Towards mission-driven investment in new antimicrobials? What role for Chinese strategic industrial financing vehicles in responding to the challenge of antimicrobial resistance?

BACKGROUND: Antimicrobial resistance (AMR) causes high levels of global mortality. There is a global need to develop new antimicrobials to replace those whose efficacy is being eroded, but limited incentive for companies to engage in R&D, and a limited pipeline of new drugs. There is a recognised need for policies in the form of 'push' and 'pull' incentives to support this R&D. This article discusses China, a country with a rapidly emerging pharmaceuticals and biotech (P&B) sector, and a history of using coordinated innovation and industrial policy for strategic and developmental ends. We investigate the extent to which 'government guidance funds' (GGFs), strategic industrial financing vehicles (a 'push' mechanism), support the development of antimicrobials as part of China's 'mission-driven' approach to innovation and industrial policy. GGFs are potentially globally significant, having raised approximately US$ 872 billion to 2020. RESULTS: GGFs have a substantial role in P&B, but almost no role in developing new antimicrobials, despite this being a priority in the country's AMR National Action Plan. There are multiple constraints on GGFs' ability to function as part of a mission-driven approach to innovation at present, linked to their business model and the absence of standard markets for antimicrobials (or other effective 'pull' mechanisms), their unclear 'social' mandate, and limited technical capacity. However, GGFs are highly responsive to changing policy demands and can be used strategically by government in response to changing needs. CONCLUSIONS: Despite the very limited role of GGFs in developing new antimicrobials, their responsiveness to policy means they are likely to play a larger role as P&B becomes an increasingly important component of China's innovation and industrial strategy. However, for GGFs to effectively play that role, there is a need for reforms to their governance model, an increase in technical and managerial capacity, and supporting ('pull') incentives, particularly for pharmaceuticals such as antimicrobials for which there is strong social need, but a limited market. Given GGFs' scale and strategic importance, they deserve further research as China's P&B sector becomes increasingly globally important, and as the Chinese government commits to a larger role in global health.

Construction of key quality indicators for aged care facilities in China: A two-tier Delphi study: Key aged care quality indicators in ACF by Delphi method.

AIM: To construct key quality indicators for aged care facilities in China. BACKGROUND: Evaluating the care quality in aged care facilities is problematic. Evaluation of nursing care quality is important for improving nursing and self-supervision in aged care facilities. However, a few regulations and studies regarding care quality evaluation have been implemented in China. DESIGN AND METHOD: This two-tier Delphi study aimed to achieve consensus on key quality indicators for aged care facilities in China. The entry pool was determined by literature review and research team discussion, followed by a discussion by a panel of experts to establish the items of the Delphi study. Finally, key care quality indicators were established through a two-round Delphi study. This study followed the SQUIRE 2.0 guidelines. RESULTS: The initial 16 quality indicators of the entry pool was developed based on a literature review and a group discussion. Sixteen quality indicators were reduced to eight after the expert discussion. After two rounds of expert consultation, the eight quality indicators became nine, which were then evaluated for importance, formula rationality, and operability using Kendall's harmony coefficients (first round: 0.150, 0.143 and 0.169, respectively; second round: 0.209, 0.159 and 0.173, respectively). CONCLUSIONS: Key quality indicators provide quantifiable evidence for evaluating the care quality in aged care facilities, but their applicability needs continuous improvement. RELEVANCE TO CLINICAL PRACTICE: Nine key quality indicators were selected from numerous indicators for measuring the care quality in aged care facilities, supporting the evaluation of the care quality and self-supervision for aged care facilities. ELDERLY OR PUBLIC CONTRIBUTION: No elderly or public contribution.

Constitutional MLH1 Methylation Is a Major Contributor to Mismatch Repair-Deficient, MLH1-Methylated Colorectal Cancer in Patients Aged 55 Years and Younger.

BACKGROUND: Most mismatch repair-deficient (MMRd) colorectal cancer (CRC) cases arise sporadically, associated with somatic MLH1 methylation, whereas approximately 20% have germline mismatch repair pathogenic variants causing Lynch syndrome (LS). Universal screening of incident CRC uses presence of MLH1 methylation in MMRd tumors to exclude sporadic cases from germline testing for LS. However, this overlooks rare cases with constitutional MLH1 methylation (epimutation), a poorly recognized mechanism for LS. We aimed to assess the frequency and age distribution of constitutional MLH1 methylation among incident CRC cases with MMRd, MLH1-methylated tumors. METHODS: In retrospective population-based studies, we selected all CRC cases with MMRd, MLH1-methylated tumors, regardless of age, prior cancer, family history, or BRAF V600E status, from the Columbus-area HNPCC study (Columbus) and Ohio Colorectal Cancer Prevention Initiative (OCCPI) cohorts. Blood DNA was tested for constitutional MLH1 methylation by pyrosequencing and real-time methylation-specific PCR, then confirmed with bisulfite-sequencing. RESULTS: Results were achieved for 95 of 98 Columbus cases and all 281 OCCPI cases. Constitutional MLH1 methylation was identified in 4 of 95 (4%) Columbus cases, ages 34, 38, 52, and 74 years, and 4 of 281 (1.4%) OCCPI cases, ages 20, 34, 50, and 55 years, with 3 showing low-level mosaic methylation. Mosaicism in blood and normal colon, plus tumor loss of heterozygosity of the unmethylated allele, demonstrated causality in 1 case with sample availability. Age stratification showed high rates of constitutional MLH1 methylation among younger patients. In the Columbus and OCCPI cohorts, respectively, these rates were 67% (2 of 3) and 25% (2 of 8) of patients aged <50 years but with half of the cases missed, and 75% (3 of 4) and 23.5% (4 of 17) of patients aged ≤55 years with most cases detected. CONCLUSIONS: Although rare overall, a significant proportion of younger patients with MLH1-methylated CRC had underlying constitutional MLH1 methylation. Routine testing for this high-risk mechanism is warranted in patients aged ≤55 years for a timely and accurate molecular diagnosis that will significantly alter their clinical management while minimizing additional testing.

Effects of Solvents on Reaction Products: Synthesis of Endohedral Metallofullerene Oxazoline and Epoxide.

Herein, we performed the reactions of M3N@Ih-C80 (M = Sc and Lu) with the methanol (CH3OH) solution of TBAOH (note that both CH3O- and OH- are nucleophiles) in benzonitrile (PhCN) and dimethylformamide, respectively. It is found that OH- ions rather than CH3O- ions selectively attacked the fullerene cage to form the M3N@C80--O- intermediate. Although the fullerene cage is initially attacked by OH- in both PhCN and DMF solvents, the products are quite different. In PhCN, two isomeric Sc3N@Ih-C80 fullerooxazoline heterocyclic products (1 and 2) were synthesized. Whereas, in DMF, an epoxide of Lu3N@Ih-C80 (3) was obtained. The preference for fullerooxazoline formation over that of fullerene epoxy in PhCN is well explained by density functional theory calculations. Plausible reaction mechanisms for the formation of metallofullerene oxazoline and epoxide were proposed based on the experimental and theoretical results.

Ectopic Expression of CsSUN in Tomato Results in Elongated Fruit Shape via Regulation of Longitudinal Cell Division.

Fruit shape, an important agronomic trait of cucumber (Cucumis sativus L.), is tightly controlled by a series of genes such as CsSUN, a homologue of SlSUN that is responsible for the tomato (Solanum lycopersicum) fruit shape via the modulation of cell division. However, the direct genetic evidence about the CsSUN-mediated regulation of fruit shape is still scarce, limiting our mechanistic understanding of the biological functions of CsSUN. Here, we introduced CsSUN into the round-fruited tomato inbred line 'SN1' (wild type, WT) via the Agrobacterium tumefaciens-mediated method. The high and constitutive expression of CsSUN was revealed by real-time PCR in all the tested tissues of the transgenic plants, especially in the fruits and ovaries. Phenotypic analyses showed that the ectopic expression of CsSUN increased fruit length while it decreased fruit diameter, thus leading to the enhanced fruit shape index in the transgenic tomato lines relative to the WT. Additionally, the reduction in the seed size and seed-setting rate and the stimulation of seed germination were observed in the CsSUN-expressed tomato. A histological survey demonstrated that the elongated fruits were mainly derived from the significant increasing of the longitudinal cell number, which compensated for the negative effects of decreased cell area in the central columellae. These observations are different from action mode of SlSUN, thus shedding new insights into the SUN-mediated regulation of fruit shape.

Recovery of wolframite from tungsten mine tailings by the combination of shaking table and flotation with a novel "crab" structure sebacoyl hydroxamic acid.

Tailings ponds for gangue mineral storage are widely recognized as a dangerous source of toxic minerals and heavy metal-bearing solution. Therefore, recovering valuable minerals and critical elements from tailings is an important means to protect the environment in an economic way. Wolframite tailings usually contain a considerable amount of tungsten resources, but the presence of high content of kaolinite sludge makes it very difficult to recycle wolframite. Herein, a novel sebacoyl hydroxamic acid (SHA) was synthesized and introduced as a novel wolframite collector to effectively utilize wolframite tailings, and its collection performance was compared with that of benzohydroxamic acid (BHA). Micro-flotation tests showed that SHA could still obtain 80% wolframite recovery in the presence of kaolinite slimes. Bench-scale flotation tests indicated that SHA can effectively recover wolframite concentrate with 55.64% WO3 grade and 75.28% WO3 recovery from wolframite tailings by the combined shaking table-flotation process. Polarized light microscope observations showed that SHA could promote the formation of hydrophobic agglomerates of wolframite particles. These results show that SHA can be used as an efficient collector for disposing of wolframite tailings, and provide an important reference for the development of efficient and comprehensive utilization of tailings.

Clinical Effects of MOTOmed Intelligent Exercise Training Combined with Intensive Walking Training on the Rehabilitation of Walking, Nerve and Lower Limb Functions among Patients with Hemiplegia after Stroke.

Objectives: To investigate the clinical effects of MOTOmed intelligent exercise training combined with intensive walking training on the rehabilitation of walking, nerve and lower limb functions among patients with hemiplegia after stroke. Methods: Randomized controlled trial was used in this study. Fifty-two patients with hemiplegia after stroke treated in 82nd Army Group Military Hospital from February 2017 to February 2018 were selected as the subjects and randomly divided into the control group and the observation group, each with 26 cases. The control group underwent intensive walking training, and the observation group underwent MOTOmed intelligent exercise training on the control group basis. Both groups' rehabilitation of walking function, nerve function and lower limb function were observed. Results: Both groups had significantly increased FAC score and 10-m maximum walking speed (P < 0.05), and the observation group had significantly higher results than those of the control group (P < 0.05); both groups had significantly higher FMA scores than before treatment (P < 0.05), and the observation group had significantly higher scores than those of the control group (P < 0.05); both groups after two months of treatment had significantly increased NGF, NT-3 and BDNF (P<0.05), and the observation group had significantly higher levels than those of the control group (P<0.05). Conclusion: MOTOmed intelligent exercise training combined with intensive walking training can significantly improve the walking function, nerve function and lower limb function among patients with hemiplegia after stroke.

Bio-inspired and Eco-friendly Synthesis of 3D Spongy Meso-Microporous Carbons from CO2 for Supercapacitors.

Inspired by the spongy bone structures, three-dimensional (3D) sponge-like carbons with meso-microporous structures are synthesized through one-step electro-reduction of CO2 in molten carbonate Li2 CO3 -Na2 CO3 -K2 CO3 at 580 °C. SPC4-0.5 (spongy porous carbon obtained by electrolysis of CO2 at 4 A for 0.5 h) is synthesized with the current efficiency of 96.9 %. SPC4-0.5 possesses large electrolyte ion accessible surface area, excellent wettability and electronical conductivity, ensuring the fast and effective mass and charge transfer, which make it an advcanced supercapacitor electrode material. SPC4-0.5 exhibits a specific capacitance as high as 373.7 F g-1 at 0.5 A g-1 , excellent cycling stability (retaining 95.9 % of the initial capacitance after 10000 cycles at 10 A g-1 ), as well as high energy density. The applications of SPC4-0.5 in quasi-solid-state symmetric supercapacitor and all-solid-state flexible devices for energy storage and wearable piezoelectric sensor are investigated. Both devices show considerable capacitive performances. This work not only presents a controllable and facile synthetic route for the porous carbons but also provides a promising way for effective carbon reduction and green energy production.

Chemical Reactions of Cationic Metallofullerenes: An Alternative Route for Exohedral Functionalization.

The chemistry of cationic forms of clusterfullerenes remain less explored than that of the corresponding neutral or anionic species. In the present work, M3 N@Ih -C80 (M=Sc or Lu) cations were generated by both electrochemical and chemical oxidation methods. The as-obtained cations successfully underwent the typical Bingel-Hirsch reaction that fails with neutral Sc3 N@Ih -C80 . Two isomeric Sc3 N@Ih -C80 cation derivatives, [5,6]-open and [6,6]-open adducts, were synthesized, and the former has never been prepared by means of a Bingel-Hirsch reaction with neutral clusterfullerenes. In the case of the Lu3 N@Ih -C80 cation, however, only a [6,6]-open adduct was obtained. Density functional theory (DFT) calculations indicated that the oxidized M3 N@Ih -C80 was much more reactive than the neutral compound upon addition of the diethyl bromomalonate anion. The Bingel-Hirsch reaction of M3 N@Ih -C80 cations occurred by means of an unusual outer-sphere single-electron transfer (SET) process from the diethyl bromomalonate anion to the stable intermediate [M3 N@C80 (C2 H5 COO)2 CBr]. . Remarkably, the diethyl bromomalonate anion was found to act as both a nucleophile and an electron donor.

Ultra-high performance supercritical fluid chromatography combined with quadrupole time-of-flight mass spectrometry for the characterization of pentaerythritol fatty acid esters.

RATIONALE: Pentaerythritol fatty acid esters are an excellent lubricant oil additive, due to their good biodegradability, thermal ability, anti-wear, and friction properties. However, to meet the application requirements, fatty acids with different alkyl chain lengths are reacted with pentaerythritol, resulting in complex ester compositions. To reveal the relation between the functionalities and the composition of esters, it is important to develop a method for their analysis. METHODS: We developed a method using ultra-high-performance supercritical fluid chromatography combined with quadrupole time-of-flight mass spectrometry (UHPSFC/QTOF-MS) to separate and characterize pentaerythritol fatty acid esters. This method has the advantages such as short analysis time and high separation efficiency for such weakly polar compounds; high-resolution mass spectrometry (HRMS) provides exact mass information, enabling the identification of the structure of the pentaerythritol fatty acid esters. RESULTS: Based on the exact masses and characteristic ions, the pentaerythritol fatty acid esters and their main fragmentation pathways were identified; the fatty acid composition was also deduced from characteristic product ions. A dihydrogen rearrangement reaction caused the neutral loss of fatty acid fragment; [M + Na-FA]+ product ions (a stable six-member ring structure) were produced due to the absence of a γ hydrogen in pentaerythritol fatty acid esters. CONCLUSIONS: A UHPSFC/QTOF-MS method was successfully employed for the separation of pentaerythritol fatty acid esters. Exact masses and product ion information were determined using HRMS. The composition of the fatty acids was effectively deduced by characteristic ions and their relative abundances. This method is an effective means for the quality control and process optimization of this type of product, serving as a positive reference for further study on pentaerythritol fatty acid esters.

[Chemical Composition of n-Butanol Fraction from Polygonum amplexicaule var. sinense].

OBJECTIVE: To study chemical composition of n-butanol fraction from Polygonoum amplexicaule var. sinense. METHODS: TLC,normal-phase silica gel, reveres-phase silica gel, Sephadex-LH and semi-preparative HPLC were used to isolate chemical compositions of n-butanol fraction from Polygonoum amplexicaule var. sinense. RESULTS: Nine compounds were identified as: caffeic acid n-butly ester (1), p-methoxy benzoic acid propyl ester (2),p-E-coumarin quinic acid methyl ester (3),p-Z-coumarin quinic acid methyl ester (4), ethyl ferulate (5), cinchonain I a (6), cinchonain Ib (7), methyl chlorogenate(8), and 6-O-ß-D-caffeoylglucose (9). CONCLUSION: All compounds are isolated from this genus for the first time.

[Randomized, double-blind, multi-center, positive parallel control clinical trial of compound Wuzhigan capsules on anemopyretic cold].

Compound Wuzhigan capsules is a compound preparation composed of Wuzhigan, Shidagonglao, Gangmei, Shanzhima. A Randomized, double-blind, multi-center, positive parallel control designed to evaluate the clinical efficacy and safety of compound Wuzhigan capsules on anemopyretic cold. One hundred and twenty anemopyretic cold patients were given compound Wuzhigan capsules (test group), 2 capsules one time, three times a day, 119 patients were given compound Wuzhigan tablets (control group) ,4 tablets one time, three times a day; three days of treatment The study showed, the markedly effective rate and total effective rate respectively were 63. 3% and 80% of the test group. For the control group, the markedly effective rate and total effective rate respectively were 72. 5% and 80. 7%. The difference was not statistically significant. Compound Wuzhigan capsules can reduce the dosage, and get better patient compliance.

Template-Free Synthesis of High Dehydration Performance CHA Zeolite Membranes with Increased Si/Al Ratio Using SSZ-13 Seeds.

Pervaporation is an energy-efficient alternative to conventional distillation for water/alcohol separations. In this work, a novel CHA zeolite membrane with an increased Si/Al ratio was synthesized in the absence of organic templates for the first time. Nanosized high-silica zeolite (SSZ-13) seeds were used for the secondary growth of the membrane. The separation performance of membranes in different alcohol-aqueous mixtures was measured. The effects of water content in the feed and the temperature on the separation performance using pervaporation and vapor permeation were also studied. The best membrane showed a water/ethanol separation factor above 100,000 and a total flux of 1.2 kg/(m2 h) at 348 K in a 10 wt.% water-ethanol mixed solution. A membrane with high performance and an increased Si/Al ratio is promising for the application of alcohol dehydration.

UFObow: A single-wavelength excitable Brainbow for simultaneous multicolor ex-vivo and in-vivo imaging of mammalian cells.

Brainbow is a genetic cell-labeling technique that allows random colorization of multiple cells and real-time visualization of cell fate within a tissue, providing valuable insights into understanding complex biological processes. However, fluorescent proteins (FPs) in Brainbow have distinct excitation spectra with peak difference greater than 35 nm, which requires sequential imaging under multiple excitations and thus leads to long acquisition times. In addition, they are not easily used together with other fluorophores due to severe spectral bleed-through. Here, we report the development of a single-wavelength excitable Brainbow, UFObow, incorporating three newly developed blue-excitable FPs. We have demonstrated that UFObow enables not only tracking the growth dynamics of tumor cells in vivo but also mapping spatial distribution of immune cells within a sub-cubic centimeter tissue, revealing cell heterogeneity. This provides a powerful means to explore complex biology in a simultaneous imaging manner at a single-cell resolution in organs or in vivo.

Human pharmacogenetic analysis in chimeric mice with 'humanized livers'.

OBJECTIVE: We investigated whether human pharmacogenetic factors could be characterized using chimeric NOG mice expressing a thymidine kinase transgene (TK-NOG) with 'humanized' livers. MATERIALS AND METHODS: The rate of human-specific metabolism of two drugs was measured in chimeric mice reconstituted with human hepatocytes with different CYP2C19 and CYP2C9 genotypes. RESULTS: The rate of generation of human-predominant drug metabolites for S-mephenytoin and diclofenac in the chimeric mice was correlated with the CYP2C19 (n=9 donors, P=0.0005) or CYP2C9 (n=7 donors, P=0.0394) genotype, respectively, of the transplanted human hepatocytes. CONCLUSION: This study suggests that TK-NOG mice reconstituted with hepatocytes obtained from a relatively small number (3-10 per genotype) of human donors may be a promising model to identify human pharmacogenetic factors affecting the metabolism of clinically important drugs. For certain compounds, this innovative model system enables pharmacogenetic analyses to be efficiently performed in vivo within a human context and with control of all confounding environmental variables.

Using chimeric mice with humanized livers to predict human drug metabolism and a drug-drug interaction.

Interspecies differences in drug metabolism have made it difficult to use preclinical animal testing data to predict the drug metabolites or potential drug-drug interactions (DDIs) that will occur in humans. Although chimeric mice with humanized livers can produce known human metabolites for test substrates, we do not know whether chimeric mice can be used to prospectively predict human drug metabolism or a possible DDI. Therefore, we investigated whether they could provide a more predictive assessment for clemizole, a drug in clinical development for the treatment of hepatitis C virus (HCV) infection. Our results demonstrate, for the first time, that analyses performed in chimeric mice can correctly identify the predominant human drug metabolite before human testing. The differences in the rodent and human pathways for clemizole metabolism were of importance, because the predominant human metabolite was found to have synergistic anti-HCV activity. Moreover, studies in chimeric mice also correctly predicted that a DDI would occur in humans when clemizole was coadministered with a CYP3A4 inhibitor. These results demonstrate that using chimeric mice can improve the quality of preclinical drug assessment.

[Study on chemical composition of ethylacetate fraction from Polygonum amplexicaule var. sinense].

OBJECTIVE: To study chemical composition of ethylacetate fraction from Polygonoum amplexicaule D. Don var. sinense Forb. METHODS: TLC, Normal-phase silica gel column, reveres-phase silica gel column, Sephadex-LH, semi-preparative HPLC column were used to isolate chemical compositions of ethylacetate fraction from Polygonoum var. sinense. RESULTS: Eight compounds were identified as: 1. P-Hydroxybenzoic acid, 2. P-Hydroxybenzoic ethanol, 3. Diisobutyl phthalate, 4. Vanillin, 5. Isovanillic acid, 6.3,4,5-trihydroxy-benzoic acid-butyl ester, 7. 4-hydroxy-3-methoxycinnamic acid, 8. 7-hydroxy-6-methoxycoumarin. CONCLUSION: Except of Diisobutyl phthalate, the others are isolated for the first from this plant, moreover, Vanillin, Isovanillic acid and P-hydro -xyphenethyl alcohol are gained from genus for the first time.

Porphyromonas gingivalis lipopolysaccharide enhances the proliferation of human periodontal ligament cells via upregulation of cyclin D1, cyclin A and cyclin B1.

Human periodontal ligament cells (hPDLCs) play a notable role in periodontal tissue homeostasis and regeneration. However, the effect of Porphyromonas gingivalis lipopolysaccharide (Pg-LPS) on the proliferation of hPDLCs remains unclear. The present study investigated the effects of Pg-LPS on the proliferation profile of hPDLCs, and the involvement of cyclins and cyclin-dependent kinases in the process. hPDLCs were treated with Pg-LPS, and cell proliferation and cycle were detected using Cell Counting Kit-8 assays and flow cytometry. The mRNA expression levels of the cyclins and cyclin-dependent kinases (CDKs), including cyclins A, B1, D1 and D2 and CDK1, 2 and 4, were detected using reverse transcription-quantitative PCR. The protein expression levels of cyclins A, B1 and D1 were analysed using western blotting. The proliferation of hPDLCs was significantly increased after treatment with Pg-LPS at the concentrations of 0.001, 0.01, 0.1, 1 and 10 µg/ml for 24, 36 and 48 h compared with the cells cultured without LPS (P<0.01). The proliferation index of hPDLCs was significantly enhanced after treatment with Pg-LPS (0.0001, 0.001, 0.01, 0.1, 1 and 10 µg/ml) for 24 h (P<0.01). However, the S-phase fraction (SPF) only significantly increased after treatment with Pg-LPS at 0.01 µg/ml for 24 h (P<0.05), while the G2/M-phase fraction increased (P<0.01) and the G0/G1-phase fraction decreased (P<0.01) compared with the controls. The proliferation index and SPF increased, peaked at 24 h and then decreased at 48 h in both Pg-LPS-stimulated and control groups. Notably, Pg-LPS significantly upregulated the expression levels of cyclins D1, A and B1 after 24 h compared with those in the controls. Overall, the present study indicated that Pg-LPS may enhance the proliferation of hPDLCs, potentially through upregulation of cyclins D1, A and B1.

Large Cancer Pedigree Involving Multiple Cancer Genes including Likely Digenic MSH2 and MSH6 Lynch Syndrome (LS) and an Instance of Recombinational Rescue from LS.

Lynch syndrome (LS), caused by heterozygous pathogenic variants affecting one of the mismatch repair (MMR) genes (MSH2, MLH1, MSH6, PMS2), confers moderate to high risks for colorectal, endometrial, and other cancers. We describe a four-generation, 13-branched pedigree in which multiple LS branches carry the MSH2 pathogenic variant c.2006G>T (p.Gly669Val), one branch has this and an additional novel MSH6 variant c.3936_4001+8dup (intronic), and other non-LS branches carry variants within other cancer-relevant genes (NBN, MC1R, PTPRJ). Both MSH2 c.2006G>T and MSH6 c.3936_4001+8dup caused aberrant RNA splicing in carriers, including out-of-frame exon-skipping, providing functional evidence of their pathogenicity. MSH2 and MSH6 are co-located on Chr2p21, but the two variants segregated independently (mapped in trans) within the digenic branch, with carriers of either or both variants. Thus, MSH2 c.2006G>T and MSH6 c.3936_4001+8dup independently confer LS with differing cancer risks among family members in the same branch. Carriers of both variants have near 100% risk of transmitting either one to offspring. Nevertheless, a female carrier of both variants did not transmit either to one son, due to a germline recombination within the intervening region. Genetic diagnosis, risk stratification, and counseling for cancer and inheritance were highly individualized in this family. The finding of multiple cancer-associated variants in this pedigree illustrates a need to consider offering multicancer gene panel testing, as opposed to targeted cascade testing, as additional cancer variants may be uncovered in relatives.

Next-generation computational genetic analysis: multiple complement alleles control survival after Candida albicans infection.

Candida albicans is a fungal pathogen that causes severe disseminated infections that can be lethal in immunocompromised patients. Genetic factors are known to alter the initial susceptibility to and severity of C. albicans infection. We developed a next-generation computational genetic mapping program with advanced features to identify genetic factors affecting survival in a murine genetic model of hematogenous C. albicans infection. This computational tool was used to analyze the median survival data after inbred mouse strains were infected with C. albicans, which provides a useful experimental model for identification of host susceptibility factors. The computational analysis indicated that genetic variation within early classical complement pathway components (C1q, C1r, and C1s) could affect survival. Consistent with the computational results, serum C1 binding to this pathogen was strongly affected by C1rs alleles, as was survival of chromosome substitution strains. These results led to a combinatorial, conditional genetic model, involving an interaction between C5 and C1r/s alleles, which accurately predicted survival after infection. Beyond applicability to infectious disease, this information could increase our understanding of the genetic factors affecting susceptibility to autoimmune and neurodegenerative diseases.