Emotional hyper-reactivity and cardiometabolic risk in remitted bipolar patients: a machine learning approach.

OBJECTIVE: Remitted bipolar disorder (BD) patients frequently present with chronic mood instability and emotional hyper-reactivity, associated with poor psychosocial functioning and low-grade inflammation. We investigated emotional hyper-reactivity as a dimension for characterization of remitted BD patients, and clinical and biological factors for identifying those with and without emotional hyper-reactivity. METHOD: A total of 635 adult remitted BD patients, evaluated in the French Network of Bipolar Expert Centers from 2010-2015, were assessed for emotional reactivity using the Multidimensional Assessment of Thymic States. Machine learning algorithms were used on clinical and biological variables to enhance characterization of patients. RESULTS: After adjustment, patients with emotional hyper-reactivity (n = 306) had significantly higher levels of systolic and diastolic blood pressure (P < 1.0 × 10-8 ), high-sensitivity C-reactive protein (P < 1.0 × 10-8 ), fasting glucose (P < 2.23 × 10-6 ), glycated hemoglobin (P = 0.0008) and suicide attempts (P = 1.4 × 10-8 ). Using models of combined clinical and biological factors for distinguishing BD patients with and without emotional hyper-reactivity, the strongest predictors were: systolic and diastolic blood pressure, fasting glucose, C-reactive protein and number of suicide attempts. This predictive model identified patients with emotional hyper-reactivity with 84.9% accuracy. CONCLUSION: The assessment of emotional hyper-reactivity in remitted BD patients is clinically relevant, particularly for identifying those at higher risk of cardiometabolic dysfunction, chronic inflammation, and suicide.

Anti-CD25 antibodies affect cytokine synthesis pattern of human dendritic cells and decrease their ability to prime allogeneic CD4+ T cells.

Anti-CD25 monoclonal antibodies are widely used in clinical transplantation to prevent acute allograft rejection. Although their effects on T lymphocytes have been extensively studied, their impact on human dendritic cells (DC) has never been reported. Furthermore, the role of the IL-2 in DC functions has not yet been fully elucidated. In this study, we confirm that the stimulation of human monocyte-derived DC with LPS strongly induced the expression of CD25 and that LPS-matured DC also expressed the beta and gamma chain of the IL-2R. We also showed that adding anti-CD25 monoclonal antibodies to LPS induced a decrease in IL-12, IL-1, TNF-alpha, IL-6, and IFN-gamma production and an increase in IL-10 synthesis by DC compared with stimulation with LPS alone. Furthermore, we showed that these modifications diminished the T helper priming ability of DC and polarized the alloimmune response toward TH2. In contrast, humanized anti-CD25 monoclonal antibodies did not affect the up-regulation of CD86, CD80, CD83, HLADR, or CD40 induced upon LPS stimulation. Taken together, this study discloses some previously unrecognized effects of anti-CD25 monoclonal antibodies on DC that may contribute to their clinical efficacy. In addition, this study also shed some light on the role of the IL-2 in human DC activation.

Anti-CD25 antibodies decrease the ability of human dendritic cells to prime allogeneic CD4 T cells.

Anti-CD25 monoclonal antibodies are largely used in clinical transplantation to prevent acute allograft rejection episodes. Although their effects on T lymphocytes have been extensively studied, their impact on human dendritic cells (DCs) has been less reported. Furthermore, the role of the interleukin-2 in DC functions has not yet been fully elucidated. In this study, we observed that stimulation of human monocyte-derived DCs with lipopolysa ccharide or CD40L strongly induced the expression of CD25. We showed that pretreatment of DC with anti-CD25 diminished their ability to prime T-helper cells. In contrast, humanized anti-CD25 monoclonal antibodies did not affect the up-regulation of CD86, CD80, CD83, HLA-DR, or CD40 induced by lipopolysaccharide stimulation. This study supported previously unrecognized effects of anti-CD25 monoclonal antibodies on DCs that may contribute to their clinical efficacy.

Mycophenolic Acid Inhibits p38 Mitogen-Activated Protein Kinase in Human Monocyte-Derived Dendritic Cells Stimulated by Lipopolysaccharide.

Dendritic cell (DC) maturation, a crucial stage in the immune response, can be induced by various stimuli, such as lipopolysaccharide (LPS). Maturation signals trigger up-regulation of costimulatory molecule expression, increasing the ability of DCs to prime T helper cells. We and others have previously reported that mycophenolic acid (MPA) inhibits DC maturation and activation. However, the mechanisms remain unknown. The primary effect of MPA is inhibition of inosine monophosphate dehydrogenase (IMPDH), an enzyme involved in the de novo synthesis of guanosine nucleotide. The process of DC maturation is highly dependent on mitogen-activated protein kinase (MAPK) phosphorylation, especially p38MAPK. We therefore decided to study whether MPA affects these processes. Human monocyte-derived DCs were activated by LPS in the presence or absence of MPA. To assess whether the depletion of guanine affected p38MAPK phosphorylation, increasing doses of exogenous guanosine were added before stimulation. The results by flow cytometry showed that MPA inhibited p38MAPK phosphorylation by 25%. Interestingly, exogenous guanosine did not reverse the MPA inhibition. Our results suggested that MPA inhibits p38MAPK activity independent of IMPDH in human DCs. This effect of MPA may explain its capacity to inhibit maturation marker expression on DCs.

Induction of porcine regulatory cells by mycophenolic Acid-treated dendritic cells.

Tolerance induction in murine allogeneic transplantation is relatively easy, often by induction of regulatory T cells (Treg). Unfortunately, the implementation of these models in clinical situations has not yielded reliable protocols of tolerance induction in humans. Our project sought to create a preclinical model of tolerance induction in large animals. Our current efforts seek to induce and characterize porcine Treg, obtaining dendritic cells (DC) able to preferentially stimulate them. DCs were differentiated from blood monocytes with porcine recombinant interleukin-4 (IL-4) and granulocyte-macrophage colony-stimulating factor (GM-CSF) for 6 days. These DCs were then stimulated by human CD40 ligand-transfected L cells with or without mycophenolic acid (MPA) for 48 hours. We analyzed surface marker expression, cytokine synthesis, and ability to stimulate allogeneic peripheral blood mononuclear cells (PBMC). The porcine lymphocytes underwent 4 rounds of 1-week stimulation with allogeneic DC treated or not with MPA. At the end of this coculture we analyzed their capacity to suppress allogeneic PBMC proliferation induced by mature DC. Our results showed that porcine DCs pretreated with MPA display a low expression of B7 costimulatory molecules, produce low levels of IL-12, and induce weak proliferation of allogeneic lymphocytes. Moreover, after 4 rounds of stimulation with MPA-treated DCs, PBMCs were able to inhibit an alloreactive response. These preliminary results suggested induction of a regulatory T-cell population that we are currently seeking to characterize.

Impact of a polymorphism in the IL-12p40 gene on the outcome of kidney transplantation.

A number of factors interfere with the outcome of renal transplantation. Revealing genetic factors that impact on graft outcome may have consequences for clinical practice. Interleukin-12 (IL-12), by stimulating interferon gamma (IFNgamma) production, plays a crucial role in immune responses against both graft and viral agents. An A-to-C single nucleotide polymorphism (SNP) within the 3'-untranslated region (3'UTR) of the IL-12p40 gene has been reported to be both functionally and clinically relevant. Since the impact of this SNP on kidney graft outcome has never been reported, we investigated the impact of the 3'UTR polymorphism on clinical events after transplantation among 253 kidney recipients transplanted between 1995 and 2003. The polymorphism was genotyped using the restriction fragment length polymorphism method. Our results showed that the 3'UTR polymorphism affected neither graft survival (P = .768) nor the occurrence of delayed graft function (DGF; P = .498). C allele carriers in our study displayed more acute rejections in the first year than patients with the A/A genotype, but it did not reach statistical significance (P = .108). In contrast, the C allele appeared to be a significant risk factor for cytomegalovirus infection (odds ratio = 1.77; P = .027). In conclusion, IL12B 3'UTR polymorphism did not affect graft survival, DGF, or acute rejection episodes, but had an impact on the occurrence of cytomegalovirus infection.

Differentiation of human dendritic cell subsets for immune tolerance induction.

OBJECTIVES: Since no further progress was achieved, in order to improve the long-term organ transplantation outcome, the immune tolerance appears as an interesting therapeutic goal. Dendritic cells (DCs) are specialized cells participating in the homeostasis of the immune response. Moreover, subsets of DCs, identified in humans, appear to have their respective competences in immune response modulation. Our objective is to purify from PBMC or to differentiate DC subsets from monocytes using several strategies and evaluate their IL10 secretion. METHODS: CD14+ cells were purified from peripheral blood mononuclear cell (PBMC) by affinity beads and cultured with cytokines up to 7 days. The pDCs were purified with anti-BDCA-2 beads from PBMC fraction enriched by Percoll® gradient. The moDCs, pDCs and moLCs subsets were analyzed by phenotype labelling and FACS analyses and IL10 secretion measured by ELISA. RESULTS: The moDCs were characterized by the CD209 expression and a lower expression of CD1a markers. Expression of CD207 and CD1a markers characterized moLCs and CD123+/BDCA-2+ pDCs. Variable IL-10 secretions were shown between the three DC subsets, both at basal and activated levels. CONCLUSIONS: As the several DC populations studied have different capacities of IL-10 synthesis, they might play, among others, distinct roles in the induction of immune tolerance.

Age- and tissue-dependent expression of CYP2C23 in the rat.

A cDNA was isolated from a library prepared with 15-day-old rat liver RNA and was shown to correspond to CYP2C23 with some minor alterations which modified the open reading frame. The expression of CYP2C23 was examined in rat liver, kidney, lung and testis and during ontogenesis. An appreciable amount of CYP2C23 RNA was observed in liver and kidney but the age-dependent expression was quite different between these two tissues. In liver, expression reached its maximal value in early neonates and remained quite stable, while the increase was progressive in kidney before declining after 3 weeks of age. In the liver, classical inducers of cytochrome P-450 decreased the CYP2C23 RNA content. Experimental data confirm the classification of CYP2C23 as a constitutive member of the 2C subfamily and clearly establish its age- and tissue-dependent expression in rat.

Insertional inactivation and cloning of the wA gene of Aspergillus nidulans.

We describe examples of wA gene inactivation (resulting in white conidiospores) obtained during transformation of Aspergillus nidulans. One wA- transformant was obtained by transformation with a prn+ plasmid of a strain with green conidia (wA+) which was unable to catabolize L-proline (prn-). This transformant contains a very large number of plasmid copies integrated at a single site inseparable from the wA locus. Passage of this transformant through the sexual cycle generated a variety of novel phenotypes for L-proline utilization, the number and frequency of which depended upon the cleistothecium from which the progeny were obtained, suggesting that the altered phenotypes were due to premeiotic events. The most extreme phenotype was severe hypersensitivity to L-proline. Hypersensitive progeny had a much reduced number of integrated plasmid copies enabling us to identify and clone putative prn-wA fusion sequences and subsequently retrieve wA sequences from a wild-type gene library. One of the wild-type clones overlapped the different sites of the insertional mutations in two wA- transformants and complemented the wA3 allele. Sequences within this clone hybridized to a transcript that was developmentally regulated in the wild type and absent in a number of mutants defective in conidiospore development. A reiterated sequence was also found in the region of the wA gene.

[The script concordance test: a new evaluation method of both clinical reasoning and skills in internal medicine]. / Le test de concordance de script: un nouvel outil d'évaluation du raisonnement et de la compétence clinique en médecine interne ?

OBJECTIVE: The script concordance test is designed to evaluate knowledge organization, which constitutes a crucial parameter of clinical skills. The objective of the present study was to assess the value of a new written evaluation tool to measure clinical skills in Internal Medicine. MATERIALS AND METHODS: A 95-item examination was completed by a group of medical students (N =17), a group of residents in Family practice (N =9), a group of residents in Internal Medicine (N =5), and a group of experienced physicians in Internal Medicine (N =7). The scores obtained were compared by analysis of variance. The reliability of the test was studied by calculating Cronbach's coefficient alpha. RESULTS: The mean score was 220.3 +/-41.7 for medical students, 230.5 +/-31.7 for residents in Family practice, 274.2 +/-32.2 for residents in Internal Medicine, and 352.1 +/-22.9 for experienced physicians in Internal Medicine. The differences observed between the scores for the various groups were significant (P <0.0001). Moreover, the value of Cronbach's coefficient alpha was 0.81 in the whole examination. CONCLUSION: Our data indicate that the script concordance test may easily allow to differentiate various levels of clinical skills in Internal Medicine. Moreover, because of Cronbach's coefficient alpha as high as 0.81, our findings suggest the validity of this test in Internal Medicine.

Differences in immunological response to a T. gondii protein (SAG1) derived peptide between two strains of mice: effect on protection in T. gondii infection.

This study presents the analysis of the immunogenicity, antigenicity and protective effects of a peptide derived from the major surface antigen of Toxoplasma gondii, SAG1. This synthetic peptide carrying three predicted H-2k restricted T cell epitopes was used to immunize mice. The protective effect of the peptide was evaluated in CBA/J and C57BL/6 mice using the decrease in brain cyst load as evidence of protection. Immunization of C57BL/6 mice yielded high antibody titres but had no protective effect after oral challenge. Immunized CBA/J, mice which responded with a lower titre, showed a 35% reduction in cyst burden after oral challenge. Both strains yielded antibodies which recognized the cognate SAG1 protein on immunoblot assay. Using the BIAcore, system, it was shown that at lower titres the CBA/J mouse sera recognized the native SAG1 protein more effectively than the C57BL/6 mouse sera, yielding much higher anti-peptide titres. Lymphoproliferation assays using the peptide experimentally confirmed the predicted T-cell epitopes and showed that they were also recognized by cells of T. gondii infected mice. The anti-peptide subclass analysis suggested a Th1 orientation in CBA/J mice, whereas a Th2 orientation was observed in C57BL/6 mice. Finally, fine analysis of sequences recognized under MHC class I indicated the existence of a T-cell epitope in the H-2k haplotype (CBA/J mice) but not in the H-2b haplotype (C57BL/6 mice). This study provides a structural basis to the understanding of the vaccination response to one of the T. gondii antigens in different strains of mice.

Cloning of the nitrate reductase gene (niaD) of Aspergillus nidulans and its use for transformation of Fusarium oxysporum.

An heterologous transformation system for the phytopathogenic fungus Fusarium oxysporum has been developed based on the use of the Aspergillus nidulans nitrate reductase gene (niaD). F. oxysporum nia- mutants were easily selected by chlorate resistance. The A. nidulans niaD gene was isolated from a gene library by complementation of an A. nidulans niaD mutant. The cloned gene is capable of transforming F. oxysporum nia- mutants at a frequency of up to ten transformants per microgram of DNA. Southern analysis of the DNA of the F. oxysporum transformants showed that transformation resulted in integration of one or more copies of the vector DNA into the genome.

Analysis of human CD4-antibody interaction using the BIAcore system.

Interaction between CD4 cell surface protein and HIV-bearing gp120 has been described as the initial step for HIV entry into host cells. Some anti-CD4 antibodies were shown to inhibit this interaction. Biosensor studies using the BIAcore were performed to determine kinetic and thermodynamic parameters of the interaction of one of these antibodies (i.e. IOT4a, clone 13B8-2) with immobilized recombinant soluble CD4 (rsCD4). A non-linear regression method was used to analyze the sensorgrams, showing the existence of a double exponential time curve. A KA of 5.2 x 10(7) M-1 was calculated at 25 degrees C. The complex formation was exothermic (-4.5 kcal.mol-1( and entropically positive (+20 cal.mol-1.K-1). The reaction rate (0.234 x 10(5) M-1.s-1 at 25 degrees C) as well as the enthalpy change of the activated complex (+9.7 kcal.mol-1) are not compatible with a diffusion controlled reaction. The thermodynamic values calculated from equilibrium data corresponded to those calculated from kinetic data confirming the validity of the theoretical approach. As for most antigen-antibody interactions, complex formation was enthalpy driven. The overall positive entropy contribution to the stabilization of the complex is in contrast to that observed for the lysozyme-anti-lysozyme model and is probably due to electrostatic interaction between the epitope and the antibody combining site.

Epitopic analysis of the Toxoplasma gondii major surface antigen SAG1.

T and B cell epitopes of the major Toxoplasma gondii surface antigen SAG1 were studied following CNBr fragmentation. Three fragments, F1, F2 and F3, were obtained, of 19, 16.5 and 14 kDa, respectively. The positions of F1 F2 and F3 within the SAG1 protein were identified by N-terminal sequence determination. The F1 fragment located on residues 125-269 contains the C-terminus, and the fragment F2 (residues 1-124) is located at the N-terminal region. F3 is a C-terminal peptide about 40 amino acids shorter than the F1 fragment (residues 165-269). Polyclonal antibodies obtained from infected animals or humans and a monoclonal anti-SAG1 antibody did not recognize either the reduced protein or the reduced fragments on immunoblotting. The monoclonal antibody 1E5 did not recognize fragment F1. Mouse IgA and IgG antibodies from infected mouse sera and intestinal secretions, as well as human IgG antibodies, only recognized the whole protein and the F1 fragment. These results suggest that the fragment F1 encompasses all B cell epitopes recognized on the SAG1 protein after infection with the parasite and that the sequence 125-165 is essential for the structural integrity of these B cell epitopes. Murine anti-SAG1 T cell proliferation was observed in SAG1 immunized CBA/J mice (H-2k) and BALB/c mice (H-2d), but not in C57BL/6 mice (H-2b). The three fragments F1, F2 and F3 were able to induce specific proliferation of anti-SAG1 T cells from CBA/J mice, while only the F1 and F2 fragments induced specific blastogenesis of anti-SAG1 T cells from BALB/c mice.(ABSTRACT TRUNCATED AT 250 WORDS)

A cytopathic effect of Trichomonas vaginalis probably mediated by a mannose/N-acetyl-glucosamine binding lectin.

The pathogenic effect of a highly pathogenic strain of Trichomonas vaginalis on McCoy cell monolayers was investigated. Specific inhibition of the cytopathic effect by monosaccharides, such as N-acetyl-glucosamine (GlcNAc) and mannose (Man), was observed. Our preliminary results suggest that the pathogenicity of T. vaginalis depends on a lectin specifically sensitive to GlcNAc and to a lesser extent to Man. Although N-acetyl-mannosamine was found to be the most efficient inhibitor, this effect seems to be unrelated to the natural biological behaviour of the infested host.

Biliary tract cryptosporidiosis immunosuppressed rat model.

Rats immunosuppressed by hydrocortisone acetate and a low protein diet were challenged with Cryptosporidium Parvum oocysts and studied on days 10, 35 and 70 post-infection. The biliary tract was found to be a major site of parasite infection. C. parvum was visible in the biliary papillary area in association with a proliferation of highly convoluted tubular glands. The papillary lumen was narrowed, and an upstream dilation with bacterial proliferation was seen. The liver was initially free of lesions, and subsequently exhibited late lesions of cholestasis. Parasites were not found in the pancreatic duct, although pancreatitis was frequently observed. Oocysts were consistently present in the distal portion of the ileum. Both challenged and unchallenged immunosuppressed rats, exhibited widespread focal hepatic infarcts and pyelonephritis. Other organs appeared free of lesions. In addition to the intestine, data identified the biliary tract as a major site of C. parvum infection and as a potential protected reservoir which may sustain a chronic infection.

Prospects for a human Toxoplasma vaccine.

Human toxoplasmosis is usually benign, but may occasionally lead to severe or lethal damages when combined with immunosuppressive states or when transmitted to the fetus during pregnancy. Only a vaccine could prevent these harmful effects. The oral route is the natural portal of entry of T. gondii. A protective immune response at the mucosal level is required to kill the parasite as soon as it penetrates the intestinal barrier thus preventing toxoplasma from invading the host and settling into tissues. The probable major roles played by both CD8 T cells and antibodies, specially IgA, suggest that the best strategy would be to stimulate both the cellular and humoral arms of the mucosal immune system. Mucosal dendritic cells have been shown to induce good protection against oral toxoplasma challenge. Our hypothesis is that an acceptable and effective human vaccine would have to carry the optimized synthetic vaccine (subunit, DNA or replicon) plus an appropriate adjuvant and to target the mucosal dendritic cells by means of an inert delivery system such as polymer microparticles, which can be endocytosed by M cells of the gut or nasal-associated lymphoid tissues.

Gene structure and promoter analysis of the rat constitutive CYP2C23 gene.

The CYP2C23 gene is expressed constitutively in the rat liver and kidney. It exhibits different profiles of expression in the two tissues, suggesting that several regulation processes could exist. In this paper, we report the structure of the 5'-flanking region of the CYP2C23 gene; 4.5 kbp were sequenced and analyzed. The CYP2C23 gene is present as a single copy into the rat genome and an unique transcription start site is used in both liver and kidney. Four DNase I hypersensitive sites have been mapped to the distal part of the hepatic promoter and three are detected in the kidney: only one site is present in the two tissues (L3/K1). In the proximal region, one site is specific for the kidney and one is detected in all the tissues tested. Footprint experiments allowed precise identification of the sequence of protected regions: HNF4 and CREB binding motifs are present in the distal liver-specific sites, motifs for AP-1, NF-1, and XRE-Bf are in the distal kidney site, and a Tf-LF1 binding site is localized in the L3/K1 protected site. In the proximal region, a sequence protected in all tissues contains a SP1/NF kappa B motif, whereas a sequence containing a HNF-4 binding motif is exclusively protected by kidney nuclear extracts. Altogether, the data clearly demonstrate that trans-acting factors involved in CYP2C23 gene expression differ in liver and kidney.

O-Glycosyl trichloroacetimidates bearing Fmoc as temporary hydroxy protecting group: a new access to solid-phase oligosaccharide synthesis.

Different O-glycosyl trichloroacetimidates bearing base sensitive Fmoc protected hydroxy groups were efficiently prepared with CCl(3)CN using a catalytic amount of sodium hydride. The resulting glycosyl donors were engaged in glycosylation reactions both in solution and on solid support with a new ester-type linker with good results. In both approaches, Fmoc groups were afterward quantitatively cleaved using mild basic conditions.