Interface Gain-of-Function Mutations in TLR7 Cause Systemic and Neuro-inflammatory Disease.

TLR7 recognizes pathogen-derived single-stranded RNA (ssRNA), a function integral to the innate immune response to viral infection. Notably, TLR7 can also recognize self-derived ssRNA, with gain-of-function mutations in human TLR7 recently identified to cause both early-onset systemic lupus erythematosus (SLE) and neuromyelitis optica. Here, we describe two novel mutations in TLR7, F507S and L528I. While the L528I substitution arose de novo, the F507S mutation was present in three individuals from the same family, including a severely affected male, notably given that the TLR7 gene is situated on the X chromosome and that all other cases so far described have been female. The observation of mutations at residues 507 and 528 of TLR7 indicates the importance of the TLR7 dimerization interface in maintaining immune homeostasis, where we predict that altered homo-dimerization enhances TLR7 signaling. Finally, while mutations in TLR7 can result in SLE-like disease, our data suggest a broader phenotypic spectrum associated with TLR7 gain-of-function, including significant neurological involvement.

Long term use of interleukin-1 inhibitors reduce flare activity in patients with fibrodysplasia ossificans progressiva.

OBJECTIVES: Fibrodysplasia ossificans progressiva (FOP) is one of the most catastrophic forms of genetic heterotopic ossification (HO). FOP is characterized by severe, progressive inflammatory flare-ups, that often lead to HO. The flare-ups are associated with increased inflammatory cytokine production, suggesting auto-inflammatory features driven by interleukin-1ß (IL-1ß). This study describes the short- and long-term responses of FOP patients to anti-IL-1 therapy. METHODS: Previously, we reported that a patient with FOP treated with anti-IL-1 agents showed dramatically lower rates of flare-ups, improved flare-up symptoms, decreased use of glucocorticoids, and apparently decreased size of residual lesions. Plasma analyses also showed marked elevation in IL-1ß levels during a FOP flare, further supporting a role of IL-1ß in the pathogenesis of FOP flares. Here, we report results from long-term therapy with IL-1 inhibitors in that patient, and describe 3 additional patients, from two medical centers. RESULTS: All 4 patients showed persistent improvement in flare activity during treatment with IL-1 inhibitors, with minimal formation of new HO sites. Two patients who stopped therapy experienced resurgence of flare activity that was re-suppressed upon re-initiation. These patients had IL-1ß levels comparable to those in IL-1ß-driven diseases. Child Health Assessment Questionnaires confirmed extensive subjective improvements in the pain and general health visual analogue scales. CONCLUSION: This case series demonstrates significant benefits from IL-1 inhibitors for reducing flare activity and improving the general health of patients with FOP. These data provide strong support for additional studies to better understand the function of IL-1 inhibition, primarily in reducing formation new HO. FUNDING: RH received support from the International FOP Association ACT grant; ECH received support from NIH/NIAMS R01AR073015 and the UCSF Robert Kroc Chair in Connective Tissue and Rheumatic Diseases III.

Nlrp2 deletion ameliorates kidney damage in a mouse model of cystinosis.

Cystinosis is a rare autosomal recessive disorder caused by mutations in the CTNS gene that encodes cystinosin, a ubiquitous lysosomal cystine/H+ antiporter. The hallmark of the disease is progressive accumulation of cystine and cystine crystals in virtually all tissues. At the kidney level, human cystinosis is characterized by the development of renal Fanconi syndrome and progressive glomerular and interstitial damage leading to end-stage kidney disease in the second or third decade of life. The exact molecular mechanisms involved in the pathogenesis of renal disease in cystinosis are incompletely elucidated. We have previously shown upregulation of NLRP2 in human cystinotic proximal tubular epithelial cells and its role in promoting inflammatory and profibrotic responses. Herein, we have investigated the role of NLRP2 in vivo using a mouse model of cystinosis in which we have confirmed upregulation of Nlrp2 in the renal parenchyma. Our studies show that double knock out Ctns-/- Nlrp2-/- animals exhibit delayed development of Fanconi syndrome and kidney tissue damage. Specifically, we observed at 4-6 months of age that animals had less glucosuria and calciuria and markedly preserved renal tissue, as assessed by significantly lower levels of inflammatory cell infiltration, tubular atrophy, and interstitial fibrosis. Also, the mRNA expression of some inflammatory mediators (Cxcl1 and Saa1) and the rate of apoptosis were significantly decreased in 4-6-month old kidneys harvested from Ctns-/- Nlrp2-/- mice compared to those obtained from Ctns-/-mice. At 12-14 months of age, renal histological was markedly altered in both genetic models, although double KO animals had lower degree of polyuria and low molecular weight proteinuria and decreased mRNA expression levels of Il6 and Mcp1. Altogether, these data indicate that Nlrp2 is a potential pharmacological target for delaying progression of kidney disease in cystinosis.

Preparation and Characterization of Self-Healing PVA-H2SO4 Hydrogel for Flexible Energy Storage.

In the past decade, hydrogels have attracted growing interest for emerging applications in flexible electronic devices, human-machine interactions, energy supply, or energy storage. Developing a multifunctional gel architecture with superior ionic conductivity and good mechanical flexibility is a bottleneck to overcome. Herein, poly(vinyl alcohol)/sulfuric acid (PVA-H2SO4) hydrogels were prepared via a freeze-thaw method. With the aim of tuning the formulation in view of a possible application in energy storage, the effects of different combinations in terms of the molecular weight (MW) of PVA and PVA-H2SO4 weight ratio were investigated. Moreover, exploiting the self-healing properties of these hydrogels and the easy possibility of functionalizing them, i.e., introducing a conducting polymer such as poly(2-acrylamido-2-methyl-1-propane) sulfonic acid doped polyaniline (PANI_PAMPSA), a sandwiched all-in-one double-layer hydrogel (electrode/electrolyte configuration) was prepared (PVA-H2SO4-PANI_PAMPSA/PVA-H2SO4). Results showed that the water content is independent of the PVA amount and MW; the polymer concentration has a significant effect on the formation of crystalline domains and therefore on swelling degree, whereas the cross-linking degree depends on the MW. The PVA MW has the maximum effect on the swelling percentage normalized with respect to the polymer fraction and the tensile properties of the hydrogel. The assembled all-in-one electrode/electrolyte shows promising ionic conductivity (439.7 mS cm-1) and specific capacitance performance (0.297 mF cm-2 at a current density of 0.025 mA cm-2), as well as excellent flexibility and considerable self-healing properties. These results will promote the development of self-healing symmetrical supercapacitors for storage devices in wearable electronics.

Cellulose/Zeolitic Imidazolate Framework (ZIF-8) Composites with Antibacterial Properties for the Management of Wound Infections.

Metal-organic frameworks (MOFs) are a class of crystalline porous materials with outstanding physical and chemical properties that make them suitable candidates in many fields, such as catalysis, sensing, energy production, and drug delivery. By combining MOFs with polymeric substrates, advanced functional materials are devised with excellent potential for biomedical applications. In this research, Zeolitic Imidazolate Framework 8 (ZIF-8), a zinc-based MOF, was selected together with cellulose, an almost inexhaustible polymeric raw material produced by nature, to prepare cellulose/ZIF-8 composite flat sheets via an in-situ growing single-step method in aqueous media. The composite materials were characterized by several techniques (IR, XRD, SEM, TGA, ICP, and BET) and their antibacterial activity as well as their biocompatibility in a mammalian model system were investigated. The cellulose/ZIF-8 samples remarkably inhibited the growth of Gram-positive and Gram-negative reference strains, and, notably, they proved to be effective against clinical isolates of Staphylococcus epidermidis and Pseudomonas aeruginosa presenting different antibiotic resistance profiles. As these pathogens are of primary importance in skin diseases and in the delayed healing of wounds, and the cellulose/ZIF-8 composites met the requirements of biological safety, the herein materials reveal a great potential for use as gauze pads in the management of wound infections.

Effectiveness of Snail Slime in the Green Synthesis of Silver Nanoparticles.

The development of green, low cost and sustainable synthetic routes to produce metal nanoparticles is of outmost importance, as these materials fulfill large scale applications in a number of different areas. Herein, snail slime extracted from Helix Aspersa snails was successfully employed both as bio-reducing agent of silver nitrate and as bio-stabilizer of the obtained nanoparticles. Several trials were carried out by varying temperature, the volume of snail slime and the silver nitrate concentration to find the best biogenic pathway to produce silver nanoparticles. The best results were obtained when the synthesis was performed at room temperature and neutral pH. UV-Visible Spectroscopy, SEM-TEM and FTIR were used for a detailed characterization of the nanoparticles. The obtained nanoparticles are spherical, with mean diameters measured from TEM images ranging from 15 to 30 nm and stable over time. The role of proteins and glycoproteins in the biogenic production of silver nanoparticles was elucidated. Infrared spectra clearly showed the presence of proteins all around the silver core. The macromolecular shell is also responsible of the effectiveness of the synthesized AgNPs to inhibit Gram positive and Gram negative bacterial growth.

Identification of a Novel Mutation in TNFAIP3 in a Family With Poly-Autoimmunity.

Haploinsufficiency of A20 (HA20) is an inflammatory disease caused by mutations in the TNFAIP3 gene classically presenting with Behcet's-like disease. A20 acts as an inhibitor of inflammation through its effect on NF-kB pathway. Here we describe four consanguineous patients (three sisters and their mother) with a predominantly autoimmune phenotype, including thyroiditis, type I diabetes, hemolytic anemia and chronic polyarthritis. All patients had recurrent oral ulcers, with only 1 patient presenting also recurrent fever episodes, as a classical autoinflammatory feature. Next generation sequencing identified a novel heterozygous frameshift mutation (p.His577Alafs*95) that causes a premature stop codon in the zinc finger domain of A20, leading to a putative haploinsufficiency of the protein. Functional analyses confirmed the pathogenicity of the mutation. The variant was associated with decreased levels of A20 in blood cells. Accordingly, ex-vivo lipopolysaccharide (LPS)-stimulated patients' peripheral blood mononuclear cells (PBMCs) showed higher levels of p65 NF-kB phosphorylation, as well as increased production of the proinflammatory cytokines IL-1ß, IL-6 and TNF-α. Moreover, in agreement with recent observations, demonstrating a role for A20 in inhibiting STAT1 and IFNγ pathways, markedly higher circulating levels of the two IFNγ-inducible chemokines CXCL9 and CXCL10 were detected in all patients. Supporting the findings of a hyperactivation of IFNγ signaling pathway in HA20 patients, patients' monocytes showed higher levels of STAT1 without stimulation, as well as higher phosphorylated (active) STAT1 levels following IFNγ stimulation. In conclusion, our study show that in the clinical spectrum of HA20 autoimmune features may predominate over autoinflammatory features and demonstrate, from a molecular point of view, the involvement of A20 in modulating not only the NF-kB, but also the IFNγ pathway.

Monocytes From Patients With Macrophage Activation Syndrome and Secondary Hemophagocytic Lymphohistiocytosis Are Hyperresponsive to Interferon Gamma.

Objective: To investigate the activation of the IFNγ signaling pathway in monocytes of patients with secondary hemophagocytic lymphohistiocytosis (sHLH)/macrophage activation syndrome (MAS) and to evaluate whether levels of phosphorylated STAT1 represent a biomarker for the identification of patients at early stages of the disease. Methods: Fresh whole blood samples from pediatric patients with active sHLH/MAS, not receiving (n=10) and receiving glucocorticoids (n=14) at time of sampling, were prospectively collected. As disease control groups, patients with active systemic juvenile idiopathic arthritis (sJIA) without MAS, patients with sHLH/MAS in remission and patients with other rheumatic diseases were also sampled. Whole blood cells were left unstimulated or stimulated with increasing concentrations of IFNγ for 10 minutes and the intracellular Tyrosine (701)-phosphorylated STAT1 (pSTAT1) levels were evaluated in monocytes by flow cytometry. Results: Monocytes from untreated sHLH/MAS patients showed significantly higher basal levels of pSTAT1 compared to those observed in monocytes from glucocorticoid-treated sHLH/MAS patients and from all the other disease controls. In addition, a significant increase in responsiveness to IFNγ, as assessed by increased levels of pSTAT1 following ex vivo stimulation, was observed in monocytes from untreated sHLH/MAS patients. pSTAT1 levels in monocytes distinguished patients with sHLH/MAS not treated with glucocorticoids from patients with active sJIA or with other rheumatic diseases [AUC, 0.93; 95% confidence interval 0.85-1.00, p<0.001]. Statistically significant correlations between IFNG mRNA levels in whole blood cells, circulating IFNγ levels and pSTAT1 levels in sHLH/MAS monocytes were found. Conclusion: Our data demonstrating higher basal levels of pSTAT1 as well as a hyperreactivity to IFNγ stimulation in monocytes from patients with sHLH/MAS point to perturbations in the activation of downstream IFNγ signaling pathway as a contributor to the hyperinflammation occurring in these patients. Finally, the observation that glucocorticoids affect pSTAT1 levels in vivo, makes it difficult to consider the measurement of pSTAT1 levels as a biomarker to identify patients at early stages of sHLH/MAS in clinical practice.

New heparinizable modified poly(carbonate urethane) surfaces diminishing bacterial colonization.

Percutaneous devices are extensively used in modern medicine therapies, even in long term applications. Complications from their use, related to bacterial colonization and/or to materials thrombogenicity, may result in a significant morbidity and mortality incidence. In this study, a novel polycarbonate-urethane (PCU), incorporating a tailor-made diamino-diamide-diol (PIME) showing the ability to bind heparin at physiological pH, was compared to commercial medical-grade PCUs (Carbothane and Bionate). Mechanical and thermal properties were evaluated by tensile tests, dynamic mechanical analysis and differential scanning calorimetry. The presence of a low amount of PIME chain extender in Bionate polyurethanes (Bionate-PIME) slightly affects the mechanical properties, remaining however comparable with the medical grade PCUs used for the fabrication of cardiovascular devices. To verify thereof heparin surface adsorbed in disfavouring bacterial colonization, heparinized Bionate-PIME was tested for bacterial adhesion, using Bionate and Carbothane as reference. In vitro bacterial interaction tests were performed with the strains mainly involved in the pathogenesis of device-related infections (S. epidermidis and S. aureus). MTT tests and SEM observations showed a decrease in colonization of the different strains on the heparinized Bionate-PIME surfaces, confirming that preadsorbed heparin plays a role in mediating the biomaterial surface/bacterial cells interactions.