B cells expressing IgM B cell receptors of HIV-1 neutralizing antibodies discriminate antigen affinities by sensing binding association rates.

HIV-1 envelope (Env) proteins designed to induce neutralizing antibody responses allow study of the role of affinities (equilibrium dissociation constant [KD]) and kinetic rates (association/dissociation rates) on B cell antigen recognition. It is unclear whether affinity discrimination during B cell activation is based solely on Env protein binding KD and whether B cells discriminate among proteins of similar affinities that bind with different kinetic rates. Here, we use a panel of Env proteins and Ramos B cell lines expressing immunoglobulin M (IgM) B cell receptors (BCRs) with specificity for CD4-binding-site broadly neutralizing antibodies to study the role of antigen binding kinetic rates on both early (proximal/distal signaling) and late events (BCR/antigen internalization) in B cell activation. Our results support a kinetic model for B cell activation in which Env protein affinity discrimination is based not on overall KD but on sensing of association rate and a threshold antigen-BCR half-life.

A Barcoded Flow Cytometric Assay to Explore the Antibody Responses Against SARS-CoV-2 Spike and Its Variants.

The SARS-CoV-2 pandemic has spread to all parts of the world and can cause life-threatening pneumonia and other severe disease manifestations known as COVID-19. This health crisis has resulted in a significant effort to stop the spread of this new coronavirus. However, while propagating itself in the human population, the virus accumulates mutations and generates new variants with increased fitness and the ability to escape the human immune response. Here we describe a color-based barcoded spike flow cytometric assay (BSFA) that is particularly useful to evaluate and directly compare the humoral immune response directed against either wild type (WT) or mutant spike (S) proteins or the receptor-binding domains (RBD) of SARS-CoV-2. This assay employs the human B lymphoma cell line Ramos, transfected for stable expression of WT or mutant S proteins or a chimeric RBD-CD8 fusion protein. We find that the alpha and beta mutants are more stably expressed than the WT S protein on the Ramos B cell surface and/or bind with higher affinity to the viral entry receptor ACE2. However, we find a reduce expression of the chimeric RBD-CD8 carrying the point mutation N501Y and E484K characteristic for the alpha and beta variant, respectively. The comparison of the humoral immune response of 12 vaccinated probands with 12 COVID-19 patients shows that after the boost, the S-specific IgG class immune response in the vaccinated group is similar to that of the patient group. However, in comparison to WT the specific IgG serum antibodies bind less well to the alpha variant and only poorly to the beta variant S protein. This is in line with the notion that the beta variant is an immune escape variant of SARS-CoV-2. The IgA class immune response was more variable than the IgG response and higher in the COVID-19 patients than in the vaccinated group. In summary, we think that our BSFA represents a useful tool to evaluate the humoral immunity against emerging variants of SARS-CoV-2 and to analyze new vaccination protocols against these variants.

Memory B Cells Activate Brain-Homing, Autoreactive CD4+ T Cells in Multiple Sclerosis.

Multiple sclerosis is an autoimmune disease that is caused by the interplay of genetic, particularly the HLA-DR15 haplotype, and environmental risk factors. How these etiologic factors contribute to generating an autoreactive CD4+ T cell repertoire is not clear. Here, we demonstrate that self-reactivity, defined as "autoproliferation" of peripheral Th1 cells, is elevated in patients carrying the HLA-DR15 haplotype. Autoproliferation is mediated by memory B cells in a HLA-DR-dependent manner. Depletion of B cells in vitro and therapeutically in vivo by anti-CD20 effectively reduces T cell autoproliferation. T cell receptor deep sequencing showed that in vitro autoproliferating T cells are enriched for brain-homing T cells. Using an unbiased epitope discovery approach, we identified RASGRP2 as target autoantigen that is expressed in the brain and B cells. These findings will be instrumental to address important questions regarding pathogenic B-T cell interactions in multiple sclerosis and possibly also to develop novel therapies.

Central role of Th2/Tc2 lymphocytes in pattern II multiple sclerosis lesions.

OBJECTIVE: Multiple sclerosis (MS) is a disease of the central nervous system with marked heterogeneity in several aspects including pathological processes. Based on infiltrating immune cells, deposition of humoral factors and loss of oligodendrocytes and/or myelin proteins, four lesion patterns have been described. Pattern II is characterized by antibody and complement deposition in addition to T-cell infiltration. MS is considered a T-cell-mediated disease, but until now the study of pathogenic T cells has encountered major challenges, most importantly the limited access of brain-infiltrating T cells. Our objective was to identify, isolate, and characterize brain-infiltrating clonally expanded T cells in pattern II MS lesions. METHODS: We used next-generation sequencing to identify clonally expanded T cells in demyelinating pattern II brain autopsy lesions, subsequently isolated these as T-cell clones from autologous cerebrospinal fluid and functionally characterized them. RESULTS: We identified clonally expanded CD8(+) but also CD4(+) T cells in demyelinating pattern II lesions and for the first time were able to isolate these as live T-cell clones. The functional characterization shows that T cells releasing Th2 cytokines and able to provide B cell help dominate the T-cell infiltrate in pattern II brain lesions. INTERPRETATION: Our data provide the first functional evidence for a putative role of Th2/Tc2 cells in pattern II MS supporting the existence of this pathogenic phenotype and questioning the protective role that is generally ascribed to Th2 cells. Our observations are important to consider for future treatments of pattern II MS patients.

Memory phenotype and polyfunctional T cells in kidney transplant patients.

Allospecific memory T cells are a barrier against long-term graft survival. Production of multiple cytokines by a single T cell is considered a sign of an active ongoing immune response, the presence of these polyfunctional cells has not been addressed in transplanted patients accordingly to graft outcome. Memory phenotype, based on the expression of CD45RO and CD27, and polyfunctional T cells were evaluated in long-term graft survival patients (LTS), short-term survival patients (STS), chronic rejection patients (ChrRx), dialysis patients (DIAL) and healthy controls (Ctrls). Memory T cells were quantified ex vivo, after allogeneic and anti-CD3 plus anti-CD28 stimulation, in cells proliferating or not to these stimuli. The percentages of cells producing IFNγ, IL-2 and/or TNFα after allogeneic stimulation and the memory phenotype of single cytokine producing cells were evaluated. Ex vivo CD8+CD45RO-CD27- effector cells were decreased in transplanted patients compared to non-transplanted individuals. After allogeneic stimulation, CD4+CD45RO+CD27+, central memory cells in LTS and CD4+CD45RO-CD27- effector cells in Dial were augmented compared to Ctrls and ChrRx, and CD8+CD45RO-CD27- effector cells were increased in ChrRx. There were no differences in the percentage of single cytokine producing cells among the groups. IFNγ+TNFα+CD4 and CD8 cells were detected in Ctrls, STS and ChrRx and no cells positive for the three cytokines were found. The phenotype of cytokine producing cells was mainly effector memory. Interestingly, in LTS there was an increase in effector cells producing IFNγ and IL-2. Changes in subpopulation distribution in patients with different outcomes may be a reflection of the graft acceptance or rejection status.

Differences in phosphorylation patterns of intracellular signaling proteins in T cells from kidney transplant patients with different outcomes.

Transplant patients with long-term graft survival (LTS) may have developed mechanisms that prevent rejection and allow graft function under low or no immunosuppressive therapy. In murine models, T cell tolerance is associated with alterations in the expression/activation of proteins involved in T cell signaling. These alterations have not been reported in transplanted patients with different outcomes. This study aimed to evaluate calcium mobilization, the phosphorylation of different proteins involved in T cell signaling and the expression of molecules associated with anergy, in T cells from kidney transplant patients. No differences were observed in calcium mobilization, although transplanted patients had a tendency toward augmented calcium flux. Chronic rejection patients (ChrRx) displayed lower Lck basal phosphorylation levels compared with LTS patients, and the phosphorylation profile of proteins evaluated was different. Among the groups, phosphorylation of Zap-70 was higher in LTS patients compared with ChrRx, and LAT phosphorylation was lower in LTS and ChrRx patients compared with healthy controls. The expression of molecules related to the anergic phenotype was similar among the study groups. Results suggest that phosphorylation patterns, rather than phosphorylation levels, may correlate with transplant outcome and that anergy may not be the main mechanism mediating LTS.

Plan andino de salud en fronteras / Proyecto "Salud: Puente para la Paz y la Integración": Informe final / Andean border health plan

El informe contiene: INTRODUCCIÓN, CAPÍTULO I: OBJETIVO ESPECÍFICO 1: DIAGNÓSTICO DE LA SITUACIÓN EN SALUD; CAPÍTULO II: OBJETIVO ESPECÍFICO 2: PARTICIPACIÓN ACTIVA DE ORGANIZACIONES; CAPÍTULO III: OBJETIVO ESPECÍFICO 3: MECANISMOS DE ATENCIÓN EN SALUD; CAPÍTULO IV: OBJETIVO ESPECÍFICO 4 Y 5: CAPACITACIÓN EN FORMULACIÓN DE PROYECTOS Y GESTIÓN SANITARIA; CAPÍTULO V CONCLUSIONES: LOGROS Y LIMITACIONES; ANEXOS.

Propuesta de la organizacion del area de salud Colpa Belgica en el distrito de salud Sara del departamento de San Cruz / sss

El contar con un area geograficamente definida y una poblacion determinada es un elemento importante para medir el buen funcionamiento de un servicio de salud de primer nivel. La APS continua siendo estrategia valida para brindar una atencion efectiva en un primer nievel de atencion. La calidad de atencion dependera de la organizacion de los servicios de salud, la capacitacion tecnica de los recursos humanos y la actitud del personal de salud hacia la comunidad. La participacion comunitaria se constituye en una linea estrategica importante para lograr un funcionamiento optimo. La articulacion de los servicios depende de la capacidad del equipo de distrito y del apoyo tecnico y administrativo que pueda otorgar el equipo a los servicios de salud...

Propuesta de la Organización del área de Salud Colpa Bélgica en el distrito de salud Sara del Departamento de Santa Cruz

El presente trabajo se refiere a la Presentación de una propuesta de la Organización del área Salud de Colpa la Bélgica. Tiene como própósito en su primera parte el Análisis e Identificación de los problemas de funcionaqmiento del Centro de Salud San Silvestre en el Distrito de Salud Sara, del Departamento de Santa Cruz, a través de información referente a la utilización del Servicio, la Participación Coumunitaria, Instrumentos de Supervisión, Análisis de la Información y Recursos Humanos. En una segunda parte se propone la Reorganización Geográfica y del Servicio respetando su Primer Nivel de atención tomando en cuenta las líneas estratégica Técnica, Administrativa y de Gestión. Por lo que se Concluye, relevando la importancia que desarrolla la Estratégia de Atención Primaria de Salud (APS) y la Organización del Servicio para lograr el funcionamiento óptimo y el rol de gestión y participación de la comunidad en el Sistema Integrado de Salud coordinado por el equipo de Gestión Dsitrital.

Propuesta de la Organización del área de Salud Colpa Bélgica en el distrito de salud Sara del Departamento de Santa Cruz

El presente trabajo se refiere a la Presentación de una propuesta de la Organización del área Salud de Colpa la Bélgica. Tiene como própósito en su primera parte el Análisis e Identificación de los problemas de funcionaqmiento del Centro de Salud San Silvestre en el Distrito de Salud Sara, del Departamento de Santa Cruz, a través de información referente a la utilización del Servicio, la Participación Coumunitaria, Instrumentos de Supervisión, Análisis de la Información y Recursos Humanos. En una segunda parte se propone la Reorganización Geográfica y del Servicio respetando su Primer Nivel de atención tomando en cuenta las líneas estratégica Técnica, Administrativa y de Gestión. Por lo que se Concluye, relevando la importancia que desarrolla la Estratégia de Atención Primaria de Salud (APS) y la Organización del Servicio para lograr el funcionamiento óptimo y el rol de gestión y participación de la comunidad en el Sistema Integrado de Salud coordinado por el equipo de Gestión Dsitrital.