Epithelial discrimination of commensal and pathogenic Candida albicans.

All mucosal surfaces are lined by epithelial cells and are colonised by opportunistic microbes. In health, these opportunistic microbes remain commensal and are tolerated by the immune system. However, when the correct environmental conditions arise, these microbes can become pathogenic and need to be controlled or cleared by the immune system to prevent disease. The mechanisms that enable epithelial cells to initiate the 'danger' signals activated specifically by pathogenic microbes are critical to mucosal defence and homeostasis but are not well understood. Deciphering these mechanisms will provide essential understanding to how mucosal tissues maintain health and activate immunity, as well as how pathogens promote disease. This review focuses on the interaction of the human fungal pathogen Candida albicans with epithelial cells and the epithelial mechanisms that enable mucosal tissues to discriminate between the commensal and pathogenic state of this medically important fungus.

Risk factors for cardiovascular disease and future osteoarthritis-related arthroplasty: a population-based cohort study in men and women from Malmö, Sweden.

OBJECTIVE: To investigate the hypothesis that cardiovascular risk factors increase the likelihood of future osteoarthritis (OA)-related arthroplasty in adult men and women. METHODS: Baseline cohort data on cardiovascular risk factors [age, socio-economic class, family history, obesity, smoking, glucose, cholesterol, blood pressure, and early cardiovascular disease (CVD) history] were linked to clinical registers of OA-related arthroplasty data. The study included 8749 women and 14 821 men with up to a 30-year follow-up. RESULTS: In women, higher cardiovascular risk groups were more likely to have an OA outcome compared to the lowest risk quartile group (trend p < 0.001). The estimates were as follows: second quartile risk: rate ratio (RR) 2.15, 95% confidence interval (CI) 1.6-2.9, third quartile risk: 3.32 (2.5-4.5); and highest risk quartile: 3.47 (2.6-4.7). In men, higher cardiovascular risk groups were also more likely to have an OA outcome compared to the lowest risk quartile group (trend p = 0.001). The estimates were as follows: second quartile risk: RR 1.44, 95% CI 1.1-1.9; third quartile risk: 1.38 (1.1-1.8); and highest risk quartile: 1.67 (1.3-2.2). CONCLUSIONS: Our large cohort study with up to a 30-year follow-up period provides evidence to support the hypothesis of shared risk factors in CVD and OA, and the findings suggest an alternative aetiological process in the pathogenesis of OA.

Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis.

OBJECTIVE: Knee osteoarthritis (OA) is common in older adults. Determination of risk factors for onset of knee OA may help in its prevention. The objective of this systematic review, and meta-analysis, was to determine the current evidence on risk factors for knee OA. DESIGN: A systematic literature search was carried out for cohort and case-control studies evaluating the association of demographic, comorbid, and other patient-determined factors with onset of knee OA. A scoring tool was developed to assess the quality of studies. Heterogeneity of studies was examined. Where possible studies were pooled to give an overall estimate of the association of factors with onset of knee OA. RESULTS: Of the 2233 studies screened, 85 were eventually included in the review. Study quality tended to be moderate. The main factors consistently associated with knee OA were obesity (pooled OR 2.63, 95% CI 2.28-3.05), previous knee trauma (pooled OR 3.86, 95% CI 2.61-5.70), hand OA (pooled OR 1.49, 95% CI 1.05-2.10), female gender (pooled OR 1.84 95% CI 1.32-2.55) and older age. Smoking appeared to have a moderate protective effect, however this was not evident once the analysis was restricted to cohort studies only. CONCLUSIONS: Whilst certain factors have been extensively reviewed (for example, body mass index), more longitudinal studies are needed to investigate the association of physical occupational and other patient-determined factors with future knee OA. The quality of such studies also needs to be improved. However, there are identifiable factors which can be targeted for prevention of disabling knee pain.