Human Alveolar and Monocyte-Derived Human Macrophage Responses to Mycobacterium tuberculosis.

Alveolar macrophages (AMs) and recruited monocyte-derived macrophages (MDMs) mediate early lung immune responses to Mycobacterium tuberculosis. Differences in the response of these distinct cell types are poorly understood and may provide insight into mechanisms of tuberculosis pathogenesis. The objective of this study was to determine whether M. tuberculosis induces unique and essential antimicrobial pathways in human AMs compared with MDMs. Using paired human AMs and 5-d MCSF-derived MDMs from six healthy volunteers, we infected cells with M. tuberculosis H37Rv for 6 h, isolated RNA, and analyzed transcriptomic profiles with RNA sequencing. We found 681 genes that were M. tuberculosis dependent in AMs compared with MDMs and 4538 that were M. tuberculosis dependent in MDMs, but not AMs (false discovery rate [FDR] < 0.05). Using hypergeometric enrichment of DEGs in Broad Hallmark gene sets, we found that type I and II IFN Response were the only gene sets selectively induced in M. tuberculosis-infected AM (FDR < 0.05). In contrast, MYC targets, unfolded protein response and MTORC1 signaling, were selectively enriched in MDMs (FDR < 0.05). IFNA1, IFNA8, IFNE, and IFNL1 were specifically and highly upregulated in AMs compared with MDMs at baseline and/or after M. tuberculosis infection. IFNA8 modulated M. tuberculosis-induced proinflammatory cytokines and, compared with other IFNs, stimulated unique transcriptomes. Several DNA sensors and IFN regulatory factors had higher expression at baseline and/or after M. tuberculosis infection in AMs compared with MDMs. These findings demonstrate that M. tuberculosis infection induced unique transcriptional responses in human AMs compared with MDMs, including upregulation of the IFN response pathway and specific DNA sensors.

Preacinar Arterial Dilation Mediates Outcomes of Quantitative Interstitial Abnormalities in COPDGene.

RATIONALE: Quantitative interstitial abnormalities (QIA) are a computed tomography (CT) measure of early parenchymal lung disease associated with worse clinical outcomes including exercise capacity and symptoms. The presence of pulmonary vasculopathy in QIA and its role in the QIA-outcome relationship is unknown. OBJECTIVES: To quantify radiographic pulmonary vasculopathy in quantitative interstitial abnormalities (QIA) and determine if this vasculopathy mediates the QIA-outcome relationship. METHODS: Ever-smokers with QIA, outcome, and pulmonary vascular mediator data were identified from the COPDGene cohort. CT-based vascular mediators were: right ventricle-to-left ventricle ratio (RV/LV), pulmonary artery-to-aorta ratio (PA/Ao), and pre-acinar intraparenchymal arterial dilation (PA volume 5-20mm2 in cross-sectional area, normalized to total arterial volume). Outcomes were: six-minute walk distance (6MWD) and modified Medical Council Research Council (mMRC) Dyspnea score ≥2. Adjusted causal mediation analyses were used to determine if the pulmonary vasculature mediated the QIA effect on outcomes. Associations of pre-acinar arterial dilation with select plasma biomarkers of pulmonary vascular dysfunction were examined. MAIN RESULTS: Among 8,200 participants, QIA burden correlated positively with vascular damage measures including pre-acinar arterial dilation. Pre-acinar arterial dilation mediated 79.6% of the detrimental impact of QIA on 6MWD (56.2-100%, p<0.001). PA/Ao was a weak mediator and RV/LV was a suppressor. Similar results were observed in the QIA-mMRC relationship. Pre-acinar arterial dilation correlated with increased pulmonary vascular dysfunction biomarker levels including angiopoietin-2 and NT-proBNP. CONCLUSIONS: Parenchymal quantitative interstitial abnormalities (QIA) deleteriously impact outcomes primarily through pulmonary vasculopathy. Pre-acinar arterial dilation may be a novel marker of pulmonary vasculopathy in QIA.

Epigenetic programming of host lipid metabolism associates with resistance to TST/IGRA conversion after exposure to Mycobacterium tuberculosis.

Mycobacterium tuberculosis (Mtb) exposure leads to a range of outcomes including clearance, latent TB infection (LTBI), and pulmonary tuberculosis (TB). Some heavily exposed individuals resist tuberculin skin test (TST) and interferon gamma release assay (IGRA) conversion (RSTR), which suggests that they employ IFNγ-independent mechanisms of Mtb control. Here, we compare monocyte epigenetic profiles of RSTR and LTBI from a Ugandan household contact cohort. Chromatin accessibility did not differ between uninfected RSTR and LTBI monocytes. In contrast, methylation significantly differed at 174 CpG sites and across 63 genomic regions. Consistent with previous transcriptional findings in this cohort, differential methylation was enriched in lipid and cholesterol associated pathways including in the genes APOC3, KCNQ1, and PLA2G3. In addition, methylation was enriched in Hippo signaling, which is associated with cholesterol homeostasis and includes CIT and SHANK2. Lipid export and Hippo signaling pathways were also associated with gene expression in response to Mtb in RSTR as well as IFN stimulation in monocyte-derived macrophages (MDMs) from an independent healthy donor cohort. Moreover, serum-derived HDL from RSTR had elevated ABCA1-mediated cholesterol efflux capacity (CEC) compared to LTBI. Our findings suggest that resistance to TST/IGRA conversion is linked to regulation of lipid accumulation in monocytes, which could facilitate early Mtb clearance among RSTR subjects through IFNγ-independent mechanisms.

Development of an Electroactive and Thermo-Reversible Diels-Alder Epoxy Nanocomposite Doped with Carbon Nanotubes.

The manufacturing of Diels-Alder (D-A) crosslinked epoxy nanocomposites is an emerging field with several challenges to overcome: the synthesis is complex due to side reactions, the mechanical properties are hindered by the brittleness of these bonds, and the content of carbon nanotubes (CNT) added to achieve electroactivity is much higher than the percolation thresholds of other conventional resins. In this work, we develop nanocomposites with different D-A crosslinking ratios (0, 0.6, and 1.0) and CNT contents (0.1, 0.3, 0.5, 0.7, and 0.9 wt.%), achieving a simplified route and avoiding the use of solvents and side reactions by selecting a two-step curing method (100 °C-6 h + 60 °C-12 h) that generates the thermo-reversible resins. These reversible nanocomposites show ohmic behavior and effective Joule heating, reaching the dissociation temperatures of the D-A bonds. The fully reversible nanocomposites (ratio 1.0) present more homogeneous CNT dispersion compared to the partially reversible nanocomposites (ratio 0.6), showing higher electrical conductivity, as well as higher brittleness. For this study, the nanocomposite with a partially reversible matrix (ratio 0.6) doped with 0.7 CNT wt.% was selected to allow us to study its new smart functionalities and performance due to its reversible network by analyzing self-healing and thermoforming.

Impact of COPD Exacerbations and Burden of Disease in Spain: AVOIDEX Study.

Purpose: Chronic obstructive pulmonary disease (COPD) is characterized by high morbidity and mortality, with a considerable consumption of healthcare resources (HRU). This study aims to obtain real world evidence regarding the consequences of COPD exacerbations and to provide updated data on the burden of this disease and its treatment. Patients and Methods: A retrospective study in seven Spanish regions was conducted among COPD patients diagnosed between 1/01/2010 and 31/12/2017. The index date was the diagnosis of COPD and patients were followed until lost to follow-up, death or end of the study, whichever occurred first. Patients were classified by patient pattern (incident or prevalent), type and severity of exacerbations, and treatments prescribed. Demographic and clinical characteristics were evaluated, together with the incidence of exacerbations, comorbidities, and the use of HRU, during the baseline (12 months before the index date) and the follow-up periods by incident/prevalent and treatment prescribed. Mortality rate was also measured. Results: The study included 34,557 patients with a mean age of 70 years (standard deviation: 12). The most frequent comorbidities were diabetes, osteoporosis, and anxiety. Most patients received inhaled corticosteroids (ICS) with long-acting beta agonists (LABA), or long-acting muscarinic agonists (LAMA), followed by LABA with LAMA. Incident patients (N=8229; 23.8%) had fewer exacerbations than prevalent patients (N=26328; 76.2%), 0.3 vs 1.2 exacerbations per 100 patient-years. All treatment patterns present a substantial disease burden, which seems to increase with the evolution of the disease (ie moving from initial treatments to combination therapies). The overall mortality rate was 40.2 deaths/1000 patient-years. General practitioner visits and tests were the HRU most frequently required. The frequency and severity of exacerbations positively correlated with the use of HRU. Conclusion: Despite receiving treatment, patients with COPD suffer a considerable burden mainly due to exacerbations and comorbidities, which require a substantial use of HRU.

Epoxy Composites Reinforced with ZnO from Waste Alkaline Batteries.

The zinc alkaline battery is one of the most popular sources of portable electrical energy, with more than 300,000 tons being consumed per year. Accordingly, it is critical to recycle its components. In this work, we propose the use of zinc oxide (ZnO) microparticles recovered from worn-out batteries as fillers of epoxy resins. These nanocomposites can be used as protective coatings or pigments and as structural composites with high thermal stability. The addition of ceramic nanofillers, such as ZnO or/and TiO2, could enhance the thermal and mechanical properties, and the hardness and hydrophobicity, of the epoxy resins, depending on several factors. Accordingly, different nanocomposites reinforced with recycled ZnO and commercial ZnO and TiO2 nanoparticles have been manufactured with different nanofiller contents. In addition to the different ceramic oxides, the morphology and size of fillers are different. Recycled ZnO are"desert roses" such as microparticles, commercial ZnO are rectangular parallelepipeds nanoparticles, and commercial TiO2 are smaller spherical nanoparticles. The addition of ceramic fillers produces a small increase of the glass transition temperature (<2%), together with an enhancement of the barrier effect of the epoxy resin, reducing the water diffusion coefficient (<21%), although the maximum water uptake remains constant. The nanocomposite water absorption is fully reversible by subsequent thermal treatment, recovering its initial thermomechanical behavior. The water angle contact (WCA) also increases (~12%) with the presence of ceramic particles, although the highest hydrophobicity (35%) is obtained when the epoxy resin reinforced with recycled flowerlike ZnO microparticles is etched with acid stearic and acetic acid, inducing the corrosion of the ZnO on the surface and therefore the increment of the surface roughness. The presence of desert rose ZnO particles enhances the de lotus effect.

Electrical Properties and Strain Sensing Mechanisms in Hybrid Graphene Nanoplatelet/Carbon Nanotube Nanocomposites.

Electrical and electromechanical properties of hybrid graphene nanoplatelet (GNP)/carbon nanotube (CNT)-reinforced composites were analyzed under two different sonication conditions. The electrical conductivity increases with increasing nanofiller content, while the optimum sonication time decreases in a low viscosity media. Therefore, for samples with a higher concentration of GNPs, an increase of sonication time of the hybrid GNP/CNT mixture generally leads to an enhancement of the electrical conductivity, up to values of 3 S/m. This means that the optimum sonication process to achieve the best performances is reached in the longest times. Strain sensing tests show a higher prevalence of GNPs at samples with a high GNP/CNT ratio, reaching gauge factors of around 10, with an exponential behavior of electrical resistance with applied strain, whereas samples with lower GNP/CNT ratio have a more linear response owing to a higher prevalence of CNT tunneling transport mechanisms, with gauge factors of around 3-4.

Complex Geometry Strain Sensors Based on 3D Printed Nanocomposites: Spring, Three-Column Device and Footstep-Sensing Platform.

Electromechanical sensing devices, based on resins doped with carbon nanotubes, were developed by digital light processing (DLP) 3D printing technology in order to increase design freedom and identify new future and innovative applications. The analysis of electromechanical properties was carried out on specific sensors manufactured by DLP 3D printing technology with complex geometries: a spring, a three-column device and a footstep-sensing platform based on the three-column device. All of them show a great sensitivity of the measured electrical resistance to the applied load and high cyclic reproducibility, demonstrating their versatility and applicability to be implemented in numerous items in our daily lives or in industrial devices. Different types of carbon nanotubes-single-walled, double-walled and multi-walled CNTs (SWCNTs, DWCNTs, MWCNTs)-were used to evaluate the effect of their morphology on electrical and electromechanical performance. SWCNT- and DWCNT-doped nanocomposites presented a higher Tg compared with MWCNT-doped nanocomposites due to a lower UV light shielding effect. This phenomenon also justifies the decrease of nanocomposite Tg with the increase of CNT content in every case. The electromechanical analysis reveals that SWCNT- and DWCNT-doped nanocomposites show a higher electromechanical performance than nanocomposites doped with MWCNTs, with a slight increment of strain sensitivity in tensile conditions, but also a significant strain sensitivity gain at bending conditions.

HDAC3 inhibitor RGFP966 controls bacterial growth and modulates macrophage signaling during Mycobacterium tuberculosis infection.

RATIONALE: Host-directed therapeutics for Mycobacterium tuberculosis (Mtb) offer potential strategies for combatting antibiotic resistance and for killing non-replicating bacilli. Phenylbutyrate, a partially selective histone-deacetylase (HDAC) inhibitor, was previously shown to control Mtb growth and alter macrophage inflammatory pathways at 2-4 mM concentrations. OBJECTIVE: To identify a more potent and selective HDAC inhibitor that modulates macrophage responses to mycobacteria and has direct antibacterial effects against Mtb. METHODS: We used cellular approaches to characterize the role of pharmacologic inhibition of HDAC3 on Mtb growth and Mtb-induced peripheral and alveolar macrophage immune functions. MEASUREMENTS AND MAIN RESULTS: RGFP966, an HDAC3 inhibitor, controlled Mtb, BCG and M. avium growth directly in broth culture and in human peripheral blood monocyte-derived and alveolar macrophages with an MIC50 of approximately 5-10 µM. In contrast, RGFP966 did not inhibit growth of several other intracellular and extracellular bacteria. We also found that RGFP966 modulated macrophage pro-inflammatory cytokine secretion in response to Mtb infection with decreased IL6 and TNF secretion. CONCLUSIONS: We identified a potent and selective small molecule inhibitor of HDAC3 with direct antimicrobial activity against Mtb and modulation of macrophage signaling pathways.

Highly Multifunctional GNP/Epoxy Nanocomposites: From Strain-Sensing to Joule Heating Applications.

A performance mapping of GNP/epoxy composites was developed according to their electromechanical and electrothermal properties for applications as strain sensors and Joule heaters. To achieve this purpose, a deep theoretical and experimental study of the thermal and electrical conductivity of nanocomposites has been carried out, determining the influence of both nanofiller content and sonication time. Concerning dispersion procedure, at lower contents, higher sonication times induce a decrease of thermal and electrical conductivity due to a more prevalent GNP breakage effect. However, at higher GNP contents, sonication time implies an enhancement of both electrical and thermal properties due to a prevalence of exfoliating mechanisms. Strain monitoring tests indicate that electrical sensitivity increases in an opposite way than electrical conductivity, due to a higher prevalence of tunneling mechanisms, with the 5 wt.% specimens being those with the best results. Moreover, Joule heating tests showed the dominant role of electrical mechanisms on the effectiveness of resistive heating, with the 8 wt.% GNP samples being those with the best capabilities. By taking the different functionalities into account, it can be concluded that 5 wt.% samples with 1 h sonication time are the most balanced for electrothermal applications, as shown in a radar chart.

New Manufacturing Process of Composites Reinforced with ZnO Nanoparticles Recycled from Alkaline Batteries.

A new manufacturing method of thermosetting resins reinforced with dense particles is developed in the present work. A rotary mold is used, avoiding the natural sedimentation of particles through applying centrifuge forces. A deep study of the sedimentation phenomenon is carried out in order to evaluate the main experimental parameters which influence the manufacturing of composite. The used reinforcement is zinc oxide (ZnO) obtained by a new recycling method from spent alkaline batteries. In order to compare the benefits, commercial ZnO nanoparticles are also analyzed. Recycled ZnO particles enhance the interaction of the epoxy matrix due to their inner moisture, allowing the manufacture of composites with relatively high ceramic content. Moreover, an increment in the glass transition temperature of the epoxy matrix and in the mechanical properties, such as its stiffness and hardness, is achieved.

Mechanical and Strain-Sensing Capabilities of Carbon Nanotube Reinforced Composites by Digital Light Processing 3D Printing Technology.

Mechanical and strain sensing capabilities of carbon nanotube (CNT) reinforced composites manufactured by digital light processing (DLP) 3D printing technology have been studied. Both CNT content and a post-curing treatment effects have been analyzed. It has been observed that post-curing treatment has a significant influence on mechanical properties, with an increase of Young's modulus and glass transition temperature whereas their effect in electrical properties is not so important. Furthermore, the strain sensing tests show a linear response of electrical resistance with applied strain, with higher values of sensitivity when decreasing CNT content due to a higher interparticle distance. Moreover, the electrical sensitivity of bending tests is significantly lower than in tensile ones due to the compression subjected face effect. Therefore, the good gauge factor values (around 2-3) and the high linear response proves the applicability of the proposed nanocomposites in structural health monitoring applications.

Nicotinamide Limits Replication of Mycobacterium tuberculosis and Bacille Calmette-Guérin Within Macrophages.

Novel antimicrobials for treatment of Mycobacterium tuberculosis are needed. We hypothesized that nicotinamide (NAM) and nicotinic acid (NA) modulate macrophage function to restrict M. tuberculosis replication in addition to their direct antimicrobial properties. Both compounds had modest activity in 7H9 broth, but only NAM inhibited replication in macrophages. Surprisingly, in macrophages NAM and the related compound pyrazinamide restricted growth of bacille Calmette-Guérin but not wild-type Mycobacterium bovis, which both lack a functional nicotinamidase/pyrazinamidase (PncA) rendering each strain resistant to these drugs in broth culture. Interestingly, NAM was not active in macrophages infected with a virulent M. tuberculosis mutant encoding a deletion in pncA. We conclude that the differential activity of NAM and nicotinic acid on infected macrophages suggests host-specific NAM targets rather than PncA-dependent direct antimicrobial properties. These activities are sufficient to restrict attenuated BCG, but not virulent wild-type M. bovis or M. tuberculosis.

Efficacy and safety of lesinurad for the treatment of hyperuricemia in gout.

The aim of this review is to present current evidence about the efficacy and safety of lesinurad in combination with xanthine oxidase inhibitors (XOIs) in the treatment of hyperuricemia in patients with gout. Gout is the most common inflammatory form of arthritis. It is caused by an elevated concentration of serum uric acid (UA) that leads to the formation of monosodium urate crystals in joints and different tissues. The goal of therapy is to maintain serum UA levels at <6 mg/dL (0.36 mmol/L), to prevent the formation and deposition of monosodium urate crystals, and to dissolve existing crystals. Lesinurad, a new uricosuric, increases renal urate excretion by selectively inhibiting the renal uric acid transporter 1 (URAT1). Lesinurad is indicated in adults, in combination with a XOI, for the adjunctive treatment of hyperuricemia in patients with gout (with or without tophi) who have not achieved target serum UA levels with an adequate dose of a XOI alone. With the combination strategy, serum UA targets could be reached with the consequence of inhibiting formation of new crystals and promoting dissolution of existing crystals and, therefore, inducing improvement of outcomes such as flares and tophi. The approval of lesinurad was based on data from three pivotal phase III studies (CLEAR 1, CLEAR 2, and CRYSTAL). These clinical studies assessed lesinurad 200 and 400 mg doses. As only lesinurad 200 mg/day dose was finally approved and commercialized, it will be the focus of this paper. In the pivotal clinical trials, the target serum UA level was achieved by significantly more patients in lesinurad 200 mg plus allopurinol group (CLEAR 1 and CLEAR 2 trials) or lesinurad 200 mg plus febuxostat group (CRYSTAL study) compared with patients who received either XOI alone. In these trials, the safety profile of lesinurad 200 mg plus a XOI was comparable to allopurinol or febuxostat alone. Lesinurad, in combination with a XOI, is an effective and safe treatment that covers unmet needs in adults with gout who have not achieved target serum UA levels with a XOI alone.

EMPHYSEMA QUANTIFICATION ON SIMULATED X-RAYS THROUGH DEEP LEARNING TECHNIQUES.

Emphysema quantification techniques rely on the use of CT scans, but they are rarely used in the diagnosis and management of patients with COPD; X-ray films are the preferred method to do this. However, this diagnosis method is very controversial, as there are not established guidelines to define the disease, sensitivity is low, and quantification cannot be done. We developed a quantification method based on a CNN, capable of predicting the emphysema percentage of a patient based on an X-ray image. We used real CT scans to simulate X-ray films and to calculate emphysema percentage using the LAA%. The model developed was able to calculate emphysema percentage with an LAA% mean error of 3.96, and it obtained an AUC accuracy of 90.73% for an emphysema definition of ≥10%, with a mean sensitivity of 85.68%, significantly improving X-ray-based emphysema diagnosis.

Immunological mechanisms of human resistance to persistent Mycobacterium tuberculosis infection.

Mycobacterium tuberculosis is a leading cause of mortality worldwide and establishes a long-lived latent infection in a substantial proportion of the human population. Multiple lines of evidence suggest that some individuals are resistant to latent M. tuberculosis infection despite long-term and intense exposure, and we term these individuals 'resisters'. In this Review, we discuss the epidemiological and genetic data that support the existence of resisters and propose criteria to optimally define and characterize the resister phenotype. We review recent insights into the immune mechanisms of M. tuberculosis clearance, including responses mediated by macrophages, T cells and B cells. Understanding the cellular mechanisms that underlie resistance to M. tuberculosis infection may reveal immune correlates of protection that could be utilized for improved diagnostics, vaccine development and novel host-directed therapeutic strategies.

Familial Blau syndrome without uveitis caused by a novel mutation in the nucleotide-binding oligomerization domain-containing protein 2 gene with good response to infliximab.

The proband in this study was a 4-year-old Mexican girl with Blau syndrome. She and her affected family members had skin rash and arthritis but no uveitis. Exome sequencing and DNA direct sequencing from blood samples revealed a novel nucleotide-binding oligomerization domain-containing protein 2 gene mutation in the affected family members. This study is the first report of a Mexican family with Blau syndrome showing good infliximab treatment response. The novel mutation in the nucleotide-binding oligomerization domain-containing protein 2 gene (c.1808A>G) enriches the mutation spectrum in Blau syndrome. This family represents one of the few cases of autosomal Blau syndrome with no uveitis; because of phenotype variability, it is important to recognize Blau syndrome's clinical spectrum and recommend genetic consultation.

Transcriptional networks are associated with resistance to Mycobacterium tuberculosis infection.

RATIONALE: Understanding mechanisms of resistance to M. tuberculosis (M.tb) infection in humans could identify novel therapeutic strategies as it has for other infectious diseases, such as HIV. OBJECTIVES: To compare the early transcriptional response of M.tb-infected monocytes between Ugandan household contacts of tuberculosis patients who demonstrate clinical resistance to M.tb infection (cases) and matched controls with latent tuberculosis infection. METHODS: Cases (n = 10) and controls (n = 18) were selected from a long-term household contact study in which cases did not convert their tuberculin skin test (TST) or develop tuberculosis over two years of follow up. We obtained genome-wide transcriptional profiles of M.tb-infected peripheral blood monocytes and used Gene Set Enrichment Analysis and interaction networks to identify cellular processes associated with resistance to clinical M.tb infection. MEASUREMENTS AND MAIN RESULTS: We discovered gene sets associated with histone deacetylases that were differentially expressed when comparing resistant and susceptible subjects. We used small molecule inhibitors to demonstrate that histone deacetylase function is important for the pro-inflammatory response to in-vitro M.tb infection in human monocytes. CONCLUSIONS: Monocytes from individuals who appear to resist clinical M.tb infection differentially activate pathways controlled by histone deacetylase in response to in-vitro M.tb infection when compared to those who are susceptible and develop latent tuberculosis. These data identify a potential cellular mechanism underlying the clinical phenomenon of resistance to M.tb infection despite known exposure to an infectious contact.