Cerebrospinal fluid eosinophils in pediatric myelin oligodendrocyte glycoprotein antibody-associated disease.

BACKGROUND: Eosinophils in cerebrospinal fluid (CSF) are an uncommon finding most often associated with parasitic infections, but have also been described in some neuroinflammatory disorders. Eosinophilic infiltration is not thought to be a typical feature of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). We aim to describe the rate of CSF eosinophil positivity in a cohort of pediatric MOGAD patients. METHODS: Single-center retrospective chart review of pediatric MOGAD patients. Clinical and laboratory data was collected from the electronic medical record and analyzed. RESULTS: Of 46 pediatric patients with positive serum myelin oligodendrocyte glycoprotein antibody (MOG-IgG) identified, 38 patients fulfilling internationally proposed MOGAD diagnostic criteria were included for analysis. 6 patients with MOGAD were excluded as no CSF data was available, and 2 patients with positive MOG-IgG but diagnosis more consistent with MS were excluded. Median age was 7.3 years, and 19/38 (50 %) were female. Acute disseminated encephalomyelitis (ADEM) was the most common presenting phenotype (23/38, 61 %), and other phenotypes included optic neuritis (10/38, 26 %), transverse myelitis (3/38, 8 %), and neuromyelitis optica spectrum disorder (NMOSD) (2/38, 5 %). 12 of 36 (33 %) patients with all lumbar puncture (LP) data available had CSF eosinophils present, with eosinophil mean of 3 % and range from 1 % to 18 % of CSF while blood cells. CONCLUSION: CSF eosinophils were present in one third of pediatric MOGAD patients, which is a higher rate than previously reported in either MOGAD or aquaporin-4 antibody positive NMOSD cohorts. Understanding the CSF composition of pediatric MOGAD patients helps to facilitate more prompt diagnosis and treatment and may shed light onto underlying pathologic mechanisms of disease with the goal to inform future therapeutic targets.

Predicting geographical variation in health-related quality of life.

Goods and services provided by businesses can either promote health or represent an additional risk factor. We assessed the association between business pattern indicators and the prevalence of adult obesity, diabetes, physical inactivity, fair or poor health and frequent physical and mental distress. Data on business types were obtained from the 2013 U.S. Census Bureau County Business Patterns. County health data were obtained from the Centers for Disease Control and Prevention Diabetes Interactive Atlas, Behavior Risk Factor Surveillance System and Fatality Analysis Reporting System. We explored the relationship at county level using the global (Ordinary Least Square regression) and local (Geographically Weighted Regression (GWR)) models in 3108 U.S. counties. Density of full service restaurants and fitness centers was associated with a significant decrease in adult obesity, diabetes, fair or poor health, physical inactivity, physical and mental distress. Conversely, density of payday loan centers was associated with an increase in these adverse health outcomes. However, our GWR models revealed substantial geographical variations in these relationships across the U.S. counties. Better understanding of the association between area-level structures and important health outcomes at the local level is important for developing targeted context-specific policy interventions. Full service restaurants and fitness centers may provide places for people to access higher quality food, socialize and exercise. Conversely, payday loans provide an expensive form of short-term credit and this debt may degrade an individual or family's ability to achieve or maintain health. Our study emphasizes the influence of local built environment characteristics on important health outcomes.

A novel membrane-dependent on/off switch mechanism of talin FERM domain at sites of cell adhesion.

The activation of heterodimeric (α/ß) integrin transmembrane receptors by cytosolic protein talin is crucial for regulating diverse cell-adhesion-dependent processes, including blood coagulation, tissue remodeling, and cancer metastasis. This process is triggered by the coincident binding of N-terminal FERM (four-point-one-protein/ezrin/radixin/moesin) domain of talin (talin-FERM) to the inner membrane surface and integrin ß cytoplasmic tail, but how these binding events are spatiotemporally regulated remains obscure. Here we report the crystal structure of a dormant talin, revealing how a C-terminal talin rod segment (talin-RS) self-masks a key integrin-binding site on talin-FERM via a large interface. Unexpectedly, the structure also reveals a distinct negatively charged surface on talin-RS that electrostatically hinders the talin-FERM binding to the membrane. Such a dual inhibitory topology for talin is consistent with the biochemical and functional data, but differs significantly from a previous model. We show that upon enrichment with phosphotidylinositol-4,5-bisphosphate (PIP2) - a known talin activator, membrane strongly attracts a positively charged surface on talin-FERM and simultaneously repels the negatively charged surface on talin-RS. Such an electrostatic "pull-push" process promotes the relief of the dual inhibition of talin-FERM, which differs from the classic "steric clash" model for conventional PIP2-induced FERM domain activation. These data therefore unravel a new type of membrane-dependent FERM domain regulation and illustrate how it mediates the talin on/off switches to regulate integrin transmembrane signaling and cell adhesion.