Pseudomonas aeruginosa induces localized immunosuppression during pneumonia.

Hospital-acquired bacterial pneumonia is a common and serious complication of modern medical care. Many aspects of such infections remain unclear, including the mechanisms by which invading pathogens resist clearance by the innate immune response and the tendency of the infections to be polymicrobial. Here, we used a mouse model of infection to show that Pseudomonas aeruginosa, a leading cause of hospital-acquired pneumonia, interferes with the ability of recruited phagocytic cells to eradicate bacteria from the lung. Early in infection, phagocytic cells, predominantly neutrophils, are recruited to the lungs but are incapacitated when they enter the airways by the P. aeruginosa toxin ExoU. The resulting paucity of functioning phagocytes allows P. aeruginosa to persist within the lungs and results in local immunosuppression that facilitates superinfection with less-pathogenic bacteria. Together, our results provide explanations for previous reports linking ExoU-secreting P. aeruginosa with more severe pulmonary infections and for the tendency of hospital-acquired pneumonia to be polymicrobial.

Signet-ring cell change versus signet-ring cell carcinoma: a comparative analysis.

Signet-ring cell change (SCC) is a nonneoplastic condition that morphologically simulates signet-ring cell carcinoma (SRCA). The few case reports on SCC have focused on morphologic characteristics in distinguishing benign from malignant. In biopsy specimens, however, SCC can be easily confused with SRCA, which often demonstrates innocuous cytologic features. The object of this study is twofold: 1) to report 14 additional cases of SCC, comparing their morphologic and phenotypic features with that of SRCA; and 2) to evaluate the incidence of SCC in pseudomembranous colitis. Paraffin sections of biopsy or resection specimens containing focal or extensive SCC and 5 cases of colonic SRCA were stained with hematoxylin and eosin, periodic-acid Schiff stain with and without diastase digestion, and by standard ABC immunoperoxidase procedure using antibodies to E-cadherin, p53, and Ki-67. Both cells in SCC and SRCA were strongly positive for neutral mucins. Cells in SCC were strongly positive for E-cadherin and negative for p53 and Ki-67. In contrast, cells in SRCA were strongly positive for p53, exhibited high proliferation, and demonstrated absent or weak positivity for E-cadherin. Although SCC is not well recognized in pseudomembranous colitis, the incidence is fairly high: 14 of 50 (28%) cases showed variable numbers of signet-ring cells. Extensive SCC, although rare, can occur in different clinical conditions and can be easily mistaken for SRCA. When in doubt, routine immunohistochemical stains such as p53, Ki-67, and E-cadherin can help to differentiate SCC from SRCA.

Prevention/reversal of choline deficiency-induced steatohepatitis by a peroxisome proliferator-activated receptor alpha ligand in rats.

Nonalcoholic steatohepatitis, often associated with obesity and diabetes, is a common liver condition in the U.S. Individuals with steatohepatitis are not eligible for liver donation and may be at increased risk from developing complications following lobectomy. If steatosis and steatohepatitis can be treated medically, these individuals can become eligible for living donor transplants and segmental resection of the liver for treatment of primary or metastatic liver diseases. Because rats fed a choline-deficient diet (CDD) develop morphological changes in the liver similar to that observed in nonalcoholic steatohepatitis, we examined the effect of ciprofibrate, a potent peroxisome proliferator activated receptor alpha (PPAR alpha) ligand and inducer of fatty acid oxidation systems in the liver, on reversal of steatosis. Rats fed CDD for 2 weeks developed marked fatty change with mild hepatitis and marked increase in serum aminotransferases and liver triacylglycerols. Concurrent administration of CDD and ciprofibrate resulted in the prevention of fatty change. Rats that were fed CDD for 2 weeks followed by feeding CDD containing ciprofibrate for 1 or 2 weeks resulted in marked reduction of fatty change and normalization of serum aminotransferases. Compared with the CDD group, all groups that received ciprofibrate showed several-fold increase in mRNA and protein levels of several PPAR alpha target genes. In addition, electron microscopic examination showed marked peroxisome proliferation in the hepatocytes. The results of these studies clearly demonstrate that the severity of CDD-induced fatty change and hepatitis in rats can be rapidly decreased by ciprofibrate and suggest the therapeutic potential of PPAR alpha ligands in the treatment of nonalcoholic steatohepatitis in humans to rapidly reverse liver changes.