Σφακιανάκης Αλέξανδρος
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5 Άγιος Νικόλαος
Κρήτη 72100
00302841026182
00306932607174
alsfakia@gmail.com

Αρχειοθήκη ιστολογίου

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Παρασκευή 15 Δεκεμβρίου 2017

Human c-SRC kinase (CSK) overexpression makes T cells dummy

Abstract

Adoptive cell therapy with T-cell receptor (TCR)-engineered T cells represents a powerful method to redirect the immune system against tumours. However, although TCR recognition is restricted to a specific peptide–MHC (pMHC) complex, increasing numbers of reports have shown cross-reactivity and off-target effects with severe consequences for the patients. This demands further development of strategies to validate TCR safety prior to clinical use. We reasoned that the desired TCR signalling depends on correct pMHC recognition on the outside and a restricted clustering on the inside of the cell. Since the majority of the adverse events are due to TCR recognition of the wrong target, we tested if blocking the signalling would affect the binding. By over-expressing the c-SRC kinase (CSK), a negative regulator of LCK, in redirected T cells, we showed that peripheral blood T cells inhibited anti-CD3/anti-CD28-induced phosphorylation of ERK, whereas TCR proximal signalling was not affected. Similarly, overexpression of CSK together with a therapeutic TCR prevented pMHC-induced ERK phosphorylation. Downstream effector functions were also almost completely blocked, including pMHC-induced IL-2 release, degranulation and, most importantly, target cell killing. The lack of effector functions contrasted with the unaffected TCR expression, pMHC recognition, and membrane exchange activity (trogocytosis). Therefore, co-expression of CSK with a therapeutic TCR did not compromise target recognition and binding, but rendered T cells incapable of executing their effector functions. Consequently, we named these redirected T cells "dummy T cells" and propose to use them for safety validation of new TCRs prior to therapy.



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E-cadherin: Its dysregulation in carcinogenesis and clinical implications

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Publication date: January 2018
Source:Critical Reviews in Oncology/Hematology, Volume 121
Author(s): Sonia How Ming Wong, Chee Mun Fang, Lay-Hong Chuah, Chee Onn Leong, Siew Ching Ngai
E-cadherin is a transmembrane glycoprotein which connects epithelial cells together at adherens junctions. In normal cells, E-cadherin exerts its tumour suppressing role mainly by sequestering β-catenin from its binding to LEF (Lymphoid enhancer factor)/TCF (T cell factor) which serves the function of transcribing genes of the proliferative Wnt signaling pathway. Despite the ongoing debate on whether the loss of E-cadherin is the cause or effect of epithelial-mesenchymal transition (EMT), E-cadherin functional loss has frequently been associated with poor prognosis and survival in patients of various cancers. The dysregulation of E-cadherin expression that leads to carcinogenesis happens mostly at the epigenetic level but there are cases of genetic alterations as well. E-cadherin expression has been linked to the cellular functions of invasiveness reduction, growth inhibition, apoptosis, cell cycle arrest and differentiation. Studies on various cancers have shown that these different cellular functions are also interdependent. Recent studies have reported a rapid expansion of E-cadherin clinical relevance in various cancers. This review article summarises the multifaceted effect E-cadherin expression has on cellular functions in the context of carcinogenesis as well as its clinical implications in diagnosis, prognosis and therapeutics.



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Epigenetic regulation of the Hedgehog and Wnt pathways in cancer

Publication date: January 2018
Source:Critical Reviews in Oncology/Hematology, Volume 121
Author(s): Leon J Wils, Maarten F Bijlsma
The Hedgehog (Hh) and wingless-Int1 (Wnt) pathways are important for tissue patterning in the developing embryo. In adult tissue, both pathways are typically dormant but are activated under certain conditions such as tissue damage. Aberrant activation of these pathways by mutations in key pathway regulators contributes to the genesis and progression of several cancer types. In addition, the impact of epigenetic regulation of the Hh and Wnt pathways on cancer is becoming increasingly clear. In this review, current knowledge on the epigenetic control of Hh and Wnt and the impact on tumor formation will be discussed. First, the role of epigenetic control on ligand production will be discussed, followed by the epigenetic regulation of the extra– and intracellular pathway members. Furthermore, the epigenetic control of pathway target genes will be highlighted. Lastly, an overview of current therapeutic strategies to target aberrant epigenetic control of the Hh and Wnt pathways is provided.



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Systematic review and survival meta-analysis of real world evidence on first-line pazopanib for metastatic renal cell carcinoma

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Publication date: January 2018
Source:Critical Reviews in Oncology/Hematology, Volume 121
Author(s): Miguel A. Climent, José Muñoz-Langa, Laura Basterretxea-Badiola, Carmen Santander-Lobera
A systematic review was conducted to identify real world studies reporting outcomes after first-line pazopanib in patients with metastatic renal cell carcinoma. Studies had to be observational and report survival data in terms of progression-free survival and overall survival in order to conduct meta-analysis techniques. These real-world data were compared to those obtained in the phase II and III randomized controlled trials of pazopanib. Real world evidence showed that the clinical and safety outcomes were consistent with those observed in the clinical trials despite the inclusion of unselected patients with a wide spectrum of prognostic features and comorbidities. Similarly to the results of the pivotal studies, good prognosis patients had the most benefit from pazopanib. Further investigation is needed to complement evidence from clinical trials, in particular focused on patient-centered outcomes.



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Meta-analyses evaluating surrogate endpoints for overall survival in cancer randomized trials: A critical review

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Publication date: Available online 23 November 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Marion Savina, Sophie Gourgou, Antoine Italiano, Derek Dinart, Virginie Rondeau, Nicolas Penel, Simone Mathoulin-Pelissier, Carine Bellera
BackgroundIn cancer randomized controlled trials (RCT), alternative endpoints are increasingly being used in place of overall survival (OS) to reduce sample size, duration and cost of trials. It is necessary to ensure that these endpoints are valid surrogates for OS. We aimed at identifying meta-analyses evaluating surrogate endpoints and assessing the strength of evidence for each study.Materials and methodsWe performed a systematic review to identify meta-analyses of cancer RCTs assessing surrogate endpoints for OS. We evaluated the strength of the association between the endpoints based on (i) the Institute of Quality and Efficiency in Health Care guidelines and (ii) the Biomarker-Surrogate Evaluation Schema.Results53 publications reported on 164 meta-analyses, with heterogeneous statistical methods Disease-free survival (DFS) and progression-free survival showed good surrogacy properties for OS in colorectal cancer, lung cancer and head and neck cancer. DFS was also highly correlated to OS in gastric cancer.Conclusion(s)Clinical settings with validated surrogate endpoints for OS remain limited. Harmonization of the statistical methodology used to evaluate surrogate endpoints is required.



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A review of the literature on the relationships between genetic polymorphisms and chemotherapy-induced nausea and vomiting

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Publication date: January 2018
Source:Critical Reviews in Oncology/Hematology, Volume 121
Author(s): Komal P. Singh, Anand A. Dhruva, Elena Flowers, Kord M. Kober, Christine Miaskowski
Despite current advances in antiemetic treatments, between 30% to and 60% of oncology patients experience chemotherapy-induced nausea (CIN) and 13% to 33% report chemotherapy-induced vomiting (CIV). Inter-individual differences are observed in the occurrence and severity of chemotherapy-induced nausea and vomiting (CINV). This review summarizes and critiques studies on associations between occurrence and severity of CINV and polymorphisms in serotonin receptor, drug metabolism, and drug transport pathway genes. Sixteen studies evaluated the associations between the occurrence and/or severity of CINV and single nucleotide polymorphisms (SNPs). Across these studies, three SNPs in 5-hydroxytryptamine receptor (5-HT3R) genes, two alleles of the cytochrome P450 family 2 subfamily D member 6 (CYP2D6) gene, and three SNPs in ATP binding cassette subfamily B member 1 (ABCB1) gene were associated with the occurrence and severity of CINV. Given the limited number of polymorphisms evaluated, additional research is warranted to identify new mechanisms to develop more targeted therapies.



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Long-term toxicity of the treatment for germ cell-cancer. A review

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Publication date: January 2018
Source:Critical Reviews in Oncology/Hematology, Volume 121
Author(s): P. Maroto, G. Anguera, C. Martin
Testicular germ-cell cancer (GCC) is a curable disease. Stage I patients are mostly cured by surgery alone. For those with good prognosis advanced disease, radiotherapy in some patients with stage II Seminoma and chemotherapy for all other patients, are responsible for 95% of long-term survivors. Unfortunately, despite this high level of curability, overall survival has been reported lower for those patients receiving either radiotherapy or chemotherapy versus patients treated by surgery alone. Long-term survivors face a higher incidence of second neoplasms, and a higher risk of cardiovascular disease and metabolic syndrome than expected. Other non-life-threatening toxicities such as ototoxicity, neurotoxicity and fertility problems are common. This paper reviews the potential causes of the higher mortality among long-term survivors of testicular tumors, the incidence of them and some recommendations for the diagnoses and prevention of long-term sequelae in patients with GCC.



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The relationship between body mass index and short term postoperative outcomes in patients undergoing potentially curative surgery for colorectal cancer: A systematic review and meta-analysis

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Publication date: January 2018
Source:Critical Reviews in Oncology/Hematology, Volume 121
Author(s): Arwa S. Almasaudi, Stephen T. McSorley, Christine A. Edwards, Donald C. McMillan
BackgroundThe prevalence of obesity has increased worldwide over the last few decades, and is a well-recognized risk factor for colorectal cancer. Surgical site infection is the most frequent complication following surgery for colorectal cancer, and the main cause of postoperative morbidity. The aim of the present systematic review and meta-analysis was to examine the relationship between increasing BMI and postoperative surgical site infection following surgery for colorectal cancer.MethodsA systemic literature search was conducted using Medline, PubMed, Embase (Ovid) and Web of Science databases from inception to the end of August 2016. Studies examining the relationship between obesity and surgical site infection following surgery for colorectal cancer were included. Analysis of the data was performed using Review Manager version 5.3(The Nordic Cochrane Centre, The Cochrane Collaboration, Copen-hagen, Denmark,)ResultsIn this meta-analysis, a total of 9535 patients from 16 studies were included. BMI <30 vs ≥30kg/m2 was used to examine the association of obesity and surgical site infection in patients from Western countries. The estimated pooled OR demonstrated that obesity increased the risk of surgical site infection by approximately 100% (OR=2.13; 95% CI 1.66-2.72, p<0.001).BMI <25 vs ≥25kg/m2 was used to examine the association of obesity and surgical site infection from Asian countries. The estimated pooled OR demonstrated that obesity increased the risk of surgical site infection by approximately 60% (OR=1.63; 95% CI 1.29-2.06, p<0.001). There was little evidence of publication bias in the meta-analysis.ConclusionFrom this systematic review and meta-analysis there was good evidence that obesity was associated with a significantly higher risk of developing surgical site infection following surgery for colorectal cancer in both ethnic groups. The magnitude of the effect warrants further investigation.



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The Therapeutic use of human albumin in cancer patients’ management

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Publication date: December 2017
Source:Critical Reviews in Oncology/Hematology, Volume 120
Author(s): Elissar Moujaess, May Fakhoury, Tarek Assi, Hanine Elias, Fadi El Karak, Marwan Ghosn, Joseph Kattan
Human albumin (HA) has been widely used in clinical practice due to its unique physiological characteristics and pharmacokinetics. However, with the absence of clear institutional recommendations, its uncontrolled prescription remains largely controversial. An extensive review on the albumin chemistry, pharmacology, physiology and pathology was performed, and data on commercially available HA, its cost, medical usage and the related available guidelines, particularly in oncology patients were gathered.Studies assessing the appropriate use and safety of HA in cancer patients are lacking. A retrospective survey of the appropriateness of HA infusions according to the SIMTI guidelines (2009) was performed in our department. Among 53 patients who received HA infusions, only 5.7% of the indications were appropriate for HA administration. Occasionally appropriate and inappropriate indications were considered in 10% and 84.3% of the prescriptions respectively with a relatively high cost. The adoption of strict guidelines may substantially reduce the inappropriate use and the subsequent healthcare costs.



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Physical activity reduces fatigue in patients with cancer and hematopoietic stem cell transplant recipients: A systematic review and meta-analysis of randomized trials

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Publication date: Available online 16 December 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Sapna Oberoi, Paula D. Robinson, Danielle Cataudella, Nicole Culos-Reid, Hailey Davis, Nathan Duong, Faith Gibson, Miriam Götte, Pamela Hinds, Sanne L Nijhof, Deborah Tomlinson, Patrick van der Torre, Sandra Cabral, LLee Dupuis, Lillian Sung
PurposeObjective was to determine whether physical activity reduces the severity of fatigue in patients with cancer or hematopoietic stem cell transplant (HSCT) recipients.MethodsWe conducted a meta-analysis of randomized trials comparing physical activity with control interventions for the management of fatigue in patients with cancer or HSCT recipients.ResultsThere were 170 trials included. Physical activity reduced the severity of fatigue when compared to all control groups (standardized mean difference −0.49, 95% confidence interval −0.60 to −0.37; P < 0.00001). Aerobic, neuromotor, resistance and combination exercises were all effective in reducing fatigue although smaller effects were observed with resistance exercises (P interaction = 0.01). Other intervention and patient characteristics did not influence the effect of physical activity on the severity of fatigue.ConclusionsPhysical activity was effective at reducing fatigue in patients with cancer and HSCT recipients across patient sub-groups. Determining the best approaches for safe implementation should be a priority.



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The role of Stereotactic body radiotherapy (SBRT) in reirradiation of Head and Neck cancer recurrence

Publication date: Available online 15 December 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): A. Román A., C. Jodar, A. Perez-Rozos, Y. Lupiañez-Perez, JA Medina, J. Gomez-Millan
IntroductionHead and neck cancer recurrence is a therapeutic challenge due to the anatomical and functional constraints of the head and neck area. Stereotactic body radiotherapy (SBRT) is a high-precision technique of radiotherapy that consists of delivering a high ablative biological dose in 1–5 high-dose fractions, requiring a very high precision of the radiotherapy process with potential application in this clinical setting.MethodsDifferent studies that investigate the role of SBRT in the treatment of recurrent head and neck cancer have been reviewed. Indications to properly select patients for this treatment are presented.ResultsRetrospective studies and phase I–II trials with selected patients have shown low to moderate toxicity, with an efficacy at least similar to that of treatment with combinations of radiotherapy and chemotherapy. In selected patients, SBRT is a treatment option for recurrent head and neck cancer with low toxicity.DiscussionNew prospective studies should clarify data regarding the efficacy and toxicity of SBRT in head and neck cancer recurrence.



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Publishers Note - Tribute to Matti

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Publication date: Available online 14 December 2017
Source:Critical Reviews in Oncology/Hematology





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Systemic treatment in adult uterine sarcomas

Publication date: Available online 14 December 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): I.M.E. Desar, P.B. Ottevanger, C. Benson, W.T.A. van der Graaf
Uterine sarcomas (US) are rare mesenchymal tumours of the uterus and are divided mainly into uterine leiomyosarcoma (uLMS), low grade endometrial stromal sarcoma (LG-ESS), high grade endometrial stromal sarcoma (HG-ESS), adenosarcomas and high grade undifferentiated sarcoma (HGUS). US are often high-grade tumours with a high local recurrence rate and metastatic risk. We here discuss the current standard of care and knowledge of systemic therapy for adult uterine sarcomas, in particular uLMS, LG-ESS, HG-ESS and HGUS, in both the adjuvant as well as the metastatic setting.



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Protective effects of curcumin against doxorubicin-induced toxicity and resistance: a review

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Publication date: Available online 14 December 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Mohammad Mohajeri, Amirhossein Sahebkar
Doxorubicin (DOX)-induced toxicity and resistance are major obstacles in chemotherapeutic approaches. Despite effective in the treatment of numerous malignancies, some clinicians have voiced concern that DOX has the potential to cause debilitating consequences in organ tissues, especially the heart. The mechanisms of toxicity and resistance are respectively related to induction of reactive oxygen species (ROS) and up-regulation of ATP-binding cassette (ABC) transporter. Curcumin (CUR) with several biological and pharmacological properties is expected to restore DOX-mediated impairments to tissues. This review is intended to address the current knowledge on DOX adverse effects and CUR protective actions in the heart, kidneys, liver, brain, and reproductive organs. Coadministration of CUR and DOX is capable of ameliorating DOX toxicity pertained to antioxidant, apoptosis, autophagy, and mitochondrial permeability.



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An attempt to conceptualize the individual onco-functional balance: why a standardized treatment is an illusion for diffuse low-grade glioma patients

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Publication date: Available online 13 December 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Emmanuel Mandonnet, Hugues Duffau
In the era of evidence-based medicine, clinicians aim to establish standards of care from randomized studies. Following, personalized medicine has emerged, as new individualized biomarkers could help to predict sensitivity to specific treatment.In this paper, we show that, for diffuse low-grade glioma, some specificities – dual goal of both survival and functional gain, long duration of the disease with multistep treatments, multiparametric evaluation of the onco-functional balance of each treatment modality – call for a change of paradigm. After summarizing how to weight the benefits and risks of surgery, chemotherapy and radiotherapy, we show that the overall efficacy of a treatment modality cannot be assessed per se, as it depends on its integration in the whole sequence. Then, we revisit the notion of personalized medicine: instead of decision-making based solely on molecular profile, we plead for a recursive algorithm, allowing a dynamic evaluation of the onco-functional balance, integrating many individual characteristics of the patient's tumor and brain function.



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Continuity and diversity

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Publication date: Available online 7 December 2017
Source:Critical Reviews in Oncology/Hematology
Author(s): Matti Aapro




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Editorial Board

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Publication date: December 2017
Source:Critical Reviews in Oncology/Hematology, Volume 120





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Progestin-primed ovarian stimulation with or without clomiphene citrate supplementation in normal ovulatory women undergoing IVF/ICSI: a prospective randomized controlled trial

Abstract

Objective

To compare the endocrinological profiles, cycle characteristics and pregnancy outcomes of progestin-primed ovarian stimulation (PPOS) with or without clomiphene citrate (CC) supplementation in normal ovulatory women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).

Design

Prospective randomized controlled study.

Patient(s)

A total of 320 infertile women undergoing IVF/ICSI. Medroxyprogesterone acetate (MPA) and human menopausal gonadotropin (hMG) were simultaneously administered on menstrual cycle day 3. The women were randomized into two equal groups with or without CC supplementation.

Measures

The primary outcome measure was the percentage of women with profound pituitary suppression (luteinizing hormone (LH) < 1.0 IU/L on the trigger day). The secondary outcomes were endocrinological profiles, cycle characteristics and pregnancy outcomes.

Results

The percentage of women with profound pituitary suppression was significantly lower in the study group (hMG + MPA + CC) than in the control group (hMG + MPA) (1.9% vs. 33.1%, P < 0.001). The mean LH level during controlled ovarian stimulation (COS) was higher in the study group than in the control group (P < 0.001), but none of the patients in either group exhibited a premature LH surge. The doses of Gn in the study group were significantly lower than those in the control group (1334.06 ± 212.53 IU vs. 1488.28 ± 325.08 IU, P < 0.001). The number of oocytes retrieved was similar between the two groups (10.03 ± 5.97 vs. 10.34 ± 7.52, P > 0.05). No significant differences were observed in either the number of viable embryos or the pregnancy outcomes between the two groups.

Conclusion(s)

CC is an effective adjuvant to alleviate pituitary suppression in the PPOS protocol; however, it has no impact on clinical outcomes.

This article is protected by copyright. All rights reserved.



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Genetic Overview of Syndactyly and Polydactyly

imageSummary: Syndactyly and polydactyly—respectively characterized by fused and supernumerary digits—are among the most common congenital limb malformations, with syndactyly presenting at an estimated incidence of 1 in 2,000–3,000 live births and polydactyly at a frequency of 1 in approximately 700–1,000 live births. Despite their relatively regular manifestation in the clinic, the etiologies of syndactyly and polydactyly remain poorly understood because of their phenotypic and genetic diversity. Further, even though concrete knowledge of genotypic links has been established for some variants of syndactyly and polydactyly, there appears to be no single comprehensive published summary of all syndromic and nonsyndromic syndactyly and polydactyly presentations, and there is decidedly no resource that maps all syndromic and nonsyndromic syndactylies and polydactylies to their genetic bases. This gap in the literature problematizes comprehensive carrier screening and prenatal diagnosis and complicates novel diagnostic attempts. This review thus attempts to collect all that is known about the genetic bases of syndromic and nonsyndromic syndactylies and polydactylies, as well as to highlight the dactyly manifestations for which no genetic bases are as yet known. Then, having established a summation of existing and missing knowledge, this work briefly outlines the diagnostic techniques that a genetics-reinforced understanding of syndactyly and polydactyly could inform.

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Activation of thyroid antigen-reactive B cells in recent onset autoimmune thyroid disease patients

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Publication date: Available online 9 December 2017
Source:Journal of Autoimmunity
Author(s): Mia J. Smith, Marynette Rihanek, Brianne M. Coleman, Peter A. Gottlieb, Virginia D. Sarapura, John C. Cambier
Autoimmune thyroid disease (AITD), including Hashimoto's thyroiditis (HT) and Graves' disease (GD), is the most common autoimmune disorder in the United States, affecting over 20 million people. At the time of diagnosis, both HD and GD are characterized by the accumulation of B and T lymphocytes in the thyroid gland and production of autoantibodies targeting the thyroid, indicating that a breach in tolerance of autoreactive lymphocytes has occurred. However, few studies have sought to understand the underlying pathogenesis of AITD that ultimately leads to production of autoantibodies and loss of thyroid function. In this study, we analyzed the phenotype of thyroid antigen-reactive B cells in the peripheral blood of recent onset and long standing AITD patients. We found that in recent onset patients thyroid antigen-reactive B cells in blood no longer appear anergic, rather they express CD86, a marker of activation. This likely reflects activation of these cells leading to their production of autoantibodies. Hence, this study reports the early loss of anergy in thyroid antigen-reactive B cells, an event that contributes to development of AITD.



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Allele-specific methylation of type 1 diabetes susceptibility genes

Publication date: Available online 8 December 2017
Source:Journal of Autoimmunity
Author(s): Alida S.D. Kindt, Rainer W. Fuerst, Jan Knoop, Michael Laimighofer, Tanja Telieps, Markus Hippich, Maria A. Woerheide, Simone Wahl, Rory Wilson, Eva-Maria Sedlmeier, Angela Hommel, John A. Todd, Jan Krumsiek, Anette-G. Ziegler, Ezio Bonifacio
The susceptibility to autoimmune diseases is influenced by genes encoding major histocompatibility complex (MHC) proteins. By examining the epigenetic methylation maps of cord blood samples, we found marked differences in the methylation status of CpG sites within the MHC genes (cis-metQTLs) between carriers of the type 1 diabetes risk haplotypes HLA-DRB1*03-DQA1*0501-DQB1*0201 (DR3-DQ2) and HLA-DRB1*04-DQA1*0301-DQB1*0302 (DR4-DQ8). These differences were found in children and adults, and were accompanied by reduced HLA-DR protein expression in immune cells with the HLA-DR3-DQ2 haplotype. Extensive cis-metQTLs were identified in all 45 immune and non-immune type 1 diabetes susceptibility genes analyzed in this study. We observed and validated a novel association between the methylation status of CpG sites within the LDHC gene and the development of insulin autoantibodies in early childhood in children who are carriers of the highest type 1 diabetes risk genotype. Functionally relevant epigenetic changes in susceptibility genes may represent therapeutic targets for type 1 diabetes.



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Innately versatile: γδ17 T cells in inflammatory and autoimmune diseases

Publication date: Available online 6 December 2017
Source:Journal of Autoimmunity
Author(s): Pedro H. Papotto, Annika Reinhardt, Immo Prinz, Bruno Silva-Santos
IL-17-producing γδ (γδ17) T cells form a versatile subset of cells that respond rapidly to innate stimuli and support the pro-inflammatory functions of different myeloid and lymphoid lineages, being particularly critical in the early stages of inflammatory and autoimmune responses. In mice, under homeostatic conditions, these innate-like lymphocytes are pre-programmed in the fetal thymus, through an intricate process involving both T cell receptor-dependent and -independent signals, which allows them to readily produce IL-17 upon stimulation. However, given their transcriptional and epigenetic wiring, γδ17 T cells are permissive to different environmental instructions, and can readily acquire the ability to co-produce multiple cytokines, such as IFN-γ, IL-22 and GM-CSF, that further propagate inflammation. Moreover, strong IL-23 signals, which are abundantly found in autoinflammatory conditions, are able to induce de novo differentiation of γδ17 T cells from uncommitted precursors, both in mice and humans. This notwithstanding, the exact mechanisms responsible for γδ17 T cell pathogenicity and multifunctionality are still poorly understood, especially in humans. The pathogenic roles attributed to γδ17 T cells in autoimmune diseases stem mainly from their ability to recruit different inflammatory myeloid populations to the target tissue, and to modulate αβ T cell function, either by enhancing inflammatory TH17 responses, or by restraining regulatory Treg cell activity. Given their capacity to link key inflammatory axes of innate and adaptive immunity, a better understanding of the molecular basis underpinning γδ17 T cell plasticity, and how much this feature accounts for their pathophysiological roles, may be critical for developing novel therapeutic approaches. In this review, we discuss the importance of γδ17 T cells in breaking tolerance and enhancing inflammation in various autoimmune diseases, such as multiple sclerosis, psoriasis and rheumatoid arthritis under the light of their basic biological traits, e.g. development, activation, effector functions and plasticity.



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Immune responses to peptides containing homocitrulline or citrulline in the DR4-transgenic mouse model of rheumatoid arthritis

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Publication date: Available online 11 December 2017
Source:Journal of Autoimmunity
Author(s): Patrick Lac, Sheri Saunders, Elena Tutunea-Fatan, Lillian Barra, David A. Bell, Ewa Cairns
Antibodies to proteins/peptides containing citrulline are hallmarks of Rheumatoid Arthritis (RA). These antibodies are strongly associated with the expression of the Shared Epitope (SE). RA patients also generate antibodies to homocitrulline-containing proteins/peptides (also referred to as anti-carbamylated protein antibodies (Anti-CarP)). This study was undertaken to investigate the relationship between homocitrulline and citrulline immune responses using an established mouse model of RA: DR4-transgenic (DR4tg) mice that express the human SE. C57BL/6 (B6) and DR4tg (on a B6 background) mice were immunized subcutaneously with a homocitrullinated peptide (HomoCitJED). Splenic T cell proliferation was evaluated by 3H-thymidine incorporation assay. Antibodies to homocitrullinated and citrullinated antigens were screened by enzyme-linked immunosorbent assay (ELISA). Antibody cross-reactivity was examined by inhibition with HomoCitJED and its citrullinated counterpart peptide, CitJED (the number of homocitrullines in HomoCitJED is equal to the number of citrullines in CitJED). HomoCitJED-immunized DR4tg mice developed early T and B cell responses to HomoCitJED and late responses to CitJED. These mice also developed anti-CCP2 antibodies. In some mice, antibodies to HomoCitJED were also reactive to CitJED. B6 mice immunized with HomoCitJED developed late T and B cell responses to HomoCitJED, but did not generate responses to citrullinated antigens. Unlike DR4tg mice, anti-HomoCitJED antibodies from B6 mice did not react to CitJED. In conclusion, DR4tg mice immunized with HomoCitJED developed immune responses to CitJED, indicating cross-reactivity. CitJED immune responses were dependent on the SE. HomoCitJED responses occurred in the absence of the SE (B6 mice); however, they developed earlier in DR4tg SE-expressing mice.



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Selective targeting of pro-inflammatory Th1 cells by microRNA-148a-specific antagomirs in vivo

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Publication date: Available online 1 December 2017
Source:Journal of Autoimmunity
Author(s): Patrick Maschmeyer, Georg Petkau, Francesco Siracusa, Jakob Zimmermann, Franziska Zügel, Anja Andrea Kühl, Katrin Lehmann, Sarah Schimmelpfennig, Melanie Weber, Claudia Haftmann, René Riedel, Markus Bardua, Gitta Anne Heinz, Cam Loan Tran, Bimba Franziska Hoyer, Falk Hiepe, Sebastian Herzog, Jürgen Wittmann, Nikolaus Rajewsky, Fritz Georg Melchers, Hyun-Dong Chang, Andreas Radbruch, Mir-Farzin Mashreghi
In T lymphocytes, expression of miR-148a is induced by T-bet and Twist1, and is specific for pro-inflammatory Th1 cells. In these cells, miR-148a inhibits the expression of the pro-apoptotic protein Bim and promotes their survival. Here we use sequence-specific cholesterol-modified oligonucleotides against miR-148a (antagomir-148a) for the selective elimination of pro-inflammatory Th1 cells in vivo. In the murine model of transfer colitis, antagomir-148a treatment reduced the number of pro-inflammatory Th1 cells in the colon of colitic mice by 50% and inhibited miR-148a expression by 71% in the remaining Th1 cells. Expression of Bim protein in colonic Th1 cells was increased. Antagomir-148a-mediated reduction of Th1 cells resulted in a significant amelioration of colitis. The effect of antagomir-148a was selective for chronic inflammation. Antigen-specific memory Th cells that were generated by an acute immune reaction to nitrophenylacetyl-coupled chicken gamma globulin (NP-CGG) were not affected by treatment with antagomir-148a, both during the effector and the memory phase. In addition, antibody titers to NP-CGG were not altered. Thus, antagomir-148a might qualify as an effective drug to selectively deplete pro-inflammatory Th1 cells of chronic inflammation without affecting the protective immunological memory.



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Excessive interferon-α signaling in autoimmunity alters glycosphingolipid processing in B cells

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Publication date: Available online 27 November 2017
Source:Journal of Autoimmunity
Author(s): Andy Hee-Meng Tan, Arleen Sanny, Sze-Wai Ng, Ying-Swan Ho, Nurhidayah Basri, Alison Ping Lee, Kong-Peng Lam
Excessive interferon-α (IFN-α) production by innate immune cells is a hallmark of autoimmune diseases. What other cell type secretes IFN-α and how IFN-α affects immune cell metabolism and homeostasis in autoimmunity are largely unclear. Here, we report that autoimmune B cells, arising from two different B cell-specific genetic lesions in mice, secrete IFN-α. In addition, IFN-α, found in abundance in autoimmunity, elicited profound changes in the B cell lipidome, increasing their expression of glycosphingolipids (GSLs) and leading to their CD1d-mediated depletion of iNKT cells in vitro and in vivo. IFN-α receptor blockade could reverse the loss of iNKT cells. Excessive stimulation of B cells with IFN-α altered the expression of enzymes that catalyze critical steps in GSL processing, increasing the expressions of glucosylceramide synthase (GCS) and globotrihexosylceramide synthase (Gb3S) but decreasing that of α-galactosidase A (α-galA). Inhibiting GCS or restoring α-galA expression prevented iNKT depletion by IFN-α-activated B cells. Taken together, our work indicated that excessive IFN-α perturbs GSL metabolism in B cells which in turn adversely affects iNKT homeostasis.



http://ift.tt/2yIiWJ0

Th17 cells in primary Sjögren's syndrome: Pathogenicity and plasticity

Publication date: Available online 27 November 2017
Source:Journal of Autoimmunity
Author(s): Gwenny M. Verstappen, Odilia B.J. Corneth, Hendrika Bootsma, Frans G.M. Kroese
Th17 cells play an important physiological role at mucosal barriers, and are involved in inflammatory responses to pathogens. Th17 cells and their signature cytokine IL-17 are also present in salivary gland lesions of primary Sjögren's syndrome (pSS) patients and can be elevated in their peripheral blood. In pSS patients, clear correlations between increased Th17 cell activity and symptoms of the disease have not been found, but Th17 cells may contribute to disease progression, for example by supporting autoreactive B cell responses. In mouse models of pSS, Th17 cells play an important role in pathogenesis, particularly at disease onset, when there is a disturbed balance between T effector and T regulatory cells. Studying the pathogenicity of Th17 cells in humans is complicated due to the plasticity of this cell subset, allowing them to obtain different effector functions depending on the local environment. Th17 cells can develop towards Th17.1 cells, producing both IL-17 and IFN-γ, or even towards Th1-like cells producing IFN-γ in the absence of IL-17. These effector subsets may be more pathogenic than bona fide Th17 cells. Co-expression of IFN-γ by Th17 cells has been shown to promote chronic inflammation in several autoimmune diseases and may also contribute to pSS pathogenesis. In line with the noticeable role of IL-17 in pSS mouse models, interference with Th17 cell generation, recruitment or effector functions (e.g. IL-17 inhibition) can prevent or ameliorate disease in these models. Therapies targeting Th17 cells or IL-17 have not been tested so far in pSS patients, although treatment with rituximab seems to lower local and systemic IL-17 protein levels, and to a lesser extent also chemokine receptor-defined Th17 cells. In this review we discuss current knowledge of pathogenicity and plasticity of Th17 cells in human pSS and murine models of pSS. We postulate that plasticity towards Th17.1 cells in pSS may enhance pathogenicity of Th17 cells at the main target sites of the disease, i.e. salivary and lacrimal glands.



http://ift.tt/2AXRNHV

Tick-borne diseases and autoimmunity: A comprehensive review

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Publication date: Available online 26 November 2017
Source:Journal of Autoimmunity
Author(s): Yhojan Rodríguez, Manuel Rojas, M. Eric Gershwin, Juan-Manuel Anaya
Tick-borne diseases (TBDs) are emerging and reemerging diseases transmitted by ticks, which portray wide heterogeneity and global distribution. TBDs may present acute clinical pictures that resemble those of autoimmune diseases (i.e., musculoskeletal symptoms, cutaneous involvement, neurologic impairment, renal failure, etc.), and in some cases infection is considered a triggering factor for autoimmunity (e.g., rheumatoid arthritis, autoimmune thyroid disease, vasculitides). The clinician should consider TBDs among the differential diagnoses when approaching autoimmune-like signs in areas of tick infestation. Epidemiological setting (e.g., endemic areas, seasons) and an accurate diagnostic approach (i.e., clinical history, physical examination and laboratory tests) are necessary to confirm TBDs. Further, control and prevention of TBDs is warranted. Research in the fields of ticks microbiome and vaccination (i.e., wildlife and humans) are ahead to control vector transmission and bacterial infection. This review offers a comprehensive update on TBDs and their relationship with autoimmunity.



http://ift.tt/2yHjMWw

Decrease of galectin-3 in keratinocytes: A potential diagnostic marker and a critical contributor to the pathogenesis of psoriasis

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Publication date: Available online 20 November 2017
Source:Journal of Autoimmunity
Author(s): Zhen-rui Shi, Guo-zhen Tan, Cui-xiang Cao, Yan-fang Han, Zhen Meng, Xiao-yong Man, Ze-xin Jiang, Yu-ping Zhang, Ning-ning Dang, Kai-hua Wei, Ding-fang Bu, Fu-tong Liu, Liangchun Wang
Psoriasis-specific proteins dysregulated in keratinocytes and involved in the pathophysiological process of psoriasis remains elusive. We report here that epidermal galectin-3 expression is significantly downregulated in lesional skin, but not in non-lesional skin in psoriasis patients, nor in a group of diseases known as psoriasiform dermatitis clinically and histologically similar to psoriasis. The deficiency of epidermal galectin-3 is sufficient to promote development of psoriatic lesions, as evidenced by more severe skin inflammation in galectin-3 knockout (gal3−/−) mice, compared to wild-type mice, after imiquimod treatment, and in skin from gal3−/− mice grafted onto wildtype mice. The development of psoriatic-like lesions is attributable to 1) the spontaneously tuning up of psoriasis signatures in keratinocytes through JNK pathway; and 2) neutrophil accumulation caused by the enhanced leukocyte-recruiting capacity associated with overexpression of S100A7-9 and CXCL-1, 8 in keratinocytes with impaired galectin-3 expression. Psoriasis-like skin inflammation is significantly improved in gal-3−/− mice both by inhibition of neutrophils accumulation with a selective CXCR2 antagonist of SB225002, and by intracutaneous injection of recombinant galectin-3. Overall, these findings offer promising galectin-3-related diagnostic and therapeutic resolutions of psoriasis.



http://ift.tt/2yGGwFY

The key role of extracellular vesicles in the metastatic process

Publication date: Available online 24 November 2017
Source:Biochimica et Biophysica Acta (BBA) - Reviews on Cancer
Author(s): Hongyun Zhao, Abhinav Achreja, Elisabetta Iessi, Mariantonia Logozzi, Davide Mizzoni, Rossella Di Raimo, Deepak Nagrath, Stefano Fais
Extracellular vesicles (EVs), including exosomes, have a key role in the paracrine communication between organs and compartments. EVs shuttle virtually all types of biomolecules such as proteins, lipids, nucleic acids, metabolites and even pharmacological compounds. Their ability to transfer their biomolecular cargo into target cells enables EVs to play a key role in intercellular communication that can regulate cellular functions such as proliferation, apoptosis and migration. This has led to the emergence of EVs as a key player in tumor growth and metastasis through the formation of "tumor niches" in target organs. Recent data have also been shown that EVs may transform the microenvironment of primary tumors thus favoring the selection of cancer cells with a metastatic behavior. The release of EVs from resident non-malignant cells may contribute to the metastatic processes as well. However, cancer EVs may induce malignant transformation in resident mesenchymal stem cells, suggesting that the metastatic process is not exclusively due to circulating tumor cells. In this review, we outline and discuss evidence-based roles of EVs in actively regulating multiple steps of the metastatic process and how we can leverage EVs to impair metastasis.

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Long pentraxin 3: A novel multifaceted player in cancer

Publication date: January 2018
Source:Biochimica et Biophysica Acta (BBA) - Reviews on Cancer, Volume 1869, Issue 1
Author(s): Arianna Giacomini, Gaia Cristina Ghedini, Marco Presta, Roberto Ronca
Since its discovery in 1992, long pentraxin 3 (PTX3) has been characterized as soluble patter recognition receptor, a key player of the innate immunity arm with non-redundant functions in pathogen recognition and inflammatory responses. As a component of the extra-cellular matrix milieu, PTX3 has been implicated also in wound healing/tissue remodeling, cardiovascular diseases, fertility, and infectious diseases. Consequently, PTX3 levels in biological fluids have been proposed as a fluid-phase biomarker in different pathological conditions.In the last decade, experimental evidences have shown that PTX3 may exert a significant impact also on different aspects of cancer biology, including tumor onset, angiogenesis, metastatic dissemination and immune-modulation. However, it remains unclear whether PTX3 acts as a good cop or bad cop in cancer. In this review, we will summarize and discuss the scientific literature data focusing on the role of PTX3 in experimental and human tumors, including its putative translational implications.



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Cystic Fibrosis Transmembrane Conductance Regulator Attaches Tumor Suppressor PTEN to the Membrane and Promotes Anti Pseudomonas aeruginosa Immunity

Publication date: Available online 12 December 2017
Source:Immunity
Author(s): Sebastián A. Riquelme, Benjamin D. Hopkins, Andrew L. Wolfe, Emily DiMango, Kipyegon Kitur, Ramon Parsons, Alice Prince
The tumor suppressor PTEN controls cell proliferation by regulating phosphatidylinositol-3-kinase (PI3K) activity, but the participation of PTEN in host defense against bacterial infection is less well understood. Anti-inflammatory PI3K-Akt signaling is suppressed in patients with cystic fibrosis (CF), a disease characterized by hyper-inflammatory responses to airway infection. We found that Ptenl−/− mice, which lack the NH2-amino terminal splice variant of PTEN, were unable to eradicate Pseudomonas aeruginosa from the airways and could not generate sufficient anti-inflammatory PI3K activity, similar to what is observed in CF. PTEN and the CF transmembrane conductance regulator (CFTR) interacted directly and this interaction was necessary to position PTEN at the membrane. CF patients under corrector-potentiator therapy, which enhances CFTR transport to the membrane, have increased PTEN amounts. These findings suggest that improved CFTR trafficking could enhance P. aeruginosa clearance from the CF airway by activating PTEN-mediated anti-bacterial responses and might represent a therapeutic strategy.

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Teaser

Anti-inflammatory PI3K-Akt signaling is suppressed in patients with cystic fibrosis (CF), a disease characterized by hyper-inflammatory responses to airway infection. Riquelme et al. find that CFTR channel directly interacts with tumor suppressor PTEN, which regulates PI3K activity. CFTR helps position PTEN at the membrane to promote PTEN function and host immunity against Pseudomonas aeruginosa infection.


http://ift.tt/2kAzX2z

Roquin Suppresses the PI3K-mTOR Signaling Pathway to Inhibit T Helper Cell Differentiation and Conversion of Treg to Tfr Cells

Publication date: Available online 12 December 2017
Source:Immunity
Author(s): Katharina Essig, Desheng Hu, Joao C. Guimaraes, Dominik Alterauge, Stephanie Edelmann, Timsse Raj, Jan Kranich, Gesine Behrens, Alexander Heiseke, Stefan Floess, Juliane Klein, Andreas Maiser, Susan Marschall, Martin Hrabĕ de Angelis, Heinrich Leonhardt, Cornelis F. Calkhoven, Elfriede Noessner, Thomas Brocker, Jochen Huehn, Anne B. Krug, Mihaela Zavolan, Dirk Baumjohann, Vigo Heissmeyer
Roquin proteins preclude spontaneous T cell activation and aberrant differentiation of T follicular helper (Tfh) or T helper 17 (Th17) cells. Here we showed that deletion of Roquin-encoding alleles specifically in regulatory T (Treg) cells also caused the activation of conventional T cells. Roquin-deficient Treg cells downregulated CD25, acquired a follicular Treg (Tfr) cell phenotype, and suppressed germinal center reactions but could not protect from colitis. Roquin inhibited the PI3K-mTOR signaling pathway by upregulation of Pten through interfering with miR-17∼92 binding to an overlapping cis-element in the Pten 3′ UTR, and downregulated the Foxo1-specific E3 ubiquitin ligase Itch. Loss of Roquin enhanced Akt-mTOR signaling and protein synthesis, whereas inhibition of PI3K or mTOR in Roquin-deficient T cells corrected enhanced Tfh and Th17 or reduced iTreg cell differentiation. Thereby, Roquin-mediated control of PI3K-mTOR signaling prevents autoimmunity by restraining activation and differentiation of conventional T cells and specialization of Treg cells.

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Teaser

Essig et al. show that spontaneous activation and aberrant differentiation of Roquin-deficient T cells involves cell-intrinsic causes in not only conventional T cells but also impaired Treg cell function. In both cell types, Roquin inhibits the PI3K-mTOR signaling pathway at several levels, thereby controlling protein biosynthesis and limiting differentiation toward Th17 and Tfh cells as well as preventing the conversion and functional specialization of Treg into Tfr cells.


http://ift.tt/2olrqpD

White Adipose Tissue Is a Reservoir for Memory T Cells and Promotes Protective Memory Responses to Infection

Publication date: Available online 5 December 2017
Source:Immunity
Author(s): Seong-Ji Han, Arielle Glatman Zaretsky, Vinicius Andrade-Oliveira, Nicholas Collins, Amiran Dzutsev, Jahangheer Shaik, Denise Morais da Fonseca, Oliver J. Harrison, Samira Tamoutounour, Allyson L. Byrd, Margery Smelkinson, Nicolas Bouladoux, James B. Bliska, Jason M. Brenchley, Igor E. Brodsky, Yasmine Belkaid
White adipose tissue bridges body organs and plays a fundamental role in host metabolism. To what extent adipose tissue also contributes to immune surveillance and long-term protective defense remains largely unknown. Here, we have shown that at steady state, white adipose tissue contained abundant memory lymphocyte populations. After infection, white adipose tissue accumulated large numbers of pathogen-specific memory T cells, including tissue-resident cells. Memory T cells in white adipose tissue expressed a distinct metabolic profile, and white adipose tissue from previously infected mice was sufficient to protect uninfected mice from lethal pathogen challenge. Induction of recall responses within white adipose tissue was associated with the collapse of lipid metabolism in favor of antimicrobial responses. Our results suggest that white adipose tissue represents a memory T cell reservoir that provides potent and rapid effector memory responses, positioning this compartment as a potential major contributor to immunological memory.

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Teaser

The role of adipose tissue in protective immunity is largely unknown. Han et al. reveal that white adipose tissue is a reservoir for memory T cells endowed with a distinct functional and metabolic profile. These memory T cells are able to protect against infection while inducing physiological remodeling of adipose tissue.


http://ift.tt/2kApfcv

Ablation of Transcription Factor IRF4 Promotes Transplant Acceptance by Driving Allogenic CD4+ T Cell Dysfunction

Publication date: Available online 5 December 2017
Source:Immunity
Author(s): Jie Wu, Hedong Zhang, Xiaomin Shi, Xiang Xiao, Yihui Fan, Laurie J. Minze, Jin Wang, Rafik M. Ghobrial, Jiahong Xia, Roger Sciammas, Xian C. Li, Wenhao Chen
CD4+ T cells orchestrate immune responses and destruction of allogeneic organ transplants, but how this process is regulated on a transcriptional level remains unclear. Here, we demonstrated that interferon regulatory factor 4 (IRF4) was a key transcriptional determinant controlling T cell responses during transplantation. IRF4 deletion in mice resulted in progressive establishment of CD4+ T cell dysfunction and long-term allograft survival. Mechanistically, IRF4 repressed PD-1, Helios, and other molecules associated with T cell dysfunction. In the absence of IRF4, chromatin accessibility and binding of Helios at PD-1 cis-regulatory elements were increased, resulting in enhanced PD-1 expression and CD4+ T cell dysfunction. The dysfunctional state of Irf4-deficient T cells was initially reversible by PD-1 ligand blockade, but it progressively developed into an irreversible state. Hence, IRF4 controls a core regulatory circuit of CD4+ T cell dysfunction, and targeting IRF4 represents a potential therapeutic strategy for achieving transplant acceptance.

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Teaser

CD4+ T cells drive allogeneic organ transplant destruction, but how this is regulated transcriptionally remains unclear. Wu et al. report that IRF4 deletion in T cells leads to the establishment of T cell dysfunction and long-term allograft survival. Therefore, targeting IRF4 represents a therapeutic opportunity for achieving transplant acceptance.


http://ift.tt/2kAzrl9

Transcription Factor IRF4 Promotes CD8+ T Cell Exhaustion and Limits the Development of Memory-like T Cells during Chronic Infection

Publication date: Available online 12 December 2017
Source:Immunity
Author(s): Kevin Man, Sarah S. Gabriel, Yang Liao, Renee Gloury, Simon Preston, Darren C. Henstridge, Marc Pellegrini, Dietmar Zehn, Friederike Berberich-Siebelt, Mark A. Febbraio, Wei Shi, Axel Kallies
During chronic stimulation, CD8+ T cells acquire an exhausted phenotype characterized by expression of inhibitory receptors, down-modulation of effector function, and metabolic impairments. T cell exhaustion protects from excessive immunopathology but limits clearance of virus-infected or tumor cells. We transcriptionally profiled antigen-specific T cells from mice infected lymphocytic choriomeningitis virus strains that cause acute or chronic disease. T cell exhaustion during chronic infection was driven by high amounts of T cell receptor (TCR)-induced transcription factors IRF4, BATF, and NFATc1. These regulators promoted expression of inhibitory receptors, including PD-1, and mediated impaired cellular metabolism. Furthermore, they repressed the expression of TCF1, a transcription factor required for memory T cell differentiation. Reducing IRF4 expression restored the functional and metabolic properties of antigen-specific T cells and promoted memory-like T cell development. These findings indicate that IRF4 functions as a central node in a TCR-responsive transcriptional circuit that establishes and sustains T cell exhaustion during chronic infection.

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Teaser

During chronic stimulation, CD8+ T cells acquire an exhausted phenotype characterized by expression of inhibitory receptors, loss of effector function, and metabolic impairments. Man et al. have identified a transcriptional module consisting of the TCR-induced transcription factors IRF4, BATF, and NFATc1 that drives T cell exhaustion and impairs memory T cell development.


http://ift.tt/2kzw2TV

High-Dimensional Phenotypic Mapping of Human Dendritic Cells Reveals Interindividual Variation and Tissue Specialization

Publication date: Available online 5 December 2017
Source:Immunity
Author(s): Marcela Alcántara-Hernández, Rebecca Leylek, Lisa E. Wagar, Edgar G. Engleman, Tibor Keler, M. Peter Marinkovich, Mark M. Davis, Garry P. Nolan, Juliana Idoyaga
Given the limited efficacy of clinical approaches that rely on ex vivo generated dendritic cells (DCs), it is imperative to design strategies that harness specialized DC subsets in situ. This requires delineating the expression of surface markers by DC subsets among individuals and tissues. Here, we performed a multiparametric phenotypic characterization and unbiased analysis of human DC subsets in blood, tonsil, spleen, and skin. We uncovered previously unreported phenotypic heterogeneity of human cDC2s among individuals, including variable expression of functional receptors such as CD172a. We found marked differences in DC subsets localized in blood and lymphoid tissues versus skin, and a striking absence of the newly discovered Axl+ DCs in the skin. Finally, we evaluated the capacity of anti-receptor monoclonal antibodies to deliver vaccine components to skin DC subsets. These results offer a promising path for developing DC subset-specific immunotherapies that cannot be provided by transcriptomic analysis alone.

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Teaser

Dendritic cells (DCs) are potent initiators of immune responses; however, human DC subsets have yet to be successfully harnessed for immunotherapies. By combining CyTOF and unbiased analysis, Alcántara-Hernández et al. profile the heterogeneity of human DC subsets among individuals and tissues, providing comprehensive insights for the development of DC-based therapeutics.


http://ift.tt/2kyuSba

HIV Envelope Glycoform Heterogeneity and Localized Diversity Govern the Initiation and Maturation of a V2 Apex Broadly Neutralizing Antibody Lineage

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Elise Landais, Ben Murrell, Bryan Briney, Sasha Murrell, Kimmo Rantalainen, Zachary T. Berndsen, Alejandra Ramos, Lalinda Wickramasinghe, Melissa Laird Smith, Kemal Eren, Natalia de Val, Mengyu Wu, Audrey Cappelletti, Jeffrey Umotoy, Yolanda Lie, Terri Wrin, Paul Algate, Po-Ying Chan-Hui, Etienne Karita, Andrew B. Ward, Ian A. Wilson, Dennis R. Burton, Davey Smith, Sergei L. Kosakovsky Pond, Pascal Poignard
Understanding how broadly neutralizing antibodies (bnAbs) to HIV envelope (Env) develop during natural infection can help guide the rational design of an HIV vaccine. Here, we described a bnAb lineage targeting the Env V2 apex and the Ab-Env co-evolution that led to development of neutralization breadth. The lineage Abs bore an anionic heavy chain complementarity-determining region 3 (CDRH3) of 25 amino acids, among the shortest known for this class of Abs, and achieved breadth with only 10% nucleotide somatic hypermutation and no insertions or deletions. The data suggested a role for Env glycoform heterogeneity in the activation of the lineage germline B cell. Finally, we showed that localized diversity at key V2 epitope residues drove bnAb maturation toward breadth, mirroring the Env evolution pattern described for another donor who developed V2-apex targeting bnAbs. Overall, these findings suggest potential strategies for vaccine approaches based on germline-targeting and serial immunogen design.

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Teaser

Understanding the molecular basis of HIV Env-specific broadly neutralizing antibodies (bnAbs) development is key for vaccine design. Landais et al. find that glycan heterogeneity played a role in the activation of V2 apex PCT64 bnAbs precursor and that viral evolution was similar to CAP256, another donor with V2 apex bnAbs.


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Natural Parasite Exposure Induces Protective Human Anti-Malarial Antibodies

Publication date: Available online 29 November 2017
Source:Immunity
Author(s): Gianna Triller, Stephen W. Scally, Giulia Costa, Maria Pissarev, Cornelia Kreschel, Alexandre Bosch, Eric Marois, Brandon K. Sack, Rajagopal Murugan, Ahmed M. Salman, Chris J. Janse, Shahid M. Khan, Stefan H.I. Kappe, Ayola A. Adegnika, Benjamin Mordmüller, Elena A. Levashina, Jean-Philippe Julien, Hedda Wardemann
Antibodies against the NANP repeat of circumsporozoite protein (CSP), the major surface antigen of Plasmodium falciparum (Pf) sporozoites, can protect from malaria in animal models but are difficult to induce in humans. Here we cloned and characterized rare affinity-matured human NANP-reactive memory B cell antibodies elicited by natural Pf exposure that potently inhibited parasite transmission and development in vivo. We unveiled the molecular details of antibody binding to two distinct protective epitopes within the NANP repeat. NANP repeat recognition was largely mediated by germline encoded and immunoglobulin (Ig) heavy-chain complementarity determining region 3 (HCDR3) residues, whereas affinity maturation contributed predominantly to stabilizing the antigen-binding site conformation. Combined, our findings illustrate the power of exploring human anti-CSP antibody responses to develop tools for malaria control in the mammalian and the mosquito vector and provide a molecular basis for the structure-based design of next-generation CSP malaria vaccines.

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Teaser

CSP is the target of protective antibodies against the malaria parasite Plasmodium falciparum (Pf). Here, Triller and Scally et al. identified potent Pf-inhibitory human anti-CSP memory B cell antibodies induced by natural exposure and unveiled the molecular details of antigen binding to two protective CSP repeat epitopes.


http://ift.tt/2kAEBOi

The Pore-Forming Protein Gasdermin D Regulates Interleukin-1 Secretion from Living Macrophages

Publication date: Available online 28 November 2017
Source:Immunity
Author(s): Charles L. Evavold, Jianbin Ruan, Yunhao Tan, Shiyu Xia, Hao Wu, Jonathan C. Kagan
The interleukin-1 (IL-1) family cytokines are cytosolic proteins that exhibit inflammatory activity upon release into the extracellular space. These factors are released following various cell death processes, with pyroptosis being a common mechanism. Recently, it was recognized that phagocytes can achieve a state of hyperactivation, which is defined by their ability to secrete IL-1 while retaining viability, yet it is unclear how IL-1 can be secreted from living cells. Herein, we report that the pyroptosis regulator gasdermin D (GSDMD) was necessary for IL-1β secretion from living macrophages that have been exposed to inflammasome activators, such as bacteria and their products or host-derived oxidized lipids. Cell- and liposome-based assays demonstrated that GSDMD pores were required for IL-1β transport across an intact lipid bilayer. These findings identify a non-pyroptotic function for GSDMD, and raise the possibility that GSDMD pores represent conduits for the secretion of cytosolic cytokines under conditions of cell hyperactivation.

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Teaser

Inflammasomes elicit pyroptosis or cell hyperactivation, with the latter defined as living cells that release IL-1. Evavold et al report that the pore-forming protein gasdermin D regulates IL-1 release from hyperactive macrophages. Cell- and liposome-based assays revealed that gasdermin D pores permit IL-1 passage across intact lipid bilayers.


http://ift.tt/2kApe8r

The TCR Takes Some Immune Responsibility

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Ashley A. Viehmann Milam, Paul M. Allen
In this issue of Immunity, Van Braeckel-Budimir et al. (2017) reveal that the pathogenic response of mice to a Plasmodium berghei infection is dominated by a Vβ8.1 T cell response. Mice lacking Vβ8.1 T cells fail to mount a pathogenic response, thus showing that the TCR locus can be an Immune response (Ir) gene.

Teaser

In this issue of Immunity, Van Braeckel-Budimir et al. (2017) reveal that the pathogenic response of mice to a Plasmodium berghei infection is dominated by a Vβ8.1 T cell response. Mice lacking Vβ8.1 T cells fail to mount a pathogenic response, thus showing that the TCR locus can be an Immune response (Ir) gene.


http://ift.tt/2om4BSC

A Sweet Solution: Glycolysis-Dependent Treg Cell Migration

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Ronen Alon
mTORC2 is a metabolic regulatory complex activated by PI3K. In this issue of Immunity, Kishore et al. (2017) demonstrate a specialized role for this complex in the migration of regulatory T (Treg) cells to sites of inflammation rather than their differentiation and survival.

Teaser

mTORC2 is a metabolic regulatory complex activated by PI3K. In this issue of Immunity, Kishore et al. (2017) demonstrate a specialized role for this complex in the migration of regulatory T (Treg) cells to sites of inflammation rather than their differentiation and survival.


http://ift.tt/2CCVArk

TGF-β Gives an Air of Exclusivity to Alveolar Macrophages

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Bart N. Lambrecht
Tissue-resident macrophages shape the development and homeostasis of the organs that they colonize. Yu et al. (2017) demonstrate that, unique to the lung, the instructive cytokine TGF-β collaborates with GM-CSF to induce the master transcription factor PPARγ to drive alveolar macrophage differentiation and maintenance early in life.

Teaser

Tissue-resident macrophages shape the development and homeostasis of the organs that they colonize. Yu et al. (2017) demonstrate that, unique to the lung, the instructive cytokine TGF-β collaborates with GM-CSF to induce the master transcription factor PPARγ to drive alveolar macrophage differentiation and maintenance early in life.


http://ift.tt/2ol66R2

The Silent Undertakers: Macrophages Programmed for Efferocytosis

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Judith E. Allen, Dominik Rückerl
Two recent Immunity papers provide new insight into efferocytosis by tissue-resident macrophages. Baratin et al. (2017) identify a resident macrophage population in the T cell zone of lymph nodes responsible for the silent uptake of vast numbers of apoptotic cells. Roberts et al. (2017) find that resident macrophages can be programmed by local tissue signals not to respond to the nucleic acid of apoptotic cells.

Teaser

Two recent Immunity papers provide new insight into efferocytosis by tissue-resident macrophages. Baratin et al. (2017) identify a resident macrophage population in the T cell zone of lymph nodes responsible for the silent uptake of vast numbers of apoptotic cells. Roberts et al. (2017) find that resident macrophages can be programmed by local tissue signals not to respond to the nucleic acid of apoptotic cells.


http://ift.tt/2CDvCny

The Skinny: Pancreatic ILC2s Promote Insulin Secretion

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Kelly M. Cautivo, Ari B. Molofsky
Regulation of pancreatic insulin production is pivotal in the pathophysiology and treatment of diabetes. In this issue of Immunity, Dalmas et al. (2017) describe a type 2 immune circuit where pancreatic interleukin-33 (IL-33) promotes insulin secretion via the activity of islet-associated group 2 innate lymphoid cells (ILC2s).

Teaser

Regulation of pancreatic insulin production is pivotal in the pathophysiology and treatment of diabetes. In this issue of Immunity, Dalmas et al. (2017) describe a type 2 immune circuit where pancreatic interleukin-33 (IL-33) promotes insulin secretion via the activity of islet-associated group 2 innate lymphoid cells (ILC2s).


http://ift.tt/2ojabW0

Swell, or Not Too Swell: Cytokines Regulate Arterial Aneurysm Formation

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Peter Libby, Amélie Vromman
Arterial remodeling participates pivotally in many diseases including arterial aneurysms. In this issue of Immunity, Da Ros et al. (2017) report that, in experimental aortic aneurysm formation, neutralization of interleukin-1β reduced arterial wall stiffness and hampered aneurysm development.

Teaser

Arterial remodeling participates pivotally in many diseases including arterial aneurysms. In this issue of Immunity, Da Ros et al. (2017) report that, in a model of aortic aneurysm formation, neutralization of interleukin-1β reduced arterial wall stiffness and hampered aneurysm development.


http://ift.tt/2oiSuFR

Glycans Function as Anchors for Antibodies and Help Drive HIV Broadly Neutralizing Antibody Development

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Raiees Andrabi, Ching-Yao Su, Chi-Hui Liang, Sachin S. Shivatare, Bryan Briney, James E. Voss, Salar Khan Nawazi, Chung-Yi Wu, Chi-Huey Wong, Dennis R. Burton




http://ift.tt/2CDonMx

Brain, Immunity, Gut: “BIG” Links between Pregnancy and Autism

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Myka L. Estes, A. Kimberley McAllister
Although dysregulation of brain, immune, and gut physiology during pregnancy have each been implicated in neuropsychiatric disorders, whether and how these presumably distinct systems are linked to cause disease is unclear. Kim et al. (2017) and Shin Yim et al. (2017) identify a pathway to explain how these aspects of our physiology are deeply and inextricably connected.

Teaser

Although dysregulation of brain, immune, and gut physiology during pregnancy has each been implicated in neuropsychiatric disorders, how these presumably distinct systems are linked to cause disease is unclear. Kim et al. (2017) and Shin Yim et al. (2017) identify a pathway to explain how these aspects of our physiology are deeply and inextricably connected.


http://ift.tt/2oo0kxW

The Broad Spectrum of Human Natural Killer Cell Diversity

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Aharon G. Freud, Bethany L. Mundy-Bosse, Jianhua Yu, Michael A. Caligiuri
Natural killer (NK) cells provide protection against infectious pathogens and cancer. For decades it has been appreciated that two major NK cell subsets (CD56bright and CD56dim) exist in humans and have distinct anatomical localization patterns, phenotypes, and functions in immunity. In light of this traditional NK cell dichotomy, it is now clear that the spectrum of human NK cell diversity is much broader than originally appreciated as a result of variegated surface receptor, intracellular signaling molecule, and transcription factor expression; tissue-specific imprinting; and foreign antigen exposure. The recent discoveries of tissue-resident NK cell developmental intermediates, non-NK innate lymphoid cells, and the capacity for NK cells to adapt and differentiate into long-lived memory cells has added further complexity to this field. Here we review our current understanding of the breadth and generation of human NK cell diversity.

Teaser

Recent advances in the field of human natural killer cell biology have revealed that there is a remarkably high amount of cellular diversity within different tissues. Freud et al. review these advances and provide insight into the generation of natural killer cell diversity and its roles in innate immunity.


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Environmental and body contamination from cleaning vomitus in a health care setting: A simulation study

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Publication date: Available online 22 November 2017
Source:American Journal of Infection Control
Author(s): Linh Phan, Yu-Min Su, Rachel Weber, Charissa Fritzen-Pedicini, Osayuwamen Edomwande, Rachael M. Jones
BackgroundEnvironmental service workers may be exposed to pathogens during the cleaning of pathogen-containing bodily fluids.MethodsParticipants with experience cleaning hospital environments were asked to clean simulated, fluorescein-containing vomitus using normal practices in a simulated patient room. Fluorescein was visualized in the environment and on participants under black lights. Fluorescein was quantitatively measured on the floor, in the air, and on gloves and shoe covers.ResultsIn all 21 trials involving 7 participants, fluorescein was found on the floor after cleaning and on participants' gloves. Lower levels of floor contamination were associated with the use of towels to remove bulk fluid (ρ = −0.56, P = .01). Glove contamination was not associated with the number or frequency of contacts with environmental surfaces, suggesting contamination occurs with specific events, such as picking up contaminated towels. Fluorescein contamination on shoe covers was measured in 19 trials. Fluorescein was not observed on participants' facial personal protective equipment, if worn, or faces. Contamination on other body parts, primarily the legs, was observed in 8 trials. Fluorescein was infrequently quantified in the air.ConclusionsUsing towels to remove bulk fluid prior to mopping is part of the recommended cleaning protocol and should be used to minimize residual contamination. Contamination on shoes and the floor may serve as reservoirs for pathogens.



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Bacteriuria is not associated with surgical site infection in patients undergoing cardiovascular surgery: Methodologic issues

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Publication date: Available online 15 December 2017
Source:American Journal of Infection Control
Author(s): Saeid Safiri, Ahad Ashrafi-Asgarabad




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Risk factors for bacteremia with extended-spectrum β-lactamase production in positive Escherichia coli bacteremia in a pediatric setting

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Publication date: 1 December 2017
Source:American Journal of Infection Control, Volume 45, Issue 12
Author(s): Fatoş Alkan, Salih Gözmen, Nuri Bayram, Gamze Gülfidan, Hurşit Apa, Nurettin Ünal, İlker Devrim




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Wearing long sleeves while prepping a patient in the operating room decreases airborne contaminants

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Publication date: Available online 6 December 2017
Source:American Journal of Infection Control
Author(s): Troy A. Markel, Thomas Gormley, Damon Greeley, John Ostojic, Jennifer Wagner
BackgroundThe use of long sleeves by nonscrubbed personnel in the operating room has been called into question. We hypothesized that wearing long sleeves and gloves, compared with having bare arms without gloves, while applying the skin preparation solution would decrease particulate and microbial contamination.MethodsA mock patient skin prep was performed in 3 different operating rooms. A long-sleeved gown and gloves, or bare arms, were used to perform the procedure. Particle counters were used to assess airborne particulate contamination, and active and passive microbial assessment was achieved through air samplers and settle plate analysis. Data were compared with Student's t-test or Mann-Whitney U, and P < .05 was considered to be significant.ResultsOperating room B demonstrated decreased 5.0- µm particle sizes with the use of sleeves, while operating rooms A and C showed decreased total microbes only with the use of sleeves. Despite there being no difference in the average number of total microbes for all operating rooms assessed, the use of sleeves specifically appeared to decrease the shed of Micrococcus.ConclusionThe use of long sleeves and gloves while applying the skin preparation solution decreased particulate and microbial shedding in several of the operating rooms tested. Although long sleeves may not be necessary for all operating room personnel, they may decrease airborne contamination while the skin prep is applied, which may lead to decreased surgical site infections.



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Epidemiologic surveillance of multidrug-resistant bacteria in a teaching hospital: A 3-year experience

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Publication date: Available online 6 December 2017
Source:American Journal of Infection Control
Author(s): Mirian Nicéa Zarpellon, Giselle Fukita Viana, Cecília Saori Mitsugui, Bruno Buranello Costa, Nathalie Kira Tamura, Elisabeth Eyko Aoki, Cesar Helbel, Sheila Alexandra Belini Nishiyama, Silvia Maria dos Santos Saalfeld, Maria Cristina Bronharo Tognim
BackgroundThe objective of this prospective study was to verify the effectiveness of a multidisciplinary surveillance program that was implemented in a teaching hospital in southern Brazil, to prevent and control the spread of multidrug-resistant organisms.MethodsThe program implemented involved establishment of prevention guidelines, hand-hygiene promotion, isolation of patients colonized or infected by such organisms, enforced contact precautions, and terminal cleaning and disinfection of isolation rooms. A microbiology service, previously provided by an external laboratory, was established in the hospital. Detection of bacteria-resistant genes and molecular typing were performed also.ResultsStatistically significant differences were observed between the pre- and post-intervention periods (P = .00198). Control measures were effective in blocking the dissemination of a previously endemic clone of Acinetobacter baumannii. Changes were observed in the dissemination pattern, from a monoclonal to a polyclonal mode. The incidence of vancomycin-resistant Enterococcus during the surveillance period was low. Only 2 isolates of BLAKPC-positive Klebsiella pneumoniae (distinct profiles), and 5 isolates of BLASPM-positive Pseudomonas aeruginosa (a single cluster), were detected.ConclusionsThese results indicate that the surveillance program implemented was effective in preventing the spread of multidrug-resistant organisms in the hospital.



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Effect of hand hygiene on infectious diseases in the office workplace: A systematic review

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Publication date: Available online 28 November 2017
Source:American Journal of Infection Control
Author(s): Paul N. Zivich, Abigail S. Gancz, Allison E. Aiello
BackgroundExtensive data suggests that hand hygiene is a critical intervention for reducing infectious disease transmission in the clinical setting. However, it is unclear whether hand hygiene is effective at cutting down on infectious illnesses in non-clinical workplaces. The aim of this review is to assess the current literature concerning the effects of hand-washing interventions on infectious disease prevention among employees in nonclinical, office-based workplaces.MethodsIn compiling this review, PubMed, Scopus, and Business Source Premier were examined for studies published from 1960 through 2016.ResultsEleven studies (eight experimental, two observational, one a simulation) were identified as eligible for inclusion. Hand-hygiene interventions at various levels of rigor were shown to reduce self-reported illness symptoms.ConclusionsHand hygiene is thought to be more effective against gastrointestinal illness than it is against respiratory illness, but no clear consensus has been reached on this point. Minimal hand-hygiene interventions seem to be effective at reducing the incidence of employee illness. Along with reducing infections among employees, hand-hygiene programs in the workplace may provide additional benefits to employers by reducing the number of employee health insurance claims and improving employee morale. Future research should use objective measures of hand hygiene and illness, and explore economic impacts on employers more fully.



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HPV vaccinations in low- and middle-income countries

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Publication date: Available online 6 December 2017
Source:American Journal of Infection Control
Author(s): Hossein Bannazadeh Baghi, Mohammad Aghazadeh




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Lessons from the domestic Ebola response: Improving health care system resilience to high consequence infectious diseases

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Publication date: Available online 15 December 2017
Source:American Journal of Infection Control
Author(s): Diane Meyer, Tara Kirk Sell, Monica Schoch-Spana, Matthew P. Shearer, Hannah Chandler, Erin Thomas, Dale A. Rose, Eric G. Carbone, Eric Toner
BackgroundThe domestic response to the West Africa Ebola virus disease (EVD) epidemic from 2014-2016 provides a unique opportunity to distill lessons learned about health sector planning and operations from those individuals directly involved. This research project aimed to identify and integrate these lessons into an actionable checklist that can improve health sector resilience to future high-consequence infectious disease (HCID) events.MethodsInterviews (N = 73) were completed with individuals involved in the domestic EVD response in 4 cities (Atlanta, Dallas, New York, and Omaha), and included individuals who worked in academia, emergency management, government, health care, law, media, and public health during the response. Interviews were transcribed and analyzed qualitatively. Two focus groups were then conducted to expand on themes identified in the interviews. Using these themes, an evidence-informed checklist was developed and vetted for completeness and feasibility by an expert advisory group.ResultsSalient themes identified included health care facility issues—specifically identifying assessment and treatment hospitals, isolation and treatment unit layout, waste management, community relations, patient identification, patient isolation, limitations on treatment, laboratories, and research considerations—and health care workforce issues—specifically psychosocial impact, unit staffing, staff training, and proper personal protective equipment.ConclusionsThe experiences of those involved in the domestic Ebola response provide critical lessons that can help strengthen resilience of health care systems and improve future responses to HCID events.



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Table of Contents

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Publication date: 1 December 2017
Source:American Journal of Infection Control, Volume 45, Issue 12





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Health care-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration

Publication date: 1 December 2017
Source:American Journal of Infection Control, Volume 45, Issue 12
Author(s): Katherine Allen-Bridson, Cindy Gross, Angela Anttila, Janet E. Brooks, Joan N. Hebden, Denise Leaptrot, Georganne Ryan, Eileen Scalise, Henrietta Smith, Marc-Oliver Wright
This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) health care-associated infection (HAI) surveillance definitions. This specific case study focuses on the definitions and protocols used to make HAI infection determinations, such as the infection window period and secondary bloodstream infection attribution period. The case reflects the real-life and complex patient scenarios that infection preventionists (IPs) face when identifying and reporting HAIs to NHSN. The intent of the case study series is to foster standardized application of the NHSN HAI surveillance definitions among IPs and encourage accurate determination of HAI events. An online survey link is provided where participants may confidentially answer questions related to the case study and receive immediate feedback in the form of correct answers and explanations and rationales. Details of the case study, answers, and explanations have been reviewed and approved by NHSN staff. We hope that participants take advantage of this educational offering and thereby gain a greater understanding of NHSN HAI surveillance definitions.



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Editorial Board

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Publication date: 1 December 2017
Source:American Journal of Infection Control, Volume 45, Issue 12





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Journal Club: Commentary on “Risk factors for MRSA colonization in the neonatal ICU: A systematic review and meta-analysis”

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Publication date: 1 December 2017
Source:American Journal of Infection Control, Volume 45, Issue 12
Author(s): Heather M. Gilmartin, Amanda Hessels




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APIC Masthead

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Publication date: 1 December 2017
Source:American Journal of Infection Control, Volume 45, Issue 12





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Information for Readers

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Publication date: 1 December 2017
Source:American Journal of Infection Control, Volume 45, Issue 12





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Information for Authors

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Publication date: 1 December 2017
Source:American Journal of Infection Control, Volume 45, Issue 12





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Epidemiology and risk factors for Clostridium difficile–associated diarrhea in adult inpatients in a university hospital in China

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Publication date: Available online 28 November 2017
Source:American Journal of Infection Control
Author(s): Chenjie Tang, Yang Li, Chengcheng Liu, Pengfei Sun, Xu Huang, Wenying Xia, Huimin Qian, Lunbiao Cui, Genyan Liu
BackgroundClostridium difficile–associated diarrhea (CDAD) is an important disease with rising incidence and mortality in western countries. However, studies about CDAD in China are limited. The aims of this study are to investigate the epidemiology and risk factors of CDAD in a university hospital located in Eastern China.MethodsDiarrhea samples of all adult inpatients were collected for C difficile culture prospectively from August 2013-April 2014. Suspected colonies were identified by biochemical identification cards. Confirmed C difficile isolates were further analyzed for the presence of toxin genes and typed by polymerase chain reaction ribotyping. Patient demographics, presumed risk factors, clinical manifestations, and laboratory findings were collected through inpatient medical record systems retrospectively.ResultsIn total, 45 stains of toxigenic C difficile were isolated from 315 nonrepetitive diarrhea samples. The isolation rate was 14.29% (45/315). No RT027/ST1 strain was found. An outbreak of CDAD occurred in the digestive ward and was finally found to be caused by ST35 strains during this study. Coloclysis and diabetes were found to be independent risk factors of CDAD, besides the common risk factors previously reported.ConclusionsCDAD is not uncommon in Chinese hospitals. C difficile ST35 as a new strain causing outbreaks should be noticed. Coloclysis and diabetes are new independent risk factors for CDAD, and further study is needed.



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APIC's strategic partners: Committed to transformational change

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Publication date: 1 December 2017
Source:American Journal of Infection Control, Volume 45, Issue 12





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Evaluation of an automated ultraviolet-C light disinfection device and patient hand hygiene for reduction of pathogen transfer from interactive touchscreen computer kiosks

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Publication date: Available online 22 November 2017
Source:American Journal of Infection Control
Author(s): Heba Alhmidi, Jennifer L. Cadnum, Christina T. Piedrahita, Amrita R. John, Curtis J. Donskey
Touchscreens are a potential source of pathogen transmission. In our facility, patients and visitors rarely perform hand hygiene after using interactive touchscreen computer kiosks. An automated ultraviolet-C touchscreen disinfection device was effective in reducing bacteriophage MS2, bacteriophage ϕX174, methicillin-resistant Staphylococcus aureus, and Clostridium difficile spores inoculated onto a touchscreen. In simulations, an automated ultraviolet-C touchscreen disinfection device alone or in combination with hand hygiene reduced transfer of the viruses from contaminated touchscreens to fingertips.



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Microbial profile and characterization of blue bulb manual suction devices used to promote airway clearance in newborns in intrapartum and postpartum units

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Publication date: 1 December 2017
Source:American Journal of Infection Control, Volume 45, Issue 12
Author(s): Pamela V. O'Neal, Ellise D. Adams, Linda A. Hanson, N. Edward Damron, Megan Breland Alexander, Jie Zhang, Joseph G. Leahy
BackgroundNewborns are suctioned with a blue bulb manual suction device to remove naso-oropharyngeal secretions and promote airway clearance. This study identifies and discusses the microbial profile and characterization of the bulb used in newborns on intrapartum and postpartum units.MethodsThis was a descriptive study with convenience sampling of a total of 50 bulbs used in cesarean births, vaginal births, and on the postpartum unit. The bulbs were tested for microbial growth, and the percentages of contaminated bulbs were calculated. The χ2 test was used to compare the proportion of bulbs with microbial growth by route of birth among bulbs sampled from the intrapartum unit.ResultsMicrobial profile and characterization identified a total of 57 different gram-positive cocci and rods and gram-negative rods. Among 50 bulbs cultured, bacterial growth was present in 42% of the bulbs, and Escherichia coli was identified in 55% of the gram-negative rod isolates. The χ2 test comparing vaginal and cesarean bulbs showed a statistically significant difference in the percentages of contaminated bulbs for any growth (P = .023) and for any Staphylococcus spp (P = .050).ConclusionsNew empirical evidence confirms the bulb is a potential bacterial reservoir and poses a potential health risk for nosocomial infections for newborns. Further studies are needed to identify bacterial transmission, newborn outcomes, bactericidal bulb cleaning methods, and quality and safe suction practices.



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Childhood hearing loss is a key feature of CAPOS syndrome: A case report

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Publication date: January 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 104
Author(s): Stéphanie Paquay, Elsa Wiame, Naima Deggouj, Antonella Boschi, Romolo Daniele De Siati, Yves Sznajer, Marie-Cécile Nassogne
CAPOS syndrome (cerebellar ataxia, areflexia, pes cavus, optic atrophy, and sensorineural hearing loss) is a rare neurological disorder, recently associated with the c.2452G > A hotspot mutation in the ATP1A3 gene, with sensorineural hearing loss as a prominent feature. We herein report on a girl who has experienced hearing loss for three years following an initial encephalitic episode when aged 15 months old. CAPOS was diagnosed only when she was six years old by targeted testing whilst she displayed optic atrophy, cerebellar signs and areflexia. CAPOS syndrome should be considered in the differential diagnosis of acquired childhood deafness, prompting clinicians to search for associated neurological features.



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Genetic analysis of CLDN14 in the Chinese population affected with non-syndromic hearing loss

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Publication date: February 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 105
Author(s): Yajie Lu, Jun Yao, Qinjun Wei, Jin Xu, Guangqian Xing, Xin Cao
ObjectiveThe CLDN14 gene, encoding the tight junction protein Claudin-14, has been proposed as a candidate causative gene affecting autosomal recessive non-syndromic hearing loss (ARNSHL). Genetic analysis of nonsynonymous single-nucleotide variations (nsSNVs) in CLDN14 has been performed in different populations. The role of CLDN14 nsSNVs in contributing to hearing loss in Chinese populations would be investigated in this study.MethodsTarget screening for CLDN14 variations were conducted in 500 unrelated patients diagnosed with non-syndromic hearing loss (NSHL).ResultsNo reported pathogenic CLDN14 nsSNVs in heterozygote or homozygote were detected in this study, however, we identified 4 heterozygous nsSNVs [c.11C > T, p.(Thr4Met); c.16G > A, p.(Val6Met); c.68T > C, p.(Ile23Thr); c.367A > C, p.(Thr123Pro)] in CLDN14. The 4 nsSNVs are located at claudin-14 transmembrane domains, but assessed to be poorly conservative and non-pathogenic via multiple in silico algorithms. The structure-based analysis also suggested that the 4 nsSNVs had less structural and functional impact on claudin-14.ConclusionOur findings indicated that CLDN14 might not be a major causative gene for NSHL in Chinese populations, which would contribute to fully understanding the genetic cause of NSHL in the East Asian populations.



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