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OBJECTIVE: The aim of this study was to evaluate the role of interleukin (IL)-6 pathways in postoperative immune suppression and to assess the reversibility of this phenomenon. BACKGROUND: The postoperative period is characterized by increased IL-6 production and features of immune suppression. In vitro, IL-6 mediates anti-inflammatory effects through inhibition of interferon gamma (IFN-γ) pathways. The significance of the immunomodulatory effects of IL-6 in the clinical setting of postoperative immune suppression remains unclear. METHODS: Patients over 45 years old undergoing elective surgery, involving the gastrointestinal tract, were recruited. IL-6 levels were assayed using an enzyme linked immunosorbent assay preoperatively, and at 24 and 48 hours. Peripheral blood mononuclear cells from healthy volunteers were cultured in perioperative serum and CD14Human Leukocyte Antigen-DR (HLA-DR) [monocyte HLA-DR (mHLA-DR)] geometric mean florescent intensity was measured in the presence and absence of IL-6 neutralizing antibody and recombinant IFN-γ. RESULTS: Of the 108 patients, 41 developed a postoperative infection. The IL-6 levels increased 19-fold from the preoperative sample to 24 hours postoperatively (Pâ<â0.0001). Higher IL-6 levels at 24 (Pâ=â0.0002) and 48 hours (Pâ=â0.003) were associated with subsequent postoperative infectious complications. mHLA-DR mean florescent intensity fell when healthy peripheral blood mononuclear cells were cultured with postoperative serum compared with preoperative serum (Pâ=â0.008). This decrease was prevented by the presence of IFN-γ in the culture media, but not by the presence of IL-6-neutralizing antibody. CONCLUSIONS: IL-6 levels increase after a major surgery and are associated with an increased susceptibility to postoperative infections. Serum obtained from postoperative patients induces an immunosuppressive response, reflected in reduced mHLA-DR levels, mediated through IL-6 independent pathways and is reversible with IFN-γ. These data may have therapeutic implications for the prevention of infection in patients undergoing major surgery.
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Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Tolerância Imunológica/fisiologia , Interferon gama/sangue , Interleucina-6/sangue , Complicações Pós-Operatórias/sangue , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologiaRESUMO
OBJECTIVES: To study innate immune pathways in patients undergoing hepatopancreaticobiliary surgery to understand mechanisms leading to enhanced inflammatory responses and identifying biomarkers of adverse clinical consequences. BACKGROUND: Patients undergoing major abdominal surgery are at risk of life-threatening systemic inflammatory response syndrome (SIRS) and sepsis. Early identification of at-risk patients would allow tailored postoperative care and improve survival. METHODS: Two separate cohorts of patients undergoing major hepatopancreaticobiliary surgery were studied (combined nâ=â69). Bloods were taken preoperatively, on day 1 and day 2 postoperatively. Peripheral blood mononuclear cells and serum were separated and immune phenotype and function assessed ex vivo. RESULTS: Early innate immune dysfunction was evident in 12 patients who subsequently developed SIRS (postoperative day 6) compared with 27 who did not, when no clinical evidence of SIRS was apparent (preoperatively or days 1 and 2). Serum interleukin (IL)-6 concentration and monocyte Toll-like receptor (TLR)/NF-κB/IL-6 functional pathways were significantly upregulated and overactive in patients who developed SIRS (Pâ<â0.0001). Interferon α-mediated STAT1 phosphorylation was higher preoperatively in patients who developed SIRS. Increased TLR4 and TLR5 gene expression in whole blood was demonstrated in a separate validation cohort of 30 patients undergoing similar surgery. Expression of TLR4/5 on monocytes, particularly intermediate CD14CD16 monocytes, on day 1 or 2 predicted SIRS with accuracy 0.89 to 1.0 (areas under receiver operator curves). CONCLUSIONS: These data demonstrate the mechanism for IL-6 overproduction in patients who develop postoperative SIRS and identify markers that predict patients at risk of SIRS 5 days before the onset of clinical signs.
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Abdome/cirurgia , Interleucina-6/metabolismo , Síndrome de Resposta Inflamatória Sistêmica/imunologia , Receptor 4 Toll-Like/metabolismo , Receptor 5 Toll-Like/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/metabolismo , Feminino , Citometria de Fluxo , Humanos , Imunidade Inata , Masculino , Pessoa de Meia-Idade , Monócitos , Estudos Prospectivos , Fatores de Risco , Regulação para CimaRESUMO
This study investigated comparatively the pathogenicity of experimental infection of mice and guinea pigs, with Angiostrongylus mackerrasae and the closely related species A. cantonensis. Time course analyses showed that A. mackerrasae causes eosinophilic meningitis in these hosts, which suggests that the species has the potential to cause meningitis in humans and domestic animals. Both A. mackerrasae and the genetically similar A. cantonensis caused eosinophilic meningitis in mice at two time points of 14 and 21 days post infection (dpi). The brain lesions in mice infected with A. mackerrasae were more granulomatous in nature and the parasites were more likely to appear degenerate compared with lesions caused by A. cantonensis. This may indicate that the mouse immune system eliminates A. mackerrasae infection more effectively. The immunologic responses of mice infected with the two Angiostrongylus species was compared by assessing ex vivo stimulated spleen derived T cells and cytokines including interferon-gamma, interleukin 4 and interleukin 17 on 14 and 21 dpi. The results were similar for mice infected with A. cantonensis and A. mackerrasae. Serum from the infected animals with either A. cantonensis or A. mackerrasae recognized total soluble antigen of A. cantonensis female worms on Western blot.
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Angiostrongylus/patogenicidade , Modelos Animais de Doenças , Eosinofilia/parasitologia , Meningite/parasitologia , Infecções por Strongylida/imunologia , Infecções por Strongylida/parasitologia , Angiostrongylus/imunologia , Angiostrongylus cantonensis/imunologia , Angiostrongylus cantonensis/patogenicidade , Animais , Antígenos de Helmintos/sangue , Antígenos de Helmintos/imunologia , Encéfalo/parasitologia , Encéfalo/patologia , Citocinas/biossíntese , Citocinas/imunologia , Eosinofilia/imunologia , Feminino , Cobaias , Humanos , Interferon gama/biossíntese , Interferon gama/imunologia , Meningite/imunologia , Camundongos , Baço/citologia , Baço/imunologia , Linfócitos T/imunologiaRESUMO
Neutrophils contribute to the pathological processes of a number of inflammatory disorders, including rheumatoid arthritis, sepsis and cystic fibrosis. Neutrophils also play prominent roles in schistosomiasis japonica liver fibrosis, being central mediators of inflammation following granuloma formation. In this study, we investigated the interaction between Schistosoma japonicum eggs and neutrophils, and the effect of eggs on the inflammatory phenotype of neutrophils. Our results showed significant upregulated expression of pro-inflammatory cytokines (IL-1α, IL-1ß and IL-8) and chemokines (CCL3, CCL4 and CXCL2) in neutrophils after 4 h in vitro stimulation with S. japonicum eggs. Furthermore, mitochondrial DNA was released by stimulated neutrophils, and induced the production of matrix metalloproteinase 9 (MMP-9), a protease involved in inflammation and associated tissue destruction. We also found that intact live eggs and isolated soluble egg antigen (SEA) triggered the release of neutrophil extracellular traps (NETs), but, unlike those reported in bacterial or fungal infection, NETs did not kill schistosome eggs in vitro. Together these show that S. japonicum eggs can induce the inflammatory phenotype of neutrophils, and further our understanding of the host-parasite interplay that takes place within the in vivo microenvironment of schistosome-induced granuloma. These findings represent novel findings in a metazoan parasite, and confirm characteristics of NETs that have until now, only been observed in response to protozoan pathogens.
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Citocinas/biossíntese , Interações Hospedeiro-Parasita , Neutrófilos/imunologia , Neutrófilos/parasitologia , Schistosoma japonicum/imunologia , Zigoto/imunologia , Animais , Fatores de Tempo , Regulação para CimaRESUMO
PURPOSE OF REVIEW: A host of immune modulators are now available in clinical practice. The perioperative period is characterized by profound alterations in host immunity, which can result in poor outcomes, which include infection, cancer recurrence and organ failure. Manipulation of the perioperative immune response has the potential to improve outcomes. A complete understanding of the mechanisms and clinical consequences of altered immune function in this setting is therefore imperative. RECENT FINDINGS: Recent in-vivo data have emerged which further our understanding of the interaction between tissue damage, immune modulation and clinical outcomes by utilizing novel laboratory techniques capable of monitoring single-cell immune signatures. Traditional gene expression assays have continued to demonstrate their utility and have been instrumental in defining the host response to perioperative allogeneic blood transfusion. These mechanistic studies are complemented by large clinical studies describing associations between anaesthetic modalities and immune-related outcomes. SUMMARY: Laboratory techniques are now available that can monitor the perioperative immune response and could be further developed to introduce personalized care pathways. Consideration must also be given to anaesthesia techniques and perioperative treatments that, although not immediately harmful, may be associated with poor outcomes temporally distant from the treatment, secondary to induced immunosuppression.
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Fenômenos do Sistema Imunitário , Período Perioperatório , Analgésicos/farmacologia , Anestésicos/farmacologia , Transfusão de Sangue Autóloga , Cuidados Críticos , Citocinas/fisiologia , Humanos , Fenômenos do Sistema Imunitário/genética , Inflamação/induzido quimicamente , Inflamação/imunologiaRESUMO
INTRODUCTION: Blood transfusion in the perioperative period has frequently been associated with an excess of nosocomial infections. Whilst transfused whole blood induces specific host immune alteration that may predispose to nosocomial infections, the immunomodulating properties associated with leukodepleted blood remain incompletely understood. In this study, we explore the hypothesis that the transfusion of leukodepleted allogeneic blood during or following major gastrointestinal surgery is associated with an immunosuppressed phenotype, which may in turn predispose to postoperative infectious complications. METHODS: Patients aged over 45 years undergoing scheduled inpatient major gastrointestinal surgery were recruited. Gene expression profiles of specific inflammatory genes were assayed from blood collected preoperatively, at 24 and at 48 hours after surgery. Genes were selected based on their ability to represent specific immune pathways. Gene expression was quantified using quantitative real-time polymerase chain reaction (qRT-PCR) to measure messenger RNA (mRNA) levels. Postoperative infections were documented using predefined criteria. RESULTS: One hundred and nineteen patients were recruited. Fifteen (13%) patients required blood transfusion within 24 hours of surgery, 44 (37%) patients developed infections and 3 (2%) patients died prior to discharge. Patients receiving a blood transfusion were more likely to develop postoperative infections (P =0.02) and to have lower tumour necrosis factor alpha (TNFα), interleukin (IL)-12, IL-23 and RAR-related orphan receptor gamma T (RORγt) gene expression in the postoperative period (P <0.05). The TNFα/IL-10 mRNA ratio at 24 hours (P =0.0006) and at 48 hours (P =0.01) was lower in patients receiving a blood transfusion over this period. Multivariable analysis confirmed that these observations were independent of the severity of the surgical insult. CONCLUSIONS: An association between an immunosuppressive pattern of gene expression and blood transfusion following major elective gastrointestinal surgery is described. This gene expression profile includes a reduction in the activity of innate immunity and T helper cell type 1 (Th1) and T helper cell type 17 (Th17) pathways in those patients receiving a blood transfusion. Blood transfusion was also associated with an excess of infectious complications in this cohort. A mechanistic link is suggested but not proven.
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Infecção Hospitalar/imunologia , Procedimentos Cirúrgicos do Sistema Digestório , Tolerância Imunológica , Período Perioperatório , Transcrição Gênica , Reação Transfusional , Idoso , Citocinas/metabolismo , Suscetibilidade a Doenças/imunologia , Procedimentos Cirúrgicos Eletivos , Feminino , Expressão Gênica , Mortalidade Hospitalar , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , RNA Mensageiro/metabolismoRESUMO
Cold stress syndrome (CSS) is the term used to describe the range of clinical signs and chronic disease processes that can occur in Florida, USA, manatees Trichechus manatus latirostris exposed to water temperatures below 20°C for extended periods. Although no cold-related adverse events have been described in the closely related dugong Dugong dugon thus far, it has been established that they make movements in response to water temperatures lower than about 17 to 18°C. In this study, archive reports for dugong carcasses submitted to The University of Queensland School of Veterinary Science for post mortem examination during 2010 to 2012 were examined. These animals had been recovered from Moreton Bay, southeast Queensland, Australia, and 10 out of 14 fulfilled the criteria for 'potential cold stress cases.' Epidermal hyperplasia and secondary bacterial infection, serous atrophy of pericardial adipose tissue, and multisystem abscessation were features commonly noted in these cases. Water temperature data were correlated with the time of year that carcasses were submitted for examination. Higher numbers of carcasses diagnosed with potential CSS were noted during sustained periods in which water temperature was below 20°C. Given the pattern of increased submission of non-specifically, chronically unwell animals in the colder months and evidence that environmental conditions known to precipitate CSS occur in southeast Queensland, it is probable that, like manatees, dugongs in this area are affected by CSS. Further investigation to confirm and to better characterize the syndrome is recommended to refine management practices and improve treatment of affected animals.
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Temperatura Baixa , Dugong , Estresse Fisiológico , Animais , Ecossistema , Feminino , Masculino , Queensland , Estações do Ano , Fatores de TempoRESUMO
Microbial infection may contribute to disease in a significant proportion of marine mammal mortalities, but little is known about infectious bacterial species and their prevalence in dugongs (Dugong dugon). This study represents a survey of the species of bacteria and fungi isolated from dugongs submitted to the University of Queensland's School of Veterinary Science for postmortem examination. Thirty-six dugongs were included in the survey, with 23 species of bacteria and four species of fungus cultured from lesions that were suspected of contributing to local infection, systemic infection, or both. The most abundant bacteria included Aeromonas spp., Clostridium spp., Vibrio spp., Enterococcus faecalis, and Pseudomonas spp. In six cases, the microorganism(s) cultured were considered to have been associated with disease. Mixed infections containing Aeromonas spp. and Vibrio spp.; Morganella morganii, Pasteurella multocida, and Serratia marcescens; and Actinomyces spp. and Peptostreptococcus spp. were associated with pneumonia or pleuritis, and Enterococcus faecalis was associated with a multisystemic infection in a neonate. Clostridium spp. was cultured from two animals with peritonitis and likely septicemia. The significance of many of the other isolates is uncertain because the samples were taken after death, and some of the species isolated may represent postmortem overgrowth. It is also difficult to fulfil Koch's postulates through experimental infection in marine mammals. Regardless, this information will assist clinicians working with dugongs to make treatment decisions and the baseline data on the prevalence of bacterial and fungal species is of value for monitoring coastal water habitat health and risks of zoonotic disease transmission.
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Infecções Bacterianas/veterinária , Dugong , Animais , Animais Selvagens , Infecções Bacterianas/epidemiologia , Queensland/epidemiologiaRESUMO
Canine splenic fibrohistiocytic nodules traditionally encompassed benign lymphoid hyperplasia, complex hyperplasia, and malignant fibrous histiocytoma. The latter has been recently re-classified into histiocytic sarcoma and stromal sarcoma. Reliable indicators of post-splenectomy survival and demographic factors predisposing to the four types of nodules are not completely understood. This study aims to estimate frequency, survival times, and identify risk factors of splenectomized dogs diagnosed with lymphoid hyperplasia, complex hyperplasia, histiocytic sarcoma, and stromal sarcoma using medical records containing histopathological diagnosis from the VetCompass Australia database (1989−2018), which collects demographic, and clinical information from veterinary clinics. Out of 693 dogs, 315 were diagnosed with fibrohistiocytic nodules, mostly lymphoid hyperplasia (169/693, 24.4%), followed by stromal sarcoma (59/693, 8.5%), complex hyperplasia (55/693, 7.9%), and histiocytic sarcoma (32/693, 4.6%). Dogs aged 8−10 years were more likely to be diagnosed with histiocytic or stromal sarcoma than lymphoid hyperplasia. Dogs diagnosed with lymphoid hyperplasia had a longer survival time than those with other diagnoses (median > 2 years). Dogs diagnosed with histiocytic sarcoma had longer survival times (median 349 days) than stromal sarcoma (median 166 days). Results suggest that knowledge of the type of splenic fibrohistiocytic nodule, patients' age, and sex can be used to increase prognostic accuracy.
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PURPOSE: Bladder urothelial cell carcinoma is uncommon in young patients. We recently reported a series of tumors in patients younger than 20 years at diagnosis and performed exhaustive genetic screening for molecular alterations. Few events typical of bladder urothelial cell carcinoma were detected. Since many carcinogenic events occur at the epigenetic rather than the genetic level, we analyzed the same tumors for alterations in DNA hypermethylation. We compared our findings with those in tumors in older patients with similar pathological profiles. MATERIALS AND METHODS: We analyzed 76 bladder urothelial cell carcinomas from 3 groups stratified by age at diagnosis, including less than 19, 20 to 45 and greater than 46 years (median 78), and matched for low grade and nonmuscle invasive stage. We used quantified methyl specific polymerase chain reaction to investigate promoter methylation for 8 tumor suppressor genes implicated in urothelial carcinogenesis. RESULTS: Tumors in the youngest age group had the lowest incidence of global hypermethylation compared to the other tumors with a methyl index of 37.5% vs 62.5% and 50%, respectively (ANOVA p = 0.009). When individual loci were analyzed, younger patients had a significantly lower rate and concentration of methylation at APC, Bcl2, MGMT and E-cadherin promoters than in the older groups (p <0.05). Few differences were present between the 2 older cohorts but the APC and MGMT methylation concentration increased with age. CONCLUSIONS: Urothelial tumors in patients younger than 19 years have a low rate of epigenetic alteration. Tumors in patients older than 20 years have epigenetic profiles similar to those of tumors in patients within the typical bladder urothelial cell carcinoma age range.
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Carcinoma de Células de Transição/genética , Epigênese Genética , Neoplasias da Bexiga Urinária/genética , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
PHOSPHO1, a new member of the haloacid dehalogenase superfamily, has recently been implicated in the mineralization process in both osteoblasts and chondrocytes. In this study we describe the identification of a novel, alternatively spliced PHOSPHO1 transcript (PHOSPHO1-3a). This transcript contains the three exons of the previously published variant, however exon 3 contains a retained, 127bp section of intron 2. This forms an in-frame start site, producing an open reading frame of 879bp and predicting a protein of 292 amino acids. The novel 40 amino acid N-terminal region of PHOSPHO1-3a contains a relatively strong secretory signal, however all three domains of the HAD superfamily are retained in exon 3. The expression of this splice variant was confirmed in both human and mouse osteoblast-like cells and also in the chondrogenic ATDC5 cell line. The data within this study indicate a possible function relating to chondrocyte differentiation/mineralization as with the previously published variant.
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Processamento Alternativo , Condrócitos/enzimologia , Monoéster Fosfórico Hidrolases/genética , Sequência de Aminoácidos , Animais , Calcificação Fisiológica/genética , Diferenciação Celular/genética , Condrócitos/citologia , Éxons , Humanos , Camundongos , Dados de Sequência Molecular , Osteoblastos/enzimologia , RNA Mensageiro/análise , RNA Mensageiro/metabolismo , Transcrição GênicaRESUMO
Complications resulting from impaired fracture healing have major clinical implications on fracture management strategies. Novel concepts taken from developmental biology have driven research strategies towards the elaboration of regenerative approaches that can truly harness the complex cellular events involved in tissue formation and repair. Advances in polymer technology and a better understanding of naturally derived scaffolds have given rise to novel biomaterials with an increasing ability to recapitulate native tissue environments. This coupled with advances in the understanding of stem cell biology and technology has opened new avenues for regenerative strategies with true clinical translatability. These advances have provided the impetus to develop alternative approaches to enhance the fracture repair process. We provide an update on these advances, with a focus on the development of novel biomimetic approaches for bone regeneration and their translational potential.
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Advances in scientific research and targeted treatment regimes have improved survival rates for many cancers over the past few decades. However, for some types of leukemia, including acute lymphoblastic and acute myeloid leukemia, mortality rates have continued to rise, with chemoresistance in leukemic stem cells (LSCs) being a major contributing factor. Most cancer drug therapies act by inducing apoptosis in dividing cells but are ineffective in targeting quiescent LSCs. Niches in the bone marrow, known as leukemic niches, behave as "sanctuaries" where LSCs acquire drug resistance. This review explores the role of the bone marrow environment in the maintenance of LSCs and its contribution to chemoresistance and considers current research on the potential use of phytochemicals to overcome chemoresistance through the modulation of signaling pathways involved in the survival and death of leukemic clonal cells and/or leukemic stem cells. Phytochemicals from traditional Chinese medicine, namely baicalein, chrysin, wogonin (constituents of Scutellaria baicalensis; huáng qín; ), curcumin (a constituent of Curcuma longa, jiang huáng, ), and resveratrol (a constituent of Polygonum cuspidatum; hu zhàng, ) have been shown to induce apoptosis in leukemic cell lines, with curcumin and resveratrol also causing cell death via the induction of autophagy (a nonapoptotic pathway). In order to be effective in eliminating LSCs, it is important to target signaling pathways (such as Wnt/ß-catenin, Notch, and Hedgehog). Resveratrol has been reported to induce apoptosis in leukemic cells through the inhibition of the Notch and Sonic hedgehog signaling pathways, therefore showing potential to affect LSCs. While these findings are of interest, there is a lack of reported research on the modulatory effect of phytochemicals on the autophagic cell death pathway in leukemia, and on the signaling pathways involved in the maintenance of LSCs, highlighting the need for further work in these areas.
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Apoptose/efeitos dos fármacos , Autofagia/efeitos dos fármacos , Resistencia a Medicamentos Antineoplásicos/efeitos dos fármacos , Leucemia/tratamento farmacológico , Compostos Fitoquímicos/uso terapêutico , Animais , Medula Óssea/anatomia & histologia , Humanos , Nicho de Células-TroncoRESUMO
For hepatic schistosomiasis the egg-induced granulomatous response and the development of extensive fibrosis are the main pathologies. We used a Schistosoma japonicum-infected mouse model to characterise the multi-cellular pathways associated with the recovery from hepatic fibrosis following clearance of the infection with the anti-schistosomal drug, praziquantel. In the recovering liver splenomegaly, granuloma density and liver fibrosis were all reduced. Inflammatory cell infiltration into the liver was evident, and the numbers of neutrophils, eosinophils and macrophages were significantly decreased. Transcriptomic analysis revealed the up-regulation of fatty acid metabolism genes and the identification of Peroxisome proliferator activated receptor alpha as the upstream regulator of liver recovery. The aryl hydrocarbon receptor signalling pathway which regulates xenobiotic metabolism was also differentially up-regulated. These findings provide a better understanding of the mechanisms associated with the regression of hepatic schistosomiasis.
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Anti-Helmínticos/uso terapêutico , Granuloma/tratamento farmacológico , Fígado/patologia , Praziquantel/uso terapêutico , Esquistossomose Japônica/tratamento farmacológico , Animais , Modelos Animais de Doenças , Eosinófilos/patologia , Feminino , Granuloma/patologia , Imuno-Histoquímica , Fígado/efeitos dos fármacos , Macrófagos/patologia , Camundongos , Camundongos Endogâmicos C57BL , Análise em Microsséries , Neutrófilos/patologia , RNA de Helmintos/isolamento & purificação , Reação em Cadeia da Polimerase em Tempo Real , Schistosoma japonicum/genética , Schistosoma japonicum/isolamento & purificação , Esquistossomose Japônica/patologia , Baço/patologia , Resultado do Tratamento , Regulação para CimaRESUMO
BACKGROUND: Survivors of critical illness are at increased risk of fractures. This may be due to increased osteoclast formation during critical illness, leading to trabecular bone loss. Such bone loss has also been observed in Paget's disease, and has been related to deficient autophagy. Deficient autophagy has also been documented in vital organs and skeletal muscle of critically ill patients. The objective of this study was to investigate whether deficient autophagy can be linked to critical illness-induced bone loss. METHODS: Osteoclasts grown in vitro and their precursor cells isolated from peripheral blood of critically ill patients and from matched healthy volunteers were analysed for the expression of autophagy genes (SQSTM1, Atg3 and Atg7), and proteins (p62, Atg-5, and microtubule-associated protein light chain 3-II (LC3-II)) and for autophagy and epigenetic signalling factors via PCR arrays and were treated with the autophagy inducer rapamycin. The effect of rapamycin was also investigated at the tissue level in an in vivo rabbit model of critical illness. RESULTS: Many more osteoclasts formed in vitro from the blood precursor cells isolated from critically ill patients, which accumulated p62, and displayed reduced expression of Atg5, Atg7, and LC3-II compared to healthy controls, suggesting deficient autophagy, whilst addition of rapamycin reduced osteoclast formation. PCR arrays revealed a down-regulation of histone methyltransferases coupled with an up-regulation of negative regulators of autophagy. Critically ill rabbits displayed a reduction in trabecular and cortical bone, which was rescued with rapamycin. CONCLUSIONS: Deficient autophagy in osteoclasts and their blood precursor cells at least partially explained aberrant osteoclast formation during critical illness and was linked to global histone hypomethylation. Treatment with the autophagy activator Rapamycin reduced patient osteoclast formation in vitro and reduced the amount of bone loss in critically ill rabbits in vivo. These findings may help to develop novel therapeutic targets to prevent critical illness-induced bone loss.
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BACKGROUND: Transfusion of packed red blood cells (PRBCs) is associated with an increased incidence of nosocomial infections and an increased risk of death. The duration of storage before transfusion may influence these outcomes. Here, we explore the association between the age of transfused PRBCs and specific patterns of inflammatory gene expression in severely injured trauma patients. METHODS: Severely injured trauma patients requiring intensive care unit treatment and receiving transfusion of PRBCs within 24 hours of the injury were recruited. Blood samples were obtained within 2 hours of the trauma, at 24 hours, and at 72 hours. Messenger RNA was extracted from whole blood, and gene expression was quantified using quantitative polymerase chain reaction. The median age of the units of PRBCs transfused to each patient was recorded. The primary outcome measure was the change in candidate gene expression over the initial 72 hours. RESULTS: Sixty-four patients were studied. Fifty-three patients (83%) were male, and the median age was 40.5 years (interquartile range [IQR], 31-59). Median Injury Severity Score (ISS) was 31.5 (IQR, 23-43), and 55 patients (86%) experienced a blunt injury. Forty-one patients (64%) developed a nosocomial infection, and 15 patients (23%) died before hospital discharge. Each patient received a median of 5 U of PRBCs (IQR, 4-9.8 U) during the first 24 hours of hospital admission. The median age of the units of PRBCs transfused in each patient was 20 days (IQR, 17-22 days). Older blood was associated with greater decreases in interleukin 12 (IL-12), IL-23, and RORγt (all p's < 0.05) gene expression over the initial 24 hours, greater decreases in IL-12 gene expression over 72 hours, and a rise in transforming growth factor ß gene expression over the first 72 hours. A multivariate analysis confirmed the independence of these associations. CONCLUSION: Increasing the duration of storage of PRBCs before transfusion is associated with a pattern of gene expression consistent with more severe immunosuppression. LEVEL OF EVIDENCE: Epidemiologic study, level III.
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Preservação de Sangue/efeitos adversos , Citocinas/genética , Transfusão de Eritrócitos , Expressão Gênica , Terapia de Imunossupressão , Fatores de Transcrição/genética , Ferimentos e Lesões/terapia , Adulto , Cuidados Críticos , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Reação em Cadeia da Polimerase , RNA Mensageiro/genética , Fatores de Risco , Fatores de Tempo , Centros de TraumatologiaRESUMO
BACKGROUND: Posttraumatic nosocomial pneumonia is a common complication resulting in significant morbidity. Trauma-induced immunocompromise is associated with an enhanced susceptibility to pneumonia. In this study, we explore the hypothesis that posttranscriptional epigenetic regulation of gene expression may be an important factor in determining this immune phenotype. We describe the pattern of production of microRNAss (miRs) and their association with nosocomial pneumonia following severe trauma. METHODS: A convenience sample of 30 ventilated polytrauma patients ( UKCRN ID: 5637) and 16 healthy controls were recruited. Messenger RNA and protein levels of key cytokines were quantified within 2 hours of the injury and at 24 hours. Three miRs per cytokine were then selected based on miRBase target prediction scores and quantified using polymerase chain reaction. Nosocomial pneumonia was defined using the Centers for Disease Control and Prevention definitions. RESULTS: Median Injury Severity Score (ISS) was 29, and 47% of the patients developed nosocomial pneumonia. miR-125a and miR-202 decreased by 34% and 77%, respectively, immediately following injury, whereas their target, IL-10, increased messenger RNA levels 3-fold and protein levels 180-fold. Tumor necrosis factor α (TNF-α) and IL-12 gene expression decreased by 68% and 43%, respectively, following injury, and this was mirrored by a 10-fold increase in miR-181, an miR predicted to target TNF-α transcripts. Lower levels of miR-125a and miR-374b were associated with the later acquisition of hospital-acquired pneumonia. CONCLUSION: Alteration in the expression of miRs with highly predicted complementarity to IL-10 and TNF-α may be an important mechanism regulating the posttraumatic immunosuppressive phenotype in intensive care unit patients. LEVEL OF EVIDENCE: Retrospective observational study, level III.
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Epigênese Genética , Regulação da Expressão Gênica , Hospedeiro Imunocomprometido/genética , MicroRNAs/genética , Ferimentos e Lesões/imunologia , Adulto , Idoso , Estudos de Casos e Controles , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/genética , Serviço Hospitalar de Emergência , Feminino , Humanos , Escala de Gravidade do Ferimento , Interleucina-10/metabolismo , Interleucina-12/metabolismo , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/genética , Traumatismo Múltiplo/imunologia , Traumatismo Múltiplo/terapia , Pneumonia/epidemiologia , Pneumonia/genética , Valor Preditivo dos Testes , Prognóstico , Respiração Artificial , Estudos Retrospectivos , Transdução de Sinais , Centros de Traumatologia , Resultado do Tratamento , Reino Unido , Ferimentos e Lesões/genética , Ferimentos e Lesões/terapiaRESUMO
The translation of stem cell-based regenerative solutions from the laboratory to the clinic is often hindered by the culture conditions used to expand cell populations. Although fetal bovine serum (FBS) is widely used, regulatory bodies and safety concerns encourage alternative, xeno-free culturing practices. In an attempt to apply this approach to a bone-forming combination product of human periosteal progenitors (human periosteum derived cells) on a clinically used calcium phosphate carrier, FBS was substituted for human allogeneic serum (hAS) during cell expansion. It was found that cell proliferation was increased in hAS along with an apparent commitment to the osteogenic lineage, indicated by enhanced Runx2 expression, as well as alkaline phosphatase activity and matrix mineralization. Following analysis of signaling pathways, it was found that interferon-mediated signaling was downregulated, whereas JAK-STAT signaling was upregulated. STAT3 phosphorylation was enhanced in hAS-cultured human periosteum derived cells, inhibition of which ablated the proliferative effect of hAS. Furthermore, following in vivo implantation of hAS-cultured cells on NuOss scaffolds, enhanced bone formation was observed compared with FBS (71% increase, p < .001). Interestingly, the de novo-formed bone appeared to have a higher ratio of immature regions to mature regions, indicating that after 8 weeks implantation, tissue-formation processes were continuing. Integration of the implant with the environment appeared to be altered, with a decrease in calcium phosphate grain size and surface area, indicative of accelerated resorption. This study highlights the advantages of using humanized culture conditions for the expansion of human periosteal progenitors intended for bone regeneration.
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Proteínas Sanguíneas/farmacologia , Osso e Ossos/citologia , Osteócitos/citologia , Periósteo/citologia , Células-Tronco/citologia , Engenharia Tecidual/métodos , Animais , Fosfatos de Cálcio/farmacologia , Bovinos , Técnicas de Cultura de Células/métodos , Diferenciação Celular/efeitos dos fármacos , Diferenciação Celular/fisiologia , Proliferação de Células/efeitos dos fármacos , Meios de Cultura/farmacologia , Voluntários Saudáveis , Humanos , Fator de Transcrição STAT3/antagonistas & inibidores , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/fisiologia , Células-Tronco/efeitos dos fármacosRESUMO
The severity of schistosome egg-induced hepatic granulomatous pathology depends markedly on the nature of the host immune responses. In this study, we used LMM and microarray analysis to compare gene expression profiles of histologically distinct zones within, and directly proximal to, hepatic granulomas that developed in C57BL/6 mice infected with Schistosoma japonicum. There was significant up-regulation of type-1, type-2, and type-17 immune-associated genes within the granuloma core (adjacent to eggs), followed by increased expression of type-2 and fibrotic genes at the outer zones of granulomas. Neutrophil-associated genes were also found to be expressed differentially in the core and at the peripheral zone of granulomas, present at 7 weeks p.i., demonstrating a significant role of neutrophils in S. japonicum granulomatous pathology. The release of NETs was observed microscopically in granulomas obtained from the livers of infected mice and when human neutrophils were incubated in vitro in the presence of S. japonicum eggs. These finding are the first to suggest a novel, dual role for neutrophils in the mediation of tissue damage and repair in S. japonicum egg-induced hepatic granulomatous lesions. Together, these results provide an overview of the local events occurring within the granuloma microenvironment.