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1.
Immunity ; 56(1): 93-106.e6, 2023 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-36574773

RESUMO

Improved identification of anti-tumor T cells is needed to advance cancer immunotherapies. CD39 expression is a promising surrogate of tumor-reactive CD8+ T cells. Here, we comprehensively profiled CD39 expression in human lung cancer. CD39 expression enriched for CD8+ T cells with features of exhaustion, tumor reactivity, and clonal expansion. Flow cytometry of 440 lung cancer biospecimens revealed weak association between CD39+ CD8+ T cells and tumoral features, such as programmed death-ligand 1 (PD-L1), tumor mutation burden, and driver mutations. Immune checkpoint blockade (ICB), but not cytotoxic chemotherapy, increased intratumoral CD39+ CD8+ T cells. Higher baseline frequency of CD39+ CD8+ T cells conferred improved clinical outcomes from ICB therapy. Furthermore, a gene signature of CD39+ CD8+ T cells predicted benefit from ICB, but not chemotherapy, in a phase III clinical trial of non-small cell lung cancer. These findings highlight CD39 as a proxy of tumor-reactive CD8+ T cells in human lung cancer.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Humanos , Neoplasias Pulmonares/genética , Carcinoma Pulmonar de Células não Pequenas/genética , Inibidores de Checkpoint Imunológico/uso terapêutico , Linfócitos T CD8-Positivos , Imunoterapia
2.
PLoS Biol ; 21(5): e3002139, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-37252926

RESUMO

Intermittent hypoxia (IH) is a major clinical feature of obstructive sleep apnea (OSA). The mechanisms that become dysregulated after periods of exposure to IH are unclear, particularly in the early stages of disease. The circadian clock governs a wide array of biological functions and is intimately associated with stabilization of hypoxia-inducible factors (HIFs) under hypoxic conditions. In patients, IH occurs during the sleep phase of the 24-hour sleep-wake cycle, potentially affecting their circadian rhythms. Alterations in the circadian clock have the potential to accelerate pathological processes, including other comorbid conditions that can be associated with chronic, untreated OSA. We hypothesized that changes in the circadian clock would manifest differently in those organs and systems known to be impacted by OSA. Using an IH model to represent OSA, we evaluated circadian rhythmicity and mean 24-hour expression of the transcriptome in 6 different mouse tissues, including the liver, lung, kidney, muscle, heart, and cerebellum, after a 7-day exposure to IH. We found that transcriptomic changes within cardiopulmonary tissues were more affected by IH than other tissues. Also, IH exposure resulted in an overall increase in core body temperature. Our findings demonstrate a relationship between early exposure to IH and changes in specific physiological outcomes. This study provides insight into the early pathophysiological mechanisms associated with IH.


Assuntos
Apneia Obstrutiva do Sono , Transcriptoma , Animais , Camundongos , Transcriptoma/genética , Apneia Obstrutiva do Sono/genética , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/patologia , Ritmo Circadiano/genética , Modelos Animais de Doenças , Hipóxia/metabolismo
4.
Nature ; 571(7766): 576-579, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31292550

RESUMO

Mutations in BRCA1 and BRCA2 predispose individuals to certain cancers1-3, and disease-specific screening and preventative strategies have reduced cancer mortality in affected patients4,5. These classical tumour-suppressor genes have tumorigenic effects associated with somatic biallelic inactivation, although haploinsufficiency may also promote the formation and progression of tumours6,7. Moreover, BRCA1/2-mutant tumours are often deficient in the repair of double-stranded DNA breaks by homologous recombination8-13, and consequently exhibit increased therapeutic sensitivity to platinum-containing therapy and inhibitors of poly-(ADP-ribose)-polymerase (PARP)14,15. However, the phenotypic and therapeutic relevance of mutations in BRCA1 or BRCA2 remains poorly defined in most cancer types. Here we show that in the 2.7% and 1.8% of patients with advanced-stage cancer and germline pathogenic or somatic loss-of-function alterations in BRCA1/2, respectively, selective pressure for biallelic inactivation, zygosity-dependent phenotype penetrance, and sensitivity to PARP inhibition were observed only in tumour types associated with increased heritable cancer risk in BRCA1/2 carriers (BRCA-associated cancer types). Conversely, among patients with non-BRCA-associated cancer types, most carriers of these BRCA1/2 mutation types had evidence for tumour pathogenesis that was independent of mutant BRCA1/2. Overall, mutant BRCA is an indispensable founding event for some tumours, but in a considerable proportion of other cancers, it appears to be biologically neutral-a difference predominantly conditioned by tumour lineage-with implications for disease pathogenesis, screening, design of clinical trials and therapeutic decision-making.


Assuntos
Linhagem da Célula , Genes BRCA1 , Genes BRCA2 , Mutação , Neoplasias/genética , Neoplasias/patologia , Fenótipo , Alelos , Estudos de Coortes , Heterozigoto , Humanos , Neoplasias/tratamento farmacológico , Inibidores de Poli(ADP-Ribose) Polimerases/farmacologia , Inibidores de Poli(ADP-Ribose) Polimerases/uso terapêutico , Zigoto
5.
Pediatr Nephrol ; 39(7): 2061-2077, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38150027

RESUMO

Free Open-Access Medical Education (FOAMed) has transformed medical education in the past decade by complementing and substituting for traditional medical education when needed. The attractiveness of FOAMed resources is due to their inexpensive nature, wide availability, and user ability to access on demand across a variety of devices, making it easy to create, share, and participate. The subject of nephrology is complex, fascinating, and challenging. Traditional didactic lectures can be passive and ineffective in uncovering these difficult concepts and may need frequent revisions. Active teaching methods like flipped classrooms have shown some benefits, and these benefits can only be multifold with current social media tools. Social media will inspire the involvement of students and allow them to create and share educational content in a "trendy way," encouraging the participation of their peers and thus building an educational environment more conducive to them while promoting revision and retainment. FOAMed also promotes asynchronous learning, spaced learning, microlearning, and multimodal presentation with a meaningful variation. This article discusses the evolution of digital education, social media platforms, tools for creating and developing FOAMed resources, and digital scholarship.


Assuntos
Nefrologia , Pediatria , Mídias Sociais , Mídias Sociais/tendências , Nefrologia/educação , Nefrologia/tendências , Humanos , Pediatria/educação , Educação Médica/métodos , Educação Médica/tendências , Educação a Distância/métodos , Educação a Distância/tendências , Currículo
6.
AIDS Res Ther ; 21(1): 27, 2024 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-38698440

RESUMO

BACKGROUND: Human genetic contribution to HIV progression remains inadequately explained. The type 1 interferon (IFN) pathway is important for host control of HIV and variation in type 1 IFN genes may contribute to disease progression. This study assessed the impact of variations at the gene and pathway level of type 1 IFN on HIV-1 viral load (VL). METHODS: Two cohorts of antiretroviral (ART) naïve participants living with HIV (PLWH) with either early (START) or advanced infection (FIRST) were analysed separately. Type 1 IFN genes (n = 17) and receptor subunits (IFNAR1, IFNAR2) were examined for both cumulated type 1 IFN pathway analysis and individual gene analysis. SKAT-O was applied to detect associations between the genotype and HIV-1 study entry viral load (log10 transformed) as a proxy for set point VL; P-values were corrected using Bonferroni (P < 0.0025). RESULTS: The analyses among those with early infection included 2429 individuals from five continents. The median study entry HIV VL was 14,623 (IQR 3460-45100) copies/mL. Across 673 SNPs within 19 type 1 IFN genes, no significant association with study entry VL was detected. Conversely, examining individual genes in START showed a borderline significant association between IFNW1, and study entry VL (P = 0.0025). This significance remained after separate adjustments for age, CD4+ T-cell count, CD4+/CD8+ T-cell ratio and recent infection. When controlling for population structure using linear mixed effects models (LME), in addition to principal components used in the main model, this was no longer significant (p = 0.0244). In subgroup analyses stratified by geographical region, the association between IFNW1 and study entry VL was only observed among African participants, although, the association was not significant when controlling for population structure using LME. Of the 17 SNPs within the IFNW1 region, only rs79876898 (A > G) was associated with study entry VL (p = 0.0020, beta = 0.32; G associated with higher study entry VL than A) in single SNP association analyses. The findings were not reproduced in FIRST participants. CONCLUSION: Across 19 type 1 IFN genes, only IFNW1 was associated with HIV-1 study entry VL in a cohort of ART-naïve individuals in early stages of their infection, however, this was no longer significant in sensitivity analyses that controlled for population structures using LME.


Assuntos
Infecções por HIV , HIV-1 , Interferon Tipo I , Polimorfismo de Nucleotídeo Único , Carga Viral , Humanos , Infecções por HIV/virologia , Infecções por HIV/genética , Infecções por HIV/imunologia , HIV-1/genética , Interferon Tipo I/genética , Masculino , Feminino , Adulto , Genótipo , Pessoa de Meia-Idade , Receptor de Interferon alfa e beta/genética , Estudos de Coortes , Progressão da Doença , Contagem de Linfócito CD4
7.
Am J Perinatol ; 2024 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-39038792

RESUMO

OBJECTIVE: This study aimed to compare the clinical endotracheal tube (ETT) depth after initial stabilization of infants with congenital diaphragmatic hernia (CDH) to weight and gestational age-based depth estimates. STUDY DESIGN: This retrospective analysis included 58 inborn infants with left-sided CDH. We compared a standard anatomic ETT depth calculated from initial chest radiographs and the clinical depth of the ETT after adjustments to predicted depths using weight and gestational age-based estimates. RESULTS: The standard anatomic depth was deeper than age (standard deviation 1.29 ± 1.15 cm, p < 0.001) and weight-based (standard deviation 0.59 ± 0.95 cm, p < 0.001) estimates. The clinical ETT depth was also deeper than age (standard deviation 1.01 ± 0.77 cm, p < 0.001) and weight-based (standard deviation 0.26 ± 0.50 cm, p < 0.001) estimates. CONCLUSION: Established strategies to predict ETT depth underestimate the ideal depth in infants with left-sided CDH. These data suggest utilizing caution during initial ETT placement based on standard depth estimates for patients with CDH. KEY POINTS: · CDH patients present unique stabilization challenges.. · Standard ETT depth estimates are too shallow.. · Resuscitation teams should cautiously choose ETT depth..

8.
J Clin Monit Comput ; 38(2): 399-405, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37535219

RESUMO

PURPOSE: Infection in the neurocritical care unit ( NCCU) can cause significant mortality and morbidity. Autonomic nervous system plays an important role in defense against infection. Autonomic dysfunction causing inflammatory dysregulation can potentiate infection. We aimed to study the relationship between autonomic dysfunction and occurrence of infection in neurologically ill patients. METHODS: Fifty one patients who were on mechanical ventilation were prospectively enrolled in this study. Autonomic dysfunction was measured for three consecutive days on admission to NCCU using Ansiscope. Patients were followed up for seven days to see the occurrence of infection. Infection was defined as per centre of disease control definition. RESULTS: A total of 386 patients were screened for eligibility. 68 patients satisfied the eligibility criteria and 51 patients were finally included in the study. The incidence of infection was 74.5%. The commonest infection was pulmonary infection (38.8%) followed by urinary tract infection (33.3%), blood stream infection(14.8%), central nervous system infection (11.1%) and wound site infection (3.7%). The degree of autonomic dysfunction (AD) percentage was more in infection group (37.7% (25.2-49.7)) compared to non infection group (23.5% (18-33.5)) and maximal on day 3 (P = 0.02). Patients with increasing trend of AD% from day 1 to day 3 had the highest infection rates. The length of NCCU stay (20(10-23) days and mortality (42.1%) was higher in infection group (p < 0.001). CONCLUSION: AD assessment can be used as a tool to predict development of infection in NCCU. This can help triage and institute early investigation and treatment.


Assuntos
Sistema Nervoso Autônomo , Respiração Artificial , Humanos , Estudos Prospectivos , Unidades de Terapia Intensiva
9.
Mol Hum Reprod ; 29(11)2023 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-37950499

RESUMO

Follicular fluid (FF) is a primary microenvironment of the oocyte within an antral follicle. Although several studies have defined the composition of human FF in normal physiology and determined how it is altered in disease states, the direct impacts of human FF on the oocyte are not well understood. The difficulty of obtaining suitable numbers of human oocytes for research makes addressing such a question challenging. Therefore, we used a heterologous model in which we cultured mouse oocytes in human FF. To determine whether FF has dose-dependent effects on gamete quality, we performed in vitro maturation of denuded oocytes from reproductively young mice (6-12 weeks) in 10%, 50%, or 100% FF from participants of mid-reproductive age (32-36 years). FF impacted meiotic competence in a dose-dependent manner, with concentrations >10% inhibiting meiotic progression and resulting in spindle and chromosome alignment defects. We previously demonstrated that human FF acquires a fibro-inflammatory cytokine signature with age. Thus, to determine whether exposure to an aging FF microenvironment contributes to the age-dependent decrease in gamete quality, we matured denuded oocytes and cumulus-oocyte complexes (COCs) in FF from reproductively young (28-30 years) and old (40-42 years) participants. FF decreased meiotic progression of COCs, but not oocytes, from reproductively young and old (9-12 months) mice in an age-dependent manner. Moreover, FF had modest age-dependent impacts on mitochondrial aggregation in denuded oocytes and cumulus layer expansion dynamics in COCs, which may influence fertilization or early embryo development. Overall, these findings demonstrate that acute human FF exposure can impact select markers of mouse oocyte quality in both dose- and age-dependent manners.


Assuntos
Líquido Folicular , Oócitos , Feminino , Humanos , Camundongos , Animais , Adulto , Oócitos/fisiologia , Folículo Ovariano , Desenvolvimento Embrionário , Meiose/genética
10.
Pediatr Dev Pathol ; 26(4): 406-410, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37278357

RESUMO

Inherited syndromes of congenital enteropathy are rare, with many genetic causes described. Mutations of the AP1S1 gene results in the syndrome of intellectual disability, enteropathy, deafness, peripheral neuropathy, ichthyosis, and keratoderma (IDEDNIK, formerly in the medical literature as MEDNIK). The clinicopathologic features of the enteropathy in IDEDNIK syndrome have not been fully explored. We describe a female infant who presented with metabolic acidosis, lethargy, and 14 watery stools per day. In the intensive care unit she required parenteral nutrition. She was found to have a novel homozygous pathogenic variant in the AP1S1 gene c.186T>G (p.Y62*). Esophagogastroduodenoscopy and colonoscopy at 6 months of age were grossly normal. However, histologic sections of the duodenum showed mild villous blunting and enterocytes with cytoplasmic vacuoles. CD10 immunostaining highlighted the disrupted brush border. MOC31 immunostaining was wild-type with a membranous pattern of expression. Electron microscopy of the duodenum showed scattered enterocytes cells with shortened and disrupted apical microvilli. Although there is a mixed gap diarrhea and disrupted brush border, there are no significant inclusions typical of microvillus inclusion disease, nor tufted enterocytes typical of tufting enteropathy, making the clinical and histopathologic features for this syndrome unique.


Assuntos
Subunidades sigma do Complexo de Proteínas Adaptadoras , Síndromes de Malabsorção , Feminino , Humanos , Lactente , Complexo 1 de Proteínas Adaptadoras/genética , Subunidades sigma do Complexo de Proteínas Adaptadoras/genética , Diarreia/genética , Duodeno , Síndromes de Malabsorção/diagnóstico , Síndromes de Malabsorção/genética , Síndromes de Malabsorção/metabolismo , Mutação , Síndrome
11.
J Clin Monit Comput ; 37(3): 765-773, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36350435

RESUMO

Brain relaxation is an important requirement in intracranial neurosurgical procedures and optimal brain relaxation improves the operating conditions. Optic nerve sheath diameter (ONSD) is a non-invasive bedside surrogate marker of intracranial pressure (ICP) status. Elevated ICP is often associated with marked autonomic dysfunction. There is no standard measure to predict intraoperative brain condition non-invasively, considering both anatomical displacement and physiological effects due to raised ICP and brain oedema. This study was aimed to determine the usefulness of heart rate variability (HRV) parameters and ONSD preoperatively in predicting intraoperative brain relaxation in patients with supratentorial tumors undergoing surgery.This prospective observational study was conducted in a tertiary care centre. 58 patients with supratentorial brain tumors undergoing elective surgery were studied. Preoperative clinical presentation, computed tomography (CT) findings, ONSD and HRV parameters were assessed in determining intraoperative brain condition. Intraoperative hemodynamic parameters and brain relaxation score after craniotomy were studied. There was significant difference in CT grade, ONSD and HRV parameters in patients between lax and tight brain. A receiver operating curve was constructed to determine the cut off to predict intraoperative brain bulge. A CT grade more than 2, ONSD of greater than 0.63 cms and ratio of low frequency to high ratio (LF/HF) of more than 1.8 were good predictors of brain bulge. The changes in ONSD and HRV parameters, with the CT findings can be used as surrogate markers of increased ICP to help predict intraoperative brain condition.


Assuntos
Hipertensão Intracraniana , Neoplasias Supratentoriais , Humanos , Frequência Cardíaca , Nervo Óptico/patologia , Estudos Prospectivos , Encéfalo , Pressão Intracraniana/fisiologia , Neoplasias Supratentoriais/cirurgia , Neoplasias Supratentoriais/patologia , Ultrassonografia
12.
Alzheimers Dement ; 19(6): 2528-2537, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36524682

RESUMO

INTRODUCTION: Inositol polyphosphate-5-phosphatase (INPP5D) is a microglia-enriched lipid phosphatase in the central nervous system. A non-coding variant (rs35349669) in INPP5D increases the risk for Alzheimer's disease (AD), and elevated INPP5D expression is associated with increased plaque deposition. INPP5D negatively regulates signaling via several microglial cell surface receptors, including triggering receptor expressed on myeloid cells 2 (TREM2); however, the impact of INPP5D inhibition on AD pathology remains unclear. METHODS: We used the 5xFAD mouse model of amyloidosis to assess how Inpp5d haplodeficiency regulates amyloid pathogenesis. RESULTS: Inpp5d haplodeficiency perturbs the microglial intracellular signaling pathways regulating the immune response, including phagocytosis and clearing of amyloid beta (Aß). It is important to note that Inpp5d haploinsufficiency leads to the preservation of cognitive function. Spatial transcriptomic analysis revealed that pathways altered by Inpp5d haploinsufficiency are related to synaptic regulation and immune cell activation. CONCLUSION: These data demonstrate that Inpp5d haplodeficiency enhances microglial functions by increasing plaque clearance and preserves cognitive abilities in 5xFAD mice. Inhibition of INPP5D is a potential therapeutic strategy for AD.


Assuntos
Doença de Alzheimer , Camundongos , Animais , Doença de Alzheimer/patologia , Peptídeos beta-Amiloides/metabolismo , Amiloide/metabolismo , Microglia/metabolismo , Placa Amiloide/patologia , Monoéster Fosfórico Hidrolases/genética , Monoéster Fosfórico Hidrolases/metabolismo , Modelos Animais de Doenças , Camundongos Transgênicos
13.
Annu Rev Pharmacol Toxicol ; 59: 237-261, 2019 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-30208281

RESUMO

Neurodegenerative diseases are characterized by a progressive loss of neurons that leads to a broad range of disabilities, including severe cognitive decline and motor impairment, for which there are no effective therapies. Several lines of evidence support a putative therapeutic role of nuclear receptors (NRs) in these types of disorders. NRs are ligand-activated transcription factors that regulate the expression of a wide range of genes linked to metabolism and inflammation. Although the activation of NRs in animal models of neurodegenerative disease exhibits promising results, the translation of this strategy to clinical practice has been unsuccessful. In this review we discuss the role of NRs in neurodegenerative diseases in light of preclinical and clinical studies, as well as new findings derived from the analysis of transcriptomic databases from humans and animal models. We discuss the failure in the translation of NR-based therapeutic approaches and consider alternative and novel research avenues in the development of effective therapies for neurodegenerative diseases.


Assuntos
Doenças Neurodegenerativas/tratamento farmacológico , Doenças Neurodegenerativas/metabolismo , Receptores Citoplasmáticos e Nucleares/metabolismo , Animais , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Humanos , Neurônios/efeitos dos fármacos , Neurônios/metabolismo , Transcriptoma/efeitos dos fármacos
14.
J Pediatr Gastroenterol Nutr ; 72(6): 807-814, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33605666

RESUMO

OBJECTIVE: Increased mortality risk because of severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) infection in adults with native liver disease (LD) and liver transplant (LT) is associated with advanced age and comorbid conditions. We aim to report outcomes for children with LD and LT enrolled in the NASPGHAN/SPLIT SARS-CoV2 registry. METHODS: In this multicenter observational cohort study, we collected data from 91 patients <21 years (LD 44, LT 47) with laboratory-confirmed SARS-CoV2 infection between April 21 and September 17, 2020. RESULTS: Patients with LD were more likely to require admission (70% vs 43% LT, P = 0.007) and pediatric intensive care unit (PICU) management (32% vs 4% LT, P = 0.001). Seven LD patients required mechanical ventilation (MV) and 2 patients died; no patients in the LT cohort died or required MV. Four LD patients presented in pediatric acute liver failure (PALF), 2 with concurrent multisystem inflammatory syndrome in children (MIS-C); all recovered without LT. Two LD patients had MIS-C alone and 1 patient died. Bivariable logistic-regression analysis found that patients with nonalcoholic fatty LD (NAFLD) (odds ratio [OR] 5.6, P = 0.02) and LD (OR 6.1, P = 0.01, vs LT) had higher odds of severe disease (PICU, vasopressor support, MV, renal replacement therapy or death). CONCLUSIONS: Although not directly comparable, LT recipients had lower odds of severe SARS-CoV2 infection (vs LD), despite immunosuppression burden. NAFLD patients reported to the registry had higher odds of severe SARS-CoV2 disease. Future controlled studies are needed to evaluate effective treatments and further stratify LD and LT patients with SARS-CoV2 infection.


Assuntos
COVID-19 , Hepatopatias , Transplante de Fígado , Adulto , Criança , Humanos , RNA Viral , Sistema de Registros , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica
15.
Dig Dis Sci ; 66(12): 4414-4422, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33433815

RESUMO

BACKGROUND: Glucose galactose malabsorption (GGM) is a congenital diarrheal disorder of intestinal Na+/glucose cotransport (SGLT1/SLC5A1). The required glucose and galactose-restricted diet has been well described in infancy, but long-term nutrition follow-up is limited. AIM: To perform a comprehensive nutritional assessment on a cohort of patients with GGM to gain insights into the consumption patterns within the population. METHODS: A cross-sectional study examining dietary intake of a GGM cohort using prospective food records. The calories and nutrients of all foods, beverages, and condiments were analyzed with descriptive statistics and compared to intake patterns of age- and sex-matched NHANES groups. RESULTS: The six patients were 0.7-26 years old. Whole foods and vegetable fats were major parts of the diet, while dairy and added sweeteners were restricted. Compared to typical US intakes, mean macronutrient distribution was 88th percentile from fat, 18th percentile from carbohydrates, and 78th percentile from protein. Fructose consumption, as a proportion of total sugar intake, decreased with age, from 86.1 to 50.4%. Meanwhile, glucose consumption increased with age, from 13.8 to 48.6% of sugar intake. However, the actual amount of glucose consumed remained low, equivalent to 4th percentile of US consumption level. Galactose intake was marginal throughout life. CONCLUSIONS: A GGM diet is a high-fat and high-protein/low-carbohydrate diet that is rich in fruits and vegetables but limited in dairy and added sugar. Relatively less fructose but more glucose is incorporated into the diet with age. Future studies should investigate the effects of the GGM diet on gut microbiome and long-term health.


Assuntos
Erros Inatos do Metabolismo dos Carboidratos/psicologia , Dieta/estatística & dados numéricos , Síndromes de Malabsorção/psicologia , Adulto , Erros Inatos do Metabolismo dos Carboidratos/genética , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Lactente , Síndromes de Malabsorção/genética , Masculino , Transportador 1 de Glucose-Sódio/genética
16.
Lancet Oncol ; 21(6): 821-831, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32437664

RESUMO

BACKGROUND: Addition of trastuzumab to first-line chemotherapy improves overall survival in patients with HER2-positive metastatic gastric cancer. We assessed the safety and activity of pembrolizumab in combination with trastuzumab and chemotherapy in first-line HER2-positive metastatic oesophagogastric (gastric, oesophageal, or gastroesophageal junction) cancer. METHODS: This study was an investigator-initiated, open-label, non-randomised, single-arm, single centre, phase 2 trial in patients aged 18 years or older with HER2-positive metastatic oesophagogastric cancer. Eligible patients had measurable or evaluable non-measurable disease, Eastern Cooperative Oncology Group performance status of 0, 1, or 2, and left ventricular ejection fraction of at least 53%. Patients were eligible to receive an initial induction cycle of 200 mg flat dose of intravenous pembrolizumab and 8 mg/kg loading dose of intravenous trastuzumab. For subsequent cycles, patients received 130 mg/m2 of intravenous oxaliplatin or 80 mg/m2 of cisplatin on day 1, 850 mg/m2 of oral capecitabine twice a day for 2 weeks followed by 1 week off (or intravenous 5-fluorouracil, 800 mg/m2 per day on days 1-5), and a 200 mg flat dose of intravenous pembrolizumab, and 6 mg/kg of trastuzumab, administered on day 1 of each 3-week cycle. The primary endpoint was 6-month progression-free survival, defined as the proportion of patients alive and free of progression at 6 months, assessed in patients who received at least one dose of trastuzumab and pembrolizumab. The regimen would be considered worthy of further investigation if 26 or more of 37 patients were progression-free at 6 months. This trial is registered with ClinicalTrials.gov, NCT02954536, and is ongoing, but closed to enrolment. FINDINGS: Between Nov 11, 2016, and Jan 23, 2019, 37 patients were enrolled. At the time of data cutoff on Aug 6, 2019, median follow-up among survivors was 13·0 months (IQR 11·7-23·5). The primary endpoint was achieved; 26 (70%; 95% CI 54-83) of 37 patients were progression-free at 6 months. The most common treatment-related adverse event of any grade was neuropathy, which was reported in 36 (97%) of 37 patients. The most common grade 3 or 4 adverse events were lymphocytopenia (seven [19%] patients with grade 3 and two [5%] with grade 4), grade 3 decreased electrolytes (six [16%] patients), and grade 3 anaemia (four [11%] patients). Serious adverse events occurred in two patients patients (both grade 3 nephritis leading to treatment discontinuation). Four patients discontinued pembrolizumab because of immune-related adverse events. There were no treatment-related deaths. INTERPRETATION: Pembrolizumab can be safely combined with trastuzumab and chemotherapy and has promising activity in HER2-positive metastatic oesophagogastric cancer. A randomised phase 3 clinical trial assessing the efficacy and safety of pembrolizumab versus placebo in combination with trastuzumab and chemotherapy in first-line HER2-positive metastatic oesophagogastric cancer is underway. FUNDING: Merck & Co.


Assuntos
Adenocarcinoma/tratamento farmacológico , Anticorpos Monoclonais Humanizados/administração & dosagem , Antineoplásicos Imunológicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Esofágicas/tratamento farmacológico , Junção Esofagogástrica/efeitos dos fármacos , Receptor ErbB-2/antagonistas & inibidores , Neoplasias Gástricas/tratamento farmacológico , Trastuzumab/administração & dosagem , Adenocarcinoma/imunologia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Progressão da Doença , Neoplasias Esofágicas/imunologia , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Junção Esofagogástrica/imunologia , Junção Esofagogástrica/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Receptor de Morte Celular Programada 1/imunologia , Intervalo Livre de Progressão , Receptor ErbB-2/imunologia , Transdução de Sinais , Neoplasias Gástricas/imunologia , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Fatores de Tempo , Trastuzumab/efeitos adversos , Adulto Jovem
17.
Nanotechnology ; 31(29): 295102, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32213681

RESUMO

We report the fabrication of silver nanoparticles (AgNPs) surface functionalized with gelatin at different concentrations (G10/G20/G40 AgNPs) with an average particle size of ∼200 nm, bioconjugated with antisera antibodies (AsAbs) of the major and clinically significant blood groups (CSBGs) at different titres from neat to 1:128. Bioconjugation using ionic interaction at pH 7.4 enabled 'end-on' configuration, with the -NH2 group of the antibody free for interaction with the red blood cell antigen, as confirmed by Fourier transform infrared spectroscopy. The tube agglutination test (TAT) revealed optimum agglutination with G20NPs, while SDS PAGE confirmed the optimal titre as 1:8 for the major blood groups A, B, AB and O. Bioconjugated AgNPs coated onto microtitre assay plates with the major blood groups and CSBGs to enable simultaneous identification, were validated against the TAT on 400 random blood samples for the major blood groups and revealed high accuracy (95%). While similar accuracy was seen for most of the CSBGs with only false negatives, the method was not found to be suitable for the Kell, Kidd and Duffy groups. The absence of false positives reflects high safety, and eliminates the risk of a mismatched blood transfusion. The method uses diluted blood and hence could enable point-of-care detection. The significantly lower AsAb requirement also provides a cost advantage.


Assuntos
Anticorpos/imunologia , Antígenos de Grupos Sanguíneos/análise , Gelatina/química , Prata/química , Testes de Aglutinação , Anticorpos/química , Química Verde , Humanos , Imunoconjugados/química , Imunoconjugados/imunologia , Nanopartículas Metálicas , Tamanho da Partícula , Sensibilidade e Especificidade , Espectroscopia de Infravermelho com Transformada de Fourier
18.
Physiol Mol Biol Plants ; 26(9): 1867-1874, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32943822

RESUMO

The Indian lac insect (Kerria lacca), a hemipteran, phloem sap sucking sedentary insect is an important bioresource which thrives on tender twigs of more than 400 plant species belonging to various genera and families. The most common commercial host plants for lac cultivation are big trees hence cultivation was concentrated mainly to dense forests across the country till last decade. Recently, a new bushy host plant belonging to the genus Flemingia has been introduced so that lac can be cultivated on farmlands like other cash crops. The insect is sedentary and feeds on the phloem sap of the host plants, the only source of its nutrition. Interestingly, the biological attributes of the insect as well as the qualitative and quantitative production of lac is influenced by the host plant on which the insect feeds upon. The present study was thus aimed at deciphering the effect of phloem sap constituents obtained from four plant host taxa belonging to the same genus Flemingia viz. F. semialata, F. macrophylla, F. bracteata and F. chapar (essential amino acids only-EAAs) on lac productivity. Moreover, a newer method for phloem sap collection i.e. Dot-blot in addition to the facilitated exudation using EDTA was also investigated. Dot-blot method for phloem sap collection also came out to be a promising method for field studies; although slightly higher concentration of EAAs were obtained from EDTA method, thus the later was used for further analysis. Phloem sap of four plant host taxa belonging to the same genus Flemingia were qualitatively and quantitatively analysed for seven EAAs (Arginine, Glycine, Leucine, Methionine, Phenylalanine Tyrosine and Valine). Amino acid concentration regime and further analysis done using statistical tools (ANOVA and PCA) points out the EAA concentration in the phloem sap is in congruency with the lac production data obtained through previous studies as F. semialata > F. macrophylla > F. chapar > F. bracteata. The present study thus scientifically points out that F. semialata can be a promising plant for lac cultivation on the basis of higher EAA content as compared to the rest three.

19.
Reprod Biol Endocrinol ; 17(1): 46, 2019 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-31189477

RESUMO

BACKGROUND: Reproductive aging is a robust phenotype that occurs in all females and is characterized by a significant reduction in gamete quantity and quality, which can have negative consequences on both endocrine function and fertility. Age-associated differences in the oocyte, follicle, and ovary have been well-documented, but how the broader environment changes with age is less well understood. Fat is one of the largest organs in the body, and peri-gonadal adipose tissue surrounds the rodent ovary and comprises a local ovarian environment. The goal of this study was to characterize how peri-ovarian adipose tissue changes with advanced reproductive age. METHODS: We isolated peri-gonadal adipose tissue from two cohorts of CB6F1 mice: reproductively young (6-12 weeks) and reproductively old (14-17 months). A comparative histological analysis was performed to evaluate adipocyte architecture. We then extracted lipids from the tissue and performed multiple reaction monitoring (MRM)-profiling, a mass spectrometry-based method of metabolite profiling, to compare the lipid profiles of peri-gonadal adipose tissue in these age cohorts. RESULTS: We found that advanced reproductive age was associated with adipocyte hypertrophy and a corresponding decrease in the number of adipocytes per area. Of the 10 lipid classes examined, triacylglycerols (TAGs) had significantly different profiles between young and old cohorts, despite quantitative analysis revealing a decrease in the total amount of TAGs per weight of peri-gonadal adipose tissue with age. CONCLUSIONS: These findings pinpoint age-associated physiological changes in peri-gonadal adipose tissue with respect to adipocyte morphology and lipid profiles and lay the foundation for future studies to examine how these alterations may influence both adipocyte and ovarian function.


Assuntos
Tecido Adiposo/metabolismo , Envelhecimento/fisiologia , Lipídeos/análise , Ovário/metabolismo , Reprodução/fisiologia , Adipócitos/citologia , Adipócitos/metabolismo , Tecido Adiposo/citologia , Fatores Etários , Animais , Feminino , Camundongos , Oócitos/citologia , Oócitos/metabolismo , Folículo Ovariano/citologia , Folículo Ovariano/metabolismo , Ovário/citologia
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