Associations between immune cell traits and autoimmune thyroid diseases: a bidirectional two-sample mendelian randomization study.

Autoimmune thyroid diseases (AITDs), mainly including Graves' disease (GD) and Hashimoto's thyroiditis (HT), are common autoimmune disorders characterized by abnormal immune responses targeting the thyroid gland. We conducted a bidirectional two-sample MR analysis using the largest dataset of peripheral immune cell phenotypes from Sardinia, and the AITD dataset from the 10th round of the FinnGen and the UK Biobank project. Instrumental variables (IVs) were rigorously selected based on the three assumptions of MR and analyzed using the Wald ratio, inverse-variance weighted (IVW), MR-Egger, and weighted median methods. Additionally, sensitivity analyses were performed using Cochrane's Q, the Egger intercept, the MR-PRESSO, and the leave-one-out (LOO) method to ensure the robustness of the results. The Steiger test was utilized to identify and exclude potential reverse causation. The results showed that 3, 3, and 11 immune cell phenotypes were significantly associated with the risk of AITD. In GD, the proportion of naive CD4-CD8- (DN) T cells in T cells and the proportion of terminally differentiated CD4+T cells in T cells showed the strongest inducing and protective effects, respectively. In HT, lymphocyte count and CD45 on CD4+T cells showed the strongest inducing and protective effects, respectively. In autoimmune hypothyroidism, CD127 CD8+T cell count and terminally differentiated DN T cell count exhibited the strongest inducing and protective effects, respectively. Through MR analysis, our study provides direct genetic evidence of the impact of immune cell traits on AITD risk and lays the groundwork for potential therapeutic and diagnostic target discovery.

High-speed centrifugation rather than Lipoclear reagent can be used for removing the interference of lipemia on serological tests of infectious diseases: AIDS, hepatitis B, hepatitis C, and syphilis by chemiluminescent microparticle immunoassay.

The aim of this study was to investigate the interference of lipemia on measurement of HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc, anti-HCV, HIV Ag/Ab, and anti-TP in serum by chemiluminescent microparticle immunoassay (CMIA) and compare lipemia removing performance between high-speed centrifugation and Lipoclear reagent. Mixed native serum samples (NSs) and hyperlipemia serum samples (HLS) were prepared for the investigated parameters. The levels of these parameters in NS and HLS were determined by CMIA on an Abbott ARCHITECT i2000SR immunoassay analyzer. HBsAg, anti-HBs, and anti-TP were affected with relative bias >12.5% (acceptable limit) when the level of triacylglycerol (TG) was higher than 27.12 mmol/L in HLS. Clinically unacceptable bias were observed for HBeAg and anti-HBe in HLS with TG higher than 40.52 mmol/L. However, anti-HCV and HIV Ag/Ab were not interfered in severe lipemia with TG < 52.03 mmol/L. In addition, the Lipoclear reagent did not reduce the interference of lipemia with relative bias from -62.50% to -18.02%. The high-speed centrifugation under the optimized condition of 12 000g for 10 min successfully removed the interference of lipemia with relative bias from -5.93% to 0% for HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc, and anti-TP. To conclude, high-speed centrifugation can be used for removing the interference of lipemia to measure HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc, and anti-TP. Accordingly, a standardized sample preanalytical preparation of the patients and other screening participants as well as a specimen examination procedure for removing lipemia interference on the serological tests was recommended.

Integrated metabolomic and transcriptomic analysis of triterpenoid accumulation in the roots of Codonopsis pilosula var. modesta (Nannf.) L.T.Shen at different altitudes.

INTRODUCTION: Codonopsis Radix is a beneficial traditional Chinese medicine, and triterpenoid are the major bioactive constituents. Codonopsis pilosula var. modesta (Nannf.) L.T.Shen (CPM) is a precious variety of Codonopsis Radix, which is distributed at high mountain areas. The environment plays an important role in the synthesis and metabolism of active ingredients in medicinal plants, but there is no report elaborating on the effect of altitude on terpenoid metabolites accumulation in CPM. OBJECTIVES: This study aims to analyse the effects of altitude on triterpenoid biosynthetic pathways and secondary metabolite accumulation in CPM. MATERIAL AND METHODS: The untargeted metabolomics based on liquid chromatography-tandem mass spectrometry (LC-MS/MS) and 10 triterpenoids based on ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry (UPLC-Q-TOF-MS) method were analysed at the low-altitude (1480 m) and high-altitude (2300 m) CPM fresh roots. The transcriptome based on high-throughput sequencing technology were combined to analyse the different altitude CPM triterpenoid biosynthetic pathways. RESULTS: A total of 17,351 differentially expressed genes (DEGs) and 55 differentially accumulated metabolites (DAMs) were detected from the different altitude CPM, and there are significant differences in the content of the 10 triterpenoids. The results of transcriptome study showed that CPM could significantly up-regulate the gene expression levels of seven key enzymes in the triterpenoid biosynthetic pathway. CONCLUSIONS: The CPM at high altitude is more likely to accumulate triterpenes than those at low altitude, which was related to the up-regulation of the gene expression levels of seven key enzymes. These results expand our understanding of how altitude affects plant metabolite biosynthesis.

Fe(III) Docking-Activated Sites in Layered Birnessite for Efficient Water Oxidation.

Non-noble metal catalysts for promoting the sluggish kinetics of oxygen evolution reaction (OER) are essential to efficient water splitting for sustainable hydrogen production. Birnessite has a local atomic structure similar to that of an oxygen-evolving complex in photosystem II, while the catalytic activity of birnessite is far from satisfactory. Herein, we report a novel Fe-Birnessite (Fe-Bir) catalyst obtained by controlled Fe(III) intercalation- and docking-induced layer reconstruction. The reconstruction dramatically lowers the OER overpotential to 240 mV at 10 mA/cm2 and the Tafel slope to 33 mV/dec, making Fe-Bir the best of all the reported Bir-based catalysts, even on par with the best transition-metal-based OER catalysts. Experimental characterizations and molecular dynamics simulations elucidate that the catalyst features active Fe(III)-O-Mn(III) centers interfaced with ordered water molecules between neighboring layers, which lower reorganization energy and accelerate electron transfer. DFT calculations and kinetic measurements show non-concerted PCET steps conforming to a new OER mechanism, wherein the neighboring Fe(III) and Mn(III) synergistically co-adsorb OH* and O* intermediates with a substantially reduced O-O coupling activation energy. This work highlights the importance of elaborately engineering the confined interlayer environment of birnessite and more generally, layered materials, for efficient energy conversion catalysis.

Iron overload in alcoholic liver disease: underlying mechanisms, detrimental effects, and potential therapeutic targets.

Alcoholic liver disease (ALD) is a global public health challenge due to the high incidence and lack of effective therapeutics. Evidence from animal studies and ALD patients has demonstrated that iron overload is a hallmark of ALD. Ethanol exposure can promote iron absorption by downregulating the hepcidin expression, which is probably mediated by inducing oxidative stress and promoting erythropoietin (EPO) production. In addition, ethanol may enhance iron uptake in hepatocytes by upregulating the expression of transferrin receptor (TfR). Iron overload in the liver can aggravate ethanol-elicited liver damage by potentiating oxidative stress via Fenton reaction, promoting activation of Kupffer cells (KCs) and hepatic stellate cells (HSCs), and inducing a recently discovered programmed iron-dependent cell death, ferroptosis. This article reviews the current knowledge of iron metabolism, regulators of iron homeostasis, the mechanism of ethanol-induced iron overload, detrimental effects of iron overload in the liver, and potential therapeutic targets.

Recent Progress on Perovskite-Based Electrocatalysts for Efficient CO2 Reduction.

An efficient carbon dioxide reduction reaction (CO2RR), which reduces CO2 to low-carbon fuels and high-value chemicals, is a promising approach for realizing the goal of carbon neutrality, for which effective but low-cost catalysts are critically important. Recently, many inorganic perovskite-based materials with tunable chemical compositions have been applied in the electrochemical CO2RR, which exhibited advanced catalytic performance. Therefore, a timely review of this progress, which has not been reported to date, is imperative. Herein, the physicochemical characteristics, fabrication methods and applications of inorganic perovskites and their derivatives in electrochemical CO2RR are systematically reviewed, with emphasis on the structural evolution and product selectivity of these electrocatalysts. What is more, the current challenges and future directions of perovskite-based materials regarding efficient CO2RR are proposed, to shed light on the further development of this prospective research area.

The endogenous factors affecting the detection of serum SARS-CoV-2 IgG/IgM antibodies by ELISA.

To investigate endogenous interference factors of the detection results of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgM/IgG. Enzyme-linked immunosorbent assay (ELISA) was used to detect SARS-CoV-2 IgM/IgG in sera of 200 patients without COVID-19 infection, including rheumatoid factor (RF) positive group, antinuclear antibody (ANA) positive group, pregnant women group, and normal senior group, with 50 in each group and 100 normal controls. The level of SARS-CoV-2 IgG in pregnant women was significantly higher than that in the normal control group (p = 0.000), but there was no significant difference between other groups. The levels of SARS-CoV-2 IgM in the pregnant women group, normal senior group, ANA positive group, and RF positive group were significantly higher than that in the normal control group (p < 0.05), with significant higher false-positive rates in these groups (p = 0.036, p = 0.004, p = 0.000, vs. normal control group). Serum RF caused SARS-CoV-2 IgM false-positive in a concentration-dependent manner, especially when its concentration was higher than 110.25 IU/L, and the urea dissociation test can turn the false positive to negative. ANA, normal seniors, pregnant women, and RF can lead to false-positive reactivity of SARS-CoV-2 IgM and/or IgG detected using ELISA. These factors should be considered when SARS-CoV-2 IgM or IgG detection is positive, false positive samples caused by RF positive can be used for urea dissociation test.

Atomic mechanism of lithium intercalation induced phase transition in layered MoS2.

The phase transition in layered MoS2 has attracted wide attention but the detailed phase transition process is still unclear. Here, the H → T' phase transition mechanism of single- and bilayer MoS2 induced by lithium intercalation has been systematically studied using first principles. The results indicated that the lithium intercalation can effectively reduce the sliding barrier of the S atom layer. Moreover, we demonstrated that the phase transition process in bilayer MoS2 is induced by S atom transition one by one instead of the collective behavior of the S atoms. Importantly, we found that the phase transition process in bilayer MoS2 consists of the formation, diffusion and recombination of S vacancies, and the phase transition originates from interlayer lithium defects. In addition, the lithium defects cannot induce phase transition in monolayer MoS2 due to the larger sliding barrier of the S atom.

N,N-dimethylformamide-induced acute liver damage is driven by the activation of NLRP3 inflammasome in liver macrophages of mice.

N,N-dimethylformamide (DMF) is a non-negligible volatile hazardous material in indoor and outdoor environments. Although the hepatotoxicity of DMF has been well recognized, the underlying mechanisms remain unclear and prophylactic medicine is still lacking. Herein, we established a DMF-induced acute liver injury mouse model and investigated the underlying mechanisms focusing on oxidative stress and the nucleotide-binding domain and leucine-rich repeat receptor (NLR) family pyrin domain (PYD)-containing 3 (NLRP3) inflammasome. DMF was found to induce oxidative stress, evidenced by the elevation of hepatic malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE) adducts levels, and the decline of reduced glutathione (GSH) levels. However, neither N-acetyl cysteine (NAC) nor sulforaphane (SF) ameliorated the hepatoxicity induced by DMF in mice. Interestingly, DMF exposure led to focal necrosis of hepatocytes and NLRP3 inflammasome activation before the onset of obvious liver damage. In addition, DMF exposure induced infiltration and proinflammatory/M1 polarization of macrophages in mice livers. Furthermore, the inactivation of hepatic macrophages by GdCl3 significantly suppressed DMF-induced elevation of serum aminotransferase activities, neutrophile infiltration, and activation of NLRP3 inflammasome in mice liver. Collectively, these results suggest that DMF-induced acute hepatotoxicity may be attributed to the activation of NLRP3 inflammasome in liver macrophages, but not oxidative stress.

[Comparison between Ultrasonography and CT in Diagnosis of Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma].

Objective To evaluate the efficacy of ultrasound and computed tomography (CT) in diagnosing cervical lymph node metastasis (CLNM) of papillary thyroid carcinoma (PTC). Methods The patients with PTC treated by surgery in the Chinese PLA General Hospital from January 2016 to January 2021 were selected for analysis.All the patients underwent preoperative ultrasound and CT examinations,the diagnostic values of which for CLNM were retrospectively analyzed. Results A total of 322 PTC patients were enrolled in this study,including 242 with CLNM and 80 with non-CLNM.The CLNM group and non-CLNM group had significant differences in age,tumor size,and maximum size of lateral CLNM (χ2=20.34,27.34,and 4.30,respectively,all P<0.001).For the central compartment,lateral compartment,and overall compartment,ultrasound diagnosis showed higher sensitivity (χ 2=82.26,P<0.001;χ2=114.01,P<0.001;χ2=82.26,P<0.001) and accuracy (χ2=20.27,P<0.001;χ2=15.56,P<0.001;χ2=44.00,P<0.001) than CT,and had no significant differences from ultrasound combined with CT (all P>0.05).However,ultrasound diagnosis had lower specificity than CT (χ2=17.01,P<0.001;χ2=21.29,P<0.001) in the central compartment and lateral compartment.Receiver operating characteristic curve analysis showed that in the central compartment,lateral compartment,and overall compartment,ultrasound diagnosis had larger AUC than CT (Z=2.99,P=0.003;Z=3.86,P<0.001;Z=4.47,P<0.001) and had no significant difference from ultrasound combined with CT (Z=1.87,P=0.062;Z=1.68,P=0.093;Z=1.61,P=0.107). Conclusions Ultrasound and CT have their own advantages in the diagnosis of central and lateral CLNM.In general,ultrasound has better performance than CT in the diagnosis of CLNM.

Analysis of natural variation of the rice blast resistance gene Pike and identification of a novel allele Pikg.

Plant major resistance (R) genes are effective in detecting pathogen signal molecules and triggering robust defense responses. Investigating the natural variation in R genes will allow identification of the critical amino acid residues determining recognition specificity in R protein and the discovery of novel R alleles. The rice blast resistance gene Pike, comprising of two adjacent CC-NBS-LRR genes, namely, Pike-1 and Pike-2, confers broad-spectrum resistance to Magnaporthe oryzae. Here, we demonstrated that Pike-1 determined Pike-specific resistance through direct interaction with the pathogen signal molecule AvrPik. Analysis of natural variation in 79 Pike-1 variants in the Asian cultivated rice Oryza sativa and its wild relatives revealed that the CC and NBS regions, particularly the CC region of the Pike-1 protein were the most diversified. We also found that balancing selection had occurred in O. sativa and O. rufipogon to maintain the genetic diversity of the Pike-1 alleles. By analysis of amino acid sequences, we identified 40 Pike-1 variants in these rice germplasms. These variants were divided into three major groups that corresponded to their respective clades. A new Pike allele, designated Pikg, that differed from Pike by a single amino acid substitution (D229E) in the Pike-1 CC region of the Pike protein was identified from wild rice relatives. Pathogen assays of Pikg transgenic plants revealed a unique reaction pattern that was different from that of the previously identified Pike alleles, namely, Pik, Pikh, Pikm, Pikp, Piks and Pi1. These findings suggest that minor amino acid residues in Pike-1/Pikg-1 determine pathogen recognition specificity and plant resistance. As a new blast R gene derived from rice wild relatives, Pikg has potential applications in rice breeding.

Monocarboxylate transporter 1 promotes proliferation and invasion of renal cancer cells by mediating acetate transport.

One hallmark of renal cell carcinoma (RCC) is metabolic reprogramming, which involves elevation of glycolysis and upregulation of lipid metabolism. However, the mechanism of metabolic reprogramming is incompletely understood. Monocarboxylate transporter 1 (MCT1) promotes transport for lactate and pyruvate, which are crucial for cell metabolism. The aim of present study was to investigate the function of MCT1 on RCC development and its mechanism on metabolic reprogramming. The results showed that MCT1 messenger RNA and protein levels significantly increased in cancer tissues of ccRCC compared to normal tissue. MCT1 was further found to mainly located in the cell membrane of RCC. The knockdown of MCT1 by RNAi significantly inhibited proliferation and migration of 786-O and ACHN cells. MCT1 also induced the expressions of proliferation marker Ki-67 and invasion marker SNAI1. Moreover, we also showed that acetate treatment could upregulate the expression of MCT1, but not other MCT isoforms. On the other hand, MCT1 was involved in acetate transport and intracellular histone acetylation. In summary, this study revealed that MCT1 is abnormally high in ccRCC and promotes cancer development. The regulatory effect of MCT1 on cell proliferation and invasion maybe mediated by acetate transport.

Unmatched Virus Preservation Solution may Impede One-Step Reagent for Detection of 2019-nCoV RNA.

BACKGROUND AND METHODS: 2019 Corona Virus Disease (COVID-19) caused by SARS-CoV-2 is still pandemic now. RT-qPCR detection was the most common method for the diagnosis of SARS-CoV-2 infection, facilitated by amounts of nucleic acid testing kits. However, the accuracy of nucleic acid detection is affected by various factors such as specimen collection, specimen preparation, reagents deficiency, and personnel quality. RESULTS: In this study, we found that unmatched virus preservation solution will inhibit N gene and OFR-1ab gene (two independent genes of SARS-CoV-2) amplification in one-step detection reagent. CONCLUSIONS: Despite just being a particular phenomenon we found in our work to fight 2019-nCoV, we concluded that unmatched virus preservation solution may have an inhibitory effect on SARS-CoV-2 nucleic acid detection which may lead to incorrect clinical diagnosis.

TM LDH Meets Birnessite: A 2D-2D Hybrid Catalyst with Long-Term Stability for Water Oxidation at Industrial Operating Conditions.

Efficient noble-metal free electrocatalyst for oxygen evolution reaction (OER) is critical for large-scale hydrogen production via water splitting. Inspired by Nature's oxygen evolution cluster in photosystem II and the highly efficient artificial OER catalyst of NiFe layered double hydroxide (LDH), we designed an electrostatic 2D-2D assembly route and successfully synthesized a 2D LDH(+)-Birnessite(-) hybrid. The as-constructed LDH(+)-Birnessite(-) hybrid catalyst showed advanced catalytic activity and excellent stability towards OER under a close to industrial hydrogen production condition (85 °C and 6 M KOH) for more than 20 h at the current densities larger than 100 mA cm-2 . Experimentally, we found that besides the enlarged interlayer distance, the flexible interlayer NiFe LDH(+) also modulates the electronic structure of layered MnO2 , and creates an electric field between NiFe LDH(+) and Birnessite(-), wherein OER occurs with a greatly decreased overpotential. DFT calculations confirmed the interlayer LDH modulations of the OER process, attributable to the distinct electronic distributions and environments. Upshifting the Fe-3d orbitals in LDH promotes electron transfer from the layered MnO2 to LDH, significantly boosting up the OER performance. This work opens a new way to fabricate highly efficient OER catalyst for industrial water oxidation.

In situ growth of Fe2WO6 on WO3 nanosheets to fabricate heterojunction arrays for boosting solar water splitting.

We demonstrate the construction of heterojunction arrays for boosting solar water splitting by combining in situ guided growth of heterointerfaces and energy band tuning. By directly growing an ultrathin Fe2WO6 layer on a preformed WO3 nanosheet array in full coverage, a uniform and dense array of intimately contacted WO3/Fe2WO6 heterojunction was created. The heterojunction array shows not only a largely broadened visible light absorption range but also a built-in interface polarization to accelerate hole transfer from WO3 to Fe2WO6. Meanwhile, fine-tuning to match energy levels at the heterojunction was achieved by doping WO3 with Fe (Fe-WO3), leading to improved electrical conductivity and reduced charge recombination. Photoanodes based on such heterojunction arrays have shown significantly enhanced photoelectrochemical (PEC) water splitting performance, clearly arising from the above-mentioned efforts. Furthermore, by decorating FeOOH/NiOOH cocatalysts on the heterojunction arrays in tandem, the surface water oxidation kinetics was considerably accelerated, and the resulting Fe-WO3/Fe2WO6/FeOOH/NiOOH photoanode achieved a photocurrent density of 2.78 mA/cm2 at 1.23 V vs reversible hydrogen electrode. This work highlights the benefits of in situ construction of heterojunction arrays for enhancing the PEC performance.

Sonographic appearances of retained surgical sponges in the abdomen and pelvis.

PURPOSE: To describe the sonographic (ultrasound-US) features of retained surgical sponges (RSSs) and compare them with the pathological findings. METHODS: Ultrasound features of RSSs in nine patients (seven women and two men) identified between June 1996 and July 2015 were retrospectively analyzed. Patient characteristics including gender and age, location of the sponge, time interval until diagnosis, clinical presentation, and patient complaints were evaluated. RESULTS: The US appearances of RSSs could be classified into three types. Type I (five cases): an echogenic arc with a strong posterior shadow; type II (two cases): US appearance mimicked a cystic teratoma; type III (two cases): a cystic mass with zigzag-shaped internal contents. CT and/or MRI showed a mass with density/signal intensity similar to that of the adjacent soft tissues. CONCLUSION: The characteristic US findings along with a history of surgery can help reach a correct diagnosis of RSS.

Three-Dimensional Decoupling Co-Catalyst from a Photoabsorbing Semiconductor as a New Strategy To Boost Photoelectrochemical Water Splitting.

A cocatalyst is normally deposited on a photoabsorbing semiconductor (PAS) for photoelectrochemical (PEC) water splitting, but with drawbacks of limited loading, reduced light absorption, and tendency of charge recombination. To tackle these problems, a scheme of three-dimensional (3D) decoupling cocatalysts from the PAS with a pore-spanning crisscross conducting polymer host is proposed in this work. To demonstrate the concept, a facile method was developed for the in situ cogrowth of FeO x nanoparticles and conducting polymer (CP) network in various PAS with different microstructures such as a TiO2 nanorod array, WO3 nanosheet array, and planar TiO2 nanoparticle film, generating the bespoke photoanodes. The as-synthesized photoanodes exhibited a significantly enhanced PEC water splitting performance, which is clearly shown to arise from the improved light utilization, increased catalytic active sites, enhanced charge separation, and decreased electrochemical impedance of the photoelectrode. This 3D decoupling strategy is expected to open a promising direction for designing efficient PEC cells.

Gas Sensors Based on Mechanically Exfoliated MoS2 Nanosheets for Room-Temperature NO2 Detection.

The unique properties of MoS2 nanosheets make them a promising candidate for high-performance room temperature gas detection. Herein, few-layer MoS2 nanosheets (FLMN) prepared via mechanical exfoliation are coated on a substrate with interdigital electrodes for room-temperature NO2 detection. Interestingly, compared with other NO2 gas sensors based on MoS2, FLMN gas sensors exhibit high responsivity for room-temperature NO2 detection, and NO2 is easily desorbed from the sensor surface with an ultrafast recovery behavior, with recovery times around 2 s. The high responsivity is related to the fact that the adsorbed NO2 can affect the electron states within the entire material, which is attributed to the very small thickness of the MoS2 nanosheets. First-principles calculations were carried out based on the density functional theory (DFT) to verify that the ultrafast recovery behavior arises from the weak van der Waals binding between NO2 and the MoS2 surface. Our work suggests that FLMN prepared via mechanical exfoliation have a great potential for fabricating high-performance NO2 gas sensors.

Mutations in KARS cause early-onset hearing loss and leukoencephalopathy: Potential pathogenic mechanism.

Leukoencephalopathies are a broad class of common neurologic deterioration for which the etiology remains unsolved in many cases. In a Chinese Han family segregated with sensorineural hearing loss and leukoencephalopathy, candidate pathogenic variants were identified by targeted next-generation sequencing of 144 genes associated with deafness and 108 genes with leukoencephalopathy. Novel compound heterozygous mutations p.R477H and p.P505S were identified in KARS, which encodes lysyl-tRNA synthetase (LysRS), as the only candidate causative variants. These two mutations were functionally characterized by enzymatic assays, immunofluorescence, circular dichroism analysis, and gel filtration chromatography. Despite no alteration in the dimer-tetramer oligomerization and cellular distribution by either mutation, the protein structure was notably influenced by the R477H mutation, which subsequently released the protein from the multiple-synthetase complex (MSC). Mutant LysRSs with the R477H and P505S mutations had decreased tRNALys aminoacylation and displayed a cumulative effect when introduced simultaneously. Our studies showed that mutations in KARS lead to a newly defined subtype of leukoencephalopathy associated with sensorineural hearing impairment. The combined effect of reduced aminoacylation and release of LysRS from the MSC likely underlies the pathogenesis of the KARS mutations identified in this study.