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1.
Psychosom Med ; 86(6): 498-506, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38648028

RESUMO

OBJECTIVE: People with coronary artery disease (CAD) are at higher risk of cognitive impairment than those without CAD. Psychological stress is a risk factor for both conditions, and assessing the hemodynamic reactivity to mental stress could explain the link between stress and cognitive function. METHODS: A total of 779 individuals with stable CAD from two prospective cohort studies were included. All individuals underwent acute mental stress testing, as well as conventional stress testing. Cognitive function was assessed both at baseline and at a 2-year follow-up. The rate-pressure product (RPP) was calculated as the mean systolic blood pressure times the mean heart rate at rest. RPP reactivity was defined as the maximum RPP during standardized mental stress test minus the RPP at rest. RESULTS: After multivariable adjustment, every standard deviation decrease in RPP reactivity with mental stress was associated with slower completion of Trail-A and Trail-B in both cohorts (13% and 11% in cohort 1, and 15% and 16% in cohort 2, respectively; p for all <.01). After a 2-year follow-up period, every standard deviation decrease in RPP reactivity with mental stress was associated with a 8% and 9% slower completion of Trail-A and Trail-B, respectively ( p for all <.01). There was no significant association between RPP reactivity with conventional stress testing and any of the cognitive tests. CONCLUSION: In the CAD population, a blunted hemodynamic response to mental stress is associated with slower visuomotor processing and worse executive function at baseline and with greater decline in these abilities over time.


Assuntos
Disfunção Cognitiva , Doença da Artéria Coronariana , Hemodinâmica , Estresse Psicológico , Humanos , Masculino , Feminino , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/complicações , Estresse Psicológico/fisiopatologia , Pessoa de Meia-Idade , Idoso , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/etiologia , Hemodinâmica/fisiologia , Estudos Prospectivos , Frequência Cardíaca/fisiologia , Pressão Sanguínea/fisiologia , Seguimentos , Cognição/fisiologia
2.
Immunity ; 40(3): 425-35, 2014 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-24613091

RESUMO

Naive CD4(+) T cell differentiation into distinct subsets of T helper (Th) cells is a pivotal process in the initiation of the adaptive immune response. Allergens predominantly stimulate Th2 cells, causing allergic inflammation. However, why allergens induce Th2 cell differentiation is not well understood. Here we show that group 2 innate lymphoid cells (ILC2s) are required to mount a robust Th2 cell response to the protease-allergen papain. Intranasal administration of papain stimulated ILC2s and Th2 cells, causing allergic lung inflammation and elevated immunoglobulin E titers. This process was severely impaired in ILC2-deficient mice. Whereas interleukin-4 (IL-4) was dispensable for papain-induced Th2 cell differentiation, ILC2-derived IL-13 was critical as it promoted migration of activated lung dendritic cells into the draining lymph node where they primed naive T cells to differentiate into Th2 cells. Papain-induced ILC2 activation and Th2 cell differentiation was IL-33-dependent, suggesting a common pathway in the initiation of Th2 cell responses to allergen.


Assuntos
Imunidade Adaptativa , Hipersensibilidade/imunologia , Imunidade Inata , Pneumonia/imunologia , Linfócitos T Auxiliares-Indutores/imunologia , Alérgenos/administração & dosagem , Alérgenos/imunologia , Animais , Antígenos CD40/metabolismo , Diferenciação Celular/efeitos dos fármacos , Movimento Celular/efeitos dos fármacos , Movimento Celular/imunologia , Células Dendríticas/imunologia , Células Dendríticas/metabolismo , Modelos Animais de Doenças , Hipersensibilidade/genética , Interleucina-13/metabolismo , Interleucina-13/farmacologia , Interleucina-4/imunologia , Interleucina-4/metabolismo , Linfonodos/imunologia , Camundongos , Camundongos Knockout , Papaína/imunologia , Pneumonia/genética , Células Th2/citologia , Células Th2/efeitos dos fármacos , Células Th2/imunologia
3.
Curr Cardiol Rep ; 25(12): 1811-1821, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-38079057

RESUMO

PURPOSE OF REVIEW: Patients with established coronary artery disease (CAD) are at high residual risk for adverse events, despite guideline-based treatments. Herein, we aimed to determine whether risk scores based on multiple circulating biomarkers that represent activation of various pathophysiologically important pathways involved in atherosclerosis and myocardial dysfunction help identify those at greatest residual risk. RECENT FINDINGS: Numerous circulating proteins, representing dysregulation of the pathways involved in the development and stability of coronary and myocardial diseases, have been identified. When aggregated together, biomarker risk scores (BRS) more accurately stratify patients with established CAD that may help target interventions in those individuals who are at elevated risk. Moreover, intensification of guideline-based therapies has been associated with parallel improvements in both BRS and outcomes, indicating that these risk scores may be employed clinically to target therapy. Multi-protein BRS are predictive of risk, independent of, and in addition to traditional risk factor assessments in patients with CAD. Those with elevated risk may benefit from optimization of therapies, and improvements in the BRS will identify those with improved outcomes.


Assuntos
Doença da Artéria Coronariana , Humanos , Doença da Artéria Coronariana/terapia , Doença da Artéria Coronariana/complicações , Proteômica , Valor Preditivo dos Testes , Fatores de Risco , Biomarcadores
4.
J Biol Chem ; 296: 100387, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33617876

RESUMO

Like other pentameric ligand-gated channels, glycine receptors (GlyRs) contain long intracellular domains (ICDs) between transmembrane helices 3 and 4. Structurally characterized GlyRs are generally engineered to have a very short ICD. We show here that for one such construct, zebrafish GlyREM, the agonists glycine, ß-alanine, taurine, and GABA have high efficacy and produce maximum single-channel open probabilities greater than 0.9. In contrast, for full-length human α1 GlyR, taurine and GABA were clearly partial agonists, with maximum open probabilities of 0.46 and 0.09, respectively. We found that the elevated open probabilities in GlyREM are not due to the limited sequence differences between the human and zebrafish orthologs, but rather to replacement of the native ICD with a short tripeptide ICD. Consistent with this interpretation, shortening the ICD in the human GlyR increased the maximum open probability produced by taurine and GABA to 0.90 and 0.70, respectively, but further engineering it to resemble GlyREM (by introducing the zebrafish transmembrane helix 4 and C terminus) had no effect. Furthermore, reinstating the native ICD to GlyREM converted taurine and GABA to partial agonists, with maximum open probabilities of 0.66 and 0.40, respectively. Structural comparison of transmembrane helices 3 and 4 in short- and long-ICD GlyR subunits revealed that ICD shortening does not distort the orientation of these helices within each subunit. This suggests that the effects of shortening the ICD stem from removing a modulatory effect of the native ICD on GlyR gating, revealing a new role for the ICD in pentameric ligand-gated channels.


Assuntos
Glicina/farmacologia , Receptores de Glicina/agonistas , Taurina/farmacologia , beta-Alanina/farmacologia , Ácido gama-Aminobutírico/farmacologia , Sequência de Aminoácidos , Animais , Células Cultivadas , GABAérgicos/farmacologia , Glicinérgicos/farmacologia , Humanos , Técnicas de Patch-Clamp/métodos , Domínios Proteicos , Receptores de Glicina/metabolismo , Relação Estrutura-Atividade , Peixe-Zebra
5.
Eur J Appl Physiol ; 122(10): 2163-2174, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35778519

RESUMO

PURPOSE: To compare local sweating rate (LSR) and local sweat sodium ([Na+]), chloride ([Cl-]), and potassium ([K+]) concentrations of tattooed skin and contralateral non-tattooed skin during exercise. METHODS: Thirty-three recreational exercisers (17 men, 16 women) with ≥ 1 unilateral permanent tattoo on the torso/arms were tested during cycling, running, or fitness sessions (26 ± 4 °C and 54 ± 13% relative humidity). Forty-eight tattoos with a range of ink colors, ages (3 weeks to 20 years), and densities (10-100%) were included. Before exercise, the skin was cleaned with alcohol and patches (3 M Tegaderm + Pad) were placed on the tattooed and contralateral non-tattooed skin. LSR was calculated from sweat mass (0.80 ± 0.31 g), patch surface area (11.9 cm2), and duration (62 ± 14 min). Sweat [Na+], [Cl-], and [K+] were measured via ion chromatography. RESULTS: Based on the analysis of variance results, there were no differences between tattooed and non-tattooed skin for LSR (1.16 ± 0.52 vs. 1.12 ± 0.53 mg/cm2/min; p = 0.51), sweat [Na+] (60.2 ± 23.5 vs. 58.5 ± 22.7 mmol/L; p = 0.27), sweat [Cl-] (52.1 ± 22.4 vs. 50.6 ± 22.0 mmol/L; p = 0.31), or sweat [K+] (5.8 ± 1.6 vs. 5.9 ± 1.4 mmol/L; p = 0.31). Multiple regression analyses suggested that younger tattoos were associated with higher sweat [Na+] (p = 0.045) and colorful tattoos were associated with higher sweat [Cl-] (p = 0.04) compared with contralateral non-tattooed skin. Otherwise, there were no effects of LSR or tattoo characteristics on regression models for LSR or sweat electrolyte concentrations. CONCLUSION: There were no effects of tattoos on LSR and sweat [K+] during exercise-induced sweating, but tattoo age and color had small effects on sweat [Na+] and sweat [Cl-], respectively. CLINICAL TRIAL IDENTIFIERS: NCT04240951 was registered on January 27, 2020 and NCT04920266 was registered on June 9, 2021.


Assuntos
Suor , Sudorese , Cloretos , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Potássio/análise , Análise de Regressão , Sódio/análise , Suor/química
6.
Int J Ind Organ ; 84: 102840, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35400771

RESUMO

In Goodkin-Gold et al. (2021), we analyzed optimal subsidies for a vaccine against an epidemic outbreak like Covid-19. This companion paper alters the underlying epidemiological model to suit endemic diseases requiring continuous vaccination of new cohorts-also suiting an epidemic like Covid-19 if, following Gans (2020), one assumes peaks are leveled by social distancing. We obtain qualitatively similar results: across market structures ranging from perfect competition to monopoly, the subsidy needed to induce first-best vaccination coverage on the private market is highest for moderately infectious diseases, which invite the most free riding; extremely infectious diseases drive more consumers to become vaccinated, attenuating externalities. Stylized calibrations to HIV, among other diseases, suggest that first-best subsidies can be exorbitantly high when suppliers have market power, rationalizing alternative policies observed in practice such as bulk purchases negotiated by the government on behalf of the consumers.

7.
Immunity ; 37(3): 463-74, 2012 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-22981535

RESUMO

Natural helper (NH) cells are innate lymphoid cells (ILCs) that produce T helper-2 (Th2)-cell-type cytokines in the lung- and gut-associated lymphoid tissues. Currently, the lineage relationship between NH cells in different tissues and between NH cells and interleukin-22 (IL-22)-producing retinoic-acid-receptor-related orphan receptor (ROR)γt-positive ILCs is unclear. Here, we report that NH cells express RORα, but not RORγt. RORα-deficient, but not RORγt-deficient, mice lacked NH cells in all tissues, whereas all other lymphocytes, including RORγt(+) ILCs, were unaffected. NH-cell-deficient mice generated by RORα-deficient bone-marrow transplantation had normal Th2 cell responses but failed to develop acute lung inflammation in response to protease allergen, thus confirming the essential role of NH cells in allergic lung inflammation. We have also identified RORα-dependent NH cell progenitors in the bone marrow. Thus, all NH cells belong to a unique RORα-dependent cell lineage separate from other lymphoid cell lineages.


Assuntos
Células da Medula Óssea/imunologia , Membro 1 do Grupo F da Subfamília 1 de Receptores Nucleares/imunologia , Pneumonia/imunologia , Linfócitos T Auxiliares-Indutores/imunologia , Alérgenos/imunologia , Animais , Antígenos Ly/genética , Antígenos Ly/imunologia , Células da Medula Óssea/metabolismo , Transplante de Medula Óssea , Linhagem da Célula/imunologia , Células Cultivadas , Feminino , Citometria de Fluxo , Subunidade gama Comum de Receptores de Interleucina/genética , Subunidade gama Comum de Receptores de Interleucina/imunologia , Linfócitos/imunologia , Linfócitos/metabolismo , Masculino , Proteínas de Membrana/genética , Proteínas de Membrana/imunologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Endogâmicos NOD , Camundongos Knockout , Camundongos SCID , Membro 1 do Grupo F da Subfamília 1 de Receptores Nucleares/genética , Membro 3 do Grupo F da Subfamília 1 de Receptores Nucleares/genética , Membro 3 do Grupo F da Subfamília 1 de Receptores Nucleares/imunologia , Papaína/imunologia , Pneumonia/genética , Proteínas Proto-Oncogênicas c-kit/genética , Proteínas Proto-Oncogênicas c-kit/imunologia , Linfócitos T Auxiliares-Indutores/metabolismo , Células Th2/imunologia , Células Th2/metabolismo
8.
Proc Natl Acad Sci U S A ; 114(39): 10414-10419, 2017 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-28893983

RESUMO

Protein phosphorylation by cyclic AMP-dependent protein kinase (PKA) underlies key cellular processes, including sympathetic stimulation of heart cells, and potentiation of synaptic strength in neurons. Unrestrained PKA activity is pathological, and an enduring challenge is to understand how the activity of PKA catalytic subunits is directed in cells. We developed a light-activated cross-linking approach to monitor PKA subunit interactions with temporal precision in living cells. This enabled us to refute the recently proposed theory that PKA catalytic subunits remain tethered to regulatory subunits during cAMP elevation. Instead, we have identified other features of PKA signaling for reducing catalytic subunit diffusion and increasing recapture rate. Comprehensive quantitative immunoblotting of protein extracts from human embryonic kidney cells and rat organs reveals that regulatory subunits are always in large molar excess of catalytic subunits (average ∼17-fold). In the majority of organs tested, type II regulatory (RII) subunits were found to be the predominant PKA subunit. We also examined the architecture of PKA complexes containing RII subunits using cross-linking coupled to mass spectrometry. Quantitative comparison of cross-linking within a complex of RIIß and Cß, with or without the prototypical anchoring protein AKAP18α, revealed that the dimerization and docking domain of RIIß is between its second cAMP binding domains. This architecture is compatible with anchored RII subunits directing the myristylated N terminus of catalytic subunits toward the membrane for release and recapture within the plane of the membrane.


Assuntos
Domínio Catalítico/fisiologia , Subunidade RIIbeta da Proteína Quinase Dependente de AMP Cíclico/química , Miócitos Cardíacos/metabolismo , Proteínas de Ancoragem à Quinase A/metabolismo , Animais , Linhagem Celular , AMP Cíclico/química , Células HEK293 , Humanos , Masculino , Espectrometria de Massas , Proteínas de Membrana/metabolismo , Miocárdio/metabolismo , Fosforilação/fisiologia , Ligação Proteica , Estrutura Secundária de Proteína , Ratos , Ratos Sprague-Dawley
9.
Biochem Soc Trans ; 47(5): 1355-1366, 2019 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-31671183

RESUMO

cAMP-dependent protein kinase (PKA) plays a central role in important biological processes including synaptic plasticity and sympathetic stimulation of the heart. Elevations of cAMP trigger release of PKA catalytic (C) subunits from PKA holoenzymes, thereby coupling cAMP to protein phosphorylation. Uncontrolled C subunit activity, such as occurs in genetic disorders in which regulatory subunits are depleted, is pathological. Anchoring proteins that associate with PKA regulatory subunits are important for localising PKA activity in cells. However, anchoring does not directly explain how unrestrained 'free swimming' of C subunits is avoided following C subunit release. In this review, I discuss new mechanisms that have been posited to account for this old problem. One straightforward explanation is that cAMP does not trigger C subunit dissociation but instead activates intact PKA holoenzymes whose activity is restrained through anchoring. A comprehensive comparison of observations for and against cAMP-activation of intact PKA holoenzymes does not lend credence to this mechanism. Recent measurements have revealed that PKA regulatory subunits are expressed at very high concentrations, and in large molar excess relative to C subunits. I discuss the implications of these skewed PKA subunit concentrations, before considering how phosphorylation of type II regulatory subunits and myristylation of C subunits are likely to contribute to controlling C subunit diffusion and recapture in cells. Finally, I speculate on future research directions that may be pursued on the basis of these emerging mechanisms.


Assuntos
Domínio Catalítico , Proteínas Quinases Dependentes de AMP Cíclico/metabolismo , Animais , AMP Cíclico/metabolismo , Proteínas Quinases Dependentes de AMP Cíclico/química , Ativação Enzimática , Humanos , Fosforilação
10.
Am J Respir Cell Mol Biol ; 57(6): 651-661, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28683207

RESUMO

Survival during lung injury requires a coordinated program of damage limitation and rapid repair. CD34 is a cell surface sialomucin expressed by epithelial, vascular, and stromal cells that promotes cell adhesion, coordinates inflammatory cell recruitment, and drives angiogenesis. To test whether CD34 also orchestrates pulmonary damage and repair, we induced acute lung injury in wild-type (WT) and Cd34-/- mice by bleomycin administration. We found that Cd34-/- mice displayed severe weight loss and early mortality compared with WT controls. Despite equivalent early airway inflammation to WT mice, CD34-deficient animals developed interstitial edema and endothelial delamination, suggesting impaired endothelial function. Chimeric Cd34-/- mice reconstituted with WT hematopoietic cells exhibited early mortality compared with WT mice reconstituted with Cd34-/- cells, supporting an endothelial defect. CD34-deficient mice were also more sensitive to lung damage caused by influenza infection, showing greater weight loss and more extensive pulmonary remodeling. Together, our data suggest that CD34 plays an essential role in maintaining vascular integrity in the lung in response to chemical- and infection-induced tissue damage.


Assuntos
Remodelação das Vias Aéreas , Antígenos CD34/genética , Endotélio Vascular/metabolismo , Lesão Pulmonar/metabolismo , Edema Pulmonar/metabolismo , Animais , Antígenos CD34/metabolismo , Bleomicina/efeitos adversos , Bleomicina/farmacologia , Endotélio Vascular/patologia , Lesão Pulmonar/induzido quimicamente , Lesão Pulmonar/genética , Lesão Pulmonar/patologia , Camundongos , Camundongos Knockout , Edema Pulmonar/induzido quimicamente , Edema Pulmonar/genética , Edema Pulmonar/patologia
11.
Eur J Immunol ; 46(1): 122-30, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26518471

RESUMO

In mouse models of infection with the gastrointestinal parasite Trichuris muris, appropriate dendritic-cell (DC) Ag sampling, migration, and presentation to T cells are necessary to mount a protective Th2-polarized adaptive immune response, which is needed to clear infection. SH2-containing inositol 5'-phosphatase 1 (SHIP-1) has been shown to be an important regulator of DC function in vitro through the negative regulation of the phosphoinositide 3-kinase (PI3K) pathway, but its role in vivo is relatively unexplored. In the current work, mice with a specific deletion of SHIP-1 in DCs (Ship1(ΔDC) ) were infected with the parasite T. muris. Ship1(ΔDC) mice were susceptible to infection due to ineffective priming of Th2-polarized responses. This is likely due to an increased production of interleukin (IL) 12p40 by SHIP-1-deficient DCs, as in vivo antibody blockade of IL-12p40 was able to facilitate the clearing of infection in Ship1(ΔDC) mice. Our results describe a critical role for SHIP-1 in regulating the ability of DCs to efficiently prime Th2-type responses.


Assuntos
Células Dendríticas/imunologia , Ativação Linfocitária/imunologia , Monoéster Fosfórico Hidrolases/imunologia , Células Th2/imunologia , Tricuríase/imunologia , Animais , Modelos Animais de Doenças , Citometria de Fluxo , Inositol Polifosfato 5-Fosfatases , Camundongos , Camundongos Mutantes , Fosfatidilinositol-3,4,5-Trifosfato 5-Fosfatases , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Trichuris/imunologia
12.
J Nerv Ment Dis ; 205(11): 867-872, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28991149

RESUMO

This study introduces a computerized clinical decision-support tool, the Fluid Outpatient Rehabilitation Treatment (FORT), that incorporates individual and ever-evolving patient needs to guide clinicians in developing and updating treatment decisions in real-time. In this proof-of-concept feasibility pilot, FORT was compared against traditional treatment planning using similar behavioral therapies in 52 adults with severe mental illness attending community-based day treatment. At posttreatment and follow-up, group differences and moderate-to-large effect sizes favoring FORT were detected in social function, work readiness, self-esteem, working memory, processing speed, and mental flexibility. Of participants who identified obtaining a General Education Diploma as their goal, 73% in FORT passed the examination compared with 18% in traditional treatment planning. FORT was also associated with higher agency cost-effectiveness and a better average benefit-cost ratio, even when considering diagnosis, baseline symptoms, and education. Although the comparison groups were not completely equivalent, the findings suggest computerized decision support systems that collaborate with human decision-makers to personalize psychiatric rehabilitation and address critical decisions may have a role in improving treatment effectiveness and efficiency.


Assuntos
Técnicas de Apoio para a Decisão , Transtornos Mentais/reabilitação , Adulto , Algoritmos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Projetos Piloto , Testes Psicológicos , Autoimagem , Resultado do Tratamento
13.
J Biol Chem ; 290(19): 12058-67, 2015 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-25802336

RESUMO

Pathological cardiac hypertrophy (an increase in cardiac mass resulting from stress-induced cardiac myocyte growth) is a major factor underlying heart failure. Src homology 2 domain-containing phosphatase (Shp2) is critical for cardiac function because mutations resulting in loss of Shp2 catalytic activity are associated with congenital cardiac defects and hypertrophy. We identified a novel mechanism of Shp2 inhibition that may promote cardiac hypertrophy. We demonstrate that Shp2 is a component of the protein kinase A anchoring protein (AKAP)-Lbc complex. AKAP-Lbc facilitates PKA phosphorylation of Shp2, which inhibits Shp2 phosphatase activity. We identified two key amino acids in Shp2 that are phosphorylated by PKA. Thr-73 contributes a helix cap to helix αB within the N-terminal SH2 domain of Shp2, whereas Ser-189 occupies an equivalent position within the C-terminal SH2 domain. Utilizing double mutant PKA phosphodeficient (T73A/S189A) and phosphomimetic (T73D/S189D) constructs, in vitro binding assays, and phosphatase activity assays, we demonstrate that phosphorylation of these residues disrupts Shp2 interaction with tyrosine-phosphorylated ligands and inhibits its protein-tyrosine phosphatase activity. Overall, our data indicate that AKAP-Lbc integrates PKA and Shp2 signaling in the heart and that AKAP-Lbc-associated Shp2 activity is reduced in hypertrophic hearts in response to chronic ß-adrenergic stimulation and PKA activation. Therefore, although induction of cardiac hypertrophy is a multifaceted process, inhibition of Shp2 activity through AKAP-Lbc-anchored PKA is a previously unrecognized mechanism that may promote this compensatory response.


Assuntos
Cardiomegalia/genética , Proteínas Quinases Dependentes de AMP Cíclico/metabolismo , Proteína Tirosina Fosfatase não Receptora Tipo 11/metabolismo , Animais , Células Cultivadas , Células HEK293 , Humanos , Ligantes , Mutação , Fosforilação , Ligação Proteica , Ratos , Receptores Adrenérgicos beta/metabolismo , Serina/química , Transdução de Sinais , Treonina/química , Tirosina/química , Domínios de Homologia de src
14.
Am J Gastroenterol ; 111(10): 1446-1454, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27481310

RESUMO

OBJECTIVES: Symptom-based criteria to diagnose irritable bowel syndrome (IBS) positively perform only modestly. Our aim was to assess whether including other items from the clinical history and limited diagnostic evaluation improves their performance. METHODS: We collected complete symptom, colonoscopy, and histology data from 318 consecutive, unselected adult patients with lower gastrointestinal (GI) symptoms in secondary care. All participants underwent colonoscopy, with relevant organic findings recorded. The reference standard used to define the presence of true IBS was patient-reported lower abdominal pain or discomfort associated with a change in bowel habit, in the absence of organic GI disease. Sensitivity, specificity, and positive and negative likelihood ratios (LRs), with 95% confidence intervals, were calculated for Rome III criteria, as well as for modifications, incorporating nocturnal stools, results of simple blood tests (hemoglobin and C-reactive protein (CRP)), measures of somatization, and/or affective disorders (hospital anxiety or depression scale (HADS) score). RESULTS: The sensitivity and specificity of the Rome III criteria for identifying IBS was 69.6%, and 82.0%, respectively, with positive and negative LRs of 3.87 and 0.37, respectively. Clinically useful enhancements in positive LRs were provided by combining Rome III criteria with: (a) high level of somatization (7.27); (b) normal hemoglobin and CRP with HADS score of ≥8 (5.04); (c) normal hemoglobin and CRP with a high level of somatization (7.56); or (d) no nocturnal passage of stool with a high level of somatization (17.3). Specificity was ≥95% with each of these modifications. CONCLUSIONS: Incorporating nocturnal stools, somatization, and affective disorders from the clinical history, and hemoglobin and CRP measurements, enhances the positive LR and specificity of symptom-based Rome III criteria for IBS.


Assuntos
Ansiedade/psicologia , Colonoscopia , Depressão/psicologia , Síndrome do Intestino Irritável/diagnóstico , Transtornos Somatoformes/psicologia , Dor Abdominal , Adulto , Idoso , Proteína C-Reativa/metabolismo , Ritmo Circadiano , Colo/patologia , Defecação , Feminino , Hemoglobinas/metabolismo , Humanos , Síndrome do Intestino Irritável/metabolismo , Síndrome do Intestino Irritável/patologia , Síndrome do Intestino Irritável/psicologia , Masculino , Anamnese , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Inquéritos e Questionários
15.
Scand J Gastroenterol ; 51(10): 1206-12, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27243102

RESUMO

OBJECTIVE: Many patients with diarrhoea undergo colonoscopy. If this is macroscopically normal, random biopsies are obtained to rule out microscopic colitis (MC), but most patients have functional disease. Accurate predictors of MC could avoid the need to take biopsies in a substantial proportion of patients, saving money for the health service. We validated a previously described diagnostic scoring system for MC, and incorporated further variables to assess whether this improved performance. MATERIAL AND METHODS: Consecutive adults with loose stools undergoing colonoscopy in Leeds, UK were included. Demographic and symptom data were collected prospectively. The diagnostic scoring system described previously was applied. In addition, the incorporation of further variables, including drugs associated with MC, number of stools, nocturnal passage of stools, and duration of loose stools, into the scoring system was assessed. Sensitivities, specificities, and positive and negative predictive values were calculated. RESULTS: Among 242 patients (mean age 51.0 years, 163 (67.4%) female), 26 (10.7%) of whom had MC, a cut off of ≥4 on the original scoring system had a sensitivity of 92.3% and specificity of 35.2%. Nocturnal passage of stools and duration of loose stools <6 months were significant predictors of MC. Incorporating these variables in a new scoring system with a cut off of ≥6 identified MC with 95.7% sensitivity and 46.0% specificity. CONCLUSIONS: Incorporating nocturnal passage of stools and duration of loose stools into the scoring system may improve ability to predict MC, and avoid random colonic biopsies in a greater proportion of patients with loose stools.


Assuntos
Colite Microscópica/diagnóstico , Colo/patologia , Colonoscopia/métodos , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Colite Microscópica/classificação , Colite Microscópica/patologia , Diarreia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Análise de Regressão , Sensibilidade e Especificidade , Reino Unido , Adulto Jovem
16.
J Allergy Clin Immunol ; 136(3): 725-736.e2, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25746967

RESUMO

BACKGROUND: Inpp5d (Src homology 2 domain-containing inositol-5-phosphatase [Ship1])-deficient mice experience spontaneous airway inflammation and have enhanced sensitivity to allergen-induced airway inflammation. OBJECTIVE: We hypothesized that lineage-specific deletion of Ship1 expression in cells known to be crucial for adaptive TH2 responses would uncover distinct roles that could either positively or negatively regulate susceptibility to allergic airway inflammation (AAI). METHODS: Ship1 expression was deleted in B cells, T cells, or dendritic cells (DCs), and the resulting Ship1(ΔB cell), Ship1(ΔT cell), Ship1(ΔDC), or Ship1(F/F) (wild-type) control mice were evaluated in a model of house dust mite (HDM)-induced AAI. RESULTS: Unlike germline panhematopoietic Ship1 deletion, deletion of Ship1 selectively in either the B-cell, T-cell, or DC lineages did not result in spontaneous airway inflammation. Strikingly, although loss of Ship1 in the B-cell lineage did not affect HDM-induced AAI, loss of Ship1 in either of the T-cell or DC lineages protected mice from AAI by skewing the typical TH2 immune response toward a TH1 response. CONCLUSIONS: Although panhematopoietic deletion of Ship1 leads to spontaneous lung inflammation, selective deletion of Ship1 in T cells or DCs impairs the formation of an adaptive TH2 response and protects animals from HDM-induced AAI.


Assuntos
Hiper-Reatividade Brônquica/imunologia , Linhagem da Célula/imunologia , Células Dendríticas/imunologia , Monoéster Fosfórico Hidrolases/imunologia , Pneumonia/imunologia , Linfócitos T/imunologia , Imunidade Adaptativa , Alérgenos/administração & dosagem , Alérgenos/imunologia , Animais , Antígenos de Dermatophagoides/administração & dosagem , Antígenos de Dermatophagoides/imunologia , Linfócitos B/imunologia , Linfócitos B/patologia , Hiper-Reatividade Brônquica/induzido quimicamente , Hiper-Reatividade Brônquica/genética , Hiper-Reatividade Brônquica/patologia , Linhagem da Célula/genética , Células Dendríticas/patologia , Expressão Gênica , Inositol Polifosfato 5-Fosfatases , Camundongos , Camundongos Knockout , Fosfatidilinositol-3,4,5-Trifosfato 5-Fosfatases , Monoéster Fosfórico Hidrolases/deficiência , Monoéster Fosfórico Hidrolases/genética , Pneumonia/induzido quimicamente , Pneumonia/genética , Pneumonia/patologia , Pyroglyphidae/química , Linfócitos T/patologia , Equilíbrio Th1-Th2
17.
J Allergy Clin Immunol ; 135(1): 100-9, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25145536

RESUMO

BACKGROUND: Resident gut microbiota are now recognized as potent modifiers of host immune responses in various scenarios. Recently, we demonstrated that perinatal exposure to vancomycin, but not streptomycin, profoundly alters gut microbiota and enhances susceptibility to a TH2 model of allergic asthma. OBJECTIVE: Here we sought to further clarify the etiology of these changes by determining whether perinatal antibiotic treatment has a similar effect on the TH1/TH17-mediated lung disease, hypersensitivity pneumonitis. METHODS: Hypersensitivity pneumonitis was induced in C57BL/6 wild-type or recombination-activating gene 1-deficient mice treated perinatally with vancomycin or streptomycin by repeated intranasal administration of Saccharopolyspora rectivirgula antigen. Disease severity was assessed by measuring lung inflammation, pathology, cytokine responses, and serum antibodies. Microbial community analyses were performed on stool samples via 16S ribosomal RNA pyrosequencing and correlations between disease severity and specific bacterial taxa were identified. RESULTS: Surprisingly, in contrast to our findings in an allergic asthma model, we found that the severity of hypersensitivity pneumonitis was unaffected by vancomycin, but increased dramatically after streptomycin treatment. This likely reflects an effect on the adaptive, rather than innate, immune response because the effects of streptomycin were not observed during the early phases of disease and were abrogated in recombination-activating gene 1-deficient mice. Interestingly, Bacteroidetes dominated the intestinal microbiota of streptomycin-treated animals, while vancomycin promoted the expansion of the Firmicutes. CONCLUSIONS: Perinatal antibiotics exert highly selective effects on resident gut flora, which, in turn, lead to very specific alterations in susceptibility to TH2- or TH1/TH17-driven lung inflammatory disease.


Assuntos
Alveolite Alérgica Extrínseca/imunologia , Alveolite Alérgica Extrínseca/microbiologia , Antibacterianos/efeitos adversos , Trato Gastrointestinal/microbiologia , Microbiota , Estreptomicina/efeitos adversos , Alveolite Alérgica Extrínseca/sangue , Alveolite Alérgica Extrínseca/patologia , Animais , Animais Recém-Nascidos , Citocinas/imunologia , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Pulmão/imunologia , Pulmão/patologia , Camundongos Endogâmicos C57BL , Saccharopolyspora , Índice de Gravidade de Doença , Vancomicina/farmacologia
18.
Am J Respir Cell Mol Biol ; 52(1): 96-105, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24988285

RESUMO

Exposure to particulate matter (PM), a major component of air pollution, contributes to increased morbidity and mortality worldwide. Inhaled PM induces innate immune responses by airway epithelial cells that may lead to the exacerbation or de novo development of airway disease. We have previously shown that 10-µm PM (PM10) activates the nucleotide-binding domain, leucine-rich repeat protein (NLRP) 3 inflammasome in human airway epithelial cells. Our objective was to determine the innate and adaptive immune responses mediated by the airway epithelium NLRP3 inflammasome in response to PM10 exposure. Using in vitro cultures of human airway epithelial cells and in vivo studies with wild-type and Nlrp3(-/-) mice, we investigated the downstream consequences of PM10-induced NLPR3 inflammasome activation on cytokine production, cellular inflammation, dendritic cell activation, and PM10-facilitated allergic sensitization. PM10 activates an NLRP3 inflammasome/IL-1 receptor I (IL-1RI) axis in airway epithelial cells, resulting in IL-1ß, CC chemokine ligand-20, and granulocyte/macrophage colony-stimulating factor production, which is associated with dendritic cell activation and lung neutrophilia. Despite these profound innate immune responses in the airway epithelium, the NLRP3 inflammasome/IL-1RI axis is dispensable for PM10-facilitated allergic sensitization. We demonstrate the importance of the lung NLRP3 inflammasome in mediating PM10 exposure-associated innate, but not adaptive, immune responses. Our study highlights a mechanism by which PM10 exposure can contribute to the exacerbation of airway disease, but not PM10-facilitated allergic sensitization.


Assuntos
Imunidade Adaptativa/efeitos dos fármacos , Proteínas de Transporte/imunologia , Imunidade Inata/efeitos dos fármacos , Material Particulado/efeitos adversos , Receptores Tipo I de Interleucina-1/imunologia , Mucosa Respiratória/imunologia , Transdução de Sinais/imunologia , Animais , Asma/induzido quimicamente , Asma/imunologia , Asma/patologia , Linhagem Celular Transformada , Citocinas/imunologia , Células Dendríticas/imunologia , Células Dendríticas/patologia , Humanos , Inflamassomos/imunologia , Camundongos , Camundongos Endogâmicos BALB C , Proteína 3 que Contém Domínio de Pirina da Família NLR , Material Particulado/farmacologia , Mucosa Respiratória/patologia
19.
Am J Physiol Lung Cell Mol Physiol ; 308(8): L816-26, 2015 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-25681437

RESUMO

Although CD103(+) cells recently emerged as key regulatory cells in the gut, the role of CD103 ubiquitous expression in the lung and development of allergic airway disease has never been studied. To answer this important question, we evaluated the response of Cd103(-/-) mice in two separate well-described mouse models of asthma (ovalbumin and house dust mite extract). Pulmonary inflammation was assessed by analysis of bronchoalveolar lavage content, histology, and cytokine response. CD103 expression was analyzed on lung dendritic cells and T cell subsets by flow cytometry. Cd103(-/-) mice exposed to antigens developed exacerbated lung inflammation, characterized by increased eosinophilic infiltration, severe tissue inflammation, and altered cytokine response. In wild-type mice exposed to house dust mite, CD103(+) dendritic cells are increased in the lung and an important subset of CD4(+) T cells, CD8(+) T cells, and T regulatory cells express CD103. Importantly, Cd103(-/-) mice presented a deficiency in the resolution phase of inflammation, which supports an important role for this molecule in the control of inflammation severity. These results suggest an important role for CD103 in the control of airway inflammation in asthma.


Assuntos
Antígenos CD/metabolismo , Asma/metabolismo , Cadeias alfa de Integrinas/metabolismo , Pulmão/metabolismo , Animais , Antígenos CD/genética , Asma/imunologia , Citocinas/biossíntese , Células Dendríticas/imunologia , Expressão Gênica , Inflamação/metabolismo , Cadeias alfa de Integrinas/genética , Pulmão/imunologia , Camundongos da Linhagem 129 , Camundongos Endogâmicos C57BL , Camundongos Knockout , Linfócitos T/imunologia
20.
J Cell Sci ; 126(Pt 20): 4537-43, 2013 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-24124191

RESUMO

The second messenger cyclic AMP (cAMP) operates in discrete subcellular regions within which proteins that synthesize, break down or respond to the second messenger are precisely organized. A burgeoning knowledge of compartmentalized cAMP signaling is revealing how the local control of signaling enzyme activity impacts upon disease. The aim of this Cell Science at a Glance article and the accompanying poster is to highlight how misregulation of local cyclic AMP signaling can have pathophysiological consequences. We first introduce the core molecular machinery for cAMP signaling, which includes the cAMP-dependent protein kinase (PKA), and then consider the role of A-kinase anchoring proteins (AKAPs) in coordinating different cAMP-responsive proteins. The latter sections illustrate the emerging role of local cAMP signaling in four disease areas: cataracts, cancer, diabetes and cardiovascular diseases.


Assuntos
AMP Cíclico/metabolismo , Animais , Doenças Cardiovasculares/metabolismo , Catarata/metabolismo , Diabetes Mellitus/metabolismo , Humanos , Neoplasias/metabolismo , Sistemas do Segundo Mensageiro
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