Bariatric surgery related proximal myopathy: A partially reversible complication.

Deficiency neuropathies and rhabdomyolysis have previously been reported after bariatric surgery (BS) but never myopathies. We report cases of five patients with morbid obesity who developed within 2 to 4 months of a BS, proximal myopathy following significant and rapid weight loss worsened by postoperative gastrointestinal complications. Muscle weakness concerned lower limbs in particular in quadriceps and less frequently in upper limbs and diaphragm, sometimes mimicked a Guillain-Barré syndrome. Muscle biopsy performed in 1 patient, revealed selective atrophy of type 2 fibers. Weakness slowly decreased with refeeding with vitamins supplementation. We enlarge here the clinical pattern of post-BS complications.

Life-threatening lactic acidosis occurring in adults with mitochondrial disorders.

Although relatively common in children, severe acute lactic acidosis is rare in adults with mitochondrial myopathies. We report here three cases, aged 27, 32 and 32 years, who developed life-threatening metabolic crisis with severe lactic acidosis, requiring hospitalisation in intensive care unit. Plasma lactates were elevated 10 to 15 fold normal values, necessitating extra-renal dialysis. By contrast CK levels were moderately increased (3 to 5N). No triggering factor was identified, but retrospectively all patients reported long-lasting mild muscle fatigability and weakness before their acute metabolic crisis. All of them recovered after prolonged intensive care but resting lactate levels remained elevated. Muscle biopsy showed ragged-red and COX-negative fibers in two patients and mild lipidosis in the third one. Heteroplasmic pathogenic point mutations were detected in MT-TL1 (m.3280G>A;m.3258C>T) and MT-TK (m.8363A>G). Life-threatening lactic acidosis may thus be a major inaugural clinical manifestation in adults with mitochondrial myopathies. Prolonged intensive care may lead to a dramatic and sustained improvement and is mandatory in such cases.

Evidence for the involvement of an oxidative stress in the initiation of infection of pear by Erwinia amylovora.

Involvement of an oxidative burst, usually related to incompatible plant/pathogen interactions leading to hypersensitive reactions, was investigated with Erwinia amylovora, the causal agent of fire blight of Maloideae subfamily of Rosaceae, in interaction with pear (Pyrus communis; compatible situation) and tobacco (Nicotiana tabacum; incompatible situation). As expected, this necrogenic bacterium induced in tobacco a sustained production of superoxide anion, lipid peroxidation, electrolyte leakage, and concomitant increases of several antioxidative enzymes (ascorbate peroxidases, glutathion reductases, glutathion-S-transferases, and peroxidases), in contrast to the compatible pathogen Pseudomonas syringae pv tabaci, which did not cause such reactions. In pear leaves, however, inoculations with both the disease- and the hypersensitive reaction-inducing bacteria (E. amylovora and P. syringae pv tabaci, respectively) resulted in superoxide accumulation, lipid peroxidation, electrolyte leakage, and enzyme induction at similar rates and according to equivalent time courses. The unexpected ability of E. amylovora to generate an oxidative stress even in compatible situation was linked to its functional hrp (for hypersensitive reaction and pathogenicity) cluster because an Hrp secretion mutant of the bacteria did not induce any plant response. It is suggested that E. amylovora uses the production of reactive oxygen species as a tool to provoke host cell death during pathogenesis to invade plant tissues. The bacterial exopolysaccharide could protect this pathogen against the toxic effects of oxygen species since a non-capsular mutant of E. amylovora induced locally the same responses than the wild type but was unable to further colonize the plant.

HrpW of Erwinia amylovora, a new Hrp-secreted protein.

Erwinia amylovora strain CFBP1430 secretes a protein called HrpW in a Hrp-dependent manner. HrpW was detected in culture supernatant of the wild-type strain grown on solid inducing hrp medium. This protein shares structural similarities with elicitors of the hypersensitive response such as HrpN of Erwinia amylovora and PopA of Ralstonia solanacearum. Furthermore, the C-terminal region of HrpW is homologous to class III pectate lyases. An hrpW mutant is as aggressive as the wild-type strain on pear and apple seedlings. It elicits the hypersensitive response on tobacco at a lower concentration than the wild-type strain.

Dual role of desferrioxamine in Erwinia amylovora pathogenicity.

To investigate the role of iron in Erwinia amylovora pathogenicity, virulence properties of two mutants of strain CFBP 1430 isolated by insertional mutagenesis and affected in the iron transport pathway mediated by desferrioxamine (DFO) were analyzed. One mutation (dfoA::MudIIpR13) disrupts DFO biosynthesis. The present analysis shows that this mutation affects an open reading frame that belongs to a biosynthetic gene cluster and shares identity with the alcA gene required for synthesis of the siderophore alcaligin in Bordetella spp. A second mutation (foxR::MudIIpR13) affects the synthesis of the ferrioxamine receptor FoxR, encoded by the foxR gene, and was shown to be transcribed into a monocistronic message. Accordingly, the foxR mutant accumulates DFO in the external medium. The growth of the mutants when supplied with various iron sources was examined; it indicates that the production of DFO and the specific transport of the DFO ferric complex are required only when iron is strongly liganded. Pathogenicity was scored after inoculation of apple seedlings and after infection of apple flowers. On seedlings, the DFO biosynthetic mutant behaved like the wild-type strain while the frequency of necrotic plants caused by the receptor mutant decreased by a factor of two to five, depending on the initial inoculum. On flowers, both mutants were strongly affected in their ability to initiate a necrotic symptom and their growth was reduced by two orders of magnitude relative to the wild-type strain. However, the virulence of the dfoA mutant varied with the inoculum concentration. Unlike the foxR mutant, the dfoA mutant only weakly induced plant cell electrolyte leakage in tobacco leaf disks. The supply with exogenous DFO, only when iron free, restored the ability to induce electrolyte leakage to the dfoA mutant and increased the leakage induced by other strains. DFO alone was not an inducer. Iron-free DFO was able to protect E. amylovora cells against lethal doses of hydrogen peroxide. The main conclusion was that production of DFO in E. amylovora during pathogenesis is not only a critical function for iron acquisition, but can play a role in the oxidative burst elicited by the bacteria.

Strategies to improve plant resistance to bacterial diseases through genetic engineering.

Many different genetic strategies have been proposed to engineer plant resistance to bacterial diseases, including producing antibacterial proteins of non-plant origin, inhibiting bacterial pathogenicity or virulence factors, enhancing natural plant defenses and artificially inducing programmed cell death at the site of infection. These are based on our knowledge of the mechanisms of action of antibacterial compounds and of the successive steps in plant-bacterial interactions. This article presents the different approaches and demonstrates that, even though several of these ideas have already been applied, no commercial applications have yet been achieved.

Attachment, Chemotaxis, and Multiplication of Agrobacterium tumefaciens Biovar 1 and Biovar 3 on Grapevine and Pea.

Tumorigenic (CG49) and nontumorigenic (CG484) strains of Agrobacterium tumefaciens bv. 3 attached to grape roots at a higher level than did a nonpectinolytic mutant of CG49 (CG50) or a tumorigenic strain of A. tumefaciens bv. 1 (CG628). Strains attached equally well to wounded and unwounded grape roots. Strains responded differently to pea plants in that biovar 3 strains consistently attached to unwounded roots at a lower level than they did to wounded roots, whereas CG628 attached equally well regardless of wounding. The lowest levels of attachment to pea roots were consistently observed for CG50. Population curves were calculated for the strains inoculated into wound sites on grape and pea roots. A. tumefaciens bv. 3 wild-type strains developed greater populations at wound sites on grape roots after 100 h (resulting in root decay) than did CG50 or CG628. Population curves for strains at wound sites on pea roots were different from those on grape roots. There were no significant differences in populations after 100 h, and no strains caused root decay. No differences in the chemotaxis of wild-type and mutant A. tumefaciens bv. 3 strains towards grape roots, crown pieces, or root extracts were observed, but the biovar 1 strain, CG628, always migrated the greatest distance towards all substrates. Polygalacturonase production may affect attachment to grape roots and multiplication of A. tumefaciens bv. 3 at wound sites and thus be associated with the specificity of the bacterium for grape.