Can We Accurately Time the Administration of Antenatal Corticosteroids for Preterm Labor?

Background. Accurate timing of antenatal corticosteroids (ACS) has resulted in improved neonatal outcomes. Objectives. Our primary objective was to determine predictors for optimal timing of ACS in women presenting with spontaneous preterm labor. Study Design. A retrospective cohort study of women receiving ACS for spontaneous preterm birth was conducted. Women were included if they presented with preterm labor or preterm premature rupture of membranes. Accurate timing of ACS was defined as administration within 7 days of delivery. Maternal demographic and obstetrics characteristics were compared between the groups receiving ACS ≤7 days and >7 days from delivery. Statistical analyses were performed using parametric and nonparametric tests. P < 0.05 was considered significant. Results. The study included 215 subjects. Median latency from ACS administration to delivery was 6 days (IQR 32). Accurate timing of ACS occurred in 113 (53%) women and was associated with rupture of membranes (OR 13.8, 95% CI 5.9-32.6), cervical change (OR 7.1, 95% CI 3.0-17.1), and cervical dilation ≥ 2 cm (OR 3.9, 95% CI 1.5-10.3). Conclusions. Rupture of membranes, cervical change, and cervical dilation ≥ 2 cm were strong predictors of optimal timing. 53% of women with preterm labor received ACS optimally.

A Potent Anti-influenza Compound Blocks Fusion through Stabilization of the Prefusion Conformation of the Hemagglutinin Protein.

An ultrahigh-throughput screen was performed to identify novel small molecule inhibitors of influenza virus replication. The screen employed a recombinant influenza A/WSN/33 virus expressing Renilla luciferase and yielded a hit rate of 0.5%, of which the vast majority showed little cytotoxicity at the inhibitory concentration. One of the top hits from this screen, designated S20, inhibits HA-mediated membrane fusion. S20 shows potent antiviral activity (IC50 = 80 nM) and low toxicity (CC50 = 40 µM), yielding a selectivity index of 500 and functionality against all of the group 1 influenza A viruses tested in this study, including the pandemic H1N1 and avian H5N1 viruses. Mechanism of action studies proved a direct S20-HA interaction and showed that S20 inhibits fusion by stabilizing the prefusion conformation of HA. In silico docking studies were performed, and the predicted binding site in HA2 corresponds with the area where resistance mutations occurred and correlates with the known role of this region in fusion. This high-throughput screen has yielded many promising new lead compounds, including S20, which will potentially shed light on the molecular mechanisms of viral infection and serve as research tools or be developed for clinical use as antivirals.

Positive regulation of TRAF6-dependent innate immune responses by protein phosphatase PP1-γ.

Innate immune sensors such as Toll-like receptors (TLRs) differentially utilize adaptor proteins and additional molecular mediators to ensure robust and precise immune responses to pathogen challenge. Through a gain-of-function genetic screen, we identified the gamma catalytic subunit of protein phosphatase 1 (PP1-γ) as a positive regulator of MyD88-dependent proinflammatory innate immune activation. PP1-γ physically interacts with the E3 ubiquitin ligase TRAF6, and enhances the activity of TRAF6 towards itself and substrates such as IKKγ, whereas enzymatically inactive PP1-γ represses these events. Importantly, these activities were found to be critical for cellular innate responses to pathogen challenge and microbial clearance in both mouse macrophages and human monocyte lines. These data indicate that PP1-γ phosphatase activity regulates overall TRAF6 E3 ubiquitin ligase function and promotes NF-κB-mediated innate signaling responses.

Cofactors required for TLR7- and TLR9-dependent innate immune responses.

Pathogens commonly utilize endocytic pathways to gain cellular access. The endosomal pattern recognition receptors TLR7 and TLR9 detect pathogen-encoded nucleic acids to initiate MyD88-dependent proinflammatory responses to microbial infection. Using genome-wide RNAi screening and integrative systems-based analysis, we identify 190 cofactors required for TLR7- and TLR9-directed signaling responses. A set of cofactors were crossprofiled for their activities downstream of several immunoreceptors and then functionally mapped based on the known architecture of NF-κB signaling pathways. Protein complexes and pathways involved in ubiquitin-protein ligase activities, sphingolipid metabolism, chromatin modifications, and ancient stress responses were found to modulate innate recognition of endosomal nucleic acids. Additionally, hepatocyte growth factor-regulated tyrosine kinase substrate (HRS) was characterized as necessary for ubiquitin-dependent TLR9 targeting to the endolysosome. Proteins and pathways identified here should prove useful in delineating strategies to manipulate innate responses for treatment of autoimmune disorders and microbial infection.