact on the pathophysiology and course of AP. For several decades multiple clinical and laboratory parameters have been evaluated, and complex scoring systems were developed to predict the clinical course of AP upon admission. However, the majority of scoring systems are determined after several days and achieve a sensitivity around 70% for early prediction of severe AP. Thus, continued efforts are required to investigate reliable biomarkers for the early prediction of severity in order to guide early clinical management of AP patients. METHODS: We designed a multi-center, prospective clinical-translational study to test whether the orointestinal microbiome may serve as novel early predictor of the course, severity and outcome of patients with AP. We will recruit 400 AP patients and obtain buccal and rectal swabs within 72 h of admission to the hospital. Following DNA extraction, microbiome analysis will be performed using 3rd generation sequencing Oxford Nanopore Technologies (ONT) for 16S rRNA and metagenomic sequencing. Alpha- and beta-diversity will be determined and correlated to the revised Atlanta classification and additional clinical outcome parameters such as the length of hospital stay, number and type of complications, number of interventions and 30-day mortality. DISCUSSION: If AP patients show a distinct orointestinal microbiome dependent on the severity and course of the disease, microbiome sequencing could rapidly be implemented in the early clinical management of AP patients in the future. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04777812.

JAK2 is required for induction of the murine DUB-1 gene.

Cytokine receptors activate multiple signal transduction pathways, resulting in the induction of specific target genes. We have recently identified a hematopoietic cell-specific immediate-early gene, DUB-1, that encodes a growth-regulatory deubiquitinating enzyme. The DUB-1 gene contains a 112-bp enhancer element that is specifically induced by the beta c subunit of the interleukin-3 (IL-3) receptor. To investigate the mechanism of DUB-1 induction, we examined the effects of dominant-negative forms of JAK kinases, STAT transcription factors, and Raf-1 in transient transfection assays. In Ba/F3 cells, IL-3 induced a dose-dependent activation of DUB-1-luciferase (luc) and GAS-luc reporter constructs. A dominant-negative form of JAK2 (truncated at amino acid 829) inhibited the induction of DUB-1-luc and GAS-luc by IL-3. A dominant-negative form of STAT5 (truncated at amino acid 650) inhibited the induction of GAS-luc but not DUB-1-luc. A dominant-negative form of Raf-1 inhibited the induction of DUB-1-luc but had no effect on the induction of GAS-luc by IL-3. The requirement for JAK2 in the stimulation of the DUB-1 enhancer was further supported by the suppression of DUB-1 induction in Ba/F3 cells stably expressing the dominant-negative JAK2 polypeptide. We hypothesize that IL-3 activates a JAK2/Raf-1 signaling pathway that is required for DUB-1 induction and is independent of STAT5.

Analysis of cis-acting sequences and trans-acting factors regulating the interleukin-3 response element of the DUB-1 gene.

The murine DUB-1 gene is a hematopoietic-specific, immediate-early gene that encodes a growth-regulatory deubiquitinating enzyme. DUB-1 contains an IL-3-inducible enhancer element that is activated in a JAK2-dependent, STAT5-independent manner. In this study, we have further characterized this novel IL-3 response element. Transcriptional reporter assays in Ba/F3 cells revealed that two AP-1 sites, a GATA motif, and an Ets site are required for induction of DUB-1 enhancer activity. Gel shift assays indicated that IL-3 activates the binding of an AP-1 complex containing JunD to the AP-1 sites and the binding of another protein complex to the Ets motif. The latter complex was not detectable in Ba/F3 cells stably transfected with a dominant-negative mutant of JAK2. As previously shown, these cells do not express DUB-1 mRNA or protein. Furthermore, we demonstrated that GATA-1 constitutively binds to the DUB-1 enhancer element. The involvement of GATA-1 may be important for the hematopoietic-restricted expression pattern of DUB-1. This combination of inducible and constitutive elements of the DUB-1 enhancer appears to account for the unique STAT-independent expression characteristics of DUB-1.

Involvement of phosphatidylinositol 3-kinase in the mediation of erythropoietin-induced activation of p70S6k.

We have previously shown that, in HCD-57 cells, erythropoietin (EPO) induces a biphasic activation of the ribosomal S6 kinase p70S6k, an enzyme playing a key role in the regulation of cell cycle progression. Here we present evidence that p70S6k is activated through both phosphatidylinositol (PI) 3-kinase-dependent and independent pathways: whereas the early phase of EPO-dependent stimulation of p70S6k activity was strongly suppressed by the potent PI 3-kinase inhibitor wortmannin, late phase was much less affected. The dose-dependent inhibition of cell growth by wortmannin indicates an important role of PI 3-kinase in the mediation of EPO-induced cell proliferation. Furthermore, our data suggest that the EPO-receptor-associated tyrosine kinase JAK2 is not essentially involved in the mediation of EPO-induced p70S6k activation.

Rapid activation of the MAP kinase pathway in hematopoietic cells by erythropoietin, granulocyte-macrophage colony-stimulating factor and interleukin-3.

MAP kinases are a family of serine/threonine specific protein kinases becoming activated in response to different proliferative stimuli by phosphorylation at both threonine and tyrosine residues. We report the involvement of MAP kinases in the signal transduction of the hematopoietic growth factors erythropoietin (EPO), granulocyte macrophage colony-stimulating factor (GM-CSF) and interleukin-3 (IL-3) in the factor dependent human erythroleukemic cell line TF-1, suggesting a crucial role of these enzymes in the regulation of proliferation of hematopoietic cells. Both time course and degree of MAP kinase activation were similar for all three cytokines. A slightly lower stimulation effect of EPO corresponds to the observation that EPO stimulated cells proliferate at a lower rate.

Role of STAT5 in interferon-alpha signal transduction in Ba/F3 cells.

In interferon-alpha (IFN-alpha) signalling, the essential role of the transcription factors STAT1 and STAT2 is well established. In contrast, the involvement of other STAT proteins, including STAT5, is much less well understood. Here we show that, in IFN-alpha-responsive Ba/F3 cells, this cytokine stimulates the DNA-binding of STAT5A and B but that IL-3 is a much more potent activator of both STAT5 isoforms. A stably expressed dominant-negative mutant of JAK2 suppressed the IL-3- but not the IFN-alpha-dependent DNA binding of STAT5, suggesting independent mechanisms of its activation. Northern blots revealed that IL-3 strongly induced the expression of two STAT5-regulated genes, pim-1 and oncostatin-M, whereas IFN-alpha had a weak stimulatory effect on pim-1 expression only. In summary our results suggest that, despite the capability of IFN-alpha to stimulate DNA binding of STAT5, this transcription factor does not play a pivotal role in IFN-alpha signalling in Ba/F3 cells.

Interferon-alpha inhibits proliferation of Ba/F3 cells by interfering with interleukin-3 action.

Interferons (IFNs) are potent inhibitors of cell proliferation that are used for the treatment of several haematological malignancies. The mechanisms through which IFNs exert their antiproliferative effects on target cells, however, are largely unknown. Here we show that IFN-alpha, in murine Ba/F3 cells, directly interferes with the action of the essential mitogen interleukin (IL)-3. In transiently transfected Ba/F3 cells, IFN-alpha efficiently inhibited the IL-3-stimulated expression of a luciferase reporter construct, GAS-luc, that is activated through the JAK2/STAT5 pathway. Electrophoretic mobility shift assays and Northern blot experiments, however, revealed that neither the IL-3-induced DNA binding of STAT5 nor the transcription of the STAT5-dependent genes oncostatin-M, pim-1 and c-fos were suppressed by IFN-alpha, suggesting that the diminished expression of the luciferase protein was due to a direct inhibition of IL-3-stimulated protein synthesis. This hypothesis was supported by the observation that IFN-alpha, even though it had no effect on the transcription of the c-fos gene, efficiently suppressed the IL-3-dependent expression of the c-Fos protein. Furthermore, our results indicate that IFN-alpha induced an overexpression of the double-stranded RNA-activated protein kinase (PKR), an enzyme that inhibits protein synthesis through the phosphorylation and inactivation of the eukaryotic initiation factor-2. Therefore, we hypothesize that IFN-alpha, in Ba/F3 cells, interrupts IL-3-dependent mitogenic signals, at least in part, through the suppression of protein synthesis and that induction of PKR activity may play a pivotal role in this process.

Erythropoietin induces biphasic activation of p70S6k: evidence for a different regulation of early and late phase of activation.

The murine erythroleukaemia cell line HCD-57 proliferates in response to erythropoietin. Stimulation of erythropoietin-deprived cells with the cytokine induces the phosphorylation and biphasic activation of the 70,000 M(r) S6 kinase. Two peaks of enzyme activity were observed after 30 and 120 min, respectively. Early and late phase of activation differ in their sensitivity to the protein kinase C inhibitor staurosporine suggesting different regulatory mechanisms.

Activation of the transcription factor NF-kappaB by the erythropoietin receptor: structural requirements and biological significance.

The transcription factor nuclear factor kappa B (NF-kappaB) has been implicated in the regulation of genes mainly involved in inflammation and immune response. We analysed the role of NF-kappaB in signalling pathways induced by the hematopoietic growth factor erythropoietin (EPO). Our data, obtained by electrophoretic mobility shift assays (EMSA) and reporter gene assays, show that the intracellular domain of the EPO receptor (EPOR) transmits signals leading to the activation of NF-kappaB. Studies employing an inhibitor specific for the EPOR-associated tyrosine kinase JAK2 suggest that JAK2-dependent pathways are not involved. The induction of an NF-kappaB-triggered reporter gene construct was inhibited by cotransfection of dominant negative forms of the src kinase Lyn, but not by dominant negative JAK2. Using epidermal growth factor (EGF)/EPOR hybrids containing mutant forms of the EPOR intracellular domain, we were able to further define the critical structures for the induction of NF-kappaB. The data show that although the activity of JAK2 seems to be dispensable, its association to the receptor, as well as the phosphorylation of membrane proximal tyrosine residues, are essential. Furthermore, the functional analysis of different receptor forms revealed a correlation of the abilities to induce NF-kappaB activity and to generate antiapoptotic signals.

Requirement for JAK2 in erythropoietin-induced signalling pathways.

Erythropoietin (EPO) exerts its activities by the induction of multiple signalling pathways through interaction with the erythropoietin receptor (EPOR). Previous studies have suggested that the Ras/MAP kinase as well as the JAK/STAT signalling cascades play significant roles in the induction of EPO-responsive genes. Here we show that, in HCD-57 erythroleukemic cells, both pathways are activated by EPO in a dose-dependent manner with similar sensitivities and kinetics. The activation of signalling molecules is closely related to the proliferative status of the cells. Using an antisense strategy, we were able to show that the downregulation of the JAK2 protein level in HCD-57 cells results in a distinct reduction of the ability to induce not only STAT5 DNA-binding, but also MAP kinase activity. Our results thus provide evidence for a significant contribution of the cytosolic tyrosine kinase JAK2 to the EPO-induced activation of the Ras/MAP kinase cascade.

cDNA cloning and functional analysis of a truncated STAT5a protein from autonomously growing FDCP-1 cells.

The transcription factor STAT5 is activated by multiple hematopoietic cytokine receptors and has been implicated in the induction of cellular processes such as differentiation, proliferation and antiapoptotic activities. Here, we report cloning of the cDNA and characterization of a mutant STAT5a protein that is expressed in interleukin-3 (IL-3)-independently growing FDCP-1 cells. Analysis of the cDNA revealed a deletion of both the transactivation and the SH2 domains. Stable expression of the protein in parental IL-3-dependent cells results in elevated DNA binding activity of wild type (WT)-STAT5 in the nucleus, enhanced growth rates and a reduced susceptibility to undergo apoptosis after withdrawal of IL-3. Although the protein is not present in DNA/protein complexes in the nucleus, we observed pronounced effects on IL-3-induced signal transduction. The results suggest competition of the mutant protein with cytosolic mechanisms regulating STAT5 activity. In conclusion, the data support the hypothesis of an involvement of STAT5 in mitogenic and antiapoptotic signaling.

Activation of STAT5 during EPO-directed suppression of apoptosis.

The ligand-dependent activation of the JAK/STAT (Januskinase/Signal Transducer and Activator of Transcription) pathway has been implicated in the explanation of cytokine-specific regulation of gene expression. Previous studies have reported conflicting results on the role of the transcription factor STAT5 in erythropoietin (EPO)-induced cellular responses. In this study we focused on the functional importance of STAT5 docking sites in the intracellular EPO receptor (EPOR) domain for the mediation of antiapoptotic activities. We demonstrate that EPO-dependent survival of erythroleukemic cell lines is accompanied by sustained STAT5 DNA-binding activity. The role of single tyrosine residues was dissected by the analysis of myeloid FDCP-1 cells stably expressing mutant EPOR proteins. The data show that receptors having a high potential to mediate antiapoptotic signals also effectively activate STAT5, whereas receptors lacking STAT5 docking sites are diminished in both activities. We conclude that the transcription factor STAT5 is functionally implicated in the EPO-dependent survival of cells.

Structural and functional characterisation of recombinant human erythropoietin analogues.

Deletion mutants of a synthetic human erythropoietin-cDNA were transiently expressed in COS-7 cells and products analyzed using Western blots and a cell proliferation assay. Only two mutants with deletions affecting the N-terminal portion and the amino acid sequence 115-121 displayed biological activity. The exchange of hydrophilic, charged amino acids by alanine in two potential alpha-helical regions, the internal amino acid sequence 102-106 and the C-terminal sequence 154-159, causes a 2-11-fold loss of activity. The results suggest that both regions are involved in either maintaining the active structure of the hormone or interacting with the receptor.

Induction of erythroid proliferation and differentiation by a trophoblast-specific cytokine involves activation of the JAK/STAT pathway.

Pregnancy is characterized by increased erythropoiesis within maternal and fetal compartments. The placenta has been shown to produce factors that stimulate erythropoiesis but convincing evidence for placental production of erythropoietin (EPO) is still lacking. Prolactin-like protein E (PLP-E) was recently found to stimulate expression of the adult beta major globin gene in mouse erythroleukemia cells. Here we demonstrate that PLP-E transiently expressed in COS-7 cells stimulates proliferation and erythroid differentiation of murine and human erythroid progenitor cell lines. Electrophoretic mobility shift assays were used to show the activation of STAT5 by PLP-E in the human erythroid cell line TF1. Furthermore, we compared the effects of PLP-E on murine myeloid FDCP1 cells which do not express EPO receptors (EPORs) with effects on cells genetically engineered to express functional EPORs. We provide evidence that PLP-E-dependent proliferation and STAT5 activation is independent of the expression of the EPOR. Taken together, these data suggest that PLP-E acts on specific receptors of erythroid-committed murine and human cells by the activation of intracellular signaling pathways promoting cell growth and differentiation.

Inhibition of proliferation but not erythroid differentiation of J2E cells by rapamycin.

During erythropoiesis, replication and maturation are tightly coupled processes. Here, we show that the immunosuppressant rapamycin inhibited basal- as well as erythropoietin-stimulated proliferation of the erythroid cell line J2E. In addition, it enhanced the antiproliferative effect of sodium butyrate. Although rapamycin suppressed erythroid cell division, it did not affect terminal differentiation induced by erythropoietin or sodium butyrate. The proliferative status of J2E cells correlated well with the activity of the ribosomal S6 kinase p70S6k, an enzyme effectively blocked by rapamycin. It was concluded from this study that erythroid maturation proceeded normally despite the rapamycin-induced inhibition of mitosis and of p70S6k activity. These data provide further evidence that separate signalling pathways for proliferation and differentiation exist in erythroid cells.

[Diagnosis of chronic alcohol abuse in intoxicated drivers: carbohydrate-deficient transferrin (CDT) in combination with other parameters]. / Diagnostik des chronischen Alkoholmissbrauchs bei Trunkenheitsfahrern: Carbohydrate deficient transferrin (CDT) in Kombination mit weiteren Parametern.

In 109 drunken male drivers from the area of Rostock the marker of alcohol abuse CDT was superior to the established laboratory parametres gammaglutamyltransferase (GGT) and mean cell volume (MCV) concerning the diagnostic efficiency. The prerequisite for the high diagnostic evidence of the CDT is the quantification of the minor band and the definition of standards of valuation by comparative studies with defined groups of probands (alcoholics, normal population). The combination of the 3 parametres CDT/GGT/MCV gave in 67% of the examined drunken drivers more or less strong hints at chronic alcohol abuse. The BAC of 1.6/1000 as a base for the decision to cause a medical-psychological examination (in case of "poison-resistance") turned out in this study to be an interchangeable, incomprehensible value. In about two thirds of the examined drunken drivers laboratory findings were pathological also in case of BAC below 1.6/1000. According to the experiences existing so far the parametres-combination CDT/GGT is unreservedly suitable as a screening procedure for the registration of potential or manifest alcoholics. Because the examinations may be performed from the usual blood samples for the BAC-detection these laboratory parametres really offer themselves for questions of traffic medicine. Further investigations are necessary.

Mathematical modelling unravels regulatory mechanisms of interferon-γ-induced STAT1 serine-phosphorylation and MUC4 expression in pancreatic cancer cells.

Interferon-γ (IFNγ)-mediated signal transduction via upregulation of signal transducer and activator of transcription (STAT) 1 leads to the expression of the mucin (MUC) 4 gene in pancreatic cancer cells. Upregulation of STAT1 may also implicate STAT1 tyrosine- or serine-phosphorylation. Experimental data indicate that reaction steps involved in IFN-γ induced serine-phosphorylation of STAT1 vary between cell types in contrast to conserved IFN-γ induced tyrosine-phosphorylation of STAT1. The above observations raise the following two questions: (i) How does IFNγ stimulation regulates serine-phosphorylation of STAT1 in the pancreatic cancer cell line CD18/HPAF? (ii) Which type of STAT1 acts as a transcription factor of MUC4? Our objective is to address these two questions by data-driven mathematical modelling. Simulation results of the parameterised ordinary differential equation models show that serine-phosphorylation of unphosphorylated STAT1 occurs in the cytoplasm. In contrast, serine-phosphorylation of tyrosine-phosphorylated STAT1 can take place in the cytoplasm or in the nucleus. In addition, our results propose that unphosphorylated or serine-phosphorylated STAT1 can act as transcription factors of MUC4, either alone by progressive binding to different sites in the promoter or both together.

Extracellular signal regulated kinases are key mediators of mitogenic signals in rat pancreatic stellate cells.

BACKGROUND: Pancreatic stellate cells (PSCs) have been implicated in pancreatic fibrosis as they synthesise increased amounts of extracellular matrix proteins in response to activation by profibrogenic mediators such as cytokines. AIMS: The purpose of this study was to analyse cytokine receptor stimulated signalling pathways involved in PSC activation. Using a rat culture model of PSCs, we have also tested the potential of the platelet derived growth factor (PDGF) antagonist trapidil and PD98059, a specific inhibitor of extracellular signal regulated kinase (ERK) activation, to suppress PSC growth. METHODS: Cultured PSCs were stimulated with PDGF, and the signal transduction pathways activated in response to the mitogen were analysed by immunoblotting, kinase assays, and electrophoretic mobility shift assays. Furthermore, comparison of signalling cascades activated in PSCs before and after completing transdifferentiation to alpha-smooth muscle actin expressing myofibroblasts was performed. Biological effects of PDGF, trapidil, and PD98059 were analysed by proliferation assays and correlated with molecular effects of the substances. RESULTS: PDGF induced rapid activation of Raf-1, ERKs 1 and 2, as well as AP-1 proteins. The transforming growth factor beta activated transcription factor Smad2 was found to be constitutively phosphorylated in PSCs of different transdifferentiation grades. Furthermore, the results indicate a correlation between ERK activities and induction of PSC activation. Trapidil efficiently inhibited both PDGF induced ERK activation and, in common with PD98059, PSC proliferation. CONCLUSIONS: Our data suggest that ERKs play a key role in the regulation of PSC growth and that inhibition of the ERK signalling pathway may become a strategy to prevent activation of these cells.

Tyrosine kinases are required for interferon-gamma-stimulated proliferation of Trypanosoma brucei brucei.

The tyrosine kinase activity of Trypanosoma brucei brucei upon stimulation with interferon-gamma (IFN-gamma) was investigated. IFN-gamma induced a rapid and strong increase of tyrosine phosphorylation of several cellular proteins that reached maximum after 5 min and was followed by a decrease to control levels after 120 min. The tyrosine kinase-specific inhibitor tyrphostin A47 at a concentration of 10(-6) M reduced IFN-gamma-induced protein phosphorylation. In vitro application of 10(-6) M tyrphostin A47 to the trypanosome cultures caused a significant reduction of [3H]thymidine uptake by IFN-gamma-stimulated trypanosomes. In animals, 2 x 0.5 mg of tyrphostin A47 (injected intraperitoneally) caused a significant reduction of parasite growth compared with the vehicle dimethyl sulfoxide or the inactive compound tyrphostin A1. In conclusion, tyrosine kinases are strongly up-regulated in IFN-gamma-stimulated T. b. brucei, and specific tyrosine kinase inhibitors can prevent trypanosome growth in vitro and in vivo.

Trypanosoma brucei brucei induces interferon-gamma expression in rat dorsal root ganglia cells via a tyrosine kinase-dependent pathway.

Dorsal root ganglia (DRG) were shown to express neuronal interferon (IFN)-gamma, which supports Trypanosoma brucei brucei growth. The ability of a trypanosome-derived factor (TLTF) to activate DRG to neuronal IFN-gamma secretion was investigated, together with the signaling pathway that might be involved during this process. Immunohistochemical staining revealed expression of neuronal IFN-gamma on stimulation with TLTF, which was blocked with the tyrosine protein-kinase inhibitor, tyrphostin A47. Western blot was used to analyze DRG lysates prepared at different time points after stimulation with TLTF. A tyrosine-phosphorylated protein induced at 15 min was seen as a band of 120-150 kDa, followed by a decrease to control levels after 30 min. A47 greatly suppressed the TLTF-induced tyrosine protein kinase activity. In addition, evidence suggesting that the transcription factor STAT-1 may play a key role in the TLTF signaling pathway was provided by the blocking effects of A47 on STAT-1 translocation to the nucleus.